|Hypocalcemia: Nursing Planning||
|Hypomagnesemia: Nursing Interventions||
What gland secretes aldosterone?
concentration of solutes; determined by the total solute concentration within a fluid compartment
|Major anion in intracellular fluids||
contributes the most fluid balance.
______________is a hypothalamic hormone which controls collecting duct permiability to H2O in a graded fasion, increase in ADH causes decrease in urine
|What does isosmotic mean?||
|Hypocalcemia: Assessment Findings||
Muscle Tremors & Cramps
"causing urine" A diuretic drug promots or stimulates urine production.
|CONTRIBUTING FACTOR OF DEHYDRATION||
*INAPPROPRIATE USE OF DIURETIC
*DECREASED FLUID INTAKE
*EXCESSIVE HEAT IN SWEATING
*CERTAIN DISEASES-DM, DI, ADDISON DISEASE
|Examples of transcellular fluid||
cerebrospinal, pericardial, pancreatic, pleural, biliary, synovial fluids
|Anabolic phase: Potassium moves _________ the cell during the formation of new tissue. a. into b. through c. out of d.around||
|Signs of Hypo and Hyper Kalemia||
the most abundant intracellular cation is
insufficient amount of potassium in extracellular fluid; muscle weakness and leg cramps. normal potassium levels for adults: 3.5-5 mEq/L and kids: 3.4-4.7 mEq/L.
vasopressin, v1 (vasoconstriction) and v2 (kidney reabsorption) receptors
|Are the hydrostatic and osmotic pressures equal? (Meaning does all the fluid that goes in return?)||
|Nursing Knowledge: Calcium (Ca+)||
Function: regulates muscle contraction, neuromuscular and cardiac function
Normal levels: 4.5-5.5 mEq/L (8.5-10.5 mg/dl)
Sources: milk products, green leafy veggies, salmon, supplements
Regulation: bone-ECF, parathyroid and calcitrol, calcitonin
*DEFICIENCY OF BODY WATER OR AN EXCESSIVE LOSS OF WATER FROM THE BODY
*BODY OUTPUT OF WATER IS GREATER THAN INTAKE
*CAN BE ASSOCIATED WITH AN INCREASE IN SODIUM OR A DISTURBANCE OF CERTAIN OTHER ELECTROLYTES SUCH AS POTASSIUM
*EXCESS ACCUMULATION OF FLUID IN THE INTERSITIAL SPACES
*CAN ALSO BE CALLED 3RD SPACE FLUID
*DUE TO DISRUPTION OF THE FILTRATION AND OSMOTIC FORCES OF THE BODY CIRCULATING FLUIDS
|_____ contains oxygen, electrolytes, and glucose and constitutes approximately 2/3 of total body fluid||
intracellular fluid (ICF)
|K homeostasis keeps plasma k concentrations in a||
|Rapid heart rate, flattened neck veins, and normal or decreased blood pressure [BP], shock are all symptoms of ______________ a. a. Edema b. Diarrhea c. Hypervolemia d. Hypertension||
|Watch potassium levels when giving insulin to patients that might be predisposed to _____________. a. strokes b. seizures c. hypokalemia d. hypernatremia||
total volume of body fluids greater than normal.
Notify physician if client shows change in mental status or cerebral perfusion such as a new unrelenting or wosenting headache, confusion, lethary, irritability, restlessness, or seizures.
Causes Fluid Volume Excess or Deficit? Vomiting
|daily water gain||
fluids ingested, food ingested, metabolic water
failure of kidneys to excrete excess, rapid redistribution, excessive intake (abuse of laxatives, fleets enema)
|_________ cells hold much of the body's water while _____ cells contain very little water.||
|What cells monitor the osmolarity of the plasma?||
|Nursing Assessment for Fluid Balance: NURSING HISTORY||
*LESS THAN 2.5 UNUSUAL BUT OFEN OCCURS WITH RESPIRATORY ALKALOSIS AND EXTENSIVE BURN INJURY
|Functions of sodium||
controls and regulates water balance (cl and water are reabsorbed with it)
|fluid and solute lost from the body must be||
|Edema due to Decreased arteriolar resistance typically occurs due to ________________ drug responses. a. Opiods b. Calcium channel-blocking c. Beta-blocker d. Anti-depressants||
b. Calcium channel-blocking
|patients with any of these conditions may be _____________. Increased dietary intake (rare), Multiple blood transfusions, Potassium-sparing diuretics, Decreased renal excretion. a. hypernatremia b. hyperkalemia c. hyperchloremia d. hypercalifragilisticexp||
Osmotic pressure less than that of plasma (more water less solute)
fluid located within cells; 42% of body weight, most prevalent cation is potassium.
|absences of vasopressin||
decreases H2O permiability to nearly zero in the collecting duct, urine is dilute
|Normal daily output and intake is about?||
|What is water directly regulated by?||
Antidiuretic hormone (ADH)
|Nursing Knowledge: Potassium (K+)||
Function: Important for ICF Water balance, transmitting nerve impulses, regulating cardiac impulse and muscle contraction, acid base balance, smooth muscle function
Normal level: 3.5-5.0 mEq/L
Sources: fruits, veggies, meats, fish, OJ, milk
Regulation: Renal excretion and conservation
|COMMON MEDICAL TREATMENT||
*ORAL OR RECTAL MEDICATION MAY BE GIVEN TO DRAW ELECTROLYTES OUT OF THE BODY THROUGH THE GASTROINTESTINAL SYSTEM
*WHEN A DEFICIT OF BODY WATER EXISTS IN THE ECF OR ELECTROLYTE DEFICIT IS DETERMINED FLUIDS ELECTROLYTES AND OTHER SUBSTANCES CAN BE ADMINISTERED TO THE CLIENT TO HELP RESTORE HOMEOSTASIS
*IV ADMINISTRATION OF ELECTOLYTES USUALLY TREATMENT OF CHOICE
|juxtaglomeralar cells or aldosterone promotes||
Na retention in the kidneys
|Hyperchloremia occurs when the pH is <, the _________ gap is normal and HCO3 is ____________. a. cation, normal b. anion, increased c. cation, decreased. d. anion, normal||
d. anion, normal
Produces about 7-9 L of gladular and tissue secretions per day. This fluid contains many nutrients , including electrolytes. This fluid (volume in blood) is equivalent to the total body plasma level and basses throug the intestinal mucosa.
The state in which the body retains water and serum sodium levels decrease
|pulmonary & cardiovascular systems||
____________have a more rapid response than renal compensation
|About _____ of the body weight of a premature infant is water.||
|A protein that acts like an enzyme and converts a plasma protein termed angiotensinogen into angiotensin I.||
|Physical Assessment: Skin and Mucous Membranes: FVD||
Sunken, dry eyes
Sticky, dry mucosa
Dry cracked lips
|There are many places in the body where transcellular fluid is found. Can you name ten of them?||
Ventricles of the brain and central canal of the spinal cord
|P cell hormone enhances||
Na, K, ATPas activity and increase open time of Na and K leak channels
|Hypochloremia may be due to_________. a. cystic fibrosis b. vomiting c. loss of HCL or Na+ d. all of the above||
d. all of the above
|ADH (antidiuretic hormone)||
What hormone causes the body to retain water?
|production of dilute urine||
is done by the nephron reabsorbing solute without H2O
|When CO2 is removed faster than it is produced (like in hyperventilation), it can cause this.||
|S/S of hypertonic dehydration||
thirst , fever, dry mucous membrane, muscle twitching, convulsions
|____ is found within the cells of the body and is vital to normal functioning of the cell.||
intracellular fluid (ICF)
|to produce dilute urine, the nephron must||
reabsorb solute w/o reabsorbing water
|Symptoms of hyponatrimic volume depletion include all of the following EXCEPT a. Anorexia, Nausea & Fatigue b. Increased heart rate, Anxiety & Blurred vision c. Muscle weakness, Decreased BP & Headache d. Confusion, Cramps & Seizures||
b. Increased heart rate, Anxiety & Blurred vision
|normal lab value of potassium||
3.5-5.5 meq/L. major ICF cation. plays a major role in transmission and conduction of nerve impulses, maintaining normal cardiac rhythm, skeletal muscle contraction, and acid-base balance.
|What hormones are involved in the regulation of fluid balance?||
ADH, aldosterone, and atrial natriuretic peptide
|Plasma proteins exert an osmotic draw called ______ or ________ pressure, pulling water from the interstitial space into the vascular compartment to maintain vascular volume.||
colloidal osmotic pressure or oncotic pressure
|What is the Trousseau's sign?||
To elicit the sign, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct.
1.excretion of wastes
2.regulation of body water, sodium, potassium
4.secretion of hormones - erythropoetin, renin, vitamin D
These are the 4 functions of the kidneys.
|Who is most susceptible to fluid loss||
infants, kidneys are not fully matured and cannot retain fluid, they breath at faster rates leading to a greater loss of fluids
|What is the Chvostek's sign?||
When the facial nerve is tapped at the angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips) because of hypocalcaemia (ie from hypoparathyroidism, pseudohypoparathyroidism, hypovitaminosis D) with resultant hyperexcitability of nerves.
|The amount of fluid filtered by the glomerulus is a function of what?||
Hydrostatic pressure- the pressure of the pump
|T/F TBW is the same for everyone.||
False: it varies depending on age and fat distribution.
|What happens to this excessive fluid in the interstitial space?||
It is returned to circulation by the lympatic system
|Where does ADH bind once it has been released?||
A receptor on the collecting duct cell (Found only in the kidney)
|Hypermagnesemia: Nursing intervention||
decreased renal elimination, excessively rapid administration, movement from ICF to ECF.
s/s nausea, vomiting, diarrhea, weakness, muscle cramps, risk of cardiac arrest, peak t waves
Intracellular fluid (ICF):
Constitutes largest portion of fluid weight
Contains Solutes such as O2, glucose, and electrolytes
|hyperventilation pts. will exhibit||
Health History: Clients chief complaint if related to fluid and electrolyte deficit compliants are usualoy r/t nausea, vomiting, iarrhea, anorexia, increasing fatigue and wekness, weight loss, fever, bloos loss, excess urine ouput or change inmental status.
If complaint is d/t fluid excess; it will be described as weight gain, cough, dyspnea, cardiac palpitaitons, pitting edema, decreasedurinary output, ormental status changes.
Relate to any previous illness, hospitalizations, surgeries trauma allergies etc to check if this could be cause. Collect data adn additional history on family etc.
syndrome of inappropriate antidiuretic hormone, failure of negative feedback system to inhibit ADH
hemorrhage, burns, ileostomy, directics, NG Suction, oversecretion of aldosterone
|Physical Assessment: Clinical Measurements||
Input and Output
too much calcium in the blood.
|NURSING CARE INCLUDES||
*COLLECTION OF DATA
*ADMINISTRATION AND OBSERVATION OF THE EFFECTS OF DIURETIC MAY BE INDICATED
*OFTEN A SODIUM RESTRICTED DIET IS ORDERED
Dehydration, when solute concentration exceeds water concentration
|When pH increases, CO2______________ a. stays the same b. decreases c. increases||
|Removing NG Tube||
Perform prliminary actions
Prepare client; Listen for Bowel sounds, do not remove is no bowel sounds (listen for at least 5 min) Place emesis basin and oepeneinplastic bag on table, clean gloves supplies etc. turn off suction machine and disconnect NG tube from suction tubing; unpin NG tube for gown or untape ; prevent stomachcontents from leading from tube. Instill 20mL ofair into NG to displace secretion back into cientes stomach or pinch tube as ou remove it. DONT FLUSH WITH AIR OR SALINE IF DOUBT ABOUT PLACEMENT.
Remove tube; instruct client to hold breath and pull tube out in one quick steady motion note intactness of tip of tube.
Finish procedure: Assis with skin and mouth care , describe bowel sound the tube rmoval and cient's reponse, contintue to monitor clients bowel status.
What gland regulates calcium and phosphoorus balance?
|1)constricts the vessels 2) causes distal nephron cells to insert aquaporins in their apical membrane||
sodium normal, concentration normal, amount decreased, 'hypovolemia'
Total solute concentration in a solution- osmoles/liter
|Nursing Knowledge: Magnesium (Mg+)||
Function: intracellular metabolism, protein and DNA synthesis, regulation of neuromuscular and cardiac function
Normal levels: 1.5-2.5 mEq/L
Sources: cereal grains, nuts, dried fruits, veggies, dairy, meat & fish
Regulation: Via Kidneys, intestine
*HAVE SHORT TERM GOALS BEEN MET
*LONG TERM GOALS
*PLANNING FOR FURTHER NURSING CARE CONSIDERS THE CLIENTS PROGNOSIS AND COMPLICATIONS AND THE CLIENTS RESPONSE TO TREATMENT
|ICF IMPORTANT ELECTROLYTES||
*POTASSIUM K+ MOST DOMINANT INTERCELLULAR CATION 3.5-5.0 BODY FLUID BALANCE
*MAGNESIUM Mg++ 1.5-1.9mEq FUNCTION OF NEURONS AND MUSCLE CELLS
*PHOSPHATE HPO4-- MOST DOMINANT ANION-1.7-2.6 mEq BODY FLUID BALANCE OSMOTIC PRESSURE
required to maintain normal body function such as kidneys need to filter at least 500ml of fluid to eliminate metabolic wastes.
|filtrate leaving the ascending limb of the lp of henle is||
|Natriuretic hormones stimulate water & sodium _____________ . a. conservation b. excretion c. storage d. genesis||
|Hypotonic hyponatremia- caused by _______________ and characterized by mOSm< 280. a. water excretion b. ischemia c. water retention d. drug overdose||
c. water retention
water pushing force; increase blood pressure
stimulates H2O conservation at the kidneys, increases H2O reabsorption to conserve H2O
less than 8.5, caused by impaired ability to mobilize calcium from bone stores, abnormal losses from kidneys, increased protein binding, vitamin d deficiency
s/s: increased neuromuscular excitability, cardiovascular effects, nerve cells less sensitive to stimuli. chvostek and trousseau used to assess tetany and excitability.
|Hypotonic dehydration can result in?||
skeletal muscle weakness
Substances exit the body faster then they enter, decrease in the amount of substances in the plasma
|Cations carry a positive charge||
Na+, K+, Ca2+, Mg2+
*USES THE RELEASE AND ACTION OF HORMONES TO MAINTAIN HOMEOSTASIS
|Function of Cl-||
functions with sodium to regulate serum osmolality and blood volume. Major component of gastric juice, acts as buffer in the exchange of oxygen and carbon dioxide in RBC's
|the largest H2o loss is||
1.5 L/day in urine
|Extracellular fluid (ECF) is all of the following except a. Intracellular b. hyperthermal c. Lymph & Transcellular fluids d. Intravascular||
|a hyposmotic ECF results from a surplus of ___________. a. solute b. fluid c. heat d. hypnotists||
the pushing of fluids and solutes against the walls of capillaries out into the interstitium.
the loop of henle is a ____________________ that creates high osmolarity in the medullary interstitial fluid by actively transporting Na+, Cl, K+ out of the nephron
|Cardiovascular effects of dehydration?||
increased pulse ratethready pulse qualitydecreased blood pressurepostural (orthostatic) hypotensionflat neck and hand veins in dependent positionsdiminished peripheral pulsesweight loss
|What is exudate rich in?||
Protein and blood cells
|What organ puts out the most fluid?||
Kidneys 1400 ml
If, however, the osmolarity of one compartment changes
It upsets the balance
Normally kidneys compensate by
excreting excess water
|increased ECF, K stimulates||
aldosterone secretion but increase ECF osmalarity inhibits it
|Which of these does NOT decrease fluid volume? a. hemorrhage b. hypothermia c. heart failure d. none of the above||
|Increase renal clearance of free water due to impaired ______________ function a. renal tubular b. cardiac c. hepatic d. gastric||
a. renal tubular
|FOCUSED ASSESSMENT FOR DEFICIENT FLUID VOLUME Extracellular/Intracellular||
EXTRACELLULAR: Generalized: Flattened neck veins in supine position, suddent wt loss, peripheral vein filling takes more than 5 seconds, decreased skin turgor, dry mucousm emebrans and furrowd tongue, speech changes, muscle weakness, in upper body, subnormal temp if severe loss, fever ifmoderate loss, depressedn fontanenla in infant soft and sunken eyebals
Cardiac Orthostatic hypotitension SBP falls more than 25 mmHg and diastolic BP falls more than 20mmHg with tahycardian up to 120 beats /min, weak thready pulse, narrow pulse pressure
Gastroindentinal - constipiation
Renal Urinary ouptu greatly exceeding intake and urininy output decreased if conpensatory response
Related Factors: Acuteness of loss, seveirty of loss, clients age and state of health, degree to which cleint combats deficit
INTRACELLULAR- dehydration intracellular more serious than extracellular b/c potential dysfuntion of mitochondrial formation of ATP ATP is critical to all cell function and transpot : characteristics include FEVER, thirst , central nervous system changes.
|What are the causes of hypocalcemia?||
Decreased intestinal absorption (Chron's, celiac's, gut removal, decreased vit D intake); glucocorticoids, Lasix; alkalosis (increased Ca binding to plasma proteins); hypoparathyroidism (low PTH) such as in thyroidectomy because parathyroid is sensitive so watch for low Ca in neck surgery patients.
|ECF volume & osmolarity||
___________will increase if you eat salty peanuts and drank H2O at the same time
|In a typical 154 lb lean adult male, about _____ of body weight is water.||
|What we take in should be... (Equal to, less than, or more than)what goes out||
|ECF or extracellular fluid||
Mainly the liquid part of blood consisting of Plasma and IF or interstitial fluid. Surrounds cells. foud in lymph, cerebrospinal fluid, muors of the eye and the synnovial hoint fluids. Smaller portion of body fluids are ECFs
|The number of particles in a solution can be expressed as||
o mOsm/liter = mmol/liter x number of particles in solution
|to concentrate urine the nephron must||
reabsorb water w/o reabsorbing solute
|Which of the following does NOT cause edema due to decrease of colloidal osmotic pressure? a. loss of plasma proteins b. liver disease c. protein-losing kidney disease d. extensive burns||
b. liver disease
|Fluid Volume Deficit||
Occurs when the body loses water and electrolytes isotonically, that is, in the same proportion as in the normal body fluid. Also, serum electrolyte levels remain normal.
patient is about to go to surgery to remove a tumor in the chest, 2 hrs before surgery patient begins with jitters causing elevated heart rate, BP, increase breathing, cold sweats & urge of urination, symptoms are a result of what???
|Elevated osmolarity is indicative of what?||
Increased solute (sodium) and decreased fluid (water)
|Water levels in humans||
Men 60% of body weight, women 50%, infants 80%. More Fat less water. After age 10 waterl levels decrease rapidly to the adult level.
|Interventions for Isotonic Fluid Volume excess||
monitor weight and vital signs, assess for edema, place in fowlers position, administer diuretics, restrict fluid intake, restrict sodium intake, assess breath sounds
|the body's ph is regulated b/c||
ph affects intracellular proteins such as enzymes and mem. channels
|Tx: IV albumin (capillaries are damaged)||
plasma proteins; synthetic or human plasma; giving albumin for burn does not help
|normal lab value of sodium||
135-145 meq/L. major ECF cation. plays a major role in generation and transmission of nerve impulses. hypernatremia > 145 meq (causes cell dehydration) and hyponatremia < 135 meq (causes the cell to swell).
|Why are diabetics always thirsty?||
Because there is an increased plasma osmolarity because of the increased glucose so the regulators are always being stimulated
|Acidifying solutions to correct metabolic alkalosis are||
5% dextrose in 0.45% NaCl and 0.9% NaCl
|key s/s for a patient with fluid volume deficit||
tachycardia, decreased blood pressure, faintness, blacking out, decreased urine output, rapid breathing, confusion.
|What organs regulate water balance?||
Kidneys, GI tract, lungs, and to a lesser extent skin
|atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) enhance||
Na excretion and urinary water loss by increasing GFR, inhibiting tubular reabsorption of NaCl and inhibiting release of renin, aldosterone, and vasopressin
|fluid volume overload is also known as:||
hypervolemia; state in which a person experiences or is at risk of experiencing intracellular or interstitial fluid overload.
|What are the tubules of the kidney are important for?||
Reabsorption and secretion of substances- modifying the filtrate.
|What is the MAX rate for K+ administration?||
Peripheral IV's = NO MORE THAN 10mEq/hr
Central lines = no more than 20mEq/hr
|How does sodium loss affect the cells?||
• It leads to movement of water into the cells (because they have a greater osmotic pressure than the interstitial fluid).
• Water in the neurons causes
o Headache, weakness, dizziness, coma
|At the venous end, the net flow of water is where?||
Back into the capillary due to the increased osmolarity of the plasma at the venous end