TLO 2.3 Nutrition, Fluid Balance Adult Flashcards
Fluid compartments: 2 types
Intracellular fluid (ICF) Extracellular fluid (ECF)
Volume regulation
Osmosis
Diffusion
Filtration
Active Transport
Fluid and electrolyte balance
Maintenance
Nursing role
Maintenance of homeostasis:
Requires fluid and electrolyte balance within a vary small range in a healthy body
Diseases and treatment may alter fluid and electrolyte balance
Nursing role:
Anticipate the potential for alterations in fluid and electrolyte balance
Recognize the signs and symptoms of imbalances
Intervene with appropriate actions
Evaluate interventions
Adults: 1500 mL/day of fluid intake
Distribution of body fluids
Calculation of fluids
1 liter of water weighs 2.2 lbs (1kg)
Sudden body weight changes is an indicator of fluid gain
Body fluids
Intracellular fluids?
Inside the cells
K+, Mg++, phosphate, glucose, O2
About 2/3 of total body water
Body fluids
Extracellular fluids?
Outside of cell
Na+, Chloride, Bicarbonate
About 1/2 of total body water
Positive imbalance?
More input than output
Negative imbalance?
More output than input
Extracellular fluids: 2 major divisions
Two major divisions:
Intravascular: plasma (20% of ECF)
Interstitial: fluid btw cells including lymph (80% of ECF)
Extracellular fluids: 1 minor division
One minor division:
Transcellular fluids: specialized compartments
CSF, synovial, pleural, pericardia, peritoneal fluids
Movement of body fluids
Osmosis: fluid moves passively from areas with more fluid to areas with less fluid
Diffusion: solutes move from areas of higher concentration to areas of lower concentration until the concentration is equal in both areas
Filtration: movement of fluids through capillaries resulting from blood pushing against the walls of the capillary. Hydrostatic pressure forces fluids and solutes through capillary wall
Active transport: energy from ATP moves solutes from an area of lower concentration to an area of higher concentration. i.e. sodium-potassium pump
Example: 70 kg man
42 L water
28 L intracellular
Water: 42 L
Intracellular: 28 L
Extracellular: 14 L of water
- Interstitial: 10 L
- Intravascular: 3 L
- Transcellular: 1 L at a given time
**3-6 L of fluid is secreted into and reabsorbed from the GI tract
Fluid spacing
Distribution of body water
First spacing: normal distribution of fluid in the ICF and ECF compartments
Second spacing: abnormal accumulation of interstitial fluid (edema)
Third spacing: Fluid accumulates in a portion of the body (transcellular fluid) that is not easily exchanged
Trapped and unavailable for functional use
-ascites
-abdominal cavity with peritonitis
-edema with burns, trauma, sepsis
Fluid balance: NI
I/O: provides valuable data regarding fluid and electrolyte problems. Excessive intake or output losses can be identified
Daily weight
Assess for:
- cardiovascular changes
- respiratory changes
- neurologic changes
- skin turgor
- monitor rates of IV infusions
- no oral fluids with NG suction (unless ordered), increases electrolyte loss
Urine output
Adult: 30 mL/hr
Children: 1 g of west diaper = 1 mL urine
Skin assessment:
Skin turgor and color: tenting, poor skin tented for 20-30 sec Weight Edema Abnormal assessment Assessment of mouth and mucus membranes Anterior fontanel in children
Skin care, NI
Protect edematous tissue
Intake includes:
Oral
IV
Tube feeding
Retained irrigates
Output includes:
Urine (adult 30mL/hr) Excess perspiration Wound drainage (est) Perspiration (est) Vomitus Diarrhea
Urine specific gravity
> 0.125 concentrated urine (dehydration)
<1.010 diluted urine (fluid overload)
Fluid balance
Daily weights
Easiest measurement of volume status Required standardized conditions -same clothes -bed weight: same linens, pillows, drainage bags off bed Same time of day Same calibrated scale
- *an increase of 1 kg is = to 1000mL of fluid retention
- *on normal diet, NOT NPO
Skin care NI
protect edematous tissue Changes in position Elevate edematous extremities Frequent skin care Application of moisturizing creams
Fluid imbalances
Sodium: hyper/hypo natremia
Potassium: hyper/hypo kalemia
Calcium: hyper/hypo calcemia
Magnesium: hyper/hypo magnesium
Sodium Na++
Normal serum sodium levels Major cation found in ECF Role Works with K+ and Ca++ to conduct nerve impulses Comes Kidneys regulate sodium balance in body
Sodium Na++
Normal serum sodium levels 135-145 mEq/L Major cation found in ECF Role is to maintain fluid volume in body Regulates osmolality and BP Works with K+ and Ca++ to conduct nerve impulses Comes from dietary intake Kidneys regulate sodium balance in body
Hyponatremia (sodium) causes?
Fluid gain:
IV fluid overload
Fluid overload after drinking water
Dilutional states (hyperglycemia, SIADH (symptom of the inappropriate diuretic hormone), heart failure)
Sodium loss:
Diuretic therapy
GI Tract (vomiting, diarrhea, GI suction, fistulas)
Excessive sweating
Hyponatremia (sodium) s/s
Decreased serum osmolality Muscle cramps, weakness HA Lethargy, stupor, coma Anorexia, nausea, vomiting Hypotension, shock
Hyponatremia (sodium) diagnostic
Serum sodium <135 mEq/L
Urine specific gravity <1.010
Serum sodium critical level <110 mEq/L
**do not correct level too fast or cerebral edema
Hyponatremia (sodium) nursing management
monitor neurological signs daily weights I/O, VS Urine color consistency and amount Maintain fluid restriction Admin 3% NaCl solution as ordered, if critically low to prevent seizures
Hypernatremia (sodium) causes
Fluid volume deficit:
not drinking enough fluids
eating high sodium diet
excessive water loss (high fever, heatstroke, diarrhea)
Interruption of body's regulatory mechanism: diabetes insipidus renal failure hyperaldosteronism Cushing syndrome uncontrolled DM
Hypernatremia (sodium) s/s
increased thirst, oliguria increased urine specific gravity dry skin and mucous membranes, decreased skin turgor, furrowed tongue, dry mouth HA, restlessness seizures, coma trachy, hypotension, vascular collapse decrease urine output
Hypernatremia (sodium) diagnosis
Serum sodium >145
Serum osmolality >300
Specific gravity >1.030
Hypernatremia (sodium) nursing management
VS
I/O
Daily weight
Edema- peripheral extremities, sacrum, face
Risk for seizures
Correction need to be provided slowly to avoid a shift of water into the cerebral cells
Potassium (kalemia)
Normal serum levels 3.5-5 mEq/L Maintains fluid balance in cells Contracts skeletal, cardiac and smoot muscle Maintains acid base balance Kidneys are the primary regulators
Hypokalemia (potassium) causes
Diuretics
Inadequate intake
GI losses: diarrhea, vomiting, GI suction, ostomy fluids
Major surgery/hemorrhage
Hypokalemia (potassium) s/s
Early signs: fatigue and muscle weakness, leg cramps Weak, irregular pulse Bradycardia Decrease GI motility EKG changes
Hypokalemia (potassium) diagnosis normal
Serum potassium <3.5 mEq/L
Hyperkalemia (potassium) causes
Excessive intake of potassium containing foods, oral or IV potassium
Potassium sparing diuretics
Renal failure
Addison disease
Increased K+ intake and absorption: rapid IV blood, salt substitute, IV K+)
Shift of K+ from cells into the ECF: trauma, chemo, diabetic ketoacidosis
Hyperkalemia (potassium) s/s
muscle cramping muscle weakness, bilateral in quadriceps increased GI motility transient ab cramps and diarrhea slow, irregular HR hypotension cardiac dysrhythmias EKG changes
Hyperkalemia (potassium) diagnostic
Serum potassium >5.0 mEq/L
Hyperkalemia (potassium) treatment
Eliminate oral and IV K+
Increase elimination of K+: diuretics, dialysis, Kayexalate
IV glucose and insulin: force K+ to ICF
Admin calcium gluconate to reverse membrane excitability
Hyper and Hypo kalemia (potassium) nursing management
Admin oral potassium supplement as ordered Pt education Monitor levels Avoid high potassium foods Avoid salt substitutes with potassium S/S of hypokalemia Telemetry
Calcium
what is it
Normal serum calcium is 8.9-10 mg/dl
Necessary for development of strong teeth and bones
Helps maintain muscle tone
Nerve transmission and contraction of skeletal and cardiac muscles
Inverse relationship with Phosphorus
Hypocalcemia causes
Chronic disease: alcoholism, ESRD Poor intake Inadequate absorption: Crohn's disease Surgical removal of thyroid or parathyroid Inadequate V D
Hypocalcemia s/s
Numbness/tingling of nose, ears, fingertips Positive Chvostek sign Positive Trousseau sign Hyperactive deep tendon reflexes EKG changes Seizures
Hypocalcemia diagnosic
Serum Ca++ <8.5-9 mg/dl
Increased Parathyroid hormones
Hypercalcemia causes
Excessive intake of C++ or V D Renal failure Hyperparathyroidism Invasive/metastatic cancers Diuretics (thiazides) Prolonged immobilization
