OXYGENATION FLUID AND ELETROLYTE NUTRITION AND METABOLISM ENDOCRINE FUNCTION

HANGIL KANG N C M 10 3

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OXYGENATION
occurs when oxygen molecules (O2) enter the tissues of the body. For example, blood is oxygenated in the lungs, where oxygen molecules travel from the air and into the blood. Oxygenation is commonly used to refer to medical Oxygen Saturation.

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THE PROCESS OF OXYGENATION

Delivery of oxygen to the body Depends upon the interplay of pulmonary, hematologic and cardiovascular system Processes involved are ventilation, alveolar gas exchange, oxygen transport and cellular respiration.

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I. VENTILATION
First step in the process of oxygenation Movement of air into and out of the lungs for the purpose of delivering fresh air in the alveoli Regulated by the respiratory centers in the pons and medulla oblongata. Rate and depth depends on the concentrating hydrogen ion and carbon dioxide (CO2) in body and fluid

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MECHANICS OF VENTILATION
1. Air Pressure Variances Air flows from region of higher pressure to a region of lower pressure. During inspiration, movement of diaphragm and other muscles of respiration enlarge the thoracic cavity and thereby lower the pressure inside the thorax to a level below that of the atmospheric pressure. During the normal expiration, the diaphragm relaxes and the lungs recoil. The alveolar pressure then exceeds atmospheric pressure, and air flows from the lungs into the atmosphere.

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2. ALVEOLAR GAS EXCHANGE

Once fresh air reaches the lungs alveoli, oxygen moves from area of higher concentration (alveoli) to lower concentration (pulmonary capillary blood). The same way that CO2 diffuses from the blood to the alveolar space.

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3. OXYGEN TRANSPORT
Once the diffusion of oxygen across the alveolar-capillary membrane occurs, the CO2 molecules are dissolved in the blood plasma. Plasma is not able to carry enough dissolved oxygen to meet the metabolic needs of the body. Oxygen carrying capacity of the blood is greatly enhanced by the presence of hemoglobin in the erythrocytes. Once oxygen is bound to hemoglobin, the oxygen is delivered to the cell of the body by circulation

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HEMOGLOBIN RBCs major component which contains heme, a complex molecule of iron gives blood its color and globin, a simple protein Hemoglobin Test Measures the grams of hemoglobin in a 100ml of whole blood.

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NORMAL VALUES

Males 14.0 17.4 g/dL Females 12.0 16.0 g/dL

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MEASUREMENT OF OXYGEN IN BLOOD SAMPLES

1) Partial Pressure of Oxygen (PaO2) measures oxygen dissolved in plasma. Normal Value: 80 100 mmHg 2) Oxygen Saturation (SaO2) measures the percentage of hemoglobin saturated with oxygen. Normal Value: 95 100 %

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IV. CELLULAR RESPIRATION

Gas exchange at the cellular level takes place via diffusion in response to pressure gradient. Oxygen diffuses from the blood to the tissues while carbon dioxide moves from the tissues to the blood. Blood is reoxygenated.

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FACTORS AFFECTING OXYGENATION

1. Age: adults often exhibit barrel chest and require increased effort to expand the lung. They are also susceptible to respiratory infection due because of decreased activity which is an effective defense mechanism.

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2. ENVIRONMENTAL AND LIFESTYLE FACTORS

Clients who are exposed to dust, animal dander, asbestos or toxic chemicals are at an increased risk for alterations in oxygenation. Smokers as well as those exposed to it should be questioned as to the type, frequency of smoking.

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3. DISEASE PROCESSES
ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDERS (HEALTH HISTORY ) Identify the chief reason for seeking health care Nurse determines when the health problems started, how long it lasted, if it was relieved any time, and how relief was obtained. Collects information about precipitating factors, duration, severity and associated factors or symptoms Assess risk factors and genetic factors that contribute to the condition Assess the impact of sign and symptoms on the patients ability to perform activities of daily living

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SIGNS AND SYMPTOMS

Dyspnea difficulty or labored breathing, shortness of breath to any constantly recurring irritant Cough results from the irritation of mucous membrane anywhere in the respiratory tract. It may arise from infectious process and from airborne irritants such as smoke, dust and gas Sputum Production reaction of lungs to any constantly recurring irritants Chest Pain sharp, stabbing and intermittent or may be dull, aching and persistent

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Wheezing high pitched musical sound heard mainly on expiration. (bronchoconstriction or airway narrowing) Clubbing Fingers found in clients with chronic hypoxic condition, chronic lung infection and malignancies of the lungs. It is described as sponginess of the nail bed and loss of nail bed angle Hemoptysis expectoration of blood from respiratory tract. A symptom of both pulmonary and cardiac disorder Cyanosis bluish discoloration of the skin. It is a late sign of hypoxia (can lead to shock or death). Cyanosis appears of there is 5 g/dL of unoxygenated hemoglobin

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PHYSICAL ASSESSMENT OF UPPER RESPIRATORY STUCTURES

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1.NOSE AND SINUSES

inspect the external nose for lesions, asymmetry or inflammation examine the internal structure for swelling, color, exudates or bleeding inspect for septum deviation, perforation or bleeding palpate the frontal and maxillary sinuses for tenderness. Using the thumb the nurse applies gentle pressure in an upward fashion at the supraorbital ridges (frontal sinuses) and in the cheek area adjacent to the nose (maxillary). Tenderness suggests inflammation

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2. PHARYNX AND MOUTH

Instruct the client to open mouth and take deep breath Inspect structures for color, symmetry and evidence of exudates, ulceration or enlargement

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3. TRACHEA

Place thumb and index finger of one hand on either side of the trachea just above the sternal notch. It is normally in the midline as it enters the thoracic inlet behind the sternum.

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CONCEPTS OF FLUID BALANCE

Functions of body fluids Fluid compartments Electrolytes Movement of fluids and electrolytes Regulation of fluid balance Problems of fluid balance

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FUNCTIONS OF BODY FLUIDS

Body needs:
 1500 mL daily  700 mL from food we eat  300 mL from oxidation of food

Functions
 Makes half the body weight  Transports nutrients and wastes to and from cells  Acts as solvent for electrolytes and nonelectrolytes  Facilitates digestion and elimination  Maintains acid-base balance  Lubricates joints and other body tissues

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FLUID COMPARTMENTS
Intracellular fluid compartment
 Contain 70% of body fluids  Fluid loss at cellular level affects entire body

Extracellular fluid compartment

 Contain 30% of body fluids  Intravascular fluids  Interstitial fluids  Transcellular fluids

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ELECTROLYTES
Electrolyte Normal Plasma Value

Sodium Potassium Calcium Magnesium Chloride Phosphorus

135 to 145 mEq/L 3.5 to 5.0 mEq/L 4.5 to 5.5 mg/dL 1.5 to 2.5 mg/dL 98 to 106 mEq/L 1.2 to 3.0 mg/dL

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MOVEMENT OF FLUIDS AND ELECTROLYTES

Osmosis
 Hypotonic  Hypertonic

Diffusion Active transport Filtration

 Colloid osmotic pressure  Hydrostatic pressure

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REGULATION OF FLUID BALANCE

Thirst
 Intake of fluids

Lymphatic system
 Sponging up

Neuroendocrine system
 Hormones

Gastrointestinal system
 Absorbssecretesreabsorbs

Renal system
 Works with neuroendocrine system to regulate volume

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PROBLEMS OF FLUID BALANCE

Deficient fluid volume
 Hypovolemia  Dehydration

Excess fluid volume

 Hypervolemia  Water intoxication

Electrolyte imbalance
 Deficit or excess of one or more electrolytes

Acid-base imbalance
 Respiratory acidosis and respiratory alkalosis  Metabolic acidosis and metabolic alkalosis

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FACTORS AFFECTING FLUID BALANCE

Lifestyle factors
 Nutrition  Exercise  Stress

Developmental factors
 Infants and children  Adolescents and middle-aged adults  Older adults

Physiological factors
      Cardiovascular Respiratory Gastrointestinal Renal Integumentary Trauma

Clinical factors
     Surgery Chemotherapy Medications Gastrointestinal intubation Intravenous therapy

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ASSESSMENT OF FLUID BALANCE

General Focused assessment for deficient fluid volume Focused assessment for excess fluid volume Focused assessment for associated problems

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GENERAL ASSESSMENT
Health history
 Chief complaint  Past history of illnesses

Diagnostic tests
 Plasma sodium  Plasma osmolality  Urine osmolality  Hematocrit  Blood urea nitrogen (BUN)

Physical examination
 Standard clinical measurements  Weighing the client  Input and output  Assessing edema

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FOCUSED ASSESSMENT FOR DEFICIENT FLUID VOLUME

Defining characteristics

 Extracellular  Intracellular
Related factors

 The acuteness of the loss  The severity of the loss  The clients age and state of health  The degree to which the client combats the deficit

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FOCUSED ASSESSMENT FOR EXCESS FLUID VOLUME

Defining characteristics

 Extracellular  Intracellular
Related factors

 Any increase in fluid intake  Any increase in sodium intake  Increase in capillary permeability  Protein loss  The clients response to fluid excess

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FOCUSED ASSESSMENT FOR ASSOCIATED PROBLEMS

Electrolyte imbalances
 Fluid imbalances rarely exists without electrolyte imbalance  Anticipate the risk for imbalance

Metabolic acidosis
 End-stage renal disease  Severe diarrhea  Hypoxia  Hyperglycemia

Metabolic alkalosis
 Consumption of excessive bicarbonate products  Loss of excessive potassium and hydrochloric acid

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DIAGNOSIS
Deficient fluid volume or Risk for deficient fluid volume Excess fluid volume or Risk for excess fluid volume Related nursing diagnoses
          Fatigue Anxiety Ineffective health maintenance Imbalanced nutrition Impaired skin integrity Impaired tissue perfusion Impaired gas exchange Constipation Impaired oral mucous membranes Disturbed sleep pattern

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PLANNING
Deficient fluid volume
 Increase in fluid intake  Moist mucous membranes  Absence of tongue furrows

Excess fluid volume

 Decrease in peripheral edema  Weight loss  Decrease in fatigue and weakness

Associated problems

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INTERVENTIONS
To reduce the risk of deficient fluid volume
 Teaching client about fluid needs  Preventing excessive fluid deficits  Restoring lost fluids

To increase fluid volume

    Restoring fluid balance Preventing further loss Instituting rehabilitative care Administering intravenous therapy

To decrease fluid volume

 Restoring fluid balance  Preventing complications  Instituting rehabilitative care

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INTERVENTIONS
To balance electrolyte levels
 General interventions
o Nutrition is the key

 Sodium imbalance: hyponatremia or hypernatremia  Potassium imbalance: hypokalemia or hyperkalemia  Calcium imbalance: hypocalcemia or hypercalcemia  Magnesium imbalance  Phosphate imbalance

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INTRAVENOUS THERAPY
Types of intravenous (IV) solutions Categorized by osmolality: how solution affects other fluids
 Isotonic  Hypotonic  Hypertonic

Potential complications
 Infiltration  Phlebitis  Infection  Air embolism  Allergic reaction  Circulatory overload

Sites for IV therapy

Care of IV site
 Peripheral  Central

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EVALUATION The time frame for evaluating fluid or electrolyte imbalance varies with the urgency of the imbalance.

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NUTRITION

is the provision, to cells and organisms, of the materials necessary (in the form of food) to support life. Many common health problems can be prevented or alleviated with a healthy diet.

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NUTRIENTS

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There are six major classes of nutrients: carbohydrates, fats, minerals, protein, vitamins, and water. These nutrient classes can be categorized as either macronutrients (needed in relatively large amounts) or micronutrients (needed in smaller quantities). The macronutrients include carbohydrates, fats, fiber, protein, and water. The micronutrients are minerals and vitamins.

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CALORIES Carbohydrates and proteins provide 17 kJ approximately (4 kcal) of energy per gram, while fats provide 37 kJ (9 kcal) per gram

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Nutrients Macronutrients

Deficiency

Excess

Calories

Starvation, Marasmus

Obesity, diabetes mellitus, Cardiovascular disease

Simple carbohydrates

none

diabetes mellitus, Obesity, Cardiovascular disease

Complex carbohydrates

micronutrient deficiency

Obesity, Cardiovascular disease (high glycemic index foods)

Protein

kwashiorkor

Rabbit starvation, Ketoacidosis (in diabetics)

Saturated fat Trans fat Unsaturated fat

none none fat-soluble vitamin deficiency

Obesity, Cardiovascular Disease Obesity, Cardiovascular Disease Obesity, Cardiovascular disease

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Micronutrients

Vitamin A

Xerophthalmia and Night Blindness

Hypervitaminosis A (cirrhosis, hair loss)

Vitamin B1 Vitamin B2 Niacin

Beri-Beri Skin and Corneal Lesions dyspepsia, cardiac arrhythmias, birth defects

Pellagra

Vitamin B12 Vitamin C

Pernicious Anemia Scurvy diarrhea causing dehydration Hypervitaminosis D (dehydration, vomiting, constipation) Hypervitaminosis E (anticoagulant: excessive bleeding)

Vitamin D

Rickets

Vitamin E

neurological disease

Vitamin K

Hemorrhage Bleeding, Hemorrhages, Hemorrhagic stroke, reduced glycemic control among diabetics Cardiovascular Disease, Cancer Cardiovascular Disease ELSEVIER ITEMS AND DERIVED ITEMS 2007 BY SAUNDERS, AN IMPRINT OF ELSEVIER INC.

Omega 3 Fats

Cardiovascular Disease

Omega 6 Fats Cholesterol

none none

Macrominerals

Calcium

Osteoporosis, tetany, carpopedal spasm, laryngospasm, cardiac arrhythmias

Fatigue, depression, confusion, nausea, vomiting, constipation, pancreatitis, increased urination, kidney stones

Magnesium

Hypertension

Weakness, nausea, vomiting, impaired breathing, and hypotension

Potassium Sodium Trace minerals Iron

Hypokalemia, cardiac arrhythmias hyponatremia

Hyperkalemia, palpitations Hypernatremia, hypertension

Anemia

Cirrhosis, Hepatitis C, heart disease

Iodine

Goiter, hypothyroidism

Iodine Toxicity (goiter, hypothyroidism)

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METABOLISM
is the set of chemical reactions that happen in living organisms to maintain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories. Catabolism breaks down organic matter, for example to harvest energy in cellular respiration. Anabolism uses energy to construct components of cells such as proteins and nucleic acids.

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ENDOCRINE SYSTEM is a system of glands, each of which secretes a type of hormone directly into the bloodstream to regulate the body. The endocrine system is in contrast to the exocrine system, which secretes its chemicals using ducts. It derives from the Greek words endo meaning inside, within, and crinis for secrete.

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HORMONES are substances (chemical mediators) released from endocrine tissue into the bloodstream where they travel to target tissue and generate a response. Hormones regulate various human functions, including Metabolism, growth and development, tissue function, and mood.

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8 MAJOR GLANDS
Hypothalamus Pituitary gland Parathyroid gland Thyroid gland Adrenal glands Pancreas Ovaries (in female body) Testes (in male body)

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HYPOTHALAMUS
A collection of specialized cells that are located in the lower central part of the brain is called the hypothalamus. The hypothalamus is the main link between the endocrine system and the nervous system. The nerve cells of the hypothalamus control the pituitary gland by stimulating or suppressing the hormone secretions.

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PITUITARY GLAND
The pituitary gland is located at the base of the brain just below the hypothalamus. The pituitary gland is the most important part in the endocrine system. The pituitary gland secrete hormones on the basis of the emotional and seasonal changes. The hypothalamus sends information that is sensed by the brain to pituitary triggering production hormones. The pituitary gland is divided into two parts: the anterior lobe and the posterior lode. The anterior lobe of the pituitary gland regulated the activity of the thyroid, adrenals, and the reproductive glands. The anterior lobe also produces hormones like:  Growth Hormone: To stimulate the growth of the bones and tissues. It also plays a role in the body's absorption of nutrients and minerals.  Prolactin: To activate the production of milk in lactating mothers  Thyrotropin: To stimulate the thyroid gland to produce thyroid hormones  Corticotropin: To stimulate the adrenal glands to produce certain hormones.

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THYROID GLAND
The thyroid gland is situated in the front part of the lower neck that is shaped like a bow tie or butterfly. The production and secretions of the hormones of the thyroid glands are controlled by thyrotropin secreted by the pituitary gland. Thyroid produces thyroxine and triiodothyronine, that control the rate at which the cells use up energy from food for production of energy. The thyroid hormones are very important a they help in growth of bones and the development and growth of the brain and nervous system in children. Over or under secretion of thyroid hormones leads to a number of thyroid problems in the body.

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PARATHYROIDS These are four tiny glands that are attached to the thyroid gland. They release the parathyroid hormone that helps in regulating the level of calcium in blood along with another hormone produced by thyroid called as calcitinin.

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ADRENAL GLANDS
On each of the two kidneys, there are two triangular adrenal glands situated. The adrenal gland is divided into two parts. The outer part called the adrenal cortex produces corticosteroids, that influence and regulate the salt and water levels. They are also helpful in the body's response to stress, metabolism, immune system and the function and development of sexual organs.

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REPRODUCTIVE GLANDS OR GONADS

The gonads are present in males and females and are the main organs producing sex hormones. In men, the gonads are related to testes. The testes are located in the scrotum and secrete androgens. The most important hormone for men testosterone is secreted from the testes. In women, ovaries are the gonads that are located in the pelvis region.

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PANCREAS
These glands are associated with the digestive system of the human body. They secrete digestive enzymes and two important hormones insulin and glucagon. These hormones work together to maintain the level of glucose in the blood.

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PINEAL The pineal gland is located in the center of the brain. Melatonin is secreted by this gland that helps regulate the sleeping cycle of a person.

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RISK FACTORS AFFECTING ENDOCRINE SYSTEM

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AGING
hormone production and secretion hormone metabolism (how quickly excess hormones are broken down and leave the body, for example, through urination) hormone levels circulating in blood biological activities target cell or target tissue response to hormones rhythms in the body, such as the menstrual cycle

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ILLNESS Illness may affect endocrine system function in several ways. Acute or chronic conditions may change endocrine functions.

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CHRONIC/ACUTE CONDITIONS Hormones are cleared from blood during their circulation to the target tissues. The liver and kidneys are primarily responsible for clearing hormones. Several clearance processes become altered or slowed in individuals who have chronic heart, liver, or kidney disorders.

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ENDOCRINE PATHOLOGIES
congenital (birth) or genetic defects (see section on Genetics below) surgery traumatic injuries cancerous and non-cancerous tumors infection autoimmune destruction (the immune system turns against the body's own organs and causes damage)

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STRESS trauma (severe injury) of any type severe illness or infection intense heat or cold surgical procedures serious diseases allergic reactions

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EXTERNAL FACTORS
disrupted sexual development decreased fertility birth defects decreased hatching in animals reduced immune response neurological and behavioral changes, including reduced stress tolerance

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GENETICS Portions of your endocrine system can be affected by genes. Genes are units of hereditary information passed from parent to child. Genes contain the instructions for the production of proteins, which are some of the essential components of the body. Genes are contained in chromosomes. The normal number of chromosomes is 46 (23 pairs).

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CYCLES OF HORMONE RELEASE

Cortisol builds up early in the day, decreases toward evening, rises again toward the end of sleep, and peaks during the morning hours. Thyroid-stimulating hormone (TSH) peaks during sleep and reaches its low point three hours after an individual awakens. Levels of growth hormone (GH) are high 90 minutes after sleep begins. GH typically increases during the first 2 hours of deep sleep. It also increases if a person is hypoglycemic (low blood sugar), starving, exercising, excited or is a victim of severe injury. There is a very definite rise-and-fall pattern to both estrogen and progesterone activity during a woman's menstrual cycle, which lasts an average of 28 days.

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