Basic Principles of Fluid Electrolyte and Acid Base

Basic Principles of Fluid, Electrolyte, and Acid. Base Balance Med-Surg 1 Unit 3 Medical Surgical Nursing 1 1

Introduction n n Fluids! Electrolytes! Acid-Base! Know your terms! Medical Surgical Nursing 1 2

Fluid and Electrolyte Balance n Fluid Compartments Intracellular n Extracellular n n Electrolytes Milliequivalent (m. Eq) per liter n Cations n Anions n Medical Surgical Nursing 1 3

Fluid and Electrolyte Balance n Kidneys-regulate electrolyte concentrations…how? n n n Selective retention and secretion of fluids Selective retention and secretion of electrolytes Regulating p. H Excretion of wastes and toxins Heart and Blood Vessels Lungs n n Factors that increase fluid loss Factors that decrease fluid loss Medical Surgical Nursing 1 4

Fluid Volume n Fluid Volume Deficit (FVD) or hypovolemia n n Causes Characteristics Interventions Fluid Volume Excess (FVE) or hypervolemia n n n Causes Characteristics Interventions Medical Surgical Nursing 1 5

Major Extracellular Electrolytes n Cations n n n Sodium(Na+) Potassium(K+) Calcium(Ca+) Magnesium(Mg+) Anions n n Chloride(Cl-) Bicarbonate(HCO 3 -) Phosphate(HPO 4 -) Sulfate(SO 4 -) Medical Surgical Nursing 1 6

Electrolyte Imbalance n Electrolytes must be in balance n n Electrolyte deficit nursing interventions Electrolyte excess nursing interventions Medical Surgical Nursing 1 7

Real Life n Is it fluid volume excess or fluid volume deficit? You tell me… Medical Surgical Nursing 1 8

Types of Electrolyte Disorders n n n Hyponatremia Hypernatremia Hypokalemia Hyperkalemia Hypocalcemia Hypercalcemia Medical Surgical Nursing 1 9

Types of Electrolyte Disorders n n Hypomagnesemia Hypermagnesemia Hypochloremia Hyperchloremia Medical Surgical Nursing 1 10

Electrolyte Supplements n n n Potassium Calcium Magnesium Medical Surgical Nursing 1 11

The Acid-Base Scale n n n Normal Range is 7. 35 to 7. 45 Anything below 7. 35 is acid Anything above 7. 45 is alkaline (or base) Medical Surgical Nursing 1 12

Acid-Base Balance n 2 types of acids produced n Volatile break down to form a gas Carbonic acid or H 2 CO 3 = H 2 O + CO 2 n Nonvolatile do not break down easily or form a gas Lactic acid Medical Surgical Nursing 1 13

3 Major Control or Buffer Systems n n n Chemical buffers Lungs Kidneys Medical Surgical Nursing 1 14

4 Types of Acid-Base Disturbances n n Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis Medical Surgical Nursing 1 15

Interpreting ABG’s n Determine p. H n n Normal 7. 35 -7. 45 Evaluate HCO 3(bicarbonate) and CO 2(carbonic acid) levels. n n HCO 3 Normal 24 -28 CO 2 Normal 35 -45 Medical Surgical Nursing 1 16

Interpreting ABG’s n Compensation-”normal” values gradually become abnormal to bring p. H into range Partial compensation n Compensated n Medical Surgical Nursing 1 17

Interpreting ABG’s n Now you decide… Medical Surgical Nursing 1 18