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AD 155

Fluid & Electrolytes

Intracellular inside the cell
Intracellular purpose provides cells with nurtrients & assist in cellular metabolism
Extracellular outside the cell. circulates between the cells. contain water, electrolytes, & nutrients
Extracellular made up of 2 compartment intravascular & interstitial
Intravascular in the bloodstream. arteries, vein, capillaries and contain plasma
interstitial located in the spaces between most of the cells in the body
Third spacing shift of fluid from intravascular space into a "third" or extra space. (serve no purpose)
regulation of fluid balances thirst, kidneys, Renin-Angiotensin-Aldosterone System, Antidiuretic hormone, Atrial Natriuretic Peptide
Thirst in the hypothalamus.
Thirst stimulated by dry mucous membranes in the mouth, drop in blood volume, increase in serum osmolality
serum osmolality lab test. measures amount of solut in the blood.
Kidneys regulate excretion and retention of water and electrolytes
Adult produce 1500-2500 in 24 hours
Renin-Angiotensin-Aldosterone system works to maintain intravascular fluid balance and blood pressure
RAAS produce in_____ & _______ kidneys and lungs
RAAS regulates______ _____, stimulates the kidneys to retain______ & ______ blood pressure, sodium, water
ADH produced in brain ( ____ ) and stored in __ hypothalamus, pituitary
ADH is triggered by________ in response to ___ ______ ______ or increassed______ _______. hypothalamus, low blood volume, serum osmolality
ADH stimulates water reabsorption in the kidneys
Atrial Natriuretic peptide secreted by cells lining the atria in the heart as a rsponse to overdistention
when atria stretched too far (pt in _____ _____ ) the ANP is stimulated causing an increased in _____ _____ fluid overload, urine output
fluid volume deficit that is a decrease in intravascular, intersitial and/ or intracellular body fluid Dehydration
Decreased circulating blood volum and isotonic fluid loss from extracellular spaces Hypovelemia
Etiology of dehydration excessive fluid loss, insufficentt fluid intake, fluid shifts, failure of regulatory mechanism
Examples of excessive fluid loss diarrhea, vomiting, sweating, blood loss, fever, insensible loss (breathing) over use of laxatives, use of diuretics, NG tube
Example of insufficient fluid intake disable, bedridden, depend on others (infants & elderly), vent dependent, unresponsive(comatose), NPO
Example of fluid shifts burns, edema from injury, wounds, ascites, plueral effusion
Dehydration clincial manifestation neurologic altered mental status (irritability, anxiety, restlessness, confusion), decreased alertness, coma
Dehydration clinical manifestation: mucous membrane dry sticky tongue, decreased tongue size, longitudinal furrows (cracks)
Dehydration clinical manifestation: skin diminished skin turgor (elderly,assess on forehead or sternum, not hand or arm), dry skin(not a good indicator in elderly), sunken eyeballs(hard to assess)
Dehydration clinical manifestation: urinary decreased urine output (oliguria), increased specific gravity
Dehydration clinical manifestation: cardiovascular decrease B/P, orthostatic hypotension, tachycardia, flat neck veins, decrease pulse volume, decrease capillary refill time, incrase hematocrit
Hemoglobin:Hematocrit normal ratio is 1:3
minimum urine output standard 0.5ml/kg body wt/hr (new standard)
Dehydration clinical manifestation: musculoskeletal fatigue, weakness
Dehydration clinical manifestation: metabolic processes increased or decreased body temp, thirst, weight loss
Dehydration: collaborative Management assessment of clinical manifestations, vital signs esp B/P, intake and output,*daily weight*
Dehydration laboratory assessment:hemoconcentration increase HCT:4:1 rtio...12gm HGB/48%HCT, normal HGB/HCT ratio=3:1..12gm Hgb/36%Hct.
Dehydration laboratory assessment: increased serum osmolality (>300mOsm/Kg) glucose,protein, BUN, and NA
urine: especially ____ ____> ____ specific gravity, 1.030
Dehydration collaborative management: fluid replacement: oral rehydration contains____,____,_____,medication treat_____ ____, intravenous therapy electrolyte, gatorade, pedialytes & underlying cause
Dehydration: fluid replacement (intravenous therapy) fluid challenge:administer a specified amt of fluid over a short time and monitor closely
what does a continous IV needs to include? A doctor order include slolution, rate, and additives(potassium)
what IV solution to give if Na is high D5W, give slowly over 48 hours, cause cell to swell
what IV solution to give if Na is not elevated? NS, isotonic fluids can be given more rapidly
solutions with small molecules that flow easily from the bloodstream into cells and tissues crystalloids
Types of crystalloids Isotonic solutions,Hypotonic solutions, hypertonic solutions
any solution with a solute concentration equal to the osmolarity of normal body fluids Isotonic solutions
Types of isotonic solutions 0.9% sodium chloride(NS) most common one, Lactated Ringers.
Isotonic solution: lactaed Ringers contains sodium, potassium, chloride and calcium concentrations similar to plasma levels
any solution with a solute concentration less than that of normal body fluids. Draws water into the cells from the extracellular fluid called? hypotonic solutions
Types of hypotonic solution 0.45% sodium Chloride (1/2NS), and 5% Dextrose in water (D5W)
any solution with a solute concentration greater than that of normal body fluid, draws fluid from intracellular space Hypertonic solutions
Types of hypertonic solutions 5%Dextrose &0.9%Sodium chloride (D5NS) and 5% Dextrose in Water (D10W) very concentrated
crystalloids are use to replace volume and hydrate
Plasma expanders colloids
Function of colloids pull fluid into the bloodstream, large molecule can't link out of blood stream. use in aggressive fluid replacement (i.e burns)
Examples of colloids Albumin, Dextran, hetastarch(Hespan)
Any route outside of GI system parental
highly concentrated, hypertonic nutrient solution administered through a large, central vein TPN ( total parenteral nutrition)
Like TPN except maximum of 10% Dextrose in peripheral vein. Peripheral parenteral nutrition
TPN triggers debilitating illness greater than 2 weeks, loss of 10% or more of pre-illness weight, excessive nitrogen loss, nonfunction of GI tract lasting 5-7 days
complications of TPN: ______ _____ , fluid shifts between ____ compartment,_____ leading to diuresis & _____, always a risk for ____ ____ &_____ _____ fluid imbalances, body, hyperglycemia &dehydration, fluid overload , pulmonary edema
used for short-term or intermittent therapy; usually use veins in arm or hand; a short,plastic, flexible catheter is inserted into the vein( needle portion is removed) peripheral lines
placed in a central vein such as subclavian or internal jugular; can be single or have multiple lumen( can hook up to three fluids to it); sits right above the right atria central venous catheter
intermediate-term therapy; long catheter (less chance of infection); commonly used in hospital& homecare.Nse needs to be certified in inserting or done in interventional radiology peripherally inserted central cathether
long-term therapy such as chemotherapy;a port is implanted under the sub q skin; access port with a 90 degree bent needle(huber) vascular access port
long-term therapy for nutrition or antibiotic therapy; tunnel external catheter; still a central line, but tunnels into abdomen area for easy access for pt Hickman, Broviac, Groshong
possible complication of IV Therapy:Local infiltration, phleblitis & thrombophleblitis, infection, hematoma and extravasation
fluid leaks from the catheter into the surrounding tissue infiltration
sign & symptoms of infiltration cool at site, pain, swelling, leaking, lack of blood return(not always reliable)
inflammation of the vein is called_____ and inflammation cause by a blood clot is called___ phlebitis, thrombophlebitis
sign and symptoms of phlebitis & thrombophlebitis) pain(pt states it tender), redness, red streak, sluggish flow, vein hard & cordlike(classic sx)
bacterial contamination at the site infection
symptoms of infection tenderness, redness, warmth, drainage
leaking of blood into surrounding tissue, usually occurs durig insertion or in pt with clotting disorder hematoma
symptom of hematoma bruising, pain
infiltration of a vesicant drugh extravasation
symptoms of extravasation pain, swelling, burning, blistering, possible necrosis, possible disfigurement
Intervention for extravasation stop infusion, follow agency protocol, aspirate any remaining drug from catheter,administer antidot per catheter or inject into subq tissue, disconnect tubing, elevate arm, apply ice, call dr.
possible complication of IV therapy: systemic bloodstream infection,allergic reaction, speed shock, fluid overload
pathogens enter the bloodstream resulting from poor aseptic technique bloodstream infection
symptom of bloodstream infection fever
Too much fluid leaking into alveoli fluid overload
symptom of fluid overload increased BP, increased respiration, SOB, crackles
Too rapid infusion of fluid & especially meds speed shock
symptoms of speed shock facial flushing, dizziness, irregular pulse, severe headache, decreased BP, loss of consciousness, arrest cardiac
local or general reaction to tape, cleansing agent, latex catheter, solution or medication allergic reaction
symptoms of allergic reaction itching, wheezing, bronchospasm, rash
Fluid overload: Etiology excess of isotonic fluid in the extracellular compartment, retention of both water and sodium, fluid shift from interstitial to intravascular space(remobilization of fluids after surgery or burn treatment, administration of hypertonic fluids or albumin
Clinical manifestations: fluid overload;____ ___,full___ pulse, pitting____,____edema, distended___ ___, tachycardia&/or____ SOB, crackles & /or____ weight gain,pounding, edema, periorbital,neck vein, dyspnea, cough
collaborative Management of Fluid overload fluid restriction(I&O), sodium restriction(limit amt of sodium), Diuretics
Physiologic action of diuretics blocking of sodium and chloride reabsorption in the kidney,
drugs whose action is earliest in the nephron produce the greatest diuresis PCT, Loop of henle
drugs whose action occurs in the distal parts of the nephron produce less diuresis: DCT
adverse effects of diuretics dehydration, acid-base imbalance, electrolytes imbalance esp potassium
High-Ceiling (Loop) Diuretics Lasix(Furosemide), Edecrin(ethacrynic acid),Bumex(bumetanide) IV & PO, demadex(torsemide)
Lasix(furosemide) action acts in loop of henle to block reabsorption of sodium and chloride,prevents passive reabsorption of water as a result diuresis
Lasix: pharmacokinetics oral: diuresis begins in 60min & lasts for 8hrs, IV: diuresis begins in 5min &lasts for 2 hrs.
Lasix: therapeutic uses pulmonary edema, edema, HTN, severe renal impaiment
Lasix: adverse effects dehydration, hypokalemia, hypotension decrease in blood volume, ototoxicity, hyperglycemia,hyperuricemia
Lasix: Drugs interactions digoxin:lasix,hypokalemia, digoxin=dig toxicity,potassium-sparing diuretic hold on to potassium, antihypertensive low blood pressure give lasix= lower blood pressure
Lasix Implications timing of doses: give in a.m. B.I.D give in a.m. and 2:00p.m. to minimize nocturia,IV push administration, give IV push slowly 20mg,min, Patient teaching, weigh daily, watch excessive wt. gain/loss
Example of Thiazide and related diuretics Esidrix,Oretic, Hydrodiuril (hydrochlothiaide), Diuril, Diurigen(Chlorothiazide),Zaroxolyn, Mykrox(metaolazone)
enhances the effect of Lasix, give 30 minutes before lasix Zaroxolyn(metolazone)
Thiazide: action promotes urine production by blocking reabsorption of sodium and chloride in the early segment of the distal convoluted tubule. less diuresis
Thiazide: therapeutic uses essential hypertension, 1st drug of choice for HTN, edema mild to moderate
Thiazide: adverse effect dehydration, hypokalemia, hyperglycemia, hyperuricemia
Thiazide: Drugs interaction Digioxin, digoxin+thiazide+low potassium = dig toxic, potassium-sparing diuretics hold on to potassium, antihypertensive= lower blood pressure
Thiazide: implication give in a.m. B.I.D give in a.m. and 2:00p.m. to minimize nocturia, IV push administration give slowly 20mg/min, patient teaching, weigh daily, watch excessive wt. gain/loss
Potassium-sparing diuretics aldactone(spironolactone), Dyrenium (triamterene)-Dyazide & Maxzide are combinations with HCTZ, Midamor (amiloride)
potassium-sparing diuretics two useful responses: increase urine output, decrease potassium loss
Potassium-sparing drugs ___used alone, used with other ____ rarely, diuretics
Aldactone (spironolactone) action retention of potassium, excretion of sodium, scant diuresis, effects take up to 48 hours to develop
Aldactone(spironolactone) therapeutic uses HTN, edema especially CHF pt, commonly used with loop or thiazide diuretic to counteract potassium wasting
Thiazide: adverse effects hyperkalemia
Thiazide: nursing implications limited potassium rich foods
Osmotic Diuretics mannitol
Mannitol(osmotic diuretics) action osmotic force within the nephron that prohibits reabsorption of water.The greater the concentration=greater diuresis
Mannitol: pharmacokinetics IV only
Mannitol: therapeutic uses prophylaxis of renal failure, reduction of intracranial pressure-most frequent use to pull fluid out of brain tissue
mannitol: adverse effects edema can leave capillary beds anywhere except in the brain
mannitol: administration concentrations of 5% to 25%(more diuresis) can crystallize at low temperature, warm to dissolve crystals and cool to body tempeerature, in line filter d/t crystals
additional collaborative management of overhydration monitor vitals sign, I&O, First sign comes from daily weights
Created by: gloriasanders