The document discusses fluid and electrolyte balance in the human body. It covers several key points: - Water makes up about 46-60% of adult body weight and serves various functions like metabolic reactions and temperature regulation. - Body fluids are divided into intracellular fluid (ICF) which is inside cells, and extracellular fluid (ECF) which is outside cells and further divided into plasma, interstitial, and transcellular fluids. - Major electrolytes like sodium, potassium, calcium, and chloride are discussed in terms of their normal levels and implications of deficits or excesses. - Factors that can disrupt fluid and electrolyte balance like vomiting, diarrhea, sweating are covered, as are

1. Fluid and electrolytes
balance
Christelle Anne Sison III-BSN

2. Body fluid and electrolyte:
• About 46 to 6o % of the average
adult weight is water.

3. Water may serve as:
• Medium of metabolic reaction with cells.
• Transporter for nutrients, waste
products, and other substance.
• A lubricant.
• Shock absorber.
• Regulate and maintain body temperature.

4. • The proportion of water decreases
with aging because fat, age and
sex effect of total body water.
• (Infant 70 – 80%).

5. Distribution of body
fluids:
• The body fluid divided in two major
compartments:
A) Intracellular fluid (ICF):
• Is found in the cells of the body. its
constitute 2/3 of the total body fluid
in the adult.

6. b) Extracelluar fluid (ECF):
• is found out side of cell and account 1/3 of
the total body fluid.
• it’s subdivided into three compartments:
1) Intravascular fluid or plasma: is found within
vascular system.
2) Interstitial fluid: is found surrounding the
cell and includes lymph.
3) Transcellular: includes cerebrospinal
fluid, pleural, peritoneal and synovial fluid.

8. Composition of Fluids
• plasma interstitial intracellular
•Cations
•Na 140 146 12
•K 4 4 150
•Ca 5 3 10
•Mg 2 1 7
•Anions
•Cl 103 104 3
•HCO 24 27 10
•SO4 1 1 -
•HPO4 2 2 116
•Protein 16 5 40

9. • Function of ICF & ECF:
• ICF: is vital to normal cell function,
its contain solutes such as oxygen,
electrolytes and glucose. It provides
a medium to metabolic process.
• ECF: it is the transport system that
carries nutrients and waste product
from the cell.

10. Movement of body fluid
and electrolyte:
1. Osmosis:
• Is the movement of water across
cell membranes, from the less
concentrated solution to more
concentrated solution. In other
word water move toward higher
concentration.

11. – Solutes are substance dissolved in liquid.
– Crystalloid: salts that dissolved readily in
to true solution.
– Colloids: substance such as large protein
molecules that do not dissolved in true
solution.
• Sodium is the major determinant of
serum osmolality.

12. 2. Diffusion:
• Is the continual intermingling of
molecules in liquid, gases by random
movement of the molecules.

13. 3. Filtration:
• Is the process where by fluid and
solutes moved together across a
membrane from one compartment
to another.

14. 4. Active transport:
• substance can move across cell
membranes from a less
concentrated solution to amore
concentrated one by active
transport.

15. Regulating body fluid:
• The average adult drinks about
1500ml per day, but need to 2500ml
per day, this added volume is
acquired by the food.
• The thirst center is located in the
brain, this center trigger by osmotic
pressure and angiotensin II .

16. Hormonal regulation

17. Regulation of ECF

18. Fluid out put:
• Urine: normal urine out put 1500ml
per 24hrs or at least 30ml per hours.
• Insensible loss: through the skin as
perspiration and through the lung a
water vapor in the expired air.
• Loss through the intestine (feces)

19. • Obligatory losses: approximately
500ml of fluid must be exerted
through the kidney to eliminate
metabolic waste product and feces,
respiration and perspiration to
maintain body temperature.
• The average daily fluid out put for an
adult 2500ml/ day.

20. Client at risk for fluid and
electrolyte imbalance:
• Post operative client.
• Client with sever trauma or burn.
• Client with chronic disease as
congestive heart failure.
• Client who are NPO.
• Client with intravenous infusion.
• Client with special drainage.
• Client who receiving diuretic

21. Factor effecting fluid and
electrolyte balance:
• Age: infant have greater water
need and greater loss due to
greater metabolic rate.
• Environment: excess heat
stimulates the sympathetic nervous
system and cause person to sweat.

22. • Diet: in nutritional deficiency, the
body preserved the protein by
breaking down the fat and glycogen.
• Stress: water retention and increase
the production antiduritic hormone.
• Illness: burn, renal disorder

23. Disturbances in fluid and electrolyte:
• Hypovolemia: decrease blood volume
• Hypovolemic shock when intravascular
fluid is depleted.
• Hypervolimia: increase blood volume.

24. Edema: is collection of fluids in the
tissue.
Type of edema:
• Dependent edma: found in the lowest
part body.
• Pitting edma: edema that leaves a
depression or pit after finger
pressure is applied on the swollen
area.

25. Pitting odema

26. • Sodium (Na):
• Is the most abundant cation in the
extracelluar fluid and major contributor
to serum osmolality.
• Function of sodium:
• controlling and regulating water balance.
• Maintaining blood volume
• Transmitted nerve impulses.

27. • Normal level is 135 – 145 mg/dl.
• Hyponatremia: sodium deficit in the
blood.
• Hypernatremia: sodium excess in the
blood.
• Sodium is found in many foods, such
as processed cheese, table salt.

28. Potassium:
• Is the major cation in intracellular fluid.
• Function of potassium:
• Maintain ICF osmolality.
• Transmitting nerve impulses.
• Regulate cardiac impulses.
• Skeletal and smooth muscle function.
• Regulate acid base balance

29. – Potassium is found in many fruits and
vegetables, meat, fish, milk.
– Normal level of potassium is 3.5 –
5.3meq/l.
– Hypokalemia: potassium deficit in the
blood.
– Hyperkalemia: potassium excess in the
blood.

30. • Hypocalcemia: calcium deficit in the
blood.
• Hypercalcemia: calcium excess in the
blood.

31. Loss of water and
electrolyte:
• Vomiting.
• Diarrhea.
• Excessive sweating.
• Ployuria.
• Fever.
• Nasogastric suction.
• Abnormal drainage.
• Anorexia.
• Nausea
• Impaired swallowing.

32. Finding associated with
fluid and electrolyte
imbalance:
• Skin: dry pale, cool skin, reduce skin
Turgor.
• Oral cavity: dry mucous
membrane, absence of salivation.
• Weak rapid pulse.
• Decreased blood pressure.
• Decreased central venous pressure

33. • Decreased urine out put.
• Increased hematocrit.
• Thirst.
• Flat neck vein.

34. Fluid volume excess:
• Excess intake of sodium – containing
intravenous fluid.
• Excess of ingestion of sodium in
diet.
• Heart failure.
• Renal failure.
• Liver cirrhosis.

35. Clinical manifestation:
• Weight gain.
• Fluid intake greater than out put.
• Moist mucous membrane.
• Tachycardia.
• Increased blood pressure.
• Distended neck vein.
• Dyspnea and crackles.
• Mental confusion.

36. Acid – Base Balance

37. Nursing care plan
• Assessment:
– Nursing history:
• Date include fluid and food intake, output.
• Recent fluid losses.
• Sign of fluid deficit.
• Common sign of electrolyte disturbance.
• Medication.

38. Clinical measurement:
– Daily weights, vital sign, fluid
intake and output (I&O), serum
electrolyte, complete blood count
(CBC). Serum osmolality, urine
specific gravity.

39. Nursing diagnosis:
• Fluid volume deficit related to dehydration.
• Fluid volume excess related to heart failure.
• Altered oral mucous membrane related to fluid
volume defects.
• Impaired skin integrity related to dehydration
• Decreased cardiac output related to hypovolemia.
• Altered tissue perfusion related to decreased
cardiac output.

40. Implementation:
• Assess clinical manifestation of hypo or
Hypervolimia.
• Provide fluid and electrolyte orally.
• Foods.
• Intravenous therapy can prescribed for those
reason
• Provide salts if needed.
• Provide glucose for metabolism.
• Provide water soluble vitamins

41. • Monitor intake & output.
• Monitor lapratory finding.
• Provide frequent oral care.
• Monitor weight.
• Assess for edma.
• Place patient in fowler position.
• Assess breathing sound, inspiration and
expiration (crackles).
• Provide safety for client