F+E balance with Acid-Base balance
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| Solute | particles
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| Solvent | Water
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| Diffusion | particles in a fluid move from an area of higher solute concentration to an area of lower solute concentration
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| osmosis | movement of water from a solution of lower solute concentration to higher solute concentration
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| Filtration | movement of water and dissolved substances from an area of high pressure to an area of low pressure
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| Solute | particles
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| Solvent | Water
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| Diffusion | particles in a fluid move from an area of higher solute concentration to an area of lower solute concentration
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| osmosis | movement of water from a solution of lower solute concentration to higher solute concentration
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| Filtration | movement of water and dissolved substances from an area of high pressure to an area of low pressure
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| average adult % of body is water | 60%
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| Extracellular fluid | found outside the cell, are divided into interstitial and intravascular compartments, and are lost more rapidly
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| Intracellular fluids | most of the fluid in our body is intracellular, found within the body cells
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| Intravascular fluids | fluid found within the blood vessels = plasma
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| interstitial fluids | fluids found between the cells and blood vessels and tissues
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| Examples of interstitial fluids | Lymph, CSF, GI, and intraocular fluids, synovial, and glandular secretions
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| infant % of body water | 80%
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| Elderly, obese clients, and infants are at risk for what because of less fluid reserve in their bodies? | complications of illness due to dehydration or fluid shifts
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| which fluids are lost more rapidly from the body? | extracellular fluids (faster than intracellular)
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| what % of body fluid loss is fatal for adults? | 20%
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| What % of body fluid loss is fatal for infants? | 15%
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| Extracellular fluid | found outside the cell, are divided into interstitial and intravascular compartments, and are lost more rapidly
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| Intracellular fluids | most of the fluid in our body is intracellular, found within the body cells
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| Intravascular fluids | fluid found within the blood vessels = plasma
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| interstitial fluids | fluids found between the cells and blood vessels and tissues
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| Examples of interstitial fluids | Lymph, CSF, GI, and intraocular fluids, synovial, and glandular secretions
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| What are intracellular and extracellular compartments separated by? | a semi-permeable membrane
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| third spacing | when extra fluid is in the body but is not available to the body
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| examples of thrid spacing | ascites and edema
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| causes of third spacing | post-op edema, burn patients and liver failure
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| Solute | particles
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| Solvent | Water
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| Diffusion | particles in a fluid move from an area of higher solute concentration to an area of lower solute concentration
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| osmosis | movement of water from a solution of lower solute concentration to higher solute concentration
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| Filtration | movement of water and dissolved substances from an area of high pressure to an area of low pressure
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| average adult % of body is water | 60%
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| infant % of body water | 80%
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| Elderly, obese clients, and infants are at risk for what because of less fluid reserve in their bodies? | complications of illness due to dehydration or fluid shifts
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| which fluids are lost more rapidly from the body? | extracellular fluids (faster than intracellular)
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| what % of body fluid loss is fatal for adults? | 20%
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| What % of body fluid loss is fatal for infants? | 15%
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| Extracellular fluid | found outside the cell, are divided into interstitial and intravascular compartments, and are lost more rapidly
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| Intracellular fluids | most of the fluid in our body is intracellular, found within the body cells
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| Intravascular fluids | fluid found within the blood vessels = plasma
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| interstitial fluids | fluids found between the cells and blood vessels and tissues
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| Examples of interstitial fluids | Lymph, CSF, GI, and intraocular fluids, synovial, and glandular secretions
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| What are intracellular and extracellular compartments separated by? | a semi-permeable membrane
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| third spacing | when extra fluid is in the body but is not available to the body
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| examples of thrid spacing | ascites and edema
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| causes of third spacing | post-op edema, burn patients and liver failure
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| electrolytes definition | elemental compounds which when dissolved in body fluids develop an electrical charge and becomes an ion
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| cation | ions with positive charge
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| anion | ions with negative charge
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| electrolyte balance | for each positively charged ion there must be a negatively charged ion
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| what does extracellular fluid contain? | large amounts of Na+, Cl- and HCO3-(Bicarb)
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| what does intracellular fluid contain? | large amounts of K, sulfates, and phosphates
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| Fluids leave the body by what routes? | skin(sweat), lungs(breathing), GI tract (lubrication), and kidneys(urinating)
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| where is the largest quantity of fluid excreted from? | the kidneys
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| where are large quantities of water secreted and reabsorbed? | the GI tract
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| Insensible loss | water lost from the lungs and skin, called this bc the individual is unaware of losing that water
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| how water enters the body | oral liquids and water content in foods
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| Avg total amount of water taken into the body each day | 2400 ml
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| What do the adrenal glands do in relation to movement of body fluids? | secretes aldosterone which regulates the amount of sodium reabsorbed by the kidneys
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| What does the pituitary gland do in relation to movement of body fluids? | secretes ADH (antidiuretic hormone) which regulates the amount of water being reabsorbed by the kidney
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| Fluid volume deficit | hypovolemia-water and electrolytes are lost from the body
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| causes of fluid volume deficit | vomiting/diarrhea, continuous GI irrigations/suctioning, Ileostomy/colostomy drainage, draining wounds/burns/fistulas, diuretics increase fluid output, or severe bleeding/hemmorhage
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| S/S of fluid volume deficit | thirst, poor skin turgor(tentin), dry mucous membranes, flushed skin, increased HR/thready pulse, postural hypertension, rapid weight loss, flat neck/hand veins,dizziness/weakness, confusion, concentrated urine, increased hematocrit
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| Nursing interventions for fluid volume deficit | VS, check mucous membranes and skin turgor for improvement, daily weights, monitor I&O, test urine for specific gravity, monitor hematocrit and electrolytes, replace fluids by PO,NG or IV(NS as prescribed)
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| fluid volume excess | an actual excess of total body fluid or relative excess in one or more fluid compartments. aka fluid overload/overhydration/hypervolemia
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| Goal of treatment for fluid volume excess | to restore fluid balance, correct electrolyte imbalances if present, and eliminate/control the underlying cause of the overload
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| causes of fluid volume excess | excessive administration of oral/IV fluids, poorly functioning kidneys, CHF, cirrhosis of the liver, Cushing's syndrome, and long time steroid use
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| S/S of fluid volume excess | cough, dyspnea, acute weight gain, pitting edema(esp dependent), inrease in RR and HR, increase in BP, bounding pulse, neck and vein distention, decreased hematocrit, confusion, and moist rales in lungs
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| Nursing Interventions for fluid volume excess | monitor vital signs, restrict fluids, restrict Na+ intake, monitor I+O q1h with diuretics and specific gravity, monitor for increasing pulmonary edema, pitting edema, weight daily, monitor skin turgor, administer diuretics, semi-fowlers for comfort
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| Potassium sparing diuretics | Aldactone (spironolactone), and Dyrenium(triamterene)
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| A non-patassium sparing diuretic | Lasix (Furosemide)
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| 2 Nursing interventions that best asses water balance | how the patient is sitting/ how many pillows/ need recliner
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| normal sodium levels | 135-145 mEq
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| Hyponatremia | a sodium deficit in which there is too little sodium in the serium <135mEq
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| causes of hyponatremia | excess Na+ loss fom skin(perspiraion) or 3rd spacng, GI vomiting/diarrhea/NG drainage, kidneys(diuretics), and water excess from too much IV flud, CHF or renal disease
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| what will their be with hponatremia? | potassium imbalance because sodium decreases from extracellular fluid and as water is pulled into the cells potassium is shifted out
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| S/S of hyponatremia | headache, postural hypotension, muscle weakness, twitching, tremors, dehydration,poor turgor, dry mucous membranes, flushed skin, elevated temp and restlessness
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| nursing interventions for hyponatremia | monitor VS, I&O, daily weight, assess skin turgor/mucous membranes, administer 3-5% NS IV therapy as prescribed, increase sodium in diet, monitor electrolytes daily, monitor neuro status
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| What do you want to monitor with lithium and hyponatremia | lithium level as hyponatremia can cause diminshed lithium excretion and cause toxicity
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| Hypernatremia | a condition in which the serum sodium concentration is >145 mEq
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| Causes of hypernatremia | inadequate water intake, diarrhea, burns. fever, diaphoresis, diabetes insipidus, too much table salt, IV bicarbonate, 3%NS or higher, kayexalate
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| S/S of hypernatremia | thirst, dry mucous membranes, fever, flushed, irritability, generalized weakness, postural hypotension ****S.A.L.T.**** (skin flushed, agitation, low fever, thirst)
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| Nursing Interventions for Hypernatremia | replace lost water, hypotonic IV solution as prescribed (D5W or .45%NaCl), increase fluid intake, diuretics to increase sodium excretion, monitor vital signs, monitor neuro changes, electrolytes, weigh daily, low sodium diet, Strict I&O, K levels
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| Foods high in sodium | bacon, bouillion cubes, canned soups, ketchup, cheese, corned beef, hodogs, soy sauce, frozen dinners
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| Normal Potassium levels | 3.5-5.0 mEq
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| What is the main intracellular cation? | Potassium
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| how much potassium is required each day? | 65 mEq
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| foods high in potassium | bananas,potatoes,avacados, apricots, beef, peaches, spinach, tomatoes
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| how much potassium is excreted through the kidneys? | 80%
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| where is the rest of potassium excreted? | 10-20% through feces and perspiration
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| When giving KCl what should you give it with? | dilute it with water or OJ to decrease GI upset
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| what does potassium do in our bodies? | promotes transmission of nerve impulses and is important for heart and muscle function and skeltal muscle function
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| Kypokalemia | potassium level <3.5 mEq **most common electrolyte imbalance and is potentially life-threatening
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| cause of hypokalemia | Duretics (#1) , burns, trauma, diarrhea, vomiting, and fistulas
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| S/S of hypokalemia | cardiac dysrhythmias (weak, irregular pulse),generalized muscle weakness, leg cramps, decreased DTR's (deep tendon reflexes), n/v, anorexia, lethargy
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| nursing interventions for hypokalemia | monitor vital signs esp apical HR and cardiac activity/changes, increase potassium intake, administer IV potassium as ordered, monitor serum electrolyte levels and asses DTR's
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| what do you never IV push? | potassium
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| Hyperkalemia | potassium >5.0 mEq
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| causes of hyperkalemia | Renal Failure (#1), excess intake, potassium sparing diuretic, burns, and sever constipation
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| S/S of hyperkalemia | cardia dysrhythmias, cardiac arrest, muscle weakness (esp in Lower exremities), n/v/d, colic, EKG spike T wave
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| nursing interventions for hyperkalemia | kayexalate(exchanges Na ions for K), monitor lab values, Apical pules for rate and rhythm, monitor EKG changes, assess kidney function, assess muscle function/weakness/cramps/parethesia
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| How does IV glucose and insulin help hyperkalemia? | Insulin will move into the cell taking potassium with it, thereby decreasin the k level in the blood stream. The glucose brings it back up.
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| Normal blood level of chloride | 96-106 mEq
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| Cl is mainly excreted from where? | the kidneys
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| What is an important function of Chloride? | necessary for the formation of HCl in gastric juices
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| hypochloremia | low chloride levels <96 mEq
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| hyperchloremia | high chloride levels >106 mEq
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| common cause of hypochlormeia | vomiting and prolonged naso-gastric or fistula drainage
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| normal blood calcium levels | 9-11mg
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| where is calcium found in the body? | 99% in the bones and teeth where it is physiologically inactive and 1% in the soft tissue and extracellular fluid
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| what does the body need in order to be able to absorb calcium? | Vitamin D
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| How is calcium removed from the body? | by urine and feces
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| what regulates calcium levels in the body? | the parathyroid hormone
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| what does calcium do for the body? | necessary for normal blood clotting, promotes normal transmission of nerve impulses, and helps to regulate muscle contractions and relaxation
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| Hypocalcemia | low calcium levels <9mg
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| causes of hypocalcemia | loop diuretics, inadequate dietary intake of calcium or vitamin D, decreased parathyroid function or removal of, calcium excreting meds such as diuretics, caffeine, anticonvulsants and heparin
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| S/S of hypocalcemia | osteoporosis with pathological fx, tingling around nose,mouth,ears,fingers,and toes, muscle cramps/spasms/twitching of feet/hands,n/v/d, cardiac dysrhythmias, hypotension, parathesias, positive Chvostek's sign, Trousseau's sign
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| nursing interventions for hypocalcemia | calcium gluconate IV, monitor vitals and apical pulse, monitor for Chovstek's sign, avoid overstimulation, initiateseizure precautions, adminiter vitamin D, monitor calcium levels, increase calcium in diet, monitor for bleeding/clotting times
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| Hypercalcemia | serum calcium level >11mg
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| causes of hypercalcemia | excessive intake of calcium, supplements, milk, and antacids, renal failure leading to decreases excretion of calcium, Paget's disease, and hyperparathyroidism
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| S/S of hypercalcemia | thirst, polyuria, increased HR and BP, bounding pulse, decreased muscle tone, dimished DTR's, n/v, abd distention, constipation, confusion, lethargy, coma, deleopment of renal stones
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| Nursing inerventions for hypercalcemia | IV fluid administration, calcitonin, increase po intake, monitor for kidney stones, monitor for flank pain, monitor VS, monitor for dysrhythmias, restrict calcium intake, increase mobility (ROM), and monitor serum calcium levels
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| normal magnesium levels | 1.5-2.5 mEq
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| Where is magnesium found in the body? | 60% in bones, 39% in muscle and fat tissue, and 1% in extracellular fluid ( most in CSF)
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| major route of excretion of magnesium | kidneys
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| what does magnesium do for the body? | important for heart, muscle, and nerve function, importat fo activation of many enzymes, promotes regulation of calcium, potassium and vitamin D, may correct hypokalemia
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| what should you always adiniter before potassium IV piggy-back? | magnesium
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| hypomagnesemia | serum magnesium levels <1.5 mEq
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| causes of hypomagnesemia | poor dietary intake of Mg, common among critically ill, GI loss(vomiting/diarrhea), osmotic diuretics, DKA, alcoholics, Poor GI absorption (Crohn's/ulcerative colitis)
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| S/S of hypomagnesemia | twitching, parathesias, hyperactive reflexes, irritability, convulsions, positive Chvostek's or Trouseau's sign/tetany, shallow respiations, tachycardia, changes in EKG rhythm's
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| Nursing Interventions for hypomagnesemia | monitor vital signs, monitor for dysrhythmias, monitor neuro changes, I&O, administer Mg supplements, monitor Mg levels, increase dietary intake of magnesium
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| Hypermagnesemia | Magnesium levels >2.5 mEq
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| Cause of hypermagnesemia | renal insufficiency, overuse of antacids with Mg, and chemotherapy
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| S/S of hypermagnesemia | decreased neuromuscular irritability, muscle weakness, decreased DTR's, n/v,drowsy, lethargy, hypotension, vasodilation
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| Nursing Interventions Hypermagnesemia | monitor vitals,for resp depression,for hypotension, bradycardia,dsyrhythmias, for neruo and musular activities, for LOC, lab values and remove excess Mg, for fluids, administer loop diuretics, prep to administer 10% Calcium Gluconate
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| Normal Phosphorus levels | 1.8-2.6 mEq
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| Phosphorus and Calcium have what in the body? | an inverse relationship; an increase in one causes an decrease in the other
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| where is phosphorus found in the body? | 80% in the bonesand teeth combines with calcium, 10% in muscles, and 10% in the nerve tissue
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| foods high in phosphorus | beef, pork, fish, poultry, milk products and legumes
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| where is phosphorus excreted from? | 90% by the kidneys, the rest in feces
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| hypophosphatemia | phosphorus levels <1.8 mEq
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| hypophosphatemia causes | hyperparathyroidism, alcoholism, antacids, diuretics
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| S/S of hypophosphatemia | musce weakness and resppiratory depression
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| Treatment of hypophosphatemia | give phosphate
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| hyperphosphatemia | phosphorus levels >2.6 mEq
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| causes of hyperphosphatemia | hypoparathyroidism, usually seen in renal failure, and bone disease
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| S/S of hyperphosphatemia | tetany
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| Treatment for hyperphosphatemia | treat underlying cause, dialysis
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