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57 Cards in this Set
- Front
- Back
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Body Fluids
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Two compartments
Intracellular fluids (ICF) Extracellular fluids (ECF) Interstitial fluid Intravascular fluid |
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Composition of Body Fluids
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Electrolytes
Ions Cations Sodium, potassium, calcium & magnesium Anions Chloride, bicarbonate, phosphate |
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Movement of Body Fluids
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Osmosis
Osmotic pressure Solutions Hypertonic Isotonic hypotonic |
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Adult Daily Fluids
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Fluid gains
Oral fluid 1100-1400cc Solid food 800-1000cc Metabolism 300cc Total Gain= 2200-2700 Fluid losses Kidneys 1200-1500cc Skin 500-600cc Lungs 400cc GI 100-200cc Total Losses 2200-2700 |
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Intravenous therapy
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Isotonic
Same osmolality as body fluids- ex. Lactated ringers, D5W, NS Hypotonic Less osmolality than body fluids-ex. 1/2 NS Hypertonic Greater osmolality than body fluids- ex. D5W in LR Important method to replace fluids & electrolytes Goes directly into blood stream- not the digestive system |
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Cation: Sodium
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Na 135-145 meq/l
Most plentiful electrolyte in the ECF Na in ECF accounts for 95% of body’s physiologically active sodium Main role: control water distribution |
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Hyponatremia
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Na < 135 meq/l
Associated with fluid volume imbalances Cell swells as H2O is pulled into cell Diluted ECF |
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Hyponatremia-Causes
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Increased sodium excretion
Excessive diaphoresis Diuretics: thiazide type Wound drainage: esp GI Hyperlipidemia Renal disease Inadequate sodium intake Dilution of serum sodium Renal failure excessive ingestion of hypotonic fluids Freshwater drowning Hyperglycemia Congestive heart failure |
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Hyponatremia Assessment
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Weak , rapid pulse
Respiratory arrest Pulmonary edema Skeletal muscle weakness Muscular twitching & seizures anorexia Headache Personality change-lethargy & confusion Increased motility of GI system Nausea & vomiting Abdominal cramping |
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Hyponatremia Interventions
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Monitor systems
If hypovolemia- IV saline infusion If hypervolemia - diuretics are administered to promote excretion of water rather than sodium If ADH problem- may give drugs Instruct patient to increase oral intake |
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Sodium Food Source
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Table salt
Soy sauce Cottage cheese American cheese Milk butter Ketchup Mustard bacon Snack food Canned food Lunch meat White & whole bread Hotdogs Processed food Cured pork |
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Hypernatremia
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Na>145 meq/l
Gain of sodium Shrinkage of cells Excess water loss Overall sodium excess |
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Hypernatremia-Causes
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Decreased water intake
Increased water loss- fever, hyperventilation, diarrhea, infection, etc Increased sodium intake Decreased sodium excretion-renal failure, corticosteroids, Cushing’s syndrome |
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Hypernatremia- Assessment
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Decreased cardiac output
Thirst Muscle irritability and convulsions Skeletal muscle weakness Lethargy, stupor or coma Elevated body temperature Increased specific gravity Decreased urine output Dry, flaky skin Restlessness, disorientation |
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Hypernatremia-Interventions
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Monitor systems
If from fluid loss-IV glucose & H2O (D5W) If from inadequate renal excretion of sodium- diuretics that promote sodium loss Dialysis if needed Restrict sodium & fluid intake |
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Cation:Potassium
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The principle cation in the intracellular compartment (98% of K* inside cell)
K* 3.5-5 meq/l Regulates many metabolic activities & necessary for: Glycogen deposits in the liver & skeletal muscles Transmission & conduction of nerve impulses Cardiac contraction |
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Potassium- Food Source
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Bananas
Avocado Pork, veal, beef Fish Tomatoes Potatoes Mushrooms strawberries |
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Hypokalemia
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K* below 3.5 meq/l
Potentially life threatening because every body system is affected. 80% excreted daily from kidneys 15% lost through bowel 5% is lost through sweat glands Adults need 40-80meq/l per day |
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Hypokalemia-Causes
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Inappropriate or excessive medications
Increased secretion of aldosterone Vomiting Diarrhea Wound drainage- esp. GI Prolonged nasogastric suction Heat-induced diaphoresis Renal disease Inadequate potassium intake-NPO Movement of K* from ECF to ICF Dilution of serum potassium |
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Hypokalemia-Assessment
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Weak, thready pulse
Peripheral pulse difficult to palpate ECG changes Shallow respirations Anxiety, lethargy, confusion, coma Decreased GI motility Nausea, vomiting Constipation Abdominal distention Paralytic ileus Decreased specific gravity Increased urine output |
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Hypokalemia-Interventions
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Monitor systems
Monitor electrolyte values Give IV or PO K* supplement Institute safety measures for pt with muscle weakness Instruct patient and family about food choices Instruct patient and family about foods that are high fiber to prevent constipation |
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Hyperkalemia
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Serum potassium > 5.1meq/l
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Hyperkalemia-Causes
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Excessive potassium intake
Decreased potassium excretion Renal failure, adrenal insufficiency, potassium sparing diuretics Movement of potassium from ICF to ECF Tissue damage, acidosis, hypercatabolism |
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Hyperkalemia-Assessment
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Irregular heart rate, slow weak pulse
Decreased blood pressure EKG changes Dysrhythmias Profound weakness of muscles Respiratory failure Muscle twitches, cramps Hyperactive bowel, diarrhea |
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Hyperkalemia-Interventions
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Monitor all systems- place on cardiac monitor
Discontinue any potassium supplements Potassium-restricted diet Potassium excreting diuretic Kayexalate Possible dialysis- monitor renal function |
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Calcium
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8.5-10.0 mg/dl
cation Essential to action potentials & muscle contractions A cofactor in many enzyme systems Critical to metabolism Clotting factor Required for synaptic release of neuro-transmitters |
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Two forms of calcium
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Ionized
Constitutes 45% of total calcium Physiologically active form of calcium Varies directly with plasma albumin concentration Ph changes vary calcium Nonionized form 40% is bound to albumin 15% is complexed to anions including phosphate, lactate, citrate & bicarbonate |
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Calcium-Food Source
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Broccoli
Low-fat yogurt Milk Rhubarb Spinach Green beans Carrots Collard greens |
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Hypocalcemia
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< 8.6mg/dl
Causes Inhibition of calcium absorption in GI tract Lactose intolerance, renal failure, malnutrition Increased calcium excretion Renal failure, diarrhea, wound drainage Decreased ionized fractions of calcium Hyperproteinemia, alkalosis, pancreatitis Immobility, hyperphosphatemia |
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Hypocalcemia-Assessment
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Decreased heart rate & contractility
Cardiac dysrhythmias Hypotension Tetany/seizures Positive Trousseau’s & Chvostek’s sign Hyperactive bowel Abdominal cramping & diarrhea |
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Hypocalcemia-Interventions
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Monitor systems esp. cardiac
Oral calcium supplements or IV calcium Give medications that reduce nerve & muscle excitability Seizure precautions Monitor patient for fractures Instruct patient in high calcium foods |
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Hypercalcemia-
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Causes >10mg/dl
Increased calcium absorption Excessive oral intake calcium & vitamin D Decreased calcium excretion Renal failure, thiazide diuretics Increased bone resorption of calcium Malignancy, immobility, hyperthroidism Hemoconcentration Dehydration, adrenal insufficiency, lithium |
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Hypercalcemia-Assessment
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Increased heart rate which changes to bradycardia and cardiac arrest
Increased blood pressure Bounding peripheral pulses Ineffective respiratory movement Profound muscle weakness Increased urine output, renal calculi Decreased GI motility, anorexia, distention |
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Hypercalcemia-Interventions
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Monitor all systems-cardiac monitor
Discontinue solutions containing Calcium DC thiazide diuretics Give IV normal saliene Give meds to inhibit calcium resorption: Phosphorus, calcitonin, biphosphonates, aspirin |
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Magnesium
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1.6-2.6 mg/dl cation
Appears in blood stream only in small amounts Essential for neuromuscular function Excreted primarily from kidneys Many uses as a smooth muscle relaxer |
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Magnesium
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Food Sources
Green leafy veg Avocado Milk Potatoes Peas Pork Peanut butter cauliflower |
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Hypomagnesemia-Causes
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<1.6mg/dl
Insufficient magnesium intake Diarrhea, celiac disease, crohn’s disease Increased magnesium secretion Diuretics, alcoholics, malnutrition Intracellular movement of magnesium Sepsis, Insulin administration, hyperglycemia |
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Hypomagnesemia-Assessment
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EKG changes
Dysrhythmias Hypertension Decreased GI motility Anorexia Nausea Abdominal distention Shallow respirations Seizures Tetany Confusion Psychosis Facial twitches Positive Trousseau Positive chvostek |
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Hypomagnesemia-Intervention
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Monitor systems
IV or po magnesium supplements Monitor magnesium level every 12 hours if receiving IV Mg |
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Hypermagnesemia-Causes
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>2.6mg/dl
Increased magnesium intake Magnesium containing antacids and laxatives such as MOM IV Mg supplements Decreased renal excretion of magnesium |
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Hypermagnesemia-Assessment
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Bradycardia
Peripheral vasodilation Hypotension Dysrhythmias ECG changes-wide QRS Decreased respiratory effort Diminished or absent tendon reflexes Skeletal muscle weakness Drowsiness, lethargy coma |
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Hypermagnesemia-Interventions
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Monitor systems
Oral & IV Mg containing medications are stopped Antacids should contain aluminum hydroxide not magnesium hydroxide |
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Phosphorus-
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2.7-4.5 mg/dl anion
Regulates many enzyme actions critical for energy transformations Excreted primarily in kidney but also stool Calcium and phosphorus are reciprocal-as one rises the other falls. |
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Phoshorus-Food Source
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Fish
Pork Beef Chicken Organ meats Nuts Whole-grain breads & cerals |
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Hypophosphatemia-Causes
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<2.7mg/dl
Insufficient intake Malnutrition, starvation Increased phosphorus excretion Hyperparathyroidism, renal failure, malignancy Intracellular shift Hyperglycemia, hyperalimentation, Respiratory alkalosis |
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Hypophosphatemia-Assessment
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Decreased cardiac output
Slowed peripheral pulses Reversible cardiomyopathy Shallow respirations Weakness Rhabdomyolysis Confusion Seizures irritability Decreased bone density |
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Hypophosphatemia-Intervention
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Monitor systems
Administer oral or IV phos Assess renal system before administering Move patient carefully Monitor for fractures |
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Hyperphosphatemia-Causes
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>4.5mg/dl
Remember that when level is high- Calcium is low Decreased renal excretion Tumor lysis syndrome Increased intake hyperparathyroidism |
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Hyperphosphatemia-Assessment
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Decreased heart rate & contractility
Cardiac dysrhythmias Hypotension Tetany/seizures Positive Trousseau’s & Chvostek’s sign Hyperactive bowel Abdominal cramping & diarrhea |
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Hyperphosphatemia-Intervention
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Administer phosphate binding medication such as aluminum hydroxide gel to increased phos excreted in stool
Instruct patient on diet restrictions |
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Chloride
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100-108mg/dl anion
Principle negative ion in the serum With sodium, maintains osmotic pressure in the serum Kidneys selectively excrete chloride ions depending on acid-base balance |
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Hypochloremia Causes
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<100
Vomiting Gastric suction Diarrhea Diuretics Alkalotic states |
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Hypochloremia-Assessment
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Anorexia
Lethargy Confusion Muscle twitching Seizures Respiratory difficulty |
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Hypochloremia-Intervention
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Monitor system
Seizure precautions IV fluids |
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Hyperchloremia-Causes
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>108
Increased sodium intake Renal failure dehydration |
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Hyperchloremia-Assessment
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Thirst
Elevated body temperature Weakness Disorientation Lethargy, stupor & coma convulsions |
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Hyperchloremia-Interventions
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Monitor systems
IV fluids Good oral care |
