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fluid n electrolytes
| Question | Answer |
|---|---|
| dehydration def | state where body loses more fluid and electrolytes than it takes in |
| fluid volume deficit | fluid (intravascular, interstitial or intracellular fluid) loss exceed fluid intake = decreased circulating BV and impaired tissue perfusion |
| Fluid volume excess | State where isotonic fluid retention increases the volume of extracellular fluid, resulting in circulatory congestion and edema (body retains more fluid than it needs) |
| Hypertonic | More solutes than cells pulling water out and shrinking cells (shrinks) (used for swelling of patient’s system) (more concentrated than normal blood) |
| hypotonic | Fewer solutes, causing water to rush in, swelling cells (swells) (used for dehydration) (more dilute than blood) |
| osmolality | Measure of number of particles per kilogram of water in weight (# of solutes/kg of solution) |
| isotonic | Fluid with same tonicity as normal blood |
| total parenteral nutrition | Refers to delivery of nutritional supplements through central or peripheral intravenous (IV) catheter |
| homeostasis | Keep a condition/situation as close to normal as possible. Body attempts to maintain a state of physiologic balance in presence of constantly changing conditions |
| homeostatic mechanisms | Mechanisms that control or safeguard body to prevent dangerous changes |
| osmosis | Movement of water only through a selectively permeable membrane |
| diffusion | movement of solutes from high to low concetration |
| filtration | movement of fluid due to pressure differences (capillaries) |
| ADH hormone function | retains water in kidneys |
| aldosterone function | retains sodium and water and excretes potassium |
| anp function | promotes sodium and water excretion |
| thrist mechanism | stimulates fluid intake |
| what is the primary regulator for fluid distribution, ecv, and osmolality | kidneys |
| how much does ICF comprise in adults | 2/3 of body water |
| how much does ECF make up in adults | 1/3 of total body water |
| how does RAAS regulate ECF vol. | influences how much sodium and water are excreted in urine, and regulation of BP |
| how do the kidneys regulate electrolytes (4) | filtration, reabsorption, secretion, excretion |
| the kidneys adjust how much electrolyte is... | returned to bloodstream and eliminated in urine |
| what is a normal sodium level in the body | 135-145 mEq/L |
| normal K levels in body | 3.5-5 mEq/L |
| what is acidosis in acid-base balance | K moves OUT of cells (hyperkalemia) |
| alkalosis acid base balance | K moves INTO cells (hypokalemia) |
| hyperkalemia can cause... | lethal dysrhythmias |
| normal calcium levels | 8.6-10.2 mg/dL |
| how much water is in our total body weight % | 55-60% |
| what is the range where our body does best at in concentration of solutes | 275-295 mOsm/kg |
| osmotic pressure | power of solution to draw water across membrane |
| tonicity def | effect a solution's osmotic pressure has on water movement across cell membrane of cells within the sol. |
| isotonic good ranges | 275-295 mOsm/kg |
| hypertonic range | >295 mOsm/kg |
| hypotonic range | <275 mOsm/kg |
| where can filtration occur (2) | glomerulus and capillary beds |
| what is a factor that determines whether fluid leaves the blood vessels and enter the tissue spaces (interstital fluid) | difference between hydrostatic pressure of capillary blood and that of the interstitial fluid |
| how does edema develop> | changes in normal hydrostatic pressure differences such as patients with right-sided heart failure (CHF) |
| what is active transport | extra energy used across a cell membrane against a concentration gradient (pumping) |
| example of active transport to control cell vol and intracellular concentrations of substances | sodium-potassium pump |
| where is aldosterone secreted in | adrenal cortex |
| where is ADH produced and stored | produced in brain, stored in posterior pituitary gland |
| natriuretic peptides are secreted by | special cells that lie in atria and ventricles of the heart |
| Natriuretic peptides responds to | increased blood pressure and volume |
| what does the parathyroid hormone (PTH) do | increases blood calcium and activate vitamin D |
| clinical correlation kidney failure = ? = ? | decreased vit. D activation = hypocalcemia |
| normal Mg levels | 1.5-2.5 mEq/L |
| what is Mg regulated by | kidneys and GI absorption (low mg = difficult to correct hypokalemia) |
| phosphate normal range | 2.5-4.5 mg/dL |
| phosphate regulated by | PTH (increases phosphate excretion) and renal fnction |
| high phosphate can lead to | renal failure |
| when acidosis occurs ... | excess H moves into cells and K moves out (hyperkalemia) |
| when alkalosis occurs | H leaves cells, K moves in hypokalemia |
| sodium potassium pump maintains.. | resting membrane potential and cellular electrical stability |
| if NAk pump fails.. | K leads out and leads to hyperkalemia |
| what is the thirst drive triggered by | increased osmolarity and decreased blood vol dry mouth |
| avg adult drinks how much water a day | 1500mL |
| ?% of solid food is water | 85 |
| metabolism range | 300mL/day |
| what is the primary route of output | urine (400-600mL) |
| diarrhea leads to a loss of | K and bicarbonate |
| NG suction leads to a loss of | K and H |
| risk factors for electrolyte imbalances | diarrhea, endocrine disorders, medications that disrupt electrolyte homeostasis |
| risk factors for fluid imbalances | NG suctioning, excessive sweating, heart failure, renal failure, increased age (<thirst perception) |
| normal chloride levels | 98-106 mEq/L |
| normal BUN levels | 10-20 mg/dL |
| normal HCT levels (%) | 37-52% |
| what are assessment cues for fluid volume deficit | dry mucous membrane, poor skin turgor, hypotension (BP), tachycardia (HR), flat neck veins |
| assessment cues for fluid volume excess | edema (swelling due to excess fluid), crackles, dyspnea, hypertension, distended neck veins |
| assessment cues for hyponatremia (Na) | confusion, seizures, weakness |
| cues for hypernatremia (na) | thrist, restlessness, dry sticky mucosa |
| cues for hypokalemia (less potassium) | muscle weakness, dysrhythmias, constipation |
| cues for hyperkalemia (increased K) | peaked t waves, muscle cramps, cardiac arrest |
| diagnoses associated with fluid and electrolyte imbalances | deficient fluid vol., excess fluid vol. risk for imbalanced fluid volume, risk for electrolyte imbalance, decreased cardiac output, impaired gas exchange, imbalance nutrition |
| what do fluids used for oral replacement of fluid losses usually contain | water, sodium, glucose, potassium |
| ex of oral fluids replacement | commercial electrolyte solutions, broth, sports drinks (use caution) |
| what should you avoid for oral fluids replacements | pure water in severe hyponatremia (lowered sodium) and high sugar beverages |
| what is the goal of IV fluid therapy | correct or prevent fluid and electrolyte disturbances |
| you should regulate IV fluid therapy continuously bc | ongoing changes in patient's fluid and electrolyte balance and cardiovascular status |
| rationale for initiating iv therapy for patient with fluid/electrolyte imbalance | to receive timely administration of fluids, correct electrolyte/fluid imbalance, and maintain homeostasis when someone cannot PO |
| allotment of oral fluids for 24 hour period for patient with restricted fluids | half the total oral fluids between 0700-1500 (more active), receive 2 meals and take most orall meds, offer remainder of fluids during evening |
| with ice chips its important to remember to chart ex( 240mL) | record half of the intake (120mL) |
| use hypotonic solutions for patients who are | severely dehydrated (brings fluid into cells) |
| use hypertonic for patients who are | severely hyponatremic (Na), brings fluids out of cells (CAUTION, close monitoring ) |
| intake output calcs | make sure to subtract output from input to get net balance total 860 mL intake - 750 mL output = 110 mL total |
| 1 kg of weight change = | 1 L of fluid |
Created by:
shinykwon