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40 Cards in this Set

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List the electrolytes
sodium, chloride, potassium, calcium, phosphate, magnesium
how much do you intake/output
~ 3 L
Solutes in ECF
SODIUM, chloride, proteins, glucose, meds
Solutes in ICF
POTASSIUM, proteins
ECF= 250 mOsm/kg
ICF= 280 mOsm/kg

Where will the water go?
to ICF (higher concentration because less water there)
Sodium is the...
main determination of tonicity and osmolality! regulates total body water.
disorders in sodium are related to total body water disturbances.
Functions of Sodium
Regulating ECF volume and distribution
Maintaining blood volume (by increasing tonicity in ECF)
Transmitting nerve impulses and contractions
Sodium-Potassium pump action
Sodium Regulation
Kidney, aldosterone, natriuretic hormones, vasopressin
Hypernatremi
> 145
common in patients with inability to retain water (output greater than input)
assoc with increased hospital mortality
state of: hyperosmolality and intracellular dehydration
Hyponatremia
<136 with osmolality < 280
mainly a sign of relative excess of water
total body sodium may be increased, decreased, or normal
tbw in... icf? ecf? interstitial? plasma?
2/3 tbw
1/3tbw
3/4 of ecf
1/4 of ecf (5 l)
What electrolytes are interrelated to water
sodium and chloride
tonicity
isotonic hypertonic hypotonic
volume status
isovolemia
hypervolemia
hypovolemia
hypervolemia
excessive isotonic fluid intake
hyperaldosteronism
increases sodium/water reabsorption
weight gain
HYPERtension
edema
distended neck veins
DECREASED hgb/hct count (dilutional effect)
Hypovolemia
ECF losses
decreased fluid intake
hemorrhage
wound drainage
weight loss
dry skin
decreased urine output
hypotension
tachycardia (body senses low volume so INCREASES heart beat)
What electrolyte drives tonicity
sodium
Factors that contribute to tonicity
ICF (K, prots)
ECF (Na/Cl, prots, glucose, medications)
What contributes to water movement between interstitial and serum
in the serum, sodium and prots
hydrostatic pressures (cardiac contraction) (increased cardiac output moves from ecf to icf)
edema causes
INC hydrostatic pressure
INC membrane permeability (inflammation disease states)
DEC serum oncotic pressure
edema sites
localized: trauma, brain, lungs, pericardial, ascites
general: feet, legs, pitting edema
edema signs and sympts
weight gain
swelling/puffiness
dehydration
INC risk of infection
pressure sores
SOB
chest pain/tightness
3 Main Causes of Electrolyte Disorders
1. Inc/Dec INTAKE
2. Inc/Dec UTILIZATION
3. Inc/Dec EXCRETION
Sodium
main determiner of tonicity and osmolality
disorders in sodium related to TBW therefore must consider volume status
very common in hospitalized patients
Sodium is important for...
regulating ECF vol and distrib
maintain blood volume (increase tonicity)
transmit nerve impulses and contractions
Sodium/Potassium pump action
Sodium Regulation
kidney
aldosterone
natriuretic
vasopressin, avp (STRONG stimulus to dec vol/bp -- increases reabsorp)
Hypernatremia
common when unable to obtain water
hyperosmalility
intracellular dehydration
iatrogenic can cause this
hypovolemic is most common
Hypovolemic hypernatremia
diuretics, gi loss, skin loss
renal failure, glycosuria
increased total body solute
Isovolemic hypernatremia
skin loss, di
PURE WATER LOSS
renal loss
insensible loss
Hypervolemic hypernatremia
mineralcorticoid excess
uncommon
PURE SODIUM EXCESS
S&S of hypernatremia
mainly CNS
if you treat too fast, increased edema in brain
Common sympts: thirst, irritability, lethargy, convulsions, coma (weight gain, edema, restlessness, muscle twitching)
can have HYPOVOL signs (tachy, orthostatic hypotension, dry mucous membranes)
Hyponatremia
< 136
OSMOLALITY <280
common in hospitalized
a sign of excess water... retention or dec elim

TOTAL BODY SODIUM MAY BE INCREASED, DECREASED, OR NORMAL

therefore, first look at tonicity then volume status
Isotonic Hyponatremia
not true cause
isotonic infusions
pseudohypernatremia
280-290
Hypertonic Hyponatremia
not true cause
hyperglycemia
hypertonic infusions
INCREASE IN BLOOD GLUCOSE IS MAIN CAUSE

MUST CORRECT SODIUM
>295
Correct Sodium eqn
must do for hypertonic hyponatremia

measured sodium + .016(serum glucose-100)
Hypotonic Hyponatremia
true cause
3 types: hypovolemic, isovolemic, hypervolemic
<280
Hypovolemic
Hypotonic
Hyponatremia
ECF volume depletion
GI loss
Diuretics
adrenal insufficiency
Isovolemic
Hypotonic
Hyponatremia
Pure water loss
Hypervolemic
Hypotonic
Hyponatremia
CONGESTIVE HEART FAILURE
hepatic cirrhosis
D5W admin
s&s of hypotonic hyponatremia
CNS
110-125
apathy, lethargy, nausea, vomitting, HA, confusion
<110
stupor, seizures, coma, brain, edema

muscle cramps with rapid change