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AD 155
Fluid & Electrolytes
| Question | Answer |
|---|---|
| Intracellular | inside the cell |
| Intracellular purpose | provides cells with nurtrients & assist in cellular metabolism |
| Extracellular | outside the cell. circulates between the cells. contain water, electrolytes, & nutrients |
| Extracellular made up of 2 compartment | intravascular & interstitial |
| Intravascular | in the bloodstream. arteries, vein, capillaries and contain plasma |
| interstitial | located in the spaces between most of the cells in the body |
| Third spacing | shift of fluid from intravascular space into a "third" or extra space. (serve no purpose) |
| regulation of fluid balances | thirst, kidneys, Renin-Angiotensin-Aldosterone System, Antidiuretic hormone, Atrial Natriuretic Peptide |
| Thirst | in the hypothalamus. |
| Thirst stimulated by | dry mucous membranes in the mouth, drop in blood volume, increase in serum osmolality |
| serum osmolality | lab test. measures amount of solut in the blood. |
| Kidneys | regulate excretion and retention of water and electrolytes |
| Adult produce | 1500-2500 in 24 hours |
| Renin-Angiotensin-Aldosterone system | works to maintain intravascular fluid balance and blood pressure |
| RAAS produce in_____ & _______ | kidneys and lungs |
| RAAS regulates______ _____, stimulates the kidneys to retain______ & ______ | blood pressure, sodium, water |
| ADH produced in brain ( ____ ) and stored in __ | hypothalamus, pituitary |
| ADH is triggered by________ in response to ___ ______ ______ or increassed______ _______. | hypothalamus, low blood volume, serum osmolality |
| ADH stimulates | water reabsorption in the kidneys |
| Atrial Natriuretic peptide | secreted by cells lining the atria in the heart as a rsponse to overdistention |
| when atria stretched too far (pt in _____ _____ ) the ANP is stimulated causing an increased in _____ _____ | fluid overload, urine output |
| fluid volume deficit that is a decrease in intravascular, intersitial and/ or intracellular body fluid | Dehydration |
| Decreased circulating blood volum and isotonic fluid loss from extracellular spaces | Hypovelemia |
| Etiology of dehydration | excessive fluid loss, insufficentt fluid intake, fluid shifts, failure of regulatory mechanism |
| Examples of excessive fluid loss | diarrhea, vomiting, sweating, blood loss, fever, insensible loss (breathing) over use of laxatives, use of diuretics, NG tube |
| Example of insufficient fluid intake | disable, bedridden, depend on others (infants & elderly), vent dependent, unresponsive(comatose), NPO |
| Example of fluid shifts | burns, edema from injury, wounds, ascites, plueral effusion |
| Dehydration clincial manifestation neurologic | altered mental status (irritability, anxiety, restlessness, confusion), decreased alertness, coma |
| Dehydration clinical manifestation: mucous membrane | dry sticky tongue, decreased tongue size, longitudinal furrows (cracks) |
| Dehydration clinical manifestation: skin | diminished skin turgor (elderly,assess on forehead or sternum, not hand or arm), dry skin(not a good indicator in elderly), sunken eyeballs(hard to assess) |
| Dehydration clinical manifestation: urinary | decreased urine output (oliguria), increased specific gravity |
| Dehydration clinical manifestation: cardiovascular | decrease B/P, orthostatic hypotension, tachycardia, flat neck veins, decrease pulse volume, decrease capillary refill time, incrase hematocrit |
| Hemoglobin:Hematocrit normal ratio is | 1:3 |
| minimum urine output standard | 0.5ml/kg body wt/hr (new standard) |
| Dehydration clinical manifestation: musculoskeletal | fatigue, weakness |
| Dehydration clinical manifestation: metabolic processes | increased or decreased body temp, thirst, weight loss |
| Dehydration: collaborative Management | assessment of clinical manifestations, vital signs esp B/P, intake and output,*daily weight* |
| Dehydration laboratory assessment:hemoconcentration | increase HCT:4:1 rtio...12gm HGB/48%HCT, normal HGB/HCT ratio=3:1..12gm Hgb/36%Hct. |
| Dehydration laboratory assessment: increased serum osmolality | (>300mOsm/Kg) glucose,protein, BUN, and NA |
| urine: especially ____ ____> ____ | specific gravity, 1.030 |
| Dehydration collaborative management: fluid replacement: oral rehydration contains____,____,_____,medication treat_____ ____, intravenous therapy | electrolyte, gatorade, pedialytes & underlying cause |
| Dehydration: fluid replacement (intravenous therapy) | fluid challenge:administer a specified amt of fluid over a short time and monitor closely |
| what does a continous IV needs to include? | A doctor order include slolution, rate, and additives(potassium) |
| what IV solution to give if Na is high | D5W, give slowly over 48 hours, cause cell to swell |
| what IV solution to give if Na is not elevated? | NS, isotonic fluids can be given more rapidly |
| solutions with small molecules that flow easily from the bloodstream into cells and tissues | crystalloids |
| Types of crystalloids | Isotonic solutions,Hypotonic solutions, hypertonic solutions |
| any solution with a solute concentration equal to the osmolarity of normal body fluids | Isotonic solutions |
| Types of isotonic solutions | 0.9% sodium chloride(NS) most common one, Lactated Ringers. |
| Isotonic solution: lactaed Ringers contains | sodium, potassium, chloride and calcium concentrations similar to plasma levels |
| any solution with a solute concentration less than that of normal body fluids. Draws water into the cells from the extracellular fluid called? | hypotonic solutions |
| Types of hypotonic solution | 0.45% sodium Chloride (1/2NS), and 5% Dextrose in water (D5W) |
| any solution with a solute concentration greater than that of normal body fluid, draws fluid from intracellular space | Hypertonic solutions |
| Types of hypertonic solutions | 5%Dextrose &0.9%Sodium chloride (D5NS) and 5% Dextrose in Water (D10W) very concentrated |
| crystalloids are use | to replace volume and hydrate |
| Plasma expanders | colloids |
| Function of colloids | pull fluid into the bloodstream, large molecule can't link out of blood stream. use in aggressive fluid replacement (i.e burns) |
| Examples of colloids | Albumin, Dextran, hetastarch(Hespan) |
| Any route outside of GI system | parental |
| highly concentrated, hypertonic nutrient solution administered through a large, central vein | TPN ( total parenteral nutrition) |
| Like TPN except maximum of 10% Dextrose in peripheral vein. | Peripheral parenteral nutrition |
| TPN triggers | debilitating illness greater than 2 weeks, loss of 10% or more of pre-illness weight, excessive nitrogen loss, nonfunction of GI tract lasting 5-7 days |
| complications of TPN: ______ _____ , fluid shifts between ____ compartment,_____ leading to diuresis & _____, always a risk for ____ ____ &_____ _____ | fluid imbalances, body, hyperglycemia &dehydration, fluid overload , pulmonary edema |
| used for short-term or intermittent therapy; usually use veins in arm or hand; a short,plastic, flexible catheter is inserted into the vein( needle portion is removed) | peripheral lines |
| placed in a central vein such as subclavian or internal jugular; can be single or have multiple lumen( can hook up to three fluids to it); sits right above the right atria | central venous catheter |
| intermediate-term therapy; long catheter (less chance of infection); commonly used in hospital& homecare.Nse needs to be certified in inserting or done in interventional radiology | peripherally inserted central cathether |
| long-term therapy such as chemotherapy;a port is implanted under the sub q skin; access port with a 90 degree bent needle(huber) | vascular access port |
| long-term therapy for nutrition or antibiotic therapy; tunnel external catheter; still a central line, but tunnels into abdomen area for easy access for pt | Hickman, Broviac, Groshong |
| possible complication of IV Therapy:Local | infiltration, phleblitis & thrombophleblitis, infection, hematoma and extravasation |
| fluid leaks from the catheter into the surrounding tissue | infiltration |
| sign & symptoms of infiltration | cool at site, pain, swelling, leaking, lack of blood return(not always reliable) |
| inflammation of the vein is called_____ and inflammation cause by a blood clot is called___ | phlebitis, thrombophlebitis |
| sign and symptoms of phlebitis & thrombophlebitis) | pain(pt states it tender), redness, red streak, sluggish flow, vein hard & cordlike(classic sx) |
| bacterial contamination at the site | infection |
| symptoms of infection | tenderness, redness, warmth, drainage |
| leaking of blood into surrounding tissue, usually occurs durig insertion or in pt with clotting disorder | hematoma |
| symptom of hematoma | bruising, pain |
| infiltration of a vesicant drugh | extravasation |
| symptoms of extravasation | pain, swelling, burning, blistering, possible necrosis, possible disfigurement |
| Intervention for extravasation | stop infusion, follow agency protocol, aspirate any remaining drug from catheter,administer antidot per catheter or inject into subq tissue, disconnect tubing, elevate arm, apply ice, call dr. |
| possible complication of IV therapy: systemic | bloodstream infection,allergic reaction, speed shock, fluid overload |
| pathogens enter the bloodstream resulting from poor aseptic technique | bloodstream infection |
| symptom of bloodstream infection | fever |
| Too much fluid leaking into alveoli | fluid overload |
| symptom of fluid overload | increased BP, increased respiration, SOB, crackles |
| Too rapid infusion of fluid & especially meds | speed shock |
| symptoms of speed shock | facial flushing, dizziness, irregular pulse, severe headache, decreased BP, loss of consciousness, arrest cardiac |
| local or general reaction to tape, cleansing agent, latex catheter, solution or medication | allergic reaction |
| symptoms of allergic reaction | itching, wheezing, bronchospasm, rash |
| Fluid overload: Etiology | excess of isotonic fluid in the extracellular compartment, retention of both water and sodium, fluid shift from interstitial to intravascular space(remobilization of fluids after surgery or burn treatment, administration of hypertonic fluids or albumin |
| Clinical manifestations: fluid overload;____ ___,full___ pulse, pitting____,____edema, distended___ ___, tachycardia&/or____ SOB, crackles & /or____ | weight gain,pounding, edema, periorbital,neck vein, dyspnea, cough |
| collaborative Management of Fluid overload | fluid restriction(I&O), sodium restriction(limit amt of sodium), Diuretics |
| Physiologic action of diuretics | blocking of sodium and chloride reabsorption in the kidney, |
| drugs whose action is earliest in the nephron produce the greatest diuresis | PCT, Loop of henle |
| drugs whose action occurs in the distal parts of the nephron produce less diuresis: | DCT |
| adverse effects of diuretics | dehydration, acid-base imbalance, electrolytes imbalance esp potassium |
| High-Ceiling (Loop) Diuretics | Lasix(Furosemide), Edecrin(ethacrynic acid),Bumex(bumetanide) IV & PO, demadex(torsemide) |
| Lasix(furosemide) action | acts in loop of henle to block reabsorption of sodium and chloride,prevents passive reabsorption of water as a result diuresis |
| Lasix: pharmacokinetics | oral: diuresis begins in 60min & lasts for 8hrs, IV: diuresis begins in 5min &lasts for 2 hrs. |
| Lasix: therapeutic uses | pulmonary edema, edema, HTN, severe renal impaiment |
| Lasix: adverse effects | dehydration, hypokalemia, hypotension decrease in blood volume, ototoxicity, hyperglycemia,hyperuricemia |
| Lasix: Drugs interactions | digoxin:lasix,hypokalemia, digoxin=dig toxicity,potassium-sparing diuretic hold on to potassium, antihypertensive low blood pressure give lasix= lower blood pressure |
| Lasix Implications | timing of doses: give in a.m. B.I.D give in a.m. and 2:00p.m. to minimize nocturia,IV push administration, give IV push slowly 20mg,min, Patient teaching, weigh daily, watch excessive wt. gain/loss |
| Example of Thiazide and related diuretics | Esidrix,Oretic, Hydrodiuril (hydrochlothiaide), Diuril, Diurigen(Chlorothiazide),Zaroxolyn, Mykrox(metaolazone) |
| enhances the effect of Lasix, give 30 minutes before lasix | Zaroxolyn(metolazone) |
| Thiazide: action | promotes urine production by blocking reabsorption of sodium and chloride in the early segment of the distal convoluted tubule. less diuresis |
| Thiazide: therapeutic uses | essential hypertension, 1st drug of choice for HTN, edema mild to moderate |
| Thiazide: adverse effect | dehydration, hypokalemia, hyperglycemia, hyperuricemia |
| Thiazide: Drugs interaction | Digioxin, digoxin+thiazide+low potassium = dig toxic, potassium-sparing diuretics hold on to potassium, antihypertensive= lower blood pressure |
| Thiazide: implication | give in a.m. B.I.D give in a.m. and 2:00p.m. to minimize nocturia, IV push administration give slowly 20mg/min, patient teaching, weigh daily, watch excessive wt. gain/loss |
| Potassium-sparing diuretics | aldactone(spironolactone), Dyrenium (triamterene)-Dyazide & Maxzide are combinations with HCTZ, Midamor (amiloride) |
| potassium-sparing diuretics two useful responses: | increase urine output, decrease potassium loss |
| Potassium-sparing drugs ___used alone, used with other ____ | rarely, diuretics |
| Aldactone (spironolactone) action | retention of potassium, excretion of sodium, scant diuresis, effects take up to 48 hours to develop |
| Aldactone(spironolactone) therapeutic uses | HTN, edema especially CHF pt, commonly used with loop or thiazide diuretic to counteract potassium wasting |
| Thiazide: adverse effects | hyperkalemia |
| Thiazide: nursing implications | limited potassium rich foods |
| Osmotic Diuretics | mannitol |
| Mannitol(osmotic diuretics) action | osmotic force within the nephron that prohibits reabsorption of water.The greater the concentration=greater diuresis |
| Mannitol: pharmacokinetics | IV only |
| Mannitol: therapeutic uses | prophylaxis of renal failure, reduction of intracranial pressure-most frequent use to pull fluid out of brain tissue |
| mannitol: adverse effects | edema can leave capillary beds anywhere except in the brain |
| mannitol: administration | concentrations of 5% to 25%(more diuresis) can crystallize at low temperature, warm to dissolve crystals and cool to body tempeerature, in line filter d/t crystals |
| additional collaborative management of overhydration | monitor vitals sign, I&O, First sign comes from daily weights |
Created by:
gloriasanders
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