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A comprehensive overview of body fluids, their composition, movement, and regulation. It discusses the role of electrolytes in maintaining physiological processes, the movement of body fluids for tissue oxygenation, acid-base disturbances, and response to illness, and the role of solutes, solvents, diffusion, osmosis, and filtration. It also covers the regulation of body fluids through fluid intake, hormonal influences, and fluid output. The document also delves into isotonic and osmolar disturbances, their causes, signs and symptoms, and nursing interventions.
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Composition of Body Fluids ● Electrolyte - an element or compound that when melted or dissolved dissociates into ions and is able to carry an electric current. ○ Vital Function - neuromuscular function and acid-base balance. ● Minerals - ingested as compounds; important in maintaining physiological processes, inorganic compounds that yield no energy. Also acts as catalysts in nerve response, muscle contraction, and metabolism of nutrients in food. ● WBC/RBC Movement of Body Fluids ● Purpose: ○ Tissue Oxygenation ○ Acid-Base Disturbances ○ Response to Illness ○ Response to Drug Therapies ● Solute - solid particle. ● Solvent - universal solvent is water. ● Diffusion - a process in which solid, particulate matter in a fluid moves from an area of higher concentration to area of decreased concentration. ● Osmosis - movement of pure solvent from a solution that has solute decreased concentration to increased concentration. ○ Osmotic Pressure - the pressure exerted on the semi-permeable membrane. ○ Osmolality - osmols or mOsm/kg of water. ○ Osmolarity - osmols or mOsm/kg of solution. Base is water or solution. ■ Normal Osmolality - 280 to 295 mOsm/kg ● Isotonic - equal pressure, no movement of water. Used for maintenance purposes. ○ PNSS ○ D5W ○ LR ○ Normosol - R ● Hypotonic - water moves inside cell due to lower concentration, cell swells. ○ .45% NaCl ○ .3% NaCl ● Hypertonic - water moves outside cell, cell shrinks. ○ D5 Saline Solution ○ D10 Saline Solution ● Oncotic Pressure - pressure exerted by plasma proteins. ● Filtration - process by which water and diffusible substance move together in response to fluid pressure. ● Hydrostatic Pressure - pressure exerted by a liquid. ● Active Transport - movement of materials across the cell membrane by chemical activity or energy expenditure. Regulation of Body Fluids ● Fluid Intake - regulated primarily through thirst mechanism. ○ Thirst Control Center
○ Activated: ECF Osmolality ● Stimuli Affecting the Thirst Mechanism ○ Psychological Factors ○ Dry Pharyngeal Mucous Membrane ○ Angiotensin I ○ Major Physiological Stimuli ○ Plasma Concentration ○ Blood Volume ○ Plasma Osmolarity ● Hormonal Influences ○ Antidiuretic Hormone (ADH) ■ Secreted when there is : ● Increased Serum/Plasma Osmolality (Hyperosmolality) ● ECF Volume Depletion/Decrease in Blood Volume ● Pain ● Stress ■ Factors Suppressing ADH: ● Hypo-Osmolarity of the ECF ● Increased Blood Volume ● Exposure to Cold ● Acute Alcohol Ingestion ● Carbon Dioxide Inhalation ● Aldosterone (Mineralocorticoid) Fluid Output ● Kidneys ● Skin ○ Sensible Water Loss - 0 up to 500 mL ○ Insensible Water Loss - via evaporation; 600 to 900 mL ● Lungs (Insensible Water Loss) - approximately 400 mL ● GIT - via stool; 100 mL/Day Isotonic Disturbances A. Hypovolemia (ECF Fluid Volume Deficit) - water and electrolytes are lost in isotonic proportions. a. Serum Electrolyte Levels Remain Unchanged i. Mild 1 to 2 L ii. Moderate 3 to 5 L iii. Severe 5 to 10 L b. Causes : i. Hemorrhage ii. Burns iii. Diarrhea iv. Fever v. Vomiting vi. Draining Fistulas vii. Kidney Disease viii. Sequestration of Fluids
i. Weight Loss ii. Increased Body Temperature iii. Dry and Sticky Mucus Membrane iv. Irritability v. Flushed and Dry Skin vi. Convulsions vii. Thirst viii. Coma c. Nursing Interventions : i. Measure I & O ii. Weigh Daily iii. Assess Skin Frequently iv. Ensure Patient with Increased Solute Intake and Increased Fluid v. Assess V/S - especially temperature. vi. Monitor TPN Accurately B. Hypoosmolar Imbalance (Water Excess) a. Causes : i. Excess Water Intake ii. Use of Diuretics iii. Inability to Excrete Water iv. SIADH v. Poor Salt Intake b. Signs and Symptoms : i. Polyuria ii. Disorientation iii. Oliguria iv. Coma v. Twitching vi. Convulsions vii. Hyperirritability viii. Abdominal Cramps ❖ Overall Effect - dilution of ECF volume with osmosis of water into cells. ❖ Can Lead To - cerebral edema → decreased LOC, convulsions, coma, and death. Electrolytes A. Cations - necessary for neurochemical and neuromuscular transmission. Influence muscular function / cardiac rhythm & contractility, mood & behavior, & GI functioning. a. Sodium (Na+) i. 135 to 145 mEq/L ii. Most abundant in ECF/maintains water balance/transmits nerve impulse & contracting muscles. iii. Water goes where sodium goes. iv. Regulated by salt intake, aldosterone, & urine output. v. Found in table salt, processed meats, snack foods, & canned vegetables. b. Hyponatremia i. Decreased sodium intake. ii. Increased sodium excretion through diaphoresis or GI suctioning.
iii. Needed for cell membrane integrity & structure; adequate cardiac conduction, blood coagulation, bone growth and formation; muscle relaxation. iv. Ca+^ in ECF is regulated by PTH and thyrocalcitonin. v. Necessary for the relaxation of skeletal muscle and contraction of cardiac muscle. vi. Abnormally high level in ECF → muscle weakness, lethargy, and coma.