F&E1

Part ONE of TWO Lectures

  • Topic: FLUIDS

  • Course: NUR 360

  • Year: 2025

Introduction to Fluid Imbalance

  • Recognize interventions for clients with:

    • Fluid volume excess

    • Fluid volume deficit

    • Electrolyte imbalances

  • Plan care for clients with fluid and electrolyte issues.

Homeostasis and Fluid Balance

  • Maintain homeostasis within major body systems:

    • Transport nutrients, electrolytes, and oxygen.

    • Remove wastes from cells.

  • Disease processes that alter fluid and electrolyte balance include:

    • Aging, gender, and fat composition affecting water balance.

Fluid Distribution in the Body

  • Total body water: Approximately 60% of body weight

    • Intracellular fluid (ICF): 2/3 (or 40% of body weight)

    • Extracellular fluid (ECF): 1/3 (or 20% of body weight)

      • Interstitial fluid: 10L (between cells)

      • Intravascular (plasma/blood volume): 3L

      • Transcellular fluid: 1L (e.g., cerebrospinal, intraocular)

  • Filtration and Reabsorption Mechanisms:

    • Capillary hydrostatic pressure and blood colloidal osmotic pressure regulate fluid movement across capillaries.

    • Arterial end: net filtration pressure (+10 mm Hg) promotes fluid exit.

    • Venous end: net reabsorption pressure (-7 mm Hg) allows fluid re-entry.

Fluid Locations in Pathophysiology

  • ICF: Site of important cellular processes, transporting molecules to organelles.

  • ECF: Encompasses fluid in blood and surrounding interstitial spaces, allowing balance of hydrostatic and osmotic forces for fluid movement.

Electrolyte Balance

  • Electrolyte levels in ECF and ICF (mEq/L):

    • Sodium (ECF: 142, ICF: 14)

    • Potassium (ECF: 4, ICF: 140)

    • Calcium (ECF: 4, ICF: 1)

    • Magnesium (ECF: 2, ICF: 35)

    • Chloride (ECF: 104, ICF: 2)

    • Phosphate (ECF: 1.2, ICF: 140)

  • Relationships between electrolytes:

    • Inverse relationships:

      • Sodium/Potassium: Increasing sodium decreases potassium.

      • Calcium/Phosphate: Increasing calcium decreases phosphate.

    • Similar relationships:

      • Calcium/Vitamin D, Magnesium/Calcium.

  • Vitamin D: Essential for calcium absorption.

Daily Fluid Intake Recommendations

  • Female: About 2.8L (12 cups) daily

  • Male: About 3.8L (16 cups) daily

Fluid Volume Deficit (FVD) Management

  • Causes: Vomiting, diarrhea, hemorrhage.

  • Clinical presentation: Restlessness, lethargy, confusion, hypotension, tachycardia, weight loss.

  • Treatment Goals: Correct underlying cause, replace water and electrolytes either orally or via IV in severe cases.

  • Fluid inclusion examples: Balanced IV solutions for severe dehydration (e.g., normal saline, lactated Ringer's).

Fluid Volume Excess (FVE) Management

  • Monitor for symptoms like edema, hypertension, and pulmonary congestion.

  • Potential complications: Pulmonary edema, ascites, impaired gas exchange.

IV Therapy Considerations

  • Types of complications:

    • Local (e.g., infiltration, thrombosis)

    • Systemic (e.g., embolism, sepsis, speed shock)

  • Blood transfusion precautions:

    • Record vital signs before, during, and after administration.

    • Monitor closely for signs of allergic reactions or overload, especially in at-risk patients (elderly, cardiac patients).

Conclusion

  • Regular assessment for fluid imbalance, careful administration of electrolytes and water, and close monitoring for complications are critical for maintaining patient health.

  • Education on the importance of hydration and nutrient transport as well as early recognition of fluid imbalance symptoms is necessary for effective patient care.