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Second level
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Fourth level
Fifth level
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Copyright 2015, 2011 by Education, Inc.
All Rights Reserved
Nursing A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright 2015, 2011 by Education, Inc.
All Rights Reserved
Nursing
A Concept-Based Approach to Learning
VOLUME ONE SECOND EDITION
Nursing A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright 2015, 2011 by Education, Inc.
All Rights Reserved
Nursing A Concept-Based Approach to Learning
Volume One, Second Edition
Click to edit Master text styles
Second level
Third level
Click to edit Master title style
Copyright 2015, 2011 by Education, Inc.
All Rights Reserved
Nursing A Concept-Based Approach to Learning
Volume One, Second Edition
Click to edit Master text styles
Second level
Third level
Click to edit Master title style
Copyright 2015, 2011 by Education, Inc.
All Rights Reserved
Nursing A Concept-Based Approach to Learning
Volume One, Second Edition
Click to edit Master text styles
Second level
Third level
Fourth level
Fifth level
Fluids and Electrolytes
Nursing
A Concept-Based Approach to Learning
MODULE
VOLUME ONE SECOND EDITION
The Concept of Fluids and Electrolytes
Concept Learning Outcomes
After reading about this concept, you will be able to
Summarize the physiology of the various body systems involved in the maintenance of fluid and electrolyte balance.
Examine the relationship between fluid and electrolyte balance and other concepts.
Concept Learning Outcomes, continued
Concept Learning Outcomes, continued
After reading about this concept, you will be able to
Describe diagnostic and laboratory tests to determine the individual s fluid and electrolyte balance.
Explain management of fluid and electrolyte balance and prevention of imbalances.
Concept Learning Outcomes, continued
After reading about this concept, you will be able to
Demonstrate the nursing process in providing culturally competent and caring interventions across the life span for individuals with common alterations in fluid and electrolyte balance.
Concept Learning Outcomes, continued
After reading about this concept, you will be able to
Compare and contrast common independent and collaborative interventions for clients with alterations in fluid and electrolyte balance.
The Concept of Fluids and Electrolytes
Fluids
Blood
Serum
Albumin
Urine
Bile
Hormones
Cerebrospinal fluid
The Concept of Fluids and Electrolytes, continued
Normal Fluids and Electrolytes
Fluids
60 of healthy adult s weight is water
Water necessary for normal cellular function
Medium for metabolic reactions
Transports nutrients, waste products
Acts as lubricant, insulator, shock absorber
Helps to regulate, maintain body temperature
Distribution and Composition of Body Fluids
Intracellular
Solutes
Cations
Anions
Extracellular
Interstitial fluid
Intravascular fluid
Transcellular and lymph fluids
Distribution and Composition of Body Fluids
Salts break into electrically charged ions in water
Cations positive charge
Anions negative charge
Electrolytes measured in milliquivalents per liter (mEq/L)
Maintaining balance of fluid volumes, electrolyte compositions essential to health
Distribution and Composition of Body Fluids
Intracellular fluid (ICF)
Found within cells of the body
2/3 of total body fluid in adults
Vital to normal cell functioning
Contains solutes such as
Oxygen
Electrolytes
Glucose
Distribution and Composition of Body Fluids
Extracellular fluid (ECF)
Found outside the cells
1/3 of total body fluid
Two main compartments
Intravascular
Interstitial
Third compartment lymph and transcelluar fluid
Principal electrolytes sodium, calcium, bicarbonate
Movement of Body Fluids
Movement of body fluid across cell and capillary membranes accomplished by
Osmosis
Diffusion
Filtration
Active transport
Movement of Body Fluids, continued
Osmosis
Movement of water across cell membranes from less concentrated solution to more concentrated solution
Solutes crystalloids, colloids
Solvent component of solution that can dissolve a solute
Movement of Body Fluids, continued
Osmosis
Osmolality concentration of solutes
Greatest determinants of osmolality in ECF sodium, glucose, urea
Greatest determinants of osmolality in ICF potassium, glucose, urea
Movement of Body Fluids, continued
Osmosis
Tonicity osmolality of solution
Isotonic solution same osmolality as body fluids
Hypertonic solution higher osmolality than body fluids
Hypotonic solution lower osmolality than body fluids
Movement of Body Fluids, continued
Osmosis
Osmotic pressure power of solution to draw water across membrane
Colloid osmotic pressure (oncotic pressure) plasma proteins pull water from interstitial space into vascular compartment
Important in maintaining vascular volume
Movement of Body Fluids, continued
Diffusion
Intermingling of molecules
Rate of diffusion varies by
Size of molecules
Concentration of solution
Temperature of solution
Movement of Body Fluids, continued
Filtration
Movement of fluid and solutes together across a membrane from one compartment to another
From area of higher pressure to lower
Hydrostatic pressure pressure a fluid exerts on walls in closed system
Movement of Body Fluids, continued
Active transport
Substances move across membranes
From less concentrated solution to more concentrated one
Metabolic energy is expended
Maintains higher sodium levels in ECF, higher potassium concentrations in ICF
Sodium-potassium pump
Regulating Body Fluids
Regulating Body Fluids, continued
Regulating Electrolytes
Regulating Electrolytes, continued
Regulating Electrolytes, continued
Regulating Electrolytes, continued
Regulating Electrolytes, continued
Calcium (Ca2 )
Neuromuscular function
Cardiac function
Blood clotting
Activates enzymes
Regulating Electrolytes, continued
Regulating Electrolytes, continued
Regulating Electrolytes, continued
Regulating Electrolytes, continued
Regulating Electrolytes, continued
Genetic and Lifespan Considerations
Pediatric differences
Infants lose more fluid through kidneys
Immature kidneys less able to conserve water
Infant respirations more rapid, body surface area proportionately greater than adults
Percentage of body weight that is fluid varies with age
Genetic and Lifespan Considerations, continued
Genetic and Lifespan Considerations, continued
Older adults
Thirst response is blunted
Nephrons become less able to conserve water in response to ADH
Dehydration risk increases
Increased sensitivity to salt
Genetic and Lifespan Considerations, continued
Gender and body size
Individuals with a higher percentage of body fat have less body fluid
Women had proportionately more body fat, less body fluid than men
Genetic and Lifespan Considerations, continued
Genetic and Lifespan Considerations, continued
Concepts Related to Fluid and Electrolyte Balance
Elimination
Cellular Regulation
Cognition
Thermoregulation
Perfusion
Assessment
Alterations and Manifestations
Fluid volume deficit (dehydration)
Fluid volume excess
Elevated electrolyte level
Low electrolyte level
Chronic kidney disease
Acute renal failure
Compensation
Body continually attempts to compensate for a fluid and electrolyte imbalance by shifting fluids and electrolytes from one component to another
Rare for only one type of imbalance to occur
Prevalence
Prevention
Heat-Related Illness
Limit outdoor activity during hottest part of the day
Take frequent breaks for rest and water
Drink water before beginning to feel thirsty
Wear lightweight clothes
Work or exercise with others when engaging in activity outside
Assessment
Components of the assessment include the nursing history and physical assessment of the client, clinical measurements, and review of laboratory test results.
Nursing Assessment
Nursing history
Risk
Current, past medical history
Medications
Functional, developmental, socioeconomic factors
Age
Lifestyle
Intake and output
Nursing Assessment, continued
Physical assessment
Skin
Oral cavity
Mucous membranes
Eyes
Cardiovascular, respiratory systems
Appearance
Clinical Measurements
Daily weights
Vital signs
Tachycardia
Blood pressure
Fluid intake and output
Clinical Measurements, continued
Fluid intake
Oral fluids
Ice chips
Liquid foods
Foods that become liquid at room temperature
Tube feedings
Parenteral fluids, IV medications
Catheter, tube irrigants
Clinical Measurements, continued
Fluid output
Urine
Vomitus
Liquid feces
Tube drainage (gastric, intestinal)
Wound drainage
Diagnostic Tests
Serum electrolytes
Complete blood count
Hematocrit affected by changes in plasma volume
Osmolality
Serum
Urine
Urine specific gravity
Interventions and Therapies
Independent
Monitor intake and output
Weigh client daily
Engage client in plan of care
Provide client education as indicated
Interventions and Therapies, continued
Collaborative
Initiating intravenous therapy
Intravenous management
Monitoring fluid balance
Medication administration
Blood transfusions
Interventions and Therapies, continued
Collaborative
Pharmacologic therapy
Electrolyte correction to restore balance
Hyperkalemia
Hypokalemia
Hypernatremia
Hyponatremia
Colloids
Crystalloids
Diuretics
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