Ncm-112-Lesson-II-introduction-to-Fluids-and-Electrolytes (1).pdf

NCM 112- CARE OF CLIENTS WITH PROBLEMS IN FLUIDS AND ELECTROLYTES, ACID-BASE BALANCE ISSA MARIE A. APODACA, MAN INSTRUCTOR I  LESSON II. RESPONSES TO ALTERATIONS/ PROBLEMS AND ITS PHYSIOLOGIC BASIS IN FLUIDS AND ELECTROLYTES AND ACID-BASE BALANCE ...

NCM 112- CARE OF CLIENTS WITH PROBLEMS IN FLUIDS AND ELECTROLYTES, ACID-BASE BALANCE ISSA MARIE A. APODACA, MAN INSTRUCTOR I  LESSON II. RESPONSES TO ALTERATIONS/ PROBLEMS AND ITS PHYSIOLOGIC BASIS IN FLUIDS AND ELECTROLYTES AND ACID-BASE BALANCE  LEARNING OBJECTIVES: DESCRIBE VARIABLES THAT INFLUENCE FLUID AND ELECTROLYTE BALANCE IDENTIFY FACTORS RELATED TO FLUID/ELECTROLYTE BALANCE ACROSS THE LIFE SPAN ASSESS A PATIENT’S NUTRITIONAL AND FLUID/ELECTROLYTE STATUS OUTLINE SPECIFIC NURSING INTERVENTIONS TO PROMOTE FLUID AND ELECTROLYTE BALANCE BASE DECISIONS ON THE SIGNS AND SYMPTOMS OF FLUID VOLUME EXCESS AND FLUID VOLUME DEFICIT BASE DECISIONS ON THE INTERPRETATION OF DIAGNOSTIC TESTS AND LAB VALUES INDICATIVE OF A DISTURBANCE IN FLUID AND ELECTROLYTE BALANCE A. FLUIDS AND ELECTROLYTES AND ACID-BASE BALANCES  WHAT IS FLUID AND ELECTROLYTE BALANCE? REFERS TO THE PROCESS BY WHICH THE BODY MAINTAINS PROPER LEVELS OF FLUIDS AND ESSENTIAL MINERALS (ELECTROLYTES) LIKE SODIUM, POTASSIUM, CHLORIDE, CALCIUM, AND MAGNESIUM, WITHIN THE BLOODSTREAM AND CELLS THIS BALANCE IS CRITICAL FOR MAINTAINING NORMAL CELLULAR FUNCTION, NERVE TRANSMISSION, MUSCLE CONTRACTION, AND OVERALL HEALTH. FLUIDS HELP TRANSPORT NUTRIENTS, REMOVE WASTE, REGULATE BODY TEMPERATURE, AND KEEP TISSUES MOIST. ELECTROLYTES- CHARGED PARTICLES THAT HELP WITH ELECTRICAL SIGNALING IN THE BODY, SUCH AS: NERVE AND MUSCLE FUNCTION, MAINTAINING ACID-BASE BALANCE REGULATING FLUID DISTRIBUTION BETWEEN CELLS AND BLOOD  BASIC CONCEPTS PERCENTAGE OF WATER TO BODY WEIGHT THE GREATEST SINGLE CONSTITUENT OF THE BODY IS WATER. Average adult: 60% Older adult: 45-55% New born infant: 70-80% Human embryo: 97% FLUID CHANGES WITH AGING SKELETAL MUSCLE MASS DECLINES PROPORTION OF FAT INCREASES WATER CONTENT DROPS TO 46% AT AGE 60 DISTRIBUTION CHANGES  BODY FLUIDS CONSISTS OF WATER, ELECTROLYTES, BLOOD PLASMA AND COMPONENT CELLS, PROTEINS, AND OTHER SOLUBLE PARTICLES CALLED SOLUTES. FOUND IN 2 MAIN AREAS OF THE BODY CALLED INTRACELLULAR AND EXTRACELLULAR COMPARTMENTS.  BODY FLUID DISTRIBUTION INTRACELLULAR FLUIDS (ICF) FLUID IN THE CELL MADE UP OF PROTEIN, WATER, ELECTROLYTES, AND SOLUTES. MOST ABUNDANT ELECTROLYTE: POTASSIUM. CRUCIAL TO THE BODY’S FUNCTIONING. ACCOUNTS FOR 60% OF THE VOLUME OF BODY FLUIDS AND 40% OF A PERSON’S TOTAL BODY WEIGHT EXTRACELLULAR FLUIDS (ECF) FLUIDS OUTSIDE THE CELL 20% OF TOTAL BODY WEIGHT MOST ABUNDANT ELECTROLYTE: SODIUM. BODY REGULATES SODIUM LEVELS TO CONTROL THE MOVEMENT OF WATER INTO AND OUT OF THE EXTRACELLULAR SPACE DUE TO OSMOSIS.  TYPES OF EXTRACELLULAR FLUID: A. INTRAVASCULAR FLUID- FOUND IN THE VASCULAR SYSTEM CONSISTS OF ARTERIES, VEINS, AND CAPILLARY NETWORKS. IT IS WHOLE BLOOD VOLUME AND ALSO INCLUDES RED BLOOD CELLS, WHITE BLOOD CELLS, PLASMA, AND PLATELETS. MOST IMPORTANT COMPONENT OF THE BODY’S OVERALL FLUID BALANCE. (NSG DX) DEFICIENT FLUID VOLUME- HYPOVOLEMIA INTRAVASCULAR FLUID LOSS CAN BE CAUSED BY SEVERAL FACTORS, SUCH AS EXCESSIVE DIURETIC USE SEVERE BLEEDING VOMITING DIARRHEA INADEQUATE ORAL FLUID INTAKE  TYPES OF EXTRACELLULAR FLUID: B. INTERSTITIAL FLUID FLUID OUTSIDE OF BLOOD VESSELS AND BETWEEN THE CELLS. EXAMPLE OF EXCESS INTERSTITIAL FLUID: EDEMA C. TRANSCELLULAR FLUID FLUID IN AREAS SUCH AS CEREBROSPINAL, SYNOVIAL, INTRAPLEURAL, AND GASTROINTESTINAL SYSTEM.  FUNCTIONS OF BODY WATER TRANSPORTATION WATER PROVIDES TRANSPORTATION OF NUTRIENTS, ELECTROLYTES, AND OXYGEN TO THE CELLS. EXCRETION WATER IS USED IN THE EXCRETION OF WASTE PRODUCTS.. REGULATION WATER IS USED IN THE REGULATION OF BODY TEMPERATURE. LUBRICATION WATER PROVIDES LUBRICATION OF JOINTS AND MEMBRANES. MEDIUM WATER SERVES AS A MEDIUM FOR FOOD DIGESTION.  FLUID MOVEMENT FLUIDS AND SOLUTES CONSTANTLY MOVE HELPS MAINTAIN HOMEOSTASIS ACROSS INTRACELLULAR, INTERSTITIAL, AND INTRAVASCULAR COMPARTMENTS. OCCURS INSIDE THE BODY DUE TO OSMOTIC PRESSURE, HYDROSTATIC PRESSURE, AND OSMOSIS. PROPER FLUID MOVEMENT DEPENDS ON INTACT AND PROPERLY FUNCTIONING VASCULAR TISSUE LINING, NORMAL LEVELS OF PROTEIN CONTENT WITHIN THE BLOOD, AND ADEQUATE HYDROSTATIC PRESSURES INSIDE THE BLOOD VESSELS.  INTACT VASCULAR TISSUE LINING PREVENTS FLUID FROM LEAKING OUT OF THE BLOOD VESSELS. PROTEIN CONTENT OF THE BLOOD (ALBUMIN) CAUSES ONCOTIC PRESSURE THAT HOLDS WATER INSIDE THE VASCULAR COMPARTMENT. EXAMPLE: PATIENTS WITH DECREASED PROTEIN LEVELS (LOW SERUM ALBUMIN) EXPERIENCE EDEMA DUE TO THE LEAKAGE OF INTRAVASCULAR FLUID INTO INTERSTITIAL AREAS BECAUSE OF DECREASED ONCOTIC PRESSURE.  HYDROSTATIC PRESSURE PRESSURE THAT A CONTAINED FLUID EXERTS ON WHAT IS CONFINING IT. IN THE INTRAVASCULAR FLUID COMPARTMENT, IT IS THE PRESSURE EXERTED BY BLOOD AGAINST THE CAPILLARIES. HYDROSTATIC PRESSURE OPPOSES ONCOTIC PRESSURE AT THE ARTERIAL END OF CAPILLARIES, WHERE IT PUSHES FLUID AND SOLUTES OUT INTO THE INTERSTITIAL COMPARTMENT. ON THE VENOUS END OF THE CAPILLARY, HYDROSTATIC PRESSURE IS REDUCED, WHICH ALLOWS ONCOTIC PRESSURE TO PULL FLUIDS AND SOLUTES BACK INTO THE CAPILLARY.  FILTRATION OCCURS WHEN HYDROSTATIC PRESSURE PUSHES FLUIDS AND SOLUTES THROUGH A PERMEABLE MEMBRANE SO THEY CAN BE EXCRETED. EXAMPLE: FLUID AND WASTE FILTRATION THROUGH THE GLOMERULAR CAPILLARIES IN THE KIDNEYS. THIS FILTRATION PROCESS WITHIN THE KIDNEYS ALLOWS EXCESS FLUID AND WASTE PRODUCTS TO BE EXCRETED FROM THE BODY IN THE FORM OF URINE. OSMOSIS WATER MOVEMENT THROUGH A SEMIPERMEABLE MEMBRANE, FROM AN AREA OF LESSER SOLUTE CONCENTRATION TO AN AREA OF GREATER SOLUTE CONCENTRATION. (LESSER TO GREATER) IN AN ATTEMPT TO EQUALIZE THE SOLUTE CONCENTRATIONS ON EITHER SIDE OF THE MEMBRANE. ONLY FLUIDS AND SOME PARTICLES DISSOLVED IN THE FLUID ARE ABLE TO PASS THROUGH A SEMIPERMEABLE MEMBRANE; LARGER PARTICLES ARE BLOCKED FROM GETTING THROUGH. REFERRED TO AS PASSIVE TRANSPORT.  OSMOSIS CAUSES FLUID MOVEMENT BETWEEN THE INTRAVASCULAR, INTERSTITIAL, AND INTRACELLULAR FLUID COMPARTMENTS BASED ON SOLUTE CONCENTRATION. EXAMPLE: EATING LARGE AMOUNTS OF SALTY FOODS CAUSES SODIUM CONCENTRATION OF THE BLOOD TO BECOME ELEVATED. DUE TO THE ELEVATED SOLUTE CONCENTRATION WITHIN THE BLOODSTREAM, OSMOSIS CAUSES FLUID TO BE PULLED INTO THE INTRAVASCULAR COMPARTMENT FROM THE INTERSTITIAL AND INTRACELLULAR COMPARTMENTS TO TRY TO EQUALIZE THE SOLUTE CONCENTRATION. AS FLUID LEAVE THE CELLS, THEY SHRINK IN SIZE. THE SHRINKAGE OF CELLS IS WHAT CAUSES MANY SYMPTOMS OF DEHYDRATION, SUCH AS DRY STICKY MUCOUS MEMBRANES.  SOLUTE MOVEMENT SOLUTE MOVEMENT IS CONTROLLED BY DIFFUSION, ACTIVE TRANSPORT, AND FILTRATION. DIFFUSION MOVEMENT OF MOLECULES FROM AN AREA OF HIGHER CONCENTRATION TO AN AREA OF LOWER CONCENTRATION TO EQUALIZE THE CONCENTRATION OF SOLUTES THROUGHOUT AN AREA. (HIGHER TO LOWER) BECAUSE DIFFUSION TRAVELS DOWN A CONCENTRATION GRADIENT, THE SOLUTES MOVE FREELY WITHOUT ENERGY EXPENDITURE.  ACTIVE TRANSPORT INVOLVES MOVING SOLUTES AND IONS ACROSS A CELL MEMBRANE FROM AN AREA OF LOWER CONCENTRATION TO AN AREA OF HIGHER CONCENTRATION. (LOWER TO HIGHER) BECAUSE ACTIVE TRANSPORT MOVES SOLUTES AGAINST A CONCENTRATION GRADIENT TO PREVENT AN OVERACCUMULATION OF SOLUTES IN AN AREA, ENERGY IS REQUIRED FOR THIS PROCESS TO TAKE PLACE. EXAMPLE: SODIUM-POTASSIUM PUMP USES ENERGY TO MAINTAIN HIGHER LEVELS OF SODIUM IN THE EXTRACELLULAR FLUID AND HIGHER LEVELS OF POTASSIUM IN THE INTRACELLULAR FLUID.  FLUID AND ELECTROLYTE REGULATION THE BODY MUST CAREFULLY REGULATE INTRAVASCULAR FLUID ACCUMULATION AND EXCRETION TO PREVENT FLUID VOLUME EXCESSES OR DEFICITS AND MAINTAIN ADEQUATE BLOOD PRESSURE. WATER BALANCE IS REGULATED BY SEVERAL MECHANISMS INCLUDING ADH, THIRST, AND THE RENIN- ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS). FLUID INTAKE IS REGULATED BY THIRST. AS FLUID IS LOST AND THE SODIUM LEVEL INCREASES IN THE INTRAVASCULAR SPACE, SERUM OSMOLALITY INCREASES. WHEN A PERSON IS UNABLE TO RESPOND TO THIRST SIGNALS, DEHYDRATION OCCURS. OLDER INDIVIDUALS ARE AT INCREASED RISK OF DEHYDRATION DUE TO AGE-RELATED IMPAIRMENT IN THIRST RECEPTION. AVERAGE ADULT FLUID INTAKE- 2,500ML/DAY (BOTH FOOD AND DRINK) AN INCREASED AMOUNT OF FLUIDS IS NEEDED IF PATIENT HAS OTHER MEDICAL CONDITIONS CAUSING EXCESSIVE FLUID LOSS, SUCH AS SWEATING, FEVER, VOMITING, DIARRHEA, AND BLEEDING.  RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS) PLAYS AN IMPORTANT ROLE IN REGULATING FLUID OUTPUT AND BLOOD PRESSURE. DEFINITION OF TERMS: RENIN- ENZYME THAT HELPS CONTROL YOUR BLOOD PRESSURE AND MAINTAIN HEALTHY LEVELS OF SODIUM AND POTASSIUM IN YOUR BODY. ANGIOTENSIN- HORMONE THAT HELPS REGULATE YOUR BP BY CONSTRICTING (NARROWING) BLOOD VESSELS & TRIGGERING WATER AND SALT INTAKE. ANGIOTENSIN I- PRODUCED BY THE ACTION OF RENIN ON A PROTEIN CALLED ANGIOTENSINOGEN, WHICH IS PRODUCED BY THE LIVER. INACTIVE (DOESN’T CAUSE ANY EFFECTS), FLOWS THROUGH YOUR BLOODSTREAM AND IS SPLIT BY ANGIOTENSIN-CONVERTING ENZYME (ACE) IN YOUR LUNGS AND KIDNEYS. ONE OF THOSE PIECES IS ANGIOTENSIN II, AN ACTIVE HORMONE.  ANGIOTENSIN II- (MAIN & ACTIVE FORM OF THE HORMONE). CAUSES THE MUSCULAR WALLS OF SMALL ARTERIES (ARTERIOLES) TO CONSTRICT (NARROW), INCREASING BLOOD PRESSURE. ANGIOTENSIN II ALSO TRIGGERS YOUR ADRENAL GLANDS TO RELEASE ALDOSTERONE AND YOUR PITUITARY GLAND TO RELEASE ANTIDIURETIC HORMONE (ADH, OR VASOPRESSIN). ALDOSTERONE- ALDOSTERONE (ALD) IS A HORMONE THAT HELPS REGULATE YOUR BLOOD PRESSURE BY MANAGING THE LEVELS OF SODIUM (SALT) AND POTASSIUM IN YOUR BLOOD AND IMPACTING BLOOD VOLUME. TRIGGERS INCREASED SERUM REABSORPTION BY THE KIDNEYS AND SUBSEQUENT INCREASED SERUM OSMOLALITY IN THE BLOODSTREAM.  FLUID OUTPUT OCCURS MOSTLY THROUGH THE KIDNEYS IN THE FORM OF URINE. FLUID IS ALSO LOST THROUGH: SKIN AS PERSPIRATION GI TRACT AS STOOL LUNGS DURING RESPIRATION 40% OF DAILY FLUID OUTPUT OCCURS DUE TO “INSENSIBLE LOSSES” REMAINING 60% OF DAILY FLUID OUTPUT IS IN THE FORM OF URINE. DECREASED URINE PRODUCTION IS AN EARLY SIGN OF DEHYDRATION OR KIDNEY DYSFUNCTION.