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42 % of total body weight-in tissue and red cells
17% total body weight
- lymphatic system
- **contains lymph, is the fluid between the cells and outside the blood vessels
- in the Plasma
- **fluid is blood plasma found in the vascular system.
- fluid is fluid separated from other fluids by a cellular barrier and consists of cerebrospinal, pleural, gastrointestinal (GI), intraocular, peritoneal, and synovial fluids
- ** Loss of transcellular fluid can produce fluid and electrolyte disturbance.
- pericardial fluid, pancreatic fluid, the eye, biliary fluid, paritineal space, synovial (joint) space
Adults body composition
- 50-60% water
- 40-50% solids
Older Adults body compostion
involves the movement of a pure solvent such as water from an area of lesser concentration to an area of greater concentration.
the movement of a solute in a solution across a semipermeable membrane from an area of higher concentration to an area of lower concentration.
the process by which water and diffusable substances move together in response to fluid pressure.
requires requires metabolic activity and the expenditure of energy to move materials across cell membranes.
Fluid output occurs through four organs of water loss:
the kidneys, the skin, the lungs, and the gastrointestinal tract
Insensible water loss is continuous and is not perceived by the person but can increase significantly :
with fever or burns.
Sensible water loss occurs through excess:
- perspiration and can be perceived by the client or by the nurse through inspection
- ***Sensible loss is continuous when you sweat, because the patient can sense that it occur
Average day the person losses about
5-600 mL of fluid via sensible and insensible in a day
The basic types of fluid imbalances are
isotonic and osmolar.
Isotonic deficit and excess exist when
water and electrolytes are gained or lost in equal proportions.
are losses or excesses of only water so that the concentration of the serum is affected.
when we loss or gain water and fluid electrolytes from equal parts
High blood sugar
- hyperosmotic state
- ***blood sugar gets so high that they are lossing water but no
- change in the amount of electrolytes.
135 - 145 mEq/L
3.5 – 5.0 mEq/L
Total Calcium (Ca 2+)
8.5 – 10.5 mg/dL
1.5 – 2.5 mEq/L
Cations interchange when
one cation leaves the cell and is replaced by another. This occurs because cells tend to maintain electrical neutrality.
Na+ lives in the
extracellular fluid (to maintain water balance)
K+ lives in the
Sodium is the most abundant cation (90%) in ECF.
- **Maintains water balance through their effect on serum osmolality,
- nerve impulse transmission, regulation of acid-base balance, and participation
- in cellular chemical reactions.
- **Regulated by dietary intake and aldosterone
a lower-than-normal concentration of sodium in the blood
**Sodium less than 135
how can somebody loss sodium and become Hyponatremia??
Sweating, intaking enough sodium, vomiting, GI fluids, diaretics, over drink water from iv fluids not just , head injuries, hypotonic tube feedings
Signs and symptoms for not enough sodium
- putting out extra fluids because you body is trying to even it out. Lower blood pressure, nausea and vomitting, may get confuesed, muscle twitching, headache, left untreated witll proceed to seziures and commas
What can we do for the patient with too little sodium
diet high in sodium, salt tablets, decrease their fluid intake
a greater-than-normal concentration of sodium
What to look for in a patient with Hypernatremia
give them more fluids, this patient is very dehydrated, dry and sticky mucous membranes, a red dry tongue, as progresses fatique and restlessness and change in level of conciousness, compulsions, (overexposure to elements, fever, diarehha, giving too much sodium in IV hypertonic solution, excesss sodium normal is (2 teaspons daily) we need iodine from table salt.
First thing we do if sodium is high
is give them water, monitor their I and O one we are restricting and the other we are encouraging
the major electrolyte and principle cation in the intracellular compartment.
Regulates many metabolic activities and is necessary for glycogen deposits in the liver and skeletal muscle, transmission and conduction of nerve impulses, normal cardiac conduction, and skeletal and smooth muscle contraction
Potassium is regulated by dietary
intake and renal excretion.
The body conserves potassium poorly, so any condition that increases
urine output decreases the serum potassium concentration.(diaretics)
is one of the most common electrolyte imbalances, in which an inadequate amount of potassium circulates in ECF. When severe hypokalemia can affect cardiac conduction and function.
Hypokalemia signs and symptoms
-Muscle cramps, charlley horse, anorexia, nausea vomiting, gastric suctioning , diahrra, poor intake of potassium, diaretic use, alcholism,
What we can do for a patient with Hypokalemia
- eat their veggies, if it is given IV has to be given slowly, monitor their heart rate and rhythum, causias to the patient receiving digoxen
a greater-than-normal amount of potassium in the blood. Severe hyperkalemia produces marked cardiac conduction abnormalities.
Signs and symptoms with a patient with Hyperkalemia
gasterointestinal hyperactivity, cardiac dysrythmias or arrest, irregular pulse
What we can do for a patient with Hyperkalemia
give them kalexalte enema (bowel slides), potassium wasting diruretics , patient with renal failure might have to put them on dialysis, and monitor cardiac activity for cardiac arrest.
Cardiac conduction and postassium
calcium is a trransporter and help across smooth muscle. What is this ??
Calcium is necessary for bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses, and muscle contraction.
- Calcium is stored in bone, plasma, and body cells. Ninety-nine percent of
- calcium is located in bone.
Normal serum ionized calcium is 4 to 5 mEq/L. Normal total calcium is 8.5 to 10.5 mg/100ml.
can result from abnormalities of the thyroid and parathyroid glands.
Hypocalcemia signs and symptoms
Signs and symptoms can be related to a diminished function of the neuromuscular, cardiac, and renal systems
- **circome oral paraesthgia (numbness and tingling around mouth and fingers), muscle cramps, tremors, cardiac dysrythmias, decrease in cardaic output, positve troussau( blood pressure cuff on arm and the patient will experience
- tremors) or positive chvostek signs(tap on the facial nerve and the patient gets a twtch), can have confuesion, hyperactive deep tendon reflexes. Less calcium in blood and comes out of the bone
- Hypocarathyroidism, pancreatitus,thyroid cancer, hyperphosortemia (if calcium
- is low high phosphate), inadequate Vit.D intake (dietary, alcohol abuse)
If patient's Calcium level is low we give them ....
calcium, Dairy products , Vegetables (dark leafy green), Salmon, Tums (antacids), Post menapausal women (give estrogen)
is frequently a symptom of an underlying disease resulting in excess bone resorption with release of calcium.
**molignancy, immobile (have higher calcium levels),
Signs and Symptoms of a patient with Hypercalcemia
-lethargy and weakness, decrease in deep tendon reflexes, bone pain, constipation, flank pain (in the back kidney problems because kidney stones are made from them), dysrythmias (heart block)
How to get the calcium down
phosphate (oral), immobile try and get them mobile, limit calcium high foods, give them water to dilute them, acid ash diet (cranberries, prun juice, counter acts does not allow the calcium to clump)
- Magnesium is essential for enzyme activities, neurochemical
- activities, and cardiac and skeletal muscle excitability. Approximately 50% - 60% of magnesium is maintained within the bone.
- Plasma concentrations of magnesium range from
- 1.5 to 2.5 mEq/L.
- Regulated by dietary intake, renal
- mechanisms, and actions of the parathyroid hormone.
can be the result of malnutrition, alcoholism, diarrhea, vomiting, fistula
Signs and Symptoms of a patient with Hypomagnesemia
- neuromuscluar irribillity with tremors, tachycardia, elevated blood pressure, vertigo
- (mesing with nerve conduction), confuesion,
What can we do with a patient with a low magnesium
mag supplement (epsin salts bathing salts), diet high in magnesium (greeen veggies, fish, legumes, nuts, dried fruits)
can be the result of renal failure, excessive oral intake of magnesium
**renal failure, excees oral intake of magnesium
Signs and Symptoms of a patient with Hypermagnesemia
vasodilation, nausea and vomitting, muscle weakness, low BP, HR slows down only for magnesium, respiratory depression, comma
Interventions for a patient with Hypermagnesemia
- no legumes, dialysis (maybe) increase fluids, think safety (side rails up put on heart monitor no walking around the hallways),
The three major anions of body fluids are:
Phosphate (PO4 3-)
Chloride is the major anion in ECF. The transport of chloride follows sodium. Normal concentrations of chloride range form 95 to 108 mEq/L.
Serum chloride is regulated by dietary intake and the kidneys.
vomiting or prolonged and excessive nasogastric or fistula drainage can result in because of the loss of hydrochloric acid
use of loop and thiazide diuretics also results in increased chloride loss as sodium is excreted.
- When serum chloride levels fall, the reabsorption of the bicarbonate ion occurs to maintain electrical neutrality
- ***may not be your patient that is dehydrated
usually occurs when the serum bicarbonate value falls or sodium level rises.
- Bicarbonate is the major chemical base buffer within the body. The bicarbonate
- ion is an essential component for acid-base balance.
- Phosphate is a buffer anion found primarily in ICF. It assists in acid-base
Calcium and phosphate are inversely proportional; if one rises, the other falls.
It is regulated by dietary intake, renal excretion, intestinal absorption, and PTH.
The normal serum level is 2.5 to 4.5 mg/100ml.
To raise phosphate- fish, pultry, dairy products, legumes
Phosphate is a buffer anion found
primarily in ICF. It assists in acid-base regulation
Calcium and phosphate are
are inversely proportional; if one rises, the other falls.
It is regulated by dietary intake, renal excretion, intestinal absorption, and PTH.
The normal serum level is 2.5 to 4.5 mg/100ml.
Regulation of Acid-Base Balance
Metabolic processes maintain a steady balance between acids and bases.
Arterial pH is an indirect measurement of hydrogen ion (H+) concentration.
The pH is also a reflection of the balance between:
**Carbon dioxide (CO2) regulated by the lungs
**Bicarbonate (HCO3-), a base regulated by kidneys.
Normal values in arterial blood range
7.35 to 7.45.
The three general types of acid-base regulators in the body are
chemical, biological, and physiological buffering systems.
A buffer is...
a substance that can absorb or release H+ to correct an acid-base imbalance.
Arterial - It measures ...
the pH the PaCO2, PaO2, bicarb level, oxygen saturation, base excess level
**Arterial blood gas draw arterial blood to test pH
Worries: we don’t want to damage the artery and has an alternative blood flow . Do the Allens test to make sure the ulnar artery is functioning
The largest chemical buffer in ECF is
- is the carbonic acid and bicarbonate buffer system. It’s the first buffering
- system to act.
Whenever carbon dioxide increases, there is an increase in hydrogen ions produced, and whenever hydrogen ions are produced, there is more carbon dioxide produced.
Below a pH of 7.35
Greater pH of 7.45
Biological buffering occurs
- when hydrogen ions are absorbed or released by cells. It occurs after chemical
The two physiological buffers in the body are
the lungs and the kidneys.
**When the concentration of hydrogen ions is altered, the lungs react to correct the imbalance by altering the rate and depth of respiration.
- **The kidneys take from a few hours to several days to regulate acid-base imbalance. They reabsorb bicarbonate in cases of acid excess and excrete it in
- cases of acid deficit.
Respitory system kicks in first to maintain the pH
Lungs kick in in the first 15 min.
- exercising we are decreasing CO2 and your breathing faster (compensation), so your exercising while sedated, they body will try to increase respiratory drive in
- an hour the kidneys will kick in
If the patient is dehydrated the lungs will still try to kick in first and then the kidneys will try and keep up after word. Kidneys take hours to days to kick in
Arterial blood gas (ABG) analysis is
the best way to evaluate acid-base balance. Measurement of ABGs involves analysis of six components.
These components are pH, PaCO2, PaO2, oxygen saturation, base excess, and HCO3-.
pH is ....
- pH measures hydrogen ion (H+) concentration in the body fluids. Even a slight
- change can be potentially life threatening.
An increase in concentration of H+ makes a solution more acidic
A decrease makes the solution more alkaline.
- Normal pH value is 7.35 to 7.45 (acidic is
- <7.35, and alkalotic is >7.45).
- PaCO2 is the partial pressure of carbon dioxide in arterial blood and is a reflection of the depth of pulmonary ventilation. The normal range is
- 35 to 45 mm Hg.
***The normal range is a Measurement of their pulmonary ventilation
Smoker will increase CO2 and O2 will be lower
COPD CO2 will go up 50-60 range and the O2 are in the same range
- PaO2 is the partial pressure of oxygen in arterial blood. It has no primary
- role in acid-base regulation if it is within normal limits.
Normal range is 80 to 100 mm Hg.
- Saturation is the point at which hemoglobin is saturated by oxygen (02). When a client is hypoxic and uses up readily available oxygen, the reserve oxygen (oxygen attached to hemoglobin) is drawn upon to provide oxygen to the
When the PaO2 falls below 60mm Hg, there is a large drop in saturation.
Normal range is 95% to 99%/
Base excess is the amount of blood buffer (hemoglobin and bicarbonate) that exists.
Serum Bicarbonate (HCO3-)
Serum bicarbonate (HCO3-) is the major renal component of acid-base balance and is excreted and reproduced by the kidneys to maintain a normal acid-base environment.
The four primary types of acid-base imbalance are:
Respiratory acidosis is marked by an increased arterial carbon dioxide concentration (PaCO2) and decreased pH.
pH and CO2 in opposite directions
When co2 rises the pH drops
Patients with COPD, sedation
Signs and symptoms- confuesion, RR increase, warm flush skin, headache or weakness
Interventions-sit them up, cough, deep breathing exercises, Ches PT suctioning, artificial respirations, bronco dialator
is marked by a decreased PaCO2, and increased pH
CO2 below 35 and pH above 7.45
Patients that hyperventiating- anxiety attack, patients on ventilator, elevated body temperatures, brain stem injury
Signs and symptoms
Respiratory alkalosis- change in HR, SOB, light headedness, numbness and tingling in mouth and fingers, difficulty consentration give them a paper bag, relaxation activity, sedate them,
Metabolic acidosis is marked by a decreased HCO3 and a decreased pH
Bicarb that is changing
Diarrhea and renal failure (causes), diabetes, hypertonic IV solutions
- Signs and symptoms- kussmals respirations, nausea and vomitting, lethargy and
- confuesion, pH will be decreased and the bicarb
- For this patient we will give them bicarb and treat the underlying problem
- (ex renal failure to dialysis to blood sugar level)
Metabolic alkalosis is marked by an increased HCO3 and an increased pH
Gastric suctioning, vomiting, overuse of antacids, decer
Signs and symptoms- tenty (hypertonic muscles), dizziness, decrease RR and depth
What to do – monitor I and O stop the vomitting , administer IV fluids, threat underlying problem
**pH elevated PCO2 diminished=alkalosis (respiratory)
**pH diminished PCO2 elevated=acidosis (respiratory)
**pH elevated HCO3 elevated=alkalosis (met)
**pH diminished HCO3 diminished=acidosis (met)
Resp Acid- ph down past 7.35, CO2 up 45
Resp Alk- pH up past 7.45, CO2 down 35
Metabloic acid- pH down no CO2 HCO3 down 22
Met alk- pH up , CO2 none, HCO3 up 26
- KNOW THIS
- Example- pH 7.48, CO2 35, HCO3 29 = met alk
7.32 pH, 48 CO2, HCO3 22= resp acid
A hypotonic solution moves fluid
- into the cells, causing them to enlarge.
- 0.45% NS
An isotonic solution
expands the body’s fluid volume. It has the same osmolarity as blood.
D5% /W – contains sodium and chloride*
A hypertonic solution
pulls fluid from cells.
D5% / 0.9% NS
D5% / 0.45% NS
Adrenal cortical regulation