15-11-2012, 04:06 PM
FLUIDS and ELECTROLYTES
Fluids and Electrolytes.ppt (Size: 250 KB / Downloads: 43)
BODY FLUIDS
Functions of Fluids
Body fluids:
Facilitate in the transport [nutrients, hormones, proteins, & others…]
Aid in removal of cellular metabolic wastes
Provide medium for cellular metabolism
Regulate body temperature
Provide lubrication of musculoskeletal jts.
Component in all body cavities [parietal, pleural… fluids]
Water is the principal body fluid & essential for life.
OBLIGATORY Reabsorption
occurs in the proximal tubules
178 L/day of glomerular filtrate (80% reabsorbed)
2 to solute reabsorption
independent of the water requirement
FACULTATIVE Reabsorption
occurs in the distal & collecting tubules
independent of the active solute transport
dependent of body’s need of water
under the control of ADH
DISTURBANCES IN FLUID BALANCE
CELL OVERHYDRATION
excess of water in the ECC w/ a normal amount of solute or a deficient amount of solute
occurs in prolonged and excessive diuresis, forcing hypotonic fluids to produce diuresis in the presence of renal impairment
fluid overload from production of adrenal corticoid hormones [Cushing’s syndrome]
CELL DEHYDRATION (DHN)
loss of body fluids, particularly from the extracellular fluid compartment
water loss > water intake
Causes
Fever
Insufficient water intake
Diarrhea, vomiting
Excess urine output [Diabetes insipidus, diuretics]
Excessive perspiration, burns
Hemorrhage, shock, metabolic acidosis
CELL DEHYDRATION (DHN)
Symptoms
Thirst, dry mucus membranes, sunken eyeballs
“Doughy“ abdomen, dry skin w/ poor turgor
temp, weight loss
HR, RR, BP
Restlessness,irritability, disorientation, convulsion, coma [22-30% body H20 loss]
Management
Fluid replacement therapy & continued fluid maintenance
CLASSIFICATION OF BURNS
Superficial Partial thickness (1st degree)
Outer layer of dermis
Erythema, pain up to 48 hrs
Healing 1-2 wks [sunburn]
Deep Partial thickness (2nd degree)
Epidermis & dermis
Blisters & edema, frequently quite painful
Healing 14-21 days
Full thickness (3rd degree)
Epidermis, dermis, subcutaneous fat
Dry, pearly white or charred in appearance
Not painful
Eschar must be removed; may need grafting
ASSESSMENT
Assess extent of body surface burned
Greater morbidity & mortality for burns affecting face, hands & perineum
Assess for dyspnea, stridor, hoarseness
Assess extent of burn injury
Rule of nine – immediate appraisal
Lund-Browder chart – more accurate
Berkow’s method – based on client’s age & changes that occur in proportion of head & legs to the rest of the body as one grows
METHODS OF TREATING BURNS
Open method or Exposure method
Face, neck, perineum, trunk
Allowing exudate to dry in 3 days
Occlusive
Less pain, absorption of secretion, comfort, transportability, accelerated debridement
Aesthetic considerations
Semi-open method
Covering of wound w/ topical antimicrobials:
Silver sulfadiazine 1% (Flamazine)
Silver nitrate 0.5% sol’n
Mafenide acetate (sulfamylon acetate)