Fluids and ElectrolytesNSG 170THERESE WILLOUGHBY, MSN, RN
Total Body Water(TBW)Lots of happy little cells!
Fluid & Electrolytes on the Move▪Osmosis▪Movement of water▪Semi-permeable membrane▪between two fluid spaces where particles cannot move through▪Diffusion▪Movement of particles▪permeable membrane▪from higher concentration to lower▪Filtration▪Fluid movement ▪cell or blood vessel membrane▪hydrostatic (water) pressure differences▪Active Transport▪Movement of ions or molecules▪Cell membrane▪From lower to higher concentration▪Requires energy5Fluctuations in water and/or electrolytes in the body can be harmful or even fatal
Dehydration▪Fluid intake or fluid retention is less than what is needed to meet body’s fluid needs▪Deficit in fluid volume▪Common causes: ▪Contributing factors:▪Body compensatory measures:▪Types of Dehydration:▪hypernatremic, hyponatremic, isonatremicWhere salt goes – water follows!
Replacement Fluids▪See “IV Fluids” SheetNursing thoughts:▪Sudden change in cognition▪Encouraging fluids▪Fluid restriction order7WARNING: random nursing thoughts
Replacement FluidsCrystalloidsISOTONIC▪Normal Saline▪NS, 0.9% NaCl, Sodium Chloride▪Dextrose 5% in water▪D5W, D5▪Ringer’s Lactate▪LR, RL, Lactated ringersHYPOTONIC▪Half Normal Saline▪1/2NS, 0.45% NaClHYPERTONIC▪3% NaCl▪5% NaCl▪Dextrose 10% in water▪D10W▪Dextrose 5% in 0.45% NaCl▪D5 and 1/2▪Dextrose 5% in Lactated Ringer’s▪D5LR
Replacement FluidsCrystalloidsPotential problems when using crystalloids•Edema•peripheral•pulmonary•Dilution of plasma proteins (colloids) – reducing osmotic pressure•Prolonged use may worsen alkalosis or acidosis
Replacement FluidsColloids▪Albumin▪5%, 25%▪a blood protein – helps keep fluid in vasculature▪considered a blood transfusion product▪Fresh Frozen Plasma (FFP)▪Starches, dextrans, gelatins10
Replacement FluidsBlood and Blood Components▪Whole Blood▪Packed Red Blood Cells▪PRBCs▪Washed Red Blood Cells▪Platelets▪Fresh Frozen Plasma▪FFP▪White Blood Cells▪WBC; granulocytes11ONLY USE NORMAL SALINE WITH BLOOD PRODUCTS!!
Impact of Aging-Related Changes on Fluid BalanceSkin:▪Loss of elasticity, decreased turgor, decreased oil production▪So... skin becomes unreliable indicator of fluid status, especially back of hand; skin dry and easily damagedKidneys: •Decreased glomerular filtration, decreased