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AHII - Chapter 13
| Intracellular vs. extracellular fluid | Intra: the fluid inside the cells Extra: the fluid outside the cells; it includes interstitial fluid, blood, lymph, bone, & connective tissue water, & transcellular fluids (CSF, synovial fluid, peritoneal fluid, & pleural fluid |
| Filtration | The movement of fluid (water) through a cell or blood vessel membrane because of hydrostatic pressure (water pressure) differences on both sides of the membrane |
| Osmosis | The movement of water only through a selectively permeable membrane to achieve an equilibrium of osmolarity; ***moves from a LOW to HIGH concentration; works with filtration to maintain ECF & ICF; ex: thirst mechanism |
| Osmolarity | Particle concentration in body fluid determines whether & how fast osmosis & diffusion occur; the number of milliosmoles in a liter of solution; normal range: 270 - 300 mOsm/L |
| Isotonic | Within normal range; ex: 0.9% saline, 5% dextrose in water (D5W) (*also used as a hypotonic solution), 5% dextrose in 0.225% saline (D5W1/4NS), lactated ringer’s; used to increase the extracelluar fluid volume due to fluid loss |
| Hypertonic | > 300 mOsm/L; ex: 3% saline, 5% saline, 10% dextrose in water (D10W), 5% dextrose in 0.9% saline, 5% dextrose in 0.45% saline, 5% dextrose in lactated ringer’s; used very cautiously due to quick side effects like pulmonary edema/fluid overload |
| Hypotonic | < 270 mOsm/L; ex: 0.45% saline, 0.225% saline, 0.33% saline; used when cells are dehydrated & fluids need to be put back intracellularly (happens when patients have diabetic ketoacidosis or hyperosmolar hyperglycemia) |
| Dehydration | When fluid intake is less than what is needed to meet the body’s needs; S/S: increased HR, decreased BP, distended neck veins, increased RR, & dry, sticky mucous membranes; assessment: skin turgor, PR & urine output (>30 mL/HR is BAD) |
| Fluid overload | An excess of body fluid; S/S: elevated BP, weight gain, SOB, crackles in lungs, pitting edema, & ***pulmonary edema; interventions: drug therapy, sodium restriction, & monitor I&O’s; rapid weight is an indicator -> weigh pt same time every day (in AM) |
| Sodium (Na) | Normal range: 136 - 145; “where sodium goes, water follows” |
| Hyponatremia | < 136 mEq/L; S/S: confusion, muscle weakness, diminished deep tendon reflexes, increased motility, with hypovolemia -> thready pulse, low BP, orthostatic hypotension, with hypervolemia -> full or bounding pulse w/ normal or high BP |
| Hypernatremia | > 145 mEq/L; S/S: short attention span, confusion/agitation, w/ fluid overload -> lethargic, stuporous, or comatose, mild -> muscle twitching, worsens -> muscles & nerves weaken, later -> absent deep tendon reflexes |
| Hypernatremia | S/S cont: w/ hypovolemia -> PR is increased, peripheral pulses are difficult to palpate, hypotension & orthostatic hypotension; w/ hypervolemia: slow to normal bounding pulses, peripheral pulses are full & hard to block, neck veins are distended, high BP |
| Potassium (K) | Normal range: 3.5 - 5.0; sodium-potassium pump: moves extra sodium ions from the ICF & moves extra potassium ions from the ECF back into the cell -> helps maintain levels; magnesium is another influencing factor for potassium balance |
| Hypokalemia | < 3.5; can be life threatening because every body system is affected; S/S: shallow respirations, muscle weakness, weak/thready pulse, altered mental status, decreased peristalsis (severe -> absent), dysrhythmias can lead to death (digoxin), U wave |
| Hypokalemia interventions | Priority: adequate gas exchange, fall prevention, injury prevention from potassium administration, & monitoring response to therapy; ***K+ infusion: check dilution, max rate is 5-10 mEq/hr (never exceed 20), NEVER GIVE IV PUSH, never given as IM or subq |
| Hyperkalemia | > 5.0; probs may not occur until > 8.0; S/S: cardiac is most severe - bradycardia, hypotension, tall T waves, early -> muscle twitches, worsens -> flaccid paralysis, respiratory not affected until lethal levels, increased motility |
| Hyperkalemia interventions | Priority: assessing for cardiac complications, fall prevention, monitor response to therapy, & health teaching for the prevention & early detection of complications |
| Calcium (Ca) | Normal range: 9.0 - 10.5; important for bone strength & density, activating enzymes, allowing muscle contraction, nerve pulse transmission, & enhancing blood clotting; PTH increases calcium; TCT decreases calcium |
| Hypocalcemia | < 9.0; S/S: charley horses, at first -> paresthesias, then -> twitching/painful cramps, Trousseau’s & Chvostek’s signs, slower or faster than normal HR, weak/thready pulse, increased peristaltic activity, osteoporosis, loss of height from bend in spine |
| Hypocalcemia interventions | Environmental management is needed due to overstimulation & injury prevention since bones become fragile |
| Hypercalcemia | > 10.5; cardiac is most severe -> mild: increased HR & BP; severe: slowed HR, blood clotting, slowed or impaired perfusion, severe muscle weakness & decreased deep tendon reflexes without paresthesia, decreased peristalsis (constipation) |
| Magnesium (Mg2+) | 1.8 - 2.6 mEq/L; important for skeletal muscle contraction, carbohydrate metabolism, generation of energy stores, vitamin activation, blood coagulation, & cell growth |
| Hypomagnesemia | < 1.8; increases the risk for hypertension, atherosclerosis, hypertrophic left ventricle, & a variety of dysrhythmias; S/S: hyperactive deep tendon reflexes, numbness & tingling, & painful muscle contractions, decreased intestinal muscle contraction |
| Hypermagnesemia | > 2.6; bradycardia, peripheral vasodilation, & hypotension, *severe -> cardiac arrest, drowsy, lethargy, reduced or absent deep tendon reflexes |
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tatianalopez03
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