Fluid And Electrolyte

Front 1

Solute

Back 1

The substance dissolved in a given solution

Front 2

Solvent

Back 2

the liquid in which a solute is dissolved to form a solution

Front 3

Diffusion

Back 3

-Movements of solutes across a semipermable membrane down concentration gradients

-Membrane seperating two areas must be permeable to substance for diffusion to occur

Front 4

Osmosis

Back 4

-Movement of water between two compartments by a membrane permeable to water but not to solutes.

- Water moves from one area of lesser solute concentration to a greater solute concentration

- Major method of transporting fluids

Front 5

Filtration

Back 5

The passage of fluid thru permable membrane- fluids move from an area of high pressure to one of lower pressure

Front 6

Tonicity

Back 6

Measure of effective osmostic pressure of two solutions.

Front 7

Hypotonic

Back 7

Lesser concentration of particles than plasma- causes a cell to burst.

Front 8

Isotonic

Back 8

Has the same concentration of particles to plasma

Front 9

Hypertonic

Back 9

Has greater concentration of particles than plasma because water moves out of the cell- causes cell to shrink.

Front 10

Osmolarity

Back 10

Concentration of particles in a solution

Front 11

Hydrostatic Pressure

Back 11

-Major force that pushes water out of vascular system at capillary level.

-The "pushing" force

Front 12

Osmotic Pressure (oncotic)

Back 12

-The Pulling force

- Osmotic pressure exerted by colloids in solution

- Protein is major colloid in vascular system

Front 13

Crystalloid

Back 13

A substance that when dissolved, forms a true solution and is able to pass through a semipermable membrane.

Front 14

Colloid

Back 14

A large solute particle such as plasma proteins

Front 15

Intracellular Fluid ICF

Back 15

-Fluid within the cells

- 70% of body wt/40% of adults weight

Front 16

Extracellular Fluid ECF

Back 16

-Fluid is all the fluid outside the cells; 30% of total body wt/20% adult body wt

-2 major components- Intravascular & Interstitial fluid

-Transcellular

Front 17

Intravascular Fluid

Back 17

Plasma in the liquid compnent of blood

Front 18

Interstitial Fluid

Back 18

Surrounds tissue cells and lymph

Front 19

Transcellular Fluid

Back 19

small amount of fluid in: Cerebrospinal, pericardial, pericardial, synovial fluids, peritoneal spaces

Front 20

Sources of Fluid for the body

Back 20

- Ingested Fluids

- Food

- Products of metabolism

Front 21

Permability

Back 21

the state or quality of a material or membrane that causes it to allow liquids or gases to pass through it.

Front 22

Semipermeable

Back 22

allowing certain substances to pass through it but not others, especially allowing the passage of a solvent but not of certain solutes.

Front 23

Active Transport

Back 23

-Process in which molecule move against concentration gradient

- ATP is energy source

Front 24

Edema is the result of.....

Back 24

-Plasma (vascular space) to interstitial fluid shift

- Elevation of hydrostatis pressure

- decrease in plasma oncotic pressure

-Elevation of interstitial oncotic pressure

Front 25

Hypovolemia

Back 25

-Isotonic Fluid Loss

-Loss of both water and solutes in the same proportion from the ECF space

Front 26

Interstitial Fuild to Plasma Fluid Shift

Back 26

- Wearing compression stockings or hose is therapeutic action on this effect

Front 27

Fluid Spacing

Back 27

- First Spacing: Normal distribution of fluid in the ICF and ECF

- Second Spacing: Abnormal accumulation of Interstitial Fluid- LEADS TO EDEMA

- Third Spacing- Abnormal Distributional shift of body fluids into transceullar compartments ex) ascites

Front 28

Fluid Volume Deficit

Back 28

- Abnormal loss thru skin, gi tract, kidney, burns

- 3rd spacing

- Sx: Dehydrated, Fatigue, Wt loss, dark urine, heart palpatation, weak pulse, poor skin turgor, sunken eyeballs, low output, BUN/Hct/Specific gravity will be elevated, confusion

- Nursing Intervention: Strict i&o, Daily wts, HOB 30 Degrees or less- water to brain, monitor vascular, respiratory

Front 29

Fluid Volume Excess

Back 29

- Excessive intake of sodium

-Pts at risk: CHF

-Sx: Increase RR, SOB, wt gain, seizure, coma, bounding pulse, crackles(lung sounds), Taut skin, BUN/Hct/Specific gravity low, Confusion

Rx: Diuretics fluid/sodium restriction

Nursing Interventions: Daily Wts, High fowlers (Easy breathing)

Front 30

Hypoproteniemia

Back 30

- Low Protein

- Caused by: Anorexia, Malnutrition

-Clinical Manifestations: Edema, slow healing, anemia, muscle loss, ascites

-Managment: High carb/protein diet, TPN/Enteral nutrition

Front 31

Renal Regulation

Back 31

- Kidneys are primary organs for regulating fluid and electrolyte balance

- Excretion of electrolytes occures

-Renal tubules are sites of action of ADH and Aldosterone

-Selective reabsoption of water and electrolytes

Front 32

Hypothalamic Regulation

Back 32

- Osmoreceptors in hypothalamus sense fluid deficit or increase in plasma osmolality

-Stimulate Thirst and antidiuretic hormone (adh) Release

- Result in increased free water

Front 33

Pituitary Regulation

Back 33

-Under control of hypothalamus, posterior pituitary releases ADH

- Stress nausea nictine and morphine also stimulate ADH release

Front 34

Adrenal Cortical Regulation

Back 34

-Adrenal cortex releases hormones to regulate both water and electrolytes

1. Glucocorticoids

2. Mineralcorticoids

Aldosterone is a mineralcorticoid with potent sodium- retaining and potassium excreting capability.

Front 35

1 KG of weight (2.2 lbs) = _____ Of fluid

Back 35

1 Liter

Front 36

Respiratory Acidosis

Back 36

- Increased Hydrogen ion concentration

- blood ph < 7.35

-Excess of carbonic acid

- Causes: anything that causes hypoventilation

Front 37

Respiratory Alkalosis

Back 37

- Decreased hydrogen ion concentration

- blood ph > 7.45

- decrease in carbonic acid

- Causes: hyperventilation

Front 38

Metabolic acidosis

Back 38

- Increase hydrogen ion or decrease in bicarbonate concentration

- Blood ph < 7.35

- Causes: chronic diarrhea, renal failure, DKA, drug overdose

Front 39

Metabolic Alkalosis

Back 39

- Loss of hydrogen ion os gain in base

- blood ph > 7.45

- Causes: excess intake of antacids, vomitting, or NG Suctioning

Front 40

Sodium

Back 40

- Lab values: 135-145 mEq/L

- Water balance, osmotic pressure of ECF, nueromuscular irritability, acid/base

- Attracts water

-Regulated in ECF by aldosterone and renal blood flow

-Neurological changes

Front 41

Hypernatremia

Back 41

- Due to decrease in water intake or increase in sodium intake

- High protein feedings with out water

- Sx: Intense Thirst, tenting, agitated, confused

- Rx: Tx underlying cause, isotonic to restore volume or hypotonic fluids, must reduse sodium levels gradulaly to avoid cerebral edema

Front 42

Hyponatremia

Back 42

- Most commmon electrolyte imbalance

- increase sodium excretion

-dilution of serum sodium

- results from loss of Na containing fluids or from excesss water

Sx: mental confusion, edema, wt gain

Rx: Loop diuretics, 0.9NS, foods with Na

Front 43

Management of Hyponatremia

Back 43

- Fluid restriction if caused by excess water

- If severe sx (seizure) occur, small amt of IV Hypertonic saline solution 3%NaCl is given

-If associated with fluid loss need to replace with appropriate fluids

Front 44

Potassium

Back 44

- Lab Values: 3.5-5.0 mEq/L

-Depolarization/repolarization of cardiac and skeletal muscle

-Major cation of ICF

- Metabolism of CHO and proteins(insulin and potassium are necessary to move glucose into the cells)

Front 45

Hyperkalemia

Back 45

- Hydrogen ion moves into the cell and pushes potassium out - Caused by excessive intake, renal failre, drugs, salt substitutes

- sx: Arrythmias, muscle cramps

- rx: Kayexalate- binds with k or insulin and glucose- moves k back in the cell - loop diuretics, dialyisis, calcium gluconate, IV sodium bicardbonate/IV insulin

- monitor ecg, electrolytes

Front 46

HypoKalemia

Back 46

- decreased intake, increase in renal excretion, gi excretion, diuretics

- sx: decrease function of muscles in heart, lung, GI

- rx: oral relplacement, iv replacement (no more than 10 meq/h)

- NEVER give iv push, monitor digoxin levels

Front 47

Calcium

Back 47

- lab values: 4.5-5.5 meq/l or 8.6-10 mg/dl

- most ca in bones and teeth

- only 1% is intravascular

- regulated by parathyyroid hormone (pth), calcitonin and vit d

- when hydrogen ions falls (alkalosis) more calcium is bound to protein- does not work

Front 48

Hypercalcemia

Back 48

- Causes: hyperparathyroidism, malginancy, prlong immobility

- sx: bone pain, flank pain, dysrrhythmias, personality changes

- RX: ivs, diuretics, calcitonin (promotes reuptake in the bones), weight bearing

- straing urine for calculi

Front 49

Hypocalcemia

Back 49

- renal failure, malabsorption

- sx: tetany, parethesia of lips and extremities, chvosteks sx, trousseau's sx, altered clotting, bradycardia

- rx: calcium gluconate

- seizure precautions

Front 50

Magnesium

Back 50

- Lab Values: 1.5-2.5 mEq/l

- Intracellular

- Eliminated by kindeys

-Magnesium and potassium levels increase/decrease together

-Causes cardiac arrest

Front 51

Hypermagnesemia

Back 51

- Renal Dysfunction or intake of antacids

- Premature labor or pregnancy induced hypertension

- sx: muscular weakness, hypotension, dimished reflexes, sedative effect

- rx: serium calcium, antagonizes magnesium; renal hydration, diuretics, IV calcium gluconate

-Nursing inteventions: assess DTR's

Front 52

Hypomagnesemia

Back 52

- usually kypokalemia or hypocalcemia, also alcoholics

-malabsorption, diarrhea, vomiting, bowel surgery, diuretics

-Sx: increased neuromuscular irritability, personality changes, seziures, tachycardia

-Rx: Magnesium replacement- oral or iv; avoid magnesium-based antacids/laxatives

-Nursing intevertions: assess for chvosteks and trousseau signs, seizure precautions

Front 53

Hypovolemia

Back 53

-can occur with loss of normal body fluids (diarrhea, fistual drainage, hemorrhage), decreased intake, or plasma-tointerstitial fluid shift

-S/S: Tachycardia, delayed capillary fill, decreased bp, thirst, orthostatic hypotension

-tx: balanced iv fluids, isotonic chloride, or blood

Front 54

Hypervolemia

Back 54

- may result from excessive intake of fluids, abnormal retention of fluids (chf) or interstitial to plasma fluid shift

- s/s: Rapid bounding pulse, edema, wheezes and crackles, distended nack veins

-tx: diuretics, fluid restriction, and sodium restriction

Front 55

Urine pH and Specific Gravity Values

Back 55

Range for pH- 4.6-8.2

SG: 1.005-1.010

Front 56

Isotonic Fluids

Back 56

- d5w (dextrose in water) - in a bag

-.9% NaCl (normal saline)

-Lactated ringers (lr)

Front 57

Hypotonic fluids

Back 57

- .45% ns (1/2 strength of NS)

Front 58

Hypertonic Fluids

Back 58

-D5.45%NSS

-D10%W

-D2.25%NS

-D5.9%NSS

Front 59

Infiltration

Back 59

- Escape of fluid into subcutaneous tissue

-dislodged cannula

-penetrated vessel wall

-Swelling, edema, pallor, coldness or pain around infusion

-D/C, Restart IV

Front 60

Phlebitis

Back 60

- inflammation of a vein related to a chemical, mechanical or bacterical irritation

- Mechanical: from needle or cath

-Chemical: related to infusate

-Bacterial: poor aseptic tech/contamination

-Red, warm, pain, swelling

Front 61

Normal saline

Back 61

- 0.9% NaCl in water

- Isotonic

-Increases circulating plasma volume when red cells are adequate

-Replaces losses without altering fluid concentrations

Helpful Na+ replacement

Front 62

1/2 Normal Saline

Back 62

- .45% NaCl in water

-Hypotonic

- Raises total fluid volume

- Useful for daily maintenance of body fluid, helpful for establishing renal function, fluid replacement for clients who dont need extra glucose (diabetics)

Front 63

Lactacted ringers (LR)

Back 63

-Normal Saline with electrolytes and buffer

- isotonic

- replasces fluid and buffers pH

- normal saline with k+, ca++, and lactate (buffer)

-Often seen with surgery

Front 64

D5W

Back 64

- DEXTROSE 5% in 0.9% saline

-isotonic (in bag) Physiologically hypotonic

-Raises total fluid volume, helpful in hydrating and excretory purposes

-Provides 170-200 calories/1000cc for energy

Front 65

S1 Heart Sound

Back 65

- At the beginning of systole (end of diastole).

- Related to the closure of the mitral and tricuspid valves.

Front 66

S2 Heart Sound

Back 66

- At the beginning of Diastole (end of systole).

- Related to the closure of the aortic and pulmonic valves.

Front 67

S3 Heart Sound

Back 67

- Ken-tuc-ky- extra sound can be normal in children, late pregnancy or High CO; rarley heard in older adults- associated with CHF

Front 68

S4 Heart Sound

Back 68

- ten-nes-see- extra sound can be normal in athletes and elderly- usually abnormal assocaited with CAD, HTN,MI, Aortic or pulmonic stenosis

Front 69

Preload

Back 69

degree of stretch on the ventricles

Front 70

Afterload

Back 70

it is the aortic pressure the l ventricle muscle must overcome to eject blood

Front 71

Sites for Cardiac Ausculations

Back 71

1. Aortic- second r intercostal space

2. Pulmonic- second l intercostal space

3. Erb's Point- 3rd l intercostal space

4. Tricuspid- 4th l intercostal space

5. Mitral- 5th l intercostal space

Front 72

MONA

Back 72

-moprhine

-oxygen

-nitroglycerin

-aspirin

Front 73

Systole

Back 73

the phase of the heartbeat when the heart contracts and pumps blood from the chambers into the arteries

Front 74

Diastole

Back 74

The pahse of the hearbest when the muscle relaxes and allows chambers to fill with blood

Front 75

Palpitation

Back 75

A noticable rapid, strong, or irregular heartbeat

Front 76

Murmur

Back 76

abnormal sound during heartbeat cycle, such as whooshing or swishing- made by turbulent blood in or near your heart

Front 77

Atreriosclerosis

Back 77

the thickening and hardening of the walls of the arteries

Front 78

Atherosclerosis

Back 78

deposition of plaques of fatty material on their inner walls

Front 79

Bruit

Back 79

the unusual sound that blood makes when it rushes past obstruction (called turbulent flow) in an artery when the sound is ausculated with the bell portion of the stethoscope

Front 80

Function of the lymphatic system

Back 80

-Maintain fluid and protein balance

- Fight infections

Front 81

PItting Edema Scale

Back 81

+1 slight pitting, 2 mm depression

+2 increasing pitting, 4mm depression

+3 deeper pitting, 6 mm depresion, obvious

+4 severe pitting, 8mm depression

Front 82

Peripheral pulse sites

Back 82

1. Temporal

2. carotid

3. brachial

4. radial

5. femoral

6. Popliteal

7. posterior tibial

8.pedal

Front 83

Grading of Pulses

Back 83

0 absent

+1 weak, thready

+2 weak

+3 normal

+4 bounding

Front 84

Blood tests to evaluate risks for PAD

Back 84

-Arterial Disease:

Lipid levels

HgB A1C for diabetic patients

C reactive protein and homeosysteine levels

-Venous:

D-Dimer

Front 85

6 p's of arterial occlusion

Back 85

Pain

Pallor

Pulselessness

Poikilothermic (coldness)

Paralysis

Paresthesia