Unit - 1o MEETING THE NEEDS OF THE PATIENT; Topic-Fluid & electrolyte imbalance.

In order to maintain health and all the functions of the body normally, fluid, electrolyte (& acid base) balance should be maintained normal. This electrolyte & acid base balance is called as homeostasis. MEANS MAINTENANCE OF NORMAL BIOLOGICAL FUNCTIONS IN THE BODY WITH NORMAL FLUID & ELECTROLYTE BALANCE. This balance is maintained by intake & output of water & electrolytes, their distribution in the body & On capacity of renal function.

Without fluid in the body skin dries with cracks & temperature increases, mind deteriorates and finally death occurs. So fluid & electrolyte balance is very essential for life.

WATER & SUNLIGHT IS ESSENTAL FOR LIFE

Fluid & electrolyte imbalances:

Fluid imbalances;

i) Hypovolemia ii)Hypervolemia. Electrolyte imbalances: SODIUM- i)Hyponatremia , ii)Hypernatremia. POTASIUM- i)Hypokalemia, ii)Hyperkalemia. CALCIUM-i)Hypocalcemia, ii)Hypercalcemia. MAGNESIUM- i)Hypomagnesemia, ii)Hyper magnesemia. CHLORIDE- i)Hypochloremia, ii)Hyper chloremia.

Distribution of body fluids Body fluids are distributed in two forms

i) Intra-cellular fluid & ii) extra cellular fluid

i) Intracellular;

Intracellular fluid found within cell membrane. It consists of dissolved substances essential for Fluid electrolyte imbalance. Our body consists of 70% of INTRACELLULAR FLUID. Large portion of potassium is found in Intracellular fluid.

 ii) Extracellular;
Extracellular fluid is found outside the cell

membrane. It Consists of both interstitial & intravascular fluid. Interstitial fluid consists of 24% of total fluids. Intravascular consists of 6% of total body fluids.
Factors influencing the amount of the body fluids

age, gender, body fluids.

FLUID BALANCE DEPENDS UPON THE BALANCE OF INTAKE & OUTPUT.

REGULATION

OF BODY FLUIDS

FLUID INTAKE IS REGULATED PRIMARILY

BY THE THIRST MECHANISM. THE THIRST CONTROL CENTER IS LOCATION IN THE HYPOTHALAS IN THE BRAIN. PHSYOLOGICAL FACTORS, DRY PHARENGEAL MUCUS MEMBRANES & ANGEOTENSIN CREATE A SENSATION.

1. Regulation of fluid output; 2. Fluid output is done by, gastrointestinal tract(feaces), kidneys , skin & lungs. 3. The kidneys are the major regulatory organs regulate of fluid balance. 4. Approximately 1ml per 1 kg for 1 hour of urine is produced. 5. From gastrointestinal tract about 1oo to 15o ml is lost in the stools(FEACES). 6. From skin through sweat fluid is lost, from lungs also fluid is lost.

 FLUID INTAKE IS REGULATED BY THIRST

MECHANISM IN HYPOTHALAMUS. FLUID OUTPUT IS DONE BY KIDNEYS,GASTROINTESTINAL TRACT,SKIN & LUNGS. BESIDE THE INTAKE OF THE FLUIS IN BODY VARIOUS TISSUE FLUIDS ARE PRODUCED. SALIVA-1500ml Gastric juice-1500ml Bile juice-800ml Pancreatic juice-1400ml Intestinal juice-1500ml

NORMAL INTAKE OF FLUIDS

INTAKE OF ORAL FLUIDS 1200ml

INTAKE OF WATER IN FOOD - 1000ml

Water produced by metabolism -400ml

TOTAL INTAKE OF FLUID IS 2600ml

NORMAL OUTPUT

URINE
Lungs 500ml

1500ml
Skin 450ml 26ooml

Stool 150ml
Total

Normal out put

Fluid & electrolyte imbalances:

Fluid imbalances;

i) Hypovolemia ii)Hypervolemia. Electrolyte imbalances: SODIUM- i)Hyponatremia , ii)Hypernatremia. POTASIUM- i)Hypokalemia, ii)Hyperkalemia. CALCIUM-i)Hypocalcemia, ii)Hypercalcemia. MAGNESIUM- i)Hypomagnesemia, ii)Hyper magnesemia. CHLORIDE- i)Hypochloremia, ii)Hyper chloremia.

 REGULATION OF electrolytes Sodium

Potassium
Calcium Magnesium chloride

 Sodium regulation; Sodium is the most abundant

cation in the extracellular fluid. The functions of sodium include; Maintaining balance of extracellular fluid , bythis it controls the movements of water between the fluid compartments. Transition of nerve impulses. Neuro muscular and myocardial impulse transmission. Normal sodium level is 135 to 145 meq/lit. Sodium is regulated by salt intake , aldosterone & urinary Output. When the renal function is normal the excretion of urine sodium can be increased to keep the serum sodium level with in normal limits.

Potassium regulation: potassium is the main intracellular cat ion . It helps in maintaining the fluid balance of the intracellular fluid. It regulates neuro muscular excitability and muscular contraction. Potassium also is needed for glycogen formation, protein synthesis and correction of acid base imbalances. potassium ion is regulated by kidneys. Any condition which decreases urine output decreases potassium excretion. If the aldosteron level is high there is increased excretion of potassium level. Another mechanism of regulation is exchange with sodium ion in renal tubule . Normal potassium level is 3.5 to5.3 Meq /L.

 CALCIUM REGULATION; calcium is the most abundant

element in the body. Functions of calcium maintenance of celmembrane. Conduction of nerve impulses in skeletal muscle. Stimulation of depolarization & contraction of cardiac muscle. Helps in blood coagulation. Growth & formation of bones. Muscle relaxation. calcium in extracellular fluid is regulated by the action of thyroid & parathyroid gland. Parathyriod hormone controls the balance among the bone calcium,gastro intestinal absorption & kidneys does the excretion of calcium. Normal serum calcium is 4 to 5 Meq/L.

Magnesium regulation; Magnesium is the second most important cat ion in the intracellular fluid. The main activities are : 1. Perceptions of the metabolic activities of the cells. 2. Enzyme activity. 3. Muscular excitability. 4. The normal range of serum magnesium is 1.5 to 2.4 Meq/q. Magnesium is primarily execrated through renal mechanism.

 Chloride regulation: chloride are found in the extracellular and intracellular fluids. The chloride ion balances the cations with in the extracellular fluid. The ion exchanges helps to maintain the electrical neutrality.
Chloride is regulated through kidneys . The dietary intake of chloride and the amount excreated in the urine are closely related. The normal serum chloride level ranges from 100 to 106 MEq/L.

FACTORS AFFECTING FLUID,ELECTROLYTE & BASE IMBALANCE. Body fluids are not stable , they shift from one compartment to compartment., and various factors are affecting them, they are: DIFFUSION OSMOSIS FILTERATION HYDROSTATIC PRESSURE ACTIVE TRANSPORTATION DIALYSIS SELECTIVE PERMIABILITY OF MEMBRANE.

 Diffusion : Diffusion is the term applied to the

spreading or scattering of molecules of gases or liquids. When two gases or liquids are brought into contact, the continual movement of molecules will soon produce a uniform mixture & are separated by thin . In the body : Fluids, electrolytes and other substances takes place movement by diffusion. Osmosis: The diffusion of water molecules from lesser concentration area to the greater concentration area is called osmosis. The principle of osmosis can be applied clinically in the administration of intravenous fluids. Usually the solutions given as intravenous infusion, are isotonic having same concentration as blood plasma. This prevents sudden shifts of fluid, electrolytes from vessels to interstitial fluids.

 Filtration ; It is the process by which water and

diffusible substances move together in response to fluid pressure. This process is active in capillary beds , where pressure differences determine the movement of water, electrolytes and other dissolved substances between the capillaries and interstitial fluid. Hydrostatic pressure :hydrostatic pressure is the pressure exerted by a fluid within a closed system. Counterbalancing the osmotic pressure of the plasma which attracts fluid into the vascular system, is the hydrostatic pressure of the blood flowing through the capillaries which pushes the fluid out of the vascular system.

NORMAL INTAKE OF FLUIDS

INTAKE OF ORAL FLUIDS 1200ml

INTAKE OF WATER IN FOOD - 1000ml Water produced by metabolism -400ml

TOTAL INTAKE OF FLUID IS 2600ml

NORMAL OUTPUT

URINE
Lungs 500ml

1500ml
Skin 450ml 26ooml

Stool 150ml
Total

Normal out put

 FLUID VOLUME DEFICIT 1)Hypovolemia; DEFINITION; Hypovolemia occurs when loss of extracellular fluid exceeds the Intake of fluids.

ETIOLOGY:Abnormal fluid loss Vomiting Diarrhoea GI suctioning Sweating Decreased intake of fluids. Inability to gain access of fluids.

 PATHOPHYSIOLOGY;

Due to the above etiological factors

Fluid intake is decreased

Imbalance in body function

Fluid & electrolyte imbalance

Hypovolemia;

CLINICAL MANIFESTATIONS; Weight loss skin turgor Oligurea Weak & rapid heart rate Increased temperature Cool skin Anorexia Nausea Muscle weakness. DIAGNOSTIC EVALUATION. History taking Physical examination Haematocrit level Na level K + level BUN(blood urea nitrogen) Serum sodium Serum potassium.

 Medical management IF the fluid loss is not severe then management wil be

oral fluids IF the fluid loss is severe than management wil be IV FLUIDS ISTONIC ELECTROLYTE SOLUTION LIKE RL. ASSESS Intake-output chart. VITAL SIGNS. PHARMACOLOGICAL management DIURETICS thiazid & loop diuretics. SOLUTIONS COLLIOD POTASSIUM SUPPLIMENTS. HYPERYONIC SOLUTIONS. Nutritional management. Sodium diet & Potassium diet.

 NURSING MANAGEMENT: Provide bed rest. Monitor intake & output chart every hourly.

Check body weight. Monitor vital signs closely. Mental function is being tested regularly. Monitor urine output. PREVENTION:
The nurse should identify the patient at risk.

Take measures to minimize the fluid loss. Oral fluid administration.