MEDICAL SURGICAL NURSING

Fluids and Electrolytes

Lecturer:Yves Mariel Rimando, RN, MN, CNN
RENAP Exam Topnotcher- Top 4
I. Fluid Imbalances

II. Electrolytes Imbalances

III. Acid-Base Imbalances

IV.Dysfunctional/Urinary Elimination Disorders

Urinary Tract Disorders, Kidney Disorders,

Neurolagic Disorders
OBJECTIVES:

After 16 hours of synchronous and asynchronous classes, the learner is able to:

1. Describe the mechanics that maintain fluid and electrolyte balance.

2. Compare the mechanisms and effects of fluid deficit and excess.

3. Discuss the mechanisms of electrolyte imbalances

4. Describe the management of patients with a fluid and electrolyte imbalance.

5. Understand Acid-Base Imbalances

6. Determine Urinary Elimination Disorders

 FLUID AND ELECTROLYTE
BALANCE

Importance:
- Fundamental to the process of life. Abnormal fluid volume and electrolyte concentrations can
seriously alter physiologic homeostasis and can be life threatening.

-Understanding how fluid and electrolyte disturbances occur and how the body compensates,
serves as a foundation for understanding many diseases and associated nursing management.
INTRODUCTION

Water - a primary component of body fluids, is the most

abundant substance in the body.

- it plays a vital role in several physiologic processes such

as digestion, absorption, use of nutrients, distribution,
waste excretion and perfusion and maintenance of
hemodynamics.
Approximately 60% of a typical adult’s weight consists of fluids
(water and electrolytes).

Total body water volume40L

Factors that influence the amount of fluid are age, gender and
body fat.
COMPOSITION OF BODY FLUIDS

WATER - universal solvent

Solutes

Electrolytes - cations and anions

Non-electrolytes- organic molecules - glucose, lipids,

creatinine and urea.
2 COMPARTMENTS OF BODY
FLUID
1. Intracellular Space

- Fluid in the Cells

-2/3 of body fluid is in the Intracellular Fluid (ICF)

11. Extracellular Space

- Fluid outside the cells.

Intravascular -fluid within blood vessels

contains plasma (approx 3L of average 6L of
blood volume is made up of plasma)

Interstitial - fluid that surrounds the cell at

11-12L in an adult (e.g. lymph)

Transcellular -smallest division at approx 1L

(e.g. sweat)
ELECTROLYTES

Carries and electrical charge

and have the ability to combine
with other ions.

- Cations (+)

- Anions (-)
MAJOR CATIONS

Hydrogen

Sodium

Potassium

Magnesium

Calcium
MAJOR ANIONS

Chloride

Bicarbonate

Sulphate

Phosphate

Unit: mEq/L
REGULATION OF BODY FLUID
COMPARTMENTS

e.g. -exchange of O2 and

CO2 between pulmonary
capillaries and alveoli

-tendency of sodium to move

from the ECF compartment
where the sodium is hight to
the ICF when the sodium is
low.
Osmosis - diffusion of water
caused by a fluid concentration
gradient passing through a
semipermeable membrane.
FILTRATION

Hydrostatic pressure in the capillaries

tends to filter fluid out of the vascular
compartment into the interstitial fluid.

Fact: Filtration allows the kidneys to

filter 180L of plasma per day.
SODIUM-POTASSIUM PUMP

Uses active transport to move

molecules from a high
concentration to a low
concentration
HOMEOSTASIS
DEFINITION
HOMEOSTASIS
means the constancy of the internal environment by the coordinated activities of the body.
The amount of water we drink is regulated by homeostasis.
a. Output = Intake
b. Thirst & Satiety
c. Hormonal regulation
Organs involved :
a. kidneys - 170L of plasma a day in the adult excreting 1.5L urine
b. lungs - it removes approx 300ml/day in adult
c. heart - pumping of the heart for sufficient pressure to kidney to form urine.
d. adrenal glands - aldosterone - fluid balance
e. parathyroid glands - regulates PTH hormone (calcium and phosphate balance)
f. pituitary gland - releases ADH that is formed in the hypothalamus. ADH controls
retention and excretion in kidneys and regulating blood volume.
POSITIVE & NEGATIVE FEEDBACK
MECHANISM

Positive Feedback Loops

A positive feedback loop occurs in nature when the

product of a reaction leads to an increase in that
reaction.

Example 1: Childbirth
When labor begins, the baby’s head is pushed
downwards and results in increased pressure on the
cervix. This stimulates receptor cells to send a chemical
signal to the brain, allowing the release of oxytocin. This
oxytocin diffuses to the cervix via the blood, where it
stimulated further contractions. These contractions
stimulate further oxytocin release until the baby is born.

Blood Clotting
When tissue is torn or injured, a chemical is released.
This chemical causes platelets in the blood to activate.
Once these platelets have activated, they release a
chemical which signals more platelets to activate, until
the wound is clotted.
NEGATIVE FEEDBACK
MECHANISM
A negative feedback loop occurs in biology when the
product of a reaction leads to a decrease in that reaction.

Negative feedback loops are responsible for the stabilization

of a system, and ensure the maintenance of a steady, stable
state. The response of the regulating mechanism is opposite
to the output of the event.

Example 1: Temperature Regulation

Example 2: Blood Pressure Regulation (Baroreflex)

Blood pressure needs to remain high enough to pump blood to
all parts of the body, but not so high as to cause damage while
doing so. While the heart is pumping, baroreceptors detect the
pressure of the blood going through the arteries. If the
pressure is too high or too low, a chemical signal is sent to the
brain via the glossopharyngeal nerve. The brain then sends a
chemical signal to the heart to adjust the rate of pumping: if
blood pressure is low, heart rate increases, while if blood
pressure is high, heart rate decreases.
POSITIVE VS. NEGATIVE
FEEDBACK

The key difference between positive and negative feedback is their response
to change: positive feedback amplifies change while negative feedback
reduces change. This means that positive feedback will result in more of a
product: more apples, more contractions, or more clotting platelets. Negative
feedback will result in less of a product: less heat, less pressure, or less salt.
Positive feedback moves away from a target point while negative feedback
moves towards a target.
WHY IS FEEDBACK IMPORTANT?

Without feedback, homeostasis

cannot occur. This means that an
organism loses the ability to self-
regulate its body. Negative feedback
mechanisms are more common in
homeostasis, but positive feedback
loops are also important. Changes in
feedback loops can lead to various
issues, including diabetes mellitus.
g. RAAS System

Renin - enzyme that converts angiotensinogen,

released by the Juxtaglomerular cells of the kidneys
(dec real perfusion) into Angiotensinogen I.
Angiotensinogen- an inactive substance formed
by the liver.
Angiotensin Converting Enzyme (ACE) converts A1
to AII

Angiotensin II- potent vasoconstrictor

(Increases BP and volume)

Angiotensin stimulates release of aldosterone to

increase water and sodiium retention (increase
blood volume)
HOW IS RAAS SYSTEM
ACTIVATED?

When there is loss of blood or a drop in blood pressure

e.g. hemorrhage or dehydration

RENIN-ANGIOTENSIN-
ALDOSTERONE SYSTEM

video # 3

https://www.youtube.com/watch?v=xOa0n4nTLT8
h. ADH - regulates water excretion
stored in the pituitary gland produced by the
hypothalamus.

i. Aldosterone- regulates water excretion/fluid balance.

-mineralocorticoid secreted by the adrenal
cortex.

j. Baroreceptors- monitors circulating volume,

regulates blood pressure

k. Osmoreceptors - sense changes in sodium

concentration.

l. Atrial Natriuretic Peptide (ANP) - Decreases blood

pressure and volume.
Released by cardiac cells in the heart.
DAILY INTAKE AND OUTPUT OF
WATER
INTAKE
Fluid - 2100cc
Metabolism- 200cc = 2300 cc
OUTPUT
Skin - 350
Lungs - 350
Sweat - 100
feces- 100
Urine Output - 1400 = 2300cc
SENSIBLE LOSS VS. INSENSIBLE LOSS
 WORKING ACTIVITY:
GERONTOLOGIC CONSIDERATIONS

Give 3 each common hydration-related medical conditions and how

it is treated in the geriatric conditions on hypovolemia and
hypervolemia.

Please submit on September 8, 2020 before 12 mn

References:

Saunders Comprehensive Review for the NCLEX-RN, L.A.

Silvesstri, 2002

Brunner and Suddart’s Textbook of Medical Surgical Nursing

(Volume 1), Smeltzer, S. & Bare, B., 2004