7/30/2019 NCM103 22nd F&E II

1/5

jcmendiola_Achievers2013

Care of Clients with Problems In Oxygenation,

Fluids and Electrolytes, Metabolism and Endocrine

(NCM103)

Patients With Fluids and Electrolytes (Renal) Alteration II

Basic Concepts on Fluids andElectrolytes

A. Definition of Terms1. Electrolytes

Are compounds / substances which when placed in a solution would break up/ dissociate in 2 electrically charged particles

Can be an:1. Ion Electrically charged particles 2. Cation / Anion

2. Fluid / Water Fluid

More ENCOMPASSING Contains WATER and ELECTROLYTES

Water Does not contain ELECTROLYTES

B. Factors That Determines the Amount of Water1. Age (The younger more water! The older the less water)

As we grow older, the LEAN portion of body (muscles), fatty tissues arereplaced by ANHYDROUS (Contains no WATER)

Babies have IMMATURE KIDNEYS. Therefore, they are at risk forDEHYDRATION (Kidneys cannot conserve water )

Body metabolism of newborn is HIGHER compared to an adult(As Age :Body Metabolism )

Body Metabolism, GREATER CONSUMPTION of WATER 2. Gender (Sex)

Males: Water - Muscle Females - Water Fats (Anhydrous)

3. Body Size Thinner

More WATER! Less FAT!

Obese Less WATER More FAT! (Anhydrous)

Topics Discussed Here Are:1. Basic Concepts of Fluids and Electrolytes2. Fluid Compartments3. Major Common Fluid Imbalances

LOOKY

HERE

FLUID is WATER, but WATER is NOT FLUID

Body is made up of 60% - 70% WATER!!

However, the deposition of muscle on males and fats on females is only a

secondary sex characteristic

7/30/2019 NCM103 22nd F&E II

2/5

jcmendiola_Achievers2013

Normal Condition of Fluid Intake Normal intake of water is 2,600 mL

Whatever we INTAKE, OUTPUT should be the same (2,600 mL) Where do we get the 2.6L of FLUID??

Water (1,300 mL) Food (1,000 mL)

Oxidation of Food (300 mL) TOTAL: 2,600 mL

Normal Conditions of Fluid Output Normal output of water is 2,600 mL

Where do we get the 2.6 L of FLUID OUTPUT? Kidney (1,500 mL) GIT (200 mL) Lungs (300 mL) Skin (600 mL)

TOTAL: 2,600 mLSituation:

Inside the classroom with a teacher speaking and students listening Who has more insensible fluid loss through the lungs? Who has more sensible fluid loss through the lungs?

FLUID COMPARTMENTS :P1. Intracellular Fluid (ICF)

Fluid inside the cell

Composes 2/3 of the TOTAL BODY FLUID of the body

Potassium Phosphate (Major ICF Electrolyte)

Potassium (+) Phosphate ()

2. Extracellular Fluid (ECF)Fluid outside the cell

1/3 of total body fluidSodium Chloride (Major ECF Electrolyte)

Sodium (+) Chloride ()

Divided into 3 Spaces~

a. Interstitial Fluid Compartment Fluid surrounding the cell or in between the cell Example: Lymph! 11 12 L of interstitial fluid

b. Intravascular Fluid Compartment Fluid inside the blood vessel 5 6 L of intravascular space

Plasma (3 L) RBC, WBC, Platelets (3 L)c. Transcellular Fluid Compartment

Consists of bodys secretions and excretions Urine, perspiration, saliva, GIT secretions, CSF, and synovial fluid

3. 3rd Space FluidIf in the event if the ICF/ECF escapes out/inside the cell respectively, the fluid does not

go to the other compartment

A special compartment wherein the fluid goes in the space, but the fluid is NOT used by

the body (Ex. Peritoneum = Ascites)

Total body fluid is the same!!

LUNGSand SKINare

INSENSIBLE FLUID LOSS (900 mL)

Fluid loss which are NOT withinour control

Fluid loss we CANNOT SEESWEAT Sensible fluid loss!

K, PO4, Na, Cl are all inside and outside the cell!

INSIDE and OUTSIDE THE CELL~

- There is a difference of concentration inthe ICF and ECF

- The amount of ion in each compartmentwill account for the osmolality~

- If the amount of concentration is thesame both inside and outside the cell,

there is no SHIFTING of FLUID

7/30/2019 NCM103 22nd F&E II

3/5

jcmendiola_Achievers2013

We Are Aware with Fluid Imbalance!!1. Thirst (1st Factor)2. Hypothalamus tells you if you are thirsty!3. Hormones

a. ADHb. Aldosterone

Px 6x

LBM

Vomiting

Fluid

Imbalance

(FVD)

Hypothalamus Pituitary Gland

Thirst Fluid intake

Posterior

Pituitary Gland

Anterior

Pituitary GlandADH

ACTH

Reabsorption

of Water

Adrenal CortexAldosterone

Urine

Output

Na, K

Na

Water

Reabsorption

Major Common Fluid Imbalances

(Isotonic fluid referred to by body fluid and ECF, Ex. Blood, plasma, urine, perspiration)

1. Hypovolemia Fluid Volume Deficit (FVD) Isotonic Deficit DehydrationCauses:

- Fluid Intake (People who cannot recognize thirst)- Fluid loss

o Diarrhea, Polyuria, Bleeding, Burns, Excessive perspiration, excessivevomiting (Hyperemesis gravidarum), drainage (fistulas)

Manifestations:

- Sunken fontanels (Newborns)- Urine Output- Weight- Blood Pressure- CVP- Urinalysis: Dark yellow urine

7/30/2019 NCM103 22nd F&E II

4/5

7/30/2019 NCM103 22nd F&E II

5/5

jcmendiola_Achievers2013

- Related to Dieto Increased Na dieto Rapid administration of IV Fluid

- Overuse of saline solution- Associated with Disorders:

o Cushings Syndrome ( Aldosterone) Na Retention, K Excretion

- Increased Na = Increased Water in body (Hypervolemia)- Urine Output due to:

o Renal Failureo Presence of Edema

Manifestations:

1. Weight is INCREASED2. Periorbital Edema3. Peripheral Edema (Sausage shaped fingers)4. Ascites5. BP

Laboratory Findings:

- Hemoglobin and Hematocrit is Decreased- Urinalysis

o Dark Yellow Urine (Cant EXCRETE)Management:

FLUID INTAKE Na Diet!

SITUATION: (Management for each complication)

Right Sided Heart Failure = Digitalis (Lanoxin) Renal Failure = Diuretic Severe Cases of Hypervolemia = Dialysis Liver Impairment

Abdominal Paracentesis Aspiration of FLUID from PERITONEUM Inserted between the Umbilicus and Symphysis Pubis by 2

3 fingers

IMPORTANT: Client MUST EMPTY the BLADDER

To prevent damage to the bladder