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Fluid&Electolyts
Fluis and electrolytes in body
| Question | Answer |
|---|---|
| Primary function of H2O | Medium for transport Facilitate metabolism and celular functioning Maintain body temp (thru respirations) Tissue lubricant Body secretions |
| Solvent | Liquid that holds substances in solution |
| Solute | Substance that dissolves in solution for electrolytes |
| Fluid departments | Intracelular (IFC) Extra celular (ECF) |
| ICF | Fluid inside cell K+, Mg+, PO4- other electrolytes |
| ECF | Fluid outside cell Na+, Cl-, HCO3- |
| ECF (special) | Interstitial = Edema, fluid between body cells Intravascular = Main func transport blood (plasma) Transcellular = Cerebrospinal fluid, pleural fluid, peritoneal fluid, Synovial fluid, Digestive Fluid |
| Careful when administering meds that... | affect ICF |
| 40% of body weight is.. | ICF |
| 20% of body weight is.. | ECF |
| increase fat will decrease | fluids |
| Women have less..... and more..... | fluids, fat |
| Muscular man have | increase fluids due to increase muscle |
| I & O should be | EQUAL |
| LArgest compartment? | ICF |
| Osmosis | Primary mode of movement, H2O moves from less concentrated to higher concentrated area across cell membrane |
| Isotonic | Same make up , same ph. What's inside cell is equal to outside. |
| Hypertonic | Maintains balance w/in compartments. Fluid contains higher concentration than blood. H20 will move from cell to ECF (Cell shrinks) |
| Hypotonic | Fewer soluble concentration. Push fluid into cell from ECF (Cell expands) |
| Osmolarity | Measure of concentration of luid to push/pull from/to cell |
| Osmotic Potential | Ability to pull H2O into fluid compartment EX. Na+ holds to H2O |
| Diffusion | Intermingling of molecules. MOLECULES move from HIGH concentration to LOW concentration until both sides are equal |
| ATP | ENERGY is used to move MOLECULES from LOW concentration to HIGH concentration |
| Na+ & K+ Pump | Na+ concentrations is higher in ECF -> enters cell by diffusion -> Pulls K+ out from ICF |
| Filtration | Movement of H2O and PARTICLES from HIGH CONCENTRATION to LOW CONCENTRATION |
| Movement between vascular compartment and Interstitial fluid | Filtration |
| Hydrostatic pressure | Pushing force created by fluid w/in closed normal circulatory system |
| Increased pressure at... than... | arterial capillaries, venous system |
| Osmotic Pressure | Solution pulling force to draw H2O |
| Hydrostatic stronger than osmotic at... | Arteries |
| Osmotic stronger than hydrostatic at... | Veins |
| Normal intake in a day? Normal output in a day? | 2,500 ml in 1,500 ml out |
| Higher fat foods produce more | WATER |
| Protein makes less | WATER |
| Sentible output (measurable) | Urine, feces |
| Insentible Output | Skin, Lungs |
| Mayor regulation of blood in body? | KIDNEYS |
| Thirst | Primary regulator supported by hypothalamus |
| Kidneys | Main organ of excretion, output from kidneys is around 1,500 ml. 175 L of plasma daily |
| Hormones that regulate fluid balance | Antidiuretic hormone (ADH) Renin-Angiotensin System Aldosterone Thyroid Hormone Natriuretic Peptid |
| ADH | Causes kidney to retain fluid. Fluid decreases, BP decreases, More ADH is release Fluid increases, BP increases, Less ADH released |
| Renin-Angiotensin System | Fluid decreases -> Rening angiotensin system kicks in and hangs to Na+ and H2O -> Aldosterone is released -> Kidneys stimulate H2O and Na+ into cell and kick out K+ |
| Natriuretic Peptid | Atrial (ANP) Brain (BNP) C-Type (CNP) |
| ANP | Right Atrium, Most important indicator of heart failure |
| Fluid Volume Deficit (FVD) | Hypo, Hyper |
| Hypovolemia | Low fluid volume. Occur due to trauma, rupture Proportional loss of fluid/electrolyte from ECF |
| Dehydration | Negative fluid balance. Loss of fluid from ICF and ECF Insufficient intake of fluids Excessive fluid loss EX. bleeding, vomiting, diarrhea Fluids shift (Leaking into body tissues) |
| Sources of fluid loss | Diarrhea/Vomiting, Draining wounds, NG suctioning, Paracentesis/Thoraceentesis, Infection, fever, Diuretics Extensive burns |
| Fluid Loss Assessment | Heart Rate ↑, BP↑, Rapid weak pulses, Skin and mucous membranes ↓, ↓ Skin Turgor, Urine output ↓, Neck veins flat, Muscle Weakness, Temp ↑, HCT lab ↑, SP gravity ↑ |
| At risk for Fluid Loss | Older Adults Infants (cant tell you) Toddlers (rather play) Pt's w Diabetes, vomiting, diarrhea |
| Fluid Volume Excess (FVE) | Hypervolemia |
| Hypervolemia | Excess of blood volume Retention of Na+ and H2O Excessive salt intake Disease of liver, kidney, heart <-(Can't bring fluid back from lower body) ↑ Osmotic pressure and ECF (Fluid from cell to ECF) |
| Dependent Edema | Heart not strong enough to pull fluids back from lower body May be up 5-10 lbs weight gain Relieve by elevation |
| Pitting Edema | Pit or depression after finger pressure |
| Fluid Excess Assessment | BP ↑, Pulse strong bounding, Respirations shallow and ↑, Neck veins distended, Skin pale/cool, Urine output ↑/dilute, Weight ↑ (If severe crackles in lungs). BUN ↓, HCT ↓, SP gravity ↓ |
| Acitasis | Build up fluid in peritoneum |
| IONS | Atom or molecule carrying an electric charge |
| ELECTROLYTE | Substance capable of braking into electrically charged ions hen dissolved in solution |
| CATION | + charge ion (NA, K, Mg, Ca) |
| ANION | - charge ion (CL, PO4, HCO3) |
| Functions of electrolytes | Regulate water distribution Transmit nerve impulses Clotting blood Regulate Acid Base balances |
| Na+ | Major cation in ECF Normal 135-145 |
| Na+ Function | Regulate fluid Volume Helps maintain blood volume Interacts with Ca+ and maintain muscle contraction Stimulates conduction of nerve impulses |
| Na+ Regulation | Moves by ATP Regulated by ADH and aldosterone Reabsorbed and excreted by Kidneys Minimal loss thru feces and perspiration ↓ Na+ = ↑ H2O intake |
| Na+ Source | Salt, Soy sauce, Pork, Cheese, Milk, Canned Products |
| Hyponatremia | ↓ Na+ levels <135 Due to: Diuretics, Adrenal insufficiency, Excessive intake of hypotonic solutions |
| Hyponatremia Sx | Lethargy, Confusion, Muscle cramps, Seizures, Anorexia, Vomiting |
| Hyponatremia Tx | Monitor I & O, Monitor Na+ levels, ↑ Na+intake, seizure precautions if severe. |
| Hypernatremia | ↑ Na+ levels >145 Due to: Excesive Na+ intake, H2O deprivation, ↑ H2O loss, Diabetes |
| Hypernatremia Sx | Thirst, ↑ temp, hallucinations, irritability, lethargy, seizures |
| Hypernatremia Tx | Monitor I&O, VS, ↓ Na+ intake, Watch for hidden Na+, IV solutions that dont contain Na+ |
| K+ | Major Cation in ICF Normal 3.5-5 |
| K+ Function | Maintain ICF osmolality Regulate conduction of cardiac rhythm Transmit electrical impulses in multiple body systems Assists with acid-base balance |
| K+ Regulations | Regulated by aldosterone Excreted n conserve thru kidneys Loss thru vomiting and diarrhea Loss triggered by many diuretics (↓ Ka+ = ↑ Urine output) |
| K+ sources | Bananas, green lefty veggies, Oranges, Apricots, figs, carrots, potatoes, tomatoes, Dairy products, meats |
| Hypokalemia | Low K+ <3.5 Due to: Steroid administrations, Hyperaldosteronism, anorexia/bulimia |
| Hypokalemia Sx | Fatigue, Muscle weakness, Disrhythmias, ECG changes, sensitive to digitalis |
| Hypokalemia Tx | Monitor I&O, K+ levels, pulse if on Digoxin, K+ supplement pills |
| Hyperkalemia | ↑ K+ levels > 5.0 Due to: inability to excrete K+, Renal failure, K+ sparing siuretics, Hypoaldosteronism, High K+ intake with renal insufficiency, acidosis, major trauma |
| Hyperkalemia Sx | Muscle weakness, dysrhythmias, ECG changes |
| Hyperkalemia Tx | Monitor I&O and K+ levels |
| Ca+ | Most abundant electrolyte in body Normal 8.9-10.1 |
| Ca+ Function | Promotes transmision of nerve impulses Major componennt of bone n teeth Regulates muscle contractions (with Na+) Maintain Cardiac automaticity Essential factor in the formation of blood clots Catalyst for many cellular activities |
| Ca+ Regulations | combines with PO4- to form mineral salts of teeth and bones Na+ and PO4- levels inversely proportional PTH stimulates release of Ca+ from bones and reabsorption from kidneys and intestines Absortion stimulated by VIT D |
| Calcitonin | Blocks bone breakdown and lower calcium levels |
| Ca+ Source | Milk, cheeses, Dark green veggies, Salmon, Breads, Cereals |
| Hypocalcemia | ↓ Na+ levels <8.9 due to: Hypoparathyroidism, Pancreatitis, Alakalosis |
| Hypocalcemia Sx | Numbness/tingling of extremities, tetany, Cardia irritability, Trousseau's and Chvostek's |
| Trousseaus | Hand/finger twitching when BP cuff inflated |
| Chvostek's | Twitching of mouth or nose when cheek is tapped |
| Hypocalcemia Tx | Encourage ↑ of Ca+, administer Ca+ supplements, Airway, Seizure and safety precautions |
| Hypercalcemia Sx | Muscle weakness, constipation, Kidney stones, Bizarre behavior, bradycardia |
| Hypercalcemia | ↑ Na+ Levels > 10.5 Due to: Hyperparathyroidism, malignant bone disease, prolonged immobilization, thiazide diuretics, Excessive intake |
| Hypercalcemia Tx | Encourage fluid intake to prevent stone formations. Fiber intake to prevent constipation, Limit Ca+ intake |
| Mg+ | Present in skeleton and ICF Second most abundant in ICF Normal 1.5 -2.5 |
| Mg+ Function | Protein and carbohydrate metabolism Necessary for protein and DNA synthesis w/in the cell Maintain normal Intracellular levels of K+ Involved in electrical activity in nerve and muscle. Including heart Influence release n activity of insulin |
| Mg+ Regulation | Ingested in the diet and absorbed thru small intestines Excreted by kidneys Loss due to diuretics, poorly controlled diabetes and excessive alcohol intake |
| Mg+ Source | Green veggies, Cereal, Grains, Nuts |
| Hypomagnesemia | ↓ Mg+, <1.5 Due to: Chronic alcoholism, prolonged gastric suction, diabetes |
| Hypomagnesemia Sx | Neuromuscular irritability, disorientation, disrhythmias, |
| Hypomagnesemia Tx | Avoid alcohol intake, encourage ↑ food with Mg+ |
| Hypermagnesemia | Too high Mg+ > 2.5 Due to: Renal failure, adrenal insufficiency, excess replacement |
| Hypermagnesemia Sx | Flushing and warmth of skin, hypotension, lethargy, hypoactive reflexes, depressed respirations, bradycardia |
| Hypermagnesemia Tx | Monitor VS, airway, reflexes, avoid Mg+ supplements and food rich in Mg+ |
| PO4- | Major anion in ICF Normal 2.5-4.5 |
| PO4- Function | Serves as catalyst for many intracellular activities Promotes muscle and nerve action Assists with Acid bace balance |
| PO4- Regulation | combines with Ca+ to form mineral salts for teeth and bones Ca+ and PO4- levels inversely proportional Regulated by PTH, inverse respond to Ca+ Excreted and reabsorbed by Kidneys |
| PO4- source | Meat, Fish, Poultry, Milk products, Carbonated Beverages, Legumes |
| Hypophosphatemia | ↓ PO4- Levels < 2.5 Due to: refeeding after starvation, alcohol withdrawal, diabetic ketoacidosis, respiratori acidosis |
| Hypophosphatemia Sx | Joint Stiffness, Seizures, impaired tissue oxygenation |
| Hypophosphatemia Tx | Monito PO4- levels, calcium levels |
| Hyperphosphatemia | ↑ levels of PO4- >4.5 Due to: Renal Failure, Hyperthyroidism, Phosphate based laxatives |
| Hyperphosphatemia Sx | Tetany Sx, tingling of extremities and craping, calcification of soft tissue |
| Hyperphosphatemia Tx | Monitor PO4- levels, monitor for tetany, administer milk of magnesia with meals to bind to PO4- |
| Cl- | Major anion in ECF Normal 96-106 |
| Cl- Function | Works with Na+ to maintain osmotic pressure between fluid compartments Essential for production for HCL for gastric secretions Functions as buffer in O2-carbon dioxide exchange in RBCs Assist with acid base balance |
| Cl- Regulation | Reabsorbed and excreted through kidneys along w Na+ Regulated by Aldosterone and ADH Deficit will lead to K+ deficit and vise versa |
| Cl- Source | Foods high in Na+ Cheese Processed foods Meats Seafood |
| HCO3- | Major buffer in both ICF and ECF Normal 22-28 |
| HCO3- Function | Maintain acid base balance by functioning as the primary buffer in body |
| HCO3- Regulation | Loss thru diarrhea, diuretics, renal insufficiency Excess possible if person ingests quantities of acid neutralizers |
| HCO3- Sources | Acid neutralizers (Sodium bicarbonate) |
| Acid | A substance that donates hydrogen ions Ph 1-6.9 |
| Base | A substance that accepts hydrogen ions Ph 7.1 - 14 |
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