1. FLUIDS AND
ELECTROLYTES

2.  60% of the weight of a typical adult
consists of fluid
 Factors that influence the amount of
body fluid are age, gender, and body
fat
 Body fluids is located in two fluid
compartments: intracellular space
and the extracellular space

3.  The ECF compartment is further
divided into the
intravascular, interstitial, and
transcellular spaces
 Loss of ECF into a space that does
not contribute to equilibrium between
the ICF and ECF is referred to as a
third-space fluid shift or third
spacing

4.  Early evidence of a third-space fluid
shift is a decrease in urine output
despite adequate fluid intake
 Other signs and symptoms of third
spacing that indicate an IVF volume
deficit include increased heart
rate, decreased BP, edema, increased
body weight, decreased CVP, and
imbalances in fluid intake and output

5.  Electrolytes in body fluids are active
chemicals
 Major cations are:
sodium, potassium, calcium, magnesi
um, and hydrogen ions
 The major anions are:
chloride, bicarbonate, phosphate, sulf
ate, and proteinate ions

6. Regulation of Body Fluid
Compartments

7. Osmosis and Osmolality
 Osmosis occurs when fluid shifts
through the membrane from the region
of low solute concentration to the
region of high solute concentration
until the solutions are of equal
concentration

8. Diffusion
 Is the natural tendency of a substance
to move from an area of higher
concentration to one of lower
concentration

9. Filtration
 Movement of water and solutes occur
from an area of high hydrostatic
pressure to an area of low hydrostatic
pressure

10. Sodium – Potassium Pump
 Located in the cell membrane and
actively moves sodium from the cell
into the ECF

11. Maintaining Fluid
and Electrolyte Balance

12.  Homeostasis is a term that indicates
the relative stability of the internal
environment
 Concentration and composition of
body fluid must be nearly constant
 If a substance must be deficient it
must be replaced normally

13.  The kidneys play a major role in
controlling all types of balance in fluid
and electrolytes
 The adrenal glands, through the
secretion of aldosterone, also aids in
controlling extracellular fluid volume
by regulating the amount of sodium
reabsorbed by the kidneys

14.  Antidiuretic hormone from the pituitary
gland regulates the osmotic pressure
of extracellular fluid by regulating the
amount of water reabsorbed by the
kidney

15. FLUID VOLUME DEFICIT
 Dehydration occurs when the fluid
intake of the body is not sufficient to
meet the fluid needs of the body
 The goal of treatment is to restore fluid
volume, replace electrolytes as
needed, and eliminate the cause of
the fluid volume deficit

16. Types of Fluid Volume Deficits
1. Isotonic Dehydration – water and
dissolved electrolytes are lost in
equal proportion
2. Hypertonic Dehydration – water
loss exceeds electrolyte loss, shrinks
cells
3. Hypotonic Dehydration –
electrolyte loss exceeds water

17. Causes of FVD
 Isotonic dehydration
Inadequate intake of fluids and solutes
Fluid shifts between compartment
 Hypertonic dehydration
Excessive perspiration
Hyperventilation
Diarrhea
ESRD
Diabetes insipidus

18.  Hypotonic dehydration
Excessive fluid replacement
Renal failure
Chronic malnutrition
Chronic illness

19. Assessment findings
 Increased pulse rate
 Decreased BP and orthostatic
(postural) hypotension
 Diminished peripheral pulses
 Fever
 Decreased urinary output
 Dry skin
 Poor skin turgor
 Dry mouth

20.  Constipation
 Increased rate and depth of
respirations
 Thirst
 Decreased body weight
 Increased hematocrit

21. Interventions
 Monitor
cardiovascular, respiratory, neuromusc
ular, renal, integumentary, and
gastrointestinal status
 Prevent further fluid losses and
increase fluid compartment volumes to
normal ranges
 Monitor intake and output

22.  Provide oral rehydration therapy and
IV fluid replacement
 Administer medications as prescribed
such as
antidiarrheal, antimicrobial, antiemetic,
and antipyretic medications
 Administer oxygen as prescribed
 Monitor electrolyte values

23. FLUID VOLUME EXCESS
 Fluid intake or fluid retention exceeds
the fluid needs of the body
 Also called overhydration or fluid
overload
 The goal of treatment is to restore fluid
balance, correct electrolyte
imbalances if present, and eliminate or
control the underlying cause of the
overload

24. Types of Fluid Volume Excess
1. Isotonic Overhydration – known as
hypervolemia, results from excessive
fluid in the extracellular fluid
compartment, causes circulatory
overload and interstitial edema
2. Hypertonic Overhydration – caused
by excessive sodium intake
3. Hypotonic Overhydration – water
intoxication; electrolyte imbalance due
to dilution

25. Causes
 Isotonic overhydration
Inadequately controlled IV therapy
Renal failure
Long term corticosteroid therapy
 Hypertonic overhydration
Excessive sodium ingestion
Rapid infusion of hypertonic saline

26.  Hypotonic overhydration
Congestive heart failure
SIADH
Inadequately controlled IV therapy

27. Assessment findings
 Bounding, increased pulse rate
 Elevated BP
 Distended neck and hand veins
 Elevated CVP
 Dyspnea
 Moist crackles on auscultation
 Pitting edema in dependent areas
 Skin pale and cool to touch

28.  Increased motility of the GI tract
 Polyuria
 Projectile vomiting
 Decreased hematocrit

29. Interventions
 Monitor
cardiovascular, respiratory, neuromusc
ular, renal, integumentary, and
gastrointestinal status
 Prevent further fluid overload, and
restore normal fluid balance
 Administer diuretics as prescribed

30.  Control fluid and sodium intake
 Monitor intake, output, and weight
 Monitor electrolyte values

31. DIURETIC

32. D – diet; increase sodium for all except
aldactone
I – intake and output, daily weight
U – undesirable effects: F&E imbalance
R – review HR, BP, and electrolytes
E – elderly careful, evening dose not
recommended

33. T – take with or after meals and in AM
I – increase risk of orthostatic
hypotension’ move slowly
C – cancel alcohol, cigarettes

34. Loop Diuretics
 Inhibits sodium, chloride, and water
reabsorption in the proximal portion of
the ascending loop of Henle
 Edema associated with
CHF, ascites, hypertension
(furosemide)
 Bumetanide (Bumex, Furosemide
(Lasix), Torsemide (Demadex)

35. Thiazides
 Increases urine output by inhibiting
reabsorption of sodium, chloride, and
water in the distal portion of the
ascending loop of Henle
 Edema associated with
CHF, ascites, hypertension
 Chlorothiazide
(Diuril), Hydrochlorothiazide
(Hydrodiuril)

36. Potassium Sparing Diuretics
 Promotes excretion of sodium and
water, but retains potassium in the
distal renal tubule
 Used with loop or thiazide diuretics in
treating CHF and
hypertension, edema
 Spironolactone (Aldactone)

37. Osmotic Diuretics
 Increases osmotic pressure of
glomerular filtrate, thus preventing
reabsorption of water
 Oliguria, edema, increased
ICP, increased IOP
 Mannitol (Osmitrol)

38. Assignment
 Form 4 groups, do a drug study of the
chosen class of diuretic, and make
your own mnemonic for that chosen
class
 Be creative in presenting your
work, use of powerpoint is not allowed
 Presentation will be next
week, indicate your reference