Medical Surgical Nursing LECTURE

By : Budek

I – FLUIDS AND ELECTROLYTES

ICF – 70%
ECF – 30%
Interstitial fluid : 25% Intravascular : 5%
Transcellular fluid : HCL, H20 and solutes in renal tubules and bladder , pleural fluid, CSF.

Infants : 80% Male : 60% Female : 50%

FUNCTIONS :

ICF
 Normal Body Temperature
 Internal medium for cellular function
 Elimination of waste products

ECF
 Maintains BLOOD VOLUME.
 Transport system TO and FROM the cell.

ELECTROLYTES – are chemical compound in a solution that can conduct electrical current.
+ CATION , - ANION = Ions are the CHARGED particles of an electrolyte.

PoPhoSoChlo = POPHOSOCHLO : Potassium IN , Phosphate IN, Sodium OUT, Chlorine OUT.

PiSo = PISO : Potassium IN, Sodium OUT.

FXN of ELECTROLYTES : DIBO : Distribution [ of water throughout the body]

Irritability [ Of the muscle ]
Balance [ Of acide base ]
Osmolarity [ Of the serum ]

Normal laboratory values of SERUM ELECTROLYTES :

Na : 135 – 145
K : 35 – 45
Ca : 4.5 – 5.5
HPO4 : 1.7 – 2.6
Cl – 98-108
Mg – 1.5-2.5

• All units are in MEQ/L

Normal fluid intake of an adult : 2,500 ml [ Food, Water… ]

Suggested water intake per day : 6-8 glasses of water a day.

SUMMARY :

1. Which Fluid Space regulates BODY TEMPERATURE ? ICF, ECF, Transcellular, Intravascular.
2. These are the electrically charged particles in the body. Electrolytes, Ion, Osmolarity, Sodium
3. Suggested intake of water in glasses per day. 6-8, 5-6, 3-8, 2-4.
4. Functions of EL except : Regulates Body Temp, Distribute Fluids, Muscular Irritability, Osmolarity.
5. Normal Serum Levels for all electrolytes..
OSMOLARITY : This is the total number of solutes / kg H20 normal value is 270-300 milliosmole / L

• Think that osmolarity is the number of salt in water. NA = WATER MAGNET

Hyperosmolarity : = Cellular dehydration [ Put a calamansi in a glass of salt, Salt attracts water…] SHRINKS
Hypoosmolarity : Cellular edema, Cerebral Edema. SWELLS

Side questions : 1. What diuretic drug is given to a person suffering from CEREBRAL EDEMA?
2. Dosage of the said drug and its action.
3. If a person drowned at sea, will you expect CELLULAR DEHYDRATION or EDEMA?
4. What is the 2 most common symptom of an increase ICP?
5. In an adult onset diabetes, If the person fails to take fluids and output increases than input, what will be
the possible end result ? HYPO or HYPEROSMOLARITY?

PRESSURES THAT INFLUENCES FLUID MOVEMENT [ ACTIVE TRANSPORT ]

1. BHP [ BLOOD HYDROSTATIC PRESSURE ] – Force exerted by the blood to the capillaries
2. Colloid Osmotic / Oncotic Pressure – Hold the fluid IN and opposes filtration.
-albumin : synthesized by the liver

FP = BHP – COP : FILTRATION PRESSURE

MOVEMENT OF FLUIDS

OSMOSIS
DIFFUSION
ACTIVE TRANSPORT

Which among this three needs energy? ATP comes from glucose.

Alteration in pressure/ Movement = EDEMA

Fluid inside a cavity is called THIRD SPACING.

Fluid inside the peritoneal cavity is :
Fluid inside the Pleural cavity is :
Blood inside Pericardial Cavity is :
Blood inside the Joint is :
Fluid in the lung is called : Characterized by : upon percussion.
Air in the lung is :

Pathophysiology of EDEMA
TX for edema….
DIURETICS
LASIX – 6 hours
Priority : check for potassium serum level.

HORMONES THAT REGULATES FLUID AND ELECTROLYTES

1. ADH
Produce by the hypothalamus and stored at the PPP.
Renal tubules are the target tissue. [ DCT ]
increases water reabsorption
decreases urine volume;increases blood volume
decreases blood osmolarity
 release is triggered by:

1. decreased blood pressure

2. increased blood osmolarity
3. decreased blood volume

2. RAA mechanism
Low in sodium, BP AND BV will stimulate the release of RENIN ANGIOTENSIN.

1. When blood pressure falls (for systolic, to 100 mm Hg or lower), the kidneys release the enzyme renin into the bloodstream.

2. Renin splits angiotensinogen, a large protein that circulates in the bloodstream, into pieces. One piece is angiotensin I.

3. Angiotensin I, which is relatively inactive, is split into pieces by angiotensin-converting enzyme (ACE). One piece is
angiotensin II, which is very active.

4. Angiotensin II, a hormone, causes the muscular walls of small arteries (arterioles) to constrict, increasing blood pressure.
Angiotensin II also triggers the release of the hormone aldosterone from the adrenal glands.

5. Aldosterone causes the kidneys to retain salt (sodium) and excrete potassium. The sodium causes water to be retained, thus
increasing blood volume and blood pressure.

ELECTROLYTES :

SODIUM : attracts water needed for blood serum osmolarity, responsible for neuromuscular functioning.
POTASSIUM : skeletal and cardiac muscle activity, has inverse relationship with hydrogen ions.
CALCIUM : promotes neuromuscular irritability and muscle contraction. Has inverse relationship with phosphate. Direct relationship
with albumin/protein.

CALCITONIN > INCREASES CALCIUM PTH : DECRESEASES SERUM CALCIUM.

ELECTROLYTE IMBALANCE :

1. HYPONATREMIA – <135 meq/L ; 2gms/day

- can be due to sodium loss or water excess [ HYPO/HYPER osmolarity ]
- Treatment with diuretics
- Loss from GI
- ADDISONS Disease [ Low aldosterone secretion ]
- Diaphoresis

*Headache, Muscle weakness, Fatigue and Apathy, Postural Hypotension, Feeling of apprehension, Coma, WT loss, Ab cramps.

MGT : IV .9%NACL, Plasma expanders, Replace other electrolytes depleted, Salt in the diet, Safety precaution.

2. HYPERNATREMIA - >145 meq/L

?What is the most common sign of HYPERNATREMIA?

- More water than sodium is lost from the body

- High sodium intake
- Water deprivation

• thirst, dry sticky mucus membrane, oliguria, red dry swollen tongue, poor skin turgor, tachy, restlessness, disorientation,
hallucination

MGT : I/O, restrict sodium, D5W IV, Diuretics, Dialysis.

POTASSIUM [ IRRITABILITY ]

3. HYPOKALEMIA < 3.5 reverse t , paralytic ileus

Mgt: KCl , Potassium sparing diuretics, Potassium rich foods. [kalium]

 4. HYPERKALEMIA >4.5 tall t , elevated st segment, prolonged qrs complex.

Mgt: Avoid potassium rich foods. 10% glucose with regular insulin, Polysterene Sulfonate [ KAYEXELATE P.O , enema] ,
Dialysis, CaGluconate, Bed rest.

Calcium – 2 types IONIZED > bound to plasma protein FREE IONIZED > Blood coagulation, Smooth Skeletal Cardiac muscle
function, Nerve function, Bone and teeth formation. [ INHIBITORY ]

Vit D and PTH : needed for calcium absorption in the GIT.

5. HYPOCALCEMIA

CHVOSTEK And TROSSEU , laryngeal stridor.

Most common cause is HYPOPTHdism.

MGT : calcium gluconate, Vit d and pth supplement, AL OH [ Phosphate binder ] , SAFETY : SEIZURE

6. HYPERCALCEMIA

MGT : Increase fluid intake, 3-4L. Acid ash diet [ cranberry, prunes juices ] increase VIT C. Diuretics, MITHRAMYCIN
[ MITHRACIN ]

Surgical mgt : PARTIAL PARATHYROIDECTOMY.

7. HYPOMAGNESEMIA [ MAGENSIUM IS SAME AS Ca, both are inhibitory ]

- TETANY, CHVOSTEK AND TROSSEU, HYPER DTR.

Mgt : dietary supplements, magnesium salts, safety and injury, laryngeal stridor.

8. HYPERMAGNESEMIA

Causes : renal failure, DKA, magnesium overdose.

Mg blocks acetylcholine = decrease motor activity.

Assessment : dec bp, thirst nausea vomiting, drowsiness and loss of DTR.

Mgt : ca gluconate, [ antagonizez Mg ] , Dialysis.

Discuss : ACID BASE IMBALANCE

Discuss : RIGHT AND LEFT SIDED FAILURE.