HCC 2008 Fluid and Electrolyte
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Variations in total body fluid | age, body fate percentage, gender
🗑
|
||||
| filtration | passage of fluid through a permeable membrane caused by hydrostatic pressure
🗑
|
||||
| osmosis | FLUID shift from low to high solute concentration
🗑
|
||||
| Oncotic pressure | the osmotic pressure influenced by plasma proteins
🗑
|
||||
| osmotic diuresis | water following a tonic substance such as sodium or glucose
🗑
|
||||
| Diffusion | SOLUTE movement from higher to lower concentration
🗑
|
||||
| sodium want to move where? | inside the cells
🗑
|
||||
| Where does potassium want to move? | outside of the cells
🗑
|
||||
| active transport | requires ATP, lesser to higher concentration, NA+ - K+ pump located in the cell membrane pumps NA out of the cell and K into the cell
🗑
|
||||
| Osmolality | the measure of the amount of solute/kg in a unit of fluid , either serum plasma or urine
🗑
|
||||
| Normal serum osmolality? | 280-900 mOsm/kg
🗑
|
||||
| what solute is measured in blood? | sodium
🗑
|
||||
| normal urine osmolality? | 250-900 mOsm/kg
🗑
|
||||
| what solutes are measured in urine? | creatinine, urea, uric acid
🗑
|
||||
| How does urine osmolality influence nursing interventions? | too high= too little H20 content, too low= water excess.... treat the patient or inform the doctor so they could be treated for dehydration or fluid overload
🗑
|
||||
| high serum osmolality indicated either... | water loss or sodium retention
🗑
|
||||
| How do you treat water loss? | hydrate
🗑
|
||||
| How do you treat retention of sodium? | fluid restrict--- less free water
🗑
|
||||
| Low serum osmolality indicates either... | water retention or loss of electrolytes
🗑
|
||||
| how do you treat water retention? | diuretics, sodium reduction
🗑
|
||||
| How do you treat electrolyte loss? | replacement
🗑
|
||||
| Routes of GAINING fluid? | food and liquids (~2600 ml), water produced by metabolism (~300 ml)
🗑
|
||||
| routes of fluid LOSS? | kidneys(~1500 ml), lungs(~400 ml) , GI(~100 ml), Skin(~600 ml)
🗑
|
||||
| Homeostatic Mechanisms | Kidneys, Heart, Lungs, Pituitary, Adrenal, Parathyroid
🗑
|
||||
| Third spacing | fluid in potential body spaces- pleura peritoneal, pericardial spaces, looks like FVD, fluid loss cannot be observed and measured, pt. may gain weight
🗑
|
||||
| Causes of third spacing | severe burn, bowel obstruction, pancreatitis, liver failure, malignancies, trauma/surgery
🗑
|
||||
| Fluid Volume Excess (FVE) | excessive retention of water and e-lytes , Hypervolemia/Overhydration/ Fluid Overload
🗑
|
||||
| FVE causes | renal failure, CHF, cirrhosis, excessive IV or po intake (fluids), excessive Na intake, SIDAH
🗑
|
||||
| SIDAH | Syndrome of inappropriate AntiDiuretic Hormone----body produces and retains too much water which decreases Sodium
🗑
|
||||
| Signs and Symptoms of FVE | bounding pulse, acute weight gain, pulmonary crackles, edema, decreased HCT, venous distention-distended jugular veins, shortness of breath/cough, elevated BP
🗑
|
||||
| FVE Nursing Implementation | assess vital signs, assess breath sounds- semi fowlers, rest, I&O, daily weights, monitor edema, dietary instruction-no restrictive diets, diuretics, bed rest to promote venous return
🗑
|
||||
| Electrolytes | cations vs. anions, Plasma(NA) vs. intracellular(K)
🗑
|
||||
| Sodium normal range | 135-145 mEq/L
🗑
|
||||
| Sodium daily requirements | 100 mEq/L
🗑
|
||||
| hypoNAtremia | low sodium--excessive water intake, sodium loss
🗑
|
||||
| hyponatremia from excessive water intake could be a result of... | hypotonic IV fluids, excessive drinking of water, SIDAH, Adrenal insufficiency
🗑
|
||||
| hyponatremia from Sodium Loss could be a result of... | diuretics, vomiting/diarrhea/fistulas
🗑
|
||||
| S/S Hypernatremia | lethargy/confusion, muscle cramps/twitching, seizures, coma, anorexia, nausea, vomiting, elevated pulse, decreased blood pressure
🗑
|
||||
| treatment of hypernatremia | free water restriction, po sodium, if po is not tolerated lactate ringers or isotonic sodium IV, if neurological symptoms are present small amounts of hypertonic solution may be administered
🗑
|
||||
| nursing actions for hypernatremia | monitor labs (serum,Na, Cl, K, urine Na and specific gravity), monitor fluid status and v/s, monitor neurologic status (seizure precautions), teach pt to eat foods high in salt
🗑
|
||||
| hypernatremia causes | excess water loss and sodium gain
🗑
|
||||
| hypernatremia from excessive water LOSS could be a result of | decreased ADH-diabetes insipidus, tube feedings(hypertonic), osmotic diuresis-drugs,DM, insensible water loss-fever diarrhea, heatstroke, hyperventilation
🗑
|
||||
| hypernatremia from sodium gain could be a result of... | excessive water intake-po hypertonic fluids
🗑
|
||||
| S/S hypernatremia | thirst increased temp, sticky musous membranes, swollen tongue, mental changes, seizures and coma, pulmonary edema, elevated pulse and blood pressure
🗑
|
||||
| Potassium K+ | intracellular electrolyte- 98%, influences skeletal and cardiac muscle activity, 80% of potassium is lost by way of the kidneys daily, the other 20% by the bowel and in sweat,
🗑
|
||||
| normal Value of Potassium | 3.5-5.0% mEq/L,
🗑
|
||||
| Daily requirements of Potassium | 40-80mEq
🗑
|
||||
| hypokalemia | K+< 3.5 mEq/L
🗑
|
||||
| hyperkalemia | K+ > 5.0 mEq/L
🗑
|
||||
| Calcium | nerve impulse transmission, blood coagulation, catalyst for many cellular chemical activities
🗑
|
||||
| Normal level of Calcium | 9-11 mg/dL
🗑
|
||||
| daily requirements Calcium | 1000-1500 mg/day
🗑
|
||||
| sources of Calcium | milk products, green leafy veggies, canned fish
🗑
|
||||
| decreased Potassium _____________ calcium | increases
🗑
|
||||
| hypocalcemia | Ca< 8.5 mg/dL
🗑
|
||||
| hypercalcemia | Ca > 10.5 mg/dL
🗑
|
||||
| Phosphorus Normal value | 2.5-4.5 mg/dl
🗑
|
||||
| Phosphorus is essential to | muscles and red blood cells and nerve function, bone and tooth formation, buffer, reciprocal relationship with calcium, regulated by PTH, excreted by kidneys
🗑
|
||||
| Sourses of Phosphorus | milk and milk products, organ meats, nuts, fish, poultry, whole grains
🗑
|
||||
| hypophosphatemia | < 2.5 mg
🗑
|
||||
| hyperphosphatemia | > 4.5 mg
🗑
|
||||
| S/S hypophosphatemia | muscle weakness/numbness/seizures, impairs oxygen delivery to tissues, respiratory muscles so weak as to impair ventilation, mental status: seizures, coma, confusion
🗑
|
||||
| treatment for hypophosphatemia | focus on prevention, add phosphorus to IV solutions, increase dietary intake, Neutra Phos capsules, Fleets Phospho sods po
🗑
|
||||
| Only administer ____ mEq?hr to watch for reciprocal hypocalcemia | 10 mEq
🗑
|
||||
| Hyperphosphatemia is caused by | renal failure
🗑
|
||||
| S/S hyperphosphatemia | tetany, hypocalcemia, calcium-phosphate precipitates in kidneys, joints, arteries, skin, cornea, tingling fingers and around mouth
🗑
|
||||
| magnesium | neuromuscular electrical activity, carbohydrate and protein metabolism, enzyme activity
🗑
|
||||
| Normal value for magnesium | 1.5-2.5 mEq/L
🗑
|
||||
| sources of magnesium | PB, Chocolate, nuts legumes, green leafy veggies, whole grains, seafood
🗑
|
||||
| Hypomagnesemia | Mg < 1.5 mEq/L
🗑
|
||||
| Causes of hypomagnesemia | GI losses, alcoholism, malabsorption, diabetic and keloid acidosis
🗑
|
||||
| S/S hypomagnesemia | neuromuscular irritability weakness, tremors, writhing movements, laryngeal, strider-seizures, cardiac arrhythmia, mental status: delirium, hallucinations
🗑
|
||||
| Treatment for Hypomagnesemia | increased dietary intake, Po magnesium- watch for diarrhea,
🗑
|
||||
| Magnesium sulfate not to exceed... | 150 mEq/min too fast can cause cardiac arrest
🗑
|
||||
| Nursing actions for Hypomagnesemia | monitor labs (serum, Mg, K, Ca), seizure precautions, teach patient to eat foods high in Mg, slow IV admin.
🗑
|
||||
| Hypermagnesemia | Mg > 2.5 mEq/L
🗑
|
||||
| S/S Hypermagnesemia | hypotension, nausea/vomiting, flushing with sensation of warmth, hypoactive reflexes, lethargy>>>>coma, dec respirtations, cardiac arrest,
🗑
|
||||
| cause of Hypermagnesemia | renal failure
🗑
|
||||
| Treatment for Hypermagnesemia | double check blood not hemolyzed in lab specimen, discontinued medications containing magnesium, loop diuretics and 0.45% NS increase excreted in kidneys, IV calcium glucose to antagonize effects of hyper magnesemia on the heart
🗑
|
||||
| Nursing actions for Hypermagnesemia | monitor labd (serum, K, Mg, Ca), treat underying cause, Monitor ECG neuro status
🗑
|
||||
| Acid | releases H
🗑
|
||||
| Base | traps H
🗑
|
||||
| pH | expression of H
🗑
|
||||
| Acid base disturbances | buffer, systems, metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis
🗑
|
||||
| Intracellular Buffer system | carbonic (acid/sodium bicarbonate), phosphate, protein
🗑
|
||||
| Intracellular buffer system | protein, phosphates, hemoglobin
🗑
|
||||
| Resp increases to get rid of _____ | CO2
🗑
|
||||
| resp decreases to ___________ CO2 | increase
🗑
|
||||
| Renal Control | Bicarb reabsorption, slower process-may take days
🗑
|
||||
| pH | 7.35- 7.45
🗑
|
||||
| pCO2 | 35-45
🗑
|
||||
| pO2 | 95-100
🗑
|
||||
| HCO3 | 22-26
🗑
|
||||
| O2 sat | 95-100
🗑
|
||||
| Metabolic acidosis | pH < 7.35, HCO3 <22
🗑
|
||||
| Metabolic acidosis is usually due to | an increase in acids other that carbonis acid,
🗑
|
||||
| acidosis causes lungs to | HYPOventilation
🗑
|
||||
| Metabolic acidodsis might be accompanied by ______ shift | K+, hyperventilation which decreases CO2
🗑
|
||||
| Signs and Symptoms of Metabolic acidosis | drowsiness, increase resp rate and depth, flushed skin, nausea/vomitting, decreased BP, cold clammy skin, dysrrythmia
🗑
|
||||
| Causes of Metabolic acidosis | diarrhea, diabetic ketoacidosis, renal failure, cardiac arrest
🗑
|
||||
| nursing actions for metabolic acidosis | monitor ABG and K, monitor renal, neuro and cardiac status, promote adequate ventilation, fluids, oral hygiene w/sodium bicarb
🗑
|
||||
| Metabolic alkalosis | pH> 7.45, HCO3> 26 mEq/L, usualy due to a loss of acids
🗑
|
||||
| alkalosis causes | HYPERventilate
🗑
|
||||
| Respiratory Acidosis | pH < 7.35, PaCO2 > 45mmHg, caused by retention of CO@ d/t pulmonary insufficiency, very dangerous
🗑
|
||||
| Respiratory Alkalosis is always due to | hyperventilation
🗑
|
||||
| Respiratory Alkalosis | ph> 7.45, PaCO2< 33mmHg
🗑
|
||||
| ROME | Respiratory Opposite Metabolic Equal
🗑
|
||||
| Respiratory indicator | pCO2
🗑
|
||||
| Metabolic indicator | HCO3
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
jaed008
Popular Nursing sets