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Stack #171425
HCC 2008 Fluid and Electrolyte
| Question | Answer |
|---|---|
| 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
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