Med Surg Iggy Ch 14, 15, 16 Fluid And Electrolytes

Front 1

Diffusion

Back 1

"goes with the flow"
Solutes move from higher to lower concentration

Front 2

osmosis

Back 2

"let's fluids through"
Passive movement of fluid across a membrane from lower to higher concentrations. Stops when concentration is equal on both sides

Front 3

Hypotonic

Back 3

hyposmotic
any solution with a solute concentration lower than the blood or normal body fluds
ex: 1/2 NS

Front 4

Isotonic

Back 4

isosmotic
any solution with a solute concentration equal to osmolarity of normal body fluids or normal saline
ex: NS

Front 5

Hypertonic

Back 5

hyperosmotic
any solution with a solute concentration greater than that of normal body fluids
ex: D5NS

Front 6

Hormonal regulation of fluid

Back 6

Renin, angiotensin, aldosterone(RAA) increases blood volume and blood pressure

Front 7

Renin

Back 7

produced in kidneys
enzyme that acts on angiotensinogen to convert angiotensin I to angiotensin II

Front 8

Angiotensin II

Back 8

vasoconstrictor
controls aldosterone release

Front 9

Aldosterone

Back 9

triggers kidneys to reabsopb sodium. sodium retension inhibits fluid loss, increasing blood volume and thus, BP

Front 10

Anti diuretic hormone (ADH)

Back 10

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

Front 11

Sensible routes of fluid loss

Back 11

measurable
oral, parenteral, enema, urine, emesis, feces, irrigation fluids, drainage

Front 12

Insensible routes of fluid loss

Back 12

immeasurable
solid food, metabolism, perspiration, lung vaporization

Front 13

Normal physical assessment for fluid loss

Back 13

moist eyes, moist mucous membranes, input equals output

Front 14

Abnornal physical assessment for fluid loss

Back 14

cotton mouth, no tearing, wt. loss, decreased output, poor skin turgor

Front 15

Places to check for skin turgor

Back 15

sternum, forehead, back of hand(not reliable in elderly patients d/t loss of elasticity)

Front 16

3 types of dehydration

Back 16

isotonic, hypertonic and hypotonic

Front 17

Isotonic dehydration-def.

Back 17

most common
fuid loss from ECF space
no shift of fluids (ICF remains normal)
hypovolemia and inadequate tissue perfusion

Front 18

Isotonic deydration assessment

Back 18

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

Front 19

hypertonic dehydration-def.

Back 19

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

Front 20

hypertonic dehydration assessment

Back 20

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

Front 21

hypotonic dehydration-def.

Back 21

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

Front 22

hypotonic dehydration assessment

Back 22

hypotension
tachycardia
changes in LOC
low serum Na and low serum osmolarity

Front 23

Isotonic overhydration assessment

Back 23

wt gain
distended neck veins
polyuria
hypertension
ful bounding pulses
crackles, SOB
elevated RR
ascites
periperal edema
decreased hematocrit and BUN(hemodilution)
liver enlarged

Front 24

hypertonic overhydration assessment

Back 24

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)

Front 25

Hypotonic overhydration assessment

Back 25

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

Front 26

Hypokalemia causes

Back 26

<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)

Front 27

hypokalemia sx

Back 27

cardio-dysrhythmia, EKG changes
GI-N/V, anorexia, decreased bowel sounds, ileus
musculoskeletal-weakness, cramps

Front 28

hypokalemia Tx

Back 28

Potassium supplements
K rich foods-
monitor K levels, cardiac monitoring, digitalis, antidysrhythmics

Front 29

hyperkalemia causes

Back 29

>5.0mEq/L
impaired renal excretion, renal failure, K sparing diuretics, adrenal insuff., excessive K intake

Front 30

hyperkalemia sx

Back 30

cardio-tall peaked T waves, widened QRS, dysrhythmia, cardiac arrest
Gi- N/V, ABD cramping, diarrhea
neuromuscular-weakness, paresthesia, flaccid paralysis

Front 31

hyperkalemia Tx

Back 31

dialysis
Calcium gluconate IV
regular insulin and glucose (
to promote K uptake of cells)
monitor I&O, K, BUN, creatinine

Front 32

hypocalcemia causes

Back 32

<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

Front 33

hypocalcemia Sx

Back 33

neuromuscular-tetany, spasm,positive Chvotek's, positive Trousseau's, anxiety, confusion
cardio-dysrhythmias, hypotension
GI ABD cramping

Front 34

hypocalcemia Tx

Back 34

oral or IV Ca, vit D may be given to increase absorption
monitor resp status
seizure precautions
diet

Front 35

hypercalcemia causes

Back 35

>10mEq/L
hyperparathyroidism, CA, immobilization, Paget's, excess milk intake

Front 36

hypercalcemia Sx

Back 36

bradycardia, various heart blocks, cardiac arrest
muscle weakness,AMS, decreased LOC, ABD pain, constipation, anorexia, N/V, dysrhythmia, hypertension,thirst

Front 37

hypercalcemia Tx

Back 37

calcitonin rapidly lowers Ca
low Ca diet
sodium phosphate in emergency
IV fluid to aid excretion

Front 38

hypomagnesemia causes

Back 38

<1.6mEq/dl
alchoholism, intestinal suction, impaired absorption

Front 39

hypomagnesemia Sx

Back 39

muscle weakness, tremors, tetany, seizures, dysphagia, anorexia, N/V/D, tachycardia, hypertension, mood changes

Front 40

hypomagnesemia Tx

Back 40

increase intake of Mg rich foods May givee IV mag sulfate if severe
Tx for alchoholism