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Stack #171425

HCC 2008 Fluid and Electrolyte

Variations in total body fluid age, body fate percentage, gender
filtration passage of fluid through a permeable membrane caused by hydrostatic pressure
osmosis FLUID shift from low to high solute concentration
Oncotic pressure the osmotic pressure influenced by plasma proteins
osmotic diuresis water following a tonic substance such as sodium or glucose
Diffusion SOLUTE movement from higher to lower concentration
sodium want to move where? inside the cells
Where does potassium want to move? outside of the cells
active transport requires ATP, lesser to higher concentration, NA+ - K+ pump located in the cell membrane pumps NA out of the cell and K into the cell
Osmolality the measure of the amount of solute/kg in a unit of fluid , either serum plasma or urine
Normal serum osmolality? 280-900 mOsm/kg
what solute is measured in blood? sodium
normal urine osmolality? 250-900 mOsm/kg
what solutes are measured in urine? creatinine, urea, uric acid
How does urine osmolality influence nursing interventions? too high= too little H20 content, too low= water excess.... treat the patient or inform the doctor so they could be treated for dehydration or fluid overload
high serum osmolality indicated either... water loss or sodium retention
How do you treat water loss? hydrate
How do you treat retention of sodium? fluid restrict--- less free water
Low serum osmolality indicates either... water retention or loss of electrolytes
how do you treat water retention? diuretics, sodium reduction
How do you treat electrolyte loss? replacement
Routes of GAINING fluid? food and liquids (~2600 ml), water produced by metabolism (~300 ml)
routes of fluid LOSS? kidneys(~1500 ml), lungs(~400 ml) , GI(~100 ml), Skin(~600 ml)
Homeostatic Mechanisms Kidneys, Heart, Lungs, Pituitary, Adrenal, Parathyroid
Third spacing fluid in potential body spaces- pleura peritoneal, pericardial spaces, looks like FVD, fluid loss cannot be observed and measured, pt. may gain weight
Causes of third spacing severe burn, bowel obstruction, pancreatitis, liver failure, malignancies, trauma/surgery
Fluid Volume Excess (FVE) excessive retention of water and e-lytes , Hypervolemia/Overhydration/ Fluid Overload
FVE causes renal failure, CHF, cirrhosis, excessive IV or po intake (fluids), excessive Na intake, SIDAH
SIDAH Syndrome of inappropriate AntiDiuretic Hormone----body produces and retains too much water which decreases Sodium
Signs and Symptoms of FVE bounding pulse, acute weight gain, pulmonary crackles, edema, decreased HCT, venous distention-distended jugular veins, shortness of breath/cough, elevated BP
FVE Nursing Implementation assess vital signs, assess breath sounds- semi fowlers, rest, I&O, daily weights, monitor edema, dietary instruction-no restrictive diets, diuretics, bed rest to promote venous return
Electrolytes cations vs. anions, Plasma(NA) vs. intracellular(K)
Sodium normal range 135-145 mEq/L
Sodium daily requirements 100 mEq/L
hypoNAtremia low sodium--excessive water intake, sodium loss
hyponatremia from excessive water intake could be a result of... hypotonic IV fluids, excessive drinking of water, SIDAH, Adrenal insufficiency
hyponatremia from Sodium Loss could be a result of... diuretics, vomiting/diarrhea/fistulas
S/S Hypernatremia lethargy/confusion, muscle cramps/twitching, seizures, coma, anorexia, nausea, vomiting, elevated pulse, decreased blood pressure
treatment of hypernatremia free water restriction, po sodium, if po is not tolerated lactate ringers or isotonic sodium IV, if neurological symptoms are present small amounts of hypertonic solution may be administered
nursing actions for hypernatremia monitor labs (serum,Na, Cl, K, urine Na and specific gravity), monitor fluid status and v/s, monitor neurologic status (seizure precautions), teach pt to eat foods high in salt
hypernatremia causes excess water loss and sodium gain
hypernatremia from excessive water LOSS could be a result of decreased ADH-diabetes insipidus, tube feedings(hypertonic), osmotic diuresis-drugs,DM, insensible water loss-fever diarrhea, heatstroke, hyperventilation
hypernatremia from sodium gain could be a result of... excessive water intake-po hypertonic fluids
S/S hypernatremia thirst increased temp, sticky musous membranes, swollen tongue, mental changes, seizures and coma, pulmonary edema, elevated pulse and blood pressure
Potassium K+ intracellular electrolyte- 98%, influences skeletal and cardiac muscle activity, 80% of potassium is lost by way of the kidneys daily, the other 20% by the bowel and in sweat,
normal Value of Potassium 3.5-5.0% mEq/L,
Daily requirements of Potassium 40-80mEq
hypokalemia K+< 3.5 mEq/L
hyperkalemia K+ > 5.0 mEq/L
Calcium nerve impulse transmission, blood coagulation, catalyst for many cellular chemical activities
Normal level of Calcium 9-11 mg/dL
daily requirements Calcium 1000-1500 mg/day
sources of Calcium milk products, green leafy veggies, canned fish
decreased Potassium _____________ calcium increases
hypocalcemia Ca< 8.5 mg/dL
hypercalcemia Ca > 10.5 mg/dL
Phosphorus Normal value 2.5-4.5 mg/dl
Phosphorus is essential to muscles and red blood cells and nerve function, bone and tooth formation, buffer, reciprocal relationship with calcium, regulated by PTH, excreted by kidneys
Sourses of Phosphorus milk and milk products, organ meats, nuts, fish, poultry, whole grains
hypophosphatemia < 2.5 mg
hyperphosphatemia > 4.5 mg
S/S hypophosphatemia muscle weakness/numbness/seizures, impairs oxygen delivery to tissues, respiratory muscles so weak as to impair ventilation, mental status: seizures, coma, confusion
treatment for hypophosphatemia focus on prevention, add phosphorus to IV solutions, increase dietary intake, Neutra Phos capsules, Fleets Phospho sods po
Only administer ____ mEq?hr to watch for reciprocal hypocalcemia 10 mEq
Hyperphosphatemia is caused by renal failure
S/S hyperphosphatemia tetany, hypocalcemia, calcium-phosphate precipitates in kidneys, joints, arteries, skin, cornea, tingling fingers and around mouth
magnesium neuromuscular electrical activity, carbohydrate and protein metabolism, enzyme activity
Normal value for magnesium 1.5-2.5 mEq/L
sources of magnesium PB, Chocolate, nuts legumes, green leafy veggies, whole grains, seafood
Hypomagnesemia Mg < 1.5 mEq/L
Causes of hypomagnesemia GI losses, alcoholism, malabsorption, diabetic and keloid acidosis
S/S hypomagnesemia neuromuscular irritability weakness, tremors, writhing movements, laryngeal, strider-seizures, cardiac arrhythmia, mental status: delirium, hallucinations
Treatment for Hypomagnesemia increased dietary intake, Po magnesium- watch for diarrhea,
Magnesium sulfate not to exceed... 150 mEq/min too fast can cause cardiac arrest
Nursing actions for Hypomagnesemia monitor labs (serum, Mg, K, Ca), seizure precautions, teach patient to eat foods high in Mg, slow IV admin.
Hypermagnesemia Mg > 2.5 mEq/L
S/S Hypermagnesemia hypotension, nausea/vomiting, flushing with sensation of warmth, hypoactive reflexes, lethargy>>>>coma, dec respirtations, cardiac arrest,
cause of Hypermagnesemia renal failure
Treatment for Hypermagnesemia double check blood not hemolyzed in lab specimen, discontinued medications containing magnesium, loop diuretics and 0.45% NS increase excreted in kidneys, IV calcium glucose to antagonize effects of hyper magnesemia on the heart
Nursing actions for Hypermagnesemia monitor labd (serum, K, Mg, Ca), treat underying cause, Monitor ECG neuro status
Acid releases H
Base traps H
pH expression of H
Acid base disturbances buffer, systems, metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis
Intracellular Buffer system carbonic (acid/sodium bicarbonate), phosphate, protein
Intracellular buffer system protein, phosphates, hemoglobin
Resp increases to get rid of _____ CO2
resp decreases to ___________ CO2 increase
Renal Control Bicarb reabsorption, slower process-may take days
pH 7.35- 7.45
pCO2 35-45
pO2 95-100
HCO3 22-26
O2 sat 95-100
Metabolic acidosis pH < 7.35, HCO3 <22
Metabolic acidosis is usually due to an increase in acids other that carbonis acid,
acidosis causes lungs to HYPOventilation
Metabolic acidodsis might be accompanied by ______ shift K+, hyperventilation which decreases CO2
Signs and Symptoms of Metabolic acidosis drowsiness, increase resp rate and depth, flushed skin, nausea/vomitting, decreased BP, cold clammy skin, dysrrythmia
Causes of Metabolic acidosis diarrhea, diabetic ketoacidosis, renal failure, cardiac arrest
nursing actions for metabolic acidosis monitor ABG and K, monitor renal, neuro and cardiac status, promote adequate ventilation, fluids, oral hygiene w/sodium bicarb
Metabolic alkalosis pH> 7.45, HCO3> 26 mEq/L, usualy due to a loss of acids
alkalosis causes HYPERventilate
Respiratory Acidosis pH < 7.35, PaCO2 > 45mmHg, caused by retention of CO@ d/t pulmonary insufficiency, very dangerous
Respiratory Alkalosis is always due to hyperventilation
Respiratory Alkalosis ph> 7.45, PaCO2< 33mmHg
ROME Respiratory Opposite Metabolic Equal
Respiratory indicator pCO2
Metabolic indicator HCO3
Created by: jaed008