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F&E slide info

fluid & electolyte med surge I (Erin's slides)

What % of body wt is fluid? 60%
How does age affect % of body fluid? Elderly have a lower % of body water
How does gender affect % of body fluid? Men have a greater % of body water than women
How does body fat affect % of body fluid? Obese people have lower % of body fluid b/c adipose tissue holds less water
What is the major solvent in our body? Water; a liquid that dissolves other substances
Fluid Composition is important b/c? it is necessary to sustain life; affects cell shape and size; maintains body temp; transports gases & wastes throughout the body; almost every organ in the body plays a vital role in maintaining electrolyte balance.
Intracellular space (ICF)= 2/3 of body fluid; "inside the cell"
Extracellular space (ECF)= Intravascular (inside vessels); "plasma"= liquid part of blood, Interstitial (b/w cells)= fl surrounding cell; Transcellular is fl that does not exist in lg amounts & causes no major fluid shifts,(CSF, pericardial, pleural,digestive, & synovial fluids)
Third Space fluid= "Held Prisoner" fluid lost from ECF (outside the cell); body can't absorb quickly, pee it out or lose it; appear "Puffy"
What is the function of Homeostasis? maintain fluid balance
Capillary walls separate what two fluid compartments? Intracellular (ICF) and Extracellular (ECF); "Act as a Dam"
Fluid moves from ________ to _________ and from _________ intravascular (inside the vessels) to extravascular (outside the vessels) and from intracellular (inside the cells) to extracellular (outside the cells)
Fluid regulation is dependent on a balance between? solutes (electrolytes) and solution (fluid) concentrations
Electrolytes are... Minerals (sometimes called salts)present in all of our body fluids; electrically charged chemicals; + or -; unite in various cojmbinations (i.e. Na+Cl- or normal saline soln)
Cations ...(has a "t" with a + in it) + charge; Na+, K+, Ca++, Mg++, & H+ ions
Anions...(has the "A" with a - in it) - charge; Cl-, HCO3-, SO4-, PO4-
Electrolyte concentrations vary from inside the cell(ICF) to outside the cell(ECF); Where are labs drawn from? ECF (outside the cells) b/c of easier access
Na+ is highly concentrated in________and an important _____________? ECF (outside the cell); regulator of of body fluid volume
K+ is highly concentrated in ________? ICF (inside the cell)
In order to keep Na+ levels higher in ECF (outside the cell) and K+ levels higher in ICF (inside the cell) the body must use_____? Energy to maintain proper concentrations; d/t using the active transport system via Na+/K+ pump
Osmosis= Movement of ________ across a semipermeable membrane from ___ ________ concentration to ____ _______ concentration. It is a _______ _________ and does not require ________. water (fluid) moves from LOW solute (electrolyte) concentration to a HIGH solute (electrolyte) concentration; a passive process and does not require energy.
Osmola "L" ity= # of particles of solute in a unit of fluid based on________; hint: "L" = Lb for the abreviation of pound. # of particles of solute in a unit of fluid based on WEIGHT (mOsm/kg)[wt of the electrolyte, not of the IV bag]; remember
Osmolarity= # of particles of solute in a unit of fluid based on ________ # of particles of solute in a unit of fluid based on VOLUME (mOsm/L); USED TO EVALUATE BLOOD OR URINE
What is the ability of solutes to cause an osmotic driving force and promote water movement from one compartment to another to try to maintain balance in the body? Tonicity
Hypotonic solutions= Hypo "LOW" Osmolality; 0.45% NaCl (Normal Saline) USE(TO INCREASE BP)IN HYPOTENSIVE PATIENTS; "low # of electrolytes as compared to water; In other words= more water and less electrolytes;
Isotonic solutions= Normal Osmolality; 0.9% NaCl (Normal Saline) USED TO INCREASE BLOOD VOLUME (TO INCREASE BP)"Same"= same # of electrolytes and water; won't see huge fluid shifts; DOES NOT ALTER CELL SHAPE OR SIZE;
Hypertonic solutions= High; D5NS (5%Dextrose Normal Saline)or D5LR (Lactate Ringer) USED TO DECREASE EDEMA POST-OPERATIVELY & REGULATES URINE OUTPUT & BP; More electrolytes and less water
Why would you give an isotonic solution? to increase blood volume/BP
Why would you give a hypertonic solution? to decrease edema in post-op pts, regulate urine output, and BP
When would you NOT give Normal Saline? in Hypernatremia
Sodium potassium pump... requires energy
Diffusion is a ..."fish downstream" Passive process; NO ENERGY NEEDED to move solutes or electrolytes across a semipermeable membrane; from HIGH to LOW concentration.
F & E Homeostasis uses almost every organ in our body in order to maintain fluid balance to regulate homeostasis...a problem with one...? A problem in one will affect the other. Kidney; Heart; Lungs; Pituitary glands; Adrenal glands; Parathyroid; Other mechanisms
How does the heart affect fluid balance to regulate homeostasis? Cardiac Output (CO)= the amount of blood pumped by the heart/min
How does the heart affect the level of renal perfusion to regulate homeostasis? CO; affects how much blood or fluid reaches the kidneys.
The lungs affect? insensible fluid loss; and are involved in acid-base balance; (acid= sour; base= bitter)
What function does the pituitary gland have in regulating fluid & electrolyte balance to regulate homeostasis? by the "Thirst Center" located in the hypothalmus
What does the hypothalmus produce? ADH; Anti-Diuretic Hormone
What does ADH do? Prevents peeing to ..."Conserve Water"/retain water; regulates water by acting on the kidneys to ↑ total body H20 reabsorption; ↑'s BP, ↑'s total blood volume
How does ADH affect urine? it is the most significant factor in determining whether excreted urine is concentrated (dark) or dilute (straw color)
How does the Adrenal Gland affect fluid & electrolyte balance to regulate homeostasis? Releases aldosterone
What affect does Aldosterone have on fluid & electrolyte balance to regulate homeostasis? ↑'s Na+ reabsorption and ↑'s/stimulates K+ excretion; Regulates the amount of electrolytes (Na+/K+ levels) in the body, thus, maintains BP & body fluids
What affect does the Parathyroid Gland have on fluid & electrolyte balance to regulate homeostasis? Regulates Ca++ & PO4-; Secretes the Parathyroid Hormone (PTH)
PTH causes... Bone reabsorption (when old bone is broken down it sends Ca++ out into the blood stream); Ca++ absorption from the intestines; Ca++ reabsorption from the renal tubules in the kidneys
What happens to the pituitary gland when Na+ ↑'s? The pituitary releases ADH which stimulates water reabsorption and ↓'s U.O. (urinary output); remember...it keeps you from peeing.
How does the Renin-Angiotensin-Aldosterone System stimulate thirst? causes vasoconstriction which ↑'s arterial perfusion pressure which stimulates thirst
The sympathetic nervous system stimulates release of...? Aldosterone in response to renin
Aldosterone regulates...? volume
Renin-Angiotensin-Aldosterone System regulates BP and water balance; a low BP causes the kidneys to secrete renin, renin stimulates Angio I & Aldosterone which ultimately causes the kidneys to hold onto Na+ and water; ↑'s BP (if BP gets too high need to give ACE inhibitors...-sartans)
What do osmoreceptors do? sense changes in Na+ concentration in our body
How does the Atrial Natriuretic Peptide (ANP)affect vessels? A cardiac hormone; opposite of renin-angiotensin-aldosterone; ANP ↓'s BP,↑'s U.O. ("ANP makes you Pee"); stimulates vasodilation which ↑'s water excretion/U.O.
What are Gerontological Considerations? ↑'d risk of F&E disorders b/c experience changes in F&E's quicker r/t decreased renal, pulmonary (lung), and adrenal function
What do you need to assess in geriatric clients to evaluate F&E's? skin turgor (clavicle or forehead); mental status; ability to swallow (NPO risks); I&O/daily wts; edema (pitting); BUN & Creatinin Clearance; thirst.
What does the CC test (Creatinin clearance) measure? The end product of muscle metabolism. The most definitive way of measuring kidney function [better than BUN (blood urea nitrogen]; but will use BUN & CC to measure kidney function.
What are the routes of fluid gain? Oral, IV, SubQ, Enteral (via gut)
What are routes of fluid loss? Kidneys and insensible losses
What is the expected fluid loss per day for the kidneys? 1500 mL/day of urine (obligatory [need to lose]U.O. is 400-600mL/day)
What are insensible losses of fluid? unmeasureable losses; skin/sweat= 600mL/day; lungs= 300-400mL/day; GI tract= 100-200mL/day
What is the term for Fluid Volume Deficit (FVD)? Hypovolemia (NOT same as dehydration)
What is the definition of hypovolemia? or When does hypovolemia occur? When extracellular fluid losses exceed fluid intake
When talking about hypovolemia we talk about a loss of...? water and electrolytes in the same proportion; an isotonic imbalance.
What is dehydration? loss of fluid; but tends to have a high sodium concentration; (thus, the loss of water is not equal to the loss of electrolytes and cannot be called the same thing as hypovolemia.)
Which is worse hypovolemia or dehydration? hypovolemia
What some causes of hypovolemia/isotonic imbalances from the GI system? vomiting, diarrhea, GI suctioning, GI fistula
What some causes of hypovolemia/isotonic imbalances from the renal system? diuretics, Addison's (↓ Aldosterone), Diabetes Insipidus (↓ ADH), osmotic diuresis
What are some insensible causes of hypovolemia/isotonic imbalances? Fever, sweating, stage III & IV wounds
As Hypovolemia worsens the signs/symptoms worsen and can lead to...? Hypovolemic Shock
What is ascites? Fluid in the abdomen.
How do you manage FVD? Administer fluids: Oral route is preferred; may give isotonic IV fluids 0.9% NS or LR (remember they do not cause huge fluid shifts); this will also increase BP
How do you assess response to treatment for FVD? I&O; Daily wts (most sensitive indicator of fluid changes); VS; Notify the MD of lack of response or worsening of symptoms (SBAR)
What pts are at risk for FVD? Elderly, renal failure, diarrhea, C.diff (pooping q 5 seconds), vomiting.
How would you educate a pt with FVD? If they are able to receive fluids orally, teach to drink some fluids every hour, etc.
How do you best assess the adequacy of FVD replacement in a pt. with hypovolemia by monitoring...? vital signs and daily weights
What is hypervolemia? Expansion of ECF (outside the cell); isotonic imbalance of fluids and electrolytes; circulatory overload
How does the body normally compensate for Hypervolemia/too much fluid? ...your body will try to compensate for fluid overload by fine tuning the circulatory or circulating levels of Aldosterone, ADH & ANP; by altering these levels it causes the kidneys to release additional water and sodium
What are the primary Signs/Symptoms of hypervolemia (we are expected to know)? Rapid wt gain (5#'s in one day); dyspnea, HTN, ↑'d JVD (↑'d time for veins to empty); may develop Pulmonary Edema if they cannot compensate well, the heart can only handle the extra load for so long; therefore, assess early.
How do you manage FVE (fluid volume excess)? Restrict fluid intake; restrict Na+ intake; give diuretics; Positioning: HOB elevated (30 or 45 degrees); elevate extremities (hopefully the body will be able to absorb the fluid) to ↓ edema and prevent skin breakdown by turning every 2h
What should you monitor for FVE? I&O, daily wts, and VS's; notify MD if there is a change in symptoms
What pts are at risk for FVE? Renal fx, Elderly, Heart & liver failure pts (conditions resulting in impaired circulating volume), any condition that presents with ↓'d serum proteins such as Liver fx, malnutrition, Burns, and Nephrotic syndrome (renal fx)
Where are electrolytes absorbed? via GI tract
Where are electrolytes excreted? via Urine
What is the #1 ECF cation? Na+
What does Na+ control/affect? controls water distribution; and affects muscle contraction/nerve impulse transmission
Why is it important to correct sodium imbalances "slowly"? d/t severe neuro side effects; neurovascular SE's;
A loss or gain in Na+= A loss or gain in water; (Water follows salt)
What is considered severe HYPONATREMIA? < 120 mEq/L;
What is a CNS symptom of severe HYPONATREMIA of < 120 mEq/L? Seizures, caused by H2O moving into the brain cell
Na+ is regulated by...? thirst center in the hypothalmus in the pituitary in the brain
What happens when sodium levels become severely low in the blood (< 120 mEq/L) excess water enters the cells; the cell swells/increases
Water toxicity causes...? HYPONATREMIA
Signs and symptoms of hyponatremia depend on...? How quickly Na+ falls or how long the levels are low, and the amount of extracellular fluid volume.
What are the GI symptoms of hyponatremia? Anorexia, N/V, cramping
What are the neurological signs and symptoms of hyponatremia? HA, lethargy, confusion, SEIZURES (caused by water moving into brain cells...that is why you want to repair the deficit slowly.)
Created by: jn study stop