fluid&electrolytes
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| ____ % of weight in average adult is water | 60
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| Components of extracellular fluid | Interstitial, intravascular, and transcellular fluid
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| Fluid between the cells and outside the blood vessels | interstitial fluid
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| Extracellular fluid containing lymph | Interstitial fluid
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| Liquid portion of the blood | intravascular fluid
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| Blood plasma found in the vascular system | intravascular fluid
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| Fluid that is separated from other fluids by a cellular barrier | transcellular fluid
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| Examples of transcellular fluid | CSF, pleural fluid, GI fluid, peritoneal fluid, intraocular, synovial fluids
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| Best indicator of fluid status | Daily weight
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| Positively charged ions | Na, K, Ca
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| Negatively charged ions | Cl, HCO3, SO4
(Chloride, bicarbonate, sulfate)
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| The number of grams of the electrolyte dissolved in a liter of plasma | mEq/L
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| Movement of a pure solvent from an area of lesser concentration to an area of greater concentration | Osmosis
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| Random movement of solute from an area of higher concentration to an area of lower concentration | Diffusion
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| Example of diffusion in the body | movement of CO2 and O2 between the alveoli in the lungs
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| Regulates fluid intake | thirst mechanism
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| Process by which water and diffusible substances move together across a membrane | Filtration
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| Movement from an area of higher pressure to an area of lower pressure | filtration
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| Example of filtration | Edema (intravascular to interstitial)
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| Filtration can be caused by: | congestive heart failure
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| Location of the thirst control center | hypothalamus
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| Transport that requires metabolic activity and energy | active transport
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| Allows cells to admit larger molecules | Active transport
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| Stimulated when excess fluid is lost | hypothalamus
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| Solute that is the greatest contributor to the osmolarity of a fluid | sodium
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| Most important regulator of fluid intake | thirst
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| Hormone stored in the pituitary that is released in response to changes in blood osmolarity | ADH
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| What types of IV fluids would be given to a dehydrated patient | hypotonic or isotonic
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| Works directly on renal tubules and collecting ducts to make them more permeable to water | ADH
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| Action of aldosterone | Retain Na and H2O, excrete K
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| Secreted from the atrial cells in response to stretching and an increase in circulating blood volume | ANP
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| Opposes ADH; acts as a diuretic causing Na loss | ANP
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| Average daily output | 1-2 L
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| 4 organs of water loss | kidneys, skin, lungs, GI tract
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| Insensible water losses | continuous and occurs through skin and lungs
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| About ___ L fluid circulates through the GI tract per day | 8
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| Most fluid circulating through GI is reabsorbed in the: | small intestine
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| Insensible water losses can be significant with: | fever and burns
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| Sensible water loss | occurs through excess perspiration
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| Fluid volume deficit | hypovolemia
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| Risk factors for hypovolemia | lethargy, depression, vomiting, dementia, fever, difficulty swallowing, diarrhea, unable to speak, paralysis, anticholinergic drugs, etc
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| Reduced body fluid in both intracellular and extracellular compartments | hypovolemia
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| translocation of fluids from intravascular or intracellular space to tissue compartments | third-spacing
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| A high ratio of blood components | hemoconcentration
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| Problem with hemoconcentration | increases risk of blood clots and kidney stones
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| Early symptom of hypovolemia | thirst
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| Hematocrit levels and hypovolemia | elevated except in hemorrhage
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| normal hematocrit levels | Men: 37-52%
women: 37-47%
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| Medical management of hypovolemia | increasing oral or IV fluids, antibiotics, antidiarrheals, antiemetics, control fluid loss
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| Report a loss of ___ or more lbs in 24 hours | 2
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| 2 lb loss = ___ L of body fluid | 1
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| Symptom of hypovolemia seen on the tongue | furrowing
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| Specific gravity of urine with hypovolemia | 1.020
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| Fluid volume excess | hypervolemia
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| high volume of water in the intravascular fluid compartment | hypervolemia
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| Causes of hypervolemia | excessive oral intake, rapid IV infusion, heart failure, kidney disease, excessive salt intake, steroid drugs
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| At risk for hypervolemia | increased ADH production, steroids, excess consumption
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| CM of hypervolemia | weight gain, elevated BP, light yellow urine, pitting & dependent edema, JVD, confusion, etc.
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| Early symptoms of hypervolemia | weight gain, elevated BP, increased breathing effort
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| There is usually a ___L fluid volume excess before pitting will occur | 3
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| Low blood cell count and hematocrit | Hemodilution
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| Urine specific gravity seen with hypervolemia | Low
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| Central venous pressure seen with hypervolemia | elevated
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| Medical management of hypervolemia | fluid restriction, diuretics, salt restriction
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| Pulmonary indications of hypervolemia | crackles
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| Best indicator of fluid retention | weight gain
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| +1 pitting edema | 2mm slight retention
normal contours
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| Interstitial fluid volume of 1+ pitting edema | Associated with interstitial fluid volume 30% above normal
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| +2 pitting edema | Deeper pit (4mm)
last longer than +1
fairly normal contour
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| +3 pitting edema | deep pit (6mm)
remains after several seconds
skin swelling obvious by inspection
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| CM of brawny edema | no pitting
hard tissue
skin surface may be shiny, warm, moist
poor circulation
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| Interventions for hypervolemia | coughing, turning q2h, inspecting
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| Third-spacing is associated with: | loss of colloids, burns, allergic reactions, liver failure
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| Assessment of third-spacing | S/S hypovolemia except weight loss, localized enlargement of body cavity or organ
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| Medical management of third-spacing | restore circulatory volume and eliminate trapped fluid, administer IV fluids and blood products or albumin, IV diuretics
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| Normal value for sodium | 135-145 mEq/L
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| Main cation in extracellular fluid | Na
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| Electrolyte that maintains normal nerve and muscle activity | Na
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| Main role is to regulate and distribute fluid volume | Na
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| 2 main problems with hyponatremia | more H2O than Na (Na is diluted)
Losing more Na than H2O (sweating, diarrhea, vomiting)
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| S/S: mental confusion, muscle weakness, anorexia, restlessness, tachycardia, seizures, coma | Hyponatremia
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| Serum osmolarity in hyponatremia | less than 280 (dilute blood)
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| Serum sodium in hyponatremia | less than 135
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| IV treatment for hyponatremia | Fluids containing sodium cholride
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| Causes of hypernatremia | profuse watery diarrhea, excessive salt intake without sufficient water, high fever, decreased water intake, unconscious, diabetes insipidus
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| CM: dry, sticky mucous membanes, decreased urine output, fever, rough/dry tongue, restlessness, coma | Hypernatremia
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| Normal potassium levels | 3.5-5 mEq/L
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| Chief electrolyte found in intracellular fluid | potassium
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| Maintains electrical activity in the cells, assists in muscle contraction | potassium
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| Causes: Lasix, thiazide diuretics, fluid loss from GI, large doses of steroids, IV admin of insulin and glucose, alkalosis | hypokalemia
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| S/S May be flat T wave on ECG | hypokalemia
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| Hypokalemia treatment | increase K in diet, potassium sparing diuretics (Aldactone), IV potassium
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| What should be kept at the bedside of a patient with hypokalemia? | ambu bag
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| About ___ mEq of K is lost in each liter of urine | 40
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| Dilution recommended for potassium infusions | no more than 1mEq/10mL solution
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| Maximum rate of potassium infusion | 5 to 10 mEq per hour; never exceed 20 mEq/hr
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| Acceptable routes for potassium administration | Oral or slow IV- NEVER give IV push, IM, or SubQ
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| Causes: renal failure, severe burns or crush injuries, acidosis, blood transfusions, addison's disease, chemo | hyperkalemia
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| CM: parasthesia, skeletal muscle weakness, hyperactivity in smooth muscles, decreased HR, irregular pulse, hypotension, cardiac arrest | hyperkalemia
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| Electrolyte imbalance that will have a widened QRS complex; tall, skinny, peaked T wave; and may have absence of P wave | hyperkalemia
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| Treatments for hyperkalemia | loop diuretics, potassium restrictions, kayexelate, calcium gluconate, sodium bicarbonate, 10 units regular insulin
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| Effect of insulin on potassium? | insulin sends K back into the cell
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| May be given to conteract effects on the heart seen with hyperkalemia, but does not bring K levels down | calcium gluconate
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| Cardiac monitoring of potassium if > ___? | 6mEq/L
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| If a patient with hyperkalemia is being given insulin, what should the nurse also monitor for? | hypoglycemia
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| If a patient with hyperkalemia is being given kayexelate, what should the nurse also monitor for? | serum sodium levels
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| Normal total calcium levels | 8.5-10 mg/dL
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| Normal ionized calcium levels | 4.5-5.5 mg/dL
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| __% calcium is found in the blood | 1
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| Hormone that is released when blood Ca is low | PTH
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| Hormone that moves Ca back into the cells | calcitonin
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| Needed for blood clotting, muscle function, nerve impulses | Calcium
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| Needed for calcium absorption in the inestine | vitamin D
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| Calcium and ___ have an inverse relationship | Phosphorous
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| Hormone that takes calcium from the bones and puts it in the blood | PTH
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| Causes: vitamin D deficiency, hypoparathyroidism, severe burns, acute pancreatitis, corticosteroids, alkalosis, hypomagnesemia, alcoholism, high phosphorous | hypocalcemia
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| One of the most common causes of hypocalcemia | removed thyroid gland
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| Most common sign of hypocalcemia | tingling in the extremities and around the mouth
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| Positive Chvostek's or Trousseau's sign indicate what electrolyte imbalance? | hypocalcemia
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| CM: muscle cramps, diarrhea, laryngeal spasms, hyperactive reflexes, tetany, seizures, bleeding, dysrhytmias | hypocalcemia
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| Hypocalcemia treatment | IV calcium gluconate or calcium chloride; oral supplements with vit D
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| What should be kept at the bedside of a patient with hypocalcemia? | tracheostomy and suction
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| Often associated with parathyroid gland tumors, multiple fractures, Paget's disease, hyperparathyroidism, excessive vitamin D, chemo, prolonged immobilization, antacid abuse ,hypophosphatemia, acidosis | hypercalcemia
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| CM: bone pain, kidney stones, confusion, lethargy, hypertension, arrhythmias, decreased GI motility | hypercalcemia
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| Hypercalcemia treatment | decrease Ca in diet, hydration (NS IV), lasix, synthetic calcitonin (mithracin)
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| Which type of diuretic is not indicated for hypercalcemia? | thiazide (inhibit calcium excretion)
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| Normal Mg levels | 1.5-2.5 mEq/L
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| Involved in transmission of nerve impulses and muscle excitability | Mg
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| Activates the functioning of B vitamins and use of K and Ca | Mg
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| __% Mg contained in bones | 60
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| Helps regulate Ca because it helps produce PTH | Mg
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| Levels in the blood regulated by GI and urinary systems | Mg
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| Causes of hypomagnesemia | alcoholism, DKA, kidney disease, burns, malnutrition, eclampsia, malaborption, excessive diuresis, hyperaldosteronism, prolonged diarrhea
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| S/S: CNS irritation, delusions, weak skeletal muscles, tremors, twitching, tetany, hyperactive DTNs | hypomagnesemia
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| Mg infusion rate | no more than 150 mg/min
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| How often should Mg levels be drawn from a person with hypomagnesemia? | after every bolus and every 6 hrs if on continuous drip
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| Causes of hypermagnesemia | kidney failure, advancing age, addison's disease, untreated DKA, excessive intake (antacids and laxatives)
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| S/S: decreased muscle and nerve activity, hypoactive DTRs, flushing, N/V, decreased LOC, shallow respirations | hypermagnesemia
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| Treatment of hypermagnesemia in an emergency situation | calcium gluconate IV
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