NCM 112: MEDICAL SURGICAL

1ST SEMESTER/MIDTERM/GAYATIN

FLUIDS AND ELECTROLYTES MAJOR ELECTROLYTES INSIDE THE CELL

BASIC CONCEPTS: Our fluids in the body are divided POTASSIUM – 3.5-5.0 mEq/L
into different compartments, so they are located in o Dominant ICF Cation
two major compartments. o Regulates cell excitability
o Conduction of nerve impulse
2 MAJOR COMPARTMENTS: o Muscle contraction and myocardial membrane
INTRACELLULAR (2/3) – inside the cell responsiveness
EXTRACELLULAR (1/3) – outside the cell o Controls ICF osmolality
PHOSPHORUS – 2.5-4.5 mg/dl
TAKE NOTE: o Major ICF Anion
In extracellular there are sub locations: o Promotes energy storage; carbohydrates, fat
➢ Intravascular – inside the blood vessels and CHON metabolism
Fluid that are inside the blood vessels: Plasma o Acts as hydrogen buffer
➢ Interstitial – in between cells there are fluids o Key role in mineralization of bones and teeth
➢ Transcellular – cerebrospinal, pericardial, MAGNESIUM – 1.5-2.5 mEq/L
synovial, intraocular, pleural fluids, sweat and o ICF Cation
digestive secretions
o Regulates neuromuscular contraction
o Promotes normal functioning of nervous and
THIRD SPACE FLUID SHIFT (THIRD SPACING)
cardiovascular system
Loss of ECF into a space that does not contribute o Aids in CHON synthesis, Na and K ion
to the equilibrium between the ICF and ECF Transportation

MAJOR ELECTROLYTES OUTSIDE THE CELL

SODIUM – 135-145 mEq/L
Occurs in ascites, burns, peritonitis, bowel o Major ECF Cation
obstruction, massive bleeding into a joint or body o Regulates fluid volume in the ECF
cavity
o Helps govern ECF osmolality
o Maintains plasma volume
o Activates nerve and muscle cells
S/S: CHLORIDE – 96-106 mEq/L
Decreased Urine Output (Intravascular Fluid o Major ECF Anion
Volume Deficit) – o Helps maintain normal ECF osmolality
increased HR,
o Affects body pH; vital role in acid base balance
decreased BP,
decreased CVP, edema, CALCIUM – 8.6-10.2 mg/dl
increased weight, Intake o Stabilizes cell membrane and reduces its
and Output Imbalance permeability to sodium
o Transmits nerve impulses; contracts muscles,
ELECTROLYTES coagulate blood
MAJOR CATIONS (+) MAJOR ANIONS (-) o Form bones and teeth
BICARBONATE – 22- 26 mEq/l
Sodium (ECF) Chloride (ECF)
o Regulates acid base balance
Potassium (ICF) Bicarbonates
REGULATION OF BODY FLUID COMPARTMENTS
Calcium Phosphates (ICF) 1. Osmosis
➢ Osmotic Pressure – amount of hydrostatic
Magnesium (ICF) Sulfates pressure needed to stop the flow of water by
osmosis. Determined by concentration of
Hydrogen Proteinates solutes.
➢ Oncotic Pressure – osmotic pressure exerted
by proteins (e.g., albumin)
➢ Osmotic Diuresis – increase in urine output
caused by the excretion of substances such
as glucose, mannitol, or contrast agents in the
urine.
2. Diffusion
3. Filtration
JASMINE KAYE C.
NCM 112: MEDICAL SURGICAL
1ST SEMESTER/MIDTERM/GAYATIN
4. Sodium – Potassium Pump
HYDROSTATIC VS. OSMOTIC PRRSSURE
• Hydrostatic – pressure is water being pushed out
by some force. If there is a lot of water in the
blood vessel, it will get pushed out, causing
edema in the tissues.
• Osmotic – pressure is water moving from its area
or high concentration to its area of low
concentration. If there are too many particles in
the plasma, water will be sucked into the blood
vessel, causing the blood pressure to elevate.
ROUTES OF FLUID GAINS AND LOSSES
Kidneys = Normal Urine Output = 1ml / kg / hr
Skin = Sweat – approx. 600ml / day
Lungs = Breathing - approx. 400 ml/day
GI Tract = 100-200 ml /day
EVALUATING FLUID STATUS
• Osmolality - number of solutes per kilogram of
solvent.
• Osmolarity - number of particles of solute per liter
of solution.
• Urine Specific Gravity - measures the ability of the
kidneys to excrete or conserve water 1.010 –
1.025 (1.003-1.030)
• BUN - end-product of protein metabolism 10 – 20
mg/dl
• Creatinine - end product of muscle metabolism
(NV: 0.7-1.4 mg/dl), best indicator of renal
function
• Hematocrit - volume percentage of RBCs (NV =
M: 42-52%; F:35-47%), increased in dehydration
and polycythemia; decreased in overhydration
and anemia
• Urine Sodium - Sodium and Water go together
HOMEOSTATIC MECHANISMS
➢ Kidney Functions
• Regulation of ECF volume and osmolality by
selective retention and excretion of body
fluids.
• Regulation of electrolyte levels in the ECF by
selective retention of needed substances and
excretion of unneeded substances.
• Regulation of pH in the ECF by retention of
hydrogen ions.
• Excretion of metabolic wastes and toxic
substance.
➢ Heart and Blood Vessel Functions – circulation
➢ Lung Functions – breathing
➢ Pituitary Functions – ADH
➢ Adrenal Functions – Aldosterone and Cortisol
➢ Parathyroid Functions – PTH (calcium and
phosphate Balance)
➢ Baroreceptors
• Low Pressure baroreceptors – Left Atria
• High Pressure baroreceptors – Nerve endings
in the aortic arch, carotid sinus, and afferent
arteriole of the nephron
➢ Renin-Angiotensin-Aldosterone System
➢ Antidiuretic Hormone (ADH) and Thirst
Mechanism
• Most significant factor in determining
concentration of urine
➢ Osmoreceptors
• Located on the surface of the hypothalamus
• Senses changes in sodium concentration and
release impulses to the posterior pituitary for
the release of ADH
➢ Atrial Natriuretic Peptide (Atrial Natriuretic Factor)
• Released by muscle cells of atria of the heart.
Action is opposite of RAA System.
• Released in response to increased arterial
pressure, Angiotensin II stimulation,
endothelin, and sympathetic stimulation
• Effect: Decreased blood pressure and blood
volume
JASMINE KAYE C.
NCM 112: MEDICAL SURGICAL
1ST SEMESTER/MIDTERM/GAYATIN
MEDICAL AND NURSING MANAGEMENT
• Correction of Fluid Loss
• Monitor: Intake and Output, weight, vital signs,
CVP, Level of consciousness, breath sounds,
skin/tongue turgor
• Check Urine concentration
• Prevent FVD: control measures and oral fluid
replacement of losses
• Correcting FVD: Oral Fluids, ORESOL, IV Fluid
FLUID VOLUME DISTUBANCES replacement

FLUID VOLUME DEFICIT (HYPOVOLEMIA)

Occurs when loss of ECF volume exceeds
the intake of fluid.
Water and Electrolytes are lost in the same
proportion as they exist in normal body
fluids.
May occur alone or in combination with
other imbalances
Note: The term DEHYDRATION refers to
loss of water alone.
ISOTONIC IV SOLUTIONS
Common Causes: decreased intake,
ISOTONIC IV REMARKS
vomiting, diarrhea, GI suctioning, sweating SOLUTIONS
Risk Factors: Diabetes Insipidus, adrenal 0.9% NaCl Expands ECF
insufficiency, osmotic diuresis, (Normal Saline) Only solution that may be
hemorrhage, coma administered with blood
Other causes: Third Space Shifts – edema products.
Lactated Ringer’s Contains electrolytes at same
in burns, ascites in liver dysfunction
Solution concentration as those in
plasma.
CLINICAL MANIFESTATIONS AND ASSESSMENT Used in treatment of
FINDINGS hypovolemia, burns, fluids
• Weight loss lost in diarrhea, acute blood
• Decreased skin turgor loss replacement.
• Oliguria: concentrated urine Should not be used in lactic
• Postural hypotension acidosis and renal failure.
• Weak rapid HR 5% Dextrose in Isotonic solution that supplies
• Flattened neck veins, decreased CVP Water 170 cal/L and free water to aid
• Increased temperature in renal excretion of solutes
• Cool clammy skin; peripheral vasoconstriction
• Thirst OTHER IV SOLUTIONS
• Anorexia; Nausea HYPOTONIC REMARKS
• Lassitude (Weakness) 0.45% NaCl Used to treat hypertonic
• Muscle Weakness; Cramps dehydration, Na and Cl
depletion and gastric
DIAGNOSTIC FINDINGS fluid loss.
• Increased BUN: increased urine specific gravity NOT indicated for 3rd
• Increased Hematocrit (Decreased hct and hgb in Space Shifts and Increased
Hemorrhage) ICP
• Hypokalemia with GI and renal losses HYPERTONIC REMARKS
• Hyperkalemia with adrenal insufficiency 3% NaCl Used in Increased ECF
(Addison’s disease) Volume; to decreased
• Hyponatremia occurs with increased thirst and cellular swelling; assists in
ADH release removing intracellular fluid
• Hypernatremia results from increased insensible excess.
loss and Diabetes Insipidus (decreased urine 5% NaCl Used to treat symptomatic
specific gravity) hyponatremia; cautious
administration.
JASMINE KAYE C.
NCM 112: MEDICAL SURGICAL
1ST SEMESTER/MIDTERM/GAYATIN
COLLOID REMARKS
Dextran in NS or Volume/plasma expander;
D5W used to treat hypovolemia
in early shock.
Decreases red blood cell
coagulation.

FLUID VOLUME EXCESS (HYPERVOLEMIA)

ETIOLOGY:
• Simple fluid overload; diminished function of
homeostatic mechanisms responsible for
regulating fluid balance.
• Heart failure, renal failure, cirrhosis of the liver,
low protein intake, anemia.
• Consumption of excessive amounts of table salt
or other sodium salts.
• Excessive administration of sodium containing
fluids.
• Isotonic expansion of the ECF caused by
abnormal retention of water and sodium; Serum
sodium concentration may remain essentially
normal.

CLINICAL MANIFESTATIONS
• Edema
• Distended neck veins
• Crackles, shortness of breath, wheezing
• Tachycardia
• Increased BP, pulse pressure and CVP
• Increased weight
• Increased urine output

DIAGNOSTIC FINDINGS
• DECREASED BUN AND HEMATOCRIT
• DECREASED SERUM OSMOLALITY
• XRAY – PULMONARY CONGESTION

MEDICAL MANAGEMENT
• Symptomatic
• Dietary restriction of sodium
• Diuretics
• Hemodialysis or peritoneal dialysis

NURSING MANAGEMENT
MONITOR:
o Intake and Output, weight, breath sounds,
degree of edema.
PREVENTING, DETECTING AND CONTROLLING
FLUID VOLUME EXCESS:
o Promoting rest, restricting sodium intake,
proper positioning, adherence to treatment.
MANAGING EDEMA:
o Treating the cause
o Diuretic therapy
o Restriction of Fluids and Sodium
o Elevation of Extremities
o Application of Elastic compression stockings
o Paracentesis; Dialysis
o Continuous renal replacement therapy

JASMINE KAYE C.