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106 Cards in this Set
- Front
- Back
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Skin function for fluid balance |
Diaphoresis, Prevention of loss
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Lungs function for fluid balance |
Exhalation |
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Kidneys function for fluid balance |
reabsorption, excretion |
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GI Tract function for fluid balance |
Reabsorption, Excretion |
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what is 24 hour average urine ouput? |
1500 mL or 62.5 mL/hour |
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what is 24 hour output that would concern the nurse? |
720 mL or 30 mL / hour |
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What is the definition of Oliguria in mls/24 hours? |
500 mL or 20.8 mL/ hr |
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What is the definition of anuria in mls/ 24 hours? |
less than 50 mL or 2mL/hour |
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Serum Osmolality |
275-310 mOsm |
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Urine Osmolality |
200-800 |
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Osmolarity |
Concentration of solutes per liter of solution - outside the body |
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Osmolality |
Concentration of solutes per kilogram of solution-inside the body |
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how to calculate serum osmolality? |
(2 x (Na + K) + (BUN/ 2.8) + (glucose/18) |
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Hydrostatic Pressure |
Forces fluid and solutes out through capillary walls into interstitial fluid |
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Colloid Osmotic Pressure |
causes reabsorption - prevents too much fluid from leaving the capillaries - vacuum cleaner - maintains pressure lack of COP = edema, third space shifting, i.e ascites |
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Prealbumin |
Range - 17-40 precursor of Albumin used for nutrition assessment more sensitive than albumin decreased in malnutrition, protein wasting, diseases, inflammation, malignancy, cirrhosis elevated in - hodgkins disease, steroid/ NSAID use |
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Albumin |
Normal Range 3.5-5 Increases COP Decreased in - cirrhosis, liver failure, severe burns, malnutrition, preeclampsia, renal disorders increased in - Dehydration, Severe Vomiting, Severe diarrhea |
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during FVD the Renin-angiotensin Cascade kicks in |
Renin secreted by the kidneys renin causes peripheral vasoconstriction Stimulates Angiotensin production Causes release of aldosterone by the adrenal cortex aldosterone causes water and sodium retention |
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Diabetes Insipidus |
Decreased ADH Increased Urine Excretion = Fluid Volume Deficit dry patient |
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SIADH |
Increased ADH Decreased Urine excretion = Fluid Volume Excess low sodium, wet patient |
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what do renin, ADH, and aldosterone help to improve? |
Fluid Volume Deficit States |
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BNP |
located in the atrial heart muscle suppress renin, aldosterone, ADH kicks in when patients are retaining water normal BNP is less than 100 5lbs = 1L of retention |
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Dehydration |
Loss of water from the body water moves to vascular space and shrinks cell blood becomes more concentrated |
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Causes of Dehydration |
decreased or inadequate intake NG tubes Vomiting Diarrhea Wound Drainage Burns Diuretics Fever Third Space shifing |
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Hypovolemia |
loss of water and solutes into vascular space vessels constrict maintaining a low BP eventually BP and cardiac output drop hypoxemia occurs |
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Causes of Hypovolemia |
hemorrhage shock severe malnutrition burns third space shifting |
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Nursing assessments for FVD |
increased temp decreased bp increased pulse, weak and thready increased respirations decreased weight dry skin and mucous membranes decreased urine output dark concentrated urine altered mental status |
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Nursing Interventions for FVD |
I&O VS weights skin care IV therapy Enteral or Parenteral feeding |
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hypervolmia |
retain water and solutes in the same proportion increased in fluid and solutes |
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causes of hypervolemia |
overhydration ( PO or IV) decreased renal function heart failure hormonal (increased aldosterone or ADH) Obstructed lymph vessels Long-term Steroid Use |
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Water intoxication |
more water than solute cell is full of fluid excess water can cause cell to burst Mannitol treates water intoxication |
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Causes of water intoxication |
Hormonal (increased aldosterone or ADH) Decreased renal output Over Hydration |
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Fluid Volume Excess nursing assessments |
Increased BP JVD Edema increased pulse, bounding increased respirations s3 heart sounds crackles in the lungs increased weight stretched, shiny skin increased urine output dilute urine possible altered mental status |
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Nursing interventions for FVE |
I&O Fluid restriction Sodium restriction VS weights Skin Care Diuretics |
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BUN |
10-20 |
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Creatinine |
0.6-1.5 |
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hematocrit |
37-54% |
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urine sodium |
50-130 |
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urine SG |
1.010-1.025 |
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PTH function with electrolytes |
regulates calcium |
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Kidneys function with electrolytes |
regulate potassium, sodium, phosphorous |
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External components for Electrolyte balance maintenance |
Diuretics IV fluids PO replacement Hormones Binders |
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calcium and phosphorous |
opposites |
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what medication can bring magnesium down? |
calcium gluconate |
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Sodium (NA+) |
135-145 |
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Causes of Hypernatremia |
excessive intake, decreased excretion, water loss, inadequate water intake |
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s/sx of hypernatremia |
Thirst, swollen dry tongue, restlessness, tachycardia |
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Tx of hypernatremia |
restrict sodium intake, HCTZ, increased water intake |
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Hyponatremia causes |
inadequate intake, excessive loss, water gain |
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hyponatremia s/sx |
nausea, headache, muscle cramps/weakness ALTERED MENTAL STATUS |
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Tx for hyponatremia |
replacement IVF, increase dietary intake, restrict water intake |
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Potassium |
3.5-5 |
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hyperkalemia causes |
excessive intake, decreased excretion, water loss, shift from intracellular to extracellular, metabolic acidosis |
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s/sx of hyperkalemia |
Acidosis, irregular pulse rates/ rhythms EKG changes - tall tented T waves, widened QRS |
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Tx of hyperkalemia |
restriction of intake, loop diuretics ( furosemide), increased water intake, kayexalate (sodium polystyrene sulfonate), regular insulin |
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hypokalemia causes |
inadequate intake, excessive loss, water gain, shift from extracellular to intracellular |
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s/sx of hypokalemia |
alkalosis, anorexia, vomiting, decreased bowel motility, leg cramps EKG changes (u waves, ST depression) |
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Tx of hypokalemia |
replacement PO/IV, increase in dietary intake, restrict water intake |
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Magnesium |
1.5-2.5 |
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hypermagnesemia causes |
Excessive intake, decreased excretion, water loss, renal insufficiecy |
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hypermagnesemia s/sx |
hypotension, muscle weakness, decreased DTR's, respiratory paralysis, bradycardia |
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Tx of hypermagnesemia |
restriction of intake, promotion of excretion, increased water intake, calcium gluconate |
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Hypomagnesemia causes |
inadequate intake, excessive loss, water gain, chronic alcoholism |
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s/sx of hypomagnesemis |
positive trousseau's and chvosteks signs mood changes hyperactive DTRs |
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tx of hypomagnesemia |
replacement of PO/IM/IV increased dietary intake, restrict water intake |
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Calcium |
9-11 total 4.5 - 5.5 ionized |
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hypercalcemia causes |
excessive intake, decreased excretion, water loss, bone trauma, hyperparathyroidism, hypophosphatemia |
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s/sx of hypercalcemia |
constipation, anorexia, nausea, vomiting, decreased DTR's, lethargy |
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tx of hypercalcemia |
restriction of intake, increase water intake, correction of hyperparathyroidism, Etidronate |
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hypocalcemia causes |
inadequate intake, excessive loss, water gain, decreased parathyroid functioning, renal failure/ hyperphosphatemia |
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s/sx hypocalcemia |
tetany, positive trousseau's and chvosteks signs, increased DTR's, decreased clotting ability and bone density |
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Tx of hypocelcemia |
replcement PO/IV increase dietary intake, restrict water intake, correct parathyroid dysfunction, correct hyperphosphatemia |
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phosphorous |
2.8-4.5 |
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hyperphosphatemia causes |
Excessive intake, decreased excretion, water loss, hypocalcemia, renal failure |
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s/sx of hyperphosphatemia |
Tetany due to hypocalcemia |
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Tx of hyperphosphatemia |
restriction of intake, Phoslo (calcium Acetate) Renagel (Sevelamer) increased water intake (non renal patients) |
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hypophosphatemia causes |
inadequate intake, excessive loss, water gain, alcoholism, hypercalcemia |
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s/sx of hypophosphatemia |
parathesias, muscle weakness, altered mental status |
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Tx of hypophopshatemia |
replacement PO/IV, increase dietary intake, restrict water intake, correction of hypercalcemia |
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Chloride |
96-106 |
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hyperchloremia causes |
excessive intake, decreased excretion, water loss, metabolic acidosis |
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s/sx of hyperchloremia |
kussmauls respirations altered LOC tachypnea, lethargy, weakness |
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Tx Hyperchloremia |
restriction of intake, increased water intake, bicarbonate |
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hypochloremia causes |
inadequate intake, excessive loss, water gain, metabolic alkalosis |
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s/sx of hypochloremia |
alkalosis, hyperactive DTR's, tetany seizures |
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Tx of hypochloremia |
replacement of PO/IV, increase dietary intake, restrict water intake, correct alkalosis |
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F&E nursing diagnosis |
FVD FVE Knowledge deficit activity intolerance altered body temp altered thought process altered tissue integrity altered tissue perfusion impaired gas exchange self care deficit |
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Crystalloids |
Dextrose saline Ringers |
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Colloids/plasma |
plasma albumin dextran |
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TPN |
very hypertonic |
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Isotonic fluids |
If the IV fluid has about 1 tsp. ofsolutes (Example: 0.9% Sodium Chloride |
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hypotonic fluids |
•Ifthe IV fluid has < 1 tsp. of solutes, (Example: 0.45%Sodium Chloride) |
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hypertonic fluids |
•Ifthe IV fluid has > 1 tsp. of solutes, then it is hypertonic (Example: D10W) |
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what do isotonic fluids cause cells to do |
neither shrink nor swell |
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waht to hypotonic solutions cause cells to do |
swell |
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what to hypertonic solutions cause the cells to do |
shrink |
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isotonic or isoosmolar |
same as the fluids in the vascular system (stays in the vascular space) |
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Hypotonic or hypoosmolar |
shifts from the vascular space into the cell because it is more diulutes than the vascular system unequal concentration within cell compared to vascular space - cell enlarges and little change to vascular space with fluid movements |
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hypertonis or hyperosmolar |
more concentrated than the vascular system so water moves from the cells into the vascular space via osmosis unequal concentration within cell compared to vascular space - cell shrinks and vascular space enlarges with fluid movements |
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hypotonic solutions |
.45% sodium chloride (half normal saline) 0.22% sodium chloride (1/4 normal saline) |
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Isotonic Solutions |
0.9% NS (normal saline)
LR (lactated Ringers) 5% Dextrose injection (D5W) |
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Hypertonic Solutions |
D5NS D5LR D5-1/2NS D5-1/4NS |
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Indications for Sodium |
Vascular Fluid Loss Hyponatremia |
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Indications for Dextrose |
Cellular Energy |
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indications for LR |
electrolyte Replacement |
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Osmotic Diuresis? |
occurs with administration of hypertonic solutions into vascular space concentration of vascular space pulls fluid from interstitial and intracellular spaces, urine ouput increases to large amounts of dilute urine - up to 3000mL per shift |
