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Fluid & Electrolytes
Chronic Exam #1
| Question | Answer |
|---|---|
| Role of sodium (Na+) | (extracellular) osmolarity, affects water distribution bw ECF and ICF |
| normal Na lab value | 135-145 mEq/L |
| Purpose of potassium (K+) | (intracellular) key role in cardiac, skeletal and sm ms contraction, generation and transmission of nerve impulses |
| normal lab values of K+ | 3.5 - 5.0 mEq/m |
| Na sources | cheeses and ham |
| K sources | spinach, potatos, bananas, nuts, citrus fruits |
| Role of Calcium (Ca+) | (cardiac/neuromuscular function), bl coagulation |
| normal lab values of Ca | 9.0 - 10.5 mg/dL |
| sources of Ca | nuts/seeds, leafy greens, fish, beans |
| oliguria | <30 cc/hr |
| intracellular fluids | fluids within cell membranes, 40% body weight, provides cells with internal aqueous medium necessary for chemical functions |
| extracellular fluids | fluids outside cell membranes, 15-20% body weight, bodys transportaiton system |
| extracellular fluids consists of... | interstitial fluid (fluid in tissues) and intravascular fluid (plasma) |
| 4 means of movement of body fluids | filtration, diffusion, osmosis, active transport |
| Filtration | movement of fluid through a membrane as a result of hydrpstatic pressure differences |
| diffusion | process by which solid, particulate matter moves from an area of higher concentration to an area of lower concentration |
| osmosis | process by which a solvent (water) moves through a semipermeable membrane from a solution of lower concentration to a higher concentration |
| active transport | movement of materials across a cell membrane by the use of metabolic activity and energy expenditure (Na/K pump) |
| Regulation of fluid intake | regulated by thirst mechanism in hypothalamus, thirst stimulated by increased serum osmolarity and decreased bl volume, water acquired from food and oxidation of food during digestion |
| Regulation of fluid output | losses occur through kidneys, GI tract, skin via sweat, lungs |
| sensible loss | perceived by individual |
| insensible loss | continued water loss not perceived by the individual |
| hormones in the regulation of fluid and electrolytes | aldosterone, ADH |
| Aldosterone | mineralcorticoid produced by adrenal cortex, causes kidneys to reabsorb Na and excrete K (increased Na causes increased water retention) |
| ADH | (antidiuretic hormone) rel from post pituitary gland in response to stimulation from the hypothalamus, increases the reabsorption of water by the kidney tubules, rel is increased with a decrease in the bodys fluid volume |
| causes of fluid deficit | excessive sweating, fever, impaired thirst or decreased fluid intake |
| specific causes of fluid deficit | prolonged vomiting/diarrhea, hemorrhage, wound/fistula drainage, burn, diuretic therapy, diabetic ketoacidosis |
| assessment findings of fluid deficit | dry skin and mucous membranes, poor skin turgor, coated tongue, low BP, collapsed veins, weak pulses, oliguria |
| laboratory findings of fluid deficit | increased Hgb and Hct, increased BUN, increased specific gravtiy, increased serum osmolarity |
| Management of fluid deficit | fluid/electrolyte restoration (oral/IV replacement), treat underlying cause |
| monitor for complications of fluid deficit | I and O, vital signs, skin turgor, lab values, assess vein filling, provide oral hygiene, ,monitor daily weights (same time) A pint a pound, the world is round (500cc) |
| causes of fluid excess | increased ingestion, decreased excretion of water (renal failure, inability of heart to circulate fluids) |
| assessment findings of fluid excess | generalized edema, weight gain, crackles, bounding pulse, distended neck veins, headache, decreased orientation, visual changes, seizure, coma, low serum Na level |
| lab findings of fluid excess | decreased Hgb and Hct, decreased BUN, decreased specific gravity, decreased serum osmolarity |
| management of fluid excess | restrict fluids, restrict Na intake, promote increased urine output, improve cardiac function |
| monitor for complications of fluid excess | I and O, daily weights, vital signs, lung sounds, edema, labs |
| ways to mobilize fluids | TED hose, turning, positioning, elevating feet |
| How to prevent shortness of breath | apply oxygen, position in high Fowlers |
| etiology of electrolyte imbalances | decrease intake and availability or increase loss of an electrolyte, increase intake and retention or decrease excretion of kidneys |
| what is used to diagnose electrolyte imbalance? | plasma levels in lab studies and through clinical manifestations |
| lab values for Hyponatremia | <135 mEq/L Na |
| etiology of hyopnatremia | water loss (diuretics, vomiting, diarrhea, excessive sweating), net water excess...intracellular edema due to fluid shofts (results from loss of sodium containing fluids |
| signs of hyponatremia | confusion, nausea, vomiting, seizures, coma |
| management of hyponatremia | restore Na+ levels, fluid restrictions |
| lab values for hypernatremia | Na > 145 mEq/L |
| what is hypernatremia? | elevated serum sodium occuring with water loss or sodium gain, leads to dehydration (excess fluid loss, excess Na intake)... increases myocardial depolarization |
| early symptoms of hypernatremia | thirst, dry flushed skin, dry tongue and mucous membranes, polyuria, anorexia, weakness, restlessness, cramping |
| late symptoms of hypernatremia | agitation, confusion, lethargy, seizures, coma, tremors, muscle twitching, rigid paralysis, discoordination |
| management for hypernatremia | treat underlying cause, 5% dextrose in water, diuretics (excrete sodium) |
| lab values for hypokalemia | K < 3.5 mEq/L |
| causes of hypokalemia | abnormal losses fo K via the kidneys or GI tract, Mg deficiency, metabolic alkalosis |
| signs and symptoms of hypokalemia | most serious are cardiac!!, skeletal ms weakness, respiratory ms weakness, decreased GI motility |
| management of hypokalemia | KCl supplements orally or IV |
| lab values for hyperkalemia | K > 5.0 mEq/L |
| causes of hyperkalemia | massive intake, impaired renal excretion, shift from ICF to ECF |
| signs and symptoms of hyperkalemia | weak or paralyzed skeletal muscles, ventricular fibrillation or cardiac standstill, abdominal cramping, diarrhea |
| management of hyperkalemia | eliminate oral and parenteral K intake, increase elimination of K (diuretics, dialysis) |
| lab values for hypocalcemia | Ca < 9.0 mg/dl |
| causes of hypocalcemia | decreased production of PTH, acute pancreatitis, multiple bl transfusions, alkalosis, decreased intake |
| signs and symptoms of hypocalcemia | positive Trousseau's or Chvosteks sign, laryngeal stridor, dysphagia, tingling around the mouth or extremities |
| management os hypocalcemia | oral or IV calcium supplements, treat pain and anxiety to prevent hyperventilation |
| lab values for hypercalcemia | Ca > 10.5-11 mg/dl |
| causes of hypercalcemia | hyperparathyroidism, malignancy, vitamin D overdose, prolonged immobilization |
| signs and symptoms of hypercalcemia | polyuria r/t osmotic diagnosis, anorexia, constipation, nausea, abdominal distension, fatigue, depression, muscle weakness |
| management of hypercalcemia | excretion of Ca with loop diuretic, hydration with isotonic saline solution, synthetic calcitonin, mobilization |
| phosphate lab values | 2.5-4.5 mg/dl |
| phosphate | primary ICF anion, essential to function of muscle, red blood cells, and nervous system. deposited with Ca for bone and tooth structure, inversely related to calcium |
| lab values for Hypomagnesemia | Mg < 1.5 mEq/L or 1.8 mg/dl |
| causes of hypomagnesemia | related to less intake and absorption |
| signs and symptoms of hypomagnesemia | confusion, hyperactive deep tendon reflexes, tremors, seizures, cardiac dysrhythmias |
| management of hypomagnesemia | oral supplements, increase dietary intake, parenteral IV or IM Mg when severe |
| lab values for hypermagnesemia | Mg > 2.5 mEq/L |
| causes of hypermagnesemia | increased intake or ingestion of products containing Mg when renal insufficiency or failure is present |
| signs and symptoms of hypermagnesemia | lethargy or drowsiness, N/V, impaired reflexes, respiratory and cardiac arrest |
| management os hypermagnesemia | prevention, emergency treatment (IV CaCl or calcium gluconate... Ca inversely related) fluids to promote urinary excretion |
Created by:
waiddancer
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