GRCC AD 155 Fluid & lytes, and endocrine
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| intracellular | inside the cell and makes up 2/3 of body fluids
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| extracellular | intravascular and interstitial
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| what provides nutrients and cell metabolism | intracellular fluids within
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| Third spacing | shift of fluid from intravascular space into the interstitial space.
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| pleural effusion | excessive amount of fluid between the layers of tissue that line the lungs and chest cavity.
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| Ascities | excessive fluid in the space between the tissues lining the abdomen and ab organs (peritoneal cavity)
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| What is ascites cause by? | high pressure in the blood vessels of the liver and decreased albumin levels.
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| When there is a shift in fluid into the interstitial spaces | edema caused by injury when there is a shift of fluid into the interstitial space.
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| Thirst | regulation of fluid balance triggered by the hypothalamus
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| The hypothalamus is stimulated by | dry MMM,blood volume drop, increase serum osmoality.
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| serum osmoality | measures solutes in the blood.
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| kidney | regulate excretion and retention of water and lytes
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| RAAS | regulates B/P and blood volume.
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| Renin | enzyme that triggers angiotensin
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| angiotensin | in the lungs turns into angiotensin II
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| angiotensin II | regulates bp and blood volume
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| angiotensin what does it do? | it stimulates angiotensin II
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| Angiotensin II stimulates the adrenal cortex | Aldosterone
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| Aldosterone | boosts water reabsorption- aka retain water
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| Angiotensin II also stimulates | ADH - antidiuretic hormone
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| Renin stimulates BP in what way? | It increases BP by constricting the blood vessels.
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| How does RAAS work to maintain intravascular-fluid balance and blood pressure | Thirst increases, BP increases with constriction of BV, and retains water
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| Blood pressure drop triggers hypothalamus and pituatary to release | ADH
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| ADH | helps to retain fluid by stimulated water reabsorption
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| ANP | This hormone is triggered in response to overdistension of the heart.
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| This is secreted by cells lining the atria d/t | overdistension
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| When pt has fluid overload and atria stretches, which hormone is stimulated? | ANP is stimulated causing an increase in urine output - includes water and sodium
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| insensible loss | dehydration d/t excess expiration, moisture from the lungs exit body
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| Examples of fluid shift causes | burns, edema from injury and pleural effusion.
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| Diabetes insipidous | results from ADH deficiency which leads to large amounts of diluted urine excretion
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| Pt suffering with diabetes insipidous excretes how much urine per day? | 30 liters
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| What are clinical manifestations of dehydrations? | neurological changes, dry/cracked pale MMM, diminished skin turgor, oliguria and increase in urine specific gravity
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| longitudinal furrow | located on tongue d/t dehydration.
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| What happens to the metabolic process when there is hydration | increase or decrease body temp.
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| measures how much space/volume in the blood is occupied by red blood cells. It is useful when evaluating a person for anemia | hematocrit
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| A protein within the red blood cells that is pigmented and carries oxygen | hemoglobin
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| hemoconcentration | dehdyration causes concentrated blood; A decrease in plasma volume resulting in an increase in the concentration of red blood cells in blood.
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| plasma | A decrease in plasma volume resulting in an increase in the concentration of red blood cells in blood.
1.The colorless fluid part of blood, lymph, or milk, in which corpuscles or fat globules are suspended.
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| lab results to id hemoconcentration | Increase in Hct of 4:1 ratio where as 12 gm of hgb: 48% of Hct
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| Increase in serum osmoality | dehydration causes this lab assess result to read over 300mOsm/kg
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| Increase in glucose, protein | dehydration
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| What happens to sodium when there is loss of water? | increase sodium
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| Oral rehydration | must contain electrolytes when trying to reverse dehydration.
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| IV therapy for dehydration if Na is high | D5W - 5% dextrose and water.
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| How is D5w given? | Slowly over 48 hours
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| d5w does what? | It pulls water into the cell and causes swelling- may cause brain swelling if given too quickly
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| what do you give if Na is normal with someone who is dehydrated? | NS- an isotonic soln
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| isotonic sln | means that it is equal or like whats in our body, such as normal saline.
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| Isotonic sln can be given at what rate? | More rapid than d5w
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| When is isotonic given | when both fluids and solutes are deficit r/t diarrhea and vomitting.
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| cytsalloids | IV therapy- solutions w/ small molecules that flow easily from blood stream into cells and tissue.
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| what are crystalloids used for? | to replace volume.
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| Isotonic solutions | soln with solute concentration equal to the osmolarity of normal body fluids.
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| what is the most common isotonic solutuion | 0.9% sodium chloride
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| Lactated ringers | additional lytes and normal saline
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| d5w | acts hypotonically
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| hypotonic solutions | draws water into the cells from the extracellular cells
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| water leaves intravascular and enters into intracellular cells and causing them to swell | hypotonic sln
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| Hypertonic soln | draws water out of cells
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| Intacellular cells shrink as water is drawn out them and enters into the extracellular space | hypertonic soln
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| t or f: dr orders need to include rate, solution, and additives for IV | True
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| colloids | plasma expanders
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| what pulls fluid into the blood stream, are large molecules to prevent leakage into the tissue | colloids
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| what are colloids used for? | aggressive fluid resuscitation
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| Risk of colloids? | cardiac arrest r/t fluid overload.
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| Medication examples of colloids | albumin, dextran, hetastarch
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| TPN | IV with highly concentrated hypertonic nutrient solution.
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| how is tpn administered | through a large central vein or PICC
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| what is TPN made up of? | concentration of glucose and dextrose with other nutrients
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| risk of TPN - fluid imbalances | Fluid shifts, hyperglycemia, fluid overload, and pulmonary edema, and lyte imbalances
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| Centeral vein line | placed in central vein such as subclavian or internal jugular and sits right above the right atria.
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| PICC | simialar to central, but is a longer catheter for prolonged treament.
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| vas port | a port planted under the subq skin. access port with a 90 degree bent needle (huber)
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| Hickman, broviac or groschong | iv therapy for long term; tunnel external cath that tunnels into the ab area for easy access and less risk for infection.
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| infiltration | fluid leaks from the cath into the surronding tissues causing swollen area.
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| s/sx of infiltration | tight, hard, swollen, skin is cold to touch and is painful, may see leak at site.
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| phlebitis or thrombophlebitis | inflammation of the vein.
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| s/sx of phlebitis or thrombophlebitis | pain, redness, red streak, sluggish flow; vein that is cordlike, skin may feel warm
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| which complication of iv therapy would a person have warm skin? infiltration or phlebitis? | phlebitis or thrombophlebitis
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| which iv complication would the extremity be cold, painful and sluggish blood flow return? | infiltration
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| phlebitis or thrombophlebitis | which IV complication would you see cord like redish marking on an area where an iv was placed?
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| s/sx of infected iv site | tender, warm, redness, purulent drainage,
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| hematoma | IV complication that causes bruising that occurs during insertion, clot disease or pt pulls out cath without holding pressure.
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| Extravasation | IV therapy complication that occurs from vesicant drugs that infiltrate iv site that induces blistering
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| vesicant | an agent that induces blistering.
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| s/sx of extravasation | pain, burning, swelling, blisters, and possible necrosis/disfigurement.
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| what are some IV meds that cause extravasation | chemo, BP meds (vasopressor), and potassium
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| what are intervention when you suspect someone has extravasation | stop infusion, follow policy, disconnect tubing and aspirate any remaining drug from cath, call doc and administer antidote per cath into subq tissues, elevate arm and apply ice.
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| s/sx of fluid overload | Increased BP, Increase respiration, SOB, Crackles
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| Speed shock | facial flushing, dizziness, irregular pulse, decreased BP, severe HA
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| Speed shock can lead to? | LOC and cardiac arrest
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| An excess of isotonic fluid leads to overhydration and goes where? | it goes into the extracellular compartments
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| with over hydration, what does body retain? | Water and sodium
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| The retention of water and sodium can be from | kidney failure, CHF r/t ineffective pumping
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| Another cause overhydration is fluid shift from | interstitial to intravascular space
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| What causes fluid shift from interstitial to intravascular space? | surgery (i.e. open heart) or burn
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| Why would you have SOB, crackles and a cough with fluid overload? | because fluid is in the lungs.
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| What does pulse sound like when somone has fluid overload? | bounding (+3 or +4)
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| If someone has a wt gain of 5lb or more in a week, distended neck and hand veins they are likely | overhydrated.
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| where sodium goes | water follows
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| diuretics | this blocks sodium so that more water is going to be released
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| High ceiling Loop diuretics | lasix,edercin, bumex and demadex
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