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40 Cards in this Set

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Diffusion
"goes with the flow"
Solutes move from higher to lower concentration
osmosis
"let's fluids through"
Passive movement of fluid across a membrane from lower to higher concentrations. Stops when concentration is equal on both sides
Hypotonic
hyposmotic
any solution with a solute concentration lower than the blood or normal body fluds
ex: 1/2 NS
Isotonic
isosmotic
any solution with a solute concentration equal to osmolarity of normal body fluids or normal saline
ex: NS
Hypertonic
hyperosmotic
any solution with a solute concentration greater than that of normal body fluids
ex: D5NS
Hormonal regulation of fluid
Renin, angiotensin, aldosterone(RAA) increases blood volume and blood pressure
Renin
produced in kidneys
enzyme that acts on angiotensinogen to convert angiotensin I to angiotensin II
Angiotensin II
vasoconstrictor
controls aldosterone release
Aldosterone
triggers kidneys to reabsopb sodium. sodium retension inhibits fluid loss, increasing blood volume and thus, BP
Anti diuretic hormone (ADH)
vasopressin
produced in brain
stored in post pituitary
makes kidney tubules more permeable to water. Increases water reabsorption, more water returned to blood=decrease in blood osmolarity
Sensible routes of fluid loss
measurable
oral, parenteral, enema, urine, emesis, feces, irrigation fluids, drainage
Insensible routes of fluid loss
immeasurable
solid food, metabolism, perspiration, lung vaporization
Normal physical assessment for fluid loss
moist eyes, moist mucous membranes, input equals output
Abnornal physical assessment for fluid loss
cotton mouth, no tearing, wt. loss, decreased output, poor skin turgor
Places to check for skin turgor
sternum, forehead, back of hand(not reliable in elderly patients d/t loss of elasticity)
3 types of dehydration
isotonic, hypertonic and hypotonic
Isotonic dehydration-def.
most common
fuid loss from ECF space
no shift of fluids (ICF remains normal)
hypovolemia and inadequate tissue perfusion
Isotonic deydration assessment
Wt loss
hypotension (orthostatic)
rapid, weak pulse
oliguria
poor skin turgor
dry mucous membranes
elevated urine specific gravity
altered LOC
increased hematocrit (except in hemorrhage)
increased serum protein and BUN
hypertonic dehydration-def.
2nd most common
water loss from ECF is greater than electrolyte loss
increases osmolarity of remaining plasma (hypertonic)
causes water to move from ICF to plasma causing cellular dehydration and shrinkage
hypertonic dehydration assessment
thirst
decreased skin turgor
dry mucous membranes
HYPERACTIVE DTR's
increased urine spec. gravity
increased serum Na and osmolarity
pitting edema
NO CARDIAC CHANGES
NO S/S SHOCK
hypotonic dehydration-def.
less common
caused by fluid shift causing a decrease in plasma volume
excessive loss of K and Na from ECF
water moves from plasma into cells causing plasma volume deficit and cells swell
hypotonic dehydration assessment
hypotension
tachycardia
changes in LOC
low serum Na and low serum osmolarity
Isotonic overhydration assessment
wt gain
distended neck veins
polyuria
hypertension
ful bounding pulses
crackles, SOB
elevated RR
ascites
periperal edema
decreased hematocrit and BUN(hemodilution)
liver enlarged
hypertonic overhydration assessment
elevated BP
elevated CVP and JVD
full, bounding pulses
thirst (d/t cell shrinkage)
high serum osmolarity
decreased output ( retaining water to dilute Na)
high urine Na levels ( can lead to disorientation, lethargy and coma)
Hypotonic overhydration assessment
s/s r/t low Na levels and fluid shifts, causing cellular swelling --increased intercranial pressure
overall H/A and photophobia
confusion and disorientation
muscle twitching
hyperirritability
N/V
Polyuria
convulsions and coma
polyuria
diarrhea
nonpitting edema
cardiac dysrhythmias assoc with electrolyte dilution
projectile vomiting
Hypokalemia causes
<3.5mEq/L
excess potassium can be lost thru kidneys(K wasting diuretics) or GI tract (vomiting or diarrhea), inadequate intake, shift to cells (alkalosis)
hypokalemia sx
cardio-dysrhythmia, EKG changes
GI-N/V, anorexia, decreased bowel sounds, ileus
musculoskeletal-weakness, cramps
hypokalemia Tx
Potassium supplements
K rich foods-
monitor K levels, cardiac monitoring, digitalis, antidysrhythmics
hyperkalemia causes
>5.0mEq/L
impaired renal excretion, renal failure, K sparing diuretics, adrenal insuff., excessive K intake
hyperkalemia sx
cardio-tall peaked T waves, widened QRS, dysrhythmia, cardiac arrest
Gi- N/V, ABD cramping, diarrhea
neuromuscular-weakness, paresthesia, flaccid paralysis
hyperkalemia Tx
dialysis
Calcium gluconate IV
regular insulin and glucose (
to promote K uptake of cells)
monitor I&O, K, BUN, creatinine
hypocalcemia causes
<8.5 mEq/L
parathyroidectomy or neck surgery, acute pancreatitis, inadequate intake, lack of sun exposure (vit D), lack of wt. bearing, drugs, calcitonin, alchohol abuse
hypocalcemia Sx
neuromuscular-tetany, spasm,positive Chvotek's, positive Trousseau's, anxiety, confusion
cardio-dysrhythmias, hypotension
GI ABD cramping
hypocalcemia Tx
oral or IV Ca, vit D may be given to increase absorption
monitor resp status
seizure precautions
diet
hypercalcemia causes
>10mEq/L
hyperparathyroidism, CA, immobilization, Paget's, excess milk intake
hypercalcemia Sx
bradycardia, various heart blocks, cardiac arrest
muscle weakness,AMS, decreased LOC, ABD pain, constipation, anorexia, N/V, dysrhythmia, hypertension,thirst
hypercalcemia Tx
calcitonin rapidly lowers Ca
low Ca diet
sodium phosphate in emergency
IV fluid to aid excretion
hypomagnesemia causes
<1.6mEq/dl
alchoholism, intestinal suction, impaired absorption
hypomagnesemia Sx
muscle weakness, tremors, tetany, seizures, dysphagia, anorexia, N/V/D, tachycardia, hypertension, mood changes
hypomagnesemia Tx
increase intake of Mg rich foods May givee IV mag sulfate if severe
Tx for alchoholism