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Fluid & Elect Balanc

Chapter 17-Fluid & Electrolyte Balance

Osmolality concentration of blood; normal serum level 275-295=isotonic
Isotonic equal osmolality of blood; no fluid shift, just increasing fluids
Hypertonic more concentrated than blood; pulls fluid into vascular space from interstitial & intracellular spaces
Hypotonic less concentrated than blood; fluid moves out to cells & interstitial space
Diffusion movement of particles from high concentration to low concentration
Osmosis movement of fluid or H2O from low to high concentration
Facilitated Diffusion movement with a carrier molecule (i.e., insulin)
Active Transport moving against grain with ATP
Fluid Compartments Intracellular--inside the cell Extracellular--everything outside cell; Interstitial-between intravascular & intracellular space; Lymph-sewer system of body, drains interstitial spaces into venous system; Vascular-veins, arteries, capillaries; CSF
Hydrostatic pressure push of the fluid from inside the vascular space; push from the inside outf
Colloid Osmotic Pressure Colloid=big cells, Albumin, RBCs; do not go through membranes easily, so pull fluids into vascular spaces
Elevation of Venous Hydrostatic Pressure--Reason for Edema #1 too much fluid in vascular space, seeps out in interstitial space
Decrease in colloid osmotic pressure --Reason for Edema #2 Loses pull and allows fluid to seep out
Increase in Interstitial Oncotic Pressure; break in vascular space (bruise, burn victim) --Reason for Edema #3 Where colloids go, fluids go;
Regulation of H2O Balance-Hypothalamic Thirst center
Regulation of H2O Balance-Pituitary Pituitary gland secretes ADH, keeps fluids; reabsorbs Na & H2O
Regulation of H2O Balance-Adrenal Cortical Adrenal gland secretes cortico/glucosteroids; secretes aldosterone that controls retension of Na; secretes cortisol that controls waking cycle
Regulation of H2O Balance-Renal Kidneys secrete Renin. Kidneys very fussy,like continuous fluid; if not getting enough, release renin, which converts to angiotensinogen, then angiotensin I, then angiotensin II which causes vasocontriction (incr. bp)
Regulation of H2O Balance-Cardiac When the heart gets flooded, it swells. When myocardium stretches too much it releases BNP (natural diuretic for kidneys) Tells kidneys to excrete fluid. Abnormally high BNP is indicator for CHF
Regulation of H2O Balance-GI Colon reabsorbs H20; about 8L/day
Regulation of H2O Balance-insensible H2O Loss of H2O from breathing/sweating-600-900mL/day
Fluid Replacements Crystalloids (clear) IV fluids Colloids (big cells) Albumin, RBC, blood products--sponges
Albumin Given to maintain, raise & hold bp; hold fluids in vascular space
Blood & blood products RBCs, FFP (given to incr. clotting factor--to reverse high INR-coumadin), platelets, cryoprecipitate (given to treat high PTT-heparin Very concentrated, give diuretics between units to protect the heart from fluid overload
Hespan Synthetic colloid, used to help increase bp
Lipids given w/TPN; TPN is hypertonic; 70% glucose--have to listen to lungs for crackles
Fluid Volume imbalance--how to tell if out of balance?? I&Os; severely dehydrated pt, not a lot of output
Fluid Volume imbalance--how to tell if out of balance?? If heart gets overload=incr hr, crackles in lungs, decreased sats,incr RR. look at BNP lab
Fluid Volume imbalance--how to tell if out of balance?? Always access for edema; ankles if sitting; hips and thighs if lying down
Hypernatremia (Na >145) High osmolality (more Na than H2O in blood) can be a sign of dehydration S&S: intense thirst, lethargic, seizures (neuro) Tx: 0.9NS or 0.45 fluids Do not want rapid fluid switch
Hyponatremia (Na <135) Low osmolality (lots of fluid in vascular space) S&S: confusion/tremors, seizures (neuro,) lethargy Manifestations: diarrhea, vomiting, NG tube suction Tx: 0.9%NS
Hypokalemia (K <3.5) Causes: diarrhea, vomiting, NG suction, diurectics S&S: leg cramps, parathesia, numbness, tingling (in legs) Tx: PO, IVPB-max 10mEq/hr on perph line, 20mEq/h on central line Biggest risk: ventricular arrhythmias, VTach, PVCs--run stat labs to chk K and
Hyperkalemia (K >5.5) Causes: Salt substitutes, Mrs. Dash(takes Na out, add K), chronic renal failure (can't excrete K), tissue injury, ACE, ARB inhibitors cause kidneys to retain more K Biggest risk: Cardiac arrhythmia, 1st brady, then 3rd degree block, tented/peaked T-waves
Treatments for Hyperkalemia sodium bicarb-pushes K into cells Calcium gluconate-protects heart Insulin&D50-pushes K into cells Kayexalate-PO or rectal
Hypocalcemia(Ca <8.5) Always look for Adj for Albumin lab Cause: chronic kidney disease, incr. phosphate, diurectics, ETOH, diarrhea S&S: Chvostek's-touch side of cheek=twitch; Trousseau's=hand tremor w/bp cuff or tourniquet, numbness & tingling around the mouth Tx: PO, IV (symptomatic, use IV first)
Hypercalcemia (Ca >10.5) Causes: multiple myeloma, bone mets, hyperparathyroid S&S: lethary, decreased reflexes, kidney stones, fractures Biggest thing: find cause; flush out
Hypophosphatemia (P <2.8) Causes: ETOH abuse, malabsorption Biggest Concerns: muscle weakness, respiratory muscle weakness (trouble getting pts off vent,) hypercalcemia
Hyperphosphatemia (P >4.5) Causes: Chronic renal failure, chemo agents, hypoparathyroid S&S: hypocalcemia S&S
Hypomagnesemia (<1.5) Causes: diarrhea, vomiting, ETOH abuse, NGT suction, diuretics S&S: confusion, hyperactive deep tendon reflexes Tx:PO, IV Worry about cardiac arrhythmias, PVCs
Hypermagnesemia (>2.5) Causes: usually created--given to slow muscle contraction; given in OB High mag levels & EKG chgs, give calcium gluconate
If you have Respiratory Acidosis... You are retaining too much CO2; can occur with hypoventilation--post op pts, sedated. High CO2 levels=lethargy. To increase ventilation, coughing, deep breathing, inflate lungs--has nothing to do with O2
If you have Metabolic Acidosis... S&S: deep rapid RR, trying to get rid of CO2 (Kussmaul Respirations); trying to get rid of CO2 acid
If you have Respiratory Alkalosis... Pt. is hyperventilating; getting rid of too much CO2(acid). Breath into paper bag Causes: anxiety, pain, emotional distress
If you have Metabolic Alkalosis... Pt. not ventilating well. Trying to maintain CO2.
Created by: divelmama