N200 electrolytes

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LaurenFleming
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50747
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N200 electrolytes
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2010-11-20 15:40:14
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fluid, electrolytes
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  1. Intracellular
    42 % of total body weight-in tissue and red cells
  2. Extracellular
    17% total body weight

    Compartments

    • Interstitial
    • Intravascular
    • Transcellular
  3. Interstitial
    • lymphatic system
    • **contains lymph, is the fluid between the cells and outside the blood vessels
  4. Intravascular
    • in the Plasma
    • **fluid is blood plasma found in the vascular system.
  5. Transcellular
    • fluid is fluid separated from other fluids by a cellular barrier and consists of cerebrospinal, pleural, gastrointestinal (GI), intraocular, peritoneal, and synovial fluids
    • ** Loss of transcellular fluid can produce fluid and electrolyte disturbance.


    - pericardial fluid, pancreatic fluid, the eye, biliary fluid, paritineal space, synovial (joint) space
  6. Adults body composition
    • 50-60% water
    • 40-50% solids
  7. Older Adults body compostion
    • 45-55% water
    • 45-55% solid
  8. infants body composition
    • 70-80% water
    • 20-30% solid
  9. Osmosis
    involves the movement of a pure solvent such as water from an area of lesser concentration to an area of greater concentration.
  10. Diffusion
    the movement of a solute in a solution across a semipermeable membrane from an area of higher concentration to an area of lower concentration.
  11. Filtration
    the process by which water and diffusable substances move together in response to fluid pressure.
  12. Active transportation
    requires requires metabolic activity and the expenditure of energy to move materials across cell membranes.
  13. Fluid output occurs through four organs of water loss:
    the kidneys, the skin, the lungs, and the gastrointestinal tract
  14. Insensible water loss is continuous and is not perceived by the person but can increase significantly :
    with fever or burns.
  15. Sensible water loss occurs through excess:
    • perspiration and can be perceived by the client or by the nurse through inspection
    • ***Sensible loss is continuous when you sweat, because the patient can sense that it occur
  16. Average day the person losses about
    5-600 mL of fluid via sensible and insensible in a day
  17. The basic types of fluid imbalances are
    isotonic and osmolar.
  18. Isotonic deficit and excess exist when
    water and electrolytes are gained or lost in equal proportions.
  19. Osmolar imbalances
    are losses or excesses of only water so that the concentration of the serum is affected.
  20. Isotonic disturbance
    when we loss or gain water and fluid electrolytes from equal parts
  21. High blood sugar
    • hyperosmotic state
    • ***blood sugar gets so high that they are lossing water but no
    • change in the amount of electrolytes.
  22. Sodium (Na+)
    135 - 145 mEq/L
  23. Potassium (K+)
    3.5 – 5.0 mEq/L
  24. Total Calcium (Ca 2+)
    8.5 – 10.5 mg/dL
  25. Magnesium (Mg2+)
    1.5 – 2.5 mEq/L
  26. Cations interchange when
    one cation leaves the cell and is replaced by another. This occurs because cells tend to maintain electrical neutrality.
  27. Na+ lives in the
    extracellular fluid (to maintain water balance)
  28. K+ lives in the
    blood cells
  29. Sodium Regulation
    Sodium is the most abundant cation (90%) in ECF.

    • **Maintains water balance through their effect on serum osmolality,
    • nerve impulse transmission, regulation of acid-base balance, and participation
    • in cellular chemical reactions.

    • **Regulated by dietary intake and aldosterone
    • secretion.
  30. Hyponatremia
    a lower-than-normal concentration of sodium in the blood

    **Sodium less than 135
  31. how can somebody loss sodium and become Hyponatremia??
    Sweating, intaking enough sodium, vomiting, GI fluids, diaretics, over drink water from iv fluids not just , head injuries, hypotonic tube feedings
  32. Signs and symptoms for not enough sodium
    - putting out extra fluids because you body is trying to even it out. Lower blood pressure, nausea and vomitting, may get confuesed, muscle twitching, headache, left untreated witll proceed to seziures and commas
  33. What can we do for the patient with too little sodium
    diet high in sodium, salt tablets, decrease their fluid intake
  34. Hypernatremia
    a greater-than-normal concentration of sodium
  35. What to look for in a patient with Hypernatremia
    give them more fluids, this patient is very dehydrated, dry and sticky mucous membranes, a red dry tongue, as progresses fatique and restlessness and change in level of conciousness, compulsions, (overexposure to elements, fever, diarehha, giving too much sodium in IV hypertonic solution, excesss sodium normal is (2 teaspons daily) we need iodine from table salt.
  36. First thing we do if sodium is high
    is give them water, monitor their I and O one we are restricting and the other we are encouraging
  37. Potassium
    the major electrolyte and principle cation in the intracellular compartment.
  38. Potassium Regulation
    Regulates many metabolic activities and is necessary for glycogen deposits in the liver and skeletal muscle, transmission and conduction of nerve impulses, normal cardiac conduction, and skeletal and smooth muscle contraction
  39. Potassium is regulated by dietary
    intake and renal excretion.
  40. The body conserves potassium poorly, so any condition that increases
    urine output decreases the serum potassium concentration.(diaretics)
  41. Hypokalemia
    is one of the most common electrolyte imbalances, in which an inadequate amount of potassium circulates in ECF. When severe hypokalemia can affect cardiac conduction and function.
  42. Hypokalemia signs and symptoms
    -Muscle cramps, charlley horse, anorexia, nausea vomiting, gastric suctioning , diahrra, poor intake of potassium, diaretic use, alcholism,
  43. What we can do for a patient with Hypokalemia
    - eat their veggies, if it is given IV has to be given slowly, monitor their heart rate and rhythum, causias to the patient receiving digoxen
  44. Hyperkalemia
    a greater-than-normal amount of potassium in the blood. Severe hyperkalemia produces marked cardiac conduction abnormalities.
  45. Signs and symptoms with a patient with Hyperkalemia
    gasterointestinal hyperactivity, cardiac dysrythmias or arrest, irregular pulse
  46. What we can do for a patient with Hyperkalemia
    give them kalexalte enema (bowel slides), potassium wasting diruretics , patient with renal failure might have to put them on dialysis, and monitor cardiac activity for cardiac arrest.

    Cardiac conduction and postassium
  47. calcium is a trransporter and help across smooth muscle. What is this ??
    Cardiac conduction
  48. Calcium Regulation
    Calcium is necessary for bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses, and muscle contraction.


    • Calcium is stored in bone, plasma, and body cells. Ninety-nine percent of
    • calcium is located in bone.

    Normal serum ionized calcium is 4 to 5 mEq/L. Normal total calcium is 8.5 to 10.5 mg/100ml.
  49. Hypocalcemia
    can result from abnormalities of the thyroid and parathyroid glands.
  50. Hypocalcemia signs and symptoms
    Signs and symptoms can be related to a diminished function of the neuromuscular, cardiac, and renal systems

    • **circome oral paraesthgia (numbness and tingling around mouth and fingers), muscle cramps, tremors, cardiac dysrythmias, decrease in cardaic output, positve troussau( blood pressure cuff on arm and the patient will experience
    • tremors) or positive chvostek signs(tap on the facial nerve and the patient gets a twtch), can have confuesion, hyperactive deep tendon reflexes. Less calcium in blood and comes out of the bone

    • Hypocarathyroidism, pancreatitus,thyroid cancer, hyperphosortemia (if calcium
    • is low high phosphate), inadequate Vit.D intake (dietary, alcohol abuse)
  51. If patient's Calcium level is low we give them ....
    calcium, Dairy products , Vegetables (dark leafy green), Salmon, Tums (antacids), Post menapausal women (give estrogen)
  52. Hypercalcemia
    is frequently a symptom of an underlying disease resulting in excess bone resorption with release of calcium.

    **molignancy, immobile (have higher calcium levels),
  53. Signs and Symptoms of a patient with Hypercalcemia
    -lethargy and weakness, decrease in deep tendon reflexes, bone pain, constipation, flank pain (in the back kidney problems because kidney stones are made from them), dysrythmias (heart block)
  54. How to get the calcium down
    phosphate (oral), immobile try and get them mobile, limit calcium high foods, give them water to dilute them, acid ash diet (cranberries, prun juice, counter acts does not allow the calcium to clump)
  55. Magnesium Regulation
    • Magnesium is essential for enzyme activities, neurochemical
    • activities, and cardiac and skeletal muscle excitability. Approximately 50% - 60% of magnesium is maintained within the bone.

    • Plasma concentrations of magnesium range from
    • 1.5 to 2.5 mEq/L.

    • Regulated by dietary intake, renal
    • mechanisms, and actions of the parathyroid hormone.
  56. Hypomagnesemia
    can be the result of malnutrition, alcoholism, diarrhea, vomiting, fistula
  57. Signs and Symptoms of a patient with Hypomagnesemia
    • neuromuscluar irribillity with tremors, tachycardia, elevated blood pressure, vertigo
    • (mesing with nerve conduction), confuesion,
  58. What can we do with a patient with a low magnesium
    mag supplement (epsin salts bathing salts), diet high in magnesium (greeen veggies, fish, legumes, nuts, dried fruits)
  59. Hypermagnesemia
    can be the result of renal failure, excessive oral intake of magnesium

    **renal failure, excees oral intake of magnesium
  60. Signs and Symptoms of a patient with Hypermagnesemia
    vasodilation, nausea and vomitting, muscle weakness, low BP, HR slows down only for magnesium, respiratory depression, comma
  61. Interventions for a patient with Hypermagnesemia
    - no legumes, dialysis (maybe) increase fluids, think safety (side rails up put on heart monitor no walking around the hallways),
  62. The three major anions of body fluids are:
    Chloride (Cl-)

    Bicarbonate (HCO3-)

    Phosphate (PO4 3-)
  63. Chloride Regulation
    Chloride is the major anion in ECF. The transport of chloride follows sodium. Normal concentrations of chloride range form 95 to 108 mEq/L.

    Serum chloride is regulated by dietary intake and the kidneys.
  64. Hypochloremia
    vomiting or prolonged and excessive nasogastric or fistula drainage can result in because of the loss of hydrochloric acid

    use of loop and thiazide diuretics also results in increased chloride loss as sodium is excreted.

    • When serum chloride levels fall, the reabsorption of the bicarbonate ion occurs to maintain electrical neutrality
    • ***may not be your patient that is dehydrated
  65. Hyperchloremia
    usually occurs when the serum bicarbonate value falls or sodium level rises.
  66. Bicarbonate Regulation
    • Bicarbonate is the major chemical base buffer within the body. The bicarbonate
    • ion is an essential component for acid-base balance.
  67. Phosphorus-Phosphate Regulation
    • Phosphate is a buffer anion found primarily in ICF. It assists in acid-base
    • regulation.

    Calcium and phosphate are inversely proportional; if one rises, the other falls.

    It is regulated by dietary intake, renal excretion, intestinal absorption, and PTH.

    The normal serum level is 2.5 to 4.5 mg/100ml.

    To raise phosphate- fish, pultry, dairy products, legumes
  68. Phosphate is a buffer anion found
    primarily in ICF. It assists in acid-base regulation
  69. Calcium and phosphate are
    are inversely proportional; if one rises, the other falls.

    It is regulated by dietary intake, renal excretion, intestinal absorption, and PTH.

    The normal serum level is 2.5 to 4.5 mg/100ml.
  70. Regulation of Acid-Base Balance
    Metabolic processes maintain a steady balance between acids and bases.

    Arterial pH is an indirect measurement of hydrogen ion (H+) concentration.

    The pH is also a reflection of the balance between:

    **Carbon dioxide (CO2) regulated by the lungs

    **Bicarbonate (HCO3-), a base regulated by kidneys.
  71. Normal values in arterial blood range
    7.35 to 7.45.
  72. The three general types of acid-base regulators in the body are
    chemical, biological, and physiological buffering systems.
  73. A buffer is...
    a substance that can absorb or release H+ to correct an acid-base imbalance.
  74. Arterial - It measures ...
    the pH the PaCO2, PaO2, bicarb level, oxygen saturation, base excess level

    **Arterial blood gas draw arterial blood to test pH

    Worries: we don’t want to damage the artery and has an alternative blood flow . Do the Allens test to make sure the ulnar artery is functioning
  75. The largest chemical buffer in ECF is
    • is the carbonic acid and bicarbonate buffer system. It’s the first buffering
    • system to act.

    Whenever carbon dioxide increases, there is an increase in hydrogen ions produced, and whenever hydrogen ions are produced, there is more carbon dioxide produced.
  76. Below a pH of 7.35
    acidodic
  77. Greater pH of 7.45
    alkaltic
  78. Biological buffering occurs
    • when hydrogen ions are absorbed or released by cells. It occurs after chemical
    • buffering.
  79. The two physiological buffers in the body are
    the lungs and the kidneys.


    **When the concentration of hydrogen ions is altered, the lungs react to correct the imbalance by altering the rate and depth of respiration.

    • **The kidneys take from a few hours to several days to regulate acid-base imbalance. They reabsorb bicarbonate in cases of acid excess and excrete it in
    • cases of acid deficit.



    Respitory system kicks in first to maintain the pH

    Lungs kick in in the first 15 min.

    • exercising we are decreasing CO2 and your breathing faster (compensation), so your exercising while sedated, they body will try to increase respiratory drive in
    • an hour the kidneys will kick in

    If the patient is dehydrated the lungs will still try to kick in first and then the kidneys will try and keep up after word. Kidneys take hours to days to kick in
  80. Arterial blood gas (ABG) analysis is
    the best way to evaluate acid-base balance. Measurement of ABGs involves analysis of six components.

    These components are pH, PaCO2, PaO2, oxygen saturation, base excess, and HCO3-.
  81. pH is ....
    • pH measures hydrogen ion (H+) concentration in the body fluids. Even a slight
    • change can be potentially life threatening.

    An increase in concentration of H+ makes a solution more acidic

    A decrease makes the solution more alkaline.

    • Normal pH value is 7.35 to 7.45 (acidic is
    • <7.35, and alkalotic is >7.45).
  82. PaCO2
    • PaCO2 is the partial pressure of carbon dioxide in arterial blood and is a reflection of the depth of pulmonary ventilation. The normal range is
    • 35 to 45 mm Hg.

    ***The normal range is a Measurement of their pulmonary ventilation

    Smoker will increase CO2 and O2 will be lower

    COPD CO2 will go up 50-60 range and the O2 are in the same range
  83. PaO2
    • PaO2 is the partial pressure of oxygen in arterial blood. It has no primary
    • role in acid-base regulation if it is within normal limits.

    Normal range is 80 to 100 mm Hg.
  84. Oxygen Saturation
    • Saturation is the point at which hemoglobin is saturated by oxygen (02). When a client is hypoxic and uses up readily available oxygen, the reserve oxygen (oxygen attached to hemoglobin) is drawn upon to provide oxygen to the
    • tissues.

    When the PaO2 falls below 60mm Hg, there is a large drop in saturation.

    Normal range is 95% to 99%/
  85. Base Excess
    Base excess is the amount of blood buffer (hemoglobin and bicarbonate) that exists.
  86. Serum Bicarbonate (HCO3-)
    Serum bicarbonate (HCO3-) is the major renal component of acid-base balance and is excreted and reproduced by the kidneys to maintain a normal acid-base environment.
  87. The four primary types of acid-base imbalance are:
    Respiratory acidosis

    Respiratory alkalosis

    Metabolic acidosis

    Metabolic alkalosis
  88. Respiratory Acidosis
    Respiratory acidosis is marked by an increased arterial carbon dioxide concentration (PaCO2) and decreased pH.

    pH and CO2 in opposite directions

    When co2 rises the pH drops

    Patients with COPD, sedation

    Signs and symptoms- confuesion, RR increase, warm flush skin, headache or weakness

    Interventions-sit them up, cough, deep breathing exercises, Ches PT suctioning, artificial respirations, bronco dialator
  89. Respiratory Alkalosis
    is marked by a decreased PaCO2, and increased pH

    CO2 below 35 and pH above 7.45

    Patients that hyperventiating- anxiety attack, patients on ventilator, elevated body temperatures, brain stem injury

    Signs and symptoms

    Respiratory alkalosis- change in HR, SOB, light headedness, numbness and tingling in mouth and fingers, difficulty consentration give them a paper bag, relaxation activity, sedate them,
  90. Metabolic Acidosis
    Metabolic acidosis is marked by a decreased HCO3 and a decreased pH

    Bicarb that is changing

    Diarrhea and renal failure (causes), diabetes, hypertonic IV solutions

    • Signs and symptoms- kussmals respirations, nausea and vomitting, lethargy and
    • confuesion, pH will be decreased and the bicarb

    • For this patient we will give them bicarb and treat the underlying problem
    • (ex renal failure to dialysis to blood sugar level)
  91. Metabolic Alkalosis
    Metabolic alkalosis is marked by an increased HCO3 and an increased pH

    Gastric suctioning, vomiting, overuse of antacids, decer


    Signs and symptoms- tenty (hypertonic muscles), dizziness, decrease RR and depth

    What to do – monitor I and O stop the vomitting , administer IV fluids, threat underlying problem
  92. ROME
    Respiratory Opposite

    **pH elevated PCO2 diminished=alkalosis (respiratory)

    **pH diminished PCO2 elevated=acidosis (respiratory)

    Metabolic Equal

    **pH elevated HCO3 elevated=alkalosis (met)

    **pH diminished HCO3 diminished=acidosis (met)

    Resp Acid- ph down past 7.35, CO2 up 45

    Resp Alk- pH up past 7.45, CO2 down 35

    Metabloic acid- pH down no CO2 HCO3 down 22

    Met alk- pH up , CO2 none, HCO3 up 26


    • KNOW THIS
    • Example- pH 7.48, CO2 35, HCO3 29 = met alk


    7.32 pH, 48 CO2, HCO3 22= resp acid
  93. A hypotonic solution moves fluid
    • into the cells, causing them to enlarge.
    • 0.45% NS
  94. An isotonic solution
    expands the body’s fluid volume. It has the same osmolarity as blood.

    Lactated Ringer’s

    0.9% NS

    D5% /W – contains sodium and chloride*
  95. A hypertonic solution
    pulls fluid from cells.

    D5% / 0.9% NS

    D5% / 0.45% NS
  96. Regulation
    Hypothalamic regulation

    Pituitary regualtion

    Adrenal cortical regulation

    Renal regulation

    Cardiac regulation

    Gastrointestinal regulation

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