Untitled Quiz

Transporting Functions of Body Fluids

• Transports nutrients to cells.
• Transports waste products from cells.
• Transports hormones, enzymes, and blood cells.
• Facilitates cellular metabolism and proper cellular chemical functioning.
• Acts as a solvent for electrolytes and non-electrolytes.
• Helps maintain normal body temperature.
• Facilitates digestion and promotes elimination.
• Acts as a tissue lubricant.

Fluid Compartments

• Intracellular Fluid (ICF): Fluid within cells, making up 70% of total body fluid.
• Extracellular Fluid (ECF): Fluid outside cells, making up 30% of total body fluid.
  • Includes intravascular fluid (blood plasma) and interstitial fluid (fluid surrounding the cells).

Total Body Fluid

• Represents 50-60% of body weight in a normal adult.

Variations in Fluid Content

• Infants have more body fluid and ECF than adults.
• Women and obese people have less body water than men.
• Fat cells contain less water than muscle cells.

Sources of Fluids

• Ingested liquids: drinking water, juices, and other beverages.
• Food: fruits, vegetables, and soups.
• Byproduct of metabolism: oxidation of carbohydrates, fats, and proteins.

Fluid Losses

• Kidneys: urine.
• Intestinal tract: feces.
• Skin: perspiration (insensible water loss).
• Lungs: exhaled air.

Fluid Intake and Losses in Healthy Individuals

• Fluid intake and losses are generally equal in healthy individuals.

Nursing Process: Assessment of Fluid Balance

• Current/Past Medical History: Previous history of fluid and electrolyte imbalances.
• Vitals: Temperature, pulse, respirations, blood pressure.
• Intake and Output (I&O): Total fluids consumed and excreted.
• Urine Concentration: Checks for dehydration or electrolyte imbalances.
• Body Weight: Significant changes in weight can indicate fluid changes.
• Facial Appearance and Eye Appearance: Observe for signs of dehydration or edema.
• Skin Turgor: Assesses skin elasticity and hydration.
• Edema: Swelling in different areas of body indicates fluid accumulation.
• Mouth and Tongue: Dryness may suggest dehydration.
• Lab Values: Electrolyte levels, creatinine, blood urea nitrogen (BUN).

Guidelines for Measuring I&O

• Instruct the patient and family regarding the rationale for I&O monitoring.
• Document I&O measurements on the patient's plan of care.
• Measure I&O accurately; do not estimate.
• Total I&O for each shift and for 24 hours.
• Intake includes all liquids and foods that are liquid at room temperature.

Fluid Balance and Imbalance

• Fluid Imbalances: Can involve either volume or distribution of water or electrolytes.

Risk Factors for Fluid Imbalance

• Pathophysiology underlying acute and chronic illnesses.
• Abnormal losses of body fluids, such as from:
  • Burns
  • Trauma
  • Surgery
• Therapies that disrupt fluid and electrolyte balance, such as:
  • Diuretics
  • IV fluid administration

Fluid Volume Excess (Hypervolemia)

• Excessive retention of water and sodium in the extracellular fluid (ECF).
• Causes:
  • Excessive water and sodium intake.
  • Impaired kidney function.
  • Heart failure.
• Hypervolemia: Excessive ECF accumulation in the intravascular compartment.
• Edema: Excessive accumulation of fluid in the interstitial space.

Assessment Findings of Fluid Volume Excess

• Edema
• Weight gain
• Shortness of breath (SOB)
• Adventitious lung sounds (crackles, wheezes)
• Increased blood pressure
• Increased pulse rate
• Weakness and fatigue
• Lab value changes (e.g., decreased hematocrit)

Interventions for Fluid Volume Excess

• Prevent or correct underlying cause.
• Dietary modifications, limiting sodium intake.
• Fluid intake modifications, restricting or limiting fluid intake.
• Monitor labs, assessing electrolyte levels, hematocrit, and urine output.
• Medication administration, such as diuretics.
• Decrease anxieties, helping patients manage stress.
• Patient and family teaching, regarding fluid management and lifestyle changes.

Fluid Volume Deficit (Hypovolemia)

• Deficiency of water and solutes (electrolytes).
• Third-space fluid shift: Distribution of body fluids into potential body spaces.

Assessment Findings of Fluid Volume Deficit

• Change in mental status (confusion, lethargy)
• Increased temperature
• Increased pulse rate (tachycardia)
• Decreased blood pressure
• Lab value changes (e.g., increased hematocrit)
• Dry mucous membranes, cracked lips, furrowed tongue
• Decreased skin turgor
• Scant, dark urine output
• Sudden weight loss (5 lbs or more)

Interventions for Fluid Volume Deficit

• Prevent or correct underlying cause.
• Dietary modifications, increasing fluid and electrolyte intake.
• Fluid intake modifications, encouraging oral fluids or administering IV fluids.
• Monitor output, tracking urine output and other fluid losses.
• Monitor labs, assessing electrolyte levels and hematocrit.
• Medication administration, such as IV fluids or electrolyte replacement therapy.
• Patient and family teaching, regarding fluid management and lifestyle changes.
• Assess for electrolyte imbalances, monitoring for symptoms and managing accordingly.

Functions of Electrolytes

• Maintain fluid balance.
• Contribute to acid-base regulation.
• Facilitate enzyme reactions.
• Transmit neuromuscular reactions.

Chief Electrolytes and Their Functions

• Sodium (Na+): Chief electrolyte of ECF; controls and regulates the volume of body fluids.
• Potassium (K+): Major cation of ICF; chief regulator of cellular enzyme activity and water content.
• Calcium (Ca2+): Nerve impulse transmission, blood clotting, muscle contraction, vitamin B12 absorption.
• Magnesium (Mg2+): Metabolism of carbohydrates and proteins; vital actions involving enzymes.
• Phosphate (PO43-): Energy storage; bone and teeth formation.
• Chloride (Cl-): Maintains osmotic pressure in blood; produces hydrochloric acid.

Electrolyte Imbalances

• Hyponatremia: Low sodium levels.

  • Causes: Increased water intake, excessive sodium loss (e.g., vomiting, diarrhea, diuretics, sweating).
  • Symptoms: Confusion, muscle cramps, weakness.

• Hypernatremia: High sodium levels.

  • Causes: Water loss, excessive sodium intake (e.g., burns, fluid deprivation, diarrhea, excess salt consumption).
  • ** Symptoms:** Restlessness, increased thirst, dry tongue.

• Hypokalemia: Low potassium levels.

  • Causes: Loss through vomiting, gastric suctioning, use of diuretics.
  • Symptoms: Muscle weakness, leg cramps, dysrhythmias, anorexia, paresthesia.

• Hypekalemia: High potassium levels.

  • Causes: Renal failure, potassium-sparing diuretics, NSAIDs.
  • Symptoms: Cardiac arrest, gastrointestinal issues.

• Hypocalcemia: Low calcium levels.

  • Causes: Inadequate calcium intake, impaired calcium absorption, excessive calcium loss.
  • Symptoms: Numbness/tingling of fingers, mouth, or feet; tetany.

• Hypercalcemia: High calcium levels.

  • Causes: Cancer, hyperparathyroidism.
  • Symptoms: Constipation, kidney stones, bone pain.

• Hypomagnesemia: Low magnesium levels.

  • Causes: ETOH withdrawal, diarrhea, NG tube suction, tube feedings, burns.
  • Symptoms: Seizures, altered mental status, hyperactive deep tendon reflexes.

• Hypermagnesemia: High magnesium levels.

  • Causes: Renal failure, excess consumption of magnesium-containing antacids.
  • Symptoms: Loss of deep tendon reflexes, respiratory depression, coma, cardiac arrest.

• Hypophosphatemia: Low phosphate levels.

  • Causes: Alcohol withdrawal.

• Hyperphosphatemia: High phosphate levels.

Carbonic Anhydrase Inhibitors

• Uses: Treatment of glaucoma, edema, and high-altitude sickness.
• Contraindications: Low sodium or potassium levels, renal failure.
• Adverse effects:
• Interactions: Digoxin, corticosteroids.

Loop Diuretics

• Examples: furosemide (Lasix), torsemide (Demadex), bumetanide (Bumex).
• Action: Potent diuretics that block chloride and sodium reabsorption in the loop of Henle.
• Uses: Edema (heart failure), hypertension, renal failure, hypercalcemia, pulmonary edema.
• Contraindications:
• Adverse effects: Dizziness, tinnitus, nausea, vomiting, diarrhea, hypokalemia, hyperglycemia.
• Interactions: Vancomycin, digoxin, NSAIDs.

Osmotic Diuretics

• Example: Mannitol (Osmitrol).
• Action: Increases osmotic pressure to pull fluid into the renal tubules, reducing cerebral edema.
• Uses: Renal failure, excretion of toxic substances, cerebral edema.
• Contraindications: Severe renal disease, pulmonary edema (use loop diuretics instead), intracranial bleed.
• Adverse effects:
• Interactions:

Potassium-Sparing Diuretics

• Examples: spironolactone (Aldactone), amiloride (Midamor), triamterene (Dyrenium).
• Action: Block aldosterone receptors, causing sodium and water excretion (weak diuretic effect).
• Uses: Hypertension, heart failure (in conjunction with loop diuretics to prevent potassium loss).
• Contraindications:
• Adverse effects: Dizziness, headache, cramps, nausea, vomiting, diarrhea, hyperkalemia.
• Interactions: Lithium, ACE inhibitors, or potassium supplements can cause significant hyperkalemia!!