Medical-Surgical Nursing I (Lecture) 2024-2025 PDF

MEDICAL-SURGICAL NURSING I (Lecture) BSN 3-1 | BSN 3-3 3rd Year, 1st Semester (S.Y. 2024-2025) Prof. Glenn L. Rianzares Intracellular fluid (ICF) Extracellu...

MEDICAL-SURGICAL NURSING I (Lecture) BSN 3-1 | BSN 3-3 3rd Year, 1st Semester (S.Y. 2024-2025) Prof. Glenn L. Rianzares Intracellular fluid (ICF) Extracellular fluid (ECF) Topic Outline: Topic I Plasma Topic II Interstitial fluid Other ECF MAIN TOPIC TOPIC SUB-TOPIC Intracellular fluid (ICF) Extracellular fluid (ECF) FLUIDS and ELECTROLYTES ⅔ of Total Body Plasma ¼ 5 % of Total Body Water Weight body ECF ○ 50-60% of total body weight weight Lean individuals: Greater percentage of body weight 40 % of body weight is water. Interstitial fluid ¾ 15 % Skeletal muscle mass (lymph) of Lower % of TBW in females correlates with a higher ECF % of adipose tissue and lower %age of muscle mass. body weight Other ECF 20 % (Transcellular ECF of fluid) body CSF, weight pericardial, synovial, tears, intraocular, pleural ICF Intracellular fluid: 2/3 of TBW, 40% of body wt Fluid Compartments → Skeletal muscle mass ACTIVITY 1 ECF Identify the percentage of Total Body Weight (TBW). Plasma: 1⁄4 ECF, 5% body wt. Interstitial fluid (lymph): 34 of ECF, 15% of body wt. Fetus = 90% Transcellular → CSF, Pericardial, synovial, tears, Pre-term = 80% Intraocular, pleural Term = 70-75% Young children = 65-75% FUNCTIONS OF BODY WATER Adolescents = 60% ECF Maintains blood volume BODY WATER CONTENT Transport system to and from the cell Body Water Content ICF In the average adult, body fluids comprise 60% of Internal aqueous medium for cellular chemical function total body weight. Maintenance of normal body temperature Body fluids occupy two main compartments: Elimination of waste products ○ Intracellular fluid (ICF) ○ Extracellular fluid (ECF) ACTIVITY 2 Identify the chemical composition to each compartments. 2 Main Components of Body Fluids ICF 1 1  K, Mg = primary cations (+) Phosphates and CHON (proteins) = primary anions (-) ECF Na = primary cations (+) Cl and carbonate = primary anions (-) CLASSIFICATION OF BODY FLUID CHANGES Normal exchange of fluid & electrolytes 2000 ml of water/day? 75% liquids 25% solid foods IDENTIFY DAILY LOSSES 1 liter urine? 250 ml stool? 600 ml insensible losses? → skin = 75 %? → lungs= 25 %? WATER BALANCE and ECF ACTIVITY 3 WATER BALANCE and ECF Internal Regulation of Body Water and Electrolytes (Na, K) To remain properly hydrated, water intake must equal 1. Thirst water output 2. Kidney Water intake sources 3. ADH ○ Ingested fluid (60%) 4. RAAS ○ Solid food (30%) 5. Baroreceptors ○ Metabolic water or water of oxidation (10%) 6. Osmoreceptors Water output 7. Heart/blood vessels ○ Urine and feces 8. Lungs ○ Insensible losses, sweat 9. Pituitary gland (PG) Increases in plasma osmolality trigger thirst 10. Aldosterone 11. Parathyroid gland (calcium/phosphate) REGULATION OF WATER INTAKE BARORECEPTORS Regulation of Water Intake BARORECEPTORS The hypothalamic thirst center is stimulated: Baroreceptors modulate volume in response to decline in plasma volume changes in pressure and circulating volume increases in plasma osmolality Via baroreceptor input, angiotensin II, and other stimuli Feedback signals that inhibit the thirst centers include: Neural Hormonal Moistening of the mucosa of the mouth and throat Activation of stomach and intestinal stretch receptors Sympathetic Renin-angiotensin Parasympathetic Aldosterone Atrial natriuretic peptide Renal prostaglandins BARORECEPTORS small nerve receptors that detect small changes in pressure within blood vessels and transmit this information to the CNS (medulla) responsible for monitoring the circulating volume regulate SNS / PNS Neural activity and Endocrine Activity categorized as high and low pressure baroreceptor systems ○ Low Pressure ○ Located in the Cardiac Atria (Left Atrium) ○ High Pressure 2  ○ Located in the nerve endings of the aortic HYPEROSMOLAR IMBALANCE "arch and cardiac sinus; afferent arteriole of HYPEROSMOLAR IMBALANCE the JGA of the nephrons Etiology Dehydration OSMORECEPTORS Excess loss of water OSMORECEPTORS ↓ intake of water Located in the surface of the hypothalamus ↑ solute intake w/o sufficient water Senses change in Na concentration Hypovolemia / Fluid Volume Deficit ACTIVITY 4 Assessment: Map out a pathophysiology in response to changes in Thirst, wt. loss, dry skin and mucous membranes pressure and circulating volume HYPOOSMOLAR IMBALANCE BARORECEPTORS HYPOOSMOLAR IMBALANCE Water intoxication Causes: OSMORECEPTORS ○ Excess-intake of electrolyte ○ Na deficit ○ ↑ ADH Assessment: ○ Changes in mental status, weight gain, PRIMARY REGULATORY HORMONES hyperventilation, warm moist skin Primary Regulatory Hormones ○ ↑ ICP Antidiuretic hormone (ADH) Stimulates water conservation and the thirst center Aldosterone Controls Na+ absorption and K+ loss along the DCT DCT (distal convoluted tubule) - loss of K+ Natriuretic peptides (ANP and BNP) Reduce thirst and block the release of ADH and aldosterone VOLUME DEFICIT / VOLUME EXCESS Volume Deficit ECF Most common fluid disorder Loss of GI fluids (e.g. vomiting, NGT secretion diarrhea, fistula drainage) Rapid losses Thermal regulation ELECTROLYTE COMPOSITION OF BODY FLUIDS Volume Excess ICF Electrolyte Composition of Body Fluids Secondary to renal insufficiency, CHF Each fluid compartment of the body has a distinctive pattern of Manifested primarily in the pulmonary circulation electrolytes Intracellular fluids have low sodium and chloride Potassium is the chief cation System Deficit Excess Phosphate is the chief anion Extracellular fluids are similar (except for the high Generalized protein content of plasma) Sodium is the chief cation Cardiac Chloride is the major anion Renal ACTIVITY 6 GI NORMAL VALUES OF ELECTROLYTES Pulmonary 3 Sodium (Na) 135 - 145 mEq/L Potassium (K) 3.5 - 5.5 mEq/L Chloride (Cl) 97 - 107 or 109 mEq/L Magnesium (Mg) 1.5 - 2.5 mEq/L Phosphorus (P) 2.5 - 4.5 mEq/L 4.5 - 5.5 mEq/L Calcium (Ca) 8.6 - 10 mg/dL NORMAL VALUES OF ELECTROLYTES EXTRACELLULAR FLUIDS and INTRACELLULAR FLUIDS (Extracellular Fluids) Sodium and potassium concentrations in extra- and intracellular fluids are nearly opposites CATIONS mEq/L REGULATION OF FLUIDS and ELECTROLYTES Sodium (Na) 142 Regulation Of Fluids And Electrolytes Potassium (K) 5 Homeostatic mechanisms respond to changes in ECF Respond to changes in plasma volume or osmotic Magnesium (Mg) 2 concentrations Calcium (Ca) 5 Note: If ECF becomes hypertonic relative to ICF, water TOTAL CATIONS 154 moves from ICF to ECF If ECF becomes hypotonic relative to ICF, mater moves from ECF into cell NORMAL VALUES OF ELECTROLYTES (Extracellular Fluids) NORMAL VALUES OF ELECTROLYTES ANIONS mEq/L (Intracellular Fluids) Chloride (Cl) 103 CATIONS mEq/L Bicarbonate (HCO3-) 26 Sodium (Na) 10 Phosphorus (P) 2 Potassium (K) 150 Sulfates 1 Magnesium (Mg) 40 Organic Acids 5 TOTAL CATIONS 200 Proteinate 17 NORMAL VALUES OF ELECTROLYTES TOTAL ANIONS 154 (Intracellular Fluids) ANIONS mEq/L Bicarbonate 10 Phosphates / Sulfates 150 Proteinate 40 TOTAL CATIONS 200 ELECTROLYTE IMBALANCES 4  SODIUM ○ Major ECF cation ○ Controls ECF osmotic pressure, ECF volume ○ Controls water distribution throughout the body ○ Necessary for neuromuscular function (IC chemical function) ○ Maintains acid-base balance CONCENTRATION CHANGES CONCENTRATION CHANGES ○ Changes in serum sodium are inversely proportional to total body water ↑ Total body water ↓ Serum sodium concentration Na - K Pump NA-K PUMP Regulates concentration of Na and K in the ICF and ECF LOVE/ HATE RELATIONSHIP Diffusion or Active Transport (STOPPED AT 01:38:00) 5