Last year by end of the lecture Dr Medinna gave cases to solve for Fluid and electrolytes....
He had a seperate slide for the cases..
Lecture slides are taken from Schwartz Textbook of surgery....
Homeostasis means keeping everything normal Is necessary for organs to perform work Functions of body water transport nutrients, e-lytes, and O2 to the cells excretion of wastes regulates body temp lubricates joints and membranes medium for food digestion Daily body fluid intake and losses liquid 1000-1200ml urine 100-1400ml food 800-1000ml feces 100 ml oxidation 200-300ml lungs 400-500ml skin 300-500ml Total – 2000-2500ml 1800-2500ml
ECF shifts between the intravascular space (blood vessels) and the interstitial space (tissue) to maintain the fluid balance within the ECF compartment
Osmolality is determined by the number of dissolved particles, mainly Na, urea and glucose per kilogram of H2O Na is the largest contributor of particles To maintain balance between ICF and ECF, the body continues to shift Na and H2O between them ICF is maintained by K+ ECF is maintained by Na+ Regulation of F/E balance requires a constant adjustment Fluid volume, distribution, and composition is accomplished by the -kidneys and the circulatory system which are influenced by the CNS, hormones, (ADH, Aldosterone, Renin) and the thirst center in the brain. Active transport – moves from lesser to higher {} and is aided by energy from ATP Na and K use ATP to move in and out of the cell – called the Na- K pump H ydrogen and glucose also need help Osmosis is passive and occurs like dilution
Solutes = dissolved substances Solvent = a liquid with a substance in solution Membrane = a layer of tissue covering a surface or organ or separating spaces Permeability = the capability of a substance, molecule, or ion to diffuse through a membrane Semi-permeable membrane = artificial membrane such as a cellophane membrane Osmosis = passage of a solvent through a membrane from a solution of higher concentration in a solution of lower concentration Diffusion = movement of molecules such as gas from higher to lesser concentration Ion = a particle carrying a positive or negative charge anion = - cation = +
Osmosis is the movement of H2O only
Isotonic – equally concentrated Hypotonic – less concentrated Hypertonic more concentrated
As long as the hydrostatic pressure exceeds plasma colloid oncotic pressure, H2O and solutes leave the capillaries and enter the interstitial spaces If the hydrostatic pressure falls below plasma colloid oncotic pressure, water and solutes return to the capillaries As long as these pressures remain constant, there are no problem with balance WITHOUT THE COLLOID OSMOTIC PRESSURE, FLUID REMAINS IN THE TISSUES CAUSING EDEMA AND SWELLING
Hypothalamus senses low blood volume > Pituitary secretes ADH > ADH causes kidneys to retain water
pH – acid or base determines how kidneys are responding to metabolic acid bas imbalances Specific gravity indicator of fluid balance reflects renal function – if able to concentrate urine Osmolality - # of dissolved particles in solution determines renal excretion or conservation of water Creatinine clearance – determines glomerular damage to kidney instruct patient to void and discard, then collect for the next 24 hours keep refrigerated usually need a serum creatinine need height, weight, and age Na – reflects Na intake and fluid volume K+ - measures renal tubular function need 24 hour specimen
HCT - % of blood volume which is RBC’s ^ in dehydration, fluid volume deficit low indicates fluid excess Serum Creat = metabolic waste product better indicator then BUN for renal function BUN = high is fluid deficit low is fluid volume excess Osmolality = measures blood concentration ^ is fluid volume deficit low is fluid volume excess Albumin = protein in blood that maintains volume by colloid osmotic pressure low and water shifts into the interstitial compartment Electrolytes =
Risks – vomiting/diarrhea, kidney disease, CHF, diabetes, burns, diuretics, NG tubes Patient complaints – fatigue, weakness, edema, dyspnea, confusion Vital signs – shows changes in volume pulse - ^ with volume excess, Na excess and Mg deficit weak, irregular, rapid may indicate severe K+ excess or Na deficit bounding – volume excess respirations – fluid volume excess acid base changes – slow shallow in metabolic alkalosis deep, rapid in metabolic acidosis temperature – fever increases metabolic rate with fluid loss subnormal with volume excess B/P – orthostatic with fluid volume deficit ^ with fluid volume overload I/O Keep accurate record problems may be prevented if found early measure all fluids in and out Weight indicator of fluid loss or gain Skin color, moisture, turgor, temperature indicate fluid balance edema reflects Na retention Mucus membranes furrow on the tongue oral cavity Veins jugular hand veins- time it takes for veins to empty and fill
SEE PAGE 159 FOR ASSESSMENT, TREATMENT AND NURSING CARE