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74 Cards in this Set
- Front
- Back
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body water content
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older adults 45-55
infant 70-80 regular adult 50-60 varies gender body mass and age infant and older adults at risk for imbalance |
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2 fluid compartments
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intracellular
extracellular |
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intracellular
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fluid inside the cells
hold two thirds of bodys water cation potassium anion phosphate |
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extracellular
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fluid located outside the cells
hold one third of bodys water cation sodium anion chloride |
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types of extracellular fluid
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intravascular- one third of ecf liquid portion of blood (plasma)
-interstitial- two thirds of ecf tissue and space btwn cells -transcellular- fluid in specialized cavities |
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electrolytes
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substance whose molecules split into ions in water
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ions
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charged particle
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cation
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positive charge
sodium potassium calcium magnesium - most powerful cation is hydrogen |
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anion
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negative charge
chloride phorphorus bicarbonate |
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valence
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electrical charge of ion
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monovalent
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combining power of 1 hydrogen atom
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osmolaLity
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concentration of solutes measured by this
-used measure fluid inside body -test used to evaluate concentration of plasma and urine more concentrated solution, higher osmo more water lower osmo normal adult 275-295 child 270-290 greater than upper number is deficit (too concentrated) lower than lower number water excess (dilute) |
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osmolaRity
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measure of total solute concentration per L of solution
-fluid outside of body |
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solute
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substance that dissolve in solvent
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solution
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homogeneous mixture of solutes dissolved in solvent
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solvent
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substance capable of dissolving a solute
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diffusion
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area higher concentration to area lower concentration
-passive transport uses no energy (fish swimming down the stream) - cellular permability |
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facilitated diffusion
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same as diffusion but specific carrier molecules increase rate
no energy used cellular permability ex glucose |
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active transport
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area lower concentration to higher concentration
- ATP energy required to move against concentration -external energy required which is ATP |
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sodium potassium pump
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Na moves out of cells K moves in
Na to extracellular K to Intracellular uses ATP |
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Where is ATP produced
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mitochondria
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osmosis
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movement of water across a membrane thats permable to water but not to solute
-trying to equalize water -move low solute to high solute concentration no energy |
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osmotic P
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amount P required to STOP osmotic flow of water
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isotonic
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fluid outside of cells is equal to fluid inside cells
same osmolaLity ex Normal saline 0.9 lactated ringers |
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hypertonic
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fluid outside cell more concentrated than fluid inside cell
WATER MOVES OUT ex D5W |
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hypOtonic
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fluid outside cell is less concentrated than fluid inside cell
WATER MOVES IN ex. 0.45 half normal saline |
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hydrostatic P
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force within fluid compartment
pushes water out -blood vessels hydrostatic p is BP -this is major force that pushes water out in capillaries |
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oncotic p
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osmotic pressure by colloids in solution
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major colloid in vascular system
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protein
-attracts water which pulls fluid from tissues to the vascular space |
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increased venous hydrostatic pressure
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slow fluid movement
result -EDEMA common causes -fluid overload -heart failure -liver failure -obstruction of venous return to heart -venous insufficiency |
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decrease in plasma oncotic pressure
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fluid remains in cells if pressure too low
occurs because plasma protein count is low cause - EDEMA common causes -excessive protein loss (renal disorder) -not enough protein synthesis (liver disease) -not enough protein intake (malnutrition) |
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elevation of interstitial oncotic pressure
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draws fluid into cells and holds
cause EDEMA causes burns trauma inflammation -do this because they damage capillary walls |
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fluid spacing
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distribution of body water
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first spacing
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fluid in ICF and EDF compartments
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second spacing
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abnormal accumulation of interstitial fluid
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third spacing
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fluid trapped thats unavailable for fx
burns, trauma, sepsis, ascites |
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calculation of fluid gain or loss
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1 L of water = 2.2 LB
ex drink 240 ml = 0.5 gain diuretic loss 4.4 LB = bout 2 L |
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function of body water
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transportation
regulate body temp lubrication |
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normal anion serum values
bicarbonate chloride phosphate |
bicarbonate 22-26
chloride 96-106 phosphate 2.4-4.4 |
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normal cation serum values
potassium magnesium sodium calcium total calcium ionized |
potassium 3.5-5.0
magnesium 1.5-2.5 sodium 135-145 calcium total 8.6-10.2 calcium ionized 4.6-5.3 |
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old ppl F & E changs
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structure kidneys change and dec abilty conserve H2O
-hormone change inc ADH dec ANP -loss subQ tissue inc loss moisture -reduced thirst mechanism |
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types of dehydration
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isotonic- E and F present balanced in loss
-hypOtonic- E loss exceeds fluid and water loss -hypertonic- excess F loss (diarrhea) |
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degree dehydration
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mild 3-5
mod 6-9 severe 10+ |
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daily fluid requirements
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-first 10 kg get 100 ml
-second 10 kg get 50 ml - any after get 20 ml per kg |
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earliest sign of dehydration
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tachycardia
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ADH
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produced in hypothalamus
-stored released in posterior pituitary -restores bl vol reducing diuresis and increase water retention -like a dam it holds when fluid levels drop and releases fluid when levels rise |
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increase osmolality or decrease in bl vol ADH
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makes kidneys reabsorb water
RESULT concentrated urine |
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dec osmolality or inc bl vol ADH
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make less water reabsorbed
RESULT dilute urine |
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renin
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causes vasoconstriction and produces aldosterone
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aldosterone
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regulate reabsorption of sodium and H2O with nephrons
-adrenal cortex secretes -when bl vol dec initiate active transport of sodium - force Na back into blood water follows and bl vol expands |
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ANP
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release atrial P inc
-dec bp and reduce bl vol -slows renin level and aldosterone release -inc urine excretion of sodium and h2o -dec ADH cause vasodilation |
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hyperCALCemia
causes |
hyperparathyroidism
-bone metastisis -overdose vitamin D |
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hyperCALCemia
LOOKS LIKE |
anorexia nausea
-fatigue -constipation -dehydration -bradycardia -nephrolithias (kidney stones) |
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hyperCALCemia
treatment |
IVF loop diuretic
PO 3000 to 4000 ml IV calcitonin antiemetic stool softener neuro check ECG - arythmias IV site check avoid Vit D supplements |
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nursing care
hyperCALCemia |
if taking digoxin assess signs toxicity
-give phosphate to inhibit GI absoption of calcium -give loop diuretic to promote calcium excretion -force fluids with high acid-sh concentration to dilute and absorb calcium (cranberry juice) -reduce dietary calcium |
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hypoCALCemia
causes |
conditions that dec parathyroid
surgical removal or injury acute pancreatitis malignancy vitamin D def Inc intake phosphorus (antacid) dec calcium intake multiple bl transfusion |
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hypoCALCemia
Looks like |
tetany- initial numbness and tingling nose ears fingertips
Chvostek Trousseau sign hyperreflexia laryngospasm arrhythmias dec cardiac contractility convusion |
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hypoCALCemia
nursing care |
oral or IV calcium
-never give rapid or by IM Vitamin D to absorption magnesium if levels low |
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chvostek sign
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contraction of facial ms in response to light tap over facial nerve in front of ear
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trousseau sign
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carpal spasm caused by inflating the blood cuff above systolic pressure for few minutes
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Sodium
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major cation in ECF
-135-145 -regulates osmolaliry -help maintain bp -controlled by -osmoreceptor = too much NA - thirst - hypothalamus = ADH= water retention -important regulating nerve and ms fiber impulses |
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hyperNATRemia
causes |
>145
MODEL Meds meals Osmotic diuretic (mannitol) Disease( DI Cushing primary hyperaldosteronism) Exc H2O loss - diarrhea vomit Low H2O intake |
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hyperNATRemia
looks like |
>145 serum osmolality >300
specific gravity >1.030 sodium exc inc CVP water loss dec CVP FRIED Fever low grade flushed skin Restless irritable confusion twitching Inc thirst fluid retention bp Edema (peripheral and pitting) Dec UO, dry mouth, dyspnea |
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hyperNATRemia
treating |
serum NA level reduced gradually to avoid cerebral edema
-H2O replacement-IVF D5W or hypotonic solution -diuretic -restricted NA intake |
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hypoNATRemia
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<135
loss NA containing fluid exc water inad intake vomit diarrhea GI suction diuretic fl shift from ICF to ECF by IVF |
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hypoNATRemia looks like
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urine specific gravity <1.010
dec ECF dec CVP inc ECF inc CVP irritable apprehension confusion dizzy -postural hypotension tachycardia -dec jug vein filling -wt loss, dry mucous membranes -tremor coma seizure |
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hypoNATRemia treatment
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fluid restriction
-hypertonic IVF small amount to restore NA (too rapid cause irreversible neurological damage) -provide nutrition education -neuro check -I & O daily wt vs -watch fl overload (SOB, tachypnea, tachycardia) |
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potassium
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major ICF
3.5-5 regulate fl balance and ICF osmo -preserving cardiac rhythms -maintain skeletal and smooth ms contraction -controlled by kidneys (inverse relationship with NA) |
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hyperKALemia
cause |
>5.1
k shift ICF to ECF exc K intake + dec K excretion most common RENAL FAILURE -trauma, burn, adrenal insuf, metabolic acidosis, meds |
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hyperKALemia
looks like |
leg pain followed by ms weakness or paralysis
-numb or tinging extremities -anxiety hypotension -bradycardia cardiac arrhythmias |
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hyperKALemia
treatment |
eliminate K intake
promote excretion hemodialysis if renal failure kayexalate (exch na for k in intestine then excrete) IV insulin (push K from ECF to ICF) give with glucose to prevent rebound -secondary to acidosis give iv sodium bicarb -IV calcium gluconate STAT cardiac arrhythmias -strict I and O -ECG BS NEVER GIVE BOLUS |
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hypoKALemia cause
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K shift from ECF to ICF
common cause Abn loss (kidney GI) -kidney-diurectic thiazides lasix steriods hyperaldosteronism GI -diarrhea vomit GI suction relationship btwn dec mag (inc aldosterone) and low K (inc excretion) |
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hypoKALemia
looks like |
ms weakness fatigue heave dec motility
-polyuria nocturia -dec DTR mental dep confusion -postural hypotension irr heartbeat |
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hypoKALemia treatment
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KCl supplement (oral or IV)
-watch UO -diet -strict I&O -labs -Iv site assessment |
