F/e Standards

Front 1

Isotonic Solution Examples...

Back 1

Lactated Ringers (LR)
0.9% Sodium Chloride (Normal Saline)
5% Dextrose in water (D5W)

Front 2

Hypotonic Solutions Examples..

Back 2

0.45% sodium chloride ("half-normal" Saline)
0.33% sodium chloride ("third-normal" saline)
0.225% sodium chloride

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Hypertonic Solution Examples...

Back 3

5% dextrose in 0.45% sodium chloride (D545 or D5 1/2)
5% dextrose in 0.9% sodium chloride (D5.9 or D5 Normal)
5% dextrose in lactacted ringers (D5LR)

Front 4

% Body weight that is water

Back 4

60%

Front 5

Intracellular (ICF)

Back 5

fluid found with in the cells. 40% of the total body weight

Front 6

Extracellular Fluid (ECF)

Back 6

fluid located outside the cells

Front 7

3 types of extracellular fluids...

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Interstitial
Intravascular
transcellular

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Interstitial fluid

Back 8

located in the spaces between most of the cells of the body

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intravascular fluid

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2.5 liters serum(plasma) found with in arteries, veins, and capillaries
(Intravascular Volume)

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transcellular fluid

Back 10

cerebral spinal fluid, urine: fluid that does not move around

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3 main ways water moves

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Filtration
Diffusion
Osmosis

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2 types Filtration

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Hydrostatic Pressure
Disequilibrium

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Hydrostatic Pressure

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created my the pumping action of the heart and gravity against the capillary wall

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Disequilibrium

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loss or lack of equilibrium disequilibrium in a resting nerve cell

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Diffusion

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process by which solute molecules move from one area of high solute concentration to an area of low solute concentration

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2 types of diffusion

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facilitated diffusion
active transport

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facilitated diffusion

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(carrier mediated diffusion) allows large waater soluable molecules, such as glucose and amino acids to diffuse across cell membranes

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active transport

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the movement of ions or molecules across a cellular membrane from a lower to a higher concentration, requiring the consumption of energy.

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Osmosis

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water moves from low solute to high solute

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Osmotic pressure

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important to keep fluids balanced in the body

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Normal Fluid Balance in the body..

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270-310 milli osmols

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Isotonic Pressure

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(equal) have the same concentration of solutes as plasma. Cells will neither shrink nor swell because there is no net gain or loss of water with in the cell, no change in the cell volume

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Hypertonic Pressure

Back 23

have greater concentration of solutes than plasma, water is drawn out of teh cell causing it to shrink

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Hypotonic Pressure

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have a lower solute concentration than plasma, When RBC's are placed in a hypotonic solution water moves into the cells, causing them to swell and rupture.

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ALdosterone

Back 25

increase tubual release of Na+

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Renin Angiotensin Aldosterone

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volume regulation

Front 27

ADH (Antidiuretic Hormone)

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-Holds water in the body
-released by anterior pituatary...hypothalmic
-Sensitive to increase serum osmolarity (Na+)
-Acts on renal tubules....more permeable to water.

Front 28

Parathyroid Hormone

Back 28

a hormone of the parathyroid gland that regulates the metabolism of calcium and phosphorus in the body (PTH)

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FVD(Fluid Volume Deficit)

Back 29

decrease intravascular, interstitial, and or intracellualr fluid in the body

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Dehydration

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loss of water alone, fluid deficit at the tissue and cellular level

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Hypovalemia

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can be dehydrated and be hypovalemia; fluid deficit in the intravascular space.

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third spacing

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space that shouldnt exist.
osmotic pressures
* Third spacing is not Edema*

Front 33

hypervolemia

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fluid volume excess

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Who has Hypervolemia?

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CHF pts.
Renal pts.
Pts. with sodium alterations

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Edema

Back 35

hydrostatic push (not third spacing)
vascular volume is maintained or excessive
--generalized (anasarca)

Front 36

Normal Serum range of Sodium

Back 36

135-145 mEq/L

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hyponatremia

Back 37

loss of Sodium

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Hypernatremia

Back 38

too much Sodium

Front 39

Normal serum range for K+ (potassium)

Back 39

3.5-5.0

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Hypokalemia

Back 40

loss of potassium

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Hyperkalemia

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too much Potassium

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Normal range for calcium

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8.5-10.0 mg/dL

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Ionized level of calcium range

Back 43

4.5-5.6

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Hypocalcemia

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too little calcium

Front 45

Hypercalcemia

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too much calcium

Front 46

Normal ranges for Magnesium

Back 46

1.6-2.6 mg/dL

Front 47

Hypomagnesemia

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too little Mg

Front 48

Hypermagnesemia

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too much Mg (very rare)

Front 49

normal range for Phosohorus

Back 49

2.5-4.5

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Hypophosphatemia

Back 50

low phosphorus levels

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Hyperphosphatemia

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too much phosphorus

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normal serum range for Chloride

Back 52

98-106 mEq/L

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6 Hormones to know for F/E

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Angiotensin II
ADH
Aldosterone
Natriuretic Peptide (NP)
Parathyroid Hormone (PTH)
Calcitonin

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Natriuretic Peptide

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ANP (atria) and BNP (brain) --body loses water and sodium...Inhibits renin

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Parathyroid Hormone

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causes body to raise blood levels of calcium---remember Ca and Phos inverse relationship so it causes body to lose Phosphate. Relesed by the parathyroid gland

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Calcitonin

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causes body to lower blood levels of calcium--remember CA and Phos inverse relationship so it causes body to raise the blood levels of phosphate. Released by the thyroid gland

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hypovolemia

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dehydration

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symptoms of Hypovolemia

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tachycardia
hypotension
decreased urine output
rapid breathing
confusion

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management for hypovolemia

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assess:
skin turgor
mucous membranes
Daily weights

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treatments for hypovolemia

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*treat the problem first*
increase Iv fluids
oral fluids

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Test results from Hypovolemia

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Serum and urine osmolarity (high)
HgB (high)
Weight- w/in 24 hour period anything greater that .5 lbs is not metabolic
central venous pressure monitoring

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Hypervolemia

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too much water (FVE)

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Symptoms of hypervolemia

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AMS
hypertension
Bradycardia
Dyspnea
crackles, rales
increased urine output
distented neck veins
bounding pulse
abdominal distention

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test results of hypervolemia

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hematocrit (low)
BUN (Low)
Hemoglobin (low)

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Management for hypervolemia

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Assess:
Daily weight
Strict I's and O's
Administer Diuretics (Lasix)
Fluid restrictions
monitor Na+ intake (possibly low)

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Anasarca

Back 66

generalized Edema

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90% of electrolytes is...

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Sodium

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Sodiums main function...

Back 68

management of fluid volume

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Where sodium goes...

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water follows

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Sodium is regulated and stored?

Back 70

Renally and is not stored

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Pathophysiology of Hyponatremia

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secreted out through vomitting, diarhea, GI suction and excess sweating

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Hyponatremia manifestations

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Serum soduim levels fall below 120 and cause AMS and headaches.
Lethargy
Muscle cramping
GI manifestations (cramping)

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management of hyponatremia

Back 73

treat the cause
IV fluids
NaCl tablets
increase sodium intake
Diuretics

Front 74

Pathophysiology of hypernatremia

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Too much sodium ingestion
increased insensible loss
tube feeders
adrenal problems

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Manifestations of hypernatremia

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too much in the intravascular space; move into the vascular space and cause dehydration.
--brain injuries
--muscle spasm
--muscle lethargy
--hypertension
--bounding pulses
--seizures
--personality irritability
*very dangerous*

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management of hypernatremia

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focus on restoring normal levels
decrease sodium intake
give hypotonic slutions IV
give diuretics

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Function of Potassium

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Glucose Utilization
--need potassium to attach to the insulin for it to work
*CHRONIC HYPOKALEMIA WILL HAVE CHRONIC LOW BLOOD SUGAR*

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Potassium is stored....

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inside the cells

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Sources of Potassium

Back 79

bananas
spinach
potatoes
tomatoes
tuna

Front 80

Potassium is regulated and stored....

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regulated in the renal system and is not stored (storage is maintained thru dietary absorption)

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pathophysiology of hypokalemia

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people who are on diuretics
significant GI body fluid loss
people who have resp. altercations

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manifestations of hypokalemia

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slowed muscle movement (crampy)
decreased Gi losses (V/D)
blood glucose alterations

Front 83

management of Hypokalemia

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Supplements (Oral and IV)
Monitor K+ levels closely

Front 84

Patho of Hyperkalemia

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increase intake of K+ (medical mismanagement)
pts. with existing acidosis
*people on chemo*

Front 85

manifestations/asssessments with hyperkalemia

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excitement
EKG changes

Front 86

Pseudo Hyperkalemia

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what looks like hyperkalemia but is not hyperkalemia. Happens with blood collection, possibility bad blood specimen.

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Management of hyperkalemia

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treat the cause first to restore balance
Give insulin
decrease K+
increase urinary output

Front 88

Calciums Function

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Muscle contraction (must have adequate amounts of calcium for contraction...cardiac contraction is very important)
Blood vessels

Front 89

Sources of calcium

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Dairy
kidney beans
soy beans
molasses
spinach

Front 90

Calcium is stored and regulated where?

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stored in the bones and renal regulated

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Patho of Hypocalcemia

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Alcoholics (absorption issues)
Lactose intolerance
high protein dieters
people with pancreatitis

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Manifestations of hypocalcemia

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very mild to very severe
numbness and tingly (fingers and lips)
hypotension
prolonged bleeding times

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Management of hypocalcemia

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make sure it is a low total calcium lab value.
check parathyroid hormone
replace calcium levels with supplements (oral and IV) Calcium Gluconate

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Patho with Hypercalcemia

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parathyroidism
people with malignancy
renal failures

Front 95

Manfestations with hypercalcemia

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Bones(achy weak bones)
Groans(Lethargy, confusion, CA)
Moans( just hurts)
Stones( kidney stones)

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Management with hypercalcemia

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if less than 12 give Calcitonin (Med)
Hydrate Dilute calcium level (diuretcis)
if very high give IV phosphate

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functions of magnesium

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-neuro/muscular (Relaxation)
--decrease Acetylcholine release at myoneural junctions..vasodilators effect
-Carb metabolism
--Mg deficiency is an identified risk factor for insulin resistance
-RNA production/ DNA replication

Front 98

Mg values are very important because....

Back 98

such a narrow range 1.6-2.6

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Sources of Mg

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green veggies
Nuts
fish
whole grains
peas and beans

Front 100

Mg is stored...

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in the bones

Front 101

Patho of hypomagnesemia

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anyone who has absorption problems
bowel ressections

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manifestations of hypomagnesemia

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increase in excitability with weakness (tremors)
cardiovascular (atrial fribulation)
increase in insulin resistance

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Management of hypomagnesemia

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supplements (oral or IV)
-Mag Sulfate

Front 104

Patho for hypermagnesemia

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*very rare*
renal Failure
Ingest too much Mg

Front 105

Manifestations of hypermagnesemia

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heart blocks

Front 106

Management with hypermagnesemia

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pt education
Dialysis
Give calcium to Combat it

Front 107

Phosphorous Functions

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Stabalizer cell membranes
ATP formation-creates energy cource
Fat Digestion
*most used in Acid/Base Balance*
-phosphate buffers

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Sources of Phosphorous

Back 108

Fish
dairy Products

Front 109

Phosphorous is regulated where..

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Renally

Front 110

Pathophysiology of hypophophatemia

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bad dietary intake
Acid/base unbalance

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manifestations of hypophosphatemia

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related to cell membrane; dysfunctional RBC's; Anemia
Muscle Weakness, Fatique, Lethargy

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management of hypophosphatemia

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Supplements (IV and PO)

Front 113

pathophysiology of hyperphosphatemia

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renal failure
too much intake of phosphorous (laxitive users)
parathyroid

Front 114

manifestations of hyperphosphatemia

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watch for people with hypocalcemia

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management of hyperphophatemia

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correct with calcium and it will correct the phosphorous
Rena-Gel- medication not calcium based and decreases serum phosphate levels

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Function of Chloride (Cl-)

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Acid Bace Balance

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cystic fibrosis

Back 117

have little fluid balance...low production of chloride

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main cations of ICF

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K+ and Mg

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main cations of ECF

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Sodiun

Front 120

main anion of ECF

Back 120

Chloride

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main anion of ECF

Back 121

Phosphate

Front 122

electrolytes with inverse relationships..

Back 122

K+ and Na
Ca and Phos

Front 123

hypotonic

Back 123

ECF fluid imbalance leads to ICF excess or cellular edema

Front 124

hypertonic

Back 124

ECF fluid imbalance leads to ICF deficit or cellular dehydration