Nursing: A Concept-Based Approach to Learning, 2nd Edition

- 3 - 3 Click to edit Master text styles Second level Third level Fourth level Fifth 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 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