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Health Adaptation

Assessment & Care of Pt's With Fluid & Electrolyte Imbalances

Percent of water in total body weight 55-60% Babies: Higher water body weight. Elders: Less water body weight.
Intracellular Fluid Fluid inside cells *Most fluid in this compartment
Extracellular Fluid Fluid outside of cells. Consists of interstitial and vascular fluids. i.e. Plasma
Interstitial Fluid "Third Space" Fluid between cells
Define Homeostasis and 3 processes 1.Filtration 2.Diffusion 3.Osmosis to control normal fluid and electrolyte imbalance
Define Filtration HIGH to LOW PRESSURE Movement of fluid through a cell/blood vessel because of pressure differences.This occurs because water volume presses outwards against the walls (Hydrostatic Pressure)
Clinical examples of Filtration (2) *Blood pressure- Moves blood from heart to capillaries where filtration can occur. *Edema-Occurs from pressure differences
Define Diffusion HIGH to LOW CONCENTRATION to find equalization. Free movement of particles and electrolytes across a permeable membrane.
Clinical examples of Diffusion (2) *Capillary Membranes-transportation of electrolytes and particles through membranes. *Sodium Pumps-Active Transport
Facilitate Diffusion example Glucose cannot enter most cell membranes without the help of insulin
Define Osmosis LOW to HIGH CONCENTRATION of WATER ONLY! Dilute fluid (less concentrated) moves to more concentrated to make it more dilute. Milliosmoles per Liter/Solution
Clinical example of Osmosis *Thirst Mechanism- feeling of thirst is caused by the activation of brain cells that respond to change in ECF osmolarity
Normal Osmolarity Level AKA "Isotonic" -Norm: 270-300 mOsm/L ->300:Hypertonic (Pull water from isotonic fluid space) -<300:Hypotonic (Water pulled from hypo-osmotic fluid into isotonic fluid space
Routes of Fluid Loss *Kidneys most important (Filtration, Re absorption, Excretion) *Insensible water loss (500-1000mL/day) from skin, lungs stool
Define Obligatory Urine Output and norm (400-600mL/day) Minimum amount of urine needed to excrete toxic waste products
Aldosterone Secreted by adrenal cortex if sodium levels are low. -Prevents water and sodium loss -Increases blood osmolarity and volume
Antidiuretic Hormone (Vasopressin) *Acts directly on kidney tubules -Produced in brain -Stored in posterior pituitary gland -Controlled by hypothalamus in response to blood osmolarity -Results in more water being absorbed from tubules and returned to blood=decreased blood osmolarity
Natriuretic Peptides "Too much fluid, get rid of some" *Effects opposite of Aldosterone Secreted in response to increased blood volume and BP which stretch heart tissue Secreted by the ANP & BNP
Dehydration S/S Hypotension ↑HR ↑RR (may need O2) Tenting Dry Mucous Membranes ∆ Mental Status ↑ Temp Concentrated/Decreased Urine
Dehydration Lab Assessment Hemoconcentration= Elevated Hemoglobin, Hematocrit, Serum Osmolarity, Glucose, Protein, BUN, Electrolyte
Normal Specific Gravity Level 1.010-1.025
Fluid Overload S/S Edema ↑HR ↑BP ↑RR Neck vein Distension *Daily Weight most accurate measure
Define Electrolyte Substances in body fluids that carry an electrical charge
Body Fluids Are electrochemically neutral (Have equal number of + and - ions)
How is the body's homeostasis controlled? By balance of dietary intake of electrolytes with renal excretion or re absorption
Sodium *Major extracellular cation Vital for skeletal muscle contractions, cardiac contraction, nerve impulse transmission, normal osmolarity and volume of the ECF.
Normal Sodium Level 135-145 mmol/L
Hyponatremia *Confusion *Muscle Weakness (First check Respiratory Status!!) -↑ GI Motility -Nausea, Diarrhea -Change in Cardiac Output (Hyper/Hypovolemia)
Hyponatremia Interventions *Monitor the patients response to therapy and preventing hypernatremia and fluid overload. Treat with fluids and sodium.
Hypernatremia *Twitching Confusion
Potassium *Cardiac *Major intracellular cation *80% of K loss if from kidneys
Normal Potassium Level 3.5-5.0 mEq/L
Hypokalemia S/S *Cardiovascular Changes -Weak Pulse -Dysrhythmias -Muscle weakness *Decreased Peristalsis -Confusion
Hypokalemia Interventions -Ensure adequate oxygenation -Monitor response to therapy -Prevent injury from K administration *Never IV PUSH,IM, or SubQ Potassium
Foods High in Potassium -Prunes, Raisins -Apricots -Nuts/Seeds -Fish -Beans -Avacados -Dark Chocolate
Hyperkalemia *Cardiovascular problems are most severe and result in most deaths -Increase GI motility, Diarrhea -Muscle Twitching
Hyperkalemia Interventions -Cardiac Monitoring -Drug Therapy (Kayexalate, glucose and insulin, dialysis)
Normal Calcium Level 9.0-10.5 mg/dL
Calcium -Closely r/t phosphorus & magnesium -Stored in the bones -Vitamin D is required for absorption
Parathyroid Hormone (PTH) is released when... Calcium levels are low
Thyrocalcitonin (TCT) is released when... Calcium levels are high
Percentage of people that are Lactose Intolerant 75-90%
Hypocalcemia S/S *Risk of bleeding -Paresthesia (numbness/tingling) -Trousseaus's or Chvostek's Sign -↑Peristalsis -Skeletal Changes(Chronic) -EKG Changes *Frequent spasms (Charley horses
Trousseaus's Sign Hand, finger spasm with BP cuff inflated 1-4 minutes
Chvostek's Sign One-sided facial twitching when brushed
Hypocalcemia Interventions -Injury prevention (brittle bones) -Seizure Precautions
Hypercalcemia S/S *Risk of blood clots -Cardiovascular changes are most serious and life threatening -Altered LOC -↓Peristalsis
Hypercalcemia Interventions -Dialysis -Cardiac Monitoring
Normal Phosphorus Level 3.0-4.5 mg/dL
The most phosphorus can be found where? In the bones. About 80%
What is phosphorus needed for in the body? For activating vitamins and enzymes, forming adenosine triphosphate, and assisting in cell growth and metabolism
The relationship between Calcium and Phosphorus ↑Calcium = ↓Phosphorus
Foods high in Phosphorus -Meats -Fish -Dairy products -Nuts
Clinical situations that would cause Hypophosphatemia -Malnutrition -Starvation -Malignancy -Alcohol Abuse
Hypophosphatemia S/S -Most apparent in cardia, Musculoskeletal, and hematologic systems, and CNS. -↓Cardiac Output -Muscle Breakdown -CNS Changes(Not til severe)
Hypophosphatemia Interventions -Vitamin D Supplements *Decreasing intake of foods high in Calcium
Hyperphosphatemia -Can be from renal insufficiency -Does not cause many problems, worst problems include the relationship with calcium. ↑Phosphorus=↓Ca
Hyperphosphatemia Interventions Since Phosphorus and Calcium have a reciprocal relationship, management of hyperphosphatemia entails management of hypocalcemia
Normal Magnesium Level 1.3-2.1 mg/dL
Magnesium Critical for skeletal muscle contraction, carb metabolism, ATP formation, vitamin activation, and cell growth
Hypomagnesemia is caused by... Increased membranes excitability and the accompanying serum calcium and potassium imbalances.
Hypomagnesemia S/S -Muscle contractions, numbness/tingling -Chvostek's & Trousseaus's Sign -Confusion, depression/psychosis -↓Peristalsis
Hypomagnesemia Drug Intervention Magnesium Sulfate-Give IV, never IM
Hypermagnesemia occurs when... excitable membranes are less excitable and need a stronger-than-normal stimulus to respond
Hypermagnesemia S/S -↓BP, ↓HR -Cardiac Arrest -Lethargy/coma -↓Reflexes -Respiratory failure r/t muscle weakness
OTC Meds high in Magnesium -Antacids -Milk of Mag
Normal Chloride Level 98-106 mEq/L
Chloride *Major Extracellular Anion -Usually occurs as a result of other electrolyte imbalances
Created by: Cortni