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Fluids & Electrolytes Saunders NCLEX-RN #4

Intravascular Compartment fluid inside a blood vessel
Intracellular Compartment Fluid inside the cell (most body fluids)
Hypotonic Solution contains lower concentration of salt or solute than another solution
Hypertonic Solution contains higher concentration of solutes than another solution
Osmotic Pressure solutions on each side of a selectively permeable membrane want to balance tonicity - not volume
Insensible Loss water lost through the skin & lungs - about 400 mL/day - average by sweating 100 mL/day - average by lungs 350 mL/day
GI water loss In feces 150 mL/day - diarrhea increases loss
Fluid Volume Deficit Isotonic dehydration Hypovolemia- Water and dissolved electrolytes are lost in equal proportions Most common type of dehydration results in decreased circulating blood volume and inadequate tissue perfusion
Fluid Volume Deficit Hypertonic dehydration Water loss > Electrolyte loss fluid moves from intracellular compartment into plasma and interstitial fluid spaces = cell dehydration and shrinkage. Assessment: hyperactive deep tendon reflexes, pitting edema
Fluid Volume Deficit Hypotonic dehydration Electrolyte loss > water loss Decrease in plasma volume fluid from plasma and IF into cell = cells swell and plasma volume deficit. Assessment: skeletal muscle weakness
Fluid Volume Deficit Lab Findings Increased serum osmolality Increased hematocrit Increased BUN Increased serum sodium level
Fluid Volume Excess Overhydration / Fluid Overload
Fluid Volume Excess Isotonic Overhydration Hypervolemia - excessive fluid in the extracellular fluid compartment. Causes circulatory overload and interstitial edema - in pt with poor cardiac function, CHF and pulmonary edema can result. Causes: poorly controlled IV therapy, RF, LT corticosteroids
Fluid Volume Excess Lab Findings Decreased serum osmolality Decreased hematocrit Decreased BUN Decreased serum sodium Decreased urine specific gravity
Sodium 135 - 145 mEq/L
Hyponatremia & Causes < 135 mEq/L - excessive diaphoresis, diuretics, vomiting, diarrhea, wound drainage esp GI, renal disease, decreased secretion of aldosterone, NPO, hyupotonic fluid ingestions, RF, freshwater drowning, SIADH, hyperglycemia, CHF
Hypernatremia & Causes >145 mEq/L - corticosteroids, Chushing's syndrome, RF, hyperaldosteronism, increase in sodium, decrease water intake, increased water loss
Potassium 3.5 - 5.0 mEq/L
Hypokalemia & Causes < 3.5 diuretics or corticosteroids, increased secretion of aldosterone, vomiting, diarrhea, wound drainage esp GI, long NG suction, excessive diaphoresis, renal disease impairing K+ reabsorption, inadequate intake (NPO), alkalosis, hyperinsulinism
Hyperkalemia & Causes > 5.1 excess K+ intake, K+ sparing diuretics, rapid infusion of K+, K+ movement from intra to extracellular,
Calcium 8.6 - 10.0 mg/dL
Hypocalcemia & Causes < 8.6 low intake, lactose intolerance, malabsorption syndromes, low vit D intake, ESRD, RF, diarrhea, steatorrhea, wound drainage esp GI, hyperproteinemia, alkalosis, CA chelator or binder meds, acute pancreatitis, hyperphosphatemia, immobility
Hypercalcemia & Causes > 10.0 inc intake, inc vit D intake, RF, thiazide diuretics, hyperparathyroidism, hyperthyroidism, malignancy, immobility, glucocorticoids, dehydration, lithium use, adrenal insufficiency
Magnesium 1.6 - 2.6 mg/dL
Hypomagnesemia & Causes < 1.6 malnutrition and starvation, vomiting or diarrhea, malabsorption syndrome, Celiac disease, Crohn's disease, diuretics, chronic alcoholism, hyperglycemia, insulin amdin, sepsis
Hypermagnesemia & Causes > 2.6 mag-containing antacids an laxatives, excess IV admin, renal insufficiency / excretion
Phosphorus 2.7 - 4.5 mg/dL Phosphorus and Calcium are opposites
Hypophosphatemia & Causes < 2.7 (hypercalcemia) - insufficient intake, malnutrition and starvation, increased excretionhyperparathyroidism, malignancy, antacids mag-based or aluminum hydroxide-based, hyperglycemia, resp alkalosis
Hyperphosphatemia & Causes > 4.5 (hypocalcemia) - decreased renal excretion (RI), Tumor lysis syndrome, inc intake, laxative and enemas containing phosphate, hypoparathyroidism
Created by: dstrobel1230