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Fluid and Electrolytes
Fluid and Electrolytes
Fluid and Electrolytes
Electrolytes
kidneys
• Are bean-shaped organs outside the
peritoneal cavity
• Right lower than the left
• N e p h r o n s - functional unit of the kidney
• Contains the g l o m e r u l u s
• Regulate the concentration of water and
soluble substances like sodium salts by
filtering the blood, reabsorbing what is
needed and excreting the rest as urine
• Eliminates wastes from the body
• Regulates blood volume and pressure
• Controls levels of electrolytes and
metabolites
• Regulates blood pH
Tests for renal function
Urinalysis Chemical
General Determinations
Characteristics Urobilirogen: 0.1 – 1
Color: Yellow - amber
NEGATIVE for glucose,
Turbidity: clear to slightly ketones, CHON and bilirubin
hazy
SG: 1.010 – 1.025 N E G A T I V E for nitrate for
pH: 4.6 – 6.8 (average 6.0) bacteria and leukocyte esterase
Microscopy
N E G A T I V E for casts,
RBCs, crystals, WBCs and
few epithelial cells
Tests for renal function
Glomerular filtration rate Blood urea nitrogen
- Gauge for renal function
2.9-7.1mmol/L
- Used clearance for creatinine
- Normal creatinine clearance: - 2/3 of renal function must be
115-125mL/min lost before significant rise in
serum BUN
Blood tests: - Less sufficient to determine
S e r u m c r e a t i n i n e 50- renal sufficiency
100mmol/L
-Reflect GFR
-Higher GFR, lower percentage of
renal function
Tests for renal function
• Cystoscopy
• Ultrasonography
• Radiologic/and
imaging studies
Disorders of fluid and electrolytes balance
Factors influencing amount of body fluid
Infection (UTI)
Obstructive Disorders
Glomerular Dysfunction
Tubulointerstitial Disorders
CONGENITAL DISORDERS OF THE KIDNEY
• Agenesis and hypoplasia
Agenesis is the complete failure of organ to develop.
Total agenesis of both kidneys is incompatible with
extrauterine life
Hypoplasia the kidneys do not develop to normal size
• Pyelonephritis
• Cystitis
• Asymptomatic
bacteriuria
Pyelonephritis
• Pyelonephritis is characterized by any or all of
the following:
• abdominal, back, or flank pain; fever; malaise;
nausea; vomiting; and, occasionally, diarrhea.
Fever may be the only manifestation.
• Newborns can show nonspecific symptoms
such as poor feeding, irritability, jaundice, and
weight loss.
• Pyelonephritis is the most common serious bacterial
infection in infants <24 mos of age who have fever
without an obvious focus.
• These symptoms are an indication that there is
bacterial involvement of the upper urinary tract.
• Involvement of the renal parenchyma is termed
acute pyelonephritis, whereas if there is no
parenchymal involvement, the condition may be
termed pyelitis.
• Acute pyelonephritis can result in renal injury,
termed pyelonephritic scarring.
Cystitis
• Cystitis indicates that there is bladder
involvement; symptoms include dysuria,
urgency, frequency, suprapubic pain,
incontinence, and malodorous urine.
• Cystitis does not cause fever and does not
result in renal injury.
Factors Predisposing to Development
• Short female urethra close
to vagina and anus
• Incomplete emptying
(reflux) and overdistention
of bladder
• Concentrated urine
• Constipation
Diagnostic Evaluation
• Clean-catch technique
• Suprapubic aspiration
• Catheterization
CLINICAL MANIFESTATIONS
Neonatal Period (Birth–1 Month) Infancy (1–24 Months)
• Poor feeding • Poor feeding
• Vomiting • Vomiting
• Failure to gain weight • Failure to gain weight
• Rapid respiration (acidosis) • Excessive thirst
• Respiratory distress • Frequent urination
• Spontaneous pneumothorax or • Straining or screaming on
pneumomediastinum urination
• Frequent urination • Foul-smelling urine
• Screaming on urination • Pallor
• Poor urine stream • Fever
• Jaundice • Persistent diaper rash
• Seizures • Seizures (with or without fever)
• Dehydration • Dehydration
• Other anomalies or stigmata • Enlarged kidneys or bladder
• Enlarged kidneys or bladder
CLINICAL MANIFESTATIONS
Childhood (2–14 • Swelling of face
Years) • Seizures
• Poor appetite • Pallor
• Vomiting • Fatigue
• Growth failure • Blood in urine
• Excessive thirst • Abdominal or
• Enuresis, back pain
incontinence, • Edema
frequent • Hypertension
urination
• Tetany
• Painful urination
THERAPEUTIC MANAGEMENT
The objectives of treatment of children with UTI are to:
(1) eliminate current infection
(2) identify contributing factors to reduce the risk of
recurrence
(3) prevent systemic spread of the infection, and
(4) preserve renal function
2. Duration of Obstruction
Damaging Effects:
1. Urinary Stasis
• High risk for infection
2. Backpressure
Development
• Interferes with renal
blood flow and destroys
kidney tissue
MANIFESTATIONS
1. Pain
• Secondary to bladder, renal capsule or collecting
system distention
• SITE: flank area (obstruction of renal pelvis or
ureter), testes/labia (obstruction is lower)
• Hypertension
2. S/Sx of UTI
3. Renal dysfunction (inability to concentrate urine)
Glomerular Injury
NEPHROTIC SYNDROME
• a clinical state that includes massive proteinuria,
hypoalbuminemia, hyperlipidemia, and
edema
• characterized by increased glomerular permeability
to plasma protein, which results in massive urinary
protein loss
The disorder can occur as:
(1) a primary disease known as idiopathic nephrosis,
childhood nephrosis, or minimal-change nephrotic
syndrome (MCNS);
(2) A secondary disorder that occurs as a clinical
manifestation after or in association with
glomerular damage that has a known or presumed
cause; or
(3) a congenital form inherited as an autosomal
recessive disorder.
Causes of nephrotic syndrome include:
• lipid nephrosis
• glomerulonephritis
• metabolic diseases such as diabetes mellitus
• collagen-vascular disorders such as SLE
• circulatory diseases, such as heart failure, sickle cell
anemia, and renal vein thrombosis
• nephrotoxins, such as mercury, gold, and bismuth
• allergic reactions
DIAGNOSTIC EVALUATION
• massive proteinuria (higher than 2+ on urine
dipstick)
• Hyaline casts, oval fat bodies, and a few red blood
cells (RBCs) can be found in the urine
• GFR is usually normal or high
• Total serum protein concentration is low
• serum albumin significantly reduced
• plasma lipids elevated
CLINICAL MANIFESTATIONS
• Weight gain -Poor intestinal absorption
• Puffiness of face (facial edema): • Ankle or leg swelling
-Especially around the eyes • Irritability
-Apparent on arising in the • Easily fatigued
morning • Lethargic
-Subsides during the day • Blood pressure normal or
• Abdominal swelling (ascites) slightly decreased
• Pleural effusion • Susceptibility to infection
• Labial or scrotal swelling • Urine alterations:
• Edema of intestinal mucosal, -Decreased volume
possibly causing: -Frothy
-Diarrhea
-Anorexia
THERAPEUTIC MANAGEMENT
• Objectives of therapeutic management include (1)
reducing excretion of urinary protein, (2) reducing fluid
retention in the tissues, (3) preventing infection, and (4)
minimizing complications related to therapies. Dietary
restrictions include a low-salt diet and, in more severe
cases, fluid restriction. If complications of edema
develop, diuretic therapy may be initiated to provide
temporary relief from edema. Sometimes infusions of
25% albumin are used. Acute infections are treated with
appropriate antibiotics.
• Corticosteroids are the first line of therapy for MCNS
Nursing Interventions:
• Maintain fluid balance and monitor for signs of fluid volume
excess, such as edema, ascites, weight gain, decreased and
concentrated urine, and pulmonary congestion.
• Assess for signs of electrolyte imbalance—cardiovascular,
neurologic, GI, and skin changes—and work with the health
care providers to correct imbalances that may exist
• Assess general nutritional status and work to improve it by
providing a diet the child will eat (with sufficient protein and
other nutrients and without excess sodium). Parents can help
with this, too, by bringing in food from home that the child
likes, as long as it fits within the child’s dietary restrictions.
• Assess for adverse effects of medications, and report them to
the health care provider as soon as possible
Glomurelar Injury
CATEGORIES:
• The NEPHRITIC SYNDROMES evokes an inflammatory
response in the glomeruli
CHARACTERISTICS:
1. Hematuria with red cell casts
2. Diminished GFR
3. Oliguria
4. Hypertension
5. Azotemia (presence of nitrogenous wastes on
blood)
Glomurelar Injury
EXAMPLES:
1. Acute Glumerulonephritis
2. Chronic Glumerulonephritis
3. IgA Nephropathy
Tubulointerstitial Disorders
• Diseases affecting the renal tubular structures;
including the proximal and distal convoluted tubules
• Also affects the interstitial tissues that surround the
tubules
EXAMPLES
1. Acute tubular necrosis
2. Renal tubular acidosis
3. Pyelonephritis
4. Effects of drugs and acute hypersensitivity
Tubulointerstitial Disorders
ACUTE
• Sudden onset
• Interstitial edema
• Examples: pyelonephritis, acute hypersensitivity to drugs
CHRONIC
• Produces interstitial fibrosis, atrophy, mononuclear
infiltrates
• Commonly manifests as electrolyte imbalances reflecting
subtle changes in tubular function (inability to
concentrate urine, metabolic acidosis, diminished
reabsorption of Na and other substances)