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What is a cation
A positively charged electrolyte
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What is an anion
A negatively charged electrolyte
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3 cations
Sodium, potassium and magnesium
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3 anions
Chloride, bi-carb and phosphate
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What do electrolytes do
Play a vital role in water distribution necessary for nerve impulses and play a role In acid base imbances
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What is Intracellular fluid
Fluid inside of the cell (35%-40%) of body weight.
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What is interstitial fluid
An extra cellular fluid located in the spaces between the cells
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What is intravascular fluid
"Plasma" fluid contained within the arteries, veins and capillaries
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What is the most abundant cation
Sodium is the most....???? In ECF
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What are Extra cellular measurements
What you see when someone draws a lab
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Normal potassium ranges are
Normal ranges for ??? 3.5 - 4.5
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What is the most abundant cation
Sodium is most abundant
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What is most abundant anion
Chloride is most abundant
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What is most abundant cation in ICF
Potassium is most abundant
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What is most abundant anion in ICF
Phosphate is most abundant
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Where is majority of body fluid
In the cells (intracellular)
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What is another name for plasma
Intravascular compartment is another name for fluid in arteries, veins and capillaries (5%)
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What are he two main fluid compartments
Intracellular and extracellular
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Extracellular compartment breaks down to what
Plasma (interstitial fluid)
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What cannot cross cell membrane
Proteins (what can they not do)
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ECF is composed of
Intravascular and interstitial fluid. (Make up what)
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Where is interstitial fluid located
Located in the space between most of the body's cells (what is located there)
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What separates intravascular and interstitial fluid
Capillary wall separates them
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What separates intracellular and extracellular fluid
Cell membrane separates what
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Major intracellular cation is potassium if cells are injured potassium could leak out causing potassium levels to be
High (these levels will be if cells are injured)
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What is diffusion
Movement of a substance from and area of greater to lesser concentration (solute only)
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What is filtration
Movement of a solute and solvent thru a permeable membrane from greater to lesser pressure (also called hydrostatic pressure)
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What is osmosis
Movement of solvent from lesser to greater solute concentration. solvent movement only
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Hydrostatic pressure and osmotic pressure regulates what
Movement of water between intravascular and interstitial spaces and capillary beds of the body. Hydrostatic pressure at arterial end and osmotic pressure at capillary end
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The more osmolarity a fluid has
The higher the concentration and the more osmotic pull it will have. Water follows salt rule
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Where is most hydrostatic pressure located
By the heart
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Protein and sodium act as
Magnet to pull fluid back into intravascular space (vein)
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If person is dehydrated what do the lack
Albumin (protein)
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What is acities
Third spacing of fluids (out of intravascular space)
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Filtration from arteries to veins
Heart pushes fluid out, (arterial end) protein (albumin) left in, proteins on venous end act as magnet to pull fluid back in (osmotic)
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Blood pressure low when
Fluid is in interstitium cuz it's not available for circulation. (Caught in space between cells)
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Interstitial FVE
•Increased blood hydrostatic pressure (heart pumping to hard pushing fluid into interstitium)
- •decreased blood colloid pressure (not enough protein to pull fluid into intravascular space)
- •increased interstitial fluid osmotic pressure
- • blocked lymphatic drainage (if not removing waste interstitial fluid may over flow and build up) lymph system gets rid of waste.
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Third spacing means
Too much fluid in interstitial space (between cells) and not being pulled back into intravascular space (veins, capillaries and arteries) B/P will be low
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More solute outside cell will make cell
Hypertonic. Cell will shrink cuz water follows solute outside cell
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Edema
Swelling from fluid in interstitial space (3rd spacing)
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Leaking proteins from capillaries can cause
Edema. Protein can leak out and can't pull fluid into intravascular space.
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To raise b/p quickly due to loss of fluid from interstitial space use what kind of fluid
Isotonic (0.9 NS which is also sodium chloride)
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If pt is hypovolemic b/p is likely
Low due to loss fluid volume give isotonic solution
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Fluid volume deficit
Is an extra cellular deficit (interstitium or intravascular)
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Hypertonic and hypotonic solutions cause
Movement between extracellular and intracellular compartment. Either pills fluid in or out
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Hypotonic solution
Will pull fluid into the cell because it has less solutes than plasma. CAUSES CELL SWELLING. NOT GOOD FOR PT W HEAD INJURY
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D5W for
Hyperneutremia. Can be used to bring down high sodium level by dilution. (Isotonic in bag, becomes hypotonic in body) Not for diabetic PTs cuz it contains dextrose
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Ringers lactate
Gets metabolized to bi-carb. Good for metabolic acidosis. Good for blood loss from burns and lower GI fluid loss
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Aldosterone is released by and consist of
Adrenal cortex and is sodium and water
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ADH is made in
Hypothalamus and released by posterior pituitary gland
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Hypotonic solutions cause
Cells to swell. Not good for head injury
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Isotonic solution examples
0.9 NS, D5W, Ringers lactate, D5.2 NS
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Hypertonic solution examples
D10W, D5.9NS, D 5.45NS, D5LR, 3%NaCL (severe hyponeutrimea)
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Hypotonic solution ex
0.45NS and 0.2NS good for cellular dehydration
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Hypothalamic thirst center is activated when
There is a 1-2% decrease in body fluids. Located in brain
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ADH causes
Water reabsorbtion. Keeps u from urinating and losing water
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Vasopressin is
Another name for ADH
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Hypovolemia
Low fluid volume
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Hyponeutrimea
Low sodium volume
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Hypernutremia
High sodium volume
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Hypokalemia
Low potassium
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Hyperkalemia
High potassium
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Juxtoglumarilar cells secrete
Renin from decreased blood flow due to hyperosmolarity which stimulates angiotensin 1 > angiotensin 2 > then causes aldosterone to be released and causes kidneys to retain sodium and water and causes b/p to increase
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Aldosterone is triggered by
Hypovolemia (low fluid volume) hyponutremia (low sodium volume) and hyperkalemia (high potassium)
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ANP (atrial natriuretic peptide) released When
there's too much blood volume From vasodilation. Blood pressure will be too low From excessive water and sodium loss. Shuts off renin angiotensin aldosterone system
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FVE
Excess of fluid in extra cellular compartment (intravascular and interstitial space )
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FVE is referred to as what type of disturbance
Isotonic hyervolemia. Too much fluid in extra cellular compartment
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FVD is referred to as what type of disturbance
Isotonic hypovolemia. Not enough fluid in extra cellular compartment
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Osmolarity problems are what type of disturbance
Hypo or hyper nutremic disturbances. Involves shifts Of sodium from extracellular to intracellular compartments
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No shift of fluids from intracellular to extracellular in what type of disturbance
Isotonic disturbances
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How to treat low fluid value with low blood-pressure
Give isotonic solution such as 0.9 NS
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In fluid volume excess extracellular compartment does what
Expands
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How does intravascular fluid affect blood pressure
It keeps B/P up
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Osmolarity problems will cause cells to
either shrink or swell
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Isotonic disturbances only affect
Extra cellular fluid
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Heart failure leads to
fluid accumulation and pooling
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FVE causes
Heart failure, Cirrhosis (Decreased hepatice profusion, increased venous pressure from protein depletion), renal failure, Adrenal gland disorders, excess 0.9NS administration
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FVE signs and symptoms (check lung sounds always)
Full bounding pulse, distended neck and peripheral veins, cough and dyspnea, orthopnea (difficulty breathing when lying down) tachypnea, crackles, pulmonary edema, ascites, anasarca (general edema) decreased hematocrit
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Specific gravity norms (renal concentrating ability)
- 1.010 - 1.025
- FVE < (low) specific gravity urine is more dilute
- FVD > (high) specific gravity urine is more concentrated (dehydration) (lot of particles (sodium)
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Hemoglobin norms (within red blood cells)
Oxygen carrying protein in RBC
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What is normal range for BUN (blood uria nitrogen) tells renal function. Final product of protein metabolism
- 6-20
- elevated BUN signals kidney damage
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Creatinine (specific indicator of kidney disease) what is the norm
0.6-1.2 (elderly renal function will decrease)
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Hematocrit (percentage of red blood cells in plasma) normal values
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low hematocrit (non anemic person) indicates
(FVE) hemodilution dilute hydration status
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FVE or isotonic hypervolemia (high fluid volume) results from
from abnormal retention of sodium and water in same proportion can cause CHF (inability to propel blood foward
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Aldosterone is
sodium and water
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Pt with polyuria with FVE would have
Low BUN (dilute urine)
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PT with renal failure would have
High BUN
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1 liter of fluid is equal to
2.2lbs
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Diluted urine indicates low....
specific gravity
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treatment for FVE
- momiter VS
- listen to lung sounds
- assess for edema
- asses neck and peripheral vein distention
- maintain semi-fowlers position
- fluid restriction
- sodium restricted diet (avoid processed meat, and fish, canned foods, condiments, snack foods)
- daily weights
- diuretics
- turn pt often for skin break down
- pulse ox to check o2 sat
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characteristic of pitting edema
edema that doesn't go back to normal after you remove your finger
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FVD causes *Isotonic hypovolemia* low fluid volume because fluid is osmotic <lot of particles> (can be dehydration)
- vomiting (metabolic alkalosis)
- diarrhea (metabolic acidosis)
- hemorrhage
- insufficient intake
- fever
- G.I. suctioning
- intestinal obstruction
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orthostatic hypotension
drop of more than 10 in systolic more than 15 in diastolic
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FVD signs and symptoms
- decreased skin turgor (skin will stay tented when pinched)
- fontanel will be sunken in in children
- droopy eyes
- high specific gravity
- mucous membranes will be dry
- dry skin
- flat neck and hand veins
- (not enough fluid in extra cellular compartment from dehydration)
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FVD treatment
- weights
- oral fluids
- I.V. fluids (0.9 NS) wanna give isotonic solution
- monitor lab values
- monitor I&O
- look for altered mental status
- moniter values
- look for orthostatic hypotension
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osmolarity disturbances
shift of fluid in and out of cells (between extracellular and intracellular compartments) sodium disturbances
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hyponatremia is
water excess (lose too much sodium thru sweat or drink too much water) too much water not enough sodium. Sodium levels will reflect disorder. give fluid and electrolytes (Gatorade)
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Hypernatremia is
water deficit (dehydration)
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in hyponatremia (water excess) cells do what
draw fluid in and swell because osmotic pressure is greater in intracellular compartment than extracellular compartment. (more particles/sodium in cell than outside of cell) can be from heart failure, renal failure and cirrhosis
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signs and symptoms of hyponatrameia
- muscle cramps
- headache
- altered mental status
- irratability
- coma and possible death
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treatment for hyponatremia
- loop diuretics
- fluid restrictions
- monitor I&O
- Daily wts
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FVE and FVD (Isotonic disturbances) only involve....
only involve extra cellular compartment (intravascular and interstitial)
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Hypernatremia (water deficit) is
water is pulled out of cells causing cells to shrink.
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Hypernatremia (water deficit) causes
- water deprivation
- dehydration
- fever
- hyperventilation
- excessive perspiration
- massive burns
- (elderly most at risk)
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signs and symptoms of Hypernatremia (water deficit)
- Loss of appetite
- Nausea
- Vomiting
- Generalized weakness
- Excessive fatigue
- Faintness
- Excessive thirst
- Muscle spasms
- Muscle tremors
- Swelling Irritability
- Excessive sleepiness
- Confusion
- Seizures
- Coma
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Treatment or hypernatremia
- use of hypotonic IV solution 0.45 NS
- skin care
- oral care
- reality orientation
- avoid high sodium foods
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Potassium charateristics
- major CATion in intracellular compartment
- vital role in cell matabolism
- 80% excreted by kidneys
- comes from diet
- clients on diuretics usually on potassium due to loss of it from excessive urination
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Kayaxolate does what to potassium
Brings potassium level down
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Norm potassium range
- 3.5-5.0 meq
- Low potassium = muscle weakness
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characteristics of sodium
- controls shift of water
- regulates extracellular fluid volume
- necessary for muscle contraction and the transmission of nerve impulses
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Sodium values
- 135-147 meq/L
- <135 = hyponatremia
- >147 = hypernatremia
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Calcium characteristics
- sedative action on nerve cells
- regulates muscle contractions
- plays a role in blood coagulation
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Calcium values
- 4.3-5.3meq/L
- <4.3 = hypocalcemia
- >5.3 = hypercalcemia
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Chvosteks sign
- is one of the signs of tetany seen in hypocalcemia. It refers to an abnormal reaction to the stimulation of the facial nerve. When the facial nerve is tapped at the angle of the jaw the facial muscles on the same side of the face will contract
- momentarily (typically a twitch of the nose or lips) because of hypocalcemia
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Trousseau sign
Trousseau sign of latent tetany is a medical sign observed in patients with low calcium.[1] This sign may become positive before other gross manifestations of hypocalcemia such as hyperreflexia and tetany, as such it is generally believed to be more sensitive (94%) than the Chvostek sign (29%) for hypocalcemia.
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Phosphorus is
major intracellular anion
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phosphorus norms
- 1.7-2.6
- < = hypophosphatemia
- > = hyperphosphatemia
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Magnesium is
important for neuromuscular function
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magnesium values
- 1.5-2.5
- < = hypomagnesemia
- >= hypermagnesemia
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chloride does what
controls shift of water
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chloride values
- 100-106
- < = hypochloremia
- > = hyperchloremia
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SIDAH is
syndrome of inappropriate ADH from diabetes, can't concentrate urine...lose a lot of water from decrease in ADH
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hyperosmolity
too much solutes in blood so body will require mote water...tells ADH hormone to kick in
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more fluid in intravascular compartment means what to blood pressure
higher blood pressure
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what fluid raises blood pressure
isotonic fluid because it will expand plasma volume (0.9 NS)
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Dehydration does what to blood pressure
lowers it cuz of low protein amount
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what solution is always hung when giving blood
0.9 NS because tonicity is similar to that of plasma
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which isotonic solution acts as hypotonic in body
D5W
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which IV solution is used to treat hypernatremia
D5W
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if diabetic and in metabolic acidosis what will potassium be
high
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which solution would you not give to a person with a head injury
hypotonic solution (0.45NS, 0.2NS or D5W) because it causes cells to swell...not good for head injury or CVA...less tonicity than ECF so it will draw into cell where more sodium lies
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