fluid and electrolytes Flashcards

ECF
Terms Definitions
bun
10-20








Fluid imbalances—come in 2 major categories:








saline imbalances and water imbalances.
calcium
8.6-10.2 mg/dL
Calcium (Ca)
8.5-10.5 mg/dL
K
3.5 - 5.0
normal glucose
60-110 mg/dl
Hyperchloremia (causes)
-Increased salt intake
Alkalosis
ph greater thn 7.45
3.5-5.0 mEq/L
normal potassium level
Alkasetlzer
has a lot of sodium
hypomagnesemia S&S
hyperactive DTR's tachycardia, confusion, hypertension
Na+
Extracellular, Maintain ECF volume, Transmission on impulses in nerve and muscle, Regulation of acid-base balance, Kidneys important and in regulating Na+
Hypokalemia ________ smooth muscle excitability
decreases
solution
homogeneous mixture of solutes dissolved in a solvent
symptoms of hyponatremia
HA, anxiety, edema
Respiratory alkalosis manifestations
lightheadedness, inability to concentrate, numbness and tingling, and sometimes loss of consciouness
Chloride (Cl-)
Major anion in the ECF
What is the electrolyte imbalance referring to low phosphorus?
hypophosphatemia
Phosphate
2.4-4.4 mg/dl
** PHOSPHATE AS AN INVERSE RELATIONSHIP WITH CALCIUM
ADH
stored in the posteroir pituitary gland and is released in response to changes in blood osmolarity
Na+ Distribution
1. Plasma- 142mcq/L
2. Interstitial- 146mcq/L
3. Intracellular- 15mcq/L
Hyperkalemia
Fluid Volume Deficit, Massive cellular damage from burns or trauma, adreanal insufficiency, Use of potassium sparing diuretics, Ingestion of K+ salt substitutes.
causes of hypervolemia
-excess fluid intake
-renal failure
-heart failure
-long term corticosteroid therapy
metabolic acidosis
overproduction of hydrogen ions, under-elimination of hydrogen ions / underproduction of bicarb ions or over-elimination of bicarb ions.
hypokalemia
Diruetic therapy with inadequate K replacement, vomitting, diarrhea, diaphoresis, dialyisis S/SX lethargy confusion, anxiety, slowed impulses, weakness, fatigue, nause and vomiting
2 main elecrolytes lost through sweat
sodiumpotassium
treatment of hyperkalemia
10% calcium gluconate, sodium bicarbonate, 50% glucose solution, kayexalate PO/PR b/c absorb through rectum. stop k supplementts and avoid k in food, fluids, salt substitutes
FVE symptoms
edema, distended neck veins, abnormal lungs sounds (crackles), tachycardia, increased BP, pulse pressure, and CVP, increased weight, increased UO, shortness of breath, wheezing
What are generally used as maintenace fluid to compensate for insensible fluid losses, as replacement fluids to correct body fluid deficits and for special purposes, such as treating specific fluid and electolyte imbalances.
crystalloids
hyponatremia caused by
Gi losses, renal losses, burns
potassium
major cation of ICF; works in reciprocal fashion w/ sodium; bananas, peaches, kiwi, fig, apricots, oranges, potatoes, meat, and dairy; normal value= 3.5-5
What is the normal range phosphate?
1.7-2.9 mEq/L
dehydration
a serious reduction in the body's water content
Third space syndrome fluid shifts from the vascular space into an area where it is not readily accessible as extracellular fluid
...
Hypercalcemia
increase in the total concentration of serum and/or ionized calcium
hyperparathyroidism or neoplasm
decreased
mechanism of Edema :
4. BLANK capillary osmotic pressure
s/s of hypertonic fluid deficit
weight lossweak pulsehypotensiontachycardiathirstAMShigh serum Na (>145 mEq/L)serum osmolality (>300 m0sm/L)urine specific gravity (>1.030)
S2
begining of diastole. closing of pulmonic and aortic
What is Sodium (Na+)?
Principal cation outside cell.
Normal concentration outside of cells is 135-145 mEq/L.
Level maintained by dietary intake of sodium chloride (salt), fish, meats, & other foods flavored, seasoned, or preserved with salt.
kidneys
the excrete varying amounts of acid or base
3 types of passive transport
1. Diffusion
2. Osmosis
3. Filtration
____ _____ tissue fluid of the eye
aqueous humor
Hypertonic
What type of solution pulls fluid FROM the cells because it has a higher osmotic pressure?
Osmotic pressure
press necessary to oppose movement of water across memb.
High Risk for Elderly
Less total body water
Decreased thirst
Difficulty obtaining fluids
May be on fluid depleting drugs
Diuretics
Laxatives
treatment of hyperchloremia
reverse acidosis, LR IV (liver converts lactate to HCO3), sodium bicarb, diuretics, limit Na, Cl, and fluids
Agglutinogens
a substance that acts as an antigen and stimulates the production of agglutinins
solvent
the fluid in which a substance is dissolved
lymphatic
mechanism of Edema :
3. blockage of BLANK drainage
treatment of hypertonic fluid deficit
monitor i&o/daily weightmonitor labadminister IVF as ordered (usually hypotonic solution)monitor LOCfrequent oral caremonitor safety
What does the anti diurectic hormone make you do?
retain H2o
intracellular fluid
inside the cells 2/3 tbf and functions as a stabilizing agent for parts of the cell
Passive Transport examples-Osmosis
Osmosis-the movement of water from an area of lower concentration to an area of higher concentration. It equalizes the concentration of ions or molecules on both sides of the membrane.
The flow of water will continue until the number of ions or molecules on both sides are equal.
the buffer system consist of a ___ acid and a ___ base. they react with a strong acid or a strong base
weak weak
isotonic solution
a solution that has about the same concentration of particles, or osmolarity, as plasma.
What are the primary electrolytes found in the ICF?
Potassium, Phosphate, & Sulfate.
hypotonic iv solution
-osmolarity value of < 275
- 0.45 NaCL (half NS)
-0.33 NaCL (1/3 NS)
- less particles than plasma
-will delute fluid in vessels
RESPONSES to fluid loss
thirst, decreased BP & cognition, sunken eyes, sleepy, weak, warm flushed skin, rapid/weak pulse & elevated temp.
hypomagnesemia definition, s/s, tx
low magnesium caused by excessive intake of Ca/Vit D, GI fluid loss, diuretics, malnutrition, pancreatitis, alcoholisms/s: increased muscle cell irritability/contractility, low BP, arrhythmiastx: magnesium replacement
hyperphosphatemia: causes
1. renal disease 2. hypoparathyriodism 2. hyperthyroidism 3. execess vit. D 4. muscle necrosis
Na
Na - Salt is expensive now a days, it costs 135-148 per kilo. (135-148 mEq/L)
1/3 left is called ______ ______ and consists of blood plasma, lymph, tissue fluid, cerebrospinal fluid, synovial fluid, aqueous humor and serous fluid.
extracellular fluid (ECF)
example problem:
ph 7.30
CO2 52
HCO3 22
ph 7.30 low
CO2 52 high
HCO3 22 normal
respiratory acidosis
Metablic Alkalosis Lab Data
ABGs: high pH, elevated bicarb (more than 28), rising CO2, normal O2. ELECTROLYTES: decreased potassium and Calcium.
respiratory alkalosis: labs
low CO2, pH high >7.45, bicarb normal if no compensation or decreased if compensation, hypokalemia, hypocalcemia
Name the Clinical manifestations of hypernatremia
thirst, dry tongue, weight changes, restlessness, cerebral hemorrhage, decreased level of consciousness, IC dehydration
Decrease fluid - (leads to)
hypovolemia - decreased BP - shock
S&S: thirst, increased HR, poor skin turgor, decreased perfusion
greater than normal potassium results may mean
crushed tissue injury, kidney failure, red blood cell destruction, metabolic or respiratory acidosis, transfusion of hemolyzed blood, Addison's disease, hypoaldosteronism (rare)
Causes of Abnormally low PaCO2 values(Respiratory Alkalosis)
Hyperventilation caused by anxiety, hypoxia, ASA overdose, sepsis
What is required for active transport?
Cellular energy is required to move substances from a low concentration to a high concentration.
hypokalemia - NEVER give as a
bolus IV push; will cause INSTANT CARDIAC ARREST;
The accurate way to determine water balance?
A simple and accurate method of determining water balance is to weigh the patient under exact conditions. Ex: same gown, same number of electrodes, same time of day.
1 L of fluid equals 1 kg (2.2 lb); a weight change of 1 kg will reflect a loss or gain of 1L of body fluid.
What is the name of the disease if you HAVE too much ADH?
Syndrome of Inappropriate ADH Secretion.(SIADH)
Why does hyponatremia cause cells to swell?
Water moves from the ECF to the ICF
d10w
hypertonic
Cl
98-106 (Anion-/Extracellular)
Hypophosphatemia (symptoms)
-cardiomyopathy
-shallow respirations
-decreased deep tendon reflexes
-irritability
anions
negatively charged electrolytes
normal potassium
3.5-5 mEq/L
ECF
-includes intravascular and interstitial fluids and transcellular
-"third spacing": loss of ECF into a space tah does not contribute to equilibrium
compensated respiratory acidosis is
...
1.5-2.5 mEq/L
normal magnesium level
Hyponatremia intervention
water restriction, sodium replacement
hypotonic
a solution of lower-than-normal osmotic pressure
passive diffusion
when dissolved substances (electrolytes) move from high concentration to low concentration through a semipermeable membrane
hypokalemia assessment findings
-weak irregular pulse
-palpations
-orthostatic hypotension
-leg weakness, cramps, paresthesias (tingling/pricking feeling of skin)
-decreased gi mobility
-heart rate may have extra beats
Isotonic Solutions
Lactated Ringers(good immediate ability to expand the blood volume). Normal Saline(most common and same same % as human body fluid), and Dextrose in 5% water(useful in keeping veins open)
STARVED hypomagnesemia
S seizuresT tetanyA anorexia/arrhythmiasR rapid heart rateV vomitingE emotional liabilityD deep tendon reflexes increased
Potassium
(3.5-5 mEq/L)
regulates contraction and nerve impulses, regulates hr and acid-base fluid balance, regulates fluid ion balance, 95% in intracellular fluid, levels, irritating to the veins
% water of average infant weight
70-80%
osmolarity
osmotic pressure of a solution expressed in osmoles or milliosmoles per liter
Overhydration
impaired water exretion, increase in ADH, drugs.
Hypocalcemia causes
removal of parathyroid, malabsorption syndromes, not enough vitamin D, Low Mg, alcoholism
homeostasis
stable conditions of the body fluid
Bicarbonate HCO3-
portion of buffer system (28)
tingling, twitches, tetany, trosseaus, chvostek
s/s hypercalcemia/hypermagnesemia
Hypovolemia
This is characterized by dry mucuous membranes, non-elastic skin turgor, decreased urine output/blood pressure, and weight loss.
Chloride
• Works with sodium to maintain osmotic pressure of blood
• Essential for production of hydrochloric acid (HCl) for gastric secretions
• Functions as a buffer for the gas exchange (oxygen and carbon dioxide) in RBCs
• Assists with acid-base balance
extracellular
20% of body weight, approx. 14L (combined intravascular & interstitial)
ion
an atom or molecule carrying an electrical charge.
ANP
Is released by cardiac cells in response to excess blood volume, acting on nephrons, it promotes Na wasting and acts as a potent diuretic, reducing vascular volume
hyponatremia ssessment findings
-lethargy, headache, lowered LOC, confusion
-muscle weakness, cramps, themors
-abdominal cramps, nauea
hypernatremia
a swerum sodium of more than 145
Lungs
insensible about 500 ml of water daily
size of the moleculeconcentration of the solutiontemperature
facilitated diffusion
S1
begining of systole. closing of tricuspid and bicuspid
active transport
cellular energy is required to move substances from a low concentration to a high concentration
What percentage of water is a Twelve year to an adult made of?
50%-60%
what is the intracelluar PH range?
6.8 to 7.0
Forms of Edema
Inflammation: hyperemia due to vessel permeability
Hydrostatic: increase in arterial pressure
Oncotic hyperotension: increase in protein loss
Obstructive: usually lymphatic
Hypervolemic: Na retention pg 112.
Oncotic pressure
osmotic pressure of a colloid in solution, such as when there is a higher concentration of a protein in the plasma on one side of a cell membrane than in the neighboring interstitial fluid
Treatment of Hyponatremia
Limit water intake, encourage salty food, hypertonic IV fluid
Hypermagnesemia
an excess of magnesium in the blood plasma
hyperphosphatemia
causes : Failure of the kidneys to excrete excess phosphate
Rapid redistribution of intracellular phosphate to the ECF compartment
Excessive intake of phosphorus
Estimated blood volume for neonates? Premie and Full term
Neonates
Premature: 95 ml/kg
Full-term: 85 ml/kg
Is the urine output concentrated or dilute in SIADH?
CONCENTRATED/AND DECREASED
Serum Sodium
-Measurement of level of Na in blood serum
-Ref. range: 135-145 mEq/L for adult
Balance between the electrolytes
for each positively charged cation, there must be a negatively charged anion
magnesium is regulated by
dietary intake, renal mechanisms, and PTH
Hydrostatic Pressue
Created by the weight of fluid against the wall that contains it.
What is the normal range of serum sodium?
135-145 mEq/L
roles of potassium
-assist in skeletal and heart muscle contraction
-aids in transmission of nerve impulses
-affects acid base balance
cerebral osmoreceptor-mediated thirst
what type of thirst causes increased osmolality of extracellular fluid
thiazide diuretics
pull out Na, small amounts of K, H20example: hydrochlorothiazide
hypomagnesemia: cause
1. alcoholism 2. protein malnutrition 3. IV w/o Mg 4. GI losses 5. hyperaldosteronism 6. osmotic diurteics 7. some antibiotics 8. overdose vit D or calcium 9. burns 10. pancreatisis 11. DKA
Both hypokalemia and hyperkalemia can cause
Skeletal muscle weakness, paralysis, lethal cardiac dysrhythmias, cardiac arrythmias
An average of ___ ml per day from beverages or liquids and and average of ___ ml per day from foods
1600, 700
Hypernatremia Signs and Symptoms
Extreme thirst, dry and flushed skin, dry and sticky tongue, and muscous membranes, postural hypotension, fever, agitation, convulsions, restlessness and irritability.
Most at risk for fluid imbalance
infants, severely ill adults, disoriented or immobile clients, and older adults
respiratory acidosis management (7)
correct cause, CPT, TCDB if able, suction as needed, semi-Fowlers, fluids to thin secretions, low-flow O2 as needed
What are the two main causes of hypervolemia?
CHF and Kidney disease
As water moves across a semiperm membrane (osmosis) it generates?
osmotic pressure. **generates by movement of water (solvent)
Osmolality of Body Fluids
Osmolality reflects the [ ] of fluid that affects the movement of water between fluid compartments by osmosis. Measure of a solution's ability to create osmotic pressure and affect the movement of water.
Fill in the blank: Low sodium levels usually causes ______ osmolarity in the fluid compartments outside the cell: so fluid moves
low/into the cells
How is fluid lost by the body?
Exhaled in air, evaporated and perspired by skin. Excreted in feces and urine.
s/s of isotonic fluid volume excess
weight gain over short period of timeperipheral edemadistended neck/peripheral veinsmoist rales in lungsbounding pulsedecreased BUNincreased BPincreased, hard pulse
Where does sodium come from in the diet by percentage?
75% from processed foods
10% occurring naturally in food
15% used in cooking and eating
hypophosphatemia: nursing care
1. phospahe supplements 2. Ca and phos inverse relationship 3.
2 major organs of homeostasis
lungs: regulate 02, C02 LEVELS H2C03kidneys: excrete chemical wastes and sort out electrolytes HC03
urine specific
1.010-1.025
isotonic
equal tonicity
phlebitis
inflammation of a vein
cations are
positively charged electrolytes
Causes of dehydration include...
&#10;&#10;&#10;&#10;&#10;&#10;&#10;&#10;emesis, &amp; diarrhea without fluid/salt replacement.
moderate signs of hypernatremia
confusion, thirst,oliguria
Hyperphosphatemia (causes)
-decreased renal function
-increased intake of phosphorus
-hypoparathyroidism
hypermagnesemia S&S
hypoactive DTR's, hypotension, decreased rate/depth of resp
Electrolytes
substances whose molecules dissociate, or split into ions, when placed in water
Respiratory acidosis (hypercapnia) a state of excess carbon dioxide in the body
...
sodium
sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS) control the rate of what?
atrial natriuretic peptide may also help in regulation of excretion
Cl- Significance
Important in acid-base balance
sodium (Na+) hypo lab value
Below 135
Sodium-hyponatremia
Less than normal concentration of sodium in the blood
Sodium level less than 134 mEq/L
Can occur when there is a sodium loss or a water excess
Body attempts to compensate by decreasing water excretion
Patient is likely to also have a potassium imbalance due to fluid being moved into the cells and potassium shifting out of the cells
S/S-irritability, muscle weakness, muscle twitching, tremors, fatigue, apathy, postural hypotension, n/v, abd. cramps, apprehension
Isotonic tonicity
cell stays the same size
filtration
uses pressure; promotes fluid movement through semipermeable membrane by pressure differences
Na+ and _________ are a couple
H2O
Overhydration occurs when water is gained in excess of electrolytes, resulting in low serum osmolality and low serum sodium levels, also known as hypo-osmolar imbalance or water intoxication
...
Hyperchloremia
chloride levels rise above normal, usually occurs when the serum bicarbonate levels fall, or sodium levels rise
aldosterone
tells kidneys to absorb more sodium
decreased sodium and potassium signs
lethargy, weakness
42%
% of body weight of intercellular fluid
Hypomagnesemia management
MEDICAL: diet, oral magnesium, and magnesium sulfate IV
NURSING: assessment, ensure safety, patient teaching related to diet, medications, alcohol use, and nursing care related to IV magnesium sulfate
Hypervolemia
What is the abnormal retention of fluids a sign of?
Impared wound healing, immunity and coagulation, hypotension, third spacing like (ascites effusion, edema) chronic weight loss
Protein Deficit
Hypochloremia
<95 mEq/L usually related to excess losses thruj GI tract, kidneys, or sweating, low levels parallel to low Na levels, is produced by stomach (hydrochloric acid) kidneys retain Na and bicarb to balance the loss of this, and this leads to metabolic acidosis
hypovalemia
- decrease in circulating blood volume leading to inadequate tissue perfusion
-weight loss occurs
Hyper/Hypochloremia
Not common unless in conjunction with Sodium or Potassium abnormalities
Na+ &gt;145 mEq/L Manifestations
Thirst, dry tongue
Restlessness
Weight changes
(Na+) hyper symptoms
thirst, dry mucous membranes, sticky tongue, restless , irritability, agitation, convulsions
Osmosis
movement of fluid from an area of lower solute concentration to an area of higher solute concentration
Define: colloid oncotic pressure
pressure exerted by protein (24mm/hg)
what are the cations?
sodium, potassium, magnesium, iron, and hydrogen
Angiotensin II
(active form) - powerful vasopressor & stimulator of aldosterone production
intravascular fluid
blood plasma found in the vascular system
S/S mnemonic for hypokalemia
SUCTION by the 6 Lesbians
unsaturated fats
have an unequal number of hydrogen atoms attached andthe caron atoms attach to each other with a double bond.
valence
the degree of combining power of an ion
Normal ECF Na+ value.Normal ICF K+ value.
140 meq/dl150meq/dl
metabolic acidosis GI signs (3)
n/v, diarrhea, abdominal pain
what is fluid volume defecit
a decrease in intravascular, interstitial and /or intracellulas fluid loss
Define: dehydration
the amount of H2O lost exceeds that gained. Water deficit or underhydration occurs.
osmosis moves from
more dilute area to more concentrated area
Fluid volume excess
Occurs when the body retains both water and sodium in similar proportions to normal ECF. hypervolemia
Hydrostatic pressure
the pressure a liquid exerts on the sides of the container that holds it; also called filtration force
Urine Specific gravity test
Normal range 1.010 and 1.025
measures the urine's degree of concentration and evaluates the kidney's ability to conserve or excrete water. 
metabolic alkalosis assessment (6)
VS, ABGs, RR/depth, LOC, I&O, ECG
Nursing care for FVE
restriction of fluids and sodium and administration of diuretics, use semi-fowler's position for orthopnea, provide skin care and position/turning, promote rest
What foods contain phosphorous?
Beef , pork, fish, poultry, milk products and legumes
Fluid imbalance
too much or too little fluid in the body
extracellular fluid can be found where?
vascular compartment(or plasma) and interstitial space
environmental stresses and disease
what can increase fluid loss, impair fluid intake, and interfere with mechanisms that regulate fluid volume composition and distribution
Treatment for hypernatremia
stop water loss and correct deficit, restore blood volume, treat underlying cause
What are some factors that contribute to Fluid Volume Excess
Excessive dietary sodium or sodium-containing IV solutions
infants, children & elderly are at increased risk for
complications from fluid loss, including infection and diseases
how stress can cause decreased potassium
ADH released; retain sodium; increased BP; lose potassium
air embolism
place pt on left side with head down. allows air to enter right atrium and into pulmonary artery
What are the functions of fluid
water is an excellent solvent because it can dissolve many different substances
the dissolved materials, or solutes, include ions, sugars, aa, vit and mins
blood volume
protect and lubricate body tissues
maintain body temp
electrolytes help regulate fluid balance
Electrolytes help nerves respond to stimuli
Treatments for Abnormally low values of Mg+
Mg+ replacement; Monitor heart and airways; High Mg+ foods; Seizure precautions
what is hypercholemia and when is it likely to occur
high levels of chloride in blood
hypertension
What are some of the physical signs of Fluid Volume Excess?
edema, distended neck veins, abnormal lung sounds (crackles), tachycardia, increased blood pressure/pulse pressure/and CVP, increased weight, increased urinary output, shortness of breath, and wheezing
what are causes of hyponatremia re water gain
excessive ttake of na free flids, kids in pool all day swalling water near drwoning when parents give water to babies instad of formula
hypocalcemia
broccoli
Mg range:
1.3-2.3
SIADH- causes
StressAnesthesiaSurgeryTumorsAidsMeds- cytoxin, diabenese, elavil
low PACO2 is
respiratory
primary ecf
na, ca,bicarbonate cl
sodium imbalance
hyponatremia or hypernatremia
Diffusion
High concentration to low
METABOLIC ALKALOSIS
restlessness, confusion, dyrhythmias, compensatory hypoventilation, slow resps, diarrhea, n&v
Treatment of Hypermagnesemia
-calcium gluconate
-ventilator support
-dialysis
-monitor hourly:
VS
I&O
LOC
DTR's
DO NOT DELEGATE!
Ca
Commonly paired with: Parathyroid maintains the body's calcium level. Need vitamin D for absorption in GI tract.
Anoxemia
reduced oxygen in the blood
ICF
provides medium for chemical functions
Calcium Excess
Interventions
The 4F's
Fluids PO
Fluids IV
Furosemide (LASIX)
Fiber increased
Calcium (Ca+) hypo lab value
below 8.5
Serum Osmolality
285-295 critical = <265 >320
Recommended intake of chloride?
AI: 2,300 mg
the phosphate buffer system is important in the regulation of the PH of the ____ by the kidneys
blood
Skin Measures
Protect edematous skin from breakdown
Pressure relieving mattresses
Assess pressure points
Change positions every 2 hours
What is hypernatremia associated with?
Possible FVD/dehydration
Agglutinins
specific antibodies formed in the blood
Edema
excess fluid in the interstitial space
90% of potassium is excreted in
urine
base
binds to H+ ions in water
Hyponatremia
-LOSS OF SODIUM, gain of water
-Serum level < 135 mEq/L and is considered severe when the serum level is < 125 mEq/L
-Cells swell as water is pulled in from ECF
Hyponatremia refers to serum sodium levels less than?
134 meq/L
intestinal obstruction
extra fluid in the bowel lumen
Patient Safety
Identify patients at risk before occurs
Prevent from becoming worse-can lead to heart failure, pulmonary edema and death Can occur quickly
All patients are at risk for pulmonary edema and heart failure-not just the elderly
Monitor for indicators of overload and report promptly to MD or call rapid response team
Educate your unlicensed patient care assistants (UAP)
Hypomagnesia occues in about _____ % of hospital pt's
10
the hormone aldosterone regulates kidney excretion of
sodium and potassium
tonicity
size of the bag does not effect...
1/3
ECF fluid outside of the cells, includes the plasma and the interstitial fluid (surrounds the cells)
Determined by the number of nondiffusible particles in solution.
Osmotic pressure
FVE, glucose
normal to high (stress response, >120)
20L
number of leaders of fluid in adult females
organs involved in homeostasis
kidneys, adrenal glands, parathyroid gland thyroid gland
Transcellular
Refers to the fluids that have a cellular barrier to contain them ie: cerebrospinal fluid, pleural fluid, gastrointestinal fluid, peritoneal/synovial fluids
Imbalance related to
changes in sodium concentration; major vascular solutes: Na and Plasma protein (albumin)
movement of intravascular fluid to interstitial spaces or body cavities (peritoneal cavity, pericardium, pleural space)
causes of hypovolemia
Hypercalcemia Signs and Symptoms
Anorexia, nausea and vomiting, weakness, hypoactive reflexes, lethargy, flank pain, decreased level of consciousness, personality changes, and cardiac arrest
Low serum albumin gives __________
false low Ca+ lvls
Cations (Positive Charge)
Sodium (Na+); Potassium (K+); Calcium (Ca++); Magnesium (Ma++); Hydrogen Ions
alkalemia
an arterial blood PH of more than 7.45
Hypophosphatemia
a serum phosphorus level less than 2.7 mg/dl
respiratory acidosis respiratory signs
dyspnea, slow shallow respirations, hypoxia and hypoventilation, cyanosis
Metabolic alkalosis manifestations
(produced by hypokalcemia)
symptoms related to decreased calcium, respiratory depression, tachycardia, and symptoms of hypokalemia
passive transport
no cellular energy is required to move substances from a high concentration to a low concentration
Patients recieving blood products should report...
pain, discomfort, flushed skin, chills, headache, burning sensation, feeling of impending doom.
Hypertonic Solutions
What type of solutions are D5 1/2NS, D5NS, D5 LR, and D10W?
s/s low volume in general
effortless breathing; fatigue; flat neck veins; reduced cognition; lethargy / sleepiness; delayed vein filling
The kidney excretes ____ amt of K+ daily
10-15 mg/dL
Distribution of Calcium (Ca+)
Plasma: 5 mcq/L; Interstitial: 3 mcq/L; Intracellular: 27 mcq/L
Third Spacing- clinical manifestations
Weak right sided pressureLow albumin levelsProtein levels
FVD osmolality (serum)
>300, more particles ↑ number of particles, concentration
What are the symptoms of hyponatremia and how is it managed?
Symptoms: lethargy, hypotension, stomach cramps, vomiting, diarrhea, seizures
Generally manage by restricting fluids
What are the functions of fluids?
Heat capacity, cooling ability, metabolism, pH balance, body fluids
To much Na+(same as fluid deficeny:to little H2O)
Cause
vomiting
diarrhea
salt H2O drowinig
too much salt
too little H2O
Bones, moans, stones and groans (hypercalcemia s/s)
bones: pain and fractures
moans: pain
stones: renal caliculi
groans: psychological stuff, confusion and depression
does weight go up or down with na loss in hyponatremia
down
What are common side effects of potassium?
diarrhea, nausea, vomitting, bleeding, ulceration, phlebitis, muscle weakness, cardiac dysrhthmias, parethesia, and paralysis.
example problem:
ph 7.52
CO2 30
HCO2 24
ph 7.52 is high
CO2 30 is high
HCO2 24 is normal
respiratory alkalosis
sedation, decreased muscle, dysrhythmiacalcium crisis: high than 15, pt. can not breathe
when should GO LYTELY or mag citrate not be given
What are the Blood Products: Precautions?
Need larger than19 gauge needle to prevent hemolysis of RBCs if rapid transfusion needed. Remember: size of needle lumen increases as gauge DECREASES!
Use a filter & Y-connector with isotonic saline solution
No medications via same blood tubing, unless completely cleared with saline.
Admin immediately after getting from blood bank.
Infuse within 4 hours. Do not infuse after 4 hours.
Remember: Infuse in 2-4 hrs through 19 gauge or larger needle into a free-flowing IV line with a Y-connector & filter. No other meds/additives in line!
What is the normal action of Aldosterone?
when blood volume gets low(vomiting, blood loss, etc.) aldosterone secretion increases leading to a retention of H2oand blood volume increases
signs and symptoms of bicarb excess
look for symptoms of low Ca, tingling in hands and feet, depressed respiration, tachycardia, low K, low intestinal motility; paralytic illius
Which groups are most at risk for dehydration and why?
Older adults - diminished sense of thirst, diuretic medications, and other reductions of food and drink.
Infants - can lose water rapidly through their skin, sever diarrhea,
How does age influence fluid content of the body?
The older you get, the less muscle you have, and thus the less fluid.
O2 saturation
93-99%
high PACO2 is
respiratory
Intake is about
2500cc/day
Hypophosphatemia deficiency in phosphate in the blood plasma
...
anasarca
severe, generalized third spacing
1 quart
1000mL = 1 L
Hyponatremia (causes)
** Low sodium
-diuretics
-wound drainage **esp GI wounds
-renal disease
-hyperglycemia
-CHF
Lab test
serum osmolaity
Normal = 285mOsm/kg
greater than 295 = increased solute in plasma or decreased fluid - complaints of thirst (increased osmolality)
hyperkalemia symptom
cardiac dysrhythmias, peaked T-wave
Third-spacing
accumulation and sequestration of trapped extracellular fluid in an actual or potential body space as a result of disease or injury, trapped volume represents a volume loss and is unavailable for normal physiological processes
Hyponatremia
LABS
decreased serum na and osmolality
RESPIRATORY ALKALOSIS
seizures, deep rapid breathing, confusion, hypokalemia, light headedness, tingling of extremities
Hypophosphatemia manifestations
neurologic symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, and increased susceptibility to infection
Blood transfusion reactions usually occurs in the first ____ minutes. Howver, a delayed reaction may occur ____ days after administration.
15; 2-4
_____ increases the reabsorption of sodium and water follows the sodium
aldosterone
Renin
enzyme acting on angiotensinogen - converts to angiotensin I
Concept Checker
Why does edema occur?
check notes
hyperkalemia causes
-too much intake
-too little output
-drugs (potassium sparing diuretic)
-tissue injury
Etiology of MAcid
lactic acidosis, ketoacidosis, starvation, renal failure, prolonged diarrhea
Hypercalcemia- causes
Hyperparathyroidism- causes too much Ca to be retainedMalignancies-some cancers produce pth.OsteoporosisProlonged immobilityDecreased renal function
Abnormally low values PaCO2(Respiratory Alkalosis)
< 35 mmHG
interstitial
in the tissue spaces between blood vessels and cells
Potassium-hypokalemia
Decrease in body's potassium to a level below 3.5 mEq/L.
The major cause of loss is renal excretion
The kidneys do not conserve potassium and excrete it even when the body needs it
Potassium can be depleted due to excessive GI losses from gastric suctioning or vomiting and the use of diuretics
S/S-can affect skeletal and cardiac function
when an amino acids carboxyl group donates to the body fluid a hydrogen it is acting as ____
acid
Particles
If a fluid has a high osmolarity/osmolality, are there more particles or more water in the solution?
PAGE 138 and 139 carbon dioxide transport.
...
Lab Changes
Serum electrolytes normal
H & H decreased due to hemodilution
PTH _______ Ca+ lvls; Calcitonin ______ Ca+ lvls
increase; decrease
Acidosis-Metabolic Etiology
Anything that decreases HCO3 or increases H+. Renal impairement, diabetes, starvation, diarrhea excess S/SX ABG: low pH low HCO3, lethargy and confusion, nausea, vomiting, headache dizziness, drowsiness confusion
respiratory acidosis cardiac signs
hypotension, peripheral vasodilation weak thready pulse, tachycardia, warm flushed skin
Hypophosphatemia causes
(serum level below 2.5 mg/dL)
Alcoholism, refeeding of patients after starvation, pain, heat stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, hepatic encephalopathy, major burns, hyperparathyroidism, low magnesium, low potassium, diarrhea, vitamin D deficiency, and diuretic and antacid use
Intracellular fluids
-MOST of our body fluid (2/3)
-Found within the cells of the body
-Contains solutes such as O2, electrolytes, and glucose
colloid osmotic pressure
abnormal condition of the kidney caused by pressure of concentrations of large particles, such as protien molecules, that will pass through a membrane
hypertonic solution
a solution that has a greater osmolarity than plasma.
hypertonic cell
small cell with lots of extracellular fluid
What is the normal range of magnessium?
1.5-1.9 mEq/L
72 hours
When should the tubing usually be changed?
IV assessment
check lung sounds to listen for crackles, if water in lungs may be due to fluid overload
Diabetes Insipidus- clinical manifestations-
Increased urine outputLower specific gravity in urineAltered thirst mechanismDehydration
Distinguishing Characteristics of Na+
#1 extracellular cation; Inverse relationship with K+ and direct with Cl-
Isotonic dehydration
loss of sodium and water from the body, decreased in the volume of extracellular fluid; diarrhea and vomiting
loop diuretics
for edema, causes loss of water and sodium at the same time
Nervous system
what is the thirst center and ADH storage?
Semi-permeable membrane
What is the structure that is present between the ECF and the ICF that allows water soluble molecules to enter and exit the cell freely?
D5 1/2 NS
a hypotonic solution that is commonly used for fluid maintencance and contains KCL for maintenance/ replacement
K+ is the ______ cation in the ________
major; ICF
peripheral line
How can all other solutions be given besides hypertonic in an IV line?
Trousseaus Signs
BP cuff inflated for 3-4 minutes hand claws up.
>>> excess fluid intake examples
excessive hypertonic fluids, binge drinking contest, psych disorders, drowning in fresh water, inappropriate dialysis
Define: hypertonic dehydration
when H2O loss is greater than Na+ loss. Resulting in concentration of solutes outside the cells causing the fluid inside the cells to move to the extracellular space. Cells dehydrate. For example, when elevated temp causes perspiration.
What are the signs and symptoms of dehydration
thirst
loss of appeitite
discomfort
head aches
stumbling
weakness
Magnesium is the ________ cation in the _______
2nd most abundant; ICF
what other factors contribute to electrolyte &amp; fluid imbalance
age, illness, injury, meds, surgery
What is the percentage of the TBW is ICF and where is it?
67%; inside cells
What is the difference between osmolarity and osmolality?
Osmolarity refers to volume whereas osmolality refers to weight.
pregnancy fluid imbalance factors
fluids gain to meet maternal and fetal needs. this amount of gain is about 6-8 L.they also have an increase in ADH which means that the body holds onto water, intracellular fluid increases, and pulse &amp; bp rise
What are the side effects of sodium?
gastric upset (N/V, cramps), venous phlebitis
treatment for hypercalcemia
get rid of it, flush it out with oral or iv therapy, get patient moving, limit foods high in it, encourage intake of acid ash fluids (prune, cranberry)
hypermagnesemia: cause
1. renal fail 2. excess antacid 3. diuretic abuse 4. excess Mg replacement
hypocalcemia causes ____, ____, ___ in the GI; hypercalcemia causes ___, ___, ___
abd cramp, /D/, increased BT; abd pain, /C/, decreased BT
What is the mechanism of action of sodium?
control of H2O distribution, fluid and electrolyte balance, osmotic pressure, regulation of acid-base system
What is intracellular fluid and how much do we have
Fluid within a cell. 2/3 of the bodys fluid are within cells
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Term:
Definition:
Definition:

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