Normal Conditions & Body Fluid – Healthcare & Nursing
These Healthcare & Nursing chapters discuss Homeostasis, Fluid status, Normal Conditions & Body Fluid, Drug & Nutrition therapy, Patient safety, Skin measures,interventions, Respiratory and Cardiac Manifestations, Fluid balance and Lab tests – Healthcare & Nursing.
Homeostasis
Maintenance of normal conditions within the body
Body works best when conditions are kept within narrow range of normal
2 liter loss or gain upsets the balance
Vital To Life
Most common substance in body
Delivers nutrients, electrolytes and substances to all organs, tissues and cells
Most cellular functions occur in a watery environment
Body Fluids & Distribution
-Infants >body water than adults
-Adults >than elderly
—Age Related Changes
-Adipose tissues have almost no water
Normal Body Fluid
Water and dissolved particles/electrolytes
Changes in water or electrolytes in body fluid can affect functioning of all cells, tissues and organs
Blood is the entrance and exit point for all fluid and electrolytes into body
Body Fluid Compartments
Intracellular Fluid
Extracellular Fluid
Intravascular Fluid
Plasma, serum and portions of blood
Interstitial Fluid
Fluid in the tissue space between and around cells
Body Fluid Exchange Between Compartments
-Capillary membranes separate:
–intravascular space
–Interstitial space
-Solutes and water move in both directions through semipermeable membranes
Principles of Fluid and Electrolyte Movement
Homeostasis: Balancing water and molecule movement, from one fluid compartment to another
Mechanisms of maintenance:
Passive
Osmosis
Diffusion
Filtration
Active
Active Transport
Osmosis
The movement of FLUID through a semipermeable membrane
From area of low solute concentration to an area of higher solute concentration until equilibrium
Diffusion
SOLUTES move from an area of higher concentration to an area of lower concentration
Particle Concentration: Osmolarity
Concentration of particles in a volume of solution
Normal osmolarity of body fluids: 270-300 mOsm/L
Osmolarity is equal between intra and extra cellular compartments-isotonic
Brain measures osmolarity of blood and stimulates thirst
How It Works
Matt sweats while running
Loss of water from skin to cool body
Water pulled from the blood to replenish cells
Blood becomes more concentrated
Osmoreceptors stimulate thirst & water retention
Filtration
Movement of FLUID through a membrane by pressure
Hydrostatic pressure(water pushing)
Capillary osmotic pressure
(water pulling)
Lymph- removes excess fluid from interstitial compartment
Active Transport
SOLUTES move from an area with lower concentration to an area of higher concentration
REQUIRES ENERGY
Adenosine triphosphate (ATP)
Concept Checker
Why does edema occur?
check notes
Fluid Balance
Maintained through intake and output
I & O must be fairly equal
Fluids are constantly purified and replaced
Water exchanges continuously between all compartments
Fluid Intake
Regulated by brain “Thirst”
Response to rising osmolarity or decreasing blood volume
Average intake:
1500 ml liquids
800 ml solids
Fluid Loss
Regulated by kidneys & various hormones
Daily output varies according to intake and needs
Minimal amount of 400-600 ml/day needed to excrete wastes
Insensible water loss from skin, GI, and lungs
Uncontrolled and can be significant
Can lose 2 L an hour from sweating
Diarrhea, drains
Hyperventilation
Hormonal Influences
Regulation of Water Balance
Aldosterone
Antidiuretic Hormone (ADH)
Vasopressin
Natriuretic peptides (NP)
Aldosterone
Decreased NA+ in blood stimulates release of Aldosterone from Adrenal Gland—–>Aldosterone triggers Kidney tubules to Hang on to water and NA+—–>Increases blood osmolarity and blood volume to normal——->
Atrial Natriuretic Peptides (ANP)
Cardiac hormone
Blocks the effect of aldosterone
ANP lower B/P and reduces intravascular blood volume
Fluid Assessment
Systems approach
Mental Status
Fluid volume changes result in changes in mental status
Cardiovascular
BP
Quality and rate of pulses
Peripheral vein filling
Neck veins/JVD
Peripheral edema
fluid assessment
Respiratory
Crackles
Skin
Turgor
Mucus membranes
I&O
Insensible loses
Drainage
Hemorrhage
Dehydration
-Fluid intake less than needed to meet daily needs
-Can result from actual decrease in total body water
Too little intake or too great of loss
-Can occur with no actual loss of body water
-Fluid shifts from plasma into interstitial fluid or other space “Third Spacing”
-Prolonged dehydration can result in decreased blood volume
-Decreased blood volume is HYPOVOLEMIA
-Vital organs may be in danger if inadequate tissue perfusion
-If uncorrected can lead to shock and death
High Risk for Elderly
Less total body water
Decreased thirst
Difficulty obtaining fluids
May be on fluid depleting drugs
Diuretics
Laxatives
Clinical Manifestations for neuro, cardio, resp, skin
Neuro
Confusion
Lethargy
Low grade fever
Cardiovascular
Elevated heart rate
Orthostatic hypotension
Dizziness
Flat hand veins
Respiratory
Increased rate
Skin
Poor Turgor
Assess turgor in older adults over sternum, hand not reliable
Mucus membranes dry
Dry skin
Tongue furrowed
Clinical Manifestations
Renal
Decreased urine output
Concentrated urine
Less than 500 ml per 24 hours cause for concern in patients without renal disease
Call MD for UO < 30 ml hour
Lab Tests
No single test for dehydration
Most changes due to hemoconcentration
Elevated H & H
Serum elevation osmolarity
Elevated BUN, protein
Nursing Interventions
Goals:
Prevent injury
Prevent further loss
Increase fluid intake
Patient Safety Priority
Monitor vital signs
Check and Monitor LOC
Monitor for orthostatic hypotension
Assess fall risk
Assess gait, muscle strength in legs
Normal Conditions & Body Fluid – Healthcare & Nursing
Safety Interventions
Assess LOC
Orient patient to environment
Assess for orthostatic hypotension
Check leg muscle strength
Assess swallowing
Implement fall precautions when indicated
Provide a safe environment
Call light in reach, low bed
Fluid Replacement
Mild to moderate-Oral replacement
Place of fluid schedule
Offer hourly
Educate your co-workers of plan
Severe dehydration-IV fluids
Rate determined by degree of dehydration & other chronic conditions such as CHF, renal failure
Priority Assessment During Rehydration
Pulse rate & quality
Urine output
Overhydration
Excess of body fluid
Intake or retention is more than body needs
Excessive intake
Inadequate excretion
Common Causes Overhydration
Excess sodium or fluid intake
Over hydration with IV fluids
Blood or plasma replacement
High intake of dietary sodium
Fluid and sodium retention
Cardiac disease
Renal disease
Long-term steroid use
SIADH Syndrome of inappropriate diuretic hormone
Key Features fpr overhydration
Neurological changes
Altered LOC
Headache
Skeletal muscle weakness
Cardiac Manifestations
Cardiac
Increased pulse rate
Bounding pulses
Elevated blood pressure
Distended neck veins
Respiratory Manifestations
SOB
Increased rate
Crackles
Skin
Cool
Pale
Pitting edema
Lab Changes
Serum electrolytes normal
H & H decreased due to hemodilution
Interventions
Goal of therapy:
Patient safety
Restore normal fluid balance
Supportive care
Prevent further overload
Patient Safety
Identify patients at risk before occurs
Prevent from becoming worse-can lead to heart failure, pulmonary edema and death Can occur quickly
All patients are at risk for pulmonary edema and heart failure-not just the elderly
Monitor for indicators of overload and report promptly to MD or call rapid response team
Educate your unlicensed patient care assistants (UAP)
Skin Measures
Protect edematous skin from breakdown
Pressure relieving mattresses
Assess pressure points
Change positions every 2 hours
Drug & Nutrition Therapy
Diuretics to remove fluids
Monitor for electrolyte depletion
Restrict fluids
Restrict sodium
No added salt
Fluid Status
I & O
Daily weights
Rapid weight gain indicator of retention
Weigh same time on same scales daily
If in renal failure may need dialysis