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Fluid and Electrolyt
Napa Nurs141
Question | Answer |
---|---|
Serum Value for Sodium Na+ | 135-145 |
Serum Value for Potassium K+ | 3.5-5.0 |
Serum Value for Ionized Calcium CA+2 | 4.4-5.5 |
Bicarbonate | 22-26 arterial, 24-30 venous |
Chloride Cl- | 95-105 |
Magnesium Mg 2+ | 1.5-2.5 |
Phosphate PO4 3- | 2.8-4.5 |
6 functions of fluids | Transport of nutriets to and wastes from cells, maintain nL body temp,lubricates and cushions,facilitates digestion and elimination,maintains vascular volume and solvent for e-lytes |
4 functions of e-lytes | body water regulation and osmolality,acid-base balance,enzyme activity,neuromuscular activity |
% of intracellular fluids | 40 |
% of extracellular fluids | 20 (5 intravascular, 15 Intertitial) |
Average L of water in adult | 28L M 20L women |
Contains lymph,fluid between the cells and outside the blood vessels | Interstitial fluid |
Blood plasma found in vascular system | Intravascular fluid |
Fluid seperated from other fluids by a cellular barrier | Transcellular |
Increase in TBW | Infants |
Increase in TBW | Muscle |
Decrease in TBW | Elderly |
Decrease in TBW | Fat (more adipose tissue) |
An element or compound that, when dissolved in water or another solvent seperates into ions that are electrically charged | Electrolyes |
+ charged e-lytes | cations |
ICF Cations (+) | Potassium, Magnesium, Sodium |
ICF Anions (-) | Phosphates, sulfates, Bicarbonates, Proteniates |
MEq/L represents | the number of grams of the specific e-lyte dissolved in a L of plamsa (solution) |
4 processes fluids/solutes move across membranes | osmosis, diffusion, filtration, active transport |
Osmosis | The movement of a pure solvent, (water) across a semi-permmeable membrane from an area of LOW concentration to HIGH concentration |
Osmolarity | The concentration of solutions, reflects the number of molecules in a L of solution (mOsm/L) |
Diffision | Solution across a semi-permenable membrane from HIGH to LOW area of contrentration |
H+ ion concentraion in the blood | PH |
NL pH | 7.35-7.45 |
A product of metabolism | Hydrogen |
Donates H+ ions | Acids |
Accepts H+ ions | Bases |
Most effective way to measure/evaluate acid-base balance | ABG Aterial blood gas |
Increased pH | Alkalosis |
Decreased pH | Aciddosis |
Excessive vomiting and excessive fluid loss | Hypovolemia |
Unble to respond to thrist mechanism | Dehydration |
The concentrations of of solutions | Osmolarity |
nL serum osmolatity | 275-295 mOsm/kg |
<275 | hypotonic |
>295 | hypertonic |
Fluid body gains | foos, fluids,oxidative metabolsim |
Fluid body loss | Lungs, skin, GI tract and kidneys |
One key way a cell gains useful energy | oxidative metabolsim |
Movement of fluids from low conc to high conc | osmosis |
move together across a memebrane in response to fluid ppressure | filtration |
primamary regulator of fluid intake | thirst |
6 mechanisms that trigger the thirst center | Increase plasma osmolality, angiontension 2, dry oropharyngeal, psychological factords, decrease potassium or increase sodium, decrease plasma volume |
horomone that increases BP | angiotension |
major organ for retention and excretion of fluids | kidneys |
pressure excerted by a fluid at equalirium due to the force of gravity | hydrostatic pressure |
GFR | 125mL/min |
nL urine output | 20-30m/hr |
process of renin-angiotension-aldosterone system | decreased BP or decreased Na triggers glomerulsu to excrete renin that then triggers the LIVER to convert angiotension to angiotension 1 to LUNGS to then convert abgiotension 1 to angiotension 2 which triggers adreanals to secrete aldosterone |
What does aldosterone do after its secreted by the adrenals | increases reabsorption of Na and water to release K in the kidneys which increases blood volume and increases BP |
Causes vasoconstriction and production of alsodterone, resulting in increase of BP | Angiotension 1 and 2 |
Drugs that interfere with the secretion or action of aldosterone | antihypertensives |
Sodium % in ECF | 90 |
nL ECF serum sodium | 135-145 mEq/L |
Role of sodium balance | control water distribution and volume |
nL serum for NaCL | 50-90mEq |
Organ that excretes Na as needed | kidney |
requires metabolic activity and expenditure of energy to move substances across cell membrane (ATP) | Active Tranport |
Functions of Potassium | regulation of ICF, nerve impulses, maint of acid-base balance |
Irregular HR if decreased | Potassium (K+) |
Food sources of K+ | meats, bananas, avacados, dried fruits, nuts, chocolate |
K+ < 3.5 | hypokalemia |
Causes of hypokalemia | Inadequate butrient intake, GI losses, renal loss, stress, strriods, alkalosis |
sxs of hypokalemia | weakness, paralyisis, leg cramps, anorexia, vomiting, SOB, apnea, polyuria (excessive urine) |
Calcium serum levels | 8.5-10.5 |
99% stored in teeth, bones | Calcium |
Bound with protein and ionized | Calcium |
Ionized Calcium serum levels | 4.5-5.5 mEq/L |
Regulation of calcium | vit d, phosphates, PTH, Calcitonin |
PLasma serum concentrations | 1.5-2.5 mEq/L |
2/3 found in bones, 1/3 in ICF, 1% ECF | Magnesium |
Small bowel | Magnesium absorbed |
kidney | Magnesium excreted |
Major chemical buffer in ECF and ICF | HCO3 (Bicarbonate) |
nL serrum Bicarbonate | 20-26 |
< 22 HCO3 | Metabolic acidosis |
> 26 HCO3 | Metabolic alkalosis |
Regulated by the kidneys | Bicarbonate |
< 7.35 pH | Acidosis |
>7.45 pH | Alkalosis |
PaCO2 serum levels | 35-45mmHg |
<35 PaCO3 | hypocapnia (decreased o2 consumption) |
>45 PaCO2 | hypercapina (increased o2 consuption) |
HCO3 serum levels | 20-26mEq/L |
<20 HCO3 | acidosis |
>26 HCO3 | alkalosis |
The accumulation of fixed acids and loss of base (high acid in the blood) | Metabolic acidosis |
Diahhrea, renal disease, ketacidosis, ingestion ASA, renal tubular acidosis | causes of metabolic acidosis |
Kussamuls respirations, starvation, headache, hyperventation, hypotension, decresed pH decreased HCO3, decreased PaCO3 | sxs of metabolic acidosis |
Inadequate excretion of CO2 and acute/chronic respiratory alterations | Respiratory acidosis |
headache, hypertension, hyperkalemia, hypoxemia(decreawsed O2 in blood) dyspensea (sweating)increased RR, decreased pH | sxs of respiratory acidosis |
hypoventalation, increased HR, decreased LOC, hpokalemia, hypocholoermia, tetany, increased pH, increased HCO3 | sxs of metabolic alkalosis |
hyperventalation, hypoxemia, anxiety, fever | causes (hyperventalation) of respiratory alkalosis |
lightheaseded, inability to concentrate, palpations, dry mouth, hypotension, blurred vsision, increased pH, decreased PaCO2 | sxs of respiratory alkslosis |
3 influencing factors of TBW | Body fat, sex and age |
lose more fliuid due to insensible water loss | infants |
infants | decreased ability to concentrate urine |
deminished thrist respone | elderly |
elderly | altered ADH response |
Risks for F/E imbalances | CHF, renal failure, cirrohsis, ADH stimulation (Stress), excess sodium containing fluids.foods, IV solutions |
druds, GI, restraints, skin, fever, blood loss | alterations in fluid intake and output |
B U N | blood urea nitrogen |
BUN serum levels | 7-20 mg/dL |
Serum plasma creatinine | .7-1.2 mg/dL |
Measures hydration, status, electrolyte concentration in bld plasma and acid-base balance | Diagnostic tests for FVD or FVE |
decrease intravascular and interstitial fluids | hypovolemia (FVD) |
equal water and electrolyle loss, = hypovolemia or dehydration | Isotonic FVD |
Isotonic defiect sxs | decreased pulse, decreased BP, decreased skin turgor, decreased weight, decreased LOC, increased RR and temp |
Diagnostic tests 4 FVD | serum increase sodium >145, BUN > 25, hematocrit > 50%, specif gravity > 1.025 |
Abnormal fluid reetention in intravascular and interstitual space (sodium and water retained) | extracellular FVE |
CHF, renal failure excessive sodium intake, increased serum aldosterone, steriods | Isotomic FVE causes |
FVE sxs | weight gain, distended veins, constant cough, dsypnea (upset stomach), cynosis |
FVE diagnsotic tests | decreased sodium levels, decreased hematocrit, decreasewd specific gravity, BUN |
Hypoosmolor FVE | water gain and electrolyle gain |
Hyperosmolar FVD | water loss and electrolyte loss |
ICFVE | fluid shift from extracellular spaces to intracellular, due to serum serum hypo-osmolality |
Potassium falls below 3.5 | Hypokalemia |
Imbalance of Na on cell >145 meQ/L | Hypernatremia (cell shrinks) |
overexcitment of nervous system, twinges in fingers and toes | alkalosis |
CNS changes from failure of swollen cells, confusion, anxiety, anorexia, nasusea | sxs of hyponatremia |
deep rapid breathing, Kussamuls, decreased pH | evidence that the compensory mechanisms are working in metaboilicacidosis |
What is the major cause od metabolic acidosis | kidney disease |
water leaves the cells and moves to the bloodstream | dehydration |
Na < 135mEq/L | Hyponatremia |
sxs of hypernatremia | thrist, weakness, disorientation, lethargy, muscle irritabilty |
sxs of hyponatremia | nausea, malaise, headache, fatigue |
causes of hyperkalemia (K+) | decreased K ewxcretion, high potassium intake, shift K out of cells |
sxs hyperkalemia | nausea, hyperactive bowel sounds, cardiac arrest, dysrythemias, EKG changes, anuria (non passaage of urine) paresthesia |
causes for hypercalcemia | metastatic cancer, immobolization, hyperthyroidism, intake of diueretics, Lithium, excess intake of Ca anatcids |
sxs of hypercalcemia | nuero weakness, polyuria, hypercalcuria, decreased peridtsalisis, cardiovacular |
sxs of hypocalcemia | tetany, parasthia, trousseaua sign, chvostek's |
dimished nuero transmission, decreased muscle funciton, hypotension, respr depression, cardiac arrest | hypermagnesemia sxs |
<1.8 mg/dL | hypomagnesemia |
Losses from GI tract, alcoholism | causes of hypomagnesemia |
DVD, FVE, Ineffective breathing pattern, Impaired mobility, Impoaired skin ingrity, Altered oral mucous membranes | Nursing Diagnosises |
Nursing Interventions | Assess colume status |
Obtain daily weights | Nursing Intervention |
Monitor Lab vlaues | Nursing Interventions |
Mouth Care, protect skin, measure I and O | Nursing Interventions |
Purpose of fluid therapy | Maintain fluid and electrolyte balance, replacement and correction in elctrolyle disturbances |
Aqeuos solution mineral salts or other water soluble molecles | Crystalloids |
Crystalloids | sodium chloride solutions, 0.45% NaCl, hypotonic |
Balance electrolyle solutrystalloidsions (Lactate Ringers) | Crystalloids |
Colliods | Protien or starcth molecules in fluid |
Increase osmotic pressure-volume expansion for fluid replacement | Colliods |
Dextran | Colliods |
Hetastarch | Colliods |