Cairan Dan Elektrolit Sawab

Fluid and Electrolytes
Copyright 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Why nurses need to understand
fluid and electrolytes?
Penting untuk mengantisipasi risiko
perubahan dalam keseimbangan cairan
dan elektrolit berhubungan faktor tertentu
dan terapi medis , untuk mengenali tanda-
tanda dan gejala ketidakseimbangan , dan
untuk membantu memberikan tindakan
yang tepat .
Apa itu homeostasis?
Proses fisiologis yang mengatur intake
dan output cairan melalui pergerakan
cairan ataupun substansi yang larut
dalam cairan tsb antara kompartemen
tubuh kita
What are the factors that influence
body fluids?
Age Body fat content
Thin people >
body fluids in obese as fat cells
younger than older contain little water
Sex Environmental
Male>Female factors
Enhanced understanding and management
of fluids and electrolytes
Composition of body fluids
Fluid compartments/Extracellular fluid osmolality
Factors that affect movement of water and
solutes
Regulation of vascular volume
Facilitated by clinical condition understanding,
nursing assessment, lab analysis
(water content of body)
60% of body weight in adult
45% to 55% in older adults
70% to 80% in infants
Varies with gender, body mass, and age
7
Changes in Water Content with
Age
Fig. 17-1
Selain air , tubuh berisi zat terlarut ; zat terpisah
dalam larutan dan melakukan arus listrik .
Konsentrasi zat terlarut dalam larutan = osmolalitas
atau osmolaritas
May by electrolytes or non-electrolytes:
Cations(+), Na, K
Anions (-), CL, HCO-3 (bicarbonate), PO
Non-electrolytes (glucose, urea, creatinine, bilirubin)
Fluid Compartments
Intracellular fluid (ICF): Located within
cells
42% of body weight
Extracellular fluid (ECF)-found outside cell
Intravascular (plasma)
Interstitial
lymph
Transcellular
30% of body weight
Fluid Compartments of the Body
Fig. 17-2
Transcellular Fluid
Part of ECF
Small but important/Approximately 1
Includes fluid in
Cerebrospinal fluid
Pericardial fluid
Pleural spaces
Synovial spaces
Intraocular fluid
Digestive secretions
Factors that affect Fluid and
Electrolyte Movement
Membranes
Osmosis
Diffusion
Facilitated diffusion
Active transport
Hydrostatic pressure
Oncotic pressure
Membrane physiology
Transport process
Osmosis
Diffusion
Active transport
filtration
Osmosis
Movement of water between two
compartments by a membrane permeable
to water but not to solute
Moves from low solute to high solute
concentration
Requires no energy
Terms associated with osmosis
Osmotic Pressure: amount of pressure required to stop
osmotic flow of water. Determined by concentration of
solutes in solution
Oncotic pressure: pressure exerted by colloids
(proteins, such as albumin)
Osmotic diuresis: increased urine output (caused by
substances such as mannitol, glucose or contrast
medium)
Osmotic movement of fluids
Cells affected by osmolality of the fluid that
surrounds them.
Isotonic-fluid with same osmolality as cell interior
Hypotonic (hypoosmolar)-solutes are less
concentrated than cells.
hypertonic (hyperosmolar)-solutes more
concentrated than cells.
Diffusion
Random movement of particles in all
directions from an area of high
concentration to low concentration.
Active transport
Relies on availability of carrier substances,
utilizes energy (ATP), to transport solutes
in and out of cells.
Na, K, hydrogen, glucose, amino-acids,
Filtration
Movement of water and solutes from area
of high hydrostatic pressure to area of low
hydrostatic pressure that is created by
weight of fluid. Kidney is example; (filters
180L/day plasma)
Hydrostatic Pressure
Force within a fluid compartment
Major force that pushes water out of
vascular system at capillary level
Fluid Movement in Capillaries
Amount and direction of movement
determined by
Capillary hydrostatic pressure
Plasma oncotic pressure
Interstitial hydrostatic pressure
Interstitial oncotic pressure
Fluid Exchange Between
Capillary and Tissue
Fig. 17-8
Fluid Shifts
Plasma to interstitial fluid shift results in
edema
Elevation of hydrostatic pressure
Decrease in plasma oncotic pressure
Elevation of interstitial oncotic pressure
Fluid Shifts (Contd)
Interstitial fluid to plasma
Fluid drawn into plasma space with increase
in plasma osmotic or oncotic pressure
Compression stockings decrease peripheral
edema
Fluid Movement between
ECF and ICF
Water deficit (increased ECF)
Associated with symptoms that result from cell
shrinkage as water is pulled into vascular
system
Fluid Movement between
ECF and ICF (Contd)
Water excess (decreased ECF)
Develops from gain or retention of excess
water
Fluid Spacing
First spacing
Normal distribution of fluid in ICF and ECF
Second spacing
Abnormal accumulation of interstitial fluid
(edema)
Fluid Spacing (Contd)
Third spacing
Fluid accumulation in part of body where it is
not easily exchanged with ECF; fluid trapped
and unavailable for functional use (ascites)
3rd spacing, fluid shift from
intravascular to interstitial space;
edema
Regulation of Water Balance
Hypothalamic regulation
Pituitary regulation
Adrenal cortical regulation
Renal regulation
Cardiac regulation
Gastrointestinal regulation
Insensible water loss
Normal fluid balance
Intake: fluids, food, oxidation=~2500ml
Output: skin and lungs (insensible loss)-900ml, feces-100ml,
urine-1500ml=~2500ml/day
Hypothalamic Regulation
Osmoreseptor dalam hipotalamus.
Osmoreceptors in Intake cairan meningkat
hypothalamus sense -rangsang haus akan mengeluarkan

hormone antidiuretic (ADH)
fluid deficit or
increase
Osmoreseptor dalam arti
Stimulates thirst and hipotalamus defisit cairan atau
antidiuretic hormone meningkat Merangsang rasa haus
dan hormon antidiuretik ( ADH )
(ADH) release rilis Mengakibatkan peningkatan air
Result in increased bebas dan penurunan osmolaritas
free water and plasma
-
decreased plasma
osmolarity
Pituitary Regulation
Under control of hypothalamus, posterior
pituitary releases ADH
Stress, nausea, nicotine, and morphine
also stimulate ADH release
Di bawah kendali hipotalamus , hipofisis

posterior melepaskan ADH Stres , mual ,
nikotin , dan morfin juga merangsang ADH
rilis
Adrenal Cortical Regulation
Releases hormones to regulate water and
electrolytes
Glucocorticoids
Cortisol
Mineralocorticoids
Aldosterone
Rilis hormon untuk mengatur air dan elektrolit
glukokortikoid
kortisol
mineralokortikoid
aldosteron
Factors Affecting Aldosterone
Secretion
Fig. 17-9
Renal Regulation
Primary organs for regulating fluid and
electrolyte balance
Adjusting urine volume
Selective reabsorption of water and electrolytes
Renal tubules are sites of action of ADH and
aldosterone
organ utama untuk mengatur keseimbangan
cairan dan elektrolit Menyesuaikan volume
urin reabsorpsi selektif air dan elektrolit
tubulus ginjal adalah situs tindakan ADH
dan aldosteron
Effects of Stress on F&E
Balance
Fig. 17-10
Cardiac Regulation
Natriuretic peptides are antagonists to the
RAAS
Produced by cardiomyocytes in response to
increased atrial pressure
Suppress secretion of aldosterone, renin, and
ADH to decrease blood volume and pressure
Gastrointestinal Regulation
Oral intake accounts for most water
Small amounts of water are eliminated by
gastrointestinal tract in feces
Diarrhea and vomiting can lead to
significant fluid and electrolyte loss
account asupan oral untuk sebagian besar
air sejumlah kecil air dieliminasi oleh
saluran pencernaan di tinja Diare dan
muntah dapat menyebabkan cairan
signifikan dan elektrolit lo
Insensible Water Loss
Invisible vaporization from lungs and skin
to regulate body temperature
Approximately 600 to 900 ml/day
is lost
No electrolytes are lost
Gerontologic Considerations
Structural changes in kidneys decrease
ability to conserve water
Hormonal changes lead to decrease in
ADH and ANP
Loss of subcutaneous tissue leads to
increased loss of moisture
Gerontologic Considerations (Contd)
Reduced thirst mechanism results in
decreased fluid intake
Nurse must assess for these changes and
implement treatment accordingly
Mengurangi hasil mekanisme rasa haus di
asupan cairan menurun Perawat harus
mengkaji perubahan ini dan menerapkan
pengobatan sesuai
Fluid and Electrolyte
Imbalances
Common in most patients with illness
Directly caused by illness or disease (burns or
heart failure)
Result of therapeutic measures
(IV fluid replacement or diuretics)
Umum pada kebanyakan pasien dengan
penyakit Langsung disebabkan oleh
penyakit atau penyakit ( luka bakar atau
gagal jantung ) Akibat tindakan terapeutik
( IV penggantian cairan atau diuretik )
Extracellular Fluid Volume
Imbalances
ECF volume deficit (hypovolemia)
Abnormal loss of normal body fluids (diarrhea,
fistula drainage, hemorrhage), inadequate
intake , or plasma-to-interstitial fluid shift
Treatment: replace water and electrolytes with
balanced IV solutions
ECF Defisit volume ( hipovolemia ) kehilangan abnormal
cairan yang normal tubuh ( diare , fistula drainase ,
perdarahan ) , asupan yang tidak memadai , atau
plasma - to- interstitial pergeseran cairan Pengobatan:
menggantikan air dan elektrolit dengan solusi IV yang
seimbang
Extracellular Fluid Volume
Imbalances (Contd)
Fluid volume excess (hypervolemia)
Excessive intake of fluids, abnormal retention
of fluids (CHF), or interstitial-to-plasma fluid
shift
Treatment: remove fluid without changing
electrolyte composition or osmolality of ECF
volume cairan berlebih ( hypervolemia ) Asupan
berlebihan cairan , retensi abnormal cairan (
CHF ) , atau interstitial - to- plasma pergeseran
cairan Pengobatan : mengeluarkan cairan tanpa
mengubah komposisi elektrolit atau osmolalitas
CES Copyright 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Nursing Management
Nursing Diagnoses
Hypovolemia
Deficient fluid volume
Decreased cardiac output
Potential complication: hypovolemic shock
Nursing Management
Nursing Implementation
(Contd)
Neurologic function
LOC
PERLA
Voluntary movement of extremities
Muscle strength
Reflexes
Nursing Management
Nursing Diagnoses (Contd)
Hypervolemia
Excess fluid volume
Ineffective airway clearance
Risk for impaired skin integrity
Disturbed body image
Potential complications: pulmonary edema,
ascites
Nursing Management
Nursing Implementation
I&O
Monitor cardiovascular changes
Assess respiratory status and monitor
changes
Daily weights
Skin assessment
Electrolytes
Substances whose molecules dissociate
into ions (charged particles) when placed
into water
Cations: positively charged (Na, K, Ca2, Mg2)
Anions: negatively charged (HCO3, CL, PO4 3)
Measurement; International standard is millimoles per liter
(mmol/L), U.S. uses milliequivalent (mEq)
Ions combine mEq for mEq
Electrolyte Composition
ICF
Prevalent cation is K+
Prevalent anion is PO43-
ECF
Prevalent cation is Na+
Prevalent anion is Cl-
Sodium
Serum levels; 135-145mEq/L
Responsible for water balance and
determination of plasma osmolality
Cation+,plays a major role in
ECF volume and concentration (movement of Cl-
closely associated with Na+)
Imbalances can exist in different volume
states: euvolemia (normal volume), hypovolemia (low volume),
hypervolemia (increased volume)
Na+ (continued)
Generation and transmission of nerve
impulses
Acidbase balance (combining HCO3 and CL to alter
pH)
Impacted by hormonal control (aldosterone, ADH)
Dietary level: current recommendation 500mg-2300mg/day,

Western diet; 4000-6000mg/day!!! Primary source; table salt (NaCL)
Differential Assessment of
ECF Volume
Fig. 17-12
Potassium
Major cation of ICF
Serum level: 3.5-5.0mEq/L
Necessary for
Transmission and conduction of nerve and
muscle impulses
Control via sodium-potassium pump (contained
within cell membrane of all cells/utilizes ATP)
Inverse relationship between Na+ and K+reabsorption in the
kidney; factors that cause Na+ retention cause K+ loss in the
urine.
K+ (continued)
Kidneys eliminate 90% of K+, thus if renal function
impaired, toxic levels may be retained.
Dietary level: 40-60mEq/day, Western diet inclusive of K+

salt substitutes may contain K+
Maintenance of cardiac rhythms/function

Acidbase balance
Calcium (Ca2+)
Function: transmission of nerve impulses,
muscle/myocardial contraction, blood clotting, formation
of teeth and bones
Balance controlled by PTH, calcitonin, vitamin D
Obtained from diet, daily need: 1-1.5G/d
More than 99% combined with phosphorus
and concentrated in skeletal system
Inverse relationship with phosphorus
Serum Level:8.5-10.5 mg/dl
Tests for Hypocalcemia
Fig. 17-15
Phosphate/phosphorus (PO4-/P+)
Serum Level: 2.5-4.5mg/dL
Primary anion in ICF
Essential to function of muscle, red blood
cells, nervous system and Ca+levels
Deposited with calcium for bone and tooth
structure, Ca+ and P+ exist in a reciprocal balance
Required for release of O2 from
hemoglobin
PO4- (continued)
Involved in acidbase buffering system
(phosphate buffer), ATP production, and cellular
uptake of glucose
90% excreted by Kidneys; requires
adequate renal functioning
Dietary level; intake via balanced diet,
daily need: 800-1600mg/dl
Magnesium
2nd most abundant cation in ICF
Serum level: 1.4-2.1 mEq/L
Daily need: 300-350mg (average Western diet
contains 170-720mg/day)
Coenzyme in metabolism of protein,

carbohydrate and Ca+ absorption and
utilization (Factors that regulate calcium balance appear to
influence magnesium balance)
Mg+ (continued)
Acts directly on myoneural junction to

transmit electrical impulses (relaxes lung muscles
that open airways)
Important for normal cardiac function
Powers Na+/K+ pump
Plays essential role in secretion and action
of insulin (impacts BG)
Chloride
Major ECF anion
Serum level: 95-108 mEq/L
Function; circulates with Na+ and H2O to
help maintain cellular integrity, fluid
balance and osmotic pressure
Affects acid/base balance (enzyme activator,
serves as buffer in exchange of O2 and CO2 in RBCs)
CL- (continued)
In conjunction with Ca+, Mg+, helps maintain
nerve transmission/muscle function
Vital role in production of HCL
Obtained primarily from foods (processed) and
table salt, daily need: ~750mg.
90% excreted by kidney
IV Fluids
Purposes
1. Maintenance
When oral intake is not adequate
2. Replacement
When losses have occurred
IV Fluids (Contd)
Hypotonic
More water than electrolytes
Pure water lyses RBCs
Water moves from ECF to ICF by osmosis
Usually maintenance fluids
Isotonic
Expands only ECF
No net loss or gain from ICF
IV Fluids (Contd)
Hypertonic
Initially expands and raises the osmolality of
ECF
Require frequent monitoring of
Blood pressure
Lung sounds
Serum sodium levels
D5W
Isotonic
Provides 170 cal/L
Free water
Moves into ICF
Increases renal solute excretion
Used to replace water losses and treat
hyponatremia
Does not provide electrolytes
Normal Saline (NS)
Isotonic
No calories
Expands IV volume
Preferred fluid for immediate response
Does not change ICF volume
Compatible with most medications/blood
administration
Lactated Ringers
Isotonic
More similar to plasma than NS
Has less NaCl
Has K, Ca, PO43-, lactate (metabolized to
HCO3)
Expands ECF
D5 NS
Hypertonic
Common maintenance fluid
KCl added for maintenance or
replacement
D10W
Hypertonic
Provides 340 kcal/L
Free water
Limit of dextrose concentration may be
infused peripherally
Plasma Expanders
Stay in vascular space and increase
osmotic pressure
Colloids (protein solutions)
Packed RBCs
Albumin
Plasma
Diuretics
Act by increasing volume of urine
production in tx of hypertension, heart
failure, and kidney disorders.
Electrolyte depletion common
(hypokalemia)
Nursing interventions
I&O, loc, nutritional status, monitor liver and
kidney function, observe for hypersensitivity,
monitor hearing and vision (loop/lasix are
ototoxic, thiazide may impact vision), monitor
alcohol and caffeine (diuretic), safety (oh),
monitor light exposure (photosensitivity), monitor
edema, labs, admin in am.
References
*Copyright@ by S. Buckley, 2012 (all rights reserved)
Medical-Surgical Nursing
Lewis, Heitkemper, Kirksen, Obrien, Bucher,
Tabers cyclopedic Medical Dictionary
Venes, 19th edition
Pharmacology, A nursing approach
Kee, Hayes, 3rd edition
Fluid and Electrolytes
Innerarity, Stark, 3rd edition
References (continued)
Fluid, Electrolyte, and Acid-base Balance
Heitz, Horne-Mosby, 4th edition
IV Therapy made incredibly Easy!
McCann, Lippincott, 3rd edition
Acute Renal Failure
Hudson, Rn, MSN
Electronic source; dynamicnursingeducation.com
Fluid & Electrolytes
Chernecky, Macklin, Murphy-ende, Saunders 2002
Fluids, Electrolytes & Acid-Base Balance
Hogan, Wane, Prentice Hall nursing

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Fluid and Electrolytes

hypothalamus sense -rangsang haus akan mengeluarkan

Di bawah kendali hipotalamus , hipofisis

Dietary level: current recommendation 500mg-2300mg/day,

Dietary level: 40-60mEq/day, Western diet inclusive of K+

Maintenance of cardiac rhythms/function

Coenzyme in metabolism of protein,

Acts directly on myoneural junction to

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