Nutrition&Fluids for Test 1 IUPUI S353
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| Dehydration means (H2O, Na) | Loss of water NOT sodium
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| Fluid volume deficit means (H2O, Na) | Loss of water AND sodium
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| What IV fluid should you use for rapid volume replacement? | 0.9% NaCl
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| ECF fluid volume deficit = | Hypovolemia
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| What is the primary use of hypertonic solutions? | TPN (total parenteral nutrition)
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| Administration of an isotonic fluid expands: | ECF only
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| When can enteral feedings be started? | When bowel sounds are present, usually 24 hrs after placemens
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| Assessments before enteral feeding | Abdomen soft, non-distended, when was last BM
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| Enteral feeding position | HOB 30-45 degrees, upright 30-60 minutes after feeding
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| When do you irrigate enteral feeding tube? | Before/after feeding, medications, residual check
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| Assessments for enteral nutrition | Daily weight (very important, same scale, same time AM)
Bowel sounds before feeding
I&O
Glucose
Change tubing every 24 hrs
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| Complications of enteral nutrition | Vomiting, diarrhea, constipation, dehydration (especially high protein content)
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| Gerontologic considerations of enteral nutrition | Fluid/electrolyte imbalance
Glucose intolerance
Increase risk of aspiration
Decreased ability to handle large volumes
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| How much of body fluid is ICF? | 2/3
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| Which fluid space is least stable? | Vascular space (part of ECF)
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| Which fluid space is the fluid reserve? | Interstitial (part of ECF)
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| Movement from high solute concentration to low solute concentration | Diffusion
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| Example of active transport | Na-K ATP pump
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| Movement of water from area of low concentration to high concentration | Osmosis
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| Osmolarity measures: | Osmotic force of solute per unit of total volume
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| Osmolality describes: | Fluids inside body
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| Osmolarity describes: | Fluids outside the body
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| Oncotic pressure deals with: | Colloidal osmotic pressure (proteins)
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| What does a hypertonic IV solution do to cells? | Sucks water out of them, into the vascular space
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| Name the two major solutes in plasma. | Na and protein
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| Define osmotic pressure | Amount of pressure required to stop the osmotic flow of water
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| What is filtration? | Movement of fluid through a cell or blood vessel
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| What is hydrostatic pressure? | The force within a fluid compartment
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| Define homeostasis | State of equilibrium in the body
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| Water content of adult in % | 50-60%
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| Water content of older adult in % | 45-55%
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| Water content of infant in % | 70-80%
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| Intravascular fluid is: | ECF within the blood vessels
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| Interstitial fluid is: | ECF fluid between the cells
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| Transcellular fluid is: | ECF fluid in specialized cavities
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| First space fluid is: | Normal, fluid is where it should be
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| Second space fluid is: | Abnormal accumulation of interstitial fluid, edema
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| Third space fluid is: | Abnormal accumulation of fluid in part of body where it is not easily exchanged with ECF (ascites)
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| Hypovolemia symptoms | ↑ HR, ↑ RR, ↓ BP
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| Hypovolemia labs: | ↑ most labs, due to concentration from fluid loss
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| What is the most accurate assessment for hypovolemia? | Daily weight
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| Hypervolemia symptoms | Moist crackles, ↑HR, ↑RR, ↑BP
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| Hypervolemia labs: | Decreased values (dilutional effect)
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| Hypotonic IV fluids move water from: | from ECF to ICF
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| Isotonic IV fluids move water from: | Nowhere. Isotonic fluids expand only the ECF.
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| Hypertonic IV fluids require frequent monitoring of : | BP, lung sounds, Na
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| Dextrose 5% in water is used to: | Move fluid to ICF, increase renal excretion of solutes,
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| what is the preferred fluid for immediate response? | 0.9% Na or NS
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| What tonicity is Lactated Ringers? | Isotonic
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| Lactated Ringers contains which electrolytes? | NaCl, K, Ca, Phosphate
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| What tonicity is D5 1/2NS? | Hypertonic
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| Functions of Na | Maintains BP, balances volume of water in body, transmits nerve impulses for muscle contraction
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| Symptoms of hypernatremia caused by sodium gain | Seizures, thirst, flushed skin, peripheral and pulmonary edema
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| Symptoms of hypernatremia caused by water loss | Seizures, thirst, weight loss, postural hypotension, weakness
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| Functions of potassium | Controls cardiac rate and rhythm, excitability of nerves and muscles, regulates glucose storage
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| Trauma can cause: | Hyperkalemia (cells are crushed and release potassium into ECF)
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| Hyperkalemia symptoms | Irregular pulse, cardiac arrest (cardiac changes), lower extremity muscle weakness, paresthesia
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| Insulin helps which electrolyte imbalance? | Hyperkalemia
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| How does insulin help hyperkalemia? | Moves potassium from ECF to ICF
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| Frequent cause of hypokalemia is: | Use of diuretics
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| Hypokalemia symptoms | Cardiac changes, muscle weakness, polyuria, hypoglycemia
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| What is rate of administration of KCl? | 10-20 mEq/L over an hour, never IV push
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| Foods high in potassium | Bananas, bacon, potatoes, peas, lima beans, fruit juices, pecans
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| How should you administer liquid K+ supplement? | Dilute in juice to conceal bad taste
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| Only give potassium if: | kidneys are functioning
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| Functions of calcium | Maintains muscle tone, cardiac contractility (blood pressure), nerve transmission and contraction of skeletal and cardiac muscle
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| Most common cause of hypocalcemia | Prolonged immobilization
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| Hypercalcemia symptoms | Weakness, depressed reflexes, hypertension, confusion, kidney stones (nephrolithiasis), cardiac changes
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| Hypercalcemia treatment | Calcitonin (promotes renal excretion of calcium); 0.9% Na IV fluid followed by loop diuretic (Na follows Ca)
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| Hypocalcemia symptoms | Tetany, Chvostek's & Trousseau's sign, hyper-reflexes, tingling lips and tongue, cardiac changes
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| Functions of phosphate | Muscle contraction, calcium homeostasis, proper function of red blood cells
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| Hyperphosphatemia symptoms | muscle problems (tetany, twitching), bone and joint pain, cardiac problems, deposits of calcium phosphate in soft tissues
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| which electrolyte moves with phosphate? | Calcium
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| What is a common cause of hypophosphatemia? | Alcohol withdrawal
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| Hypophosphatemia symptoms | Cardiac dysrhythmias, CNS dysfunction, respiratory muscle weakness, slurred speech, confusion
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| Functions of magnesium | Muscular irritability and contractions, vasodilation, strong bones, transporter for Na and K across cellular membranes
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| Hypermagnesemia symptoms | Loss of deep tendon reflexes, bradypnea, bradycardia, hypotension, decreased level of consciousness
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| Treatment for hypermagnesemia | Calcium gluconate
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| What electrolyte imbalance are pts who undergo bariatric surgery susceptible to? | Hypomagnesemia
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| Hypomagnesemia symptoms | Hyper active deep tendon reflexes, tremors, seizures, dysrhythmias
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| Which electrolyte imbalance may develop with hypomagnesemia? | Hypocalcemia
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| Cause of pitting edema | Fluid volume excess
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| Cause of flushed, dry skin | Na excess
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| Cause of cold, clammy skin | Na deficit, shift of plasma to interstitial fluid
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| Cause of poor skin turgor | Fluid volume deficit
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| Cause of bounding pulse | Fluid volume excess, shift of interstitial fluid to plasma
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| Cause of rapid, weak, thready pulse | Na deficit, fluid volume deficit, shift of plasma to interstitial fluid
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| Cause of weak, irregular, rapid pulse | Severe K deficit
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| Cause of weak, irregular, slow pulse | Severe K excess
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| Cause of hypotension | fluid volume deficit, Na deficit, shift of plasma to interstitial fluid
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| Cause of hypertension | Fluid volume excess, shift of interstitial fluid to plasma
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| Cause of shortness of breath | Fluid volume excess
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| Cause of moist crackles | fluid volume excess, shift of interstitial fluid to plasma
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| Cause of restricted airway | Ca deficit
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| Cause of cramping of exercised muscle | Ca deficit, Mg deficit
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| Cause of flabby muscles | K deficit
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| Cause of picking at bedclothes | K deficit, Mg deficit
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| Cause of indifference | Fluid volume deficit, Na deficit
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| Cause of apprehension | Shift of plasma to interstitial fluid
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| Cause of extreme restlessness | K excess, Na excess, fluid volume deficit
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| Cause of confusion and irritability | K deficit, Na deficit, Ca excess, Mg excess, H20 excess
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| Cause of decreased LOC | Na deficit, H2O excess
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