fluid and electrolytes

Created by mnewble 

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homeostasis

process in which the body maintains balance by constantly adjusting to internal and external stimuli

Fluids

makes up the large portion of the body. Elderly decreases 45-50% of body weight. r/t decreased muscle mass, smaller fat stores, and decrease in body fluids

intracellular fluid

inside the cells 2/3 tbf and functions as a stabilizing agent for parts of the cell

extracellular fluid

outside the cells 1/3 tbf appears mostly in the interstitial fluid and intravascular fluid

primary icf

k, ph, mg, sulfate

interstitial fluid

is found between the cell

primary ecf

na, ca,bicarbonate cl

intravascular fluid

aka plasma

hypervolemia

is too much fluid in the blood

hypovolemia

is too little fluid in the blood

over hydration

excess of waste in the body

edema

excessive accumulation of fluid into interstitial tissue spaces.
aka.third spacing

Fluid volume shifts

fluid normally shifts between ic and ec compartments to maintain equilibrium between spaces

fluid volume shifts

fluid not lost from body but not available for use in either compartment. considered third spacing

causes of third spacing

burns, peritonitis, bowel obstruction, massive bleeding into or cavity, liver or renal failure

signs/symptoms of third spacing

decreased urine output with adequate intake, increased HR, decreased BP, increased weight, pitting edema

Treatment of Third spacing

monitor I & O, most reliable indicator

edema

has four stages, pitting

edema

local and systemic

treatment of edema

diurectics, I & O, daily weight, monitor K

Fluid volume excess

hypervolemia, isotonic expansion of ECF caused by abnormal retention of H2O and Na, fluid moves out of ECF into cells and cells swell

Fluid volume excess causes

cardiovascular-heart failure, urinary-renal failure, hepatic-liver failure,cirrhosis,normal imbalances

interventions

Na restrictions, fluid restrictions, closely monitor IVF, push at correct speed to prevent pulmonary edema, if dyspnea or othropnea put in Semi-Fowlers, strict I & Os

dehydration

excessive loss of water from the body

dehydration i

increases in Na or a disturbance of electrolytes such as K

Factors of dehydration

diarrhea, vomiting, inappropriate use of diuretics, decreased fluid intake, excessive heat, sweating, fever

dehydration

thirst, decreasing urine/cease sweating, water moves from ICF to intravascular fluids, body tissues dried out, mental confusion, coma, and severe kidney/liver damaged

signs/symptoms of dehydration

acute weight loss, oliguria, concetrated urine, weak rapid pulse, cap refills time elongated, decreased BP, increased pulse, sensations of thirst, weakness, dizziness, muscle cramps

dehyration

sunken eyes, depressed fontanels, significant wt loss

labs for dehydration

dark concentrated urine, specific gravity is

other causes of water loss

fever,burns, diarrhea, vomiting, NG suctioning, surgery, wound drainage fistulas

Isotonic

solution exerting equal pressures on opposite sides of the membranes, used to expand the ECF compartment

Hypertonic

cause the water from within a cell to move to the ECF compartment. Immersion in a hypertonic solutiion will result in shrinkage of blood cells.

Hypotonic

immersion in a hypotonic solution will result in swellin of blood cells, hydrate cells and deplete the circulatory system

urine specific

1.010-1.025

creatinine

0.7-1.5

hematocrit

male, 44-52, female 39-47

electrolytes

are active chemicals or elements within the body

electrolytes

found in all body fluids

electrolytes

are expressed in mEq

electrolytes

an element or compound that will dissociate into ions when dissolved in water

electrolyte values

na-135-145, k 3.5-5.0, ca 4.3-5.3, mg 1.5-1.9, cl 95-108, ph 1.7-2.6, bicarbonate 2.2-2.6

cations

na, k, ca, mg, fe, h

anions

cl, hco3, s04, hp04

organs involved in homeostasis

kidneys, adrenal glands, parathyroid gland thyroid gland

serum concentration

in ecf are used to measure imbalances

osmosis

movement of h2o frm low concentration to high concentration w/o energy

diffusion

movement of area of high concentration to low concentration in a permeable membrane

filtration

substances moving across membranes filtering either direction

active transport

energy is required for it to move ATP

1/2 NS

hypotonic

NS

iso/hyper

d5w

isotonic

d10w

hypertonic

d5 1/2 ns

hypotonic

d5rl

isotonic

rl

isotonic

two types of losses

sensible and insensible

sensible loss

measurable, kidneys, wound, bile,

insensible loss

unmeasurable sweat, sneezing, lungs

hyponatremia

results from excess na loss or water loss

hyponatremia

gi losses, diuretic therapy, severe renal dysfunction, severe diaphoresis, some drugs

hypernatremia

gain of na in excess of water or loss of water in excess of na

hypernatremia

excessive infusion of saline, diarrhea, insufficient water intake, rapid breating

early signs of hypernatremia

genralized muscle weakness, faintness, muscle fatigue, HA

moderate signs of hypernatremia

confusion, thirst,oliguria

late signs of hypernatremia

edema, restlessness, thirst, hyperreflexia, muscle twitching, irritability, seizures. possible coma

treatment of hypernatremia

reduce intake of salt

Hypokalemia

serum k level below 3.5 mEq

hypokalemia

loss of gi secretions, excessive renal excretion of k, movement of k into the cells, prolonged fluid adm without k supplementation, diuretics

s/s

skeletal muscle weakness, muscle twitching, paralysis, decreased bp, ekg changes, possible cardiac arrest, n/v, diarrhea, metabolic alkalosis, mental confusion and depression

treatment of hypokalemia

hypertonic glucose solution, monitor, i&0, bowel sounds, vs,cardiac rhythm, myscle strength, digoxin level if neccessary

hyperkalemia

serum k level above 5.3 mEq

hyperkalemia

excessive k intake especially in renal failure, tissue trauma, acidosis, catabolic state

treatment of hyperkalemia

10% calcium gluconate, sodium bicarbonate, 50% glucose solution, kayexalate PO/PR b/c absorb through rectum. stop k supplementts and avoid k in food, fluids, salt substitutes

calcium

required for blood coagulation, neuromuscular contraction, enzymatic activity, and strength durability of bones and teeth

calcium

nerve cell membranes less excitable with enough calcium

hypocalcemia

most common depressed function or surgical removal of the parathyroid gland

signs/symptoms of hypocalcemia

abdominal and/or extremity cramping, tingling and numbness, positive chvostek, trousseau signs, tetany hyperactive reflexes, irritability, reduced cognitve ability, seizures abnormal clotting

treatment of hypocalcemia

high calcium diet or oral calcium salts, iv calcium as 10% cacl or 10% calcium gluconate, close monitoring of serum ca an digitalis levels, vitamin d therapy

METABOLIC ALKALOSIS

restlessness, confusion, dyrhythmias, compensatory hypoventilation, slow resps, diarrhea, n&v

RESPIRATORY ALKALOSIS

seizures, deep rapid breathing, confusion, hypokalemia, light headedness, tingling of extremities

RESPIRATORY ACIDOSIS

hypoventilation, rapid and shallow respirations, increased bp, dyspnea, headache,hyperkalemia, cardiac output, disorientation, muscle weakness, hypoxia high pCO2

METABOLIC ACIDOSIS

headache, disorientation, hyperkalemia, changes in LOC, muscle twitching, kussmaul resps low HCO3

Acid Base

buffer, bicarbonate NaHCO3=base

Acid Base

buffer, carbon dioxide-H2CO3=acid

acid base organs

kidneys/lungs

lungs

chemical buffers, regulate acid, CO2, CO2 + H2CO3 carbonic acid, hyperventilation increasd in co2 inhaled

Kidneys

regulates, bicarbonate and base

arterior blood gases

used to monitor acid base balance

ph balance

7.35-7.45

PaCO2

35-45

HCO3

22-26

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