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Nutrition&Fluids for Test 1 IUPUI S353

Dehydration means (H2O, Na) Loss of water NOT sodium
Fluid volume deficit means (H2O, Na) Loss of water AND sodium
What IV fluid should you use for rapid volume replacement? 0.9% NaCl
ECF fluid volume deficit = Hypovolemia
What is the primary use of hypertonic solutions? TPN (total parenteral nutrition)
Administration of an isotonic fluid expands: ECF only
When can enteral feedings be started? When bowel sounds are present, usually 24 hrs after placemens
Assessments before enteral feeding Abdomen soft, non-distended, when was last BM
Enteral feeding position HOB 30-45 degrees, upright 30-60 minutes after feeding
When do you irrigate enteral feeding tube? Before/after feeding, medications, residual check
Assessments for enteral nutrition Daily weight (very important, same scale, same time AM) Bowel sounds before feeding I&O Glucose Change tubing every 24 hrs
Complications of enteral nutrition Vomiting, diarrhea, constipation, dehydration (especially high protein content)
Gerontologic considerations of enteral nutrition Fluid/electrolyte imbalance Glucose intolerance Increase risk of aspiration Decreased ability to handle large volumes
How much of body fluid is ICF? 2/3
Which fluid space is least stable? Vascular space (part of ECF)
Which fluid space is the fluid reserve? Interstitial (part of ECF)
Movement from high solute concentration to low solute concentration Diffusion
Example of active transport Na-K ATP pump
Movement of water from area of low concentration to high concentration Osmosis
Osmolarity measures: Osmotic force of solute per unit of total volume
Osmolality describes: Fluids inside body
Osmolarity describes: Fluids outside the body
Oncotic pressure deals with: Colloidal osmotic pressure (proteins)
What does a hypertonic IV solution do to cells? Sucks water out of them, into the vascular space
Name the two major solutes in plasma. Na and protein
Define osmotic pressure Amount of pressure required to stop the osmotic flow of water
What is filtration? Movement of fluid through a cell or blood vessel
What is hydrostatic pressure? The force within a fluid compartment
Define homeostasis State of equilibrium in the body
Water content of adult in % 50-60%
Water content of older adult in % 45-55%
Water content of infant in % 70-80%
Intravascular fluid is: ECF within the blood vessels
Interstitial fluid is: ECF fluid between the cells
Transcellular fluid is: ECF fluid in specialized cavities
First space fluid is: Normal, fluid is where it should be
Second space fluid is: Abnormal accumulation of interstitial fluid, edema
Third space fluid is: Abnormal accumulation of fluid in part of body where it is not easily exchanged with ECF (ascites)
Hypovolemia symptoms ↑ HR, ↑ RR, ↓ BP
Hypovolemia labs: ↑ most labs, due to concentration from fluid loss
What is the most accurate assessment for hypovolemia? Daily weight
Hypervolemia symptoms Moist crackles, ↑HR, ↑RR, ↑BP
Hypervolemia labs: Decreased values (dilutional effect)
Hypotonic IV fluids move water from: from ECF to ICF
Isotonic IV fluids move water from: Nowhere. Isotonic fluids expand only the ECF.
Hypertonic IV fluids require frequent monitoring of : BP, lung sounds, Na
Dextrose 5% in water is used to: Move fluid to ICF, increase renal excretion of solutes,
what is the preferred fluid for immediate response? 0.9% Na or NS
What tonicity is Lactated Ringers? Isotonic
Lactated Ringers contains which electrolytes? NaCl, K, Ca, Phosphate
What tonicity is D5 1/2NS? Hypertonic
Functions of Na Maintains BP, balances volume of water in body, transmits nerve impulses for muscle contraction
Symptoms of hypernatremia caused by sodium gain Seizures, thirst, flushed skin, peripheral and pulmonary edema
Symptoms of hypernatremia caused by water loss Seizures, thirst, weight loss, postural hypotension, weakness
Functions of potassium Controls cardiac rate and rhythm, excitability of nerves and muscles, regulates glucose storage
Trauma can cause: Hyperkalemia (cells are crushed and release potassium into ECF)
Hyperkalemia symptoms Irregular pulse, cardiac arrest (cardiac changes), lower extremity muscle weakness, paresthesia
Insulin helps which electrolyte imbalance? Hyperkalemia
How does insulin help hyperkalemia? Moves potassium from ECF to ICF
Frequent cause of hypokalemia is: Use of diuretics
Hypokalemia symptoms Cardiac changes, muscle weakness, polyuria, hypoglycemia
What is rate of administration of KCl? 10-20 mEq/L over an hour, never IV push
Foods high in potassium Bananas, bacon, potatoes, peas, lima beans, fruit juices, pecans
How should you administer liquid K+ supplement? Dilute in juice to conceal bad taste
Only give potassium if: kidneys are functioning
Functions of calcium Maintains muscle tone, cardiac contractility (blood pressure), nerve transmission and contraction of skeletal and cardiac muscle
Most common cause of hypocalcemia Prolonged immobilization
Hypercalcemia symptoms Weakness, depressed reflexes, hypertension, confusion, kidney stones (nephrolithiasis), cardiac changes
Hypercalcemia treatment Calcitonin (promotes renal excretion of calcium); 0.9% Na IV fluid followed by loop diuretic (Na follows Ca)
Hypocalcemia symptoms Tetany, Chvostek's & Trousseau's sign, hyper-reflexes, tingling lips and tongue, cardiac changes
Functions of phosphate Muscle contraction, calcium homeostasis, proper function of red blood cells
Hyperphosphatemia symptoms muscle problems (tetany, twitching), bone and joint pain, cardiac problems, deposits of calcium phosphate in soft tissues
which electrolyte moves with phosphate? Calcium
What is a common cause of hypophosphatemia? Alcohol withdrawal
Hypophosphatemia symptoms Cardiac dysrhythmias, CNS dysfunction, respiratory muscle weakness, slurred speech, confusion
Functions of magnesium Muscular irritability and contractions, vasodilation, strong bones, transporter for Na and K across cellular membranes
Hypermagnesemia symptoms Loss of deep tendon reflexes, bradypnea, bradycardia, hypotension, decreased level of consciousness
Treatment for hypermagnesemia Calcium gluconate
What electrolyte imbalance are pts who undergo bariatric surgery susceptible to? Hypomagnesemia
Hypomagnesemia symptoms Hyper active deep tendon reflexes, tremors, seizures, dysrhythmias
Which electrolyte imbalance may develop with hypomagnesemia? Hypocalcemia
Cause of pitting edema Fluid volume excess
Cause of flushed, dry skin Na excess
Cause of cold, clammy skin Na deficit, shift of plasma to interstitial fluid
Cause of poor skin turgor Fluid volume deficit
Cause of bounding pulse Fluid volume excess, shift of interstitial fluid to plasma
Cause of rapid, weak, thready pulse Na deficit, fluid volume deficit, shift of plasma to interstitial fluid
Cause of weak, irregular, rapid pulse Severe K deficit
Cause of weak, irregular, slow pulse Severe K excess
Cause of hypotension fluid volume deficit, Na deficit, shift of plasma to interstitial fluid
Cause of hypertension Fluid volume excess, shift of interstitial fluid to plasma
Cause of shortness of breath Fluid volume excess
Cause of moist crackles fluid volume excess, shift of interstitial fluid to plasma
Cause of restricted airway Ca deficit
Cause of cramping of exercised muscle Ca deficit, Mg deficit
Cause of flabby muscles K deficit
Cause of picking at bedclothes K deficit, Mg deficit
Cause of indifference Fluid volume deficit, Na deficit
Cause of apprehension Shift of plasma to interstitial fluid
Cause of extreme restlessness K excess, Na excess, fluid volume deficit
Cause of confusion and irritability K deficit, Na deficit, Ca excess, Mg excess, H20 excess
Cause of decreased LOC Na deficit, H2O excess
Created by: bjperkin