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87 Cards in this Set
- Front
- Back
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What does water mean to the human body?
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Water is the most important nutrient for life
Water is the primary body fluid Adult weight is 55-60% water Loss of 10% body fluid= 8% weight loss SERIOUS Loss of 20% body fluid= 15% weight loss FETAL Fluid gained each day should = fluid lost each day (2-3 L/day average) |
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What is the minimum output per hour necessary to maintain renal function?
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30 mL
If minimum needs are not met, it results in renal failure Watching someone's weight is crucial to maintaining fluid balance Output isn't always exactly equal to input because there are other ways of releasing fluids, ie: diaphoresis |
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What are the functions of body fluid?
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Medium for transport
Needed for cellular metabolism Solvent for electrolytes and other constituents Helps maintain body temperature Helps digestion and elimination Acts as a lubricant |
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What are the mechanisms of fluid gain and loss?
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Gain
Fluid intake 1500 ml Food intake 1000 ml Oxidation of nutrients 300 ml (10ml of H2O per 100 kcal) Loss "Sensible" Can be seen Urine 1500 ml Sweat 100 ml "Insensible" Not visible Skin (evaporation) 500 ml Lungs 400 ml Feces 200ml |
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What does the hypothalamus have to do with regulation of fluids?
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Thirst receptors (osmoreceptors) continuously monitor serum osmolarity (concentration). If it rises, thirst mechanism is triggered.
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Describe pituitary regulation of fluids.
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Posterior pituitary releases ADH (antidiuretic hormone) in serum response to increasing osmolarity. Causes renal tubules to retain H2O
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What does renal regulation have to do with renal regulation?
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Nephron receptors sense decreased pressure (low osmolarity) and kidney secretes RENIN
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What does angiotensin II do to regulate fluids?
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Causes Na and H2O retention by kidneys
& Stimulates adrenal cortex to secrete aldosterone which causes kidneys to excrete K and retain Na and H2O also ANP (atrial natriuretic peptide) hormone is secreted by atrial cells of heart in response to atrial stretching |
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What does angiotensin II cause?
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vasoconstriction
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What does an increase is ADH do to the urinary output?
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decrease in urinary output
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What holds a greater % of water, muscle tissue or aipose tissue (fat)?
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Muscle tissue
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What is intracellular fluid?
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ICF
Fluid inside the cell Most (2/3) of the body's H2O is in the ICF |
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What is extracellular fluid?
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ECF
Fluid outside the cell 1/3 of the body's H2O More prone to loss |
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What are the 3 types of extracellular fluid?
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Interstitial
fluid around/between cells Intravascular (plasma) fluid in blood vessels Transcellular CSF, synovial fluid, etc |
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What is the relationship between age and total body water?
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Total body water decreases from birth to adolescence
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Describe fluid balance.
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Dynamic process
Balance between body fluids and electrolytes Attraction between ions (electrolytes) and water (fluids) causes fluids to move across membranes and leave their compartments |
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What is osmosis?
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The main way fluids move
Water shifts from low solute/high water concentration to high solute/ low water concetration to reach homeostasis (balance) |
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What does semi permeable mean?
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The cell membrane only allows certain particles through, one of which is water molecules
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What is osmolarity?
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The concentration of particles in a solution
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What is osmotic pressure?
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The greater the osmolality of a solution, the greater the pulling force
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What is normal serum (blood) osmolality?
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275-295 mOSM/kg
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What is a hypertonic solution?
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A solution that has a high osmolality and is one that is > serum osmolality
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What is a hypotonic solution?
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A solution that has low osmolality is one that is < serum osmolality
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What is an isotonic solution?
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A solution that has equal osmolality to serum
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If a patient has a lot of edema, what kind of solution would you give?
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hypertonic
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If the serum is very concentrated, what kind of solution would you give?
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hypotonic
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What are crystalloids?
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Solutions that have small particles in them
They work mainly by osmotic properties These are our common IV solutions |
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What are colloids?
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Solutions with large particles
They have a stronger pulling action ex: blood and blood components |
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Describe hypertonic fluids.
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Hypertonic fluids have a higher concentration of particles (high osmolarity) than ICF
The higher osmotic pressure shifts fluid from cells into the ICF Therefore cells placed in a hypertonic solution will shrink Used to expand vascular volume Fosters normal BP and good urinary output |
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What are some types of IV solutions which are hypertonic?
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D5% 0.45% NS (D5 1/2 NS)
D5% NS (D5 NS) D5% LR (D5 LR) |
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Why are hypertonic solutions not commonly used with patients who have renal or cardiac disease?
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Because aldosterone releases increases as a result of decreased blood pressure
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Describe hypotonic fluids.
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Hypotonic fluids have less concentration of particles (low osmolality) than ICF
This low osmotic pressure shifts from ECF into cells Cells placed in a hypotonic solution will swell Used to "dilute" plasma particularly in hypernatremia |
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What are some types of IV solutions that are hypotonic?
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0.45% NS
0.33% NS |
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In what type of patient conditions would a hypotonic IV solution be contraindicated?
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If someone had a lot of edema
Increased intracranial pressure |
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Describe isotonic solutions.
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Isotonic fluids have the same concentration of particles (osmolality) as ICF (275-295 mOsm/L)
Osmotic pressure is the same inside and outside the cells Cells neither shrink nor swell in an isotonic solution, they stay the same Expands both intracellular and extracellular volume Most commonly used -treatment for excessive vomiting, diarrhea |
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What are some common isotonic IV solutions?
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0.9% normal saline
D5W Ringer's Lactate (also contains some Na, K, Ca, Cl |
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Are isotonic solutions always safe?
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No
D5W needs to be used carefully because when glucose is metabolized, it releases more water RL is known to stimulate inflammatory responses (neutrophils released) and can cause ARD (acute respiratory distress) in trauma patients |
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What should you know about albumin and osmosis?
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Albumin in the serum has osmotic properties called colloid pressure
Albumin pulls H2O from the interstitial compartments into the intravascular compartments (serum). Helps to maintain BP. Persons with low serum albumin levels tend to retain fluid in the interstitial layers |
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What causes the solute to move by diffusion?
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Movement of solutes from high concentration to low concentration
It is a passive movement down the concentration gradient Many body processes use diffusion ex: O2, and CO2 exchange Rate is affected by: concentration gradiant, permeability-surface area thickness of membranes, and size of particles (Fick's Law) |
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What abnormal assessments might you find in the client with low serum albumin levels?
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3rd spacing
low blood pressure |
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What would be of benefit to give a patient with low albumin levels?
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D5NS (hypertonic)
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Describe active transport.
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It requires energy (ATP) to move from low concentration to high concentration (uphill)
May be enhanced by carrier molecules with binding sites on cell membrane ex: glucose (insulin promotes the insertion of binding sites for glucose on cell membranes |
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What is filtration?
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Solvent and solute movement
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What is hydrostatic pressure?
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Passage from an area of high pressure to an area of low pressure
ex: 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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What is fluid volume deficit?
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Loss of both H2O and electrolytes from ECF
Causes include: increased output, hemorrhage, vomiting, diarrhea, or burns or fluid shift out of vascular space into interstitial spaces ("third spacing") |
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What is hyperosmolar imbalance (hypertonic dehydration)?
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H2O loss greater than electrolyte loss; excessive perspiration, diabetes insipidus (profuse urination)
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How would you assess for fluid volume deficit?
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Cardiovascular:
Diminished peripheral pulses; quality 1+ (thready) Decreased BP and orthostatic hypotension Increased HR Flat neck and hand veins in dependent position Elevated hematocrit (Hct) Gastrointestinal: Thirst Decreased motility; diminished bowel sounds, possible constipation Neuromuscular: Decreased CNS activity (lethargy to coma) Possible fever Skeletal muscle weakness Hyperactive DTR Renal: Decreased output Increased specific gravity of urine Weight loss Hypernatremia |
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What is a nursing diagnosis for fluid volume deficit?
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Deficient fluid volume r/t loss of GI fluids via vomiting AEB elevated Hct, dry mucous membranes, decreased output, thirst
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What should the RN plan for FVD?
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Patient will demonstrate fluid balance AEB moist mucous membranes, balanced I & O measurements, Hct WNL, by....... (insert time frame)
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What would the RN implement in regards to FVD?
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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 safely |
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What is overhydration?
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Fluid overload is an excess of body fluid
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What is hypervolemia?
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Excess fluid volume in the intravascular area
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What is edema?
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Excess fluid volume in interstitial spaces
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What causes fluid volume excess?
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Increased Na/H2O retention
Excessive intake of Na (PO or IV) Excessive intake of H2O (PO or IV) (water toxication) Syndrome of inappropriate antidiuretic hormone (SIADH) Renal failure, congestive heart failure |
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What drug stimulates ADH?
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Ectasy
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How would you assess for fluid volume excess?
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Cardiovascular:
Elevated pulse; 4+, bounding, elevated BP, distended neck and hand veins, ventricular gallop (S3), Hyponatremia Respiratory: Dyspnea, Moist crackles, Tachypnea Integumentary: Periorbital edema Pitting or non-pitting edema Gastrointestinal? Increased motility Stomach cramps Nausea and vomiting Renal: Weight gain Decreased specific gravity of uring Neuromuscular: Alreder LOC, headache, skeletal muscle twitching |
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What is a nursing diagnosis related to fluid volume excess?
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Excess fluim volume r/t excessive H2O intake, AEB confusion, headache, muscle twitching,abdominal cramps. Elevated BP and HP. hyponatremia.
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What should the RN plan for a patient with FVE?
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Client will demonstrate fluid balance by balanced I & O measurements, serum Na WNL, etc by.....
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What should the RN do to implement proper care for a patient with FVE?
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Restore normal fluid balance
Prevent further overload Drug therapy; diuretics Diet therapy; decrease Na & 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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What is the purpose of electrolytes in our body?
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They work with fluids to keep the body healthy and in balance
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What are electrolytes?
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They are solutes that are found in various concentrations and measured in terms of milliequivalent (mEq) units
They can be negatively charged (anions) or positively charged (cations) For homeostasis, body needs: total body anions = total body cations |
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Compare/contrast anions and cations
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Cations
positively charged Sodium Na+ Potassium K+ Calcium Ca++ Magnesium Mg++ Anions Negatively charged Chloride Cl- Phosphate PO4- Bicarbonate HCO3- |
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What are the functions of electrolytes?
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Regulate water distribution
Muscle contraction Nerve impulse transmission Blood clotting Regulate enzyme reactions (ATP) Regulate acid-base balance |
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What should you know about sodium?
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Na+
135-145 mEq/L Major Cation Chief electrolyte of the ECF Regulates volume of body fluids Needed for nerve impulse & muscle fiber transmission (Na/K pump) Regulated by: Kidneys Hormones (Aldosterone, Renin, ADH) |
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What is Hyponatremia?
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Serum Na+ < 135 mEq/L
Caused by: increased water loss of Na+ Water shifts from ECF into cells S/S: H/A, confusion, muscle weakness, N/V, abd cramps (hyperactive bowel sounds, hypotension, tachycardia Tx: Diet/IV therapy/Fluid restrictions |
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What is hypernatremia?
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Serum Na+ > 145 mEq/L
Cause: Na+ gained in excess of H2O Water is lost in excess of Na+ Water shifts from cells to ECF S/S: thirst, dry mucous membranes & lips, oliguria, increased temp & pulse, flushed skin, confusion, irritability, muscle twitching |
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What are some implementations for sodium imbalance?
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Hypo
Increase oral Na intake Fluid restriction Hypertonic IV fluids |
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What should you know about potassium?
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3.5-5.0 mEq/L
Chief electrolyte of ICF Major mineral in all cellular fluids Aids in muscle contraction, nerve & electrical impulse conduction, regulates enzyme activity, regulates IC H2O content, assists in acid-base balance Regulated by kidneys & hormones Inversely proportional to Na |
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What is Hypokalemia?
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Serum level < 3.5 mEq/L
Results from decreased intake, loss via GI/Renal & potassium depleting diuretics Life threatening-all body systems affected S/S: muscle weakness & leg cramps, decreased GI motility (N/V Anorexia), cardiac arrhythmias d/t cardiac irritability: PACs, PVCs, possible VT, VF, death |
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What does too much potassium do to the heart?
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slows it to the point of potentially stopping all together
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What is hyperkalemia?
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Serum level > 5 mEq/L
Results from excessive intake, trauma, crush injuries, burns, renal failure S/S: muscle weakness, cardiac changes slowed cardiac conduction, decreased HR leading to cardiac arrest, N/V, increased GI motility & diarrhea, parathesias of face/fingers/tongue |
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What RN implementations would be taken to correct potassium imbalances?
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Hypo
Dietary potassium or supplements IV potassium added to IV fluids IVs with K added should should always be on a pump and ideally into a central line Hyper IV diuretics IV fluids to dilute Kayexalate (draws potassium to it) If severe: IV calcium chloride & IV calcium gluconate (stimulate conduction of heart to prevent cardiac arrest) IV sodium bicarb and IV insulin (shifts potassium out of the blood and back into cells Dialysis |
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What should you know about calcium?
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4.4-5.5 mEq/L
Most abundant in body but: 99% in teeth and bones Needed for nerve transmission, vitamin B12 absorption, muscle contraction & blood clotting Inverse relationship with phosphorous (regulated by parathyroid hormone PTH) Vitamin D needed for Ca absorption |
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What is Hypocalcemia?
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Serum Ca < 4.3 mEq/L
Results from low intake, loop diuretics, parathyroid disorders, renal failure, common after thyroid surgery S/S: lethargy, EKG changes, decreased HR and BP, numbness/tingling in fingers, muscle cramps/tetany, seizures, Chovstek Sign & Trousseau Sign Tx: diet/IV therapy |
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What is Hypercalcemia?
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Serum Ca> 5.3 mEq/L
Results from hyperparathyroidism, some cancers, prolonged immobilization, high intake of supplements wit hCa and Vit D S/S: muscle weakness, renal calculi, lethargy, fatigue, altered LOC, decreased GI motility, constipation, cardiac changes (decreased HR) |
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What implementations should the RN be making to correct calcium imbalance?
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Hypo
To increase HR: IV calcium gluconate IV calcium chloride PO Aluminum hydroxide gel (binds to phosphorous) Vit D-aids absorption Diamox (promotes phosphorous excretion) Hyper IV saline and /or diuretics (increases Ca excretion) Steroids-decrease intestinal absorption of Ca Phosphorous replacements Calcitonin-promotes excretion Dialysis Calcium Chelators: Mithramycin (anti-neoplastic) stimulates Ca uptake by bones therefore reducing Ca in serum |
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What is a chelator?
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Aids the excretion of something out of the body because of an excess
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What should you know about magnesium?
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1.5-2.5 mEq/L
Most located within the ICF Needed for activating enzymes, electrical activity, metabolism of carbs/proteins, DNA synthesis Regulated by intestinal absorption and kidney |
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What is Hypomagnesemia?
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Serum <1.5 mEq/L
Results from decreased intake, prolonged NPO status, chronic alcoholism & nasogastric suctioning S/S: muscle weakness, cardiac changes (cardiac irritability) mental changes, hyperactive reflexes & other hypocalcemia s/s 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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What is hypermagnesemia?
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Serum >2.5 mEq/L
Results from renal failure, increased intake (laxatives with Mg) S/S: flushing, lethargy, cardiac changes (decreased HR and BP), decreased respirations, loss of deep tendon reflexes |
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What implementations should the RN do in order to correct Magnesium imbalances?
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Hypo
Oral Magnesium Restore Ca levels IV magnesium Hyper Diuretics to promote Mg loss Calcium gluconate to promote cardiac function Dialysis |
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What should you know about Chloride?
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95-105 mEq/L
Most abundant anion in ECF Combines with Na to form salts Maintains water balance, acid-balance, aids in digestion (hydrochloric acid) & osmotic pressure (with Na and H2O) regulated by kidneys Follows sodium (Na) |
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What is Hypochloremia?
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Serum level < 96 mEq/L
Results from prolonged vomiting and suctioning S/S:metabolic alkalosis, nerve excitability, muscle cramps, twitching, hypoventilation, decreased BP if severe Tx: diet/ IV therapy |
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What is hyperchloremia?
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Serum level > 106 mEq/L
Results from excessive intake or retention by kidneys-metabolic acidosis S/S: Arrhythmias, decreased cardiac output, muscle weakness, LOC changes, Kussmaul's respirations Tx: restore fluid & electrolyte balance |
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What should you know about phosphate?
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1.8-2.6 mg/dl
Needed for acid-base balance, neurological & muscle function, energy transfer ATP & affects metabolism of carbs/proteins/lipids, B vitamin synthesis Found in the bones Regulated by intake and the kidneys Inversely proportional to calcium (therefore some regulation by PTH as well) |
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What is hypophosphatemia?
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Serum level < 1.8 mEq/L
Results from decreased intestinal absorption and increased excretion S/S: bone & muscle pain, mental changes, chest pain, resp failure Tx: Diet/IV therapy |
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What is Hyperphosphatemia?
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Serum level > 2.6 mEq/L
Results from renal failure, low intake of calcium S/S: neuromuscular changes (tetany), EKG changes, parathesia-fingertips/mouth Tx: Diet; hypocalcemic interventions, medications (phosphate binding) The body can tolerate hyperphosphatemia fairly well BUT the accompanying hypocalcemia is a larger problem |
