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Fluids + Electrolyte

F+E balance with Acid-Base balance

QuestionAnswer
Solute particles
Solvent Water
Diffusion particles in a fluid move from an area of higher solute concentration to an area of lower solute concentration
osmosis movement of water from a solution of lower solute concentration to higher solute concentration
Filtration movement of water and dissolved substances from an area of high pressure to an area of low pressure
Solute particles
Solvent Water
Diffusion particles in a fluid move from an area of higher solute concentration to an area of lower solute concentration
osmosis movement of water from a solution of lower solute concentration to higher solute concentration
Filtration movement of water and dissolved substances from an area of high pressure to an area of low pressure
average adult % of body is water 60%
Extracellular fluid found outside the cell, are divided into interstitial and intravascular compartments, and are lost more rapidly
Intracellular fluids most of the fluid in our body is intracellular, found within the body cells
Intravascular fluids fluid found within the blood vessels = plasma
interstitial fluids fluids found between the cells and blood vessels and tissues
Examples of interstitial fluids Lymph, CSF, GI, and intraocular fluids, synovial, and glandular secretions
infant % of body water 80%
Elderly, obese clients, and infants are at risk for what because of less fluid reserve in their bodies? complications of illness due to dehydration or fluid shifts
which fluids are lost more rapidly from the body? extracellular fluids (faster than intracellular)
what % of body fluid loss is fatal for adults? 20%
What % of body fluid loss is fatal for infants? 15%
Extracellular fluid found outside the cell, are divided into interstitial and intravascular compartments, and are lost more rapidly
Intracellular fluids most of the fluid in our body is intracellular, found within the body cells
Intravascular fluids fluid found within the blood vessels = plasma
interstitial fluids fluids found between the cells and blood vessels and tissues
Examples of interstitial fluids Lymph, CSF, GI, and intraocular fluids, synovial, and glandular secretions
What are intracellular and extracellular compartments separated by? a semi-permeable membrane
third spacing when extra fluid is in the body but is not available to the body
examples of thrid spacing ascites and edema
causes of third spacing post-op edema, burn patients and liver failure
Solute particles
Solvent Water
Diffusion particles in a fluid move from an area of higher solute concentration to an area of lower solute concentration
osmosis movement of water from a solution of lower solute concentration to higher solute concentration
Filtration movement of water and dissolved substances from an area of high pressure to an area of low pressure
average adult % of body is water 60%
infant % of body water 80%
Elderly, obese clients, and infants are at risk for what because of less fluid reserve in their bodies? complications of illness due to dehydration or fluid shifts
which fluids are lost more rapidly from the body? extracellular fluids (faster than intracellular)
what % of body fluid loss is fatal for adults? 20%
What % of body fluid loss is fatal for infants? 15%
Extracellular fluid found outside the cell, are divided into interstitial and intravascular compartments, and are lost more rapidly
Intracellular fluids most of the fluid in our body is intracellular, found within the body cells
Intravascular fluids fluid found within the blood vessels = plasma
interstitial fluids fluids found between the cells and blood vessels and tissues
Examples of interstitial fluids Lymph, CSF, GI, and intraocular fluids, synovial, and glandular secretions
What are intracellular and extracellular compartments separated by? a semi-permeable membrane
third spacing when extra fluid is in the body but is not available to the body
examples of thrid spacing ascites and edema
causes of third spacing post-op edema, burn patients and liver failure
electrolytes definition elemental compounds which when dissolved in body fluids develop an electrical charge and becomes an ion
cation ions with positive charge
anion ions with negative charge
electrolyte balance for each positively charged ion there must be a negatively charged ion
what does extracellular fluid contain? large amounts of Na+, Cl- and HCO3-(Bicarb)
what does intracellular fluid contain? large amounts of K, sulfates, and phosphates
Fluids leave the body by what routes? skin(sweat), lungs(breathing), GI tract (lubrication), and kidneys(urinating)
where is the largest quantity of fluid excreted from? the kidneys
where are large quantities of water secreted and reabsorbed? the GI tract
Insensible loss water lost from the lungs and skin, called this bc the individual is unaware of losing that water
how water enters the body oral liquids and water content in foods
Avg total amount of water taken into the body each day 2400 ml
What do the adrenal glands do in relation to movement of body fluids? secretes aldosterone which regulates the amount of sodium reabsorbed by the kidneys
What does the pituitary gland do in relation to movement of body fluids? secretes ADH (antidiuretic hormone) which regulates the amount of water being reabsorbed by the kidney
Fluid volume deficit hypovolemia-water and electrolytes are lost from the body
causes of fluid volume deficit vomiting/diarrhea, continuous GI irrigations/suctioning, Ileostomy/colostomy drainage, draining wounds/burns/fistulas, diuretics increase fluid output, or severe bleeding/hemmorhage
S/S of fluid volume deficit thirst, poor skin turgor(tentin), dry mucous membranes, flushed skin, increased HR/thready pulse, postural hypertension, rapid weight loss, flat neck/hand veins,dizziness/weakness, confusion, concentrated urine, increased hematocrit
Nursing interventions for fluid volume deficit VS, check mucous membranes and skin turgor for improvement, daily weights, monitor I&O, test urine for specific gravity, monitor hematocrit and electrolytes, replace fluids by PO,NG or IV(NS as prescribed)
fluid volume excess an actual excess of total body fluid or relative excess in one or more fluid compartments. aka fluid overload/overhydration/hypervolemia
Goal of treatment for fluid volume excess to restore fluid balance, correct electrolyte imbalances if present, and eliminate/control the underlying cause of the overload
causes of fluid volume excess excessive administration of oral/IV fluids, poorly functioning kidneys, CHF, cirrhosis of the liver, Cushing's syndrome, and long time steroid use
S/S of fluid volume excess cough, dyspnea, acute weight gain, pitting edema(esp dependent), inrease in RR and HR, increase in BP, bounding pulse, neck and vein distention, decreased hematocrit, confusion, and moist rales in lungs
Nursing Interventions for fluid volume excess monitor vital signs, restrict fluids, restrict Na+ intake, monitor I+O q1h with diuretics and specific gravity, monitor for increasing pulmonary edema, pitting edema, weight daily, monitor skin turgor, administer diuretics, semi-fowlers for comfort
Potassium sparing diuretics Aldactone (spironolactone), and Dyrenium(triamterene)
A non-patassium sparing diuretic Lasix (Furosemide)
2 Nursing interventions that best asses water balance how the patient is sitting/ how many pillows/ need recliner
normal sodium levels 135-145 mEq
Hyponatremia a sodium deficit in which there is too little sodium in the serium <135mEq
causes of hyponatremia excess Na+ loss fom skin(perspiraion) or 3rd spacng, GI vomiting/diarrhea/NG drainage, kidneys(diuretics), and water excess from too much IV flud, CHF or renal disease
what will their be with hponatremia? potassium imbalance because sodium decreases from extracellular fluid and as water is pulled into the cells potassium is shifted out
S/S of hyponatremia headache, postural hypotension, muscle weakness, twitching, tremors, dehydration,poor turgor, dry mucous membranes, flushed skin, elevated temp and restlessness
nursing interventions for hyponatremia monitor VS, I&O, daily weight, assess skin turgor/mucous membranes, administer 3-5% NS IV therapy as prescribed, increase sodium in diet, monitor electrolytes daily, monitor neuro status
What do you want to monitor with lithium and hyponatremia lithium level as hyponatremia can cause diminshed lithium excretion and cause toxicity
Hypernatremia a condition in which the serum sodium concentration is >145 mEq
Causes of hypernatremia inadequate water intake, diarrhea, burns. fever, diaphoresis, diabetes insipidus, too much table salt, IV bicarbonate, 3%NS or higher, kayexalate
S/S of hypernatremia thirst, dry mucous membranes, fever, flushed, irritability, generalized weakness, postural hypotension ****S.A.L.T.**** (skin flushed, agitation, low fever, thirst)
Nursing Interventions for Hypernatremia replace lost water, hypotonic IV solution as prescribed (D5W or .45%NaCl), increase fluid intake, diuretics to increase sodium excretion, monitor vital signs, monitor neuro changes, electrolytes, weigh daily, low sodium diet, Strict I&O, K levels
Foods high in sodium bacon, bouillion cubes, canned soups, ketchup, cheese, corned beef, hodogs, soy sauce, frozen dinners
Normal Potassium levels 3.5-5.0 mEq
What is the main intracellular cation? Potassium
how much potassium is required each day? 65 mEq
foods high in potassium bananas,potatoes,avacados, apricots, beef, peaches, spinach, tomatoes
how much potassium is excreted through the kidneys? 80%
where is the rest of potassium excreted? 10-20% through feces and perspiration
When giving KCl what should you give it with? dilute it with water or OJ to decrease GI upset
what does potassium do in our bodies? promotes transmission of nerve impulses and is important for heart and muscle function and skeltal muscle function
Kypokalemia potassium level <3.5 mEq **most common electrolyte imbalance and is potentially life-threatening
cause of hypokalemia Duretics (#1) , burns, trauma, diarrhea, vomiting, and fistulas
S/S of hypokalemia cardiac dysrhythmias (weak, irregular pulse),generalized muscle weakness, leg cramps, decreased DTR's (deep tendon reflexes), n/v, anorexia, lethargy
nursing interventions for hypokalemia monitor vital signs esp apical HR and cardiac activity/changes, increase potassium intake, administer IV potassium as ordered, monitor serum electrolyte levels and asses DTR's
what do you never IV push? potassium
Hyperkalemia potassium >5.0 mEq
causes of hyperkalemia Renal Failure (#1), excess intake, potassium sparing diuretic, burns, and sever constipation
S/S of hyperkalemia cardia dysrhythmias, cardiac arrest, muscle weakness (esp in Lower exremities), n/v/d, colic, EKG spike T wave
nursing interventions for hyperkalemia kayexalate(exchanges Na ions for K), monitor lab values, Apical pules for rate and rhythm, monitor EKG changes, assess kidney function, assess muscle function/weakness/cramps/parethesia
How does IV glucose and insulin help hyperkalemia? Insulin will move into the cell taking potassium with it, thereby decreasin the k level in the blood stream. The glucose brings it back up.
Normal blood level of chloride 96-106 mEq
Cl is mainly excreted from where? the kidneys
What is an important function of Chloride? necessary for the formation of HCl in gastric juices
hypochloremia low chloride levels <96 mEq
hyperchloremia high chloride levels >106 mEq
common cause of hypochlormeia vomiting and prolonged naso-gastric or fistula drainage
normal blood calcium levels 9-11mg
where is calcium found in the body? 99% in the bones and teeth where it is physiologically inactive and 1% in the soft tissue and extracellular fluid
what does the body need in order to be able to absorb calcium? Vitamin D
How is calcium removed from the body? by urine and feces
what regulates calcium levels in the body? the parathyroid hormone
what does calcium do for the body? necessary for normal blood clotting, promotes normal transmission of nerve impulses, and helps to regulate muscle contractions and relaxation
Hypocalcemia low calcium levels <9mg
causes of hypocalcemia loop diuretics, inadequate dietary intake of calcium or vitamin D, decreased parathyroid function or removal of, calcium excreting meds such as diuretics, caffeine, anticonvulsants and heparin
S/S of hypocalcemia osteoporosis with pathological fx, tingling around nose,mouth,ears,fingers,and toes, muscle cramps/spasms/twitching of feet/hands,n/v/d, cardiac dysrhythmias, hypotension, parathesias, positive Chvostek's sign, Trousseau's sign
nursing interventions for hypocalcemia calcium gluconate IV, monitor vitals and apical pulse, monitor for Chovstek's sign, avoid overstimulation, initiateseizure precautions, adminiter vitamin D, monitor calcium levels, increase calcium in diet, monitor for bleeding/clotting times
Hypercalcemia serum calcium level >11mg
causes of hypercalcemia excessive intake of calcium, supplements, milk, and antacids, renal failure leading to decreases excretion of calcium, Paget's disease, and hyperparathyroidism
S/S of hypercalcemia thirst, polyuria, increased HR and BP, bounding pulse, decreased muscle tone, dimished DTR's, n/v, abd distention, constipation, confusion, lethargy, coma, deleopment of renal stones
Nursing inerventions for hypercalcemia IV fluid administration, calcitonin, increase po intake, monitor for kidney stones, monitor for flank pain, monitor VS, monitor for dysrhythmias, restrict calcium intake, increase mobility (ROM), and monitor serum calcium levels
normal magnesium levels 1.5-2.5 mEq
Where is magnesium found in the body? 60% in bones, 39% in muscle and fat tissue, and 1% in extracellular fluid ( most in CSF)
major route of excretion of magnesium kidneys
what does magnesium do for the body? important for heart, muscle, and nerve function, importat fo activation of many enzymes, promotes regulation of calcium, potassium and vitamin D, may correct hypokalemia
what should you always adiniter before potassium IV piggy-back? magnesium
hypomagnesemia serum magnesium levels <1.5 mEq
causes of hypomagnesemia poor dietary intake of Mg, common among critically ill, GI loss(vomiting/diarrhea), osmotic diuretics, DKA, alcoholics, Poor GI absorption (Crohn's/ulcerative colitis)
S/S of hypomagnesemia twitching, parathesias, hyperactive reflexes, irritability, convulsions, positive Chvostek's or Trouseau's sign/tetany, shallow respiations, tachycardia, changes in EKG rhythm's
Nursing Interventions for hypomagnesemia monitor vital signs, monitor for dysrhythmias, monitor neuro changes, I&O, administer Mg supplements, monitor Mg levels, increase dietary intake of magnesium
Hypermagnesemia Magnesium levels >2.5 mEq
Cause of hypermagnesemia renal insufficiency, overuse of antacids with Mg, and chemotherapy
S/S of hypermagnesemia decreased neuromuscular irritability, muscle weakness, decreased DTR's, n/v,drowsy, lethargy, hypotension, vasodilation
Nursing Interventions Hypermagnesemia monitor vitals,for resp depression,for hypotension, bradycardia,dsyrhythmias, for neruo and musular activities, for LOC, lab values and remove excess Mg, for fluids, administer loop diuretics, prep to administer 10% Calcium Gluconate
Normal Phosphorus levels 1.8-2.6 mEq
Phosphorus and Calcium have what in the body? an inverse relationship; an increase in one causes an decrease in the other
where is phosphorus found in the body? 80% in the bonesand teeth combines with calcium, 10% in muscles, and 10% in the nerve tissue
foods high in phosphorus beef, pork, fish, poultry, milk products and legumes
where is phosphorus excreted from? 90% by the kidneys, the rest in feces
hypophosphatemia phosphorus levels <1.8 mEq
hypophosphatemia causes hyperparathyroidism, alcoholism, antacids, diuretics
S/S of hypophosphatemia musce weakness and resppiratory depression
Treatment of hypophosphatemia give phosphate
hyperphosphatemia phosphorus levels >2.6 mEq
causes of hyperphosphatemia hypoparathyroidism, usually seen in renal failure, and bone disease
S/S of hyperphosphatemia tetany
Treatment for hyperphosphatemia treat underlying cause, dialysis
Created by: Purple butterfly