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Fluid & Electrolytes (Adult Health I)
Terms in this set (99)
Atrial natriuretic peptide (ANP)
A hormone released by atrial muscle cells in response to distention from fluid overload.
Fluid Volume Deficit (FVD)
A decrease in intravascular, interstitial, and/or intracellular fluid in the body.
A loss of water alone
Decreased circulating blood volume
(A loss of extracellular fluid volume can lead to this)
(form of fluid volume deficit but different because stays in body/hard to detect)
A shift of fluid from the vascular space into an area where it is not available to support normal physiologic processes
*Triggers: increased vascular permeability or decreased protein levels
*Areas: (Fluid LEAVES blood vessels to...) tissue, abdomen (peritoneal), pleural, pericardial spaces.
Fluid Volume Deficit Manifestations
BP: decreased systolic; postural hypotension
Pulse Amplitude: decreased
Jugular Vein: flat
Skin Turgor: loose, poor turgor (meaning when pinched it tents)
Output: low, concentrated
Urine Specific gravity: high
FVD Severity (%'s)
Each liter of body fluid=1 kg/ 2.2 lbs(severity of it can be estimated by percentage or weight loss) --> 2%=mild FVD, 5%= moderate FVD, 8%= severe FVD.
FVD Diagnostic Tests Findings
1) Serum electrolytes-isotonic fluid deficit, Na+ levels normal; w/ only water loss Na+ high; decreases in potassium are common
2) Serum osmolality- differentiates isotonic fluid loss form water loss; w/ water loss, osmolality is high, can be WDL in isotonic fluid loss
3) Hemoglobin and hematocrit- elevated due to loss of intravascular volume and hemoconcentration
4) Urine specific gravity & osmolality- both increase as kidneys conserve water
5) Hemodynamic pressures- MAP, CVP, RAP, & PAWP decrease in severe cases
*Oral rehydration (safest/most effective> alert pt's able to swallow)(mild FVD from heat/exercise > water alone helps)(severe [water & electrolytes lost] from vomit/diarrhea/strenuous exercise 1+ hrs > need carb./-lyte solution [pedialyte or rehydrate])
*When severe FVD/pt cannot ingest water> IV Therapy needed.
FVD H.C. promotion
TEACH (importance of adequate fluid intake > mainly when exercising or hot weather)(instruct to maintain fluid intake when ill especially w/ fever, diarrhea, vomit)
Monitor I's and O's for @ risk pt's: vomit, diarrhea, NG suction, increased urine output, fever, draining wounds
Monitor those w/ decreased LOC , disoriented, nauseous, anorexic, limited physically
*Health hx: risk factors like meds, acute/chronic renal or endocrine disease, other factors-hot weather, extensive exercise, lack of fluid access, recent illness (accompanied by fever, diarrhea, vomit).
*Physical assessment: weight, vitals (orthostatic BP and pulse, peripheral pulses, cap. Refill, jugular vein distention, skin color, temperature, turgor, LOC, urine output)(check older adult BP and pulses after they stand for a min)
Fluid Volume Excess Manifestations
Pulse Amplitude: increased
Respirations: most crackles; wheezing
Jugular Vein: distended
Skin Turgor: taut (meaning stretched/pulled tight)
Output: may be low OR normal
Urine Specific gravity: low
Fluid Volume Excess (FVE)
Occurs when both water and sodium are retained in the body
***Caused by 1) fluid overload, such as excess water/sodium intake OR 2) impairment of mechanisms that maintain homeostasis
FVE Diagnostic Tests
1) Serum electrolytes (Na+) + serum osmolality measured (low)
2) Serum Hematocrit + Hemoglobin measured (decreased due to plasma dilution from excess extracellular fluid
3) Serum Creatinine, BUN, liver enzymes done for renal & liver funct. to determine cause of FVE
4) pleural effusions
5) ABGs (low pO2 & pCO2, decreasing pH)
6) CXR reveal pulmonary congestion
Diuretics mainly used to treat FVE(inhibit sodium AND water reabsorption, increase urinary output)(3 classes, each acts on diff. part of kidney tubule)....
1)Loop Diuretic (ascending loop of Henle)
2) Thiazide-type diuretic (distal convoluted tubule)
3) Potassium-sparing Diuretic (distal nephron)
1) Fluid Management (may restrict intake, HCP prescribes allowed intake per day)
2) Dietary Management (Na+ retention primary cause of FVE, Na+ restricted diet is prescribed [mild=reduce, moderate-severe=cut Na+ out])
*can put pt in semi-high fowlers for SOB
FVE Health Promotion
Teach pt's @ risk (ex. heart failure), discuss sodium & water retention, guide them to low-sodium diet, have them learn to identify food labels for sodium and processed foods, have them weigh themselves often + use same scale (notify HCP if gain >5lbs in a week or less)
*Health HX: meds, heart failure, acute/chronic renal or endocrine disease, recent illness/diet/meds change, recent weight gain, persist cough, SOB, feet/ankle swelling, difficulty sleeping lying down.
*Physical Exam: vitals, peripheral pulses, cap refill, jug. neck vein distention, edema, lung sounds (crackles or wheezes), dyspnea, cough, sputum, urine output, mental status
The ability to maintain internal equilibrium by adjusting physiologic processes
(Normal physiologic processes depend on this for the internal environment of the body)
Q: What must remain constant (w/in relatively narrow range), in homeostasis, in order to maintain health and life?
A: Fluid volume, electrolyte composition, and pH of both intracellular and extracellular spaces.
Q: What can imbalances of fluids, electrolytes, and pH affect?
A: Ability to 1) maintain ADLs (activity-exercise), 2) think clearly (cognitive-perceptual), & 3) engage in self care (health perception-health management)
Q: What is the goal for managing fluid, electrolyte, and acid-base imbalances?
A: Reestablish and maintain homeostasis
Excess intravascular fluid (that comes from excess fluid)
Abnormal accumulation of fluid (swelling) in interstitial spaces of tissues
Difficulty breathing when in supine position
Arterial Blood Gas (ABGs)
A blood test that is performed to determine the concentration of oxygen, carbon dioxide, and bicarbonate, as well as the pH of the blood.
(This test checks the function of a patient's lungs/for impaired gas exchange [administer O2 as indicated] and for any acid-base disorders)
Levels for ABGs
*pH: 7.35-7.45 (<7.35=patient has acidosis....>7.45= patient has alkalosis)
*SaO2 (meaning oxygen saturation)= 92-100%
*PaO2 (meaning partial pressure of oxygen in arterial blood)= 80-100 mmHg (<80 mmHg=hypoxemia)
*Partial pressure of carbon dioxide in arterial blood (PaCO2): 35-45 mmHg (<35 mmHg= hypocapnia...>45 mmHg= hypercapnia)
*Bicarbonate (HCO3-): 22-26 mEq/L --> this is the bicarbonate concentration in plasma.
*Base Excess (BE): -3 to +3 --> this is a measure of buffering capacity
Helpful Tips for Interpreting ABGs
pH CO2 HCO3 (use these 3 categories, in this order, to reference the different arrows/word "normal" below...to see the difference between metabolic and respiratory)
Respiratory acidosis ↓ ↑ Normal
Respiratory alkalosis ↑ ↓ Normal
Respiratory acidosis with metabolic compensation ↓ ↑ ↑
Respiratory alkalosis with metabolic compensation ↑ ↓ ↓
Remember this below ("ROME") to differentiate Respiratory or Metabolic..
a condition marked by muscular spasms of the face and extremities, caused by a consequent deficiency of calcium (called hypocalcemia).
substances that release hydrogen ions when dissolved in water (proton donors)
Bases (AKA Alkaline/Alkalis)
Accept hydrogen ions in a solution/dissolved water (proton acceptors)
pH level less than 7.35
pH level above 7.45
Serum Bicarbonate (HCO3-)
Reflects the renal regulation of acid-base balance
Base Excess (BE)
Buffer base capacity
Labored, deep, and rapid respirations. A patient with this may complain of SOB/dyspnea (can occur from, metabolic acidosis, accumulation of acids when insulin not available in body).
Increased carbon dioxide levels (affects neurologic function and cardiovascular system)
BUN normal range
*Checks renal function and hydration status
*HIGH= dehydration, excessive protein intake
*Low= over hydration, liver damage, malnutrition
(measure % of RBCs in whole blood)(Assess hydration status prior to this lab, to prevent false outcome)
the concentration of solutes in body fluids
Osmolality Level Results
>295= water deficit
Average Urinary Output Per Day
1200-1500 mL (aka 1.2-1.5 L)
(should urinate ~30 mL an hour)
Sodium (Na) Values
(Serum Na+ <135 mEq/L)
*Cause: adrenal insufficiency, water intoxication, SIADH, vomit, diarrhea, sweat, diuretics.
*Manifestations: poor skin turgor, dry mucosa, headache, decreased salivation, decreased BP, nausea, abdominal cramping, near changes, muscle weakness, depression, hyperreflexia, muscle twitching, seizures ..very low=coma
*Meds: (IVs) Isotonic Ringers Solutions or Isotonic Saline (0.9% NaCl) w/ hypo-natremia AND -volemia. 3% (Hypertonic) NaCl for those w/ very low Na+ levels.
*Treatment: Increase Na+ intake in foods (if >130 mEq/L). Fluids restricted (reduce ECF volume)
(Serum Na+ >145 mEq/L)
*Cause: excess water loss or Na+admin, diabetes insipidus, heat stroke, hypertonic IV solution.
*Manifestations: thirst (1st manifestation), increased serum osmolality, oliguria, increased specific gravity, dry swollen tongue, dry skin/mucous membranes, decreased skin turgor, furrowed tongue, dry mouth, headache, restless, seizure, coma, tachycardia, hypotension, vascular collapse
*Meds: Oral, enteral, or IV water replacement. Hypotonic IV fluid (0.45% NaCl or 5% dextrose in H2O [isotonic when given but turns into hypotonic and provides pure water). Diuretics (increase Na+ excretion.
Chloride (Cl-) Values
Bicarbonate (HCO3-) Values
(total carbon dioxide)
Calcium (Ca^2+) Values
4.5-5.5 mEq/L (9-11 mg/dL **) <— PP uses mg/dL
(Serum calcium <9 mg/dL)
*Causes: Hypoparathyroidism, Malabsorption, Pancreatitis, Alkalosis, Massive transfusion of citrated blood, Renal failure, Medications
*Manifestations: Tetany (spasms), Circumoral numbness, Paresthesia, Hyperactive DTR's, Trousseau's sign, Chvostek's sign, Seizures, Respiratory symptoms, Dyspnea
(serious complications: airway obstruction, respiratory arrest, ventricular dysrhythmias, heart failure, convulsions).
*Meds: Oral (calcium carbonate, calc. glucose, calc. lactate > for chronic asymptomatic) or IV calcium (if severe or have prob. like airway obstruction). Calc supplements given w/ vitamin D (<or this alone) to increase GI absorption of calcium.
Nutrition-diet high in Ca w. chronic pt's (dairy products, canned salmon, broccoli, spinach, tofu).
(Serum calcium > 11 mg/dL)
*Causes: Malignancies, Hyperparathyroidism, Tumors, Immobilization, Thiazide diuretics, Vitamin A & D intoxication, Lithium and theophylline toxicity
*Manifestations: Anorexia, Dehydration, Constipation, Abdominal/bone pain, Excessive urination, Severe thirst, Confusion, impaired memory, slurred speech, lethargy, acute psychotic behavior or coma
*Meds: (acute >) IV fluid w/ loop diuretic (lasix, to promote elimination of Ca). Bone resorption inhibit drugs (for malignancies; osteoporosis) > biphosphonates, pamidronate, etidronate. IV plicamycin (inhibit bone resorption). Glucocorticoids, vitamin D, low calcium diet. Calcitonin (decrease skeletal mobilization + increase renal output).
Fluid Management- IV fluids (isotonic saline usually)for severe cases.
Potassium (K+) Values
(Serum K+ <3.5 mEq/L)
*Cause: meds, GI loss, acid base alter., hyperaldosteronism, poor diet intake
*Manifestations: EKG- flat T wave/ development of U waves/depressed ST seg.
, muscle weakness, leg cramps (lower extrem. then upper), atrial and ventricular dysrhythmias (abnormal rhythm), decrease CO, polyuria, paresthesia, low muscle strength
*Meds: oral and/or parenteral (IVs) supplements to prevent/treat.
*Nutrition: Diet his in K+ (to supplement drug therapy)(ex: bananas, potatoes, tomatoes, meat, seafood, milk, yogurt)
(Serum K+ >5.3 mEq/L)
*Cause: treatment, impaired renal fx, hyperaldosteronism, tissue trauma, acidosis, OTHER?
*Manifestation: EKG- prolonged PRI/ST seg depressed/Tall tented T wave, dysrhythmias, cardiac arrest, paresthesia, muscle weakness, twitch, weak, ascending paralysis, dyspnea, ab. cramp, ileus, nausea/vom/diarrhea.
*Meds: (if renal fx normal) diuretic (furosemide) given. Mod-severe calcium gluconate given in IV to counter heart effects. Rapidly lower: insulin and 50 g glucose given (promote K+ uptake by cells). Remove K+, sodium polystyrene sulfonate given oral/rectally.
**When other measure unsuccessful...Dialysis: when renal fx limited (either peritoneal or hemodialysis)
Phosphate (PO 4^2-)
1.7-2.6 mEq/L (2.5-4.5 mg/dL**) <— PP uses mg/dL
(Serum phosphate < 2.5 mg/dL)
*Causes: ETOH, Refeeding pts after starvation, Pain, Heat stroke, Respiratory alkalosis, Hyperventilation, Hepatic encephalopathy, Major burns
*Manifestations: intention tremor, paresthesia, confusion, stupor, bone pain, joint stiffness, bleeding disorder (platelet dysfunction), impaired WBCs, seizures, tissue hypoxia.
*Treatments: Improved diet, oral phosphate supplement (mild), IV phosphate (severe, levels <1)
(Serum phosphate >4.5 mg/dL)
*Causes: Renal failure, Excess phosphorus, Excess Vitamin D, Hypoparathyroidism, Chemo
*Manifestations: paresthesia, muscle weakness, nausea and vomit, dysphagia, tetany, decreased BP, cardiac dysrhythmias, soft tissue calcification, symptoms r/t hypocalcemia.
*Treatment: Phosphate containing drugs eliminated, and foods containing phosphate restricted, agents that bind w/ phosphate in GI tract may be prescribed, if renal function adequate can administer IV of normal saline (to excrete phosphate), dialysis for reducing in renal failure pt's.
Magnesium (Mg^2+) Values
1.5-2.5 mEq/L (1.8-3.0 mg/dL**) <— PP uses mg/dL
(Serum magnesium < 1.8 mg/dL)
*Causes: Alcoholism, GI losses, Enteral/parenteral feeding deficient in Mg, Medications, Rapid administration of citrated blood, Diabetic ketoacidosis, Sepsis, Burns/hypothermia
*Manifestations: Mood changes, Neuromuscular (confused/mood changes/hallucinate), irritability, Muscle weakness, Tremors, EKG changes (prolonged PRI, did QRS, depressed ST seg)(ventricular dysrhythmia), Dysrhythmia..HTN, tachycardia
Positive Babinski, Chvostek and Trousseau. Cardiac arrest (severe).
*Treatment: Increase (if able to eat) magnesium intake (veggies, seafood, milk, bananas, citrus fruit, chocolate). Parenteral Magnesium Sulfate (IV or IM injection).
(Serum magnesium > 3 mg/dL)
*Causes: Renal failure, Diabetic ketoacidosis, Excessive MgSO4.
*Manifestations: Flushing; NV, low BP, Diminished DTRs, Drowsiness, Muscle weakness, Depressed respirations, EKG changes, Dysrhythmias, Coma / cardiac arrest
*Treatment: Identify underlying cause. All meds (containing magnesium) are withheld. Renal failure pt- hemo or peritoneal dialysis (remove excess mg). Calcium gluconate IV (to reverse this). Mechanical Ventilation (support respirations) and may need pacemaker (maintain adequate output).
Serum Osmolality (normal range)
(From powerpoint: <275= water excess & >295= water deficit)
Q: What is a solute?
A: a substance that is dissolved in a mixture or solution
Intracellular (Fluid Inside Cell) Fluids Solutes
(40%-60% of body weight, most stable)
Potassium (K+) <-- MAIN ONE
Extracellular (Fluid Outside Cell) Fluid Solutes
(Least stable. 15% interstitial, 5% plasma)
Sodium (Na+) <-- MAIN ONE
Q: What're the compartments of extracellular fluid?
A: Interstitial and Plasma (AKA intravascular)
Q: Does intracellular or extracellular fluid make most of the body's fluid?
A: Intracellular (40%)
Q: What is the body's fluid composed of?
A: Water (primary component of body fluids & functions) & Electrolytes (def: substances that dissociate in solution to form charged particles called ions > cations or anions)(Functions: regulate water and acid-base balance, contribute to enzyme reactions, and essential for neuromuscular activity)
Q: How much water makes up the body weight of an adult male and an adult female?
A: Male is 60% and Female is 50% (rationale- females have more fat & adipose tissue contains less water. Males have more skeletal muscle which contains more water).
Q: How much water does an older adult (male and female) typically have?
A: Older male is 50% and older female is 45%
Q: Average fluid intake and output over a 24-hr period?
A: 2500 mL
*Intake: Fluids taken orally (1200), Water in food (1000), and water that is a result of food metabolism (300)
*Output: Urine (1500), Feces (200), Perspiration (500), and Respiration (300)
Q: Average daily urine output in adults?
A: 1200-1500 mL (1.2-1.5 L)
Q: How much urine per day is required to excrete metabolic wastes produced by the body?
A: About 500 mL
Recall..How much water should a person be drinking a day?
About 2 L (Eight 8 oz glasses of water)
Low to high SOLUTE concentration (water can move, solutes cannot, so water moves to balance it out)(NO energy necessary)
PRIMARY process that controls body fluid movement between ICF and ECF
Concentration of solution. # of solutes per kg of water (mOsm/kg)
(osmolality of ECF mainly depends on Na+)
**Plasma proteins are important: pulls fluid from interstitial space into intravascular compartment (help hold water within vascular system)
Power of a solution to draw water across a membrane
-Pressure exerted by the protein in plasma
Tonicity (3 types)
The effect of a solutions osmotic pressure has on water movement across membrane of cells
1) Isotonic- has same concentration of solutes as plasma (cell does not shrink/swell)
2) Hypertonic- greater concentration of solutes than plasma (water goes out and cell shrinks)
3) Hypotonic- lower solute concentration than plasma (water goes into cell > can swell and rupture [hemolysis])
Random Q: Administering a hypotonic IV solution will cause what? Hypertonic IV solution?
Hypotonic IV- cause concentration of sodium (because IV fluids will go into ECF, and Na+ is main solute) to reduce and then water will move from low to high concentration, into the cell (can cause it to swell and even rupture- hemolysis)
Hypertonic IV- cause concentration of ECF (Na+) to increase then the water will move from low to high, out of the cell and it will shrink.
Move from high to low concentration (no energy necessary).
*movement stops when equal
Two types: Simple Diffusion (occurs by movement of particles through solution. Water, CO2, O2, solutes move between plasma and interstitial space). Facilitated Diffusion (allows large water-soluble molecules, glucose and amino acids, to diffuse across cell membranes. Proteins in cell membranes act as carriers. NO energy needed)
Where water and solutes (dissolved substances) moves from high hydrostatic pressure (def: pressure exerted on walls of blood vessels) to low hydrostatic pressure.
Where molecules move across cell membrane and epithelial membranes AGAINST concentration gradient (from low to high concentration...NEEDS ENERGY [adenosine triphosphate] & carrier mechanism)
*EX: Sodium-potassium pump
Regulatory mechanisms that maintain balance between fluid intake and excretion
Thirst, kidneys, renin-angiotensin-aldosterone mechanism, antidiuretic hormone (ADH), and atrial natriuretic peptide (ANP).
*All effect volume, distribution, and composition of body fluids
Primary regulator of water intake
-maintains fluid balance and prevents dehydration
-thirst center= hypothalamus (stimulated when blood volume drops b/c water loss or when serum osmolality increases)
*Increased sodium in ECF --> increases serum osmolality (>295= fluid deficit)--> stimulating thirst center
Primarily responsible for regulating fluid volume and electrolyte balance in body.
*In adults: 170 L of plasma filtered through glomeruli daily
Explain the: Renin-Angiotensin-Aldosterone System
Maintains intravascular fluid balance and blood pressure.
*Decrease in blood pressure stimulates juxtaglomerular cells (in nephrons) to produce renin
-Renin (enzyme)> angiotensin (plasma protein) > angiotensin I (converted in blood) > angiotensin II (converted in lungs by angiotensin-converting enzyme)(this is vasoconstrictor & raises BP)(stimulates thirst mechanism b/c high BP=low blood volume)> stimulates adrenal cortex to release aldosterone (which promotes sodium and water retention in distal nephron and restores blood volume).
Antidiuretic Hormone (ADH)
Regulates water excretion from the kidneys.
-stimulated by:high serum osmolality or fall in blood volume
-posterior pituitary gland releases
-increases the permeability of distal tubules, promoting water reabsorption
Atrial Natriuretic Peptide (ANP)
Hormone released by atrial muscle cells, in response to distention from fluid overload.
-affects CV, renal, neural, GI, endocrine systems and opposes renin-angiotensin-aldosterone system
*Promotes sodium wasting and increased urine output.
What's the pathophysiology (causes) of fluid volume deficit (FVD)?
Most common: loss of GI fluids from vomiting, diarrhea, GI suctioning, intestinal fistulas, and intestinal drainage.
Other causes: diuretics, renal or endocrine disorders, excessive exercise, hot environment, hemorrhage, chronic abuse of laxatives or enemas, unable to access fluids or request/swallow fluids, oral trauma, altered thirst mechanism.
Who is mainly at risk for a (FVD)?
The geriatric (older adult) population.
(reasons under slide 22 [I added personally] of the p.p)
*What it is: Low pH (<7.35), Low bicarb (<22 mEq/L), Commonly r/t renal failure
*Causes: lactic acidosis, ketoacidosis (diabetes), renal failure, diarrhea, fistulas, NaCl IV, renal tubular acidosis
*Manifestations: HA, Confusion, Drowsines, ↑ respiratory rate/depth (kussmaul/hyperventilation), ↓ blood pressure, ↓ cardiac output, Dysrhythmias, Shock, anorexia, malaise, stomach pain
*Meds: Bicarb (alkalinizing) solution for severe cases. (IV-severe acute. Oral-chronic). Insulin for ketoacidosis pt.
(what I will do= correct underlying problem and imbalance, administer bicarb, monitor)
*What it is: High pH > 7.45, High bicarb >26 mEq/L, Commonly r/t vomiting or gastric suction, Also r/t medications (especially long-term diuretic use), Hypokalemia
*Causes: vomit, gastric suction, hypokalemia, alkali ingestion, excess bicarb. admin.
*Manifestations: Symptoms r/t ↓calcium, Respiratory depression, Tachycardia, Symptoms of hypokalemia, confusion, hyperreflexia, dysrhythmias.
*Meds/treatment: Restore normal fluid volume. Administer potassium chloride and NaCl solution. Severe> Acidifying solution (hydrochloric acid or ammonium chloride). Drugs for underlying cause.
(what I will do= correct underlying disorder, supply Cl- to allow excretion of bicarb, restore fluid volume with NaCl)
*What is it? Low pH <7.35, PaCO2 >45 mm Hg, Always r/t respiratory problem with inadequate CO2 excretion, Body may compensate
*Causes: (acute-acute resp. conditions, opiate overdose, chest trauma)(chronic- chronic resp. like COPD, multiple sclerosis or neurological diseases)
*Manifestations: (acute- headache, warm skin, irritability, cardiac arrest)(chronic-weakness, dull headache, daytime sleepiness, impaired memory, personality change) Professors slide-Sudden increased pulse, ↑ respiratory rate, ↑ BP, Mental changes, Feeling of head fullness, Potential ↑ ICP
*Meds/treatment: bronchodilator drugs (open airways), antibiotics. Drugs to reverse effects if narcotics caused this. Breathing treatments, percussion and drainage, mechanical ventilation.
(what I will do= improve ventilation > instruct pt to breathe in but blow out)
*What is it? High pH > 7.45, PaCO2 < 35 mm Hg, Always r/t hyperventilation
*Causes: anxiety-induced hyperventilation, fever, early salicylate intoxication, hyperventilation w/ mechanical ventilator.
*Manifestations: Lightheadedness, Inability to concentrate, Numbness/tingling (mouth, hands, feed), palpitations, Loss of consciousness, dyspnea, anxiety, tetany, seizures.
*Meds: sedative or anti anxiety agent, drugs for underlying problem.
(what I will do= correct hyperventilation [can have them blow into paper bag and rebreathe own air back in])
(Comparison of density to water)
(< 1.003= excess fluid)(>1.030= dehydration)
Isotonic Solution Examples
0.9% NaCl (normal saline), lactated ringers solution, plasma-lyre 148, 5% dextrose in water
Indications- hypotension, hypovolemia
Complications- fluid overload, acidosis (liver failure), Changes in K+ levels and cardiac rhythm
Hypotonic Solution Examples
0.45% NaCl (1/2 normal saline ) and 0.225% NaCl (1/4 NS)
Indication- dehydration and diabetic ketoacidosis
Complications- acute brain injury, inflammation at IV site, do not give to those with risk for 3rd spacing (burns, trauma...)
Hypertonic Solution Examples
5% dextrose in NS, 10% Dextrose in water, 5% dextrose in lactated ringers solution, 3% NaCl, 5% NaCl, parenteral solution. Also: 50% dextrose, albumin, blood products
Indications- stabilize BP, increase urine output, reduce edema, sodium levels <115
Complications- intravascular overload and pulmonary edema
For ELECTROLYTES...which one(s) does Dr. Coleman keep emphasizing can cause issues with the HEART?
(MAIN> ) Magnesium, potassium!!! And also, calcium and phosphorous
Steps for assessing ABG
1) look at pH (low, normal, high?)
2) primary cause? (Acidosis or alkalosis)
3) looks at PaCO2 (respiratory > low=alkalosis and high=acidosis) and HCO3- (metabolic > low= acidosis, and high=alkalosis)
Sets found in the same folder
Chapter 10 Adult health
Patho chapters 25, 27, 28, 12, 16
Patho Ch. 46
Patho chap. 45
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