Rnur126 Fluid And Electrolytes

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body fluids

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provides a medium for transportating nutirients to cells and waste from cells.
facilitate cellular metabolism and proper cellular chemical functioning.
acts as a solvent for electrolytes and nonelectrolytes.
facilitates digestion and promotes elimination
acts as a tissue lubricant

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ion

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atom or molecule carrying an electrical charge

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electrolytes

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substances capable of breaking into electrically charged ions when dissolved in a solution

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anions

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neg charge

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cations

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pos charge

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major electrolytes

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Na+
K+
Ca2+
Mg2+
Cl-
HCO3-
PO4-

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Na+ (sodium)

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chief electrolyte of EFC that moves freely between intravascular and interstitial spaces and moves by active transport, influential in chemical reations such as nervous and muscle tissue cells

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K+ (Potassium)

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major cation of the ICF working in a reciprocal fashion with sodium.(excessive in take of sodium results in excretion of potassium)

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Ca2+ (Calcium)

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most abundant electrolyte in the body, close link in concentration of calcium and phosphate

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Mg2+ (magnesium)

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most of cation magnesium found within the body cells, heart, bone, nerve and muscle. second most important cation in ICF

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Cl- (chloride)

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chief extracellular anion,,found in blood, interstitial fluid and lymph and in minute amounts in ICF

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HCO3- (bicarbonate)

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an anion that is a major chemical base buffer within the body, found in ICF and ECF

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PO4- (phosphate)

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major anion, helps body maintain an acid base balance, necessary for b vitamins to be effective

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osmosis

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passage of a solvent through a semipremeable membrane from areas of lesser concentration to areas of greater concentration until equilibrium is estb

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osmolarity

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concentration of particles in a solution or the solutions pulling power

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isotonic

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having the same concentration as the solution in which its being compared

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hypertonic soultion

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having a greater concentration than which its being compared with

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hypotonic

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having lesser concentration than which its being compared with

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filtration

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passage of fluid through a premeable membrane, areas from high pressure to low pressure

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fluid sources

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ingested liquids
water in food
water from metabolic oxidation

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fluid loss

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kidneys excrete urine(sensible)
Gi excretes feces(sensible)
skin through perspiration(sensible)
lungs through exhalation(insensible)

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solvent

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liquids that hold a substance in a solution

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solutes

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substances that dissolve is a solution

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acidosis

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excessive of H ions; ph of 7.35 or less

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alkalosis

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lack of H ions; ph of 7.45 or greater

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acid

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substance contain H ions that can be liberated or released

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base

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substance that can trap H ions

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buffer

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a substance that prevents body fluids from becoming over acidic or alkaline

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carbonic acid-sodium bicarbonate buffer system

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most important. buffers up to 90% of the H ion in the EFC, either acts as a base and soaks up free hydrogen ions or acts like an acid and released hydrogen when to many are present, the lungs help by regulating the production of carbonic acid resulting from the combination of carbon dioxide and water, the kidneys assist the bicarbonate system by regulating the production of bicarbonate, trying to bring a balance, ratio should be 20:1 20 parts bicarbonate to 1 part carbonic acid

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phosphate buffer system

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active in intracellular fluids, especially in the renal tubules, it converts alkaline sodium phosphate (a weak base) to acid-sodium phosphate in the kidneys

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protien buffer system

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mixture of plasma protiens and globin portion of hemoglobin in red blood cells., contain proteins that can combine or liberate H so it can maintain the pH in the blood

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respiratory control of H balance

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hard to explain, just read!

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hypovolemia (isotonic fluid loss)

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fluid volume deficit caused by loss of both water and solutes in the same proportion fromthe EFC space

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hypervolemia (excessive isotonic fluid)

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excessive retention of water and sodium in EFC in near equal proportions

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Na+

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Sodium- normal ranges 135-145mEq/L

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Hypernatremia

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surplus of sodium in the EFC can result from excess of water lossor overall excess of sodium, pt can experience neurological impairment, thirst, pyrexia,
Serum Na above 145

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Hyponatremia

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sodium deficit in EFC caused by loss of sodium or gain of watercan lead ot swelling of the cells and cerebral edema, SZ, confusion, anorexia
serum Na below 135

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K+

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Potassium-normal ranges 3.5-5 mEq/l

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Hyperkalemia

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excess of potassium in the EFC, levels above 5, pt can experience vauge muscle weakness,cardiac arrthymias, paresthesias of face, tounge, feet and hands, GI upset

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hypokalemia

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deficit of potassium in the EFC, levels below 3.5, pt can experience fatigue, N/V, decreased bowel mobility, cardiac arrthymias, sensitivity to digitals, poluria, nocturia, dilute urine, postural hypotension, levels below 3.5

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Ca+

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calcium levels between 8.5-10.5

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hypercalcemia

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high levels of calcium in EFC. pt can experience muscle weakness, tiredness, lethargy, decrease memory, renal stones, polyuria, polydipsia,cardiac arrest, levels above 10.5

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hypocalcemia

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low levels of calcium in EFC, pt can experience numbness, tingling of fingers and toes, mental changes, EKG changes, cramps in extremities levels below 8.5

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Mg

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Magnesium levels between 0.33-2.4

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hypermagnesemia

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excess levels of mag in EFC, pt can experience flushing, hypotension, depressed respers, drowiness, cardiac abnormalities; levels above 2.4

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hypomagnesemia

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decreased levels of mag in EFC, pt can experience neruomuscular irritability, icreased refluxes, coarse tremors, sz, tachy arrhythmias mental changes, mood changes; levels below 0.33

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PO4

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phosphate levels between 3.0-4.5mg/100ml

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hyperphosphatermia

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excess levels of phosphate, pt can experience short term signs of tetany, long term perciptiation calcium phosphate in nonosseous sites such as kidney and joints, arteries, skin, cornea levels above 4.5

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hypophosphatermia

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low levels of phosphate in EFC, pt can experience cardiomyopathy, acute resp failure, sz, decreased tissue O2 joint stiffness, levels below 3.0

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respiratory acidosis

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excess of carbonic acid in the EFC, any decrease in alveolar ventilation that results in retention of carbon dioxide can result in respiratory acidosis

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respiratory alkalosis

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deficit of carbonic acid in the EFC, result of alveolar hyperventilation, it increases the elimination of CO2 which leads to a higher PH

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metabolic acidosis

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proportionate deficit of of bicarbonate in EFC, result of increase in acid componets or an excess loss of bicarbonate, lungs try to increase resp rate and depth to excrete CO2 , kidneys will retain bicarbonate to compensate and release H,

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metabolic alkalosis

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excess of bicarbonate a decrease of H or both in the EFC, result of excess acid losses or increased base ingestion or retention, respers slow and the kidneys attempt to excrete water and sodium ions with excessive bicarbonate and retain H

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pt hx

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acute/chronic illness
abnormal body fluid loss(v/d)
burns
trauma
therapies(drugs")

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assessment

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i&o
urine volume and concentration
moisture in oral cavity
body weight
thrist
n/v/d
tearing/salivation
appearance of skin

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cbc

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complete blood count; determines total number of red blood cells and values for hemoglobin and hematocrit

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hematocrit levels

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low- acute, massive blood loss, rection after transfusion, fluid overload

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1

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hypervolemia

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excessive isotoic solution

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edema

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accumulation of fluid in the interstitial space

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hemoglobin values

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low-found in anemia, hemorrhage
high- found in hemoconcentration of blood

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5% dextrose in water (d5w)
isotonic

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supplies about 170 cal/L and contains 50g of glucose, doesnt contain sodium so should not be used in excess

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0.9% NaCl (normal saline)
isotonic

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not desirable as routine maintence because it provides only Na and Cl in excessive amounts, used to treat diabetic ketoacidosis

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Lactated Ringers solution
isotonic

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a roughly isotonic solution that contains multiple electrolytes in about the same concentrations found in plasma, used to treat hypovolemia, burns, fluid loss as bile or diarrhea

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0.33% NaCl (1/3 strength saline)
hypotonic

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a hypotonic solution that provides Na and Cl and free water, Na and Cl allows kidney to select and retain needed amounts, water aids kidneys in elimination of solutes

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0.45% NaCl (1/2 strength saline)
hyptonic

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used to treat hypernatremia```

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5% dextrose in 0.45% NaCl
hypertonic

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common; used to treat hypovolemia; used to maintain fluid intake

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10% dextrose in water (d10w)
hypertonic

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supplies 340 cal/L used for peripheral parenteral nutrition

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5% dextrose in 0.9% NaCl
hypertonic

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replaces nutrients and electrolytes

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peripheral venous catheters

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most common, brief IV therapy, cath is < 3 inches, rotated ever 72-96 hrs

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midline peripheral catheter

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inserted peripherally normally through the antecubital fossa into the proximal basilica or cephalic veins, < than 3 inches, stays anywhere from 7 days to 49 days

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central venous acess device

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provide access for IV therapy medications, blood products, TPN, blood samples,

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antigen

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a substance that causes the formation of antibodies

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antibody

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is a protien substance developed in the body in response to the presence of an antigen that has entered the body

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agglutinin

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is an antibody that causes clumping of specific antigens

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Blood type A

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can donate to A or AB

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blood type B

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can donate to B or AB

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blood type O

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can donate to A, B, AB

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blood type AB

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can recieve A, B, AB, O

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Rh neg

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must recieve Rh neg blood

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Rh pos

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can recieve both Rh neg and pos