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80 Cards in this Set

  • Front
  • Back
How much of a fluid loss is fatal?
20%
Normal Sodium level
135-145 mEq/L
Normal Potassium level
3.5-5.1 mEq/L
Normal Chloride level
96-106 mEq/L
Normal Calcium level
8.6-10.0 mg/dl
Normal Phosphate level
2.5-4.5 mEq/L
Normal Magnesium level
1.5-2.5 mEq/L
Normal Bicarbonate level
22-26 mEq/L
What is the major cation in the interstitial fluid?
Sodium
What is the major cation in the intracellular fluid?
Potassium
What affect does protein have on edema?
Capillaries get big and holey. Proteins spill out through the holes and pull fluid with them.
What does it mean if Creatinine is bad?
The kidneys are not working
Increased BUN?
Dehydrated
Decreased BUN?
Overhydrated
What is diffusion?
Passive movement of particles. Requires no energy.
What is osmosis?
Passive movement of water.
What is active transport?
Requires energy to move fluids and electrolytes against a concentration gradient.
Hydrostatic pressure?
Pushing pressure
Oncotic pressure?
Pulling pressure
Filtration?
The sum of hydrostatic and oncotic forces across the capillary into tissues.
What is osmolality?
Concentration of body fluids. Affects movement of fluids by osmosis.
How do you estimate osmolality of blood?
2 X sodium level
What is an isotonic solution?
A solution that contains the same amount of salt and solutes as human cells. Very little osmotic pull.
Examples of isotonic solutions (3)
Normal saline 0.9%
5% dextrose in water D5W
LR
What is a hypotonic solution?
A solution with a lower concentration of salt than other solutions. Less salt or more water.
Examples of hypotonic solutions (2)
0.45% NS
D5 in 0.45% NS
What are hypotonic solutions used for?
To treat cellular dehydration.
What happens to D5W after it metabolizes?
It becomes hypotonic.
What is a hypertonic solution?
A solution with a higher concentration of solutes. It will draw water into it. It expands intravascular volume.
Examples of hypertonic solution (5)
D5LR
D5NS
D10W
3% NaCl
5% NaCl
What factors increase osmolality?
Free water loss
Diabetes insipidus
Na overload
Hyperglycemia
Uremia
What factors decrease osmolality?
SIADH - too much ADH
Renal failure
Diuretic use
Adrenal insufficiency- Not releasing aldosterone
What two hormones control fluid?
ADH and aldosterone
What does BUN stand for?
Blood urea nitrogen
What is hematocrit?
% of red blood cells
Normal value of hematocrit?
37-48%
Normal value of hemoglobin?
12-16 g/dL
Oncotic pressure comes from?
Proteins
What happens to the kidneys during diabetes insipidus?
They cant concentrate urine.
What is diabetes insipidus caused by?
A deficiency of ADH.
What is third spacing?
Fluid is put into a part of the body that is not an area of use.
What are some causes of third spacing?
Burns, peritonitis, bowel obstruction, massive bleeding into joint or cavity, liver or renal failure, lowered plasma proteins, lymphatic blockage
S/S of third spacing
Decreased urine with adequate intake, increased HR, Decreased BP or CVP, increased weight, pitting edema, ascities.
What is dehydration?
Loss of water only
What is hypovolemia?
Water and electrolytes are lost in the same proportion as they exist on normal body fluid (isotonic loss)
Causes of fluid volume deficit
V/D, fever, excessive sweating, burns, diabetes insipidus, uncontrolled diabetes, GI suctioning, colostomy, draining wounds or fistulas.
S/S of dehydration
Acute wt loss, decreased skin turgor, oliguria, concentrated urine, weak rapid pulse, cap filling longer, decreased BP, thirst, weakness, dizziness, muscle cramps.
S/S of dehydration in infants
Sunken eyeballs, depressed fontanels, significant wt loss, low urine output, high specific gravity.
Lab results in dehydrated patients
Hct- Increased
BUN- Increased
Serum osmo- High
Urine osmo- high
Urine SG- High
Urine volume- decreased
What kind of IV fluids would you give someone who is dehydrated?
Isotonic until BP back to normal, then hypotonic.
What are some causes of fluid volume excess?
Heart failure, renal failure, liver failure, irrigation of body cavities, CA, SIADH, thrombus, high sodium intake, protein malnutrition.
Physical S/S of fluid volume excess
Wt gain > 2lbs, distended neck veins, increased RR, crackles in lungs, dyspnea, cough, pink sputum, mental status changes d/t brain cells swell, edema.
VS and Lab values of FVE patient
CVP- high
CO- Increased
Hct- Low
Serum osmo- low
BUN- low
SG- low
What does an infiltration look like?
Pale, cold, swollen
What does phlebitis look like?
Red, hard and irritated
What does an infected IV site look like?
Red, heat, pain, swelling
What does sodium do in the body?
Regulates voltage of action potentials, transmission of impulses in nerve and muscle fibers, one of the main factors in determining ECF volume.
What helps balance sodium in the body?
Thirst mechanism, ADH, aldosterone, Glomeruli filtration, RAAS
Hypernatremia >145 Causes
Excessive salt intake, decreased loss of salt d/t renal failure, lack of water intake
S/S hypernatremia
Red dry swollen tongue, flushed dry firm skin, intense thirst, oliguria, anuria, agitation, lethargy, urine SG > 1.030, high Hct, confusion.
Why is it important to gradually lower sodium levels with a hypotonic solution?
Too fast could lead to swelling of the brain cells.
What are some causes of hyponatremia?
Dilution from excessive free water, SIADH, Abnormal loss of GI secretions, excessive suctioning.
S/S of hyponatremia
Depression of CNS, Generalized weakness, abdominal cramps, urine SG < 1.003, low hct
What is the purpose of potassium?
Normal cardiac and neurological functioning, influences nerve impulse conduction, helps maintain acid base balance, controls fluid movement in and out of cell by osmosis.
What are some foods high in potassium?
Bananas, dried fruits, green leafy veggies, avocados, all bran, potatoes, tomatoes and mushrooms.
Causes of hypokalemia
Loss of GI secretions, potassium wasting diuretics, renal disease, chronic use of steroids, and alkalosis.
S/S of hypokalemia
CNS depression, leg and abdominal cramps, constipation, weak shallow resp, weak thready pulse, numbness or tingling in hands or feet.
Rules of potassium IV supplementation
No more than 10 mEq/hr
No more than 40 mEq/L
Causes of hyperkalemia
Excessive intake of potassium, burns, tissue trauma, acidosis, kidney failure with oliguria.
S/S of hyperkalemia
Irregular heartbeats, hypotension, bradycardia, muscle twitching or cramps, parasthesias, hyperactive bowel tones.
Oral potassium must be given with ________ because ___________.
Food, hard on the stomach
How fast should potassium be ran at?
No faster than 10-20 mEq/hr
Calcium is required for ?
Blood coagulation, neuromuscular contraction, enzymatic activity, and strength and durability of bones and teeth.
What does calcium do to nerve cells?
Makes them less excitable, less twitchy, more smoothly.
How can immobility lead to high calcium levels?
When a person is immobile calcium can come out of the bones and go into the blood.
What level should be evaluated with calcium?
Albumin
Hypocalcemia causes
Decreased intake, decreased absorption, pancreatic disease, PTH or Vit D deficiency, hyperphosphatemia
S/S of hypocalcemia
Neuronal excitability, numbness, tingling, convulsions, dysrhythmias, N/V/D, muscle spasms, muscle tetany, positive trousseau and chvosteks sign.
Hypercalcemia causes
Mobilization of Ca from bone, Cancer, hyperparathyroidism, immobilization, thiazide diuretics, excessive ingestion of Ca or Vit D.
S/S of hypercalcemia
Anorexia, constipation, muscle weakness, lethargy, loss of muscle tone, depression, ataxia, altered gait, fatigue, dysrhythmias, deep bone pain, polyuria, renal calculi, bone fractures.