fluids and electrolye

1. CARE OF PATIENT WITH FLUIDS
AND ELECTROLUYTES
Acidosis : Increase in H inside the blood .
Alkalosis : Excess of bicarbonate ion inside the blood .
Anaphylactic Reaction : it is a life threatening condition
characterized by a severe respiratory and cardiovascular
collapse , severe GI disturbance.
Blood transfusion : It is the procedure of administering blood
or its components to a client
Dehydration : Loss of water/fluid from extra cellular space .
 Fluid : Liquid available in body .

2. BODY FFLUIDS
Approximately 60% of a typical adult’s weight consists of fluid
( Water and Electrolyte ) .
Factors that influence the amount of body fluid are
Age
Gender
Body fat
In general ,younger people have a higher percentage of body
fluid than older people .
Men have proportionately more body fluids than women .
People who are obese have less fluid than those who are thin
,because fat cells contain little water.
The skeleton also has low water content .
Muscle skin and blood contain the higher amount of water .

3. DISTRIBUTION OF BODY FLUIDSBody fluid is located in two fluid compartment :
 intracellular space ( fluid in the cells )
Extra cellular space ( fluid outside the cells )
Approximately two thirds of body fluid is in the ICF
compartment and is located primarily in the skeletal muscle
mass.
Approximately one third is in the extra cellular fluid ECF
compartment.

4. ECF FLUID COMPARTMENT
 The ECF compartment is further divided into the
 Intra vascular
 Interstitial
 transcellular

5. The intravascular space ( the fluid within the blood vessels)
contains plasma , the effective circulating volume.
Approximately 3 L of the average 6 L of blood volume in
adults is made up of plasma . The remaining 3 L is made up
of erythrocytes, leukocytes , And thrombocytes
The interstitial space contains the fluid that surrounds the
cell and totals about 11 to 12 L in an adult . Lymph is an
interstitial fluid.
The transcellular space is the smallest division of the ECF
compartment and contains approximately 1 L . Example –
synovial fluids , CSF, pericardial fluids.

6. 67%
33%
Sales
1st Qtr
2nd Qtr

7. Source of Body Water Gains and losses
Intake (mL) Output (mL)
Oral intake As water 1,000 Urine 1,500
In food 1,300 Stool 200
Water of oxidation 200 Insensible
Lungs 300
Skin 500
Total gain 2,500 Total loss 2,500

8. FUNCTION OF BODY FLUIDS
Regulation of body temperature.
Protects and cushions vital organs.
Transportation of nutrients to the cells.
Helps convert food into energy .
Transportation of Waste products away from cells.
Transportation of hormones to activity site .
Lubrication of joint spaces.
Flushes the kidneys of the waste products of metabolism .
Improves intestine health and helps prevent constipation

9. ELECTROLYTES
 Electrolytes in body fluids are active chemicals (
cations that carry positive charge and anoin that carry
negative charge .
 The major cations in body fluids are sodium ,
potassium , calcium , magnesium ,
 The major anions are chloride , bicarbonate ,
phosphate , sulphate .

10. Extracellular fluids ( plasma )
Cations
Sodium
Potassium
Calcium
magnesium
142
5
5
2
Anion
Chloride
Bicarbonate
Phosphate
Sulphate
103
26
2
1
Intracellular fluid
Cation
Potassium
Magnesium
Sodium
Anion
Phosphate and sulphate
Bicarbonate
Chloride
150
40
10
150
10

11. Factor affecting fluid and electrolyte
balance
Age : At different ages , the body weight , body surface area ,
renal filtration capacity and metabolic rate is different , that
influences the fluid intake.
Climate : Climate changes affect the fluid intake and fluid
loss . High heat and low environmental humidity increases
the sweating and fluid loss . Exercise , dry atmospheric
condition , heavy sweating imbalances the fluid and
electrolyte balance

12. Illness : Nausea ,vomiting diarrhea ,increase metabolism
,wound and burns affect the fluid and electrolyte balance
Medication : Excessive use of cathartics , enemas , diuretics ,
and steroids stimulate bowel evacuation by irritating the
smooth muscles intestine . This can result in fluid volume
deficit from excessive water and electrolyte loss .
Medical treatment

13. ALTERATION IN FLUID AND ELECTROLYTE
BALANCE
FLUID OLUME ALTERATION: It includes the following
1. Fluid volume deficit: It is also known as dehydration and is
defined as loss of water and or electrolyte from ECF . Extra
Cellular Fluid Deficit applies either proportionate or
disproportionate losses.
Disproportion losses In this two condition exist
 Hypotonic dehydration Electrolyte loss is proportionately
greater than loss of water . Its causes include diabetes
insipidus

14. Hypertonic dehydration
 Water loss is proportionately greater than electrolyte loss
EFFECT S:-
Hypovolemia : Loss of blood volume either through
Haemorrhage or through severe depletion of the ECF by
another causes lead to circulatory failure.
Other effect include : Brain cells are more sensitive .
Tachycardia , restlessness dry mucus membrane , poor skin
turgor ,decrease urine output

15. Fluid volume excess
 When water and solutes are gained in proportionate amounts
of extra cellular fluid ,it is known as Extra cellular fluid
excess or over hydration.
 Causes
a) Rapid administration of iv fluids.
b) Cardiac and renal failure.
c) Liver disease.
Symptoms:
a) Generalized edema.
b) Wide spread accumulation of fluid in the intestial spaces.
c) Weight gain ,jugular vain engorgement.

16. Nursing measures to prompt optimum fluid and
electrolyte balance
1. PREVENTIVE CARE
In this the cause of fluid and electrolyte imbalance are
provided to the clients so that they can take preventive
measure .
A. Life style analysis : Factors like age , stress , diet of a client
are analysed to prevent the occurrence of fluid and
electrolyte imbalance.
B. Life style counselling.
C. Health education : Health education regarding stress
relieving factors , dietary pattern and medical symptom i.e.
 Hyperirritability
 Bradicardia
 Shallow respirations.
 paresthesia

17. Laboratory tests for evaluating
fluid status
 Osmolality is the concentration of fluids that affects
the movement of water between fluids compartment
by osmosis .osmolality measures the solute
concentration per kilogram in blood and urine .it is
also a measure of a solution’s ability to create osmotic
pressure and affect the movement of water.
 Serum osmolality primarily reflects the concentration
of sodium , although blood urea nitrogen (BUN) and
glucose also play a measure role in determining serum
osmolality.

18.  Urine osmolality is determined by urea , creatinine and uric
acid . When measured with serum osmolality , urine
osmolality is the most reliable indicator of urine
concentration . Osmolality is reported as miliosmole per kilo
gram of water.
 In healthy adults , normal serum osmolality is 270 to 300
mOsm/kg .sodium predominates in ECF osmolality and
hold water in this compartment .

19.  Urine specific gravity measures the kidneys’ ability to
create or conserve water . The specific gravity of urine
is compared to the weight of distilled water , which has
a specific gravity of 1.000 . The normal range of urine
specific gravity is 1.010 to 1.025 .
 Specific gravity varies inversely with urine volume ;
normally , the larger the volume of urine the lower the
specific gravity .
 Specific gravity is less reliable indicator of
concentration than urine osmolality .
 Increase glucose or protein in urine can cause a falsely
elevated specific gravity .

20.  BUN is made up of urea , which is an end product of the
metabolism of protein ( from muscle and dietary intake ) by
the liver.
 Amino acid breakdown produces large amount of ammonia
molecules , which are absorbed into the blood stream .
Ammonia molecule converted to urea and excreted in the
urine. The normal BUN is 10 to 20 mg/dl . The BUN level
varies with urine output . Factor that increase BUN include
decreased renal function, GI bleeding , Dehydration
,increase protein intake fever and sepsis . Those that decrease
BUN include end stage liver disease , low protein diet ,
starvation , and any condition that result in expanded fluid
volume.

21.  Creatinine is the end product of muscle metabolism . It is
a better indicator of renal function than BUN because it
does not vary with protein intake and metabolic state . The
normal serum creatinine is approximately 0.7 to 1.4 mg/dl;
however , its concentration depends on lean body mass
and varies from person to person.
 Serum creatinine level increase when renal function
decrease.

22.  Hematocrit measures the volume percentage of red blood
cells in whole blood and normally ranges from 42% to 52%
for male and 35% to 47% for females . Conditions that
increase the hematocrit are over hydration and anaemia.
 Urine sodium values change with sodium intake and the
status of fluid volume ; as sodium intake increase ,
excretion increases ;as the circulating fluid volume
decrease , sodium is conserved .normal urine sodium
levels range from 75 to 200 mEq/24 hours .
 Urine sodium levels are used to assess volume status are
useful in the diagnosis of hyponatremia and acute renal
failure

23. COMMON LABORATORY TEST TO ASSESS FLUID,
ELECTROLYTE AND ACID BASE BALANCE
Fluid Balance Test Normal findings
 Serum osmolarity : Measures
total concentration of dissolved
particles in serum ; determined
largely by sodium concentration.
Urine osmolarity : measures
concentration or number of solute
particles ,regardless of size in urine .
Urine specific gravity : measures
density of water compared to distilled
water not as precise a measurement as
Child =70-290
mosm/kg
Adult = 280-
300mosm/kg
New born = 100-
600mosm /kg
Child =50-1200
mosm/kg
Average =200-
800mosm/kg
1.003-1.040

24. Fluid balance test Normal finding
 Hematocrit (Hct) :
Measures percentage by
volume of Red blood cells
in whole blood provides a
relative indication of fluid
volume alteration.
Haemoglobin (Hgb or Hg):-
Measures oxygen carrying
capacity of blood ; also an
indicator of fluid balance
Blood Urea Nitrogen
(BUN):-
Measures level of nitrogenous
waste in blood stream
Adult male = 42-52%
Adult female = 35-47%
Adult male =14-18 g/dl
Adult female = 12-16g/dl
6-20 mg/dl or 2.1-7.1
mmol/l