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74 Cards in this Set

  • Front
  • Back
body water content
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
2 fluid compartments
intracellular
extracellular
intracellular
fluid inside the cells
hold two thirds of bodys water
cation potassium
anion phosphate
extracellular
fluid located outside the cells
hold one third of bodys water
cation sodium
anion chloride
types of extracellular fluid
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
electrolytes
substance whose molecules split into ions in water
ions
charged particle
cation
positive charge
sodium
potassium
calcium
magnesium
- most powerful cation is hydrogen
anion
negative charge
chloride
phorphorus
bicarbonate
valence
electrical charge of ion
monovalent
combining power of 1 hydrogen atom
osmolaLity
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)
osmolaRity
measure of total solute concentration per L of solution
-fluid outside of body
solute
substance that dissolve in solvent
solution
homogeneous mixture of solutes dissolved in solvent
solvent
substance capable of dissolving a solute
diffusion
area higher concentration to area lower concentration
-passive transport uses no energy (fish swimming down the stream)
- cellular permability
facilitated diffusion
same as diffusion but specific carrier molecules increase rate
no energy used
cellular permability
ex glucose
active transport
area lower concentration to higher concentration
- ATP energy required to move against concentration
-external energy required which is ATP
sodium potassium pump
Na moves out of cells K moves in
Na to extracellular
K to Intracellular
uses ATP
Where is ATP produced
mitochondria
osmosis
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
osmotic P
amount P required to STOP osmotic flow of water
isotonic
fluid outside of cells is equal to fluid inside cells
same osmolaLity
ex Normal saline 0.9
lactated ringers
hypertonic
fluid outside cell more concentrated than fluid inside cell
WATER MOVES OUT
ex D5W
hypOtonic
fluid outside cell is less concentrated than fluid inside cell
WATER MOVES IN
ex. 0.45 half normal saline
hydrostatic P
force within fluid compartment
pushes water out
-blood vessels hydrostatic p is BP
-this is major force that pushes water out in capillaries
oncotic p
osmotic pressure by colloids in solution
major colloid in vascular system
protein
-attracts water which pulls fluid from tissues to the vascular space
increased venous hydrostatic pressure
slow fluid movement
result -EDEMA
common causes
-fluid overload
-heart failure
-liver failure
-obstruction of venous return to heart
-venous insufficiency
decrease in plasma oncotic pressure
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)
elevation of interstitial oncotic pressure
draws fluid into cells and holds
cause EDEMA
causes
burns
trauma
inflammation
-do this because they damage capillary walls
fluid spacing
distribution of body water
first spacing
fluid in ICF and EDF compartments
second spacing
abnormal accumulation of interstitial fluid
third spacing
fluid trapped thats unavailable for fx
burns, trauma, sepsis, ascites
calculation of fluid gain or loss
1 L of water = 2.2 LB
ex drink 240 ml = 0.5 gain
diuretic loss 4.4 LB = bout 2 L
function of body water
transportation
regulate body temp
lubrication
normal anion serum values
bicarbonate
chloride
phosphate
bicarbonate 22-26
chloride 96-106
phosphate 2.4-4.4
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
old ppl F & E changs
structure kidneys change and dec abilty conserve H2O
-hormone change inc ADH dec ANP
-loss subQ tissue inc loss moisture
-reduced thirst mechanism
types of dehydration
isotonic- E and F present balanced in loss
-hypOtonic- E loss exceeds fluid and water loss
-hypertonic- excess F loss (diarrhea)
degree dehydration
mild 3-5
mod 6-9
severe 10+
daily fluid requirements
-first 10 kg get 100 ml
-second 10 kg get 50 ml
- any after get 20 ml per kg
earliest sign of dehydration
tachycardia
ADH
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
increase osmolality or decrease in bl vol ADH
makes kidneys reabsorb water
RESULT concentrated urine
dec osmolality or inc bl vol ADH
make less water reabsorbed
RESULT dilute urine
renin
causes vasoconstriction and produces aldosterone
aldosterone
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
ANP
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
hyperCALCemia
causes
hyperparathyroidism
-bone metastisis
-overdose vitamin D
hyperCALCemia
LOOKS LIKE
anorexia nausea
-fatigue
-constipation
-dehydration
-bradycardia
-nephrolithias (kidney stones)
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
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
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
hypoCALCemia
Looks like
tetany- initial numbness and tingling nose ears fingertips
Chvostek Trousseau sign
hyperreflexia
laryngospasm
arrhythmias
dec cardiac contractility
convusion
hypoCALCemia
nursing care
oral or IV calcium
-never give rapid or by IM
Vitamin D to absorption
magnesium if levels low
chvostek sign
contraction of facial ms in response to light tap over facial nerve in front of ear
trousseau sign
carpal spasm caused by inflating the blood cuff above systolic pressure for few minutes
Sodium
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
hyperNATRemia
causes
>145
MODEL
Meds meals
Osmotic diuretic (mannitol)
Disease( DI Cushing primary hyperaldosteronism)
Exc H2O loss - diarrhea vomit
Low H2O intake
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
hyperNATRemia
treating
serum NA level reduced gradually to avoid cerebral edema
-H2O replacement-IVF D5W or hypotonic solution
-diuretic
-restricted NA intake
hypoNATRemia
<135
loss NA containing fluid
exc water
inad intake
vomit diarrhea
GI suction
diuretic
fl shift from ICF to ECF by IVF
hypoNATRemia looks like
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
hypoNATRemia treatment
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)
potassium
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)
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
hyperKALemia
looks like
leg pain followed by ms weakness or paralysis
-numb or tinging extremities
-anxiety hypotension
-bradycardia cardiac arrhythmias
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
hypoKALemia cause
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)
hypoKALemia
looks like
ms weakness fatigue heave dec motility
-polyuria nocturia
-dec DTR
mental dep confusion
-postural hypotension irr heartbeat
hypoKALemia treatment
KCl supplement (oral or IV)
-watch UO
-diet
-strict I&O
-labs
-Iv site assessment