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109 Ch. 14

Fluids & Electrolytes

How much wt of adult is fluid? child? 60%, younger, thin, and men have more fluid. lean mass = decr fluid child: 80%
what are the two fluid compartments ICF: intracellular 2/3 body, 40% ECF: extracellular, 1/3 body, 20% Ex: 70kg has 42L h2o...30L in cells, 11L in man
how many liters of blood does body contain 6L...3L = plasma, 3L = rbc,wbc, thrombocytes
what is third spacing loss of ECF into space it does not belong. Edema. Occer w/ hypocalcemia, decr iron intake, liver disease, alcoholism, hypothyroidism, malabsorption, immobility, burns, cancer
what are major cations in body fluid ICF: K,Mg,Na ECF: NA, K, Ca, Mg potassium, sodium, mag, calcium, hydrogen
what are major anions in body fluid ICF: PO4,S,hCO3,proteinate ECF: Cl-,HCO3,PO,S Chloride, Bicarbonate, Phosphate, Sulfate, proteinate
What are three compartments of ECF Intravascular - inside vessels interstitial/ECF: between cells, lymph transcellular: cerebrospinal, pericardial, synovial,intraocular,pleural,sweat,digestive
how much fluid is secreted in and reabsorbed from GI 3-6L
1L = how many lbs Acute loss of 0.5kg(1lb) = fluid loss of? 1L = 2 lbs 500ml
What are fx of body fluid 1. transport 02,food,waste 2.regulate temp 3.lubricate joints/tissues 4.medium for food digestion
What are three fluid spacings 1st - ICF, ECF 2nd - edema: fluid in interstitial 3rd - lg shift w/ inflammation, ascites, interstitial edema
ss of fluid shift from vascular to interstitial weak, rapid pulse, cold extremeties, hypotension, oliguria
tx for fluid shift from vascular to interstitial treat cause: inflammatory, autoimmune, loss of proteins, burns manage hypovolemia w/ colloids, diuretics/fluid restriction
Nursing tx for fluid shift from vascular to interstitial I/O, abd girth, neuro chks, balanced diet, wt
S/S fluid shift interstitial > vascular bounding pulse, crackles, incr BP, jugular vein distention
tx for fluid shift from interstitial > vascular treat case, manage hypervolemia w/ diurectics/fluid restriction, vasodilators
nursing tx for fluid shift from interstitial > vascular I/O, daily wts, neuro chk, balanced diet
Mvmt of fluid thru capillary walls depends on hydrostatic pressure and osmotic pressure
what is hydrostatic pressure pressure exerted on walls of blood vessels pushing(forced) fluid through to ECF. Solute move from higher concentration > lower
what is osmotic pressure, oncotic, colloidal osmotic pull water back into capillaries exerted by protein(albumin) in plasma. Low solute concentration > high
What is filtration mvmt of water, solutes from high hydrostatic pressure to low wtih semi-permeable membrane as a result of hydrostatic pressure
what is active transport NA-K pump moves fluid and solutes from lower concentration > higher against concentration gradient, need ATP
What are two types of diffusion simple, facilitated
what is simple diffusion mvmt of molecules from high > low, and must have permeable membrane, no energy
what is facilitated diffusion use specific carrier molecules to accelerate diffusion
what is osmolality/ osmolarity osmolality: amt of solutes in 1 L of fluid, incr osmo move to decr osmolarity: controlled by hypothal, regulates amt of fluid in each of 3 compartments
what is isotonic env solute and free water concentration are same inside/outside cell. water flow equal rate
what is hypertonic env solute conc is greater outside cell, free water greater inside, so free water flows out of cell, so shrinks
what is hypotonic env solute greater inside cell, free water greater outside, so water flows into cell, bursting
What is kept in balance with NA-K pump Na diffuses into cell, so pumped out of cell into ECF, K pumped into cell(ICF) w/ ATP
what are Average Daily I/O Intake Total:2100-2900 fluids(IV/PO)/1500-2000, Solids/900-1000, Oxidation/2-400... Out Tot: 21-2900 kidneys/15-2000, skin/6-700, GI/1-200, Lungs/4-500
hypovolemia triggers body to incr thirt, incr ADH(incr h2o by kidney), decr urine. renin release(vasoconstrict), incr aldosterone, decr urine
hypervolemia triggers body to incr ANP/BNP(decr RA system, aldosterone, ADH), incr GFR, incr urine
How does kidney's regulate F & E 1.selective retention/excretion fluids 2.reg electrolyte levels by ret/exr 3.reg pH by ret of H ions 4.exr waste/toxic sub (filter 170L/day plasma, exr 1500mls(1.2L)/day, respond to aldosterone/ADH
What does Kidney use to regulate F&E? Heart? Hypothalamus/post pituitary? Adrenal Cortex? Kidney: renin Heart: ANP/BNP Hypo: ADH Adrenal: Aldosterone
what are baroreceptors in left atrium(catotids), stimulate SNS: incr HR, contractility, circulating blood volume, constricts renal arterioles, incr aldo(hold h2o/na)
what are osmoreceptors on hypo and sense change in Na as incr..ADH released to kidney to hold h2o
How does ANP work incr blood volume, BP stretch atria and shuts off RA/ADH systems
how is renin angiotensin system released activated by decr blood to kidney, so renin by kidney, converts angiotensin in liver to I(mild vasoconstricotr), then in lung to II, which stimulate cortex to release aldo...incr BP, maintain blood volume
Aldosterone does what secreted by outer zone of adrenal cortex and incr Na/H2o retention, with K loss
What does cortisol do adn where in adrenal cortex, retains Na/fluid
What do parathyroid hormones do for homeostasis in thyroid gland, regulate Ca and PO balance by bone resorbtion, Ca absorption in intestines and renal tubules
how does pituitary gland help homeostasis hypothalamus reg ADH stored in post pituitary, which conserves H2O, maintain osmotic pressure of cells
How does Cushing's syndrome affect F&E? SIADH? DI? Cushing's: incr corticosteroids SIADH: incr ADH r/t brain/lung tumors(hold H2O) DI: decr ADH (can't hold h2o)
what are s/s of Diabetes insipedis polyuria, thirst, fatigue, dehydration
What diagnotics are for DI? urine specific gravity (<1.010), Na>145, incr BUN, serum osmolality
what are tx of DI? monitor urine output, fix fluid deficit w/ hypotonic(1/2NS), replace ADH
what r s/s of SIADH decr serum Na/osmal, oliguria(incr urine), vol overload, N/V/D, dyspnea, pulm edema, HA, altered LOC, seizures, muscle weakness/cramps
Tx for SIADH DC causative drugs, fluid restriction, 3%NaCl, seizure precautions
how to find MAP 22 x DBP + SBP/3
FVD- fluid volume deficit S/S restless, oliguria/conc. urine, postural hypo, rapid pulse, decr temp, cool, clammy skin, muscle weak, cramp
nursing tx for FVD I/O, skin/tongue turgor, daily wts, VS, urine specific gravity
severe FVD S/S tears absent, membranes dry, sunken eyes, tachy, slow cap refill, cool extremities, apathy somnolence
Serum electrolyte changes can be found where in the body hypokalemia(GI/renal losses) hyperkalemia(adrenal insuff) hyponatremia(incr thirst/ADH release) hypernatremia(insensible losses/DI)
S/S of FVE edema, bound PP, distend neck vv, crackles, tachy, S3, incr BP/PP/CVP/Wt/UO, SOB/wheeze, seizure w/ cranial press
tx for FVE restrict fluids/na, diruetics, dig, nitro, morphine, hemodialysis
Nsg tx for FVE I/O, daily wts, assess lung(acid/base bal), edema, restrict fluids/Na, semi fowlers, turn/cough/deep/breath
what are electrolytes chemical that carry cations+ and anion- electrical charges that move to lower conc and to opp charges
what is insensible loss snesible loss? continuous evap thru skin(600ml/day), lungs(300ml/day) sensible: sweating(0-1000), GI(1-200ml/day)
what is urine specific gravity measures kidneys' ability to excrete/conserve water. Compared to wt of distilled water...1.010-1.025, lgr vol of urine = lower sp. gravity
what is BUN made up or urea, by product of protein metabolism 10-20mg/dL incr: dehydration, incr prtotein, GI bleed, decr renal fx Decr: liver dis, low protein diet, starvation, preg
what is creatinine end product of muscle metabolism, better renal indicator 0.7-1.4mg/dL
what is hematocrit, Hct? vol. of RBCs males: 42%-52% female: 35%-47% incr: dehydration, polycythemia decr: overhydration, anemia
what organs are involved with homeostasis kidneys, lungs, heart, adrenal glands, parathyroid glands, pituitary gland
What leads to incr interstitial fluid Na retention, burns, infections, albumin <1.5, decr osmotic pressure
Sodium normal values 135-145mEq/L
what causes hyponatremia Na <135, imbalance of water rather than sodium b/c water follows sodium. As Na level decr, H2O pulled into cells
S/S hyponatremia HA, decr saliva, orthostatic fall in BP, N/V, abd cramps, alterer mental, coma, status epilepticus
Tx for hyponatremia Na by PO/nasogastric/parenteral, restrict H2O 800ml/24hrs, (if edema alone: Na restricted), (if edema and hyponatremia: H20/Na restrict)
what auses hypernatremia Na >145, caused by hypertonic enteral feedings, excess Na HCO3, hyperventilation, burns, DI, heat stroke, D, fever, incr BS
S/S of hypernatremia neurologic, restless, weakness, dehydration 3 types: hypovolemic, Euvolemic, hypervolemic
tx of hypernatremia hypotonic solution(0.3% NaCl), isotonic(D5W, replace h2o w/o na)
Potassium normal 3.5-5.0 mEq/L, regulated by kidneys by adjusting amt of K excr in urine. Aldosterone incr excr of K
what causes hypokalemia <3.5- reduce excitability of cell, so less responsive, alkalosis- temporary shift of K into cells, GI loss(V/D, GI suction), hyperaldosteronism, insulin hypersecretion, bulemia, mg loss, meds
S/S of hypokalemia death, fatigue, anorexia, N/V/D, muscle weakness, leg cramps, decr bowel motility, paresthesias, weak pulse, shallow resp, thirst, dysrhythmias. (hemolysis: false low)
EKG changes with hypokalemia flat T waves, elevate U wave
tx for hypokalemia incr dietary K(bananas,apricots,oranges,whole grain, milk,meat) /replacement (Aldactone), IV for severe deficit, monitor ECG/ABGs
what causes hyperkalemia >5.0mEq/L, cell more excitable, acidosis, retention of K, excess release of K(burns), excess IV/PO of K. Renal probs more at risk
S/S of hyperkalemia dysrythmias, muscle weak, paresthesias, anxiety, tachy then brady, hypotension, N/D(explosive)
EKG changes in hyperkalemia tall T waves
tx for hyperkalemia IV Ca gluconate, incr fluids, Na bicarb IV, K wasting diuretics, Kaexylate, low K diet, dialysis
Calcium 8.6-10.2mEq/L, most abundant ion, works with phosphorus for bones/teeth,
what causes hypocalcemia <8.6, Cushing's dis, metabolic alkalosis, meds, poor absorption in gut, vit D difficiency
S/S of hypocalcemia tetany, trousseaus sign(BP cuff), Chvostek's sign(tap cheek), dyspnea, D, prolong QT, hypotension, seizure,
tx for hypocalcemia Ca replacement, O2, High Ca, low phosphorus diet (gr leafy, milk, salmon, sardines), Vit. D, antacids, wt bearing,
Nsg tx for hypocalcemia Adm Ca, monitor cardiac rhythms, assess dig toxicity, trousseau's/Chvostek's sign, monitor incr bleeding, safety
what causes hypercalcemia >10.5, malignancy, hyperparathyroidism, immobility, metabolic acidosis
S/S of hypercalcemia anorexia, N/V, constipation, muscle weakness, abd/bone pain, polyuria, thirst, dysrhythmias, kidney stones
tx of hypercalcemia fluids, lasix, IV NS, phophates, calcitonin, biphosphonates
nsg tx of hypercalcemia encourage ambulation, fluids(3-4L/day) w/ Na, fiber
Magnesium 1.3-2.3 mg/dL
What does Mg do? important in neuromuscular fx, most abundant cation, bones have 60%, linked to albumin levels, influences Ca level thru PTH,
what are dietary sources of MG chocolate, dry beans/peas, nuts,
what causes hypomagnesium <1.5, alcoholism, DM, renal disease Also look for hypocalcemia
S/S of hypomagnesium Chevoskek's sign, Trousseau's sign
Memory Jogger for hypomag STARVED S-seizures T-tetany A-Anorexia/arrhythmias R-Rapid HR V-Vomiting E-emotional lability D-Deep tendon reflexes incr
Tx for hypomag adm mg sulfate slowly, no faster than 150mg/min
What is hypermagnesium >2.5, decr CNS: drowsy/lethargic,coma
S/S of hypermag RENAL(common cause renal failure) R-Reflexes decr E-Electrocardiogram changes, brady, hypotension N-N/V A-Appearance flushed L-Lethargy
Tx of hypermag IV or Ca gluconate in emergency
Phosphorus 2.5-4.5 mg/dL
What does Phosphorus do essential fx of cell membrane integrity, muscle/RBCs, formation of ATP, structure to bones/teeth.
Sources of dietary phosphorus Mainly from diet: dried beans, eggs, fish, dairy, organ meats(brain/liver)
Hypophosphetemia hyper <2.5, respiratory alkalosis causes, sugar high >4.5, chemotherapy causes
S/S of hypophosphetemia/hyper muscle weakness
Plasma pH 7.35-7.45
3 mechanisms to maintain pH chemical buffers: bicarbonate, phosphate, protein Lungs: regulate CO2 Kidneys: absorb/excrete acids or produce bicarbonate
Acids vs bases Acids: give up or donate H+, lower pH Bases: accept H+, higher pH
If incr acid decr pH, kidney absorb HCO3 and excrete H+/P/ammonia
If decr acid incr pH, kidney excrete HCO3
compensation means pH returns to normal
PaCO2 and pH move opposite, if paCO2 rises, pH falls
what is normal paCO2 normal paO2 normal SaO2 CO2: 35-45 O2: 80-100 SaO2: 95-100%
pH and HCO3(bicarbonate) incr/decr together
Quick look at ABGs 1.check pH 2.check paCO2 3.Check bicarbonate 4.Check for signs of compensation 5.Check PaO2/SaO2
How to figure anion gap gap bn two measurements, <14 is incr in one or more unmeasured anions in blood. Normal 8-12mEq/L
metabolic acidosis low pH, incr H+, low HCO3, low CO2, Compensation: hyperventilation lowering CO2(conserves HCO3) hyperkalemia, direct loss of bicarbonate in diarrhea
S/S metabolic acidosis HA, confusion, drowsy, incr resp/depth, N/V, vasodilation, decr CO, decr bp, clammy skin
Metabolic alkalosis high pH, high HCO3, high CO2, Compensation: hypoventilation with incr CO2 Vomiting, gastric suction, hypokalemia, hypocalcemia
S/S metabolic alkalosis tingling, dizzy
respiratory acidosis low pH/<7.35, high CO2 >45, high/normal HCO3 Compensation: incr HCO3
respiratory alkalosis high pH/>7.45, low CO2 <35, low/normal HCO3, hyperventilation Compensation: decr HCO3
Isotonic fluids total osmolality close to ECF, expander (3L to replace 1L blood loss) Ex: NS 0.9%, D5W, LR
What is NS 0.9% used for and not used for Na losses, burns NOT heart failure, Pulmonary edema, renal impairment, Na retention
Why is D5W not always isotonic Glucose burned up and become hypotonic entering cells. Not good kcal replacement
what does LR contain K, Ca, NA/Cl, used to correct dehydration, Na depletion, replace GI loss
hypotonic fluids replace cellular fluid, give free water for excretion of body wastes. Can lead to decr intravascular, decr BP, cell edema/damage ex: .45%NS
hypertonic fluids 5% dextrose, draw water from ICF to ECF. Again dextrose burns up and left with isotonic
which needle gauge is best for IV fluids? blood: IV:20-22 blood: 14-18
How often should IV be replaced q 3days
Infiltration is evidenced by edema @ insertion site, leakage, coolness, decr flow rate
Phlebitis is evidenced by inflammation of vein, reddened, warm, pain, tenderness, swelling
Thrombophlebitis is evidenced by local pain, red, warm, swelling TX: cold compress first followed by warm compress, elevate, restart in other arm
Created by: palmerag