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GWCC Block 2 nursing

Hypotonic solutions do move water from vascular system into cells
Isotonic solutions do nothing- water stays in the appropriate compartments
Hypertonic solutions do move water from cells into vascular system
Hypertonic is ___ mEq/kg less than body osmolality at less than 250
Isotonic is ___ mEq/kg 285- 295, equal to body osmolality
Hypertonic is ___ mEq/kg more than body osmolality, 375+
ADH a hormone secreted from the pituitary mechanism that causes the kidney to conserve water
ANP atrial natiuretic peptide, a cardiac hormone found in the atria of the heart that is released when atria are stretched by high blood volume
Parathyroid hormone regulates calcium and phosphate balance.
Aldosterone responsible for renal absorption of sodium, which results in retention of chloride and water.
Epinephrine increases blood pressure, dilates blood vessels needed for emergencies and constricts others.
Cortisol produces sodium and fluid retention, and K deficit
A ___ mg/Hg fall in systolic BP when shifting from lying to standing position indicates fluid volume deficit 20
What respiratory signs indicate fluid volume excess? tachypnea and dyspnea
HCT and BUN in hypovolemia normal or high HCT and BUN
HCT and BUN in hypervolemia low
Conditions that cause isotonic overhydration excess administration of IV fluids, excessive irrigation of body cavities/organs, use of hypotonic fluids to replace isotonic fluid loss. Also corticosteriods, renal and heart failure, high aldosterone levels.
Conditions that cause hypotonic over-hydration aka water intoxication- SAIDH (syndrome of inappropriate antidiuretic hormone hypersecretion), excess water intake, CHF
A dehydrated pt should have __mL fluid intake per day 2000
candy and gum can ___ mucous membranes dry
normal BUN 10-20; BUN is normal or high in FVD
normal specific gravity of urine 1.005- 1.030; high in FVD
suppression of PTH results in FVD
Potassium 3.5 -5
Sodium 135-145
Magnesium 1.5 - 2.5
Phosphate (HPO4) 3.0- 4.5
Chloride 95-108
Concentrations of K greater than ___ should never be given in a peripheral vein 60
Concentrations of K greater than ___ can cause pain and irritation in peripheral veins, leading to phlebitis 8mEq/100mL
Do not add K to a ____ hanging container
Administer K at a rate not more than ___ through a peripheral vein 10mEq/hr
Calcium and __ have a reciprocal relationship- when one in higher the other is lower. phosphate
The most dangerous sign of hypocalcemia is laryngospasm
Patients with calcium imbalances may need seizure precautions
SAIDH is the most common cause of __ in hospitals hyponatremia
serum osmolality 285-295; less than 280 is hypovolemia, more than 300 is hypervolemia
When K moves out of cells H moves in and vice versa
Roles of K regulates fluid volume within a cell; promotes nerve impulses, cx of mucles, acid base balance, enzyme function
If ECF K becomes depleted K moves out of cells and into the ECF
an increase in aldosterone levels stimulates and increases excretion of K
On an EKG, hypokalemia results in flattened T wave and appearance of U wave
On an ECG, hyperkalemia results in tall tented T wave, S-T segment depression, wide QRS wave ("shark teeth")
Insuline facilitates movement of K back into cells from ECF. Giving insulin is one treatment of hyperkalemia
Calcium 8.5- 10.5
Most common cause of hypocalcemia inadequate secretion of PTH
Symptoms of hypocalcemia numbness of fingers, cramps, Trousseu's sign, Chvostek's sign, hyperactive deep tenden reflexes
A deficiency in chloride reflects a deficiency in K
serum osmolality 285-295
urine specific gravity 1.003 - 1.030, OR 3-30
Hypocalcemia- Check for__ rapid labored respirations, stridor= tetany/spasms in the airways, Chvosteks's sign- face twitch, test for deep tendon reflexes with hammer, numbness of extremities.
How does hypocalcemia affect the body? (2 things) Impairs clotting; Hypocalcemia causes lowered threshold of muscle excitement --> spasms, tetany
Hyperkalemia, check for s/s Weakness, fatigue, HR (will be lower than normal),Check ability to move muscle groups against resistance and gravity
How does hyperkalemia work in the body? Prolongs re-polarization period, slows HR, reduces BP; Na builds up, K does not leave cells, depolarization is difficult.
How is hyperkalemia treated (esp. in renal patients)? In renal failure K is not excreted effectively, increases blood K level. Treated with drug therapy
Continuous cardiac monitoring
What is SIADH? Syndrome of inappropriate antidiuretic hormone hypersecretion, excessive release of antidiuretic hormone (ADH). The result is hyponatremia, and sometimes fluid overload.
How is SIADH treated? loop diuretic, hypertonic IV solution, restrict fluid intake, I&O, weigh daily, hyperactive bowel and filud build up in abdomen, monitor LOC frequently, monitor for signs of GI involvement
3 ways the body tries to maintain pH levels 1.blood buffer pH 7.35-7.45 2.lungs: pco2 35-45 (short term but limited). Breathe faster, blow off acid co2. 3.kidneys: hco3 22-26 (long-term)
Respiratory acidosis not enough breathing, retaining acid. Body accomodates by breathing more. anxiety, hyperventilation, exercise, high altitude, pregnancy, diarrhea,hypoventillation, airway obs, COPD, chest trauma, neuro-muscular disease, drug overdose (pass out).
Respiratory alkalosis breathing too much, try to slow down to not blow off too much acid.
anxiety, hyperventilation,
Metabolic acidosis not enough bicarbonate being produced. renal failure, aspirin overdose, (diarrhea, lose it through their "acid"dosis).
Metabolic alkalosis losing acid, vomiting, suction, Alcoholic throws up, alkalosis, diuretics--> urine is acidic.
Isotonic IV salines (2) 0.9% NaCl (normal saline); LR (Lactated Ringers), like Gatorade. For someone who's healthy but dehydrated, or to go to surgery with.
Hypotonic IV fluids pulls fluid from blood vessels into intracellular spaces, rehydrates cells. 0.45% (1/2 normal saline); D5W (5% dextrose in water)
Hypertonic IV fluids Has more salt. 3% saline; TPN (has so much glucose, NA, lipids, etc). Can only do through central line because of caustic veins. Never D/C TPN because will cause PT to crash, must wean down to saline and then D/C.
Osmolality stuff in blood
Osmolarity stuff in IV bags
aldosterone - what does it do? Holds onto sodium! Aldosterone is a hormone that increases the reabsorption of sodium and water and the release (secretion) of potassium in the kidneys. This increases blood volume and, therefore, increases blood pressure.
What to give IV for hyper-K? Glucose IV with insuline. It will take the K with it and lower K levels in the body.
Production of aldosterone is triggered by low blood volume, low Na, high K, low CO, stress
When aldosterone is secreted, what happens to Na, K and H? Na is held onto. K and H are excreted by kidneys.
Loss of skin turger means dehydration
regulation of K excretion depends on (3) amt of Na available for exchange; number of H ions being excreted, aldosterone levels.
Low serum K levels associated with (acidosis or alkalosis) alkalosis
Hig serum levels of K associated with (acidosis or alkalosis) acidosis
Ca and __ are antagonistic Mg
Biggest risk of hypocalcemia tetany
Signs of hypercalcemia muscle weakness, bradycardia
Created by: AmericanChai