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Fluids + Electrolyte
F+E balance with Acid-Base balance
| Question | Answer |
|---|---|
| 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 |
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