1 Fluid Balance and Electrolytes.docx - Lecture Notes NURS 360 Fluid Balance Electrolytes Regulation of Fluids tonicity isotonic hypotonic ability of

1 Fluid Balance and Electrolytes.docx - Lecture Notes NURS...

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Lecture Notes NURS 360 Fluid Balance & Electrolytes Regulation of Fluids tonicity- isotonic, hypotonic; ability of solutes to cause a shift in water; Na and glucose osmotic pressure- stops the flow of water oncotic pressure- ability of albumin to pull fluids osmotic diharesis- if edema, ascities diffusion- movement of high to low of solute filtration- r/t kidneys; hydrostatic pressure on capillaries to allow fluid shifting out Regulation Kidneys 30 mL/hour normal urine output- lowest amount; should be more 1 ml/kg/hour- best indicator 1 L = 1 kg output 1-2 L/day Skin Loss varies Average 500 mL/day Lungs Average 300 mL/day GI 100-200 mL/daily Where is the majority of water absorbed in GI tract? 1
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Lecture Notes o Large intestine 270- 300 serum osmolality (if high, more solutes) 200-800 urine osmolality Kidney RAAS- increase thrist, water intake, holding onto water and Na Heart and Blood Vessels Vasoconstriction/dilation What condition may affect fluid regulation? Lungs If large blood volume, may be breathing faster Pituitary ADH- vasopressin- holds onto water Adrenal Aldosterone Cortisol- holds onto water and Na Baroreceptors- volume receptors Osmoreceptors- osmolality receptors Natriuretic Peptides BNP- increases with heart failure ANP Fluid Balance Problems: Assessment- KNOW S/S Fluid Volume deficit: Hypovolemia Thirst (late indicator) Temperature increases Rapid/weak pulse (>100 bpm) Tachypnea Poor skin turgor Hypotension *Weight loss- best indicator of fluid balance rather than I&O* o Measured first in morning/daily Dry mucous membranes Headache , confusion, lethargy Oliguria/anuria Fluid volume excess: Hypervolemia Pulse increase/bounding Tachycardic SOB/dyspnea/cough/crackles (heart can’t keep up, backup in lungs- hydrostatic pressure cause fluid in lungs) o Crackles heard best at bottom of lungs (where fluid will sit) Weight gain Peripheral edema 2
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Lecture Notes o Pitting, nonpitting JVD- measure at 45 degrees o Indicator of heart failure Muffled heart sounds Increased venous pressure/CVP- amount of blood coming to R atrium 0-10,12 normal reading Edema versus Ascites Edema- can be generalized Ascites- Fluid accumulation in the peritoneal cavity related to certain conditions such as cirrhosis, nephrotic syndrome , certain malignancies; not enough albumin, fluid leaking Identify Causes of Fluid Volume Deficit and Excess Deficit Dehydration Diabetes Medication Lasix ADH, aldosterone issues Excess Kidney failure Heart failure Fluid Balance Problems: Lab Tests Fluid volume deficit: hypovolemia Urine specific gravity > 1.030 Increased Hgb and HCT (dilution elevation) Increased sodium (dilution elevation) Increased serum osmolality Increased BUN- (dilution elevation) o Creatinine is NOT volume dependent Fluid volume excess: hypervolemia Urine specific gravity < 1.010 Decreased Hgb and HCT Decreased sodium Decreased serum osmolality
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  • Spring '16
  • Kim McCarron

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