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94 terms

fluid and electrolytes

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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
bun
10-20
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