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CAPILLARY EXCHANGE
The 5% of the blood in systemic capillaries the bulk of blood that exchanges materials with systemic tissue
cells.
Substances that pass through thin capillary walls into interstitial fluid and then into cells are:
a. Nutrients b. Oxygen
Substances that are secreted by tissue cells and are removed from the are:
a. Wastes b. Carbon dioxide
Extracellular space
25 %
Fluids outside the cells.
Maintains blood volume.
Transport system to and from the cell.
a. Interstitial ¾
Contains fluids that surrounds the cells
e.g. Lymph
b. Intravascular ¼
Fluid within the blood vessels.
c. Transcellular
Smallest division of ECF comapartments.
e.g. Cerebrospinal fluid, synovial, intraocular and pleural fluids, sweat and digestive secretions.
BODY WATER
Distributions vary with age and sex.
a. Infant – 80 %
b. Male - 60 %
c. Female – 50 %
(Fat is water free. Females have more adipose tissues, so they have lesser percentage of body water.)
ELECTROLYTES
Chemical compounds in solution that have the ability to conduct an electrical current.
Are substances that, when in solution separate into electrically charged particles called Ions.
FUNCTION OF ELECTROLYTES
Promote neuromuscular irritability.
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Maintain body fluid volume and osmolarity.
Distribute water between fluid compartments.
Regulate acid – base imbalance.
1. Kidney
Regulates ECF volume and osmolality by selective retention and excretion of body fluids.
Regulation of electrolyte levels in the ECF by selective retention of needed substances and excretion of
unneeded substances.
Regulation of pH of the ECF by retention of hydrogen ions.
Excretion of metabolic waste and toxic substances.
3. Lungs
Through the exhalation the lungs remove water.
Maintains acid – base balance.
4. Pituitary
Release ADH that retains water.
Maintaining the osmotic pressure of the cells by controlling the retention and excretion of water by the
kidneys and by regulating blood volume.
5. Adrenal
Secretes Aldosterone that causes sodium retention and potassium loss.
6. Parathyroid
PTH influences bone reabsorption, calcium absorption from the intestine and calcium reabsorption from
the tubules.
Intake Output
Water in food = 1,000 mls Skin = 500 mls
Water from oxidation = 300 mls Lungs = 300 mls
Water as liquid = 1,200 mls Feces = 150 mls
Kidneys = 1,500 mls
TOTAL : 2,500 mls
TOTAL : 2,500 mls
1. Antiduiretic Hormone
Restore blood volume by reducing diuresis and increasing water retention.
Hypothalamus senses low volume and increased serum osmolality and signals the pituitary gland.
Pituitary gland secretes ADH into the blood stream
Kidneys retain water
Water retention
Increased blood volume and serum osmolality
3. Aldosterone
Acts to regulate fluid volume.
TRANSPORT MECHANISM
1. Diffusion
Substances move from an area of higher concentration to and area of lower concentration.
2. Osmosis
Water moves from an area of higher concentration to an area of lower concentration.
Is the diffusion of water caused by fluid gradient.
Tonicity
Is the ability of solutes to cause osmotic driving force that promotes water movement from one
compartment to another.
Osmotic Pressure
Is the amount of hydrostatic pressure needed to stop the flow of water by osmosis.
Oncotic Pressure
Is the osmotic pressure exerted by proteins (e.g. albumin).
Osmotic Diuresis
Is the increase in urine output caused by the excretion of substance.
Filtration
Movement of water and solutes from an area of high hydrostatic pressure to an area of low
hydrostatic pressure.
Osmolality
Reflects the concentration of fluid that affects the movements of water between fluid
compartments by osmosis.
2. Pinocytosis
Tiny vacuoles take droplets of fluid containing dissolve substances into the cell.
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b. Potassium
The major ICF cation and regulates intracellular osmolality.
Important in the conduction of nerve impulses and promotion of proper skeletal and cardiac muscle
activity.
The major excretion site of excess potassium is the kidney.
Aldosterone
Increased the amount of K secreted of K from distal tubules s.K.
Hydrogen Ion
Hydrogen Ion concentration
Hyperkalemia
c. Calcium
Promotion of neuromuscular irritability and muscular contrations.
Calcium and Phosphorus: 99% found in bones and teeth, 1% in blood.
Calcium and Phosphorus have inverse relationship.
If both are elevated insoluble precipitate.
total CHON and albumin - total s.Ca.
Parathormone s. Ca PTH release Ca is withdrawn from the bones.
Ca absorption in GIT
s. Ca. Ca reabsorption in renal
tubules
Risk Factors
Danger Signs
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h. Weight loss k. Weak or absent peripheral pulses
i. Flat jugular veins l. Shock
j. Decreased central venous pressure
Diagnostic test
1. Normal or high serum sodium > 145 mEq/L 3. Elevated creatinine and BUN ratio
2. Hemorrhage – decreased hemoglobin and 4. Increase urine specific gravity
hematocrit 5. Increased serum osmolality
Medical Management
1. IV fluids replacement
2. Blood transfusion
3. Vasopressors such as dopamine
4. Oxygen therapy
5. Surgery
Nursing Intervention
Risk Factors
Diagnostic Findings
a. Low hematocrit
b. Low serum potassium and BUN levels
c. Decreased serum osmolality
d. Low O2 level
e. Pulmonary congestion through X - ray
Medical Management
Nursing Intervention
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1. Assess patient’s vital signs and hemodynamic 6. Follow ABG result and watch for a drop in O2
status. level or changes in acid – base balance.
2. Monitor for respiratory patterns for worsening 7. Raise the head of the bed.
distress. 8. Restrict fluid intake.
3. Watch for distended veins in hands and neck. 9. Maintain IV access for administration of
4. Record intake and output hourly. medications.
5. Listen to breath sounds regularly to assess for 10. Weigh the patient daily.
pulmonary edema. 11. Offer emotional support.
HYPERALDOSTERONISM
Iatrogenic hypervolemia: Mistake made by Health Care Staff …. Too much IV fluids!
ELECTROLYTES AND ITS IMBALANCES
HYPONATREMIA
Sodium loss or water excess
Etiology
Collaborative Management
1. Treatment of shock
2. Replace other electrolytes depleted (K, Ca, HCO3)
3. Salt, salty foods in diet
4. Safety precaution (e.g. Use of side rails and supervision of ambulation)
HYPER NATREMIA
Na and water excess edema: Excess Na in relation to water in ECF Hypernatremia
Etiology
More water than Na is lost from the body such as Rapid infusion of saline or IV
hyperventilation and diarrhea. Water deprivation
High Sodium intake
Salt tablets Na ECF osmolality ICF moves into ECF
ICF dehydration
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a. Extreme thirst f. Tachycardia
b. Dry, sticky mucous membrane g. Fatigue
c. Oliguria h. Restlessness
d. Firm, rubbery tissue turgor, excitement, i. Disorientation
agitation j. Hallucination
e. Red, dry, swollen tongue
Collaborative Management
1. Monitor I and O.
2. Restrict sodium in diet.
3. Monitor behavioral changes.
4. Increase oral fluids or D5W / IV.
5. Diuretics
6. Dialysis
Dietary Sources
• Banana
• Dried fruits (raisin, prunes)
• Orange
• Raw carrot
• Raw tomato
• Baked potato
• Melon (Cantaloupe)
• Watermelon
HYPOKALEMIA
HYPOKALEMIA
CV
MUSCLE KIDNEY
GIT
CNS Decreased in
Weakness Anorexia
standing BP
Anorexia Capacity
Lethargy Dysrhythmias
Nausea and Flaccid paralysis concentration
Diminished
vomiting Weakness of waste
deep tendon ECG changes
Abdominial respiratory muscles
reflexes
distention Water loss
Confusion Myocardial
Respiratory arrest
Mental damage
Paralytic ileus (Probably cause of Thirst
depression
death in
Cardiac Arrest
hypokalemia) Kidney Damage
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Collaborative Management
HYPERKALEMIA
HYPERKALEMIA
MUSCLES CV
CNS KIDNEY
GIT
(Early) Conduction
Numbness Irritability disturbance Oliguria
Nausea and
(Late)
vomiting
Tingling Weakness Ventricular
sensation fibrillation
Diarrhea Colic
Flaccid Cardiac Arrest Anuria
Paralysis
Collaborative Management
GI TRACT CV
BONES CNS MUSCLES
OTHER
Increased Dysrhymias
Osteoporosis Tingling Muscle Spasm
Abnormal Peristalsis
deposits of
calcium body Nausea and
tissue Vomiting Cardiac Arrest
Fracture Convulsion Tetany
Diarrhea
Increases Calcium blocking effect on cell membrane permeability depressed nerve and muscle
activity.
When a person is immobilized, Calcium leaves the bones and concentrate in ECF precipitates and forms
stones in the kidneys.
Collaborative Management
HYPERCALCEMIA
HYPERCALCEMIA
MUSCLES
KIDNEY CNS CV
BONES
Muscles fatigue,
Stones Deep tendon Hypotonia Depressed activity
Bone pain
reflexes
Dysrhythmias
Osteoporosis
Lethargy Gastrointestinal
Kidney Tract
Fracture
Damage Coma Cardiac Arrest
Collaborative Management
1. Increased fluid intake (3-4 L/day). To reduce risk of stone formation in the kidneys (Urolithiasis) and relieve
thirst due to polyuria.
2. Acid – ash fruit juices (prune juices and cranberry), ascorbic acid. Acidic urine inhibits stone formation in the
kidney.
3. NSS / IV and diuretic. Calcium excretion is promoted by Sodium excretion.
4. Mithramycin (mithracin). It reduces serum Calcium level.
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5. Protect from injury to avoid fracture.
Dietary sources
• Green leafy vegetables such as spinach and • Peas
broccoli • Potatoes
• Avocado • Pork, Beef and Chicken
• Canned white tuna fish • Raisins
• Low fat yogurt • Peanut butter
• Cooked rolled oats • Cauliflower
• Milk
HYPOMAGNESEMIA (Tetany)
HYPOMAGNESEMIA
MENTAL CNS CV
CHANGES MUSCLES
Convulsion Tachycardia
Agitation Cramps
Paresthesias Hypotension
Depression Spasticity
Tremor Dysrhythmias
Tetany
Confusion Ataxia
Collaborative Management
1. Dietary supplement : Fruit, green vegetables, whole grains, cereal, milk, meat, nuts, and seafoods.
2. Magnesium sulfate oral / parenteral.
3. Promote safety, prevention from injury.
4. Monitor for laryngeal stridor.
5. Correct underlying cause.
HYPERMAGNESEMIA (Weakness)
Etiology
Renal failure
Diabetic ketoacidosis
Frequent use of magnesiem – containing antacids or cathartics.
a. Decreased BP
b. Thirst, nausea and vomiting
c. Drowsiness
d. Loss of DTR’s (deep tendon reflexes)
Collaborative Management
1. Calcium Gluconate / IV
Antagonist of Magnesium
2. Dialysis – if with Renal Failure
3. Correction of underlying cause.
HYPOPHOSPHATEMIA
Occurs when serum level falls below 1.8 mEq/L.
Etiology
Medical Management
1. Phosphorus replacement
2. High phosphorus diet
3. Neura – Phos and Neura – Phos – K
4. IV phosphorus replacement
Nursing Management
1. Monitor for sign and symptoms of this 4. Monitor rate and depth of respirations.
imbalance. 5. Monitor for signs of heart failure.
2. Monitor vital signs. 6. Ensure client maintains bed rest.
3. Assess the patient’s level of consciousness and 7. Record intake and output.
neurologic status.
HYPERPHOSPHATEMIA
Occurs when serum phosphorus level exceed 2.6 mEq/L.
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Risk Factors
a. Hypocalcemia d. Hyperreflexia
b. Paresthesia e. (+) chvostek’s test and trousseau’s sign.
c. Muscle spasm f. Delirium and seizures
Medical Management
Nursing Intervention
G. Bicarbonate (HCO3) :
Present in ECF.
Regulates acid – base balance.
Edema
Capillary acid
Carbon dioxide dissolved in plasma
Buffers
Carbonic Acid
Carbonic dioxide dissolved in plasma.
Normal Values
pH = 7.35 – 3.45
pCO2 = 35 – 45 mmHg
HCO3 = 22 – 26 mEq/L
Steps in ABG Analysis
1. Determine the pH
a. Low = ACIDIC
b. High = ALKALOSIS
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2. Determine the area affected
a. Lungs = RESPIRATORY
b. Kidneys = METABOLIC
HCO3
RESPIRATORY pH pCO2
COMPENSATED UNCOMPENSATED
Acidosis N or
Alkalosis N or
pCO2
METABOLIC pH HCO3
COMPENSATED UNCOMPENSATED
Acidosis N or
Alkalosis N or
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