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UNCW NSG 326 - NSG 326 AH I WK _6 Fluid & Electrolyte Balance spring2012

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NSG 326 Adult Health IHOMEOSTASISSlide 3NCLEXComposition of Body FluidsSlide 6Movement of Body FluidsOsmosis: Clinical Function & SignificanceDiffusion: Clinical Function & SignificanceFiltrationKidneysBlood PressureClinical Significance of FiltrationSlide 14Active Transport – “Pumps”Slide 16EC Fluid Volume DeficitSlide 18Dehydration: state in which the body loses water & the serum sodium levels increaseSlide 20EC Fluid Volume ExcessEC Fluid Volume ExcessSlide 23Slide 24Nursing AssessmentAssessment (cont.)Nursing ManagementSlide 28Gerontological ConsiderationsRegulation of Body FluidsAntidiuretic Hormone (ADH)Slide 32Slide 33IV FluidsSlide 35Slide 36Slide 37Slide 38Slide 39Blood ReplacementSlide 41Slide 42Slide 43Slide 44Slide 45SODIUM (Na+)Hyponatremia <135 mEq/mLHypernatremia >145 mEq/mLSlide 49Potassium (K+)Hypokalemia <3.5 mEq/mLHyperkalemia >5.0 mEq/mLSlide 53Slide 54Slide 55Slide 56Slide 57Calcium (Ca++)Hypocalcemia <8.6mg/dLSlide 60Slide 61Hypercalcemia >10.2 mg/dLPhosphorous (P)Hypophosphatemia <2.4 mg/dLHyperphosphatemia (> 4.4mg/dL)Slide 66Magnesium (Mg++)Hypomagnesemia <1.3 mEq/LHypermagnesemia > 2.1 mEq/LRegulation of AnionsChloride (Cl-)QuestionAnswerAcid-Base BalanceSlide 75NSG 326 Adult Health IFluid & ElectrolyteBalance2HOMEOSTASISBalance Maintaining fluid volume & compositionECF (1/3) and ICF (2/3)Water (solvent) needed to dissolve nutrients, electrolytes, & other substances (solutes)Functioning of all cells, tissues, & organs4NCLEXPlasma the liquid constituent of blood, is correctly identified as:a. Interstitial fluidb. Intravascular fluidc. Intracellular fluidd. 40% of total body fluid5Composition of Body FluidsWater60% of body weightPrimary component of our body fluidsPromotes homeostasis (balance) at cellular level Chemical transport in bloodOsmosispH control [H+]Electrochemical forcesCell volume regulationVital forSolvent properties; temperature control; blood volume (plasma) control; metabolism; physiological fluids production (e.g. tears)ElectrolytesAnionsCations67Movement of Body FluidsOsmosisNet diffusion of water across a membraneOsmolarity, fluid concentrations, osmotic pressureDiffusionUsed when considering solute movementFiltrationActive transport8Osmosis: Clinical Function & SignificanceOsmosis is movement of water only through a selectively permeable membraneOsmosis & filtration act together in capillary fluid dynamics to control both ECF and ICF volumesThe thirst mechanism is an example of how osmosis helps maintain homeostasis.9Diffusion: Clinical Function & SignificanceDiffusion – free movement of most electrolytes, atoms, & molecules through cell membranesCell membranes are selective and impermeableNo matter what the concentration gradient, glucose cannot cross cell membrane without insulin.10FiltrationHeart pushes blood through the CV system generating hydrostatic pressureFiltration occurs across the walls of small blood vesselsPushing water & dissolved solutes into tissues11KidneysFiltration across specialized blood vessels in the kidneys is an essential step in the production of urine12Blood PressureHydrostatic pressure measured in mm HgOne factor that determines whether fluid leaves the blood vessels and enters the tissue spaces (interstitial fluid) is the difference between the hydrostatic pressure of capillary blood and that of the interstitial fluid.13Clinical Significance of FiltrationEdemaHeart failureBlood backs into the venous system causing capillary hydrostatic pressure to increase until it is higher than the hydrostatic pressure in the interstitial space.1415Active Transport – “Pumps”Cells use active transport to control cell volume and the intracellular concentrations of many substancesGatekeeper mechanismRequires energySodium-potassium pumpA clinical example of what occurs when active transport fails is what results from tissue hypoxia16NCLEXThe movement of the solvent water from an area of lesser solute concentration to an area of greater solute concentration until equilibrium is established is known as:a. Osmosisb. Diffusionc. Active transportd. Filtration17EC Fluid Volume DeficitOccurs when body loses water & electrolytesCauses: increased insensible water loss, vomiting, diarrhea, GI suctioning, sweating, inadequate fluid intake, massive edema as in initial stage of major burns, ascites, elderly forgetting to drink18EC Fluid Volume DeficitSymptoms: restlessness, lethargy, confusion, weight loss (one pint fluid loss equals one pound weight loss), decreased skin turgor, oliguria (concentrated urine), dry & sticky mucous membranes, postural hypotension, weak, rapid pulse, increased body temperature, weakness, thirstNursing care: strict I & O, replacement of fluids isotonically (orally), *water is a hypotonic fluid, if IV hydration is needed, isotonic fluids are used.19Dehydration: state in which the body loses water & the serum sodium levels increase20EC Fluid Volume DeficitPatient OutcomesElectrolyte balance; fluid balance; hydration; nutritional status: food & fluid intakeUrine output > 1300 ml/day; or 30ml/hr; normal BP, pulse, & temperature; elastic skin turgor; moist tongue & mucous membranes;A & O x321EC Fluid Volume Excess Occurs when the body retains water & electrolytes isotonicallyWater intoxication: state in which the body retains water & serum sodium levels decrease22EC Fluid Volume ExcessCauses: heart failure, renal failure, cirrhosis (liver failure), excessive ingestion of table salt, over-hydration with sodium-containing fluid, poorly controlled isotonic/hypotonic IV therapy23EC Fluid Volume ExcessSymptoms: headache, confusion, lethargy, peripheral edema, I > O, increased bounding pulse, elevated BP, distended neck & hand veins, dyspnea, crackles heard when lungs auscultated, attention loss, anxiety, confusion, altered level of consciousness, muscle spasms, weight gain, seizuresNursing Care: diuretics, fluid restriction, strict I&O, sodium-restricted diet, weigh daily, serum K+ monitored.24EC Fluid Volume ExcessPatient OutcomesElectrolyte balance, fluid balance, hydrationFree of edema, pulmonary effusionWeight appropriate for clientClear lung soundsNo evidence of dyspnea or orthopneaFree of jugular vein distention25Nursing AssessmentPhysical AssessmentHydration stateSkin turgorMucous


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UNCW NSG 326 - NSG 326 AH I WK _6 Fluid & Electrolyte Balance spring2012

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