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80 Cards in this Set
- Front
- Back
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Dehydration
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Fluid volume overload
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Fluid compartments
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Extracellular fluid
Intracellular fluid Transcellular fluid,in epithelial cells, saliva, CSF |
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Infants H20
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70 to 80%
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Adults H20
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60%
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Elderly Adults
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45 to 55% H2o
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who has more water men or women
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Men due to less fat content
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The primary body fluid
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lubricates
transports solvent for electrolytes |
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Electrolytes
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water balance
acid base balance enzyme reaction very important with neuromuscular activity |
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where do we get our water
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ingested 2000
and it is oxidized in food |
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Water loss
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skin 300 to 500
lung 400 to 500 urine 1000 to 5000 stool 100 ml |
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what are you looking for in urine
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specific gravity which is urine concentration, this has a direct reflection on electrolytes
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Diarrhea
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an adult can have loose stools for 3 or 4 days but watch out for kids and elderly
dehydration can happen very fast |
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Meds what kinds of interaction will these cause
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meds can throw off electrolytes, you will need to replace them example lasix
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abnormal fluid losses
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Fever
Burns Hemorrhage Emesis Secretions Wound Exudate Diaphoresis Heart Problems |
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Why do we lose so much water due to burns
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because of the albumin leakage. water will follow it and the patient will lose a large amount of fluid, they can also 3rd space water keep an eye on them.
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Purpose of IV solution
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Maintenance
catch up keep up nutrition adminstration |
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Emises
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they lose potasium and become acidotic.
They lose fluids Dont forget aspiration |
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Osmotic presure
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the power of a solution to draw water across a membrane
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Tonicity
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Effect a solutions osmotic pressure has on water movement across a cell membrane within that solution
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Isotonic solution
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has the same solutes as plasma.
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hypertonic solution
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greater cconcentrations of solutes than plasma
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Organs that maintain fluid and electrolyte balance
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Kidney
Cardiovascular system Lungs Adrenal Glands Pituitary Gland Parathyroid Thyroid Hypothalamus Intestine |
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What do the kidneys do
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regulates I and O
Filters blood |
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Cardiovascular system
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pumps and perfuses the kidney
problems here will cause all kinds of fluid build up |
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Lungs
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asses for fluid build up
this is a source of water loss and can excrete co2 and change Ph balance |
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Adrenal glands
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secretes aldosterone which will retain Na, and water and secrete K
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Pituitary
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stores ADH which retains water only
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Parathyroid
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PTH -CA
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Thyroid
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hormones increase-blood flow increases, and kidney perfusion
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Hypothalamus
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thirst center
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Intestine
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dehydration will cause the intenstines to take more water out of the stool, which can cause major impaction
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insulin
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allows potasium to enter the cell along with suger this causes the Na to go out and Hydrogen to go out ....and throws off the hydrogen ions
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Plasma Protein
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albumin, keeps fluid in our vessels
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Glucose
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important to keep vascular space normal sugar and water needs to be equal
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How do the kidneys save water
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Na is retained thus water is retained
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Dehydration can cause
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H/A
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Fever can cause
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Dehydration
Vasodilation Vomiting electrolyte imbalance |
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dehydration causes (isotonic)
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Inadequate fluid intake
excessive fluid loss third spacing |
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potasium
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shaky people the potasium fires the neruons
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Hypertonic Dehydration
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2nd most common dehydration
loss of extracellular fluid -increase in plasma osmotic pressure -fluid is pulled from the Intracellular fluid -cell dehydration -ADH is released increasing H20 reabsorption -the hypothalamus thirst center is activated to get you to drink more |
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norms for Na
Ca K What are they going to do to you if they swing to high or to low |
answer this using patho book
remember nervous system |
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calciam is important
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because the bones use it so keep your patient moving, and if you have too much ca you can get kidney scaring and stones
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assesment priority
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ABC
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Discuss the functions of the regulatory mechanisms that maintain water and electrolyte balance in the body
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Renal regulation adjusts the water balance and electrolyte balance This adjustment helps maintain normal plasma osmolality, electrolyte balance , blood volume and acid base balance
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Describe cardiac regulation of fluids
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ANP and BNP are hormones producd by cardiomyocytes. They are antagonists to the Renin angiotensin aldosterone system. When they sense increased arterial pressure or high serum sodium they suppress secretion of aldosterone, renin , and ADH
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What is insensible water loss
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it is invisible vaporization from the lungs and skin, assist in regulating body temp. about 600 to 900ml lost dailey
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Describe a drenal corticla regulation of water
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The hypothalamus tells the posterior pituitary gland to release ADH and the kidney holds on to water
It also tells the anterior pituitary to release ACTH which effects the adrenal cortex, this causes the release of aldosterone and cortisol causing the retention of Na and K+ excretion. |
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what is venous hydrostatic pressure
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it is about 10 mmhg and elevation can be caused by fluid overload, heart failure,liver failure, thrombosis, varicose veins
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Decreased plasma oncotic pressure
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this can cause fluid to remain in the interstitium,
caused by excesive protien loss from kidney failure, malnutirition or failure of the liver to do protien synthesis |
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Elevation of interstitial oncotic pressure
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this can cause albumin to leak out into the interstitium and cause a huge water loss
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Normal electrolyte values for potassium K+ is
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3.5 to 5.0 mEq/L
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Normal electrolyte values for Magnesium Mg2+ is
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1.5 to 2.5 mEq/L
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Normal electrolyte values for Sodium Na+ is
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135 to 145 mEq/L
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Normal electrolyte values for Calcium Ca2+ is
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4.5 to 5.5 mEq/L
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Normal values for Bicarbonate HCO3- is
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22-26 mEq/L
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Normal values for Chloride cl- is
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96 to 106 mEq/L
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Normal values for Phosphate is PO43-
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2.8 -4.5 mg/dl
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What are some ways edema is managed
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Medications such as colloids, dextran, mannitol, or hypertonic solutions. this will draw the fluid out of the interstitium
Increasing hydrostatic pressure is another way such and wearing elastic compression socks |
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what are the normal values for Na
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135 to 145 mEq/L
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what are the nomal values for potassium
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3.5 to 5 mEq/L
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What are the normal values for Calcium
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4.5 to 5.5 mEq/L
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What are the normal values for Magnesium
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1.5 to 2.5 mEq/L
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What are the normal values for Phosphate
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1.7 to 4.6 mg/100ml
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Symptoms of Hypernatremia
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lethargy, weakness, irritability, and edema. With more severe elevations of the sodium level, seizures and coma may occur.
Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 158 mEq/L (normal is typically about 135-145 mEq/L). Values above 180 mEq/L are associated with a high mortality rate, particularly in adults. However such high levels of sodium rarely occur without severe coexisting medical conditions. |
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Symptoms of Hyponatremia
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Severe hyponatremia may cause osmotic shift of water from the plasma into the brain cells. Typical symptoms include nausea, vomiting, headache and malaise. As the hyponatremia worsens, confusion, diminished reflexes, convulsions, stupor or coma may occur. Since nausea is, itself, a stimulus for the release of ADH, which promotes the retention of water, a positive feedback loop may be created and the potential for a vicious circle of hyponatremia and its symptoms exists
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Symptoms of Hyperkalemia
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malaise, palpitations and muscle weakness; mild breathlessness may indicate metabolic acidosis, one of the settings in which hyperkalemia may occur
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what causes hypocalcemia
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hypoparathyroidism
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what are the symptoms of hypocalcemia
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Perioral tingling and parasthesia, 'pins and needles' sensation over the extremities of hands and feet. This is the earliest symptom of hypocalcemia.
Tetany, carpopedal spasm are seen. |
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what are the symptoms of hypercalcemia
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Hypercalcemia per se can result in fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, pancreatitis or increased urination
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what causes hypercalcemia
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hyperthyroidism
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what are the symptoms of Hypomagnesemia
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hypokalemia
Deficiency of magnesium causes weakness, muscle cramps, cardiac arrhythmia, increased irritability of the nervous system with tremors, athetosis, jerking, nystagmus and an extensor plantar reflex. In addition, there may be confusion, disorientation, hallucinations, depression, epileptic fits, hypertension, tachycardia and tetany. |
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What are the symptoms of Hypermagnesemia
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Weakness, nausea and vomiting
Hypotension Impaired breathing Arrhythmia and asystole, most prominent cardiac symptoms are due to conduction delays, since magnesium acts as physiologic calcium blocker |
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what are the symptoms of Hypophosphatemia
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Muscle dysfunction and weakness. This occurs in major muscles, but also may manifest as diplopia, low cardiac output, dysphagia, and respiratory depression due to respiratory muscle weakness.
Mental status changes. This may range from irritability to gross confusion, delirium, and coma. White cell dysfunction, causing worsening of infections Instability of cell membrates due to low ATP levels: this may cause rhabdomyolysis |
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what causes Hypophosphatemia
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Respiratory alkalosis Any alkalemic condition moves phosphate out of the blood into cells. This includes most common respiratory alkalemia
Increased excretion (e.g. in hyperparathyroidism) |
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Describe Hyperphosphatemia
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Often, calcium levels are lowered (hypocalcemia) due to precipitation of phosphate with the calcium in tissues.
It can be caused by hypoparathyroidism and is commonly seen in chronic renal failure. High phosphate levels can be avoided with phosphate binders and dietary restriction of phosphate. Signs and symptoms include ectopic calcification, secondary hyperparathyroidism, and renal osteodystrophy. |
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What can lower calcium levels
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Hyperphosphatemia
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what will blood gasses show in Acidosis
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Arterial blood gasses will indicate low pH, low blood HCO3, and normal or low PaCO2.
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how can you tell the difference between respiratory or metabolic acidosis
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in respiratory acidosis, the CO2 is increased while the bicarbonate is either normal (uncompensated) or increased (compensated). Compensation occurs if respiratory acidosis is present, and a chronic phase is entered with partial buffering of the acidosis through renal bicarbonate retention.
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What are the symptoms of Acidosis
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Symptoms may include chest pain, palpitations, headache, altered mental status, decreased visual acuity, nausea, vomiting, abdominal pain, altered appetite (either loss of or increased) and weight loss (longer term), muscle weakness and bone pains. Those in metabolic acidosis may exhibit deep, rapid breathing
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How does insulin effect Potasium
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forces cells to absorb serum potassium; lack of insulin inhibits absorption.
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