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
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
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
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
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
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