Normal Conditions & Body Fluid – Healthcare & Nursing

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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


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