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101 Cards in this Set
- Front
- Back
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serious vs fatal weight loss |
1. loss of 10% body fluid = 8% weight loss (Serious)
2. loss of 20% body fluid = 15% weight loss (fatal) |
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functions of body fluid |
1. medium for transport 2. needed for cellular metabolism 3. solvent for electrolytes and other constituents 4. helps maintain body temperature 5. helps digestion and elimination 6. acts as lubricant |
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fluid gain |
1. fluid intake 1500 ml 2. food intake 1000 ml 3. oxidation of nutrients 300 ml (10 ml of H2O per 100 Kcal) |
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fluid loss |
1. sensible = can be seen urine 1500 ml sweat 100 ml
2. insensible = not visible skin (evaporation) 500 ml lungs 400 ml feces 200 ml |
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hypothalamus |
thirst receptors (osmoreceptors) continuously monitor serum osmolarity (concentration). If it rises thirst mechanism is triggered |
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pituitary regulation |
posterior pituitary releases ADH in response to increasing serum osmolarity. Causes renal tubules to retain H2O |
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renal regulation |
nephron receptors sense decreased pressure (low osmolarity) and kidney secretes renin
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renin sequence |
renin - angiotensin I - angiotensin II |
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Angiotensin II |
causes Na and H2O retention by kidneys and stimulates adrenal cortex to secrete aldosterone and ANP (atrial natriuretic peptide hormone) |
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aldosterone |
causes kidneys to excrete K and retain Na and H2O |
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Normal older adult physiological aging results regarding fluids |
1. decreased thirst mechanism 2. decreased # of sweat glands 3. decreased renal function 4. may be functional decline causing decreases in mobility and/or cognitive function which impacts their ability to get adequate fluid intake |
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intracellular fluid components |
fluid inside the cell
most (2/3) of the body's H2O is in the ICF |
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extracellular fluid components |
- fluid outside the cell -1/3 body's H2O -more prone to loss
3 types 1. interstitial - fluid around/between cells 2. intravascular - (plasma) fluid in blood vessels 3. transcellular - CSF, synovial fluid, etc |
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osmolality and pulling force |
greater the osmolality, greater the pulling force (osmotic pressure) |
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normal serum (blood osmolality) |
275-295 |
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hypertonic solution (osmolality) |
high osmolality
when solution osmolality > serum osmolality |
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hypotonic solution (osmolality) |
solution osmolality < serum osmolality |
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osmolality |
concentration of particles in a solution |
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crystalloids |
- solutions that have small particles in them - work mainly by osmotic properties - common IV solutions |
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colloids |
solutions with large particles have stronger pulling action (blood) |
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why are hypertonic fluids used for IV |
- to expand vascular volume - fosters normal BP and good urinary output (often used preop)
has a greater concentration of sodium than circulating plasma. Pulls fluid from the cells into the vascular spaces. Too much and the cells will crenate or shrivel up like prunes. Will rapidly expand circulating volume and might be used to treat bad burns, septic shock, etc... |
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3 types of hypertonic IV solutions |
1. D5% 0.45% NS 2. D5% NS 3. D5% LR |
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why would hypotonic IV fluid be used |
to dilute plasma particularly in hypernatremia
solution has less sodium than that of the patient's currently circulating plasma. Would be used to push fluid from the vascular spaces into the cells. Too much and the cells will explode. Will decrease circulating volume, so you'd use it when you don't want increased pressure like cerebral edema, or in a dehydrated patient with very high electrolytes, etc... |
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2 hypotonic IV fluids |
1. 0.45% NS 2. 0.33% NS |
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isotonic IV fluid used for ... |
excessive vomiting, diarrhea most commonly used for
has same sodium concentration of plasma. Use to replace volume in cases of blood loss, or to maintain hydration. No fluid shift between vascular spaces and cells - they're equalized |
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3 isotonic IV fluids |
1. 0.9% Normal saline 2. D5W 3. Ringer's Lactate (also contains some Na, K, Ca, Cl) |
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Albumin |
- serum protein - albumin in the serum has osmotic properties called colloid pressure - pulls H2O from the interstitial compartments into the intravascular compartments (serum). Helps to maintain BP - poor albumin level = higher incidence of retaining fluid in interstitial layers |
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diffusion vs osmosis |
osmosis = water shifting from low solute/ high water concentration to high solute/low water concentration
diffusion = movement of solutes from high concentration to low (passive movement down concentration gradient). Used in O2 and CO2 exchange |
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active transport |
requires ATP to move from low to high concentration, such as Na/K pump
may be enhanced by carrier molecules with binding sites on cell membrane (example glucose - insulin promotes the insertion of binding sites for glucose on cell membranes) |
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filtration |
aka "hydrostatic pressure" - from high pressure to low pressure |
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2 examples of filtration |
- arterioles = have higher pressure than ICF fluid. oxygen and nutrients move into cells - venules = have lower pressure than ICF. Fluid, carbon dioxide and wastes move out of cells |
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fluid volume deficit (FVD) |
loss of both H2O and electrolytes from ECF - present when there is insufficient isotonic fluid in the extracellular compartment - ECF has high Na content and with FVD output of isotonic fluid exceeds intake of Na containing fluid |
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causes of FVD |
- increased output -hemmorrhage -vomiting -diahrrhea -burns - fluid shift out of vascular space into interstitial spaces (third spacing) |
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third spacing |
fluid shift out of vascular space into interstitial spaces |
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other terms for FVD |
hypovolemia, isotonic dehydration |
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hyperosmolar imbalance |
another type of dehydration
also called "hypertonic dehydration"
H2O loss greater than electrolyte loss; excessive perspiration, diabetes insipidus |
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cardiovascular assessment findings for FVD |
- diminished peripheral pulses; quality 1+ (thready) - decreased BP and orthostatic hypotension - increased HR - flat neck and hand veins in dependent position - elevated hematocrit (Hct) |
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gastrointestinal assessment findings for FVD |
- thirst - decreased motility; diminished bowel sounds, possible constipation |
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neuromuscular assessment findings for FVD |
- decreased CNS activity (lethargy to coma) - possible fever - skeletal muscle weakness - hyperactive DTR |
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integumentary assessment findings for FVD |
- dry mouth and skin - poor turgor (tenting) - pitting edema - sunken eyeballs |
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renal assessment findings for FVD |
- decreased output - increased spec gravity of urine - weight loss - hypernatremia |
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respiratory assessment findings for FVD |
- increased rate and depth |
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implementation for FVD |
- prevent further fluid loss - oral rehydration therapy - IV therapy - medications: antiemetics, antidiarrheals - monitor CV, Resp, Renal, GI status - monitor electrolytes - possible supplement rx - monitor weight and I & O - health promotion - heat and hydration safety |
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3 types of fluid volume excess FVE |
1. overhydration 2. hypervolemia 3. edema |
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overhydration |
fluid overload is an excess of body fluid |
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hypervolemia |
excess fluid volume in the intravascular area |
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edema |
excess fluid volume in interstitial spaces
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fluid volume excess FVE causes |
- increased Na/H2O rentention - excessive intake of Na (PO or IV) - excessive intake of H2O (PO or IV) aka water intoxication - syndrome of inappropriate antidiuretic hormone (SIADH) - renal failure, congestive heart failure
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cardiovascular assessment findings for FVE |
- elevated pulse; 4+ bounding - elevated BP - distended neck and hand veins - ventricular gallop (S3) - hyponatremia |
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gastrointestinal assessment findings for FVE |
- increased motility - stomach cramps - nausea and vomiting |
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respiratory assessment findings for FVE |
- dypsnea - moist - crackles - tachypnea |
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renal assessment findings for FVE |
- weight gain - decreased spec grav of urine |
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integumentary findings for FVE |
- periorbital edema - pitting or non pitting edema |
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neuromuscular findings for FVE |
- altered LOC - headache - skeletal muscle twitching |
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implementation FVE |
- restore normal fluid balance - prevent further overload - drug therapy; diuretics - diet therapy; decrease Na and fluids - MONITOR WEIGHT and I & O - monitor electrolytes - monitor CV, respiratory, renal systems - health promotion - teach patients with cardiac disease to weigh daily and report a significant day to day gain |
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hypernatremia |
osmolality imbalance water deficit, hypertonic condition
Serum Na+ > 145mEq/L |
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causes of hypernatremia |
2 general causes make body fluids too concentrated 1. loss of relatively more water than salt 2. gain of relatively more salt than water
may occur in combo with FVD.
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hyponatremia |
osmolality imbalance water excess or water intoxication hypotonic conidition
serum Na+ <135mEq/L |
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hyponatremia causes |
arises from gain of relatively more water than salt or loss of relatively more salt than water
excessively dilute condition of interstitial fluid causes water to enter cells by osmosis, causing the cells to swell
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clinical dehydration |
FVD and hypernatremia occur at same time often combination of 2 is called clinical dehydration
EVC is too low and body fluids are too concentrated
occurs when people are not able to replace their fluid output with enough intake of dilute sodium containing fluids |
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electrolytes |
- work with fluids to keep the body healthy and in balance - they are solutes found in various concentratins - can be cation or anion |
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electrolytes and homeostasis |
total body anions = total body cations |
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cations |
positively charged - sodium Na+ (high content in plasma) - potassium K+ (high content in cellular fluid) - calcium Ca++ (low content in plasma, interstitial fluid and cellular fluid) - magnesium Mg++ (low content in plasma and interstitial fluid, higher in cellular fluid) |
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anions |
negatively charged - chloride Cl - (high content in plasma and interstitial fluid) - phosphate Po4 - (high content in cellular fluid) - bicarbonate HCO3 - (moderate in plasma and interstitial fluid, low in cellular fluid)
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electrolyte functions |
- regulate water distribution - muscle contraction - nerve impulse transmission - blood clotting - regulate enzyme reactions (ATP) - regulate acid - base balance |
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sodium Na+ |
- 135 - 145 mEq/L - major cation - chief electrolyte of ECF - regulates volume of body fluids - needed for nerve impulse and muscle fiber transmission (Na/K pump) - regulated by kidneys and hormones (aldosterone, renin, ADH) |
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implementation for sodium imbalance - hyponatremia |
- increase oral Na intake - fluid restriction - hypertonic IV fluid |
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implementation for sodium imbalance - hypernatremia |
- decrease oral Na intake - fluid push - hypo or isotonic fluids |
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potassium K+ |
- 3.5-5.0 mEq/L - chief electrolyte of ICF - major mineral in all cellular fluids - regulated by kidneys/hormones - inversely proportional to Na |
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what does K+ aid in? |
- muscle contraction - nerve and electrical impulse conduction - regulates enzyme activity - regulates IC H2O content - assists in acid base balance |
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hypokalemia |
- serum level < 3.5 mEq/L - results from decreased intake, loss via GI/Renal and potassium depleting diuretics - life threatening all body systems affected |
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hypokalemia s/s |
- muscle weakness - leg cramps - decreased GI motility (N/V Anorexia) - cardiac arrythmias - PACs, PVCs, possible VT, VF - death |
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hyperkalemia |
- serum level >5 mEq/L - results from excessive intake, trauma, crush injuries, burns, renal failure |
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hyperkalemia s/s |
- muscle weakness - cardiac changes slowed cardiac conduction - decreased HR leading to cardiac arrest - N/V (increased GI motility and diarrhea) - parathesias of face/fingers/tongue |
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implemenation potassium imbalance: hypokalemia |
- dietary potassium or supplements - IV potassium added to IV fluids - IVs with K added should always be on a pump and ideally into a central line |
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implementation potassium imbalance: hyperkalemia |
- IV diuretics - IV fluids to dilute - kayexalate - if severe give IV of calcium chloride, calcium gluconate, bicarb, insulin - dialysis |
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calcium Ca++ |
- 4.5-5.5 mEq/L - most abundant in body but 99% in teeth and bones - needed for nerve transmission, vitamin B12 absorption, muscle contraction and blood clotting - inverse relationship with phosphorus - regulated by parathyroid hormone PTH - vitamin D needed for Ca absorption |
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hypocalcemia |
- serum Ca < 4.5 mEq/L - results from low intake, loop diuretics, parathyroid disorders, renal failure, common after thyroid surgery |
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hypocalcemia s/s |
- lethargy - EKG changes - decreased HR and BP - numbness/tingling in fingers - muscle cramps/tetany - seizuers - chovstek sign (cheek) and trousseau sign (arm) - tx diet/ IV therapy |
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hypercalcemia |
- serum Ca > 5.5 mEq/L - results from hyperparathyroidism, some cancers, prolonged immobilization, high intake of supplements with Ca and vitamin D |
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hypercalcemia s/s |
- muscle weakness - renal calculi - lethargy - fatigue - altered LOC - decreased GI motility - constipation - cardiac changes (decreased HR) |
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implementation calcium imbalance: hypocalcemia |
- to increase HR = IV calcium gluconate, IV calcium chlorise - PO albumin hydroxide gel (binds to phosphorus) - vitamin D aids absorption - diamox (promotes phosphorus excretion) |
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implementation calcium imbalance: hypercalcemia |
- IV saline and/or diuretics - increases Ca excretion - steroids - decrease intestinal absorption of Ca - phosphorus replacements - calcitonin - promotes excretion - dialysis - calcium chelators - Mithramycin (anti - neoplastic) stimulates Ca uptake by bones therefore reducing Ca in serum |
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magnesium Mg2+ |
- 1.5-2.5 mEq/L - most located within ICF - needed for activating enzymes, electrical activity, metabolism of carbs/proteins, DNA synthesis - regulated by intestinal absorption and kidney |
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hypomagnesemia |
- serum < 1.5 mEq/L - results from decreased intake, prolonged NPO status, chronic alcoholism and nasogastric suctioning |
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hypomagnesemia s/s |
- muscle weakness - cardiac changes (cardiac irritability) - mental changes (lethargy, confusion) - hyperactive reflexes - some hypocalcemia s/s |
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hypomagnesemia and mortality |
- common in critically ill patients - associated with high mortality rates - increases cardiac irritability and ventricular dysrhythmias - especially in patients with recent MI - maintenance of adequate serum Mg has been shown to reduce mortality rates post MI |
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hypermagnesemia |
- serum > 2.5 mEq/L - results from renal failure, increased intake (laxatives with Mg) |
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hypermagnesemia s/s |
- flushing - lethargy - cardiac changes (decreased HR and BP) - decreased respirations - loss of deep tendon reflexes |
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implementation magnesium imbalance: hypomagnesemia |
- oral magnesium - restore Ca levels - Iv magnesium |
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implementation magnesium imbalance: hypermagnesemia |
- diuretics to promote mg loss - calcium gluconate to promote cardiac function - dialysis
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chloride Cl- |
- 95-105 mEq/L - most abundant anion in ECF - combines with Na to form salts - maintains water balance, acid base balance, aids in digestion (hydrochloric acid) and osmotic pressure (with Na and H2O) - regulated by kidneys - follows sodium
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hypochloremia |
- serum level <95 mEq/L - results from prolonged vomiting and suctioning |
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hypochloremia s/s |
- metabolic alkalosis - nerve excitability - muscle cramps - twitching - hypoventilation - decreased BP if severe - tx is diet and IV therapy |
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hyperchloremia |
- serum level > 105 mEq/L - results from excessive intake or retention by kidneys - metabolic acidosis
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hyperchloremia s/s |
- arrhythmias - decreased cardiac output - muscle weakness - LOC changes - Kussmauls respirations - tx is restore fluid and electrolyte
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phosphate PO4- |
- 2.5-4.5 mg/dl - needed for acid base balance, neurological and muscle function, energy transfer ATP and affects metabolism of carbs/proteins/lipids, B vitamin synthesis - found in the bones - regulated by intake and kidneys - inversely proportional to calcium (some regulation from PTH) |
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hypophosphatemia |
- serum level < 2.5 mg/dL - results from decreased intestinal absorption and increased excretion |
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hypophosphatemia s/s |
- bone and muscle pain - mental changes - chest pain - resp failure - tx is diet/IV therapy |
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hyperphosphatemia |
- serum level > 4.5 mg/dL - results from renal failure, low intake of calcium
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hyperphosphatemia s/s |
- neuromuscular changes (tetany) - EKG changes - parathesia fingertips/mouth - tx diet, hypocalcemic interventions, phosphate binding medications
body can tolerate this condition well but hypocalcemia is larger problem |
