nursing skills

• ICF
• ECF
• INTERSTITIAL
• INTRAVASCULAR

• Fluid inside cells
• about 40% of total body weight
• 2/3 of total body fluid

• about 20% of total body weight
• 1/3 of total body fluid
• fluid outside cell
• composed of : Intravascular and Interstitial

Blood plasma

called 3rd space

Substance dissolved in a solution

Liquid with a substance in solution

ie - plasma protein

• Osmosis
• Difusion
• Osmotic Pressure
• Colloid Osmotic Pressure
• Filtration
• Active Transport

Movement of a SOLVENT through a membrane from higher to lower conc. through a semipermeable membrane

Movement of a SOLUTE from an area of higher concentration to lower conc. thru semipermeable membrane

• Isotonic
• Hypotonic
• Hypertonic

Same solute concentration

Higher solute conc.

Lower solute conc.

• Drawing power for water (solvent).
• Depends on number of molecules in solution (concentration)
• depends mostly on sodium

• Osmotic pressure created by plasma proteins which are too big to normally pass through capillary membrane
• most important protein responsible: ALBUMIN
• This pressure keeps fluid in the Intravascular Compartment

• Movement of water and diffusible substances in response to fluid pressure (hydrostatic pressure)
• Normally venous pressure is lower than interstitial pressure which allows movement into venous system

• Requires energy to transport material across cell membrane
• larger molecules than normally admitted such as glucose
• movement of substances from area of lower to higher concentrations, such as sodium potassium pump

• Responds to increased K+ levels
• promotes reabsorption of Na+ and excretion of K+ = reabsorption of water
• Angiotensin II stimulates release of Aldosterone

• enzyme secreted by kidneys in response to decreased renal perfusion
• Acts to produce angiotensin I and II which causes slective constriction and increased blood flow to kidneys

• after sx
• unstable condition
• Temp increase
• fluid restriction
• on diuretic or IV
• chronic cardiopulomary

• Skin - insensible water loss- continuous not perceived
• sensible water loss - thru excessive sweat

• Kidneys - respond to decreased volume or increased osmolality
• Gi Tract - Normally very little output, unless disease process (diarrhea, vomiting)
• Lungs

100/200 ml/day (insensible)

2000-3000 ml/day (sensible)

Insensible

Sensible

• Nerve Impulse Transmission
• Skeletal and Cardiac muscle function
• Acid-Base Balance
• Hormone Balance
• Water Balance

• most abundant electrolyte in ECF
• Maintains water balance
• Important for transmitting nerve impulses and muscle contraction
• regulated by salt intake, aldosterone, UO

• by taking in too much water, overhydration
• decrease in sodium
• symptoms: decreased LOC, sensorium, weakness, fatigue,

• caused: Dehydration
• Sx: similar to low level symptoms -- decreases LOC, disorientation, weaknes,, fatigue, THIRST

135-145

3.5-5

• most abundant in ICF
• Important in neuromuscular excitability and muscle contraction and electrical conductivity
• Involved in acid-base balance bc it can be exchanged with H+
• Regulated by kidneys : as K+ levels rise, kidneys excrete more K+

Kidneys to retain NA+ and excrete K+

• causes: Diuretics and vomiting
• S&S: cardiac dysrythmias, muscle cramps

• causes: renal disease, crush injuries
• S&S -cardiac abnormalities

• found in bones and teeth
• only 1% of body's Ca+ is in serum
• imp. for cell membrane integrity
• imp in cardiac impulse
• affects contraction of cardiac, smooth, and skeletal muscle
• involved in blood coagulation

• second most abundant cation in ICF
• promotes enzyme reactions
• helps body produce ATP
• influences Ca levels
• 30% of circulating Mg is bound to ALBUMIN
• =low albumin = low Mg
• alterations in MG = SERIOUS ILLNESS

• Most abundant anion in ECF
• imp for fluid acid and base balance
• contributes to gastric acid
• regulated by kidneys

135-145

3.5-5.0

90-110

24-30 an indirect measure of bicarbonate

7.35-7.45 (arterial)

• major ECF buffer in blood
• Functions with carbonic acid in maintaining acid-base balance
• Measured in venous blood indirectly as carbon dioxide content
• Regulated by kidneys

• Buffer Ion
• Helps maintain healthy teeth and bones
• regulated by kidneys
• calcium adn phosphate are inversley proportional

• respiration increases or decreases in respoonse to changes in pH
• works by changing blood levels in CO2
• rapid response to changes in pH

• Reabsorb or excrete bicarbonate and hydrogen in response to changes in pH
• takes from several hours to several days to regulate balance

HYPOVOLEMIA

• common with electrolyte loss
• causes: Vomiting/Diarrhea
• GI suctioning
• Hemorrhage
• Burns

• decreased BP
• Orthostatic BP Changes
• Increased HR
• decreased UO
• dizzy

• volume expanders- ALBUMIN
• this pulls fluid that has been sequestered in 3rd space
• O2
• Vasopressors
• Trendelenburg position

• S&S: increased sweating
• diarrhea
• decreased mental status
• dry mucous membranes
• poor skin turgor
• thirsty

• sodium increases and volume decreases
• major dif between hypovolmia and dehydration- is the cells are dehydrated

• fever
• excessive sweating
• diabetis insipidus

there is a shift of volume from cells and interstitial

treatment-give pt hypertonic fluid (dont do this in short amount of time)

• 2 issues: fluid overload & electrolyte overload
• excess isotonic fluid in extracellular compartment
• caused by: excessive isotonic fluid intake--excess Na+
• usually body compensates by excreting h20 and Na+

• can result in pulmonary edema
• hydrostatic pressure forces fluid out of vascular space into interstitial spaces and eventually alveoli of lung and interferes with oxygen exchange

• increased BP
• Edema
• SOB
• decreased Sats
• early stages- increased UO
• later stages- decreased UO

• restrict fluid, NA+ intake
• diuretics
• address cause

• less common
• water intoxication
• excess hypotonic fluid in extracellular space
• results in fluid moving to intracellular space-cellular edeuma

• SIADH
• rapid infusion of hypotonic fluids
• excess use of tap water enemas

• causes serum osmolality decreases
• fluid shifts into cells
• sodium decreases
• cererbral edema

• replace solutes to draw water out of cells
• fluid restriction
• increase hypertonic solution of sodium --dont do fast

0.9% sodium chloride