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Fluid & Electrolytes LPN

Intracellular Fluid (inside cells) More Fluid
Extracellular Fluid (outside cells) Less Fluid
Organs of fluid loss Kidneys, skin, lungs, GI tract
Osmosis (fluid/water) Movement of fluid from an area of lower solute concentration to an area of higher solute concentration with eventual equalization
Diffusion (solutes) Movement of solutes from an area of greater concentration to an area of lesser concentration.
Hypervolemia Equal/isotonic expansion of Extra-cellular plasma. Retention of sodium & H2O in equal proportions.
Hypervolemia Almost always result of increased total body sodium
Hypervolemia Causes Excessive salt intake, renal failure, heart failure, cirrhosis of the liver
Hypervolemia clinical manifestations Edema, distended neck veins, abnormal lung sounds, increased weight, increased urine output, tachycardia, increased B/P
Hypervolemia Diagnostics BUN and hematocrit levels decreased due to plasma dilution (too much water)
Hypervolemia Diagnostics Sodium, Urine specific gravity, physical exam, chest x-ray
Sodium 135-145 mEq/L
BUN (kidney function) 10-20 mg/dl
Hematocrit 42-52% male35-47% female
Hypervolemia management Restrict sodium and fluid, TED hose improve venous return, diuretics, dypsnea can occur, dialysis if severe
Potassium sparing (weakest) spironolactone can cause hyperkalemia
Thiazide (moderate) hydrochlorothiazide, can cause hypokalemia (potassium low) and hyponatremia (low sodium)
Loop Diuretics (most potent) Rapid onset, can cause hypokalemia (potassium low) and hyponatremia (low sodium) ototoxicity: hearing loss
Hypovolemia Fluid volume deficit H20 & electrolytes lost in equal proportions
Hypovolemia Risk Factors Fever, tachypnea (rapid breathing), vomiting, diarrhea, gi suctioning, sweating, hemorrhage, excercising
Hypovolemia Risk Factors Malnutrition, sepsis, burns, ascites, diabetes insipidus, adrenal insufficiency, incapacitated, elderly
Diabetes insipidus condition characterized by excessive thirst and excretion of large amounts of severely diluted urine
Hypovolemia Clinical manifestations Thirst, anorexia, nausea, fatigue, muscle weakness, cramps, increased HR, increased B/P, cool, clammy skin if severe
Hypovolemia Labs BUN = 20:1, usually 10:1, hematocrit increased, Urine specific gravity increased
Hematocrit (Percentage of RBC's) 42-52% male, 35-47% female
Urine Specific Gravity 1.010-1.025
Hypovolemia (management) Replace fluids PO if not severe, Isotonic IV fluids, Anti-emetics for vomiting, Anti-diarrheals, accurate & frequent I&O
Hypovolemia (management) Frequent Assessment & VS, level of consciousness, skin color, skin turgor, weight (1L=2.2lbs), breath sounds
Hypovolemic Shock Significant fluid lost from intravascular space occurs in hemorrhage, burns, GI loses
Hypovolemic Shock Symptoms: increased pulse, increased B/P, Urine output <30 ml/hr, thirst, neuro changes
Hypovolemic Shock Actions: Fluid replacement with colloids (blood products) Isotonic (normal saline) Supine position-elevate legs, Monitor vital signs, I/O's
Third Spacing Sometimes fluid is not lost from the body but is unavailable for use by either the ICF or ECF.
Third Spacing The movement of body fluid to a non-functional space, occurs frequently and can be potentially fatal
Third Spacing Decrease in urine output, occurs in ascites (edema within peritoneal cavity), burns, peritonitis, trauma, lymphatic obstruction
Anasarca Severe, widespread accumulation of fluid in all of the tissues and cavities of the body at the same time.
Third Space Peripheral edema, organ edema
MEq measure of chemical activity
Cations Positive charge, Sodium (Na+) Potassium (K+) Calcium (Ca+) Magnesium (Mg+)
Intracellular Contains K+ Potassium
Extracellular Contains Na+ Sodium
Most common electrolyte imbalances Potassium and Sodium
Sodium Most abundant solute in ECF, responsible for muscle contraction & transmission of nerve impulses
Aldosterone Conserves sodium, regulate Na+ balance
Hyponatremia Serum Na <135
Hyponatremia Risk Factors Renal: diuretics, Adrenal insufficiency, low aldosterone, Non renal: vomitting, diarrhea, excessive sweating, excessive water intake, hypervolemia, IV therapy, head injury
Hyponatremia management Na+ replacement slowly not to exceed >12 mEq/L in 24 hrs., isotonic solution, water restriction
Hypernatremia Na+ >145
Hypernatremia Risk Factors Dehydration, elderly, infants, comatose, GI diarrhea, high Na+ diet, diabetes insipidus, heat stroke
Dehydration Behavioral changes in elderly
Hypernatremia Clinical Manifestations Flushed skin, dry, swollen tongue, peripheral edema, pulmonary edema
Hypernatremia prevention & mangement Diuretics, IV fluids, hypotonic electrolyte solution, 0.3% sodium chloride
Potassium (3.5-5) Major intracellular electrolyte, influences skeletal & cardiac muscles, 80% excreted from kidneys, 20% lost bowel & sweat
Hypokalemia <3.5 causes risks Too much insulin, insulinemia, burns, vomiting, diarrhea, NG suctioning, diuretics
Hypokalemia clinical manifestations Cardiac: dysrhythmias & weak pulse, flat/inverted T-waves on ECG, cardiac & respiratory arrest
Hypokalemia Prevention & management K+ replacement slowly, never administer IV push, cardiac arrest
Hyperkalemia K+ >5 Prolonged use of tourniquet, anemia, K+ intake (salt substitutes) renal failure most common
Hyperkalemia clinical manifestations Cardiac, slow irregular puse, hypotension, restlessness, irritability, weakness, paralysis, diarrhea
Hyperkalemia management Diuretics, PO or rectal enema, Insulin, dialysis
Created by: angienoriega