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Yoost Ch. 39 F/E and Acid Base Balance

Terms in this set (168)

% of body wt that consists of water
total body water
___% of a healthy adults wt is water
60
body fluid within the cell
intracellular
body fluid outside the cell thats interstitial, intravascular, transcellular (cerebrospinal, synovial, peritoneal, pleural, and pericardial fluids)
extracellular
fluid between the cells of an organ/tissue (25% of total body fluid)
interstitial fluid
blood plasma thats 8% of body fluid
intravascular fluid
chemical substances dissolved in a liquid (electrolytes, nonelectrolytes like O2, CO2, and glucose)
solutes
liquid that solutes are dissolved in
solvent
solutes that dissolve easily
crystalloids
substances (proteins) that don't dissolve easily
colloids
charged atoms/molecules (ions) that conduct electrical impulses across cells (cations/anions)
electrolytes
- ability of cations to bond with anions to form molecules
- how electrolytes are measured per liter of water (mEq/L)
milliequivalent
- blood plasma
- contains large amounts of proteins (albumin)
intravascular fluid
the force created when 2 solutions of different concentrations are separated by selectively permeable membrane
osmotic pressure
number of osmols per KG of a solvent
osmolality
number of osmols per L of solvent
osmolarity
the level of osmotic pressure in a solution
tonicity
solution with same osmolarity as blood plasma (NS 0.9% NaCL)
isotonic
solution that pulls water from cell to extracellular fluid compartment (cells shrink)
hypertonic
solution where excess water moves into cells (cells swell)
hypotonic
what controls osmotic pressure in intravascular space (oncotic pressure)
proteins/albumin
process by which fluid and solutes move together from high pressure to low pressure
filtration
- force of fluid pressing against blood vessel wall
- controlled by force of myocardial contraction, rate of contraction, and blood flow
- different on arterial and venous sides
hydrostatic pressure
average daily fluid intake
1600
average daily urine output
1500
average daily food intake
700
average daily feces output
200
average daily metabolism intake
200
average daily skin/perspiration output
500
average daily lung output
300
total average daily intake
2500
total average daily output
2500
how is water primarily lost?
urine
examples of insensible water loss
respiration, perspiration, feces
what 3 things help fluid balance homeostasis?
ras, adh, thirst
regulates BP and fluid balance through vasoconstriction and excretion/reabsorption of sodium
renin angiotensin system
secreted by pituitary gland to maintain serum osmolality by controlling amount of water excreted in urine
adh
what monitors fluid balance homeostasis?
kidneys
where is ACE found?
lungs and kidneys
causes:
- vasoconstriction (increase BP)
- water reabsorption into blood
- aldosterone stimulation
- ADH secretion
- thirst mechanism stimulated
- stimulated by hypovolemia
angiotensin 2
- located in the hypothalamus
- monitor osmolarity of blood plasma
- stimulate posterior pituitary to secrete ADH
osmoreceptors
- secreted by cells in the atrium (heart) in response to increased BP
- increase glomerular filtration rate
- increased Na and water excretion
- inhibits renin, ADH, and NaCl reabsorption into blood
atrial natriuretic peptide
what are the 3 mechanisms that electrolytes move in and out of the intracellular and extracellular spaces?
diffusion, filtration, active transport
- movement of solutes across a selectively permeable membrane from areas of higher concentration to areas of lower concentration until equilibrium is reached
- influenced by temp, molecular wt, concentration gradient, membrane permeability
- CO2, small molecules, O2 movement
diffusion
- occurs when a solute is unable to pass through a membrane and requires a carrier
- solute is moving down the concentration gradient so it does not require energy
- passive process
- glucose is unable to move into the cell without insulin as its carrier
facilitated diffusion
- transport of a solute from areas of lower to higher concentration; it is the opposite of diffusion
- requires energy.
- sodium-potassium pump
active transport
major cations
Na, Mg, K, Ca, H+
major anions
Cl-, HCO3-, PO43-
intracellular ions
K+, PO43-
extracellular (intravascular) ions
Na+, Cl-
- Responsible for resting membrane potential
- Essential in depolarization for nerve and muscle function
- ECF
- Body heat production
- Acid base balancce
- Moves out of cell by Na K pump (body heat production)
- Regulated by aldosterone and ANP
- 90-95% osmolarity
Na
normal sodium levels
136-145
- produces resting membrane potentials and action potentials of nerve and muscle cells
- ICF/intracellular osmolarity
- involved in protein synthesis
- moves into the cell by Na-K pump
- levels regulated by kidneys (reabsorption/excretion)
k
normal potassium levels
3.5-5
- primary component of bones and teeth w/ phosphate (99% found in teeth/ bones)
- role in blood clotting, nerve impulse transmission, cardiac conduction, and muscle contraction
- decrease → parathyroid hormone and calcitriol pull from the bone to maintain normal levels
- increase → calcitonin moves excess into the bone
ca
calcium normal levels
9-10.5
- intracellular
- role in production/use of ATP
- regulates intracellular metabolism by activation of enzymes
- part of Na-K pump
- required for synthesis of nucleic acids and proteins
- maintains normal serum calcium levels
- normal levels maintained by increased reabsorption/excretion by kidneys
- absorbed through the intestine in w/ vitamin D and parathyroid hormone
Mg
normal magnesium levels
1.3-2.1
- Most abundant anion in the ECF - Maintains serum osmolarity - Required for formation of HCl
- Helps acid base buffering
- Goes wherever Na goes
cl
normal chloride levels
98-106
- Most abundant anion in the ICF - Helps maintain bone and teeth structure
- Role in cellular metabolism and ATP production
- Essential for carbohydrate metabolism
- Inverse relationship with calcium - Parathyroid hormone increases excretion by the kidneys
po43-
normal phosphate levels
3-4.5
what is the primary buffering system in the ECF?
carbonic acid bicarbonate system
what is the primary buffering system in the cell & renal tubules?
phosphate buffering system
___ K+ for acidosis
high
___ K+ for alkalosis
low
___ pH is compensated with increasing rate and depth of respirations
low
___ pH is compensated with slow and shallow respirations
high
in acidosis, the kidneys ___ H+ ions and retain bicarbonate
excrete
in alkalosis, the kidneys ___ retain H+ ions and ___ bicarbonate
excrete
what blood type are universal donors
o
what blood type are universal receivers?
AB
After the person has been exposed, subsequent contact with Rh + blood can lead to life-threatening destruction of red blood cells
hemolytic reactions
Use:
- 5% and 25% concentrations
- Contains globulins and plasma proteins
- Treat acute renal failure, burns, or trauma.
- Increases plasma oncotic pressure, causing excess fluid to move from the interstitial space and into the vascular system. Concerns:
- Cause fluid overload, HF or pulmonary edema
- Use cautiously in the elderly and patients with impaired cardiac/renal function.
albumin
Use:
- For pts w/ thrombocytopenia or platelet dysfunction, multiple transfusions of PRBCs.
- Infused as quickly as possible, within 10 min after leaving lab
Concerns:
- Rh compatible
- Monitor for allergic reactions.
platelets
Cause:
Hemorrhage, burns, vomiting, diarrhea, Addison disease, fever, excessive perspiration
S/S:
Confusion, thirst, dry mucous membranes, orthostatic hypotension, tachycardia, weak and thready pulse, decreased skin turgor, prolonged capillary refill, and decreased urinary output
Labs:
- Urine specific gravity >1.030
- Increased hematocrit Adult males >52 Adult females >48
- BUN >20
Treatment:
- Fluids
- VS
- I&Os
- Monitor labs, hematocrit, BUN, and urine specific gravity
isotonic fluid volume deficit (hypovolemia)
Cause:
DI, DKA, osmotic diuretics, hypertonic tube feedings, hypertonic IV fluids, vomiting/ diarrhea
S/S:
Dry sticky mucous membranes, flushed dry skin, increased temp, irritability, seizures, and coma
Labs:
- Urine specific gravity >1.030
- Increased hematocrit Adult males >52 Adult females >48
- BUN >20
- Serum sodium >145
Treatment:
- Fluids
- VS
- I&Os
- Monitor labs: hematocrit, BUN, and urine specific gravity
hypertonic fluid volume deficit (dehydration)
Causes:
HF, renal failure, cirrhosis
S/S:
Wt gain, edema, bounding peripheral pulses, hypertension, JVD, dyspnea, cough, abnormal lung sounds
Labs:
- Urine specific gravity <1.005
- Decreased hematocrit Adult males <42 Adult females <37
- BUN <7
Treatment:
- VS
- I&Os
- Assess for edema and JVD
- Auscultate lungs
- Monitor labs: hematocrit, BUN, and urine specific gravity
isotonic fluid volume excess
Cause:
Excessive water intake, hypotonic IV solutions, SIADH
S/S:
Similar to isotonic fluid volume excess plus neurologic changes indicating cerebral edema, including decreased LOC, coma, and seizures
Labs:
- Urine specific gravity <1.005
- Decreased hematocrit Adult males <42 Adult females <37
- BUN <7 Serum sodium <135
Treatment:
- VS
- I&Os
- Assess for neurologic changes
- Monitor labs: hematocrit, BUN, and urine specific gravity
hypotonic fluid volume excess
- predisposed to fluid volume deficit
- decreased thirst mechanism
- kidneys less able to concentrate urine
- polypharmacy/medication side effects
- diuretic use
- swallowing problems
- frailty
- dementia
- inability to independently drink or hold a cup
older people
- abnormal accumulation of fluid in the interstitial spaces
- extremities: fingers, ankles, and feet and face/abdomen.
- third spacing
- fluid moves into a tissue at a faster rate than it can be reabsorbed into the intravascular space
edema
4 primary causes of edema
increased HP, decreased proteins, lymphatic drainage obstruction, increased capillary permeability
Ex. cirrhosis
Causes:
- low serum albumin level
- hydrostatic pressure > oncotic pressure,
- fluid seeps into the interstitial spaces
S/S:
- wt gain
- pulmonary congestion
- edema
- hypotension
- weak and thready pulse
- tachycardia.
Treatment:
- replace plasma proteins and allowing the fluids to shift back to the intravascular space
- fluid replacement after fluid shift occurs
simultaneous fluid volume excess and deficit
Causes:
- Hypovolemic hyponatremia
- Diuretics
- GI fluid loss (vomit/diarrhea)
- Diaphoresis
- Water intoxication
- Hypotonic IV solutions
- SIADH
- <136
S/S:
Lethargy, confusion, weakness Muscle cramping Seizures Anorexia, nausea, vomiting Serum osmolarity <280 mOsm/kg
Treatment:
- VS
- I&Os
- Monitor labs: serum sodium and serum osmolality
- High Na+ foods
- Restrict water intake
- Hypertonic IV solutions
hyponatremia
Cause:
- high Na+ intake
- Hypertonic IV solutions
- Hypertonic tube feedings w/o water
- Diarrhea
- Low water intake
- Insensible loss: fever
- >145
S/S:
Thirst, dry/sticky mucous membranes, weakness, elevated temp, confusion and irritability, decreased LOC, hallucinations, and seizures, serum osmolarity >300 mOsm/kg
Treatment:
- VS
- LOC
- I&Os
- Monitor labs: serum sodium and serum osmolarity
- Limit salt intake
- Increase water intake
- Hypotonic IV solutions
hypernatremia
Cause:
- Vomiting, gastric suction, diarrhea laxatives, enemas diuretics, low intake, alcoholism, hyperaldosteronism
- <3.5
S/S:
Weak, irregular pulse, Fatigue, lethargy, Anorexia, nausea, vomiting, Muscle weakness/ cramping, Decreased peristalsis, hypoactive bowel sounds ,Paresthesia, Cardiac dysrhythmias , Increased risk for digitalis toxicity
Treatment:
- VS (HR/rhythm)
- ECG
- Monitor labs: serum potassium levels.
- Assess for digitalis toxicity
- Encourage foods high in potassium/supplements/IV slowly
hypokalemia
Cause:
- Renal failure Massive trauma, crushing injuries, burns Hemolysis IV potassium Potassium-sparing diuretics Acidosis, DKA
- >5.0
S/S:
Anxiety, irritability, confusion Dysrhythmias, including bradycardia and heart block Muscle weakness, flaccid paralysis Paresthesia Abdominal cramping
Treatment:
- VS (HR/rhythm)
- ECG
- Monitor labs for serum potassium levels
- Limit potassium-rich foods
- Cation-exchange resins (Kayexalate), glucose, insulin
hyperkalemia
Cause:
Hypoparathyroidism Pancreatitis Vitamin D deficiency Inadequate intake of calcium-rich foods Hyperphosphatemia Chronic alcoholism
- <9
S/S:
Confusion, anxiety Numbness and tingling of extremities Muscle cramps that progress to tetany and seizures Hyperactive reflexes Cardiac dysrhythmias Positive Chvostek and Trousseau signs
Treatment:
- Monitor HR/rhythm
- ECG
- Fall and seizure precautions
- Supplements/calcium-rich foods
hypocalcemia
Cause:
- Prolonged bed rest
- Hyperparathyroidism
- Bone malignancy
- Paget disease
- Osteoporosis
- >10.5
S/S:
Lethargy, stupor, coma Decreased muscle strength and tone Anorexia, nausea, and vomiting Constipation Pathologic fractures Dysrhythmias Renal calculi
Treatment:
- Monitor HR/rhythm
- ECG
- Increased fluid intake, activity, ROM
hypercalcemia
Cause:
Overhydration, HF, SIADH Vomiting or gastric suction Addison's disease Burns Metabolic alkalosis, meds, aldosterone, bicarbonates, steroids, loop and thiazide diuretics
- <98
S/S:
Irritable nerves and muscles, tetany, hypotension, shallow breathing
Treatment:
- VS
- I&Os
- Monitor labs
- Restrict water intake
- Hypertonic IV solutions
hypochloremia
Cause:
Dehydration Anemia Excessive normal saline infusion Cushing syndrome Kidney disease Metabolic acidosis Respiratory alkalosis or hyperventilation
- >106
S/S:
weakness, lethargy, deep breathing
Treatment:
- VS
- LOC
- I&O
- Monitor labs
- Limit salt intake
- Increase water intake
- Hypotonic IV solutions
hyperchloremia
Causes:
Decreased intake TPN without Mg, Decreased absorption, NG suction, Draining fistulas, diarrhea, Laxatives, Malabsorption syndrome, Ulcerative colitis , Crohn disease, Increased renal excretion, Diuresis, Loop/thiazide diuretics
- <1.3
S/S:
Irritable nerves and muscles Hyperactive deep tendon reflexes Seizures Dysrhythmias, especially tachyarrhythmias ECG changes Altered level of consciousness Mood swings Delusions, hallucinations Dysphagia, nausea, and vomiting
Treatment:
- VS (HR/rhythm)
- ECG
- mental status
- LOC changes
- Monitor labs: potassium and calcium levels.
- Assess swallowing
- Seizure precautions
hypomagnesemia
CauseL
Excessive intake of magnesium-containing antacids or cathartics TPN with too much magnesium Prolonged use of intravenous magnesium sulfate Renal failure Severe dehydration Adrenal insufficiency Leukemia
- >2.1
S/S:
Warm, flushed appearance Nausea, vomiting Drowsiness, lethargy Decreased muscle strength Generalized weakness Decreased deep tendon reflexes Hypotension Dysrhythmias, especially bradycardia and heart block Slow, shallow respirations; respiratory arrest
Treatment:
- VS (HR/rhythm)
- ECG
- mental status
- LOC changes
- neuromuscular strength/activity - increase oral intake/IV fluids
- loop diuretics
- respiratory support
hypermagnesemia
Cause:
shift into the cell, Hyperventilation, resp alkalosis, Hyperglycemia, Phosphorus-binding antacids, Starvation Malabsorption syndrome, low vitamin D, diarrhea, laxatives, Thiazides/loop diuretics, DKA, Hyperparathyroidism Hypocalcemia
- <3
S/S:
Weak pulse Shallow respirations Hypotension Decreased cardiac output Hemolytic anemia Bleeding, increased bruising Muscle weakness Decreased deep tendon reflexes Tremors Bone pain Anorexia Increased risk for infection
Treatment:
- VS: RR, SpO2, BP
- muscle strength/neuromuscular function
- assess for HF
- phosphate-rich foods
- oral and IV phosphorus
- pain medications
hypophosphatemia
Cause:
Impaired renal function Hypoparathyroidism Acid-base imbalances Cellular injury
- >4.5
S/S:
Signs of hypocalcemia Tetany Hyperreflexia Muscle spasms, weakness Tachycardia Nausea Diarrhea, cramping
Treatment:
- VS
- Monitor serum phosphorus and calcium levels
- Monitor BUN, creatinine
- Assess signs of hypocalcemia
- I&Os
- Avoid phosphorus-rich foods.
hyperphosphatemia
Cause:
- Hypoventilation
- Chest injury
- Asthma attack
- Pulmonary edema
- Brainstem injury
- Medications: Anesthetics, opioids, sedatives
- Decreased gas exchange bc abnormal ventilation, perfusion, or diffusion
S/S:
- Headache
- Hypercapnia
- Altered level of consciousness, irritability, confusion
- Dyspnea Tachycardia Muscle twitching
- pH <7.35
- PaCO2 >45
- ABG results: pH <7.35 PaCO 2 >45 mm Hg HCO 3 − normal
- Partially compensated ABG results: pH <7.35 PaCO 2 >45 mm Hg HCO 3 − >28 mEq/L As compensation continues, the pH increases.
Treatment:
- VS (rate/depth of respirations, SpO2)
- Breath sounds
- Cardiac rhythm.
- O2
- Monitor ABG results
- Have mechanical ventilation available.
- Deep breathing/coughing.
- Fluid intake
respiratory acidosis
Cause:
- Pain
- Hyperventilation
- Salicylate overdose
- Nicotine overdose
- Increased metabolic states
- Acute hypoxia
S/S:
- tachypnea
- hypocapnia
- numbness/tingling on fingers
- muscle cramping
- palpitations
- anxiety, restlessness, ECG changes
- pH >7.45
- PaCO2 <35
- ABG results: pH >7.45 PaCO 2 <35 mm Hg HCO 3 − normal
- Partially compensated ABG results: pH >7.45 PaCO 2 <35 mm Hg HCO 3 − <21 mEq/L
- As compensation continues, the pH decreases.
Treatment:
- VS
- Slow, deep breaths
- Monitor ABGs
- Provide reassurance and emotional support to anxious patient
respiratory alkalosis
Cause:
- Shock
- Trauma
- Cardiac arrest
- Diabetic ketoacidosis
- Chronic renal failure
- Salicylate overdose
- Sepsis
- Chronic diarrhea
S/S:
- kussmaul respirations
- hypotension
- increased depth and rate of respirations
- headache
- decreased LOC
- weakness
- N/V, anorexia
- pH: <7.35
- bicarb <21
- ABG results: pH <7.35 PaCO 2 normal HCO 3 − <21 mEq/L
- Partially compensated ABG results: pH <7.35 PaCO 2 <35 mm Hg HCO 3 − <21 mEq/L As compensation continues, the pH increases.
Treatment:
- VS (RR/rhythm, BP, SpO2)
- Monitor cardiac rhythm, ABGs and serum electrolytes, glucose, and BUN or creatinine.
- LOC
- Have mechanical ventilation available as needed
- Administer sodium bicarbonate as ordered.
metabolic acidosis
Cause:
- Vomiting
- Nasogastric suctioning
- Overuse of bicarbonate antacids
- Hypokalemia Loop and thiazide diuretics
S/S:
- hypotension
- mental confusion
- muscle twitching, tetany
- increased deep tendon reflexes
- numbness
- seizures
- anorexia, n/v
- polyuria
- pH >7.45
- bicarb >28
- ABG results: pH >7.45 PaCO 2 normal HCO 3 − >28 mEq/L
- Partially compensated ABG results: pH >7.45 PaCO 2 >45 mm Hg HCO 3 − >28 mEq/L As compensation continues, the pH decreases.
Treatment:
- VS (HR/rhythm, RR/depth, SpO2, BP)
- Monitor ABGs and serum electrolytes, potassium
- LOC
- O2
- Seizure precautions
- Treat hypokalemia
metabolic alkalosis
kussmaul respirations are found in
metabolic acidosis
Hypokalemia can lead to hydrogen ions shifting into the cell in exchange for ____ ions in metabolic alkalosis
k
___ can lead to f/e imbalances (aloe, ginseng, licorice, celery, dandelion)
herbs
a prolonged ___ leads to increased body fluid loss (dehydration)
fever
in severe dehydration, body temp ___
increases
in isotonic fluid volume deficit, body temp ___
decreases
when there is a decrease in circulating blood volume, the __ ___ decreases
stroke volume
___ is the first indication of fluid volume deficit to ensure adequate oxygenation of tissues and maintain normal CO
tachycardia
changes in ___ ___ can indicate f/e imbalances as compensation
bp
alterations in potassium, calcium, and magnesium levels can cause ___
dysrhythmias
pulse pressure norm
40
pulse pressure of less than ___ mm Hg indicates severe fluid volume deficit
24
hypernatremia ___ BP
increases
hyperkalemia ____ BP
decreases
how many mL is one cup of ice chips
120
what is a more precise way to monitor fluid balance
weight
a change of 1 kg is equal to __ L
1
Edema: deep indentation (6 mm) indentation lasts several seconds
+3
Edema: very deep indentation (8 mm) indentation remains for several minutes
+4
skin turgor appears with fluid volume ___
deficit
Assess:
- Chvostek sign (spasm of the facial muscle after tapping on the facial nerve)
- Trousseau sign (spasm of the muscles in the hand and wrist from pressure on the nerves of the upper arm)
- Deep tendon reflexes
- Tremors
- Confusion
- Agitation
- Coma
neurologic hydration assessments
Assess:
- Jugular vein distention - Electrocardiographic (ECG) waveforms
- Pulses
- Blood pressure
cardiovascular hydration assessments
Assess:
- Abnormal lung sounds (crackles)
- Diminished lung sounds
- Respiratory rate
respiratory hydration assessments
Assess:
- muscle strength
musculoskeletal hydration assessments
Assess:
- stool frequency and characteristics
- nausea/vomiting
- urine output
elimination hydration assessments
Dx test:
Direct information on extracellular levels and indirect information on intracellular levels of the electrolytes.
serum electrolyte levels
dx test:
indicates renal function
BUN, creatinine
dx test:
Information on hydration status; useful in managing fluid requirements.
serum osmolarity
dx test:
Indicates oxygen-carrying capacity. Hematocrit levels can be influenced by fluid volume, can be diagnostic of fluid volume deficit or fluid volume excess.
RBC, hgb, hct
dx test:
indicates colloid oncotic pressure capability
serum albumin levels
dx test:
Increases when fluid volume is concentrated and is low with fluid volume excess.
specific gravity
dx test:
Reflects solute concentration of the urine. Urine osmolarity is increased in fluid volume deficit and decreased in fluid volume excess.
urine osmolarity
amount of O2 bound to hgb
o2 sats
- free floating o2 molecules
- decreases in hypoxemia
pao2
PaO2 of 60 to 80 mm Hg: ___ hypoxemia
mild
PaO2 of 40 to 60 mm Hg: ___ hypoxemia
moderate
PaO2 of <40 mm Hg: ___ hypoxemia
severe
____ production is increased in stress → increased ADH secretion → decreases water excretion
aldosterone
Total body fluid is disproportionate to body weight in people who are ____
obese
Patients with ___ failure have decreased plasma levels of albumin, which leads to fluid moving out of the intravascular space and into the interstitial space (ascites)
liver
CO decreases (HF) → BP decreases → increase secretion of aldosterone and ADH → ___ of excess fluid
retention
abnormal collection of fluid in the peritoneal cavity.
ascites
- people with impaired ___ function are at a higher risk for fluid and electrolyte imbalances bc of the decreased ability to regulate excretion and reabsorption
- retain metabolic waste products
- prone to metabolic acidosis.
renal
- intake > output
- good for fluid volume deficit
- indicate fluid volume excess
positive fluid balance
- monitor fluid & f/e balance
- oral f/e replacement
- IV therapy (use rights)
evaluating f/e and acid base balances
restricting fluid intake ordered for pts w/
HF and renal failure
___ Na+ restriction is 3000 to 4000 mg/day; it is indicated as "no added salt."
mild
____ Na+ restriction is 2000 mg/day; it is indicated as the need to consume foods with a low-sodium content.
moderate
__ Na+ restriction is 500 mg/day
severe
what to check when monitoring fluid balance
VS, wt, I&O
for fluid replacement, avoid
caffeine/diuretics
- solutions with small molecules, usually electrolytes that are able to pass through cell membranes
- used for f/e maintenance and replacement
- isotonic, hypotonic, hypertonic
crystalloids
swelling of brain cells from continued use of hypotonic solutions causes increased ___ pressure or water intoxication
intracranial
- lower the osmolarity of blood plasma and cause fluid to shift into the cell. These fluids are used to treat hypernatremia or severe dehydration
- can lead to water intoxication
hypotonic
- plasma expanders, are solutions that contain protein or starch.
- particles remain intact in the solution and are unable to pass through the capillary membrane.
- used to reestablish circulating volume and oncotic pressure.
- ex albumins
colloids
- same as that of blood plasma
- increase intravascular volume but do not cause fluid shifts in or out of the cell.
- can lead to circulatory overload
- ex. 5% dextrose in water (monitor for hyperglycemia), normal saline 0.9% NaCl
isotonic
- increase the osmotic pressure of plasma and force fluids to move out of the cell and into the bloodstream.
- cellular dehydration and fluid volume overload
- irritating to peripheral veins and the sites must be closely monitored.
hypertonic
- used for replacement of fluid, sodium, and chloride
- only fluid used to begin or finish blood transfusions
- prolonged use leads to hypernatremia and circulatory overload
normal saline
- contains sodium, potassium, calcium chloride, and lactate (which metabolizes to bicarbonate) and most closely resembles blood plasma
- considered a balanced electrolyte solution and is often used as a replacement solution after surgery or trauma
- don't use with renal or liver disease
lactated ringers
Continued use of 5% dextrose in water (D 5 W) as a primary infusion can lead to water intoxication or intracellular fluid excess. After the dextrose enters the bloodstream, it is quickly metabolized, leaving only free water, a _______ solution.
hypotonic
never bolus or push
k
pH normal range
7.35-7.45
paco2 normal range
35-45
HCO3- normal range
21-28
paO2 normal range
80-100
ph on the low side of normal, paco2 and bicarb high = compensatory respiratory
acidosis
ph on the high side of normal, paco2 and bicarb low = compensatory respiratory
alkalosis
ph on the low side of normal, paco2 and bicarb low = compensatory metabolic
acidosis
ph on the high side of normal, paco2 and bicarb increased = compensatory metabolic
alkalosis
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