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Fluid and Electrolyt
Napa Nurs141
| Question | Answer |
|---|---|
| Serum Value for Sodium Na+ | 135-145 |
| Serum Value for Potassium K+ | 3.5-5.0 |
| Serum Value for Ionized Calcium CA+2 | 4.4-5.5 |
| Bicarbonate | 22-26 arterial, 24-30 venous |
| Chloride Cl- | 95-105 |
| Magnesium Mg 2+ | 1.5-2.5 |
| Phosphate PO4 3- | 2.8-4.5 |
| 6 functions of fluids | Transport of nutriets to and wastes from cells, maintain nL body temp,lubricates and cushions,facilitates digestion and elimination,maintains vascular volume and solvent for e-lytes |
| 4 functions of e-lytes | body water regulation and osmolality,acid-base balance,enzyme activity,neuromuscular activity |
| % of intracellular fluids | 40 |
| % of extracellular fluids | 20 (5 intravascular, 15 Intertitial) |
| Average L of water in adult | 28L M 20L women |
| Contains lymph,fluid between the cells and outside the blood vessels | Interstitial fluid |
| Blood plasma found in vascular system | Intravascular fluid |
| Fluid seperated from other fluids by a cellular barrier | Transcellular |
| Increase in TBW | Infants |
| Increase in TBW | Muscle |
| Decrease in TBW | Elderly |
| Decrease in TBW | Fat (more adipose tissue) |
| An element or compound that, when dissolved in water or another solvent seperates into ions that are electrically charged | Electrolyes |
| + charged e-lytes | cations |
| ICF Cations (+) | Potassium, Magnesium, Sodium |
| ICF Anions (-) | Phosphates, sulfates, Bicarbonates, Proteniates |
| MEq/L represents | the number of grams of the specific e-lyte dissolved in a L of plamsa (solution) |
| 4 processes fluids/solutes move across membranes | osmosis, diffusion, filtration, active transport |
| Osmosis | The movement of a pure solvent, (water) across a semi-permmeable membrane from an area of LOW concentration to HIGH concentration |
| Osmolarity | The concentration of solutions, reflects the number of molecules in a L of solution (mOsm/L) |
| Diffision | Solution across a semi-permenable membrane from HIGH to LOW area of contrentration |
| H+ ion concentraion in the blood | PH |
| NL pH | 7.35-7.45 |
| A product of metabolism | Hydrogen |
| Donates H+ ions | Acids |
| Accepts H+ ions | Bases |
| Most effective way to measure/evaluate acid-base balance | ABG Aterial blood gas |
| Increased pH | Alkalosis |
| Decreased pH | Aciddosis |
| Excessive vomiting and excessive fluid loss | Hypovolemia |
| Unble to respond to thrist mechanism | Dehydration |
| The concentrations of of solutions | Osmolarity |
| nL serum osmolatity | 275-295 mOsm/kg |
| <275 | hypotonic |
| >295 | hypertonic |
| Fluid body gains | foos, fluids,oxidative metabolsim |
| Fluid body loss | Lungs, skin, GI tract and kidneys |
| One key way a cell gains useful energy | oxidative metabolsim |
| Movement of fluids from low conc to high conc | osmosis |
| move together across a memebrane in response to fluid ppressure | filtration |
| primamary regulator of fluid intake | thirst |
| 6 mechanisms that trigger the thirst center | Increase plasma osmolality, angiontension 2, dry oropharyngeal, psychological factords, decrease potassium or increase sodium, decrease plasma volume |
| horomone that increases BP | angiotension |
| major organ for retention and excretion of fluids | kidneys |
| pressure excerted by a fluid at equalirium due to the force of gravity | hydrostatic pressure |
| GFR | 125mL/min |
| nL urine output | 20-30m/hr |
| process of renin-angiotension-aldosterone system | decreased BP or decreased Na triggers glomerulsu to excrete renin that then triggers the LIVER to convert angiotension to angiotension 1 to LUNGS to then convert abgiotension 1 to angiotension 2 which triggers adreanals to secrete aldosterone |
| What does aldosterone do after its secreted by the adrenals | increases reabsorption of Na and water to release K in the kidneys which increases blood volume and increases BP |
| Causes vasoconstriction and production of alsodterone, resulting in increase of BP | Angiotension 1 and 2 |
| Drugs that interfere with the secretion or action of aldosterone | antihypertensives |
| Sodium % in ECF | 90 |
| nL ECF serum sodium | 135-145 mEq/L |
| Role of sodium balance | control water distribution and volume |
| nL serum for NaCL | 50-90mEq |
| Organ that excretes Na as needed | kidney |
| requires metabolic activity and expenditure of energy to move substances across cell membrane (ATP) | Active Tranport |
| Functions of Potassium | regulation of ICF, nerve impulses, maint of acid-base balance |
| Irregular HR if decreased | Potassium (K+) |
| Food sources of K+ | meats, bananas, avacados, dried fruits, nuts, chocolate |
| K+ < 3.5 | hypokalemia |
| Causes of hypokalemia | Inadequate butrient intake, GI losses, renal loss, stress, strriods, alkalosis |
| sxs of hypokalemia | weakness, paralyisis, leg cramps, anorexia, vomiting, SOB, apnea, polyuria (excessive urine) |
| Calcium serum levels | 8.5-10.5 |
| 99% stored in teeth, bones | Calcium |
| Bound with protein and ionized | Calcium |
| Ionized Calcium serum levels | 4.5-5.5 mEq/L |
| Regulation of calcium | vit d, phosphates, PTH, Calcitonin |
| PLasma serum concentrations | 1.5-2.5 mEq/L |
| 2/3 found in bones, 1/3 in ICF, 1% ECF | Magnesium |
| Small bowel | Magnesium absorbed |
| kidney | Magnesium excreted |
| Major chemical buffer in ECF and ICF | HCO3 (Bicarbonate) |
| nL serrum Bicarbonate | 20-26 |
| < 22 HCO3 | Metabolic acidosis |
| > 26 HCO3 | Metabolic alkalosis |
| Regulated by the kidneys | Bicarbonate |
| < 7.35 pH | Acidosis |
| >7.45 pH | Alkalosis |
| PaCO2 serum levels | 35-45mmHg |
| <35 PaCO3 | hypocapnia (decreased o2 consumption) |
| >45 PaCO2 | hypercapina (increased o2 consuption) |
| HCO3 serum levels | 20-26mEq/L |
| <20 HCO3 | acidosis |
| >26 HCO3 | alkalosis |
| The accumulation of fixed acids and loss of base (high acid in the blood) | Metabolic acidosis |
| Diahhrea, renal disease, ketacidosis, ingestion ASA, renal tubular acidosis | causes of metabolic acidosis |
| Kussamuls respirations, starvation, headache, hyperventation, hypotension, decresed pH decreased HCO3, decreased PaCO3 | sxs of metabolic acidosis |
| Inadequate excretion of CO2 and acute/chronic respiratory alterations | Respiratory acidosis |
| headache, hypertension, hyperkalemia, hypoxemia(decreawsed O2 in blood) dyspensea (sweating)increased RR, decreased pH | sxs of respiratory acidosis |
| hypoventalation, increased HR, decreased LOC, hpokalemia, hypocholoermia, tetany, increased pH, increased HCO3 | sxs of metabolic alkalosis |
| hyperventalation, hypoxemia, anxiety, fever | causes (hyperventalation) of respiratory alkalosis |
| lightheaseded, inability to concentrate, palpations, dry mouth, hypotension, blurred vsision, increased pH, decreased PaCO2 | sxs of respiratory alkslosis |
| 3 influencing factors of TBW | Body fat, sex and age |
| lose more fliuid due to insensible water loss | infants |
| infants | decreased ability to concentrate urine |
| deminished thrist respone | elderly |
| elderly | altered ADH response |
| Risks for F/E imbalances | CHF, renal failure, cirrohsis, ADH stimulation (Stress), excess sodium containing fluids.foods, IV solutions |
| druds, GI, restraints, skin, fever, blood loss | alterations in fluid intake and output |
| B U N | blood urea nitrogen |
| BUN serum levels | 7-20 mg/dL |
| Serum plasma creatinine | .7-1.2 mg/dL |
| Measures hydration, status, electrolyte concentration in bld plasma and acid-base balance | Diagnostic tests for FVD or FVE |
| decrease intravascular and interstitial fluids | hypovolemia (FVD) |
| equal water and electrolyle loss, = hypovolemia or dehydration | Isotonic FVD |
| Isotonic defiect sxs | decreased pulse, decreased BP, decreased skin turgor, decreased weight, decreased LOC, increased RR and temp |
| Diagnostic tests 4 FVD | serum increase sodium >145, BUN > 25, hematocrit > 50%, specif gravity > 1.025 |
| Abnormal fluid reetention in intravascular and interstitual space (sodium and water retained) | extracellular FVE |
| CHF, renal failure excessive sodium intake, increased serum aldosterone, steriods | Isotomic FVE causes |
| FVE sxs | weight gain, distended veins, constant cough, dsypnea (upset stomach), cynosis |
| FVE diagnsotic tests | decreased sodium levels, decreased hematocrit, decreasewd specific gravity, BUN |
| Hypoosmolor FVE | water gain and electrolyle gain |
| Hyperosmolar FVD | water loss and electrolyte loss |
| ICFVE | fluid shift from extracellular spaces to intracellular, due to serum serum hypo-osmolality |
| Potassium falls below 3.5 | Hypokalemia |
| Imbalance of Na on cell >145 meQ/L | Hypernatremia (cell shrinks) |
| overexcitment of nervous system, twinges in fingers and toes | alkalosis |
| CNS changes from failure of swollen cells, confusion, anxiety, anorexia, nasusea | sxs of hyponatremia |
| deep rapid breathing, Kussamuls, decreased pH | evidence that the compensory mechanisms are working in metaboilicacidosis |
| What is the major cause od metabolic acidosis | kidney disease |
| water leaves the cells and moves to the bloodstream | dehydration |
| Na < 135mEq/L | Hyponatremia |
| sxs of hypernatremia | thrist, weakness, disorientation, lethargy, muscle irritabilty |
| sxs of hyponatremia | nausea, malaise, headache, fatigue |
| causes of hyperkalemia (K+) | decreased K ewxcretion, high potassium intake, shift K out of cells |
| sxs hyperkalemia | nausea, hyperactive bowel sounds, cardiac arrest, dysrythemias, EKG changes, anuria (non passaage of urine) paresthesia |
| causes for hypercalcemia | metastatic cancer, immobolization, hyperthyroidism, intake of diueretics, Lithium, excess intake of Ca anatcids |
| sxs of hypercalcemia | nuero weakness, polyuria, hypercalcuria, decreased peridtsalisis, cardiovacular |
| sxs of hypocalcemia | tetany, parasthia, trousseaua sign, chvostek's |
| dimished nuero transmission, decreased muscle funciton, hypotension, respr depression, cardiac arrest | hypermagnesemia sxs |
| <1.8 mg/dL | hypomagnesemia |
| Losses from GI tract, alcoholism | causes of hypomagnesemia |
| DVD, FVE, Ineffective breathing pattern, Impaired mobility, Impoaired skin ingrity, Altered oral mucous membranes | Nursing Diagnosises |
| Nursing Interventions | Assess colume status |
| Obtain daily weights | Nursing Intervention |
| Monitor Lab vlaues | Nursing Interventions |
| Mouth Care, protect skin, measure I and O | Nursing Interventions |
| Purpose of fluid therapy | Maintain fluid and electrolyte balance, replacement and correction in elctrolyle disturbances |
| Aqeuos solution mineral salts or other water soluble molecles | Crystalloids |
| Crystalloids | sodium chloride solutions, 0.45% NaCl, hypotonic |
| Balance electrolyle solutrystalloidsions (Lactate Ringers) | Crystalloids |
| Colliods | Protien or starcth molecules in fluid |
| Increase osmotic pressure-volume expansion for fluid replacement | Colliods |
| Dextran | Colliods |
| Hetastarch | Colliods |
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