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27 Cards in this Set
- Front
- Back
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Fluid Compartments: name and describe
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1. Intravascular compartment: fluid inside vessels
2. Intracellular compartment: fluid inside cells 3. Extracellular compartment: fluid outside cells such as interstitial fluid - sometimes referred to as the third space |
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Third-spacing
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An accumulation and entrapment of fluids in abnormal spaces such as the pericardium, pleural space, abdomen, etc. The fluid is unable to perform normal physiological processes and so is considered fluid loss meaning these patients can become hypovolemic. Common causes are burns / trauma.
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Edema
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An accumulation of fluid in the interstitial space. Can be caused by trauma, surgery, burns, inflammatory processes. Generalized total body edema is called anascara and is often caused by renal, hepatic, or heart failure.
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Body Fluids: the basics
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Fluids transport nutrients and waste, maintain homeostasis. Total body fluid = 60% body weight in adult, 55% in elderly, and 80% in infants. Logically, the infant and older adult are at a higher risk for fluid imbalances.
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Body Fluids: movement
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Diffusion: movement of a dissolved solute (salt) from an area of higher concentration to an area of lower concentration through a permeable membrane.
Osmosis: movement of solvent (water) from an area of lower concentration to an area of higher concentration through a permeable membrane. Filtration: movement of solutes and solvents across a permeable membrane through force (hydrostatic pressure) exerted by the weight of the solution (e.g. glomerular filtration in kidneys) Osmolarity: # of particles per kg of water expressed as mOsm/kg. Normal is 270-300 mOsm/kg. |
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Solutions
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Isotonic: solution on both sides of membrane is in equilibrium. Isotonic solutions are made for human cells meaning has same osmolarity: 0.9% NS, 5% dextrose in water (D5W)*, 5% dextrose in 0.225% Saline (D5W 1/4NS), Ringer's Lactate.
Hypotonic: Lower concentration than isotonic. Either more fluid or less solute. The cells would remain isotonic meaning that osmosis would continue to try and return to homeostasis. 0.45% NS (1/2 NS), 0.225% NS (1/4 NS), 0.33% NS (1/3 NS). Hypertonic: Higher concentration. 3% NS, 5% NS, 10% dextrose in water (D10W), 5% dextrose in 0.9% NS (D5WNS), 5% dextrose in 0.45% NS (D5W1/2NS), 5% dextrose in ringer's lactate. |
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Fluid Volume Deficit
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Isotonic dehydration: Water and solutes are lost in equal proportions known as hypovolemia. Most common dehydration and results in decreased blood volume/tissue perfusion. Causes: inadequate intake, fluid shifts between compartments, excessive losses of both water and solute.
Hypertonic dehydration: Water loss exceeds solute loss. Fluid moves from cells into vessels or interstitial space and results in shrivelled cells with decreased function. Causes: excessive perspiration, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early-stage kidney disease, diabetes insipidus. Hypotonic dehydration: Solute loss exceeds water loss. Fluid moves from plasma or interstitial space into cells causing them to swell or burst. Causes: excessive hypotonic fluid replacement, kidney disease, chronic malnutrition. |
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Assessment findings: fluid volume deficit
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Cardio: thready, increased HR, decreased BP, orthostatic hypertension, diminished peripheral pulses, dysrhythmias
Resp: Increased rate and depth, dyspnea Neuromuscular: lethargy to coma, fever, weakness Renal: decreased output Integumentary: dry skin, poor turgor, dry mouth Gastrointestinal: decreased motility and diminished sounds, constipation, thirst, decreased body weight Laboratory findings: increased osmolarity, hematocrit, urea, sodium, urinary specific gravity |
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Fluid volume excess (fluid overload)
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Isotonic overhydration: Excess fluid in the extracellular space and, resulting in circulatory overload and interstitial edema. When severe or occurs in someone with poor cardiac function can lead to pulmonary edema. Caused by uncontrolled IV therapy, kidney disease, long-term corticosteroid therapy.
Hypertonic overhydration: Rare condition caused by excessive intake of sodium. Fluid drawn from intracellular into extracellular space (plasma). Caused by excessive sodium intake, rapid infusion of hypertonic IV solution, excessive sodium bicarbonate therapy. Hypotonic overhydration: known as water intoxication. All cell spaces expand and electrolyte imbalances occur. Caused by early kidney disease, heart failure, SIADH, uncontrolled IV therapy, irrigation of wounds with hypotonic solution. |
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Assessment findings: fluid volume excess
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Cardio: bounding, increased pulse rate, elevated BP, distended neck and hand veins, dysrhythmias,
Resp: Increased shallow breaths, dyspnea, moist crackles upon auscultation. Neuromuscular: altered LOC, headache, visual disturbances, weakness, paresthesias Renal: increased urine output (unless kidney disease is cause) Integumentary: pitting edema, pale, cool skin Gastrointestinal: increased motility, diarrhea, increased body weight, liver enlargement, ascites Laboratory findings: decreased osmolarity, hematocrit, urea, sodium, urine specific gravity |
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Hyponatremia:
normal range, causes, and assessment findings |
Normal sodium range between 135-145mEq/L
N.B. hyponatremia precipitates lithium toxicity Causes: excessive diaphoresis, diuretics, V/D, wound drainage (especially GI), kidney disease, decreased secretion of aldosterone, fasting/NPO status, low-salt diet (rare), excessive ingestion/IV therapy of hypotonic solutions, freshwater drowning, SIADH, hyperglycaemia, heart failure Assessment findings: depending on fluid volume status could be findings for hypo/hypervolemia PLUS: Resp: shallow, ineffective respirations related to muscle weakness (late sign) Neuromuscular: generalized muscle weakness especially in periphery, decreased reflexes CNS: headache, personality changes, confusion, seizure, coma GI: increased motility, nausea, diarrhea, cramping, hyperactive bowel sounds Renal: increased urinary output Integumentary: dry mucous membranes Laboratory Findings: low serum sodium, decreased urine specific gravity |
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Hypernatremia:
normal range, causes, and assessment findings |
Normal sodium range between 135-145mEq/L
Causes: corticosteroids, cushing's syndrome, kidney disease, hyperaldosteronism, excessive oral intake or IV therapy with hypertonic solutions, saltwater drowning, fasting/NPO status, fever, hyperventilation, infection, excessive diaphoresis, diarrhea, diabetes insipidus Assessment findings: depending on fluid volume status could be findings for hypo/hypervolemia PLUS: Neuromuscular: spontaneous twitching (early sign), muscle weakness and decreased reflexes (late sign) CNS: altered cerebral function is most common sign, agitation, lethargy, confusion, stupor, coma GI: extreme thirst Renal: decreased output Integumentary: dry, flushed skin, extreme dry mucous membranes Laboratory findings: high serum sodium, increased urine specific gravity |
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Hypokalemia: normal range and causes
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Normal serum potassium level between 3.5 - 5.0 mEq/L
N.B. when IV K therapy is being used to regulate K levels it must be diluted and observed carefully, NEVER given through push or any other method as high K levels can cause life-threatening dysrhythmias Causes: Actual loss: diuretics, corticosteroids, cushing's disease, V/D, wound drainage (especially GI), prolonged NG suction, excessive diaphoresis, kidney disease Inadequate intake: Fasting/NPO status Movement of K: alkalosis, hyperinsulinism Dilution of serum K: water intoxication, IV therapy |
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Hypokalemia: assessment findings
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Cardio: thready, weak, irregular pulse, orthostatic hypotension
Resp: shallow, ineffective breaths resulting from profound skeletal muscle weakness, diminished breath sounds Neuromuscular: anxiety, lethargy, confusion, coma, muscle weakness & cramps, loss of tactile discrimination, paresthesias, decreased reflexes GI: decreased motility, hypoactive/absent bowel sounds, N/V, constipation, abd distension, paralytic ileus Laboratory findings: low serum potassium, ECG changes: ST depression, flat/inverted T wave, prominent U wave |
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Hyperkalemia: normal range & causes
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Normal serum potassium level between 3.5 - 5.0 mEq/L
N.B. this can cause serious dysrhythmias and is a life-threatening condition. Causes: Excessive intake: over ingestion of K containing food or medication, IV therapy Decreased excretion: diuretics, kidney disease, adrenal insufficiency (Addison's disease) Movement of K: tissue damage, acidosis, hyperuricemia, hypercatabolism |
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Hyperkalemia: assessment findings & treatment
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Cardio: slow, weak, irreglar pulse, decreased BP
Resp: profound weakness of skeletal muscle leading to respiratory failure Neuromuscular: muscle cramps, twitches, paresthesias (early), profound weakness, paralysis (late) GI: increased motility, hyperactive bowel sounds, diarrhea Laboratory findings: high serum K level, ECG changes: peaked T wave, flat P wave, wide QRS, prolonged PR interval Tx: Have IV calcium on hand to prevent cardiac hyper excitability, as well as diuretics. Kayexalate binds and excreted K (1st line) may be used even with renal impairment. |
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Hypocalcemia: normal range and causes
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Normal serum calcium level between 8.6 - 10 mg/dL
Causes: Inhibition of absorption: inadequate oral intake, lactose intolerance, malabsorption disorders such as celiac or crohn's, inadequate vitamin D intake, end-stage kidney disease Increased secretion: kidney disease polyuric phase, diarrhea, steatorrhea, wound drainage especially GI Conditions that decrease the ionized fraction of calcium: hyperproteinemia, alkalosis, medications such as calcium binders, acute pancreatitis, hyperphosphatemia, immobility, removal or destruction of parathyroid gland |
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Hypocalcemia: assessment findings & treatment
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Cardio: decreased HR, hypotension, diminished peripheral pulses
Resp: can be impaired due to muscle tetany or seizure Neuromuscular: twitches, cramps, tetany, seizures, painful calf or foot cramps during inactivity, paresthesias followed by numbness affecting limbs as well as lips, nose, ears, positive Trousseau and Chvostek's signs, hyperactive reflexes, anxiety, irritability Renal: urinary output depends on cause GI: increased motility & bowel sounds, cramping, diarrhea Laboratory findings: low serum calcium, ECG changes: prolonged ST and QT interval Tx: 10% calcium gluconate on hand for Tx of extreme cases, aluminum hydroxide lowers phosphate levels and in turn increases calcium levels, vitamin D and calcium rich foods |
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Hypercalcemia: normal range and causes
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Normal serum calcium level between 8.6 - 10 mg/dL
N.B. Client at risk for pathological fractures, move carefully. Causes: Increased absorption: excessive intake of calcium or vitamin D Decreased calcium excretion: kidney disease, use of thiazide diuretic Increased bone resorption: hyperparathyroidism, hyperthyroidism, malignancy, immobility, glucocorticoids Hemoconcentration: dehydration, lithium, adrenal insufficiency (Addison's disease) |
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Hypercalcemia: assessment findings & treatment
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Cardio: increased HR (early), bradycardia - arrest (late)
Resp: ineffective respirations due to profound muscle weakness Neuromuscular: profound muscle weakness, diminished reflexes, disorientation, lethargy, coma Renal: output varies depending on cause, formation of renal calculi, flank pain GI: decreased motility & bowel sounds, anorexia, nausea, distension, constipation Laboratory findings: high serum calcium, ECG changes: shortened ST segment, wide T wave Tx: discontinue thiazide diuretics, administer diuretics that enhance calcium excretion, administer phosphorous, calcitonin, bisphosphonates, and prostaglandin synthesis inhibitors (aspirin, NSAIDs), prepare for dialysis if severe |
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Hypomagnesemia: normal range and causes
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Normal serum magnesium range between 1.6 - 2.6 mg/dL
Causes: Insufficient intake: malnutrition and starvation, V/D, malabsorption syndrome, celiac, crohn's disease Increased secretion: diuretics, chronic alcoholism Movement of Mg: hyperglycaemia, insulin administration, sepsis |
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Hypomagnesemia: assessment findings & treatment
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Cardio: tachycardia, hypertension
Resp: shallow resps Neuromuscular: twitches, paresthesias, positive Trousseau and Chvostek's signs, hyperreflexia, tetany, seizures CNS: irritability, confusion Laboratory findings: low serum magnesium, ECG changes: tall T waves, depressed ST segments Tx: IV therapy if very severe, oral can cause more diarrhea and worsen condition and IM causes muscle damage, calcium levels also corrected as often related, high Mg containing foods given |
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Hypermagnesemia: normal range and causes
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Normal serum magnesium range between 1.6 - 2.6 mg/dL
Causes: Increased intake: magnesium-containing antacids and laxatives, excessive IV therapy Decreased excretion: renal insufficiency |
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Hypermagnesemia: assessment findings
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Cardio: bradycardia, dysrhythmias, hypotension
Resp: respiratory failure when muscles involved Neuromuscular: diminished or absent reflexes, weakness CNS: drowsiness, lethargy, coma Laboratory findings: high serum magnesium, ECG changes: prolonged PR interval, widened QRS complex |
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Hypophosphatemia: normal range and causes
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Normal serum phosphate range between 2.7 - 4.5 mg/dL
N.B. A decrease in serum phosphate causes and increase in serum calcium. Causes: Insufficient intake: starvation and malnutrition Increased excretion: hyperparathyroidism, malignancy, use of magnesium-based or aluminum-hydroxide based antacids Movement: hyperglycemia, respiratory alkalosis |
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Hypophosphatemia: assessment findings
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Cardio: diminished peripheral pulse
Resp: shallow Neuromuscular: weakness, decreased reflexes CNS: irritability, confusion, seizures |
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Hyperphosphatemia: normal range and causes
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Normal serum phosphate range between 2.7 - 4.5 mg/dL
N.B. most body systems tolerate high phosphate levels well, the problems that occur are a result of simultaneous hypocalcemia Causes: - Decreased output due to renal insufficiency - Tumor lysis - Increased dietary intake or oversee of phosphate-containing laxatives/enemas - Hypoparathyroidism |
