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Health Adaptation
Assessment & Care of Pt's With Fluid & Electrolyte Imbalances
| Question | Answer |
|---|---|
| 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
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