Funds Chapter 25

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copperkid2
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122330
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Funds Chapter 25
Updated:
2011-12-10 00:27:28
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Funds Chapter 25
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Fluid and Electrolyte Balance
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  1. Water serves four functions...
    • Is a vehicle for transporting substances to and from cells
    • Aids in heat regulation
    • Assists in (H+) balance in the body
    • Is a medium for enzymatic action of digestion
  2. Why do infants and the elderly dehydrate more rapidly?
    • Infants’ kidneys reabsorb less fluid
    • Elderly have less antidiuretic hormone and diminished thirst sensation
  3. Waters' avenues of loss
    • Urine
    • Perspiration
    • Feces
    • Expired air
  4. Cation
    • positively charged ion
    • an electrolyte
  5. Anion
    • negatively charged ion
    • an electrolyte
  6. Sodium
    • normal range: 135-145 mEq/L
    • water regulation and balance
    • transmission of nerve impulses
    • maintains acid base balance
  7. Potassium
    • normal range: 3.5-5 mEq/L
    • nerve impulse transmission
    • muscle contraction
    • maintains normal heart rhythm
    • plasma
    • acid–base balance
  8. Calcium
    • normal range: 8.4-10.6 mg/dL
    • muscle activity
    • blood coagulation
    • builds bone and teeth
    • nerve activity
  9. Magnesium
    • normal range: 1.3-2.5 mg/dL
    • builds bone and teeth
    • nerve transmission
    • muscle contraction
    • VIP in metabolic reaction
  10. Phosphate
    • normal range: 2.5-4.5 mg/dL
    • ATP production
    • activates B complex vitamins
  11. Chloride
    • normal range: 96-106 mEq/L
    • hydrochloric acid production
    • acid–base balance
    • maintains plasma electroneutrality
  12. Bicarbonate
    • normal range: 22-26 mEq/L
    • acid–base balance
  13. Non-electrolytes
    amino acids, glucose, and fatty acids
  14. Plasma volume is affected by...
    • alterations to body fluid volume.
    • plasma volume can affect blood pressure
    • (if dehydrated, body fluid volume drops, plasma fluid volume drops, blood pressure drops)
  15. Extracellular fluid
    • fluid outside of the cell
    • Makes up approximately 1/3 of the total body water
    • Transports nutrients, oxygen, and waste products to and from cells
    • Is regulated by renal, metabolic, and neurologic factors
    • Is high in sodium content
    • 3 types: intravascular, interstitial and transcellular
  16. Intravascular fluid
    • fluid within the blood vessels
    • Consists of plasma and fluid within the blood cells
    • Contains large amounts of protein and electrolytes, which help maintain intravascular volume
  17. Transcellular fluid
    • saliva
    • cerebrospinal fluid
    • fluid in the urinary tract
    • GI secretions
    • aqueous humor
    • pleural, peritoneal, synovial, and pericardial fluids
  18. Which part of the brain controls the thirst mechanism?
    Hypothalamus
  19. Which organ is the main organ for fluid excretion?
    the kidney
  20. Do hormones affect urine output?
    • yes
    • antidiuretic hormone (ADH)
    • aldosterone
    • atrial natriuretic peptide (ANP)
  21. A healthy kidney...
    regulates fluid and electrolyte balance by regulating the volume and composition of extracellular fluid
  22. Who is at risk for deficient fluid volume?
    • patients unable to take in enough fluids (coma, weakness, impaired swallowing)
    • patients who lose excessive amounts of fluid (diarrhea, hemorrhage, diaphoresis)
    • patients on diuretic therapy and GI suction w/o fluid replacement
  23. Signs and symptoms of dehydration
    • dizziness
    • dark, concentrated urine
    • poor skin turgor
    • dry mucous membrane
    • weak, thready pulse
    • flat neck veins
    • postural hypertension
  24. Signs of overhydration
    • weight gain
    • crackles in the lungs
    • slow bounding pulse
    • elevated blood pressure
    • edema
  25. Dependent edema
    • excessive fluid build up in lower extremties; ambulatory patients
    • excessive fluid build up in the sacral area; bedridden patients
  26. Generalized edema
    • kidney failure
    • heart failure
    • liver failure
    • hormonal disorders
    • caused when excess interstitial fluid is spread throughout the body
  27. Hypnonatremia
    • sodium deficit in the blood < 135 mEq/L
    • most common electrolyte imbalance
    • may be caused by excessive vomiting or diarrhea
  28. Hypernatremia
    • Excess serum sodium content; > 145 mEq/L
    • usually water loss from fever or respiratory infection
    • sometimes too much sodium bicarbonate; treament for acidosis
  29. Hypokalemia
    • Occurs with excess potassium or loss of body water; may be from poor diet, vomiting, diarrhea, excessive sweating, or diuretic therapy
    • potassium < 3.5 mEq/L
  30. Hyperkalemia
    • Occurs with burns, crush injuries, uncontrolled diabetes mellitus, and renal failure
    • potassium < 5.0 mEq/L
    • over use of salt substitutes
  31. Hypocalcemia
    • Occurs with nutritional deficiency of calcium or vitamin D or in bone disorders such as metastatic cancer of the bone
    • calcium < 8.4 mg/dL
    • alkalosis
    • blood transfusion
    • hypoparatyhroidism
  32. Hypercalcemia
    • Most cases related to hyperparathyroidism or malignancy such as multiple myeloma
    • Calcium > 10.6 mg/dL
  33. Hypomagnesemia
    • Results from malabsorption, malnutrition, renal tubular dysfunction, thiazide diuretic use, extensive gastric suction, or diarrhea
    • magnesium < 1.3 mEq/L
  34. Hypermagnesemia
    • Occurs only in presence of renal failure
    • Magnesium > 2.1 mEq/L
  35. Hypochloremia
    • Chloride level below 96 mEq/L is associated with hyponatremia
    • Anion imbalance
  36. Hyperchloremia
    • Chloride level above 106 mEq/L
    • Occurs along with hypernatremia and a form of metabolic acidosis
    • Anion imbalance
  37. Hypophosphatemia
    • Occurs when the level of phosphate falls below 3.0 mg/dL
    • May result from use of aluminum-containing antacids, from vitamin D deficiency, or from hyperparathyroidism
  38. Hyperphosphatemia
    • A phosphate level above 4.5 mg/dL
    • Commonly occurs in renal failure
  39. Bicarbonate
    • Normal range is 22 to 26 mEq/L
    • buffer to neutralize excess acids in the body and maintain bicarbonate-to–carbonic acid ratio at 20:1
    • Kidneys selectively reabsorb or excrete bicarbonate to regulate serum levels and help maintain acid–base balance
  40. 3 PH control mechanisms
    • Blood buffer system (weak acids and bases)
    • Lungs
    • Urinary system
  41. Respiratory acidosis
    • Increased carbon dioxide levels from:
    • Airway obstruction
    • Pneumonia, asthma
    • Chest injuries
    • Opiate intake
    • Chronic obstructive lung disease
  42. Metabolic Acidosis
    • An excessive loss of bicarbonate ions orretention of hydrogen ions caused by:
    • Kidney disease
    • Diabetic ketoacidosis
    • Circulatory failure
    • Shock states
  43. Respiratory Alkalosis
    • Anxiety
    • High fever
    • Hyperventilation
    • Salicylate poisoning (ASA overdose)
    • Encephalitis
    • treat with a rebreather mask
  44. Metabolic alkalosis
    • Vomiting
    • Gastric suctioning
    • Excessive antacid consumption
    • Diuretic therapy
    • Potassium deficit
  45. Acidosis signs and symptoms
    • headache
    • lethargy
    • weakness
    • confusion
  46. Alkalosis signs and symptoms
    • restlessness
    • muscle twitching
    • tingling and numbness in fingers
  47. Best method of assessing peripheral edema is...
    measure circumference of the extremity in the same location every day
  48. Urine
    • always wear gloves when handling urine containers
    • empty drainage bags before they are full or at least once per shift
    • average output of 1000 - 1500 mL/day
    • report output < 720 mL in a 24 hr perioud
    • concentration provides clue of fluid status
    • specfic gravity range: 1.003 - 1.030
  49. Skin turgor
    • skin elasticity
    • useful when assessing fluid balance
    • sternum is most reliable place to check
  50. Which fluids are recorded as intake?
    • Most fluids (including IV) except blood
    • Blood and blood products recorded on separate charts

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