fluid and electrolytes

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fluid and electrolytes
2010-11-17 20:14:40
Fluid electrolytes acid base nursing

Fluid, electrolytes, acid, base,nursing
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  1. 1. fluid movement after burn treatment
    2. IV administration of hypertonic fluid
    3. Use of albumin or other plasma proteins
    causes of fluid shifting into intravascular space
  2. 1. Tachypnea
    2. Dyspnea
    3. Crackles
    4. Bounding, Rapid pulse
    5. HTN (unless heart is failing)
    6. Increased CVP, PAP, & PAWP
    7. Distended jugular and hand veins
    8. Acute weight gain
    9. Peripheral edema
    10. S3 gallop
    11. Pulmonary edema
    Signs and symptoms of Hypervolemia
  3. 1. low HCT (hemodilution)
    2. Normal Serum Na+ level
    3. Lower K+ and BUN (hemodilution)
    4. High K+ & BUN (renal failure/impaired renal perfusion
    5. low O2
    6. Pulmonary congestion (X-rays)
    Labs for Hypervolemia
  4. 1. Sluggish skin turgor
    2. Dry,sticky mucous membranes
    3. Increased temperature
    4. Hypotension
    5. CVP decreased
    6. Rapid, weak pulse
    7. Decreased UOP
    8. Weight loss
    9. Excess
    Signs of Fluid Volume Deficits
  5. Fluid inside the cell, comprises 40% of total body weight about .5 L for normal 160 lb adult male
    Intracellular fluid (ICF)
  6. Fluid outside of the cell, 20% of body weight about 15 L of which 5 L of blood
    Extracellular Fluid (ECF)
  7. The liquid constituent of blood, make where we check our levels (Na make assumptions on Intracellular space
    Intravascular Fluid (IVF):
  8. liquid constituent outside of the blood Vessel
    Extravascular Fluid (EVF)
  9. Extra Weight Gain from fluid
    Pt needs to be on Fluid & Salt Restrictions
  10. 1. Respiratory System
    2. Renal System (Kidneys)
    3. Chemical Buffers
    Systems that work to create an acid-base balance
  11. 1. Bicarbonate
    2. Phosphate
    3. Ammonium
    4. Protein
  12. What's normal pH?
  13. Normal pH range
  14. Measures H+ concentration
  15. any substance that can reduce the hydrogen ions in a solution
    Base (Alkali)
  16. the pH is normal, doesn’t mean there isn’t an acid-base disturbance
    Changes in oxygenation can provoke changes in acid/base as well
  17. 40mm Hg
    Range 35-45mm Hg
    respiratory component
    reflects the partial pressure of CO2 in arterial blood
    adjusted by changes in pulmonary ventilation
    Excess H2CO3 breaks down to H2O and CO2, the respiratory rate increases
  18. PaCO2 > 45 mm Hg
    indicated alveolar hypoventilation respiratory acidosis
  19. Hyperventilation lowers the PaCO2 (<35 mm Hg) and produces
    respiratory alkalosis
  20. instantly combine with the offending acid or base, Neutralizing harmful effects until other regulators take over
    Chemical buffers
  21. Uses Hypo/Hyperventilation to regulate acid excretion or retention
    Within Min. of pH change
    Respiratory System
  22. Excrete or Retain more acids or bases as needed
    Restores normal balance within hours or days
    The Kidneys
  23. Used to assess
    breathing effectiveness
    acid-base balance
    a pts response to tx
    ABG (arterial blood gas) analysis
  24. pH less than 7.35 reflects
  25. pH >7.45 reflects
  26. H2CO3 (Carbonic acid) deficit exists 3 things occur
  27. 1.respiratory rate decreases
    • 2.CO2 is retained
    • 3. more carbonic acid is formed
  28. increased alveolar ventilation to 4 to 5 times the normal level
  29. decreases alveolar ventilation to 50% to 75% of the normal level
  30. mechanism is 50 to 70% effective in healthy lungs
  31. indicates the amount of blood buffers
    Abnormally high values reflect alkalosis and low values reflect acidosis
    BE +2, Base Excess
  32. aids in the excretion of H+ in the renal tubules
  33. After an acid load, ammonia (NH3+) is produced by the renal tubular cell and is combined with H+ in the renal tubule to form ammonium (NH4+). This process allows
    greater renal excretion of H+ in the urine
  34. Buffer that is Present in cells, blood, and plasma
  35. most important protein buffer
  36. 24mEq/L
    Range 22-26 mEq/L
    HCO3- (Bicarbonate)
  37. major renal component
    most important buffer in the body
  38. ratio of bicarbonate with carbonic acid
  39. indicate metabolic acidosis
    the decreased level could be compensation for respiratory alkalosis
    Decreased levels HCO3- <22 mEq/L
  40. indicate primary metabolic alkalosis
    the elevated level could be compensation for respiratory acidosis
    Elevated levels HCO3- > 26 mEq/L
  41. Excess H+ is excreted in the urine and HCO3- (an anion) is retained to maintain
    • 1:20 ratio respectively
    • (20:1 ratio, Balance between H2CO3 and HCO3-)
  42. manufactured by renal tubules may be influenced by pH levels
  43. indirect measurement of H+ concentration
    Arterial pH
  44. 1. Examine the PaO2 and SaO2
    2. Determine if pH is normal
    3. Study the PaCO2 and HCO3- values
    4. Determine which compensatory mechanism is working
    4 step ABG analysis
  45. 95 mmHg Range: 80-100 mmhg
  46. 95%-99% Range: 93%-100%
  47. spares K + & eliminates Na+
    Spironolactone (Aldactone)
  48. One value indicates the primary sourse of the pH change
    The other indicates the bodies effort to compensate for the disturbance
    change in PaCO2 & HCO3 values
  49. Occurs when the body so effectively compensates that pH falls within NORMAL range
    Complete compensation
  50. Compensation when PH remains outside of the normal range
    Partial compensation
  51. which 2 ABG values rise and fall together?
    HCO3- & pH
  52. Reflects the body's ability to pick up oxygen from the lungs
    indicates when to make adjustments to O2 concentration given to patient
  53. Represents Hypoxemia
    can cause Hyperventilation
    Low PaO2
  54. If molecules in the body remain intact
    Non- electrolytes or colloids
  55. Urea
    Non- electrolytes or colloids
  56. · Regulation of H2O distribution
    · Regulation of acid-base balance
    · Transmission of nerve impulses
    · Clotting of blood
    · Generation of ATP
    Chief functions of electrolytes
  57. PCO2 or HCO3- doesnt match the PH
    1 value is normal
  58. 2.2 kbs= Kg?
    1 kilo
  59. 1. Same time each day (morning)
    2. after voids b4 BM
    3. in same atire
    4. on same scale
    Factors that make Daily Weight the most accurate measure of Fluid imbalances after I&O