NUR107 Fluid and electrolyte

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  1. Atrial Natriuretic Peptide (ANP)
    Triggered by stretching of right atrium-Causes suppression of RAAS/ ADH-increases GFR and causes vasodilation.
  2. ADH
    • Saves water-Makes the kidney tubules more permeable.
    • synthesized by hypothalamus
    • secreted by posterior pituitary
    • Controlled by osmoreceptors in hypothalamus
    • Other factors which stimulate ADH- hypovolemia, stress, nausea, nicotine and morphine.
  3. Distribution of water
    • First spacing: Normal distribution
    • Second spacing: increased fluid in interstitial compartment: (EDEMA)
    • Third spacing: Abnormal fluid distribution in areas where there is minimal to no fluids. (Ascites)/(Pulmonary edema).
  4. Brawny edema
    Non-compressible edema-leads to release of clotting factors-caused from injury
  5. Renin
    • Released by kidneys due to decrease in pressure or sodium. 
    • Converts angiotensinogen to angiotensin 1 which then gets converted by ACE to angiotensin 2 which has vasoconstrictive effects and increases blood flow to kidneys.
  6. Aldosterone
    angiotensin 2 stimulates release of aldosterone form adrenal glands which act on the kidneys to reabsorb conserve sodium and also increasing water reabsorption. Aldosterone also stimulates ADH.
  7. Hypoabluminemia (third spacing)
    • decreased oncotic pressure
    • Lack of proteins to draw or pull fluids back into the capillaries. (Malnutrition/decreased protein synthesis/excess renal losses)
  8. Increased Hydrostatic Pressure (third spacing)
    inhibits the movement of fluids back into the capillaries.
  9. Increased interstitial oncotic pressure (third spacing)
    due to damage to capillaries allowing protein to leak into the tissue.
  10. Inflammation (third spacing)
    • Due to histamine ad bradykinins
    • Endothelial cells retract allowing openings in the capillaries and venules.-Allowing larger molecules to leave intravascular. 
    • This can dilute toxins and deliver WBC, O2 and nutrients to the tissue.
  11. Hypervolemia causes
    • CHF
    • Renal failure
    • cirrhosis-liver failure
    • cushings syndrome
    • hyperaldosteronism
  12. Nursing plan of care for fluid volume excess
    Nursing diagnosis
    *related to increased sodium and water retention secondary to hyperaldosteronism, excess fluid intake, excess sodium intake, renal failure, heart failure, or liver failure.
  13. Nursing care plan steps
    • assessing: systemic collection of data
    • diagnosis: data analysis, bases on present illness, problem identification, formulate nursing diagnosis outcome
    • identification: what the pt. is expected to acheive
    • planning: holistic plan of care-to achieve outcomes. 
    • implementation: execute nursing care plan
    • evaluation: Pt level of outcome achievement
  14. Increased interstitial hydrostatic presure
    Obstructed lymph flow which prevents removal of fluids from interstitium causing localized swelling.
  15. Peritoneum and lumen FVE
    up to 6L
  16. Peritoneal cavity
    up to 2-3L
  17. Nursing interventions
    • *Assessing*Inspection, Palpation, Auscultation*
    • Treating*Focuses on restoring normal levels, preventing complications, and treating underlying problems*
    • Preventing*Prevent injuries and maintain a safe environment*
    • Teaching*To provide information that will empower patients to perform self-care and make informed healthcare decisions.
  18. Assessment of FVE
    monitor intake and output
  19. Impending renal failure
    urine output less than 30cc/hr indicates potential renal failure
  20. Urine specific gravity
    <1.010 indicates dilute urine. too much water
  21. Monitor for rapid weight gain in regards to FVE
    • 2%=mild
    • 5%=moderate
    • 8% severe
  22. Fluid gain or loss calculations
    • 1 liter=1kg
    • 1kg=2.2 pounds
    • 1 pound=454ml
  23. What is an excellent indicator for  fluid volume loss or gain?
    Body weight
  24. Pitting edema
    10% increase in body weight-(FVE)
  25. serum osmolarity
    <280 mOsm/l- sodium determines this less than 280=FVE
  26. Calcium(Serum)
    • Necessary for transmission of nerve impulses, blood clotting, strengthens capillary membranes.
    • Adult-4.5-5.5mEq/L, 9-11mg/dL. 
    • Child- 4.5-5.8 mEq/L, 9-11.5mg/dL.
  27. Chloride (serum)
    • maintaining homeostasis, osmolality of body fluids, Ph balance
    • Adult: 95-105 mEq/L
    • Child: 98-105 mEq/L
  28. Hematocrit
    • RBC, hydration status, anemia
    • Adult: male-40-54% in 100ml of blood/ Female-36-46% in 100ml of blood.
    • Panic value less than 15% or greater than 60%.
  29. Magnesium (Mg) (Serum)
    • Neuromuscular activity, influences use of potassium, calcium and protein. responsible for transport of sodium and potassium across cell membrane.
    • Adult: 1.5-2.5 mEq/L, 1.8-3.0mg/dL
    • Child: 1.6-2.6 mEq/L
  30. Osmolality (serum)
    • Indicator of hydration status, helpful in diagnosing fluid and electrolyte imbalances. Sodium contributes 85-90% of serum osmolality.
    • Adult: 280-300 mOsm/kg
    • Child: 270-290 mOsm/kg
    • Panic values: <240 or >300 mOsm/kg
    • High value indicates: hemoconcentration due to dehydration
    • Low value indicates: hemodilution due to overhydration.
  31. Osmolality (Urine)
    • More accurate than specific gravity, indicator of hydration status, helpful in diagnosing fluid and electrolyte imbalances.
    • Adult: 50-1200 mOsm/kg/H2O.
    • 1.010-specific gravity considered normal
  32. Phosphorus (serum)
    • Principal intracellular anion; exists in blood as phosphate. functions include metabolism of carbohydrates, fats, ph balance, use of B vitamins, promotion of nerve transmission. Requires vitamin D for absorption from gastrointestinal tract-stored with calcium in bones/teeth.
    • Adult: 1.7-2.6 mEq/L or 2.5-4.5mg/dL
    • Child: 4.5-5.5 mg/dL
  33. Potassium (serum)
    • Most abundant intracellular fluids, Narrow range (2.5 mEq/L-7.0 mEq/L)-can lead to cardiac arrest. 90% of potassium excreted by kidneys. *Rhabdomyolysis can lead to hyperkalemia.
    • Adult: 3.5-5.3 mEq/L
    • Child: 3.5-4.8 mEq/L
  34. Protein (total) (serum)
    • Composed mostly of albumin and globulins-important in fluid and electrolyte balance.
    • Adult: 6.0-8.0 g/dL
    • Child: 6.2-8.0 g/dL
  35. Sodium (serum)
    • Major cation in extracellular fluid, retains water,Maintains body fluids, neuromuscular impulses via sodium pump (Na+ shifts into cells as K+ shifts out for cellular activity) Enzyme activity, regulates PH balance by combining with chloride or bicarbonate ions. 
    • Adult: 135-145 mEq/L
    • Panic: < 115 mEq/L
  36. Electrolyte distribution Sodium
    • Extracellular: 142 mEq/L
    • Intracellular: 10 mEq/L
  37. Electrolyte distribution Potassium
    • Extracellular: 4.2 mEq/L
    • Intracellular: 150 mEq/L
  38. Electrolyte loss from Sweat
    *Sodium and Potassium
    • Sodium:45 mEq/L
    • Potassium:5 mEq/L
    • Chloride: 58 mEq/L
    • Bicarb: 0
  39. Electrolyte loss from Gastric
    *Sodium and potassium
    • Sodium: 60 mEq/L
    • Potassium: 9 mEq/L
    • Chloride: 84 mEq/L
    • Bicarb: 0
  40. Electrolyte loss from diarrhea
    • mainly from Lg bowel, but can also come from Sm bowel dependent on severity on diarrhea.
    • Mainly going to lose Sodium, Potassium and Bicarb.
    • In mEq/L
    • Sm bowel:
    • Sodium: 129
    • Potassium: 11
    • Bicarb: 29
    • Lg bowel:
    • Sodium: 80
    • Potassium: 21
    • Bicarb: 22
  41. Hypo or Hyper-natremia
    Panic values: <115 mEq/L and >150 mEqL
    CNS most easily affected by this. <115 mEq/L leads to cerebral edema. Water/fluids from ECF goes into the ICF causing swelling. Opposite is said for >150 mEq/L-Crenation takes place or shrinkage.
  42. Hypo or hyper-kalemia
    Panic value: <2.5 mEq/L and >7.0 mEq/L
    • Mainly found in ICF, with hypo there is an increase in ICF distribution leading to abnormal amounts. Leads to Cardiac arrest and respiratory insufficiency. 
    • Respiratory failure #1 cause of death in Hypokalemia.
    • Never give potassium supplement if urine output less than 0.5ml/kg/hr. Kidneys main regulator for K+.
    • Most common cause of Hyperkalemia is Renal failure

    Maximum infusion rate: K+ 5-10 mEq/hr never exceed 20 an hour.
  43. Osmolality
    concentration of solutes
  44. Distribution of sodium vs potassium on ICF and ECF?
    K+ concentrated in ICF while Na+ concentrated in ECF
  45. list a few S&S of Hyponatremia? What is a low value?
    • <135 mEq/L is considered Hypo anything below 120 is severe.
    • Profound thirst, headache, malaise, tremors, decreased LOC, tachycardia, nausea.
  46. Break: Think of something beautiful!
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  47. List a few S&S of Hypernatremia, What is a high value?
    • >145 mEq/L is considered high
    • S&S are the same as Hyponatremia.
  48. List a few S&S of hypokalemia, What is a low value?
    • anything <3.5 mEq/L. <2.5 mEq/L is considered a panic value.
    • S&S a similar to Hyper, but their is a higher probability for respiratory insufficiency.
  49. List a few S&S of Hyperkalemia, what is a high value?
    • anything  >5.3 mEq/L. Panic value > 6.0 -7.0 mEq/L.
    • ECG changes, tremors, twitching, anuria, acidotic, malaise, irritable.
  50. Hypocalcemia
    • 4.5-5.5 mEq/L, 9-11mg/dL
    • Panic value: <7mg/dL causes tetany any lower leads to arrhythmias or death. 
    • Common cause: is renal failure, hypomagnesemia, hypoparathryoidism, diuretics, malabsorption, hypoalbuminemia, hyperphophatemia (reciprocal relationship).
    • hyperexcitability of cells, (think twitchy) cells are easily depolarized due to increased permeability of membranes.
  51. List a few S&S of Hypocalcemia, What is a low value?
    • <7mg/dL OR <4.5 mEq/L
    • arrhythmias, twitchy, prolonged QT interval, hypotension, weak pulse, confusion,
  52. Hypercalcemia
    • 4.5-5.5 mEq/L OR 9-11mg/dL
    • Panic value: >13 mg/dL
    • Causes: Renal failure, hyperparathyroidism, vitamin D intoxication,
    • (Think floppy), decreased neuromuscular excitability, bradyarrhythmias, decreased LOC, confusion, hypophophatemia.
  53. List a few S&S of hypercalcemia, what is a high value?
    • >13mg/dL or >5.5 mEq/L
    • Decreased LOC, Bradyarrhythmias, think floppy, malaise/ muscle weakness,
  54. Who's at greatest risk of F&E imbalances?
    • Elderly
    • pediatrics
    • renal failure pt
    • endocrine disorder pt.
  55. Hypomagnesemia
    • <1.5 mEq/L 
    • causes: chronic alcoholism which is associated with malnutrition. malabsorption, medications(gentamicin, neomycin, amphotericin B, insulin.
    • similar S&S to Hypocalcemia/hypokalemia due to magnesium playing an important roll in the transport of Na+ and K+.
  56. Hypermagnesemia
    • > 2.1 mEq/L
    • causes: untreated diabetic ketoacidosis, addisons disease, volume depletion.
    • S&S similar to Hypercalcemia and kalemia.
  57. Hyperphosphatemia
    • >4.5 mg/dl
    • common cause: renal failure, problems focused on hypocalcemia which is the reciprocal change seen. Hypoparathyroidism lack of PTH causes calcium loss and a phosphate increase.
    • S&S will be associated with hypocalcemia.
  58. Hypophosphatemia
    • <2.6 mEq/dl
    • common causes: Hypercalcemia, alcoholism, malabsorption.
    • S&S associated with hypercalcemia.
  59. Hypertonic solutions
    fluids are pulled from the cells and interstitial spaces and into the intravascular space
  60. Hypotonic solution
    fluids are forced into cells and interstitial spaces.
  61. Isotonic solutions
    used to replace ECF due to illness. expands circulating volume. has same osmolality as plasma
  62. Isotonic fluids
    • 0.9% NaCl
    • Ringers-Balanced electrolyte solution resembling normal plasma
    • Lactated Ringers-Converted into bicarbonate by the liver.
  63. Hypotonic solutions
    • Dilutes ECF, restores ICF balance-flushes kidneys and excretes electrolytes.
    • 0.45% NaCl
    • D5-10W-2/3 enters cells, 1/3 stays in ECF
  64. Hypertonic solutions
    • Rarely used, very dangerous.
    • water pulled from cells causing crenation 
    • 3-5% saline bags for dangerously low sodium levels.
Card Set:
NUR107 Fluid and electrolyte
2016-01-18 00:55:58
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