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____ % of weight in average adult is water 60
Components of extracellular fluid Interstitial, intravascular, and transcellular fluid
Fluid between the cells and outside the blood vessels interstitial fluid
Extracellular fluid containing lymph Interstitial fluid
Liquid portion of the blood intravascular fluid
Blood plasma found in the vascular system intravascular fluid
Fluid that is separated from other fluids by a cellular barrier transcellular fluid
Examples of transcellular fluid CSF, pleural fluid, GI fluid, peritoneal fluid, intraocular, synovial fluids
Best indicator of fluid status Daily weight
Positively charged ions Na, K, Ca
Negatively charged ions Cl, HCO3, SO4 (Chloride, bicarbonate, sulfate)
The number of grams of the electrolyte dissolved in a liter of plasma mEq/L
Movement of a pure solvent from an area of lesser concentration to an area of greater concentration Osmosis
Random movement of solute from an area of higher concentration to an area of lower concentration Diffusion
Example of diffusion in the body movement of CO2 and O2 between the alveoli in the lungs
Regulates fluid intake thirst mechanism
Process by which water and diffusible substances move together across a membrane Filtration
Movement from an area of higher pressure to an area of lower pressure filtration
Example of filtration Edema (intravascular to interstitial)
Filtration can be caused by: congestive heart failure
Location of the thirst control center hypothalamus
Transport that requires metabolic activity and energy active transport
Allows cells to admit larger molecules Active transport
Stimulated when excess fluid is lost hypothalamus
Solute that is the greatest contributor to the osmolarity of a fluid sodium
Most important regulator of fluid intake thirst
Hormone stored in the pituitary that is released in response to changes in blood osmolarity ADH
What types of IV fluids would be given to a dehydrated patient hypotonic or isotonic
Works directly on renal tubules and collecting ducts to make them more permeable to water ADH
Action of aldosterone Retain Na and H2O, excrete K
Secreted from the atrial cells in response to stretching and an increase in circulating blood volume ANP
Opposes ADH; acts as a diuretic causing Na loss ANP
Average daily output 1-2 L
4 organs of water loss kidneys, skin, lungs, GI tract
Insensible water losses continuous and occurs through skin and lungs
About ___ L fluid circulates through the GI tract per day 8
Most fluid circulating through GI is reabsorbed in the: small intestine
Insensible water losses can be significant with: fever and burns
Sensible water loss occurs through excess perspiration
Fluid volume deficit hypovolemia
Risk factors for hypovolemia lethargy, depression, vomiting, dementia, fever, difficulty swallowing, diarrhea, unable to speak, paralysis, anticholinergic drugs, etc
Reduced body fluid in both intracellular and extracellular compartments hypovolemia
translocation of fluids from intravascular or intracellular space to tissue compartments third-spacing
A high ratio of blood components hemoconcentration
Problem with hemoconcentration increases risk of blood clots and kidney stones
Early symptom of hypovolemia thirst
Hematocrit levels and hypovolemia elevated except in hemorrhage
normal hematocrit levels Men: 37-52% women: 37-47%
Medical management of hypovolemia increasing oral or IV fluids, antibiotics, antidiarrheals, antiemetics, control fluid loss
Report a loss of ___ or more lbs in 24 hours 2
2 lb loss = ___ L of body fluid 1
Symptom of hypovolemia seen on the tongue furrowing
Specific gravity of urine with hypovolemia 1.020
Fluid volume excess hypervolemia
high volume of water in the intravascular fluid compartment hypervolemia
Causes of hypervolemia excessive oral intake, rapid IV infusion, heart failure, kidney disease, excessive salt intake, steroid drugs
At risk for hypervolemia increased ADH production, steroids, excess consumption
CM of hypervolemia weight gain, elevated BP, light yellow urine, pitting & dependent edema, JVD, confusion, etc.
Early symptoms of hypervolemia weight gain, elevated BP, increased breathing effort
There is usually a ___L fluid volume excess before pitting will occur 3
Low blood cell count and hematocrit Hemodilution
Urine specific gravity seen with hypervolemia Low
Central venous pressure seen with hypervolemia elevated
Medical management of hypervolemia fluid restriction, diuretics, salt restriction
Pulmonary indications of hypervolemia crackles
Best indicator of fluid retention weight gain
+1 pitting edema 2mm slight retention normal contours
Interstitial fluid volume of 1+ pitting edema Associated with interstitial fluid volume 30% above normal
+2 pitting edema Deeper pit (4mm) last longer than +1 fairly normal contour
+3 pitting edema deep pit (6mm) remains after several seconds skin swelling obvious by inspection
CM of brawny edema no pitting hard tissue skin surface may be shiny, warm, moist poor circulation
Interventions for hypervolemia coughing, turning q2h, inspecting
Third-spacing is associated with: loss of colloids, burns, allergic reactions, liver failure
Assessment of third-spacing S/S hypovolemia except weight loss, localized enlargement of body cavity or organ
Medical management of third-spacing restore circulatory volume and eliminate trapped fluid, administer IV fluids and blood products or albumin, IV diuretics
Normal value for sodium 135-145 mEq/L
Main cation in extracellular fluid Na
Electrolyte that maintains normal nerve and muscle activity Na
Main role is to regulate and distribute fluid volume Na
2 main problems with hyponatremia more H2O than Na (Na is diluted) Losing more Na than H2O (sweating, diarrhea, vomiting)
S/S: mental confusion, muscle weakness, anorexia, restlessness, tachycardia, seizures, coma Hyponatremia
Serum osmolarity in hyponatremia less than 280 (dilute blood)
Serum sodium in hyponatremia less than 135
IV treatment for hyponatremia Fluids containing sodium cholride
Causes of hypernatremia profuse watery diarrhea, excessive salt intake without sufficient water, high fever, decreased water intake, unconscious, diabetes insipidus
CM: dry, sticky mucous membanes, decreased urine output, fever, rough/dry tongue, restlessness, coma Hypernatremia
Normal potassium levels 3.5-5 mEq/L
Chief electrolyte found in intracellular fluid potassium
Maintains electrical activity in the cells, assists in muscle contraction potassium
Causes: Lasix, thiazide diuretics, fluid loss from GI, large doses of steroids, IV admin of insulin and glucose, alkalosis hypokalemia
S/S May be flat T wave on ECG hypokalemia
Hypokalemia treatment increase K in diet, potassium sparing diuretics (Aldactone), IV potassium
What should be kept at the bedside of a patient with hypokalemia? ambu bag
About ___ mEq of K is lost in each liter of urine 40
Dilution recommended for potassium infusions no more than 1mEq/10mL solution
Maximum rate of potassium infusion 5 to 10 mEq per hour; never exceed 20 mEq/hr
Acceptable routes for potassium administration Oral or slow IV- NEVER give IV push, IM, or SubQ
Causes: renal failure, severe burns or crush injuries, acidosis, blood transfusions, addison's disease, chemo hyperkalemia
CM: parasthesia, skeletal muscle weakness, hyperactivity in smooth muscles, decreased HR, irregular pulse, hypotension, cardiac arrest hyperkalemia
Electrolyte imbalance that will have a widened QRS complex; tall, skinny, peaked T wave; and may have absence of P wave hyperkalemia
Treatments for hyperkalemia loop diuretics, potassium restrictions, kayexelate, calcium gluconate, sodium bicarbonate, 10 units regular insulin
Effect of insulin on potassium? insulin sends K back into the cell
May be given to conteract effects on the heart seen with hyperkalemia, but does not bring K levels down calcium gluconate
Cardiac monitoring of potassium if > ___? 6mEq/L
If a patient with hyperkalemia is being given insulin, what should the nurse also monitor for? hypoglycemia
If a patient with hyperkalemia is being given kayexelate, what should the nurse also monitor for? serum sodium levels
Normal total calcium levels 8.5-10 mg/dL
Normal ionized calcium levels 4.5-5.5 mg/dL
__% calcium is found in the blood 1
Hormone that is released when blood Ca is low PTH
Hormone that moves Ca back into the cells calcitonin
Needed for blood clotting, muscle function, nerve impulses Calcium
Needed for calcium absorption in the inestine vitamin D
Calcium and ___ have an inverse relationship Phosphorous
Hormone that takes calcium from the bones and puts it in the blood PTH
Causes: vitamin D deficiency, hypoparathyroidism, severe burns, acute pancreatitis, corticosteroids, alkalosis, hypomagnesemia, alcoholism, high phosphorous hypocalcemia
One of the most common causes of hypocalcemia removed thyroid gland
Most common sign of hypocalcemia tingling in the extremities and around the mouth
Positive Chvostek's or Trousseau's sign indicate what electrolyte imbalance? hypocalcemia
CM: muscle cramps, diarrhea, laryngeal spasms, hyperactive reflexes, tetany, seizures, bleeding, dysrhytmias hypocalcemia
Hypocalcemia treatment IV calcium gluconate or calcium chloride; oral supplements with vit D
What should be kept at the bedside of a patient with hypocalcemia? tracheostomy and suction
Often associated with parathyroid gland tumors, multiple fractures, Paget's disease, hyperparathyroidism, excessive vitamin D, chemo, prolonged immobilization, antacid abuse ,hypophosphatemia, acidosis hypercalcemia
CM: bone pain, kidney stones, confusion, lethargy, hypertension, arrhythmias, decreased GI motility hypercalcemia
Hypercalcemia treatment decrease Ca in diet, hydration (NS IV), lasix, synthetic calcitonin (mithracin)
Which type of diuretic is not indicated for hypercalcemia? thiazide (inhibit calcium excretion)
Normal Mg levels 1.5-2.5 mEq/L
Involved in transmission of nerve impulses and muscle excitability Mg
Activates the functioning of B vitamins and use of K and Ca Mg
__% Mg contained in bones 60
Helps regulate Ca because it helps produce PTH Mg
Levels in the blood regulated by GI and urinary systems Mg
Causes of hypomagnesemia alcoholism, DKA, kidney disease, burns, malnutrition, eclampsia, malaborption, excessive diuresis, hyperaldosteronism, prolonged diarrhea
S/S: CNS irritation, delusions, weak skeletal muscles, tremors, twitching, tetany, hyperactive DTNs hypomagnesemia
Mg infusion rate no more than 150 mg/min
How often should Mg levels be drawn from a person with hypomagnesemia? after every bolus and every 6 hrs if on continuous drip
Causes of hypermagnesemia kidney failure, advancing age, addison's disease, untreated DKA, excessive intake (antacids and laxatives)
S/S: decreased muscle and nerve activity, hypoactive DTRs, flushing, N/V, decreased LOC, shallow respirations hypermagnesemia
Treatment of hypermagnesemia in an emergency situation calcium gluconate IV
Created by: beshoe