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56 Cards in this Set
- Front
- Back
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purpose of fluids
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1. transport nutrients, electrolytes, 02 to cell
2. removes waste products 3 lubricants joints 4. regulation of body temp |
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two compartments
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ICF intracellular = inside cells = 2/3rd
ECF = outside 1/3 = interstitial - surrounds cell intravascular - liquid plasma transcellular - fluid in pleural & pericardial cavities |
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What are electrolytes
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substances whole melecules dissociate into ions when placed in water
active chemicals in body fluids cations = positive anions = negative |
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F&E movement
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Diflfusion
osmosis hydeostatic pressure oncotic pressure active transport |
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Diffusion
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movement of particles from an area high concentration to lesser
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osmosis
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movement of fluid across a semi-permeable membrane from an area of lower solute to a higher solute
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hydrostatic pressure
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fluid pushing out of vascular system at capillary level
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oncotic pressure (colloidal osmotic pressure)
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excerted by colloids (proteins) in solution ie: albumin and electrolytes pull fluid back into cell
albumin is a water magnet |
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active transport
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particles move agains the concentration gradient ATP found in cells
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osmolality verses osmolarity
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osmolality is the concentration of molecules ie: the STUFF in water (used to describe fluids inside body
Osmolarity is the total solute concentraoin per liter of solution (used to discribe fluids outside body) |
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tonicity of fluid
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Isotonic or iso-osmolar 270 - 300 = balanced or equal concentration of ICF & ECF
Hypertonic or hyer osmolar over 300 greater concentration = lots of stuff inn blood = greater pulling power - water moves ICF (cells) to ECF (blood) so cells shrink HYPOTONIC or hypo osmolar less than 270 diluted = cells swell fluids more dilute than serum so water moves from ECF to the ICF |
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what do the three types of fluids due
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ISOTONIC expand ECF. uses = volume replacement in dehydration & most types of shock
HYPERTONIC = pull fluides into ECF uses: decrease cellular swelling HYPOTONIC = pulls fluid into ICF uses: cellular dehydration |
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systemic regulators of body fluids
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RENAL - major regulator of sodium & water balance - renin - andiogensin system = angiotensin is a vasoconstrictor that releases aldosterone which is a water magnet, adults exrete 1.5l of urine per day
ENDOCRINE - promary regulator of thirst and ADH hormone = vasopressin or water conserving CARDIOVASCULAR - respiratory pulmonary - insensible loss, water vopr loss rate of 500ml/day GASTROINTESTINAL -24 hour loss 200ml increases with vomiting & diarhea |
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Lab tests for evaluating fluid status
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Osmolality = serum - normal is 275 - 295 and urine
urine specific gravity normal = 1.01 - 1.03 Blood urea nitrogen = measurement of urea which is an end product creatinine which is end product of muscular metabolism and a better indicator or renal function |
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FVD what is it and what causes it
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fluid loss exceeds fluid intake
can be colled hypovolemia causes: GI vomiting diarrhea, NG suction GU = diurecis 2nd renal disease or diuretic use Skin = excessive sweating/burns Hemorrhage Third spacing |
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S/S of FVD
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Increased specific gravity
Increased BUN elevated Hct elevated to normal sodium weight loss, urine loss, confusion, decreased skin turgor, rapid thready pulse, furrowed tongue, decreased bp |
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THIRD SPACING
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shift from vasular space into a portion of the body which it is not easily exchanged has no function use and will have S/S of FVD
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FVE what is it what causes it
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an increase of water vollume and solute concentration in the ECF
excessive intake of Na+ and water long term use of corticosteroids SIADH organ dysfunction decreased bun & decreased Hct bounding pulse rate, increased bp, neck vein distention, peripheral edema, rapid weight gain, crackles on lung, pleural effusion, pericardial effusion, pulmonary edema (pink frothy sputum) |
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FVD & FVE nursing care
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daily weight more accurate than I's & o's
strickt I's & o's 1 glass of ice chips = 1/2 glass of water IV, tube feedigns measure + vomitus, incontinent urine, liquid feces & wound drainage IV s/b on a pump VS, neuro LOC, PERRLA |
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Soduim
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135 - 145
controls muscle impulse transmission, assists in acid-bace balance, influences potassium and chloride levels kidneys excrete or hold onto it GI absorbs sodium |
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hyponatremia
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< 135
if d/to water excess = SIADH, hyperglycemia, psychosis, excessive IVF admin. d/t Na+ loss = Vomiting, excessive diaphoresis, K+ deficiency, adreanal insufficiency, diuretic threapy, alcoholism d/t both = renal disease |
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HYPONATREMIA S/S
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d/t hypovolemia = orthostatic hypotension, tachycardia, headache, tremors, weakness, seizures, lethargy, confusion stupor, coma
d/t water excess = hypertension, weight gain, rapid, bounding pulse and crackles |
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hypernatremia
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>145
if d/t net gain of Na+ = hypertonic IVF, TPN, tube feedings, excessive dietary intake if d/t water loss = diabetes insipidus, severe diarrhea, heavy sweating, hypodipsia s/s = tachycardia, hypotention, thirst, hyper reflexia, lethargy, seizures, coma think SALT: S= skin flushed, A= agitation, L= low grade fever and T = thirst |
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potasium
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normal is 3.5 to 5.5 function think cardiac. in muslces helps with acid base blance, we must ingest it it is elimiated thru kidneys with age we loose more
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Hypokalemia
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< 3.5
caused by inadequate intake, lasix, excessive losses via GI system or skin, metabolic alkalosis Think a sic walt Alkalosis, shall respirations, confusion, weakness, arrythmias, lethargy, thready pulse |
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Hyperkalemia
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>5.5
caused by renal failure, too much salt substitues, excessive potassium via IV or oral, potassium sparing diuretics, hyponatremia, burns |
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emergancy treatment for Hyperkalemia
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IV calcium gluconate to antagonize the effects on myocardial conduction system
IV sodium bicarbonate to temporarily shift K+ into cells IV insulin and dextrose stimulates K uptake |
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Calcium
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normal levels 8.5 - 10.5
makes bones and teeth strong, cell membrane permeability, assists in blood clotting and hormone secreation, major role in trasnmission of nerve impulses |
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HYPOCALCEMIA
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d/t inadequate intake or absorption, anorexia, renal failure, vit. D deficiency, alcohol abuse, hypoparathyriodism, reapid infusion of citrated blood
s/s tetany, intermittent tonic spasms, trousseaus's sign, chvostek's sign complications can lead to laryngeal and bronch spasms |
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Hypercalcemia
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>10.5
d/t excessive calcium intake, cancer, hyperparathyroidism, prolonged immobilization s/s altered LOC, confussion, weakness, constipation, N/V, kidneys stones, bradycardia, severe arrythmias tx loop diuretics, IV NS, calcitonin, fosamax, phosphate salts K-phos, dialysis |
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Hypomagnesium
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<1.8
s/s altered LOC, memory loss, weak skeletal muscles, seizures, hyperactive deep tendon reflexes, tremors tx oral cocoa, nuts green fleafy and magox IV mag make sure order is specific |
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WHEN giving Magnesium via IV s/s of hypermagnesia
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cardiac arrythmias, hypotension d/t vasodilation, bradycardia, respiratory arrest
STOP infusion run IV to KVO notifiy Doc be prepared to admin IV calcium when giving IV mag ALWAYS have artificial ventilation and IV calcium on hand |
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Hypermagnesium
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serum level 2.4
d/t renal failure, excessive ingestion of malox, mylanta or guaiscon s/s cardiac arrthymias, hypotension, bradycardia, respiratory arrest tx diuretics, hemodialysis, get dietician involved |
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Phosphorus
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normal levels 2.5-4.5 maintains cell membrane integrity, calcium and phosphorus are opposites
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hypophosphatemia
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<2.5
d/t anorexia, vomiting, alcoholism, diuretic use, hypercalcimia s/s muscle weakness, nystagmus, parathesia, hemolytic enemia, respiratory weakness, cardiac arrythmias tx eat diary products increase fluid, coks, kphos neutrophos, fleets soda or enema, IV phosphate but not until less than 1 |
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hyperphoshatemia
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> 4.5
d/t excess vit. D, increased intestinal absorption, tooo much phosphorus, renal filure, hyperparathyroidism s/s tetany, musle pain & spasms, dysrthymias tx dietary restictions, renege, basojel, amphojel, tums, IV NS, dialysis, phosphate binding agents |
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ICF & EFC main electrolytes
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ICF = potassium, mag and phosphorus
ECF = sodium ad chloride |
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Serum sodium up or down
serum osmolility up or down hematocrit up or down urine specific gravity up or down blood urea nitrogen up or down with Fluid volume deficite |
everything is increased expect for the serum sodium it depends on the cause
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Serum sodium up or down
serum osmolility up or down hematocrit up or down urine specific gravity up or down blood urea nitrogen up or down with Fluid volume excess |
everything is decreased except for the serum sodium which depends on the cause
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Goal of FVD and what type of intravenous fluids
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correct the underlying cause & replace both water and needed electrolytes
Isotonic fluids ie: NS, Lactated ringers |
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Goal with FVE
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remove the fluid w/o producing electrolyte imbalances,
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assessment findings of a client with hyponatremia
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watery explosive diarrhea with ab cramping
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what system is most sensitive to changes in ECF sodium concentration
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central nervous system / brain ie: hypo causes change in mental status / increased intracranial pressure
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Who are more prone to hypokalemia
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severely malnourised older men
short bowel syndrome or on TPN older adults getting high-dose gentamycin chf ileostomy diabetic Ketoacidosis receving IV insulin cancer patients getting blood chg U taking loop diuretics |
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who are more prone to hyperkalemia
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trauma w/crushed extremities
gout copd on prednisone hypertensive receiving aldactone early stages of serve burns high co2 content in ABG |
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what can cause hypophosphatemia
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alcohol withdrawl
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what can cause hyperphosphatemia
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parathyroidectomy
fleet's enema promary polydipsia |
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what can cuase hypokalemia
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metabolic alkalosis
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what can cause hypocalcemia
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parathyroidectory & metabolic alkalosis
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ISOTONIC FLUIDS
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0.9% NS
LR have no effect on osmolarity of body fluids used to expand Intravascular volume |
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HYPOTONIC FLUID samples
and uses |
0.45% NS, D5W,
Osmolarity lower than body fluids used to shift water from ECF to ICF contraindicated in increased intracranial pressure |
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HYPERTONIC FLUIDS samples and uses
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D10W, 3%NS, D5NS,
osmolarity higher than body fluids used to shift water from ICF to ECF contraindicated in DKA (cellular dehydration) |
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S/S of metabolic Acidosis
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kussmaul respirations
decreased bicarbonate warm flushed skin loss of bicarb N&V, drowsiness, headache coma may be d/t diarrhea,renal failure, severe shock, Diabetic Ketosis compensated via hyperventilation = kussmaul respirations which are deep and rapid |
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s/s of respiratory acidosis
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warm flushed skin
hypercapnia drowsiness, headache, coma, dizziness, decreased bp, seizures caused by hypoventilation, respiratory failure, sedative or narcotic overdose compensation occurs via renal reabsorption of bicarb and secrete H+ |
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Causes of Respiratory alkalosis how is it compensated and s/s
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d/t anxiety, hyperventilation, pulmonary emboli, fear, pain, brain injurym mechanical overventilation
results in hypocalcemia by kidneys excrete HCO3 or retain H+ s/s lethargy, lightheaded confusion, tachycardia, dysrthmias, N&V tetnay, tingling of exremeties |
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causes of metabolic alkalosis
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may be d/t blood transfusions, prolonged vomiting
associated with ingestion of antacids ie: overprocution of or the under elimination of H+ ions or the under procution of or over elimination of HCO3 compensation via hypoventilation |
