NCM 112 – Nursing Care of at Risk and Sick Adult Clients with Alterations/Problems in

Fluids, Electrolytes and Acid-Base Balance

Terms to Remember:

1. Acidosis
2. Ascites
3. Active Transport
4. Alkalosis
5. Diffusion
6. Homeostasis
7. Hydrostatic Pressure
8. Hypertonic Solution
9. Hypotonic Solution
10. Isotonic Solution
11. Osmolality
12. Osmolarity
13. Osmosis
14. Tonicity

Kidneys are bean shaped organs

Dark red, slightly

10 cm, 5cm wide, 2-3 cm thick, 120-170g

Ureters

Urinary Bladder

Urethra

Main Jobs: filter. Regulates quantity and quality of waste

Maintain proper amount of water, salts, ad nutrients

Placed at back wall of abdominal cavity just below diaphragm, slightly assymetrical, left
kidney slightly higher than right

Convex and Concave

Notch – Renal Vein and Artery

Inside Kidney:

Cortex – reddish brown layer of tissue

Medulla – Pale conical shaped striations

Remove excess water and products

Filters are called Nephrons, millions of Nephrons packed together

- Structural and functional

Renal:

Glomerulus – mini filtering or seeping device formed by capillaries

Bowman’s Capsule

Urine Slides down thru Ureters towards storage sack – Urinary Bladder which is
connected to urethra for removal of urine out of the body

Kidneys process around 200 liters of blood, 1-2 liters as Urine

Why Fluids and Electrolyte Balance is Essential to Life?

- It is a dynamic process which is considered crucial to life

- Any alterations in the fluid and electrolyte balance can affect the whole
system of the body
- Potential and actual disorders of fluid and electrolyte imbalance occur in every
setting, with every disorder, and with a variety of changes that affect well
people
- Increased fluid & sodium loss with strenuous exercise and high environmental
temperature; inadequate intake of fluid and electrolytes as well as those who
are ill

 Nurses need to understand the physiology of fluid and electrolyte balance and acid-
base balance to anticipate, identify, and respond to possible imbalances in each.
 Nurses also must use effective teaching and communication skills to help prevent
and treat various fluid and electrolyte disturbances
 Nearly all major organs work together to maintain a balance of daily fluid gains and
losses
 Insensible fluid losses occur through the skin and lungs
 Sensible fluid losses occur through urination, defecation, and wounds

Function of Body Fluids

1. Maintain blood volume

2. Regulate body temperature
3. Transport material to and from cells
4. Serve as an aqueous medium for cellular metabolism
5. Assist with digestion of food
6. Serve as a medium for excreting waste

Body Fluids 2 Major Compartments

1. Intracellular Compartment
a. Located inside the cells
b. Contains solutes such as oxygen, electrolytes, and glucose
c. Contains 2/3 of body fluid (skeletal muscle mass)
2. Extracellular Compartment
a. Located outside the cells
b. 1/3 of body fluids
i. Intravascular Fluid/Plasma – inside vascular system or blood vessels
ii. Interstitial Fluid – located in between the cell
iii. Transcellular Fluid
1. CSF – spinal cord,
2. Pleural – lungs and thoracic cavity,
3. Peritoneal – abdominal cavity,
4. Synovial – between joints,
5. Digestive Juices - stomach)
iv. Lymph Compartments

Amount and Composition of Body Fluids

- Approx. 60% of a typical adult’s weight consists of fluid (water and

electrolytes)
- Factors that influence the amount of body fluid are age, gender, and body fat
- Approx. 2/3 of body fluid is in the intracellular fluid (ICF) compartment and is
located primarily in the skeletal muscle mass
The Extracellular Fluid (ECF) compartment is further divided into:

- Intravascular
o The fluid within the blood vessels contains plasma
o Approximately 3L of the average 6L of blood volume is made of plasma
o The remaining 3L is made up of Erythrocytes, Leukocytes, and
Thrombocytes
- Interstitial
o Contains the fluid that surround the cell and totals about 11 to 12L in
an adult
o Lymph is an example
- Transcellular Fluid Spaces
o It is the smallest division of the ECF compartment
o Contains approximately 1L of fluid at any given time
o Examples: Cerebrospinal, Pericardial, Synovial, Intraocular, and Pleural
Fluids; Sweat; and Digestive Secretions

ECF and ICF contains;

- Oxygen from the Lungs

- Dissolved nutrients from gastrointestinal tract
- Excretory products of metabolism such as CO2 and charged particles called ions

 Body Fluid normally moves between two major compartments or spaces in an

effort to maintain equilibrium between the spaces
 Loos of fluid from the body can disrupt this equilibrium
  Sometime fluid is not lost from the body but is unavailable for use by either the
ICF or ECF

Third Space Fluid Shift

- Third Space Fluid Shift or Third Spacing - Loss of ECF into a space that does not
contribute to equilibrium between the ICF and ECG
- An early S/S: decrease in urine output despite adequate fluid intake
- Urine output decreases because fluid shifts out of the intravascular space
- The kidneys then receive less blood and attempt to compensate by decreasing
urine output
- Other signs and symptoms of third spacing that indicate an intravascular fluid
volume deficit (FVD) include:
o Increased heart rate
o Decreased blood pressure
o Decreased central venous pressure
o Increased body weight
o Edema
o Imbalances in fluid intake and output (I&O)

Central venous Pressure

- Is considered a direct measurement of the blood pressure in the right atrium and
vena cava.
- It is acquired by threading a central venous catheter (subclavian double lumen
central line shown) into any of several large veins