Fluid & Electrolytes LPN
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| Intracellular Fluid (inside cells) | More Fluid
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| Extracellular Fluid (outside cells) | Less Fluid
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| Organs of fluid loss | Kidneys, skin, lungs, GI tract
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| Osmosis (fluid/water) | Movement of fluid from an area of lower solute concentration to an area of higher solute concentration with eventual equalization
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| Diffusion (solutes) | Movement of solutes from an area of greater concentration to an area of lesser concentration.
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| Hypervolemia | Equal/isotonic expansion of Extra-cellular plasma. Retention of sodium & H2O in equal proportions.
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| Hypervolemia | Almost always result of increased total body sodium
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| Hypervolemia Causes | Excessive salt intake, renal failure, heart failure, cirrhosis of the liver
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| Hypervolemia clinical manifestations | Edema, distended neck veins, abnormal lung sounds, increased weight, increased urine output, tachycardia, increased B/P
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| Hypervolemia Diagnostics | BUN and hematocrit levels decreased due to plasma dilution (too much water)
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| Hypervolemia Diagnostics | Sodium, Urine specific gravity, physical exam, chest x-ray
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| Sodium | 135-145 mEq/L
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| BUN (kidney function) | 10-20 mg/dl
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| Hematocrit | 42-52% male35-47% female
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| Hypervolemia management | Restrict sodium and fluid, TED hose improve venous return, diuretics, dypsnea can occur, dialysis if severe
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| Potassium sparing (weakest) | spironolactone can cause hyperkalemia
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| Thiazide (moderate) | hydrochlorothiazide, can cause hypokalemia (potassium low) and hyponatremia (low sodium)
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| Loop Diuretics (most potent) | Rapid onset, can cause hypokalemia (potassium low) and hyponatremia (low sodium) ototoxicity: hearing loss
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| Hypovolemia | Fluid volume deficit H20 & electrolytes lost in equal proportions
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| Hypovolemia Risk Factors | Fever, tachypnea (rapid breathing), vomiting, diarrhea, gi suctioning, sweating, hemorrhage, excercising
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| Hypovolemia Risk Factors | Malnutrition, sepsis, burns, ascites, diabetes insipidus, adrenal insufficiency, incapacitated, elderly
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| Diabetes insipidus | condition characterized by excessive thirst and excretion of large amounts of severely diluted urine
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| Hypovolemia Clinical manifestations | Thirst, anorexia, nausea, fatigue, muscle weakness, cramps, increased HR, increased B/P, cool, clammy skin if severe
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| Hypovolemia Labs | BUN = 20:1, usually 10:1, hematocrit increased, Urine specific gravity increased
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| Hematocrit (Percentage of RBC's) | 42-52% male, 35-47% female
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| Urine Specific Gravity | 1.010-1.025
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| Hypovolemia (management) | Replace fluids PO if not severe, Isotonic IV fluids, Anti-emetics for vomiting, Anti-diarrheals, accurate & frequent I&O
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| Hypovolemia (management) | Frequent Assessment & VS, level of consciousness, skin color, skin turgor, weight (1L=2.2lbs), breath sounds
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| Hypovolemic Shock | Significant fluid lost from intravascular space occurs in hemorrhage, burns, GI loses
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| Hypovolemic Shock | Symptoms: increased pulse, increased B/P, Urine output <30 ml/hr, thirst, neuro changes
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| Hypovolemic Shock | Actions: Fluid replacement with colloids (blood products) Isotonic (normal saline) Supine position-elevate legs, Monitor vital signs, I/O's
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| Third Spacing | Sometimes fluid is not lost from the body but is unavailable for use by either the ICF or ECF.
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| Third Spacing | The movement of body fluid to a non-functional space, occurs frequently and can be potentially fatal
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| Third Spacing | Decrease in urine output, occurs in ascites (edema within peritoneal cavity), burns, peritonitis, trauma, lymphatic obstruction
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| Anasarca | Severe, widespread accumulation of fluid in all of the tissues and cavities of the body at the same time.
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| Third Space | Peripheral edema, organ edema
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| MEq | measure of chemical activity
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| Cations | Positive charge, Sodium (Na+) Potassium (K+) Calcium (Ca+) Magnesium (Mg+)
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| Intracellular | Contains K+ Potassium
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| Extracellular | Contains Na+ Sodium
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| Most common electrolyte imbalances | Potassium and Sodium
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| Sodium | Most abundant solute in ECF, responsible for muscle contraction & transmission of nerve impulses
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| Aldosterone | Conserves sodium, regulate Na+ balance
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| Hyponatremia | Serum Na <135
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| Hyponatremia Risk Factors | Renal: diuretics, Adrenal insufficiency, low aldosterone, Non renal: vomitting, diarrhea, excessive sweating, excessive water intake, hypervolemia, IV therapy, head injury
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| Hyponatremia management | Na+ replacement slowly not to exceed >12 mEq/L in 24 hrs., isotonic solution, water restriction
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| Hypernatremia | Na+ >145
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| Hypernatremia Risk Factors | Dehydration, elderly, infants, comatose, GI diarrhea, high Na+ diet, diabetes insipidus, heat stroke
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| Dehydration | Behavioral changes in elderly
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| Hypernatremia Clinical Manifestations | Flushed skin, dry, swollen tongue, peripheral edema, pulmonary edema
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| Hypernatremia prevention & mangement | Diuretics, IV fluids, hypotonic electrolyte solution, 0.3% sodium chloride
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| Potassium (3.5-5) | Major intracellular electrolyte, influences skeletal & cardiac muscles, 80% excreted from kidneys, 20% lost bowel & sweat
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| Hypokalemia <3.5 causes risks | Too much insulin, insulinemia, burns, vomiting, diarrhea, NG suctioning, diuretics
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| Hypokalemia clinical manifestations | Cardiac: dysrhythmias & weak pulse, flat/inverted T-waves on ECG, cardiac & respiratory arrest
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| Hypokalemia Prevention & management | K+ replacement slowly, never administer IV push, cardiac arrest
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| Hyperkalemia K+ >5 | Prolonged use of tourniquet, anemia, K+ intake (salt substitutes) renal failure most common
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| Hyperkalemia clinical manifestations | Cardiac, slow irregular puse, hypotension, restlessness, irritability, weakness, paralysis, diarrhea
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| Hyperkalemia management | Diuretics, PO or rectal enema, Insulin, dialysis
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