USCR Fluids Flashcards
What is physiological homeostasis?
balance of fluids, electrolytes, acids&bases regulated by multiple processes.
These processes regulate fluid intake&output, movement of water and substances dissolved in in.
Function of fluid in the body?
transport of nutrients/waste, electrolytes, oxygen
lubricant
insulator& shock absorber
assist in regulating/maintaining body temperature
all metabolic reactions in the body occur in a fluid environment
Fluid compartments in the body?
extracellular: plasma, interstitial, intravascular
Intracellular
Transcellular fluid: cerebrospinal, pleural, synovial fluids and fluids in GI tract; separated from other fluids by epithelium.
Intracellular fluid (ICF) is all the fluid within body cells, approx. 40% of body weight. Extracellular fluid (ECF) is all the fluid outside cells; 20% of body weight, divided into: -interstitial fluid, including lymph: fluid between cells and outside blood vessels: 15% -intravascular fluid: blood plasma: 5%
What does ICF & ECF contain?
oxygen from lungs
dissolved nutrients from GI tract
excretory products of metabolism (carbon dioxide)
electrolytes
Water body composition of infant, adult, older adult?
infant: 70-80%
Adult 50-60%
Older adult: 45-55%
4 methods in which electrolytes and water move throughout the body?
osmosis
diffusion
filtration
carrier-mediated transport
What is osmosis?
water movement through a semi-permeable membrane from a low solute concentration to a high solute concentration
What is diffusion?
movement of molecules from high concentration to low concentration
What is filtration?
movement of water and solutes across a membrane from high pressure to low pressure
What is carrier-mediated active transport?
assisted movement of molecules across plasma membrane that would not otherwise be able to move
EX: sodium-potassium pump
What are electrolytes?
chemical compounds found in all body fluids, dissolved into ions
carry an electrical charge as ions and exchange for other ions with the same charge
vital for many body functions and carefully regulated
ingested and used for basic physiological processes
stored for future use or excretes
solute [solid] dissolved into solvent [liquid] (expressed as mmol/L, mmol of electrolyte per L of solvent)
What electrolytes are in ECF?
sodium
chloride
bicarbonate
What electrolytes are in ICF?
potassium
magnesium
phosphate
Function of sodium?
maintenance of fluid balance
maintenance of PH balance
transmission pf nerve impulses
important for muscle contraction
Normal serum sodium?
135-145mmol/L
What is hyponatremia?
decrease sodium level
Causes of hyponatremia?
net loss of sodium or net gain of water vomiting diarrhea excessive sweating extensive burns use of diuretics excessive water intake (polydipsia)
What is hypernatremia?
increase sodium level
Causes of hypernatremia?
net loss of fluids or excess salt intake fever diarrhea excessive intake of table salt or IV saline solution inadequate fluid intake
Signs & symptoms of hyponatremia?
Serum Na < 135mmol/L anorexia/Nausea & vomiting/abdominal pain Lethargy/confusion/apprehension seizure/coma postural hypertension tachycardia dry mm
Action demands for hyponatremia?
diet high in sodium
weighing daily
limit water intake
put safety measures in place (seizures)
Signs & symptoms of hypernatremia?
Serum Na > 145 mmol/L dry, red swollen tongue dry/sticky mm thirst oliguria postural hypertension disorientation seizures
Action demands for hypernatremia?
diet low in sodium
increase fluid intake (PO or IV)
safety measures to prevent falls
oral care
Potassium function?
maintenance of regular heart rhythm
conduction of neuromuscular impulses
muscle contraction
PH maintenance
normal potassium range: 3.5-5.0 mmol/L
What is hypokalemia?
decrease potassium level
Causes of hypokalemia?
Due to : loss or poor intake of potassium
diarrhea/overuse of laxatives potassium wasting diuretics porr intake of potassium rich foods vomiting/gastric suction excessive perspiration
Causes of hyperkalemia?
Hyperkalemia
NOTE! It is less common than hypokalemia (mostly with renal failure)
renal failure oliguria high potassium intake extensive burns IV solutions containing potassium
Signs & symptoms of hypokalemia?
serum potassium less than 3.5 mmol/L muscle weakness leg cramps depressed deep tendon reflexes fatigue confusion/disorientation cardiac dysrhythmia anorexia/N & V
Action demands for hypokalemia?
diet high in potassium take KCl supplements (PO or IV) rest periods safety measures taking antiemetics (prevent N & V)
S & Symptoms of Hyperkalemia?
Potassium level > 5.0 mmol/L neuromuscular weakness/absence of reflexes cardiac dysrhythmia low BP numbness in extremities diarrhea
Action demands for hyperkalemia?
avoid foods high in potassium
use safety measures to prevent falls
avoiding K-containing salt substitutes
Regulation of body fluids by intake?
liquids
solid foods
metabolism or carbohydrates, proteins & fats
Regulation of body fluids by output?
urine feces insensible losses skin: perspiration lungs: exhalation
Regulation of body fluids by hormones?
ADH (antiduretic hormone): regulates water excretion from kidneys
Aldosterone: regulates Na & K balance & wate reabsorption
Factors affecting fluid & electrolyte balance?
age gender body size temperature exercise diet
Chronic diseases for fluid & electrolyte balance?
CHF COPD renal disease diabetes cancer malnutrition
Chronic diseases for fluid & electrolyte balance?
CHF COPD renal disease diabetes cancer malnutrition
Acute conditions for fluid & electrolyte balance?
gastroenteritis trauma surgery fever bowel obstruction
Medications for fluid & electrolyte balance?
diuretics corticosteriods NSAIDs antibiotics laxatives potassium
Medical treatment for fluid & electrolyte balance?
chemotherapy IV NG suction NG feeding respirators
What happens when homeostasis is not maintained?
Fluid volume excess (hypervolemia)
Fluid volume deficit (hypovolemia)
Clinical manifestation of FVE fluid volume excess?
Weigh gain moist mm bounding pulse, tachycardia increase BP distended neck & peripheral veins moist crackles in lungs, dyspnea, SOB, cough peripheral edema
Nurisng actions for FVE?
place client in fowler's position (30-90 degrees) administer diuretics prn restrict fluid intake restrict sodium intake prevent skin breakdown
Helping to restrict fluid intake actions?
Give the client rationale; explain how much & what type of fluids can be taken in
Help the client decide amount & time of fluids to be taken with & between meals
Set short term goals
Place fluids in small containers-perception
Offer ice chips-melted are half the frozen volume
Frequent mouth care to ↓ thirst sensation
Avoid chewing salty or sweet foods (candy, gum)
Encourage participation of patient and family in keeping record of fluid intake
Clinical manifestation of FVD fluid volume deficit?
Weight loss Dry mucous membranes Decreased or absent tearing (eyes) Flat neck veins Weak pulse Low BP Headache, disorientation
Nursing actions for FVD?
↑ PO intake & administer IV fluids prn
Provide mouth care
Provide safety measures
Prevent skin breakdown
Facilitating fluid intake?
Give the client rationale & amount of fluid needed (promotes compliance )
Establish 24 hour plan
Identify fluids that client likes
Help client choose foods high in water content (ice cream, jello, fruits, sorbet )
Supply cups, straws; keep fluids within reach
Encourage client participation in recording
Involve family members
Assessment of fluids?
Client’s Health History: Interview (BCF data, subjective data).
Physical Examination: (objective data)
Diagnostic and laboratory studies
Client health history: BCF data?
Developmental data
Cognitive & physical abilities
Age
Elderly & young children dependent on others
Health state data
History of kidney disease or diabetes mellitus
Recent acute condition-gastroenteritis, trauma
Effects on ADLs
Health care systems factors Treatment plan- medications affecting fluid balance
Patterns of living
Occupation-demands of work
Resources-economic (ability to buy healthy food)
Client health history: subjective data?
Thirst/dry mouth Headache Dizziness Dyspnea (SOB) Anorexia / Nausea Change in amount/colour of urine
Client health history: self care practices?
Food intake:
amount of sodium intake
Restricted diet
Typical fluid intake in 24 hours: Amount Type: ETOH (alcohol) consumption Caffeine intake (tea, coffee) Time of day Likes / dislikes
Exercise
Client health history: Physical examination; objective data?
Proceed in an organized manner. Use techniques of: Inspection Palpation Percussion Auscultation
Inspection?
Skin Color Eyes Sunken / bulging Conjunctivae
Mouth / Lips
Moisture
Intactness
Neurological system Level of consciousness Respiratory system Rate Rhythm Depth CVS system Jugular & hand veins
Palpation?
Cardiovascular system
Capillary refill
Pulse: rate, rhythm, strength
Peripheral pulses
Skin Turgor Edema Temperature Moisture
GU (genitourinary) System
Palpation of bladder or use of a bladder scanner to see how much urine is in the bladder if necessary
Auscultation?
Respiratory System:
Breath sounds
Wheezes and crackles in FVE
CVS System:
Blood pressure
GI System:
Bowel sounds
Objective data?
Fluid balance
Fluid intake:
PO
IV
Tube feeding
Fluid output: Urine Feces Vomitus Tube drainage
Intake and output?
Nursing responsibility to measure and keep record of intake (all PO, NG feeding, IV) and output (tube drainages, urine, feces prn, vomitus)
Record on sheets provided by hospital and/or in patients chart/nursing notes
Lab and chart data?
Urine specific gravity (concentration) Electrolytes ( Na, K ) BUN, creatinine levels Arterial blood gases (pH of blood) Hematocrit
Nursing diagnoses and prescription?
Fluid Volume balance
Fluid Volume deficit (Hypovolemia)
(loss of both water & electrolytes from ECF)
Fluid volume excess (Hypervolemia)
(retention of water & Na+ in circulation)
Standard Action Demand Fluid & Electrolyte Balance?
Maintain, promote fluid & electrolyte balance by:
1.Consuming 2000-2500 ml of water daily
2.Avoiding foods or fluids high in salt, sugar
caffeine
3.Following a well balanced diet
4.Limiting alcohol intake
5.↑ fluid & electrolyte intake before,
during & after strenuous exercise
6.Maintaining normal body weight
7.Educating oneself about medications affecting
fluid & electrolyte balance
8.Recognizing risk factors such as vomiting, diarrhea, inability to
consume fluids due to illness
9.Recognizing signs of fluid imbalance such as sudden weight change, decreased urine output, swollen ankles, SOB, dizziness, confusion.
10.Seeking professional help for noticeable signs of fluid
