FLUID AND ELECTROLYTE BALANCE Flashcards

fluid balance
Terms Definitions
HCo3
*22-26
villi
infolding of epithelium
Anasarca
severe generalized ("dropsy")
Osmolarity
describes concentration of solutions
Major anion of ECF
Chloride
plicae circuaris
infolding of entire area
CALCIUM GLUCONATE
*ANTIDOTE FOR MAG INTOXICATION
These conditions cause _____________fluid needs: increased osmolarity of the ECF, loss of fluid volume, stress or trauma, surgery, pain, drugs and anesthetics, and inappropriate ADH secretion. a. decreased b. increased c. unknown d. erratic
b. increased
recommended daily fluid intake
2000-2500 ml.
Define extracellular?
interstitial and intravascular spaces
Isotonic Solutions
Same osmolarity as body plasma
Examples:
Normal Saline= 0.9% NaCl
LR= Lactated Ringers, Ringers Lactate
Physical Assessment: Respiratory: FVD
No overt signs
PaCo2
*35-45 HIGH OR LOW ITS RESPIRATORY
The Major Electrolytes
• Sodium
• Chloride
• Potassium
• Calcium
With alkalosis the tubules preferentially excrete potassium and conserve hydrogen, which leads to ___________. a. hypocholemia b. hyperthyroidsm c. hypokalemia d. hyperkalemia
c. hypokalemia
Other causes:
renal failure, hepatic obstruction, standing for a long time (localized; not systemic); All of these can lead to venous obstruction/congestion (not really able to escape at a certain rate)
Diffusion
Passive process by which molecules move through a cell membrane from an area of higher concentration to an area of lower concentration without an expenditure of energy.
Kidneys
What organ excretes metabolic wastes and toxic substances?
low BP
stimulates the release of renin
Examples of insensible losses because they can't be measured are?
skinlungs
Primary Function of electrolytes
Maintaining fluid balance
Contribute to acid-base regulation
Facilitate enzyme reactions
Neuromuscular reactions
hyponatremia
too little blood sodium levels, bleow 136
ALKALOSIS
*WHEN BLOOD IS MORE BASIC THAN NORMAL
PULMONARY EDEMA
*ACCUMULATION OF INTERSITIAL FLUID IN THE LUNGS
Found in ECF, bone, skeletal muscle and nerve tissue, essential for functioning of muscles, nerves and RBC's. Involved in the metabolism of fat, protein and carbs
Phosphate
When HCO3 decreases, pH ____________ a. stays the same b. decreases c. increases
b decreases
Hyponatremia (cont.)
Without any large solutes present; just loss of water; hypertonic type
DIAGNOSIS
Deficient fluid volume or risk for deficient fluid volume; excess luid volume or risk for excess fluid volume, reltated nursing diagnoses: fatigue, anxiety ,ineffective health meantnance, imbalanced nutrition, imparied skin integrity, imiparied tissue perfusion, impaired gas excange,constipation, impairedoral mucous membranes, distrubed sleep pattern
CLUSTERING DATA TOMAKE A NURSING DIAGNOSIS
Deficit
Causes Fluid Volume Excess or Deficit? Inadequete Fluid Intake
active transport
deals with solute movement; solutes move from an area of low concentration to high concentration; similar to swimming against the current; requires energy.
aldosterone
is a steroid hormone that increases Na+ reabsorption & K+ secretion
Common causes of isotonic dehydration?
hemorrhagevomiting diarrheaprofuse salivationfistulasabscessesileostomycecostomyfrequent enemasprofuse diaphoresisburns severe woundslong-term NPOdiuretic therapyGI suction
characterized by destruction of tubular epithelial cells and clinically by acute suppression of renal function
most common cause of acute renal failure (when urine flow is <400 ml/day)
reversible
caused by ischemia from trauma, toxicity from chemicals
acute tubular necrosis
Cephalic phase reflex
conditioned reflex from aromas before food hits stomach
urine volume
the most important function of the renal tubules is the rate of of water and salt reabsorption. Remember ADH and aldestrone promote reabsorption by DECREASES urine volume. ANH does the opposite, it INCREASES output because it is water-absorbing or diuretic, it does not reabsorb.
HYPERNATERMIA
*SERUM SODIUM LEVELS OF 145 mEq OR GREATER
*IS MOST COMMONLY DUE TO WATER LOSS AND EXCESS OF SODIUM
Water always moves towards
the region of high solute.
Food metabolism accounts for ____ ml fluid volume
200 ml
fluid and solute added to the body must be
removed
Selective re-absorption of water and electrolytes occurs in the ___________.a. interstitial fluid b. capillaries c. renal tubules d, anus
c. renal tubules
Nephrotic syndrome:
damage to glomerular capillary walls - large amount of protein lost in urine - decreased osmotic pressure (dip stick tests)
Isotonic solution
Osmotic pressure equal to that of plasma (solute is enevly distributed within the water) SODIUM CHLORIDE 0.9 Normal Saline same as body.
1+ pitting edema
slight indentation (2 mm), normal contours, associated w/ interstitial fluid volume 30 % above normal.
If a hypertonic solution is given to a patient, it may cause too much fluid to be pulled from ______ into the ___________, and the cells may __________.
cellsbloodstreamshrink
entergastric reflex function (4)
1. inhibits vagus nerve (inhibiting digestion)
2. inhibits local reflexes in nerve plexus
3. activates sympathetic fibers that cause pyloric sphinctor to tighten
4. secretion of gastrin
CARBONIC ACID
*CO2 IS A POTENTIAL ACID BECAUSE ONCE DISSOLVED IN WATER IT BECOMES CARBONIC ACID
*WHEN CO2 INCREASES (AS IN A CLIENT WITH COPD) THE CARBONIC ACID CONTENT ALSO INCREASES
*OPPOSITE CAN OCCUR IN HYERVENTILATION STATES WHERE CO2 DECREAES, RESULTING IN A DISEASE OF CARBONIC ACID
Function of potassium
vital for skeletal, cardiac and smooth muscle activity, maintains acid-base balance, contributes to enzyme reactions.
Serum aldosterone levels will rise in response to _________ of the serum sodium concentration, blood volume or blood pressure. a. stabilization b. a rise c. a drop
c. a drop
hydrostatic and osmotic pressure imbalances result in imbalances
Edema: peripheral & pulmonary
Ascites: fluid shift to 3rd space (peritoneal cavity/abdominal); doesn't easily exchange back to vascular; needle aspiration for abdominal cavity
Electrolyte Values in Normal Plasma
Sodium 135-145 mEq/L/ PotassiumEq/Lm 3.5-5.0 / Calcium 4.5-5.5 mEq/L Lack of Osteoporosmis/ Magnesium 1.5-2.5 mg/dL lack of Vit D. Mental emotional, muscle disorder (Chocolate good for) Chloride 98-106 mEq/L, Phosphorus 1.2 - 3.0 mg/dL Sodium and Potassium go together for Pump Less than 3.5 Hypokalemia Give K fluid monitor lab and Hyperkalemia more than 5 renal failure will have heart attack id doesn't filterout K.
colloid osmotic pressure
the reabsorbing or pulling in of solutes/fluids from interstitium back into the capillaries.
Protective mechanisms of ECF volume
alterations in hemodynamic variables: vaso constriction and increase HR
alreations in sodium water balance, isotonic contraction or expansion of ECF, hypotonic dilution or hypertonic concentration of extracellular sodium brought about by changes of extracellular water
If a hypotonic fluid is given to a patient, it may cause too much fluid to move from the _________ into the ___________, and the __________will swell.
veinscellscells
What is one treatment for patients with fluid overload and hypertension?
ACE inhibitors, diuretics
Water intake and output
*body conserves and reuses water as much as possible
*kidneys and to some extent the intestines continously filter and recycle water
*a person must take in approximately the same. Amount of fluid as he or she loses
*body can survive many days without food but only a few days without water
Factors that can affect fluid balance
illness (nausea, vomiting, diabetes, COPD, cancer), trauma (burns, head injury) , surgery (nasogastric suctioning), and medications (corticosteroids, diuretics)
Catabolic phase: Potassium moves out of the cell during ____________________. a.ATP production b. the breakdown of tissue c. anaphase d. transcription
b. the breakdown of tissue
What do you use in hypokalemia?
potassium-sparing diurectics, not as effective
spironolactone
A. Overall fluid balance requires
that fluid output equals fluid intake
What are the two components of extracelluar fluid?
Plasma and interstitial fluid
ATRIAL NATRIURETIC PEPTIDE (ANP)
*RELEASED BY THE HEART RIGHT ATRIUM TO CORRECT OVERLOAD BALANCE
*IT PROMOTES RENAL DIURESIS (KIDNEY EXCRETION) OF SODIUM AND WATER
A hypotonic solution will cause the RBC to _____, a hypertonic solution will cause the RBC to _____.
swell, shrink (water is pulled)
Outward push of the interstitial fluid against the outside of the capillary walls. a. Capillary hydrostatic pressure b. Interstitial oncotic pressure c. Capillary oncotic pressure d. Interstitial fluid hydrostatic pressure
d. Interstitial fluid hydrostatic pressure
ALERT ALERT
If rapid wt gain more than 2-3 lbs etc all characteristings crackels increased severity of cardiac manifestations change inurinary output less than 30mL. Notify Physician
E. Capillary blood pressure helps
regulate water by the amount of pressure in the capillary controls how much water and other things in the blood can be filtered out.
factors that act as mechanisms for controlling fluid volume in plasma, IF, and ICF
concentration of electrolytes in ECF, capillary blood pressure, concentration of proteins in blood.
the vasa recta cap. carry away
water leaving the nephron tubule so that the water does not dilute the medullary interstitium
B. ECF electrolyte concentration influences ECF.
If there is an increase of Sodium (Na+) in the ECF, there is an increase in water in the ECF. This stimulates ADH which causes more water to be reabsorbed and less urine produced.
Can you think of situations in which there would be loss of sodium from the interstitial fluid?
Sodium loss can result from:
• Vomiting, burns, diarrhea, and perspiration
the most significant source of acid is
Co2 from respiration which affects ph and combines with water to form carbonic acid h2co3
In hypotonic dehydration, what is the relationship between plasma, interstitial fluid, and cells?
fluid moves out of plasma and interstitial space and into cells, causing cells to swell
What will happen to interstitial fluid osmotic pressure with a drop in Na+ concentration?
A drop in Na+ concentration causes a
• Drop in interstitial osmotic pressure
D. Aldosterone and ADH hormones are two hormones that influence
the regulation of salt (Na+) and thus the regulation of water being reabsorbed.
Why is it important that aldosterone is a steroid hormone?
Because it is a lipid itself so it crosses the plasma membrane easily.
14
*BASE
*ALKALOSIS
*ALKALI
*OH++
Hypokalemia: Nurse Planning
Goals:
Outcomes:
Magnesium for NCLEX
...
Hypercalcemia: Nursing Interventions
Nutritional teaching
Normal bicarbonate levels
22-26 mEq/L
carbohydrate digestion starts
mouth via amalayse
PHOSPHORUS
*CRITICAL COMPONENT OF ALL TISSUES
metabolic water
200 ml, metabolic reactions
Dehydration results in?
fluid volume deficit
composition of body fluids: Infants
70-80% Water
Hypercalcemia: Assessment findings
Lethargy & Weakness
Depressed Reflexes
Nausea & Vomiting
Polyuria
Dysrhythmias,
Heart Block
NERVOUS SYSTEM
*REGULATED HOMEOSTASIS BY SENSING SYSTEM DEVIATION AND SENDING NERVE IMPULSES TO APPROPRIATE ORGANS TO RESTORE BALANCE
How would hyposecretion of aldosterone cause volume depletion?
Aldosterone
With ______________ the tubules preferentially excrete hydrogen and conserve potassium, which leads to hyperkalemia. a. alkalosis b. acidosis c.halitosis d. hypohydroxidation
b. acidosis
Liver disease:
Decreased protein synthesis (not capillary walls; problem with not having enough proteins) decreased osmotic pressure
Renal System
Works Interdependently affecting many electrolytes Ca Mag, PO H, Cl and bicarbonate. Renal nephrons regulate electrolyte bal by secreting excess ions into the tubules where they are later excreted as urine. When there is deficit, electrolytes are reabsobe from the renal tubules back in to the capillary netwok surrounding the tubules of nephron.
Working with the neuroendocrine system regulate extracellurlar fluid vol by being a target organ for ADH and aldosterone. Renin-angiotensin-aldosterone- functions to maintain homeostatsis b/t sodium and water and regulate blood pressure. Renin converts angiotensinogen to Angiotensin 1 in liver; it then travels to lungs converted to angiotensin II (potent vasoconstrictor): raises BP by vasoconstriction and it stimulates production of aldosterone from adrenal glands which raises B: by increaseng blood volume.
(Add Na imbalance later for NCLEX)
...
acidosis
in_________the kidneys secrete H+ & reabsorb HCO3-, caused by hypoventilation, found in emphysema patients
_________ _________ is considered isotonic because the concentration of ________in the solution nearly equals the concentration of ________ in the blood.
Normal salinesodiumsodium
Osmosis
the process of water movement across cell membranes from the less concentrated to the more concentrated solution.
Calcium
calcium is the most abundant mineral in the body. Normal range 8.4-10.5
HYPERCALCEMIA
*TOTAL SERUM CALCIUM LEVELS OF MORE THAT 10.5
*COMMONLY DUE TO CANCER OR PRIMARY HYPERPARATHYROIDISM
SODIUM (Na+)
This is the most abundant extracellular ion in the body.
The functions of sodium include
• Fluid-electrolyte balance
• Action potentials
If serum osmolality decreases, ____ is suppressed, the collecting ducts become less permeable to water, and urine output increases
ADH
When CO2 increases, pH ______________ a. stays the same b. decreases c. increases
b. decreases
Acid-base __________ is necessary for normal body functioning. a. fluctuation b. balance c. interaction d. separation
b. balance
How proteins are lost
Malnutrition; neoplastic wasting (cachexia); Liver failure, decreased production of proteins; Burns; Nephrotic syndrome
Types of IV therapy
Dextrose soloutions: Hypotonic provides free water, without saline andadds enough calories to prevent ketosis whcih is 170 cal. Not complete nutrition at risk for hyponatremia and hypokalemia Hypertonic: Ostmotic diuretic, treats hypoglycemia These solution are not used in head trauma v/c could worsen crerbral edema.
SALINE SOLUTIONS: Hypotonic and Isotonic normal saline water repalcement withoutincrease of osmotic pressure adds 170 cal and replaces loss of NA through normal diaoly excretion,
POTASSIUM ADDITIVE and RINGER'S SOLUTIONS (Total parenteral nutriation hypertonic version
s/s of hyperkalemia
severe skeletal muscle weakness, cardiac arrhythmias.
high medullary osmolarity
____________is necessary for formation of concentrated urine
Examples of sensible losses are? They are so deemed because they are measurable.
urinationdefecationwounds
when blood pressure drops in the kidney, kidney cells release this, resulting in vasoconstriction, elevating BP
renin
excitatory gastric secretion
stimulates mucosal cells to secrete gastrin
Hypokalemia
refers to a low blood potassium level below 3.8
Fluid imbalances result from abnormalities of fluid volume, fluid concentration or fluid distribution between compartments. They include:
• Fluid deficiencies
Volume depletion
Dehydration
• Fluid excess
Volume excess
Water intoxication
Electrolytes stored in cells and bone
potassium and calcium
if both volume and concentration are altered, which symptoms should show? a. only volume b. only concentration c. both d. neither
c. both
Increased capillary hydrostatic
Filtration pressure; BP
Excess Na and water (in vascular system - increases BP); most common: CHF (increased systemic venous pressure + increased blood volume resulting in edema)
ICF
the majority of total body water is found here
fluid overload
also known as hypervolemia. may result in edema.
treament of potassium disorders
calcium antagonizes potassium induced decreased in membrane excitability
sodium bicarb will cause k to move into ICF
insulin will decrease ECF K conc.
decrease intake, absorption, increase renal excretion
Define isotonic dehydration?
water and dissolved electrolytes are lost in equal proportions
Populations at Risk for Fluid Imbalances: May be reversible or progressive
Dietary Changes
Diuretic Therapy
Fluid Restriction
Dialysis
INTRAVASCULAR FLUID
*WATER FLUID OF THE BLOOD KNOWN AS PLASMA
*4-4-5-5.INFANT MEN WOMEN AND ELDERLY
Foods with calcium
milk and milk products, dark green leafy vegetables and canned salmon
which of the following is inside the normal limits for P+ for the human body. a. 3.45 mEq/L b. 5.45 c. 5.7 d. there are no acceptable limits.
5.45 mEq/L
Which of these would be considered hypernatremic? a. 132 mEq/L b. 149 mEq/L c. 144 mEq/L
b. 149 mEq/L
Decreased osmotic pressure/increased capillary permeability
Decreased plasma protein in blood (nothing to pull fluids back in); liver complications; burns
Funtions of Body fluids
Makes half of body weight
Transports nutrients and wastes to and from cells
Acts a solvent for electrolytes and nonelectrolytes
Facilitates digestion and elimination
Maintains acid-base balane,
lubricates joints and other body tissues
hematacrit
blood test that measures the % of the volume of whole blood that is made up of RBC.
male-40.7-50.3%
female-36.1%-44.3%
s/s could be shock or anemia.
hypernatremia
gain of more salt than water from tube feeding, hypertonic iv, food with reduced water intake, no access to water, inability to respond to thirst
loss of more water than salt from DI, diarrhea, diaphoresis
causes dry skin, mucous membranes, oliguria, polydipsia, tachycardia, seizures, agitation
Where is the receptor for the aldosterone hormone?
In the nucleus
hypotonic dehydration
excess loss of NA and K from ECFCause-NA deficit or water loss
POTENTIAL OF HYDROGEN (pH)
*POTENTIAL OR POWER (p) OF HYDROGEN (H+) CONCENTRATION WITHIN A SOLUTION
*pH SCALE RANGES FROM 0-14
*PURE WATER WHICH IS NEUTRAL, HAS A pH OF 7
*pH NUMBER IS LOWER THAN 7 THE SOLUTION IS AN ACID
*pH GREATER THAN 7 THE SOLUTION IS A BASE OR ALKALINE
*pH OF BLOOD AND LYMPH (ECF) IS NORMALLY SLIGHTLY ALKALINE ABOUT 7.35 TO 7.45
*RATION 20:1 TEN FOLDS FROM BASE TO ACID
*BODY MUST MAINTAIN THE SLIGHTLY ALKALINE pH OF BLOOD WITHIN THIS NARROW RANGE BECAUSE A DECREASE OR INCREASE OF ONLY ONE pH UNIT WILL RESTULT IN A CHEMICAL DISASTER
*TENDENCY TO DEVELOPE ACIDOSIS (TOO MANY HYDROGEN ATOMS) BY RETURNING THE SERUM pH BACK INTO THE ALKALINE STATE
Normal levels of total calcium
8.5-10.5 mg/dl (bound and unbound), 4.0-5.0mg/dl for ionized serum calcium (free calcium circulating in plasma)
Total Body Weight is affected by losses in which of the following structures/processes? a. Skin, lungs, excrement b. Heart rate & blood pressure c. Aging & exposure to carcinogens d. Endocrine function, travel & sense of humor
a. Skin, lungs, excrement
Increased hydrostatic pressure causes
more fluid out of capillary into cells; On arterial end of capillary (Ex. HTN) problems with swelling; On venous end of capillary (Ex. constricting clothes, especially in legs); prolonged standing; varicose veins; mostly common in lower extremities (also esophagus from alcoholism; insufficient valves); CHF
How does the body regulate calcium?
PTH (parathyroid hormone) and calcitonin. Increased PTH leads to increased plasma calcium (which means it's being pulled from the bones. Increased calcitonin leads to decreased plasma calcium (bones retain calcium). CALCIUM LEVELS ARE INVERSELY RELATED TO PHOSPHORUS LEVELS.
The phrase Fluid Balance implies
homeostasis or relative constancy of body fluid levels.
What is transudate normally found in?
Edema of right heart failure
RAA SYSTEM FLUID REGULATION CYCLE
*CONTROL FLUID VOLUME
*IF THERE IS A DECREASE IN BLOOD VOLUME RENIN IS RELEASED BY KIDNEYS CAUSES SECRETIONS OF ANGIOTENSIN 1 ANGIOTENSIS 1 CONVERSTED TO ANGIOTENSIN 2 IN THE LUNGS
Name some clinical manifestations of isotonic fluid volume deficit
thirst, weakness, fluid intake less than output, dry mucous membranes, weak & rapid pulse, decreased BP, postural hypotension, increased BUN, hematocrit and specific gravity of urine.
One would expect to see a serum sodium level of ___________ with these causes: Vomiting, Diarrhea, Certain diuretic drugs, Insufficient aldosterone, Adrenal insufficiency, Decreased urine formation . a. >1.35 mEq/L b. <1.35 mEqL c. >135 mEq/L d. <135 mEqL
d. <135 mEqL
How does hypocalcemia differ from hypercalcemia?
HYPO Ca = excitability, decreased threshold, seizures
HYPER Ca = increased threshold, decreased excitability, poor digestion
B. Overhydration
- drinks too much water, and can be a problem. This occurs when water intake exceeds water output. Several factors such as excessive amounts of intravenous fluids given too fast, the kidneys not reabsorbing the water, or maybe the bladder not being able to void the urine produced.
The more ionic particles a substance forms, the larger
larger the mOsm/liter
This means that, the more particles a substance splits into, the greater the osmotic pressure it creates.
A shift of water from ICF to ECF is called _____________. a reverse osmosis b. active transport c. hypertonic hyponatremia d. weird
c. hypertonic hyponatremia
4. Mechanisms that maintain Fluid Balance
A. Fluid output - mainly urine volume.
B. ECF electrolyte concentration influences ECF.
C. Capillary Blood Pressure - pushes water out of blood into Interstitial Fluids (IF).
D. Electrolytes in the body are very important.
E. Capillary Blood Pressure and Blood Proteins have been mentioned before in their roll of regulations of Body Fluid Maintaince.
Common nutrient solutions that prevent dehydration and ketosis are
5% dextrose in water, 5% dextrose in 0.45% sodium chloride
Which of these weighs 1 kg? a. 50 mL of water b. 2.2 L of water c. 1 L H2O d. 1 pound of water
c. 1 L H2O
In hypertonic dehydration, what is the relationship between plasma, interstial fluid, and cells?
fluid moves out of cells and into interstitial spaces and plasma, causing cells to shrink
Fluid in the body is found in several different compartments
• Intracellular fluid - 66%
• Extra cellular fluid - 33%
-Plasma -20% of the extracellular fluid
-Interstitial fluid - 80% of the extracellular fluid
C. Capillary Blood Pressure - pushes water out of blood into Interstitial Fluids (IF).
The blood proteins in the blood, if they increase they will pull water back into the blood. The proteins in the blood also helps regulate fluids in the body and maintain fluid balance.
What is the purpose of stimulating the release of aldosterone with low BP, in general or low pressure through the kidney, specifically?
To conserve water in order to increase plasma volume.
7
*NEUTRAL
Hyponatremia Nursing Planning
Goals
Outcomes
Phosphate for NCLEX
...
Hypocalcemia: Nursing Interventions
Nutritional teaching
Crystalloids
salts that dissolve easily
protein digestion starts
stomach via pepsin
CATION
*POSITIVELY CHARGED ION
*MEMORY HELPER FOR CATION=Ca + ION
A hyperpolarized cell requires more/less than normal stimulus to reach the threshold potential.
less
water balance
intracellular fluids 67%, extracellular fluids 33%
Half-normal saline is considered ________ because the concentration of sodium is lower than the concentration in patient's blood.
hypotonic
Infant implications
Surface area is proportionally larger
More rapid respirations
Kidneys are immature
Hypokalemia: <3.5 mEq/L
Causes
Loss of Potassium
Poor Potassium Intake
Hyperaldosteronism
Regulation of Potassium
Aldosterone
• Stimulates secretion of potassium and excretion in urine
Potassium is regulated by _____________. a. diet b. exercise c. aldosterone d. ADH
c. Aldosterone
Brawny
hardening & thickening of tissues; inflammation; discoloration (reddish-brown); ulcers (decreased vascularization); too much triple antibiotic ointment is bad; bacterial growth; opposite effect
Metabolic acidosis
Pathological condition caused by increase in noncarbonic acids or decrease in bicarbonate in extracellular fluid or both. B/c kidneys are responsible for excreting acids and reabsorbing bicarbonate, an rval insufficiency leads to metabolic acidosis.
s/s of hypokalemia
weakness/hypo reflex, cardiac arrhythmias, hypotension, cardiac arrest.
elevated BUN and creatinine (from inability to produce urine)
azotemia
Hypokalemia: Nursing Interventions
Nutritional Teaching: Veggie, Fruits Meat, Milk
ANTIDURETIC HORMONE
*KEEP FROM PUSHING OUT MORE WATER
*RELEASED FROM STORAGE IN THE POSTERIOR PITUITARY GLAND AS PART OF THE NEGATIVE FEEDBACK MECHANISM
*RESPONSE TO CONDITION WITH THE CARDIOVASCULAR SYSTEM
*REGULATES THE AMOUNT OF WATER THAT THE KIDNEY ABSORB
*ONCE RELEASED THE PRODUCTION OF URINE IS DECREASED AND WATER REABSORPTION N THE KIDNEY TUBULES IS INCREASED
SODIUM ABNORMALITIES
Hyponatremia
• Loss of sodium from the interstitial fluid
• Hypernatremia
Hypernatremia means excess sodium
• Excess cellular dehydration (water moves out of the cells).
This leads to
• Agitation and coma
Functions of calcium
regulates muscle contraction and relaxation, neuromuscular function and cardiac function.
T/F The percentage of dissolved body sodium in ECF and potassium in ICF is both 90%.
TRUE
The most precicely regulated ion is__________. a. Na+ b. Cl- c. H+ d. HCO3-
c. H+
Hyperglycemia:
glucose pulls water into vascular & cells shrink; increases wter in vascular - dilutes Na
Regulation of Fluid Balance
Thirst, Luymphatic System, Neuroendocrine system, Gastrointestinal System, Renal System
angiotensin II (ANG II)
stimulates aldesterone secretion, thirst, vasconcstriction, increases vasopression secretion & activates cardiovascular control center (raises blood pressure)
What is the daily output forskin?
600 ml
A potent vasoconstrictor, this causes an increase in peripheral vascular resistance thatt raises blood pressure.
It is a potent stimulus for the release of aldosterone.
Angiotensin II
descending limb of loop of henle is impermeable to
solutes
the prescnece of what forces water to move ?
sodium
SODIUM CHLORIDE
*NaCl (TABLE SALT)
*ONE OF THE MOST COMMON COMPOUNDS IN THE BODY
Who has the highest proportion of water in the body?
Infants (70%)
Examples of anions (4)
Bicarbonate (HCO3-), Chloride (Cl-), phosphate (HPO4), sulfate (S04 2-)
T/F a decrease in capillary hydrostatic pressure may cause edema
False: an increase
Hypertonic Alterations in Fluid Balance do NOT include a. Most common cause as hypernatremia b. lack of Aldosterone c. Results in ICF dehydration d. Osmolality of ECF is elevated
b. lack of Aldosterone
Dehydration
total volume of body fluids less than normal
hemoglobin
carries oxygen in the blood via RBC. 12-18 g/deciliter. if count is low, it could be anemia.
The total volume and distribution of water in body remains normal or
"relative constant"
Define hypertonic dehydration?
water loss is greater than electrolyte loss
SIGNIFICANT FUNCTION OF WATER
*EFFICIENT MEDIUM FOR DELIVERY OF NUTRIENTS TO THE CELLS
*EXPORT WASTE PRODUCTS FROM THE CELL
*HELP TO REGULATE MANY BODY PROCESSES
*PROTECTS AND LUBRICATES BODY SURFACES
*IMPORTANT IN THE REGULATION OF BLOOD PRESSURE AND FLUID AND ELECTROLYTE BALANCE
This mineral is a Major factor in carbohydrate metabolism, osmotic pressure balance, acid-base balance and normal muscle contraction. a. iron b. lead c. sodium d. potassium
d. potassium
Lymphatic Obstruction
Excess fluid to lymph back to vascular system; surgical excision with cancer (lymphodema; no BP in that arm to avoid triggering lymphodema); Retention of fluid and plasma protein in interstitial
HYPONATREMIA Imbal.
If soidum less than 135 Chloride less than 98 and serum osmolatitlyt less than 238 mOsm/kg general fatigue, Wt loss, muscle weakness, cardiac orthostatic hypotension, rapid thread weak pulse, PVF takes more than 5 seconds, Tachypnea, nausea vomiting diarrhea, Renal: oliguria, anuria, hypothermia, decreased thirst, confusion, seiqures
R/F Low salt diet, esp taking diuretics at same time, excess sweating, athletic events, dilutional from taking in too much water, excess vomiting and diarrhea
LOW SODIUM SHOULD BE MOITORS OF DECREASED URINARY OUTPUT.
water
accounts for 60% of the body weight in adults; 70-80% of body weight in infants; varies with gender, body, mass, and age.
extracellular fluids (ecf)
remaining 1/3 of body water, fluids outside of cell, interstitial space, and vascular space, high concentration of Na
What is thirst regulated by?
The osmolarity of the plasma
4 cells of the fundic region
mucus neck cells
cheif cells
parietal cells
enteroendocrine
Fluid and electrolytes balance
*Vital for the proper functioning of all body systems
*body must maintain the correct portion of the fluids to solute in each compartment
*body compensates for imbalances immediately
*electrolyte may be lost through vomiting diarrhea or hemorrhage
The two main compartments of the ECF are the_____ and ______.
intravascular and interstitial
Atrial Natriuretic Hormone is produced in the _____________ . a. lungs b. thymus c. atrial muscle of heart d. adenoids
c. atrial muscle of heart
Decreased Osmotic Pressure Causes
less fluid pulled back into vascular from cells
How do you manage hypercalcemia?
Encourage mobility, promote fiber to help with constipation, implement safety precautions because they will may have LOC. Admin IV NS to dilute serum Ca and encourage kidneys to excrete. Admin IV phosphate or oral inorganic phoshpate salts (Ca and Phosphate are inversely related). Admin furosemide (Lasix). Admin calcitonin.
What happens to circulating blood volume in isotonic dehydration?
*circulating blood volume decreases (hypovolemia) and leads to inadequate tissue perfusion*loss of plasma volume causes problems
What stimulates the release of aldosterone?
low plasma sodium/
high plasma potassium
Metabolism is the synthesis or breakdown of molecules. Which of these processes release water to the body?
Water is released during synthesis reactions.
• These reactions are thus referred to as dehydration synthesis.
Electrolytes are important in that they (4)
maintiain fluid balance, contribute to acid-base balance, facilitate enzyme reactions, transmit neuromuscular reactions.
Osmolality of ECF is less than normal due to_____________. a. water excess b. water deficit c. hyponatremia d. a & c
d. a & c
What diuretic do you use for more urgent hypervolemia?
Loop diuretics, monitor potassium.
furosemide (Lasix)
What is the daily output for lungs?
400 ml(200 for each side)
When chloride is reabsorbed in the kidneys, does its concentration in the blood increase or decrease?
Reabsorption moves fluid from the nephron back to the blood.
Thus, Chloride levels in the blood would increase.
Which of these does NOT cause water excess? a. renal or heart failure b. drinking 1-2 L H2O/day c. cirrhosis d. IV glucose solutions
b. drinking 1-2 L H2O/day
A solution of dextrose 5% in NS is considered ______ to patient's blood?
hypertonic(because the concentration of solutes in the NS is greater than the solutes in patient's blood.
The number of ions that carry a positive charge are called ______, the number of ions that carry a negative charge are called ________.
cations, anions (both should be equal)
Which of these is NOT a symptom of hypernatremic fluid loss? a. Weight loss b. Weak pulses c. Increased heart rate d. Postural hypotension e. Excessive urination f. none of the above
f. none of the above
Where does atrial natriuretic peptide come from and what causes it to be released?
Atrial cells in the heart in response to increased stretch.
If you add the same gram molecular weight of the following compounds to a solution of water, which would exert the greatest osmotic pressure?
C6H12O6
Na+Cl-
The Na+Cl- would exert the greatest osmotic pressure because it would dissociate or split into two ions.
The C6H12O6, (glucose) dissolves but does not ionize in water.
When ADH binds to the receptor what does this stimulate?
the formation of membrane channels in the collection duct cells to increase permeability of water from the filtrate back to the plasma.
What are the two mechanisms in the kidney that regulate output?
What is filtered at the glomerulus and what is reabsorbed or secreted by the tubules.
0
*ACIDIC
*ACID
*ACIDOSIS
*H+
Hypernatremia: Nursing Planning
Goals
Outcomes
Tonicity
osmolarity of a solution
Charged particles are called
ions
fat digestion starts
small intestine CCK
DIAGNOSTIC TEST
*CHEMICAL STUDIES OF ELECTROLYTES
*CBC
*LFT-LIVER FUNCTION TEST
*pH OF BLOOD AND ABG"s
*COMPOSITION OF URINE AND OTHER BODY FLUIDS
Interstitial _____________ pressure refers to the inward-pulling force of particles in the interstitial fluid. a. osmotic b. hydrostatic c. interstitacular d. extramolar
a, osmotic
extracellular fluids
interstitial 80%, plasma 20%
In adults, interstitial fluid (surrounds cells accounts for about ____ of extracellular fluid.
75%
Hypermagnesemia: >2.5 mEq/L
Causes
High Mg intake
Abnormal retention of magnesium
What controls sodium reabsorption in the kidney?
Aldosterone
BICARBONATE
*KIDNEY REGULATE THE BICARBONATE LEVEL IN THE ECF BY CONSERVING OR EXCRETING BICARBONATE IONS FROM THE RENAL TUBULES
*LEVELS ARE IMPORTANT IN MAINTAINING THE ACID BASE BALANCE IN THE BODY
*BICARBONATE IONS (HCO3-) ARE BASIC (ALKALINE)
*KIDNEYS ARE ONE THE THE MAJOR FACTORS IN REGULATING THE AMOUNT OF BASE (BICARBONATE) IN THE BODY
*TOO MUCH OR TOO LITTLE BASE IN THE BODY; BUFFER SYSTEM USED TO HAVE THE KIDNEYS EXCRETE MORE OR FEWER IONS
Regulation of Chloride
Aldosterone
• Chloride passively follows sodium as it is reabsorbed from the kidneys
The following are causes/contributing factors of ___________: alkalosis, insulin, dietary deficiency, antibiotics. a. hypernatremia b. hypoglycemia c. hyperkalemia d. hypokalemia
d. hypokalemia
Ions
the dissociated particles of an electrolyte and carry either a positive or negative electrical charge.
Inserting/Maintaining Nasogastric Tube
Preform preliminary actions
Prepare equipment; dressing to secure tube, check suction apparatus pressure of 80-100mm gg
Prepare client: In correct position usually High Fowlers hOV elevated 60-90degrees and put head forward to swallow; if unconscious keep him in recumbent position. Determin if nostril is mos open occlude one and listen; inspect nostril for septal deviateion
Pass Tube: Proper length; Nose to earlobe measurement and down to stomach. lubricate final 3 inches tip of tube; insert tube in patent nostril and pass through to nasopharynx
when past epiglottis have client bend head forward toching chin to chest advance tube unti lyou reach the tape market incdication the tube has reached stomach.
Connect tube to suction tape tube to nose verify tube placement in stomach; aspirate for gastric secretion if none adnave tube 2 inces more and repeat test. Check for gastris pH on strip when aspirating stomach pH is less than 5 usually, use 5-1 connected to attach distal end of tube to suction colection devise finish taping tube to nose . Set suction control to presecribed level.
Finish Procedure: Docutment reason for NG tube; probide comfort care q8hours; clean cotton-tipped swab and water soluble lubricant to clen nostril ; assess amt and characteristics of nasogasatric drainage. Avoid alcohol based mouth care agents tend to promote dryness;
Monitor Client: q8h for listen to bowel sound and pinch suction tube to ausculate d/t to mistaking suction sounds. Moniter and document amt and characterisiting of NG output and fluid vol etc. Chck for low electrolyte level (sodium, K Ca CL mag and also plasma levels suggest deficient flouid vol. such as elivated sodium blood urea nitrogen and heatocrit; Notify physician if NG output exceeds 100mL/hour or secere signs of defiient fluid vol. If clients tube stops draining assess for function errors or consult physician for irrigating the tube.
extracellular fluid
fluid spaces between cells (interstitial) and fluid in the plasma space (intravascular).
hypophosphatemia
depletion of phosphorus due to insufficient absorption, shifts, increased renal losses, malnutrition, alcohol abuse
True or False...

In transudate there is no vascular damage and there is no leakage of protein or cells into the interstitial space.
True
Hyponatremia: Nursing Interventions
Nutritional teaching: Increase Sodium intake
_____ has a higher concentration of potassium
ICF
_____________ promotes movement of K+ into liver and muscle cells. a. ADH b. aldosterone c. progesterone d. Insulin
d. Insulin
_____________ is responsible for ICF osmotic balance a. Cl- b. Na+ c. HC0- d. K+
d. K+
Three Mechanisms causing Edema
Decreased osmotic pressure/Increased capillary permeability;
Increased capillary hydrostatic pressure;
Lymphatic obstruction
EVALUTAION
Time frame for evalutaing fuid or electroytle imbalance varies with the urgency of the imbalance.
common electrolytes are:
sodium, chloride, potassium, calcium, magnesium, and phosphate.
final concentration of urine
______________depends on H2O permeability of the collecting duct
___________ __________ area of an infant is greater than that of an adult relative to their respective _________ so infants ________ more _______from their skin than adults do and are at higher risk for ____________.
Body surfaceweightswaterdehydration
kidney cells sense reduced O2 carrying capacity of blood and release this to stimulate the bone marrow to produce more red blood cells
erythropoetin
Positive ions
sodium Na+, calcium Ca++, potassium K+ and magnesium Mg++
SODIUM LOSS
*MAY OCCUR DUE TO DIURETIC THERAPY RENAL DISEASE ADRENAL INSUFFIENCY OR LOSS OF GI FLUIDS DUE TO VOMITING OR GI SUCTION
The net effect of the angiotensin-aldosterone system is to
restore blood volume
The following lead to edema via Increased capillary filtration pressure EXCEPT: a. Heart Failure b. Infection c. Pregnancy d. Kidney disease
b. infection
This condition is associated with Loss of chloride, hyponatremia or elevated bicarbonate levels and metabolic alkalosis. a. colitis b. hypokalemia c. Hypochloremia d. aceites
c. Hypochloremia
Respiratory alkalosis
Rapid or excess elimination of CO2 resulting in increae in pH with decrease in partial pressure of CO2; Hyperventilation will cause CO2 to be blown off leaving alkalotic state S&S dizziness, cardiac dysrhythmias, light-headedness, tingling fingers/toes. Hydrogen and chloriede ar retained and potassium /bicarbontate ore lost to compensate.
What meds cause hypokalemia?
Lasix; beta adrenergic agonists; aminoglycosides/penicillin increases urinary K loss; digoxin and K compete for same receptor so if K is low, it increases the dig effect and can lead to toxicity.
daily water loss
gi tract defecation, lungs exhale, skin sweating, kidneys urine
A. Extracellular
i. Types - Plasma, Interstitial Fluids (IF), and Others such as lymph, joint fluids, cerebrospinal fluids and fluids in eye.
ii. Internal environment of body
iii. Surrounding the cells and transports substances to and from them
Daily total intake of water of oxidation?
300 ml
Nursing Knowledge: Sodium (Na+)
The most abundant cation in ECF
Function: Regulates ECF, maintain blood volume, transmits nerve impulses and contracts muscles
Normal Level: 135-145 mEq/L
Sources: Foods (bacon, ham, processed cheese, table salt)
Regulation: RAA system
BODY FLUID
*MAKE UP LARGE PORTIONS OF THE BODY
*COMPOSED OF WATER AND ELECTROLYTE SUBSTANCES THAT DISSOLVE IN WATER
Who has the lowest proportion of water in the body?
Elders (50%)
A patient with hyperkalemia would have an ECF K+ level of a. 36 mEq/L b. 5.6 mEq/L c. 0.42 mEq/L d. anything greater than 1 mEq/L
b. 5.6 mEq/L
Imbalances between hydrostatic and Osmotic Pressures
Increased hydrostatic pressure or decreased osmotic pressure
CLINICAL FACTORS
SURGERY : Longer client has NPO the risk of introperative and postoperative complications such as cathartic or enemas excessive blood loss or fluid volume deficit. Infection is still one of the most common postoperative complications such as fever , diporesis and tachypnesa increase flouid loss.
CHEMOTHERAPY: Drugs cdause GI cell damage leading to complication of anorexia nausea vomiting taste changes and these effect fluid deficit through decreased intake or increased loss.
MEDICATIONS: Diuretics cause fluid loss. Meds can cause SE that result in fluid loss vomiting diarrhea. Some promote bowel elimination Insuling antiodiabeticas control hyperglycemia and this causes fluid loss. Clucocorticoids increase sodiumretention water retention this is excess of water retention.
Gastiointestinal Intubation: To empty stomach contents or when nasogastric tube is place for purposes of gastric emptying increases risk for fluid defecit. Alsoays monitor client forfluid and electrolyte defiecit and metabolic alkalosis. NG tube provides route for foods and fluid who can not take by mouth. Tube feedsings due hae complications to diarrhea and this causes fluid deficit.
INTRAVENOUS THERAPY - IV therapy if not adequate to meet maintenance needs a risk for fluid deficit exists. When client has been 3 or more days without food through oral or enteralroute IV approach is chosen to provide nutrients and they provide carbs, proteins, fats and electrolytes this is total parenteral nutrition. Monitor for hyperglycemia and secondary polyuria d/t risk for osmotic diuress from high glucose levels in solution.
B. Intracellular Fluids (ICF)
i. Large Fluid Compartment
ii. Located INSIDE Cells
iii. Serves as solvent to facilitate intracellular chemical reactions
Lack of ADH secretion results in what?
Copious dilute urine
composition of body fluids: Over 60 years of age
46-52%
Implications: some impaired
because of medication especially water soluble
Solutes are particles that dissolve in fluid.
They include:
• Nonelectroytes
Organic molecules and others that don't break apart in solution such as Glucose, urea, creatine, amino acids
• Electrolytes
Molecules that split into ions when dissolved
Acids, bases, salts
_____ of blood is the force exerted by blood against the vascular walls
hydrostatic pressure
If the hydrostatic pressure and capillary permeability are within normal limits, what else could lead to edema? a. Obstruction of Lymphatic Flow b. Hyperglycemia c. Low Cardiac Output d. hypothermia
a. Obstruction of Lymphatic Flow
INTERVETNISON TO BALANCE ELECTROLYTE LEVELS
General intervention - Nutrition is key
Sodium imbalane- hyponatremia/hypernatremia
Potassium imbalance: hypokalemia/hyperkalemia
Calcium imbalane: hypocalcemia/hypercalcemia
Magnesium imbalane and phosphate imbalance,
Diagnostic findings of hypovolemia?
BUN/Cr ratio > 20:1 (Creatinine stays, BUN goes up, kidneys reabsorb urea), elevated Hct, urine specific gravity increases (normal is 1.010-1.025).
Define hypotonic solution?
The first solution has a lower SOLUTE concentration than the second solution, so the fluid is going to flow to the second solution.(So the first solution is hypotonic to the second solution.)
How is fluid balance regulated?
By regulating intake (thirst) and output (kidneys)
The main factor determining the direction in which water will move is
the amount of solute (dissolved particles) in each compartment.
Major buffer systems is the ____ and ____.
bicarbonate and carbonic acid
A patient with an ECF K+ level of ____________ would be considered to be within normal limits. a. 3.4 mEq/L b. 4.7 mEq/L c. 36 mEq/L d. 4.2 mEq/L
d. 4.2 mEq/L
What are causes of HYPERkalemia?
Cellular trauma/lysis (K is stored in the cell and gets released when cell is lysed), insulin deficiency, acute acidosis - K in exchange for H+, HYPOaldosteronism.
What pressure does the blood enter the capillary at?
32 mmHg- hydrostatic pressure
The reason that there is no net flow of fluid between these compartments is that they have
• The same osmolarity
Which of these is paired up correctly referring to potassium: a. Glucagon promotes potassium entrance into cells b. Epinephrine blocks entry c, Glucocorticoids promote potassium excretion d. you crazy! They're all matched correctly.
c, Glucocorticoids promote potassium excretion
Fluid imbalances occur in the elderly population because?
their skeletal muscle mass declines. (Skeletal muscle cells hold lots of water. The elderly are more prone to get fat cells which does not hold water.)
_____ accounts for 20% of ECF and ____ accounts for 75%.
Intravascular or plasma, interstitial fluid (surrounds the cells)
What are the ECG changes in hypocalcemia?
A prolonged QT interval, prolonged ST segment, Torsades de pointes could be possible.
What is the increased osmolarity of the plasma at the venous end due to?
Retained protein in the plasma- it does not leave the capillary
Water is lost from the body through the
• Kidneys
• Urine
• Skin
• Sweat
• Skin
Transporation or evaporation
• Expired air
• G.I. Tract
Large intestine
After a mastectomy patients may suffer from persistant edema for life- why?
Because in a mastectomy they take out the lymph nodes and therefore it is unable to drain anymore resulting in edema.
What would happen if there was low albumin concentrations?
There would be nothing to pull the fluid back in so edema would result.
hypotonic
swell
Hyperkalemia: Nursing Planning
Goals:
Outcomes:
gi tract
100 ml
Physical Assessment: Neurological: FVE
Restlessness
TX
insulin with fluid replacement
Hypomagnesemia: Assessment findings
Neuromuscular irritability
Increased reflexes
Tachycardia
Confusion
Vertigo
Nml levels of Cl-
95-108 mEq/L
3rd Spacing
Ascites: abdomen
Pleural: around lungs
Pericardial: around heart
Pulmonary: in lungs
increased ECF K+
stimulates aldosterone secetion
H ion elevated/bicarbonate ion decreased.
acidosis
Hyperkalemia: K+ >5.0 mEq/L
Causes
Decreased excretion
Increased intake
What is the symbol for sodium?
Na+
INTERSITIAL FLUID
*FOUND BETWEEN THE CELLS
*25-11-10-15 INFANT MEN WOMEN AND ELDERLY
Hypoosmolar imbalance
Overhydration, when water exceeds total solute concentration
The _____________ control(s) the volume and electrolyte concentration of body fluids. a. kidneys b. pancreas c. thyroid d. thalamus
a. kidneys
Respiratory Acidoses
Respiratory acidoses results fro rentetion of CO2 and a decrease in pH. Hypoventilation increased Co2 to build will result in respiratory acidosis. Conditions that depress respiratory center, lung diseases, airway obstruction. S&S: weakness, tremors, conusion, depresseion even compa. Potassium and bicarbonate are retained and hudrogen and choloride are lost to compensate.
factors affecting fluid balance
lifestyle, developmental, physiological, clinical.
kidney activates this, which stimulates the GI tract to absord more dietary calcium
vitamin D
Hypernatremia: Sodium >145 mEq/L
Causes
Loss of Fluids
Water deprivation
Excess salt intake
Medical conditions
INTRACELLULAR FLUID
*FLUID INSIDE THE CELLS CONSTITUTES ABOUT 2 THIRDS OF THE TOTAL BODY FLUID IN ADULTS
*CONSTANT OF INTERCELLULAR FLUID
*STABILIZING AGENT FOR THE PART OF THE CELL
*HELP TO MAINTAIN CELL SHAPE
*ASSIST WITH TRANSPORT OF NUTRIENTS ACROSS THE CELL MEMBRANE AND IN AND OUT THE CELL
*CONTAINS SODIUM BUT IN MUCH SMALLER AMOUNTS THAN EXTRACELULAR FLUID
*48-45-35-25 INFANT MEN WOMEN AND ELDERLY
ASCILES
*EXCESS AMOUNT OF FLUID IN THE PERITONEAL CAVITY
Colloids
substances like protein that do not dissolve easily in true solutions
vasopressin causes
Distal nephron cells to insert aquaporin water pores in their apical mem.
Capillary hydrostatic pressure refers to the outward push of the ______________ against the capillary walls. a. lymph fluid b. ICF c. CSF d. vascular fluid
d. vascular fluid
________________ ~ 1.7 mEq/L decrease in Na for every 100mg/dL increase in glucose. a. hypoglycemia b. ketoacidosis c. hyperglycemia d. diabetes insipidus
c. hyperglycemia
Fluid Balance
homeostasis, or relative constancy of body fluid levels; a condition required for healthy survival.
Complications of IV therapy:
Infiltration, phlebitis, infection, air embolism, allergic reaction, circulatroy overload. Phlebitis, inflammation of vein
Lungs
What organ rids the body of approximately 300mL of fluid per day and plays a role in acid-base balance?
hypomagnesium
serum less than 1.8 causes personality changes, nystagmus, tetany, positive babinski, chvostek, and trousseau signs, tachycardia, hypertension, and cardiac dysrhythmias
The total amount of extracellar fluid averages ____ of the person's body weight or about _____ Liters.
20%14
What is the principal regulator of water intake?
Thirst
Homeostasis-Hormonal Regulation: ANP
Secreted by the Atrial Cells
In response to an increase in circulating blood volume
Acts as a diuretic
Causes Na+ loss and inhibits thirst
NURSING CONSIDERATION FOR ALKALOSIS
*MONITOR LAB VALUES
*ADMINISTER IV SOLUTION AS ORDERED TO TREAT ANY ELECTROLYTE IMBALANCES
*MAKE SURE THE ALKALOSIS DOES NOT WORSEN OR RESULT IN THE OPPOSITE IMBALANCE
*SIMPLE TREATMENT OF RESPIRATORY
CAUSES OF EDEMA
*OBSTRUCTION OF VENOUS BLOOD OR LYMPHATIC RETURN
*INCREASED CAPILLARY PERMEABILITY OR INCREASED CAPILLARY PRESSURE
*EXTERNAL PRESSURE (TIGHT BINDERS OR CAST)
*INFLAMMATORY REACTIONS
*LOSS OF PROTEINS IN THE PLASMA OF THE BLOOD
____ is found in the skeleton and intracellular fluid.
magnesium
when vasopressin is absent
water permeability is nearly 0
When the membrane potential is more _____________________ than normal, the cell is in a hyperpolarized state. a. positive b. isotonic, c. negative d. atrophied
c. negative
Lifestyle
Nutrition - Body requires 1500 mL of fluid to maintain cellular function; Recommended 8-10 glasses of water/fluid to total 2000-2400mL We get fluid from food.
Exercise - loss of fluid d/t body temp humidity fluid loss of 2% can cause increased heart rate; increased body temp and decreased plasma vol.
Stress -Trigor hypothalamic realsing factors timulateing anterior pituitary to release ACTH capillary leakding and increased sodium ; water retention and aldosterone has more influience on sodiujm retention. Both promote loss of potassium in creases risk of hypokalemia metabolic alkalosis.
brawny edema
fluid can no longer be displaced secondary to excessive interstitial fluid accumulation, no pitting, tissue palpates as firm or hard, and skin surface is shiny, warm, and moist.
thirst is triggered
________by osmoreceptors & increase in osmolarity
Transcellular fluids are other fluids besides extra and intracellular fluids and are located in which places?(5)
cerebrospinal columnpleural cavitylymph systemjointeyes
Primary functions of fluids
A medium for metabolic reactions within cells
A transporter for nutrients, waste products (CO2), and other substances
A lubricant
An insulator and shock absorber
One means of regulating and maintaining body temperature
DEPENDENT EDEMA
*OCCUR IN THE AREA THAN HANGS DOWN
*COMMON IN THE FEET AND ANKLES
Interventions for Isotonic Fluid Volume deficiet
monitor weight, vital signs, temperature, fluid intake and output, frequent mouth care, administer oral or IV fluids
All of the following may cause hyponatremia except a. Inadequate sodium intake b. excess Cl- c. Sodium losses d. Dilution of body's sodium level
b. excess Cl-
Eletrolyte imbalance
Person has eiher a deficit or an excess of one or more electrolytes. Clients often have moe than one electrolyte imbalance as well as fluid imbalance.
best areas to assess for edema
sacrum, feet, and ankles.
Edema
is the swelling of an area caused by the overhydration of that area.
What is modified in the filtrate?
Both solute and water
CHLORIDE (Cl-)
The second most abundant extracellular ion
The functions of chloride include
• Balancing osmotic pressure
• The chloride shift in red cells
Angio II. had addition effects that
raise bp, including increased vasopressin secretion, stimulation of thirst, vasoconstriction, and activation of the card. control cntr
Edema caused by liver disease, starvation or malnutrition is due to a. decreased colloidal osmotic pressure b. decreased arteriolar resistance c.decreased plasma protein production d. increased capillary osmotic pressure
c. decreased plasma protein production
Fluid Compartments Intracellular
Contains 70% of body fluid; fluid loss at cellular level afects entire body
congestive heart failure
your heart can't pump enough blood to meet you body's needs; it's a pump problem. shortness of breath, cough, and not being able to deep breathe are symptoms. Lab values are increased BUN, and increased creatinine.
The most obvious and life-threatening problems are seen when?
dehydration decreases the plasma volume
60% of the body's weight is made up of what? water
Water
Volume depletion involves the loss of
proportionate amounts of water and sodium from the Interstitial fluid or Plasma. The amount of fluid in the compartment decreases. The osmolarity of the fluid remains normal
high medullary osmolarity is necessary for
formation of concentrated urine as filtrate flows throughout the collecting duct
Symptoms of Weakness, Agitation, Firm subcutaneous tissue, Increased thirst, Edema & Elevated BP would be expected with a sodium level of ______. a. >1.47 mEq/L b. <1.47 mEqL c. >147 mEq/L d. <147 mEqL
c. >147 mEq/L (hypernatrimic fluid excess)
What is calcium's role with digitalis?
For patients taking digitalis, assess for s/s of toxicity (Confusion, Irregular pulse, Loss of appetite, Nausea, vomiting, diarrhea, Palpitations, VISUAL CHANGES (unusual) such as: Blind spots in vision, Blurred vision, Changes in color perception, HALOS OR RINGS OF LIGHT AROUND OBJECTS, Seeing lights or bright spots) because increased calcium potentiates digitalis effects.
What could cause hyperaldosterone secretion?
tumor in the adrenal cortex causing hypokalemia
This leads to a
This leads to a net movement of water from the interstitial fluid to the intercellular fluid.
The loss of interstitial fluid causes a drop in
• Interstitial fluid hydrostatic pressure
This causes
• Water to move from the plasma to the interstitial fluid
This causes a
• Decreased blood volume
This results in
• Decreased blood pressure
• Excess water in nerve cells
• Convulsions, coma, and death
How balance of electrical neutrality is maintained
When one cation is retained Sodium another cation is excreted Potassium.
Where is ADH produced and stored?
Produced by the neurons in the hypothalamus and stored in the axon terminals of the posterior pituitary.
Normal levels of potassium and what are the foods taht contain it?
ICF 125/140 mEq/L, normal serum levels are 3.5-5.0 mEq/L. (fruits, veggies, meat, fish)
What diuretic do you use for mild hypervolemia?
Thiazide diuretics, need to monitor hypokalemia.
hydrochlorothiazide (HydroDIURIL) and metolazone (Zaroxolyn)
Increased stretch of the heart is caused by what?
Increased venous return to the heart, caused by excess fluid volume
The ___ and ___ work continously to regulate acid-base balance
lungs and kidneys (kidneys take longer but have a more permanent change)
1. correction - the cause of the disturbance is repaired
2. compensation - physiological adjustments are made
2 ways to return pH to normal
We need to intake K+ every day because a. we use it all up b. it has a short half life c. the kidneys and GI tract excrete almost all of it every day d. we don't know.
c. the kidneys and GI tract excrete almost all of it every day
/ 356
Term:
Definition:
Definition:

Leave a Comment ({[ getComments().length ]})

Comments ({[ getComments().length ]})

{[comment.username]}

{[ comment.comment ]}

View All {[ getComments().length ]} Comments
Ask a homework question - tutors are online