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affected by urea, creatine and uric acid
- Hypervolemia- excess fluid which can cause edema (water is pulled from cells) causing accumulation of fluids in interstitial spaces.
- may be caused by malfunctioning kidneys, failure of heart to pump
- cells shrink
- Edema can be around eyes, finers, ankles, sacral area and in or around organs
- More water than Na...
- 0.33% NaCl
- 0.45% NaCl (1/2 strength of NS)
- D5W hypotonic in BODY
WATER moves From lOw solute concentration to high solute concentration
- Caused by; GI losses, water intox. psychogenic polydipsia, hypoglycemia, SIADH, use of diuretics.
- S/S: coma, cerebral edema, muscle twiches, R & W
- TTT: Na replacement: water restriction, 0.9 NS LR ISO, lasix for SIADH.
increased Aldosterone causes?
Sodium & Water retention, K+ Loss
Secretes parathyroid hormone--> regulates Ca and Phosphorus
"PULLING force" back into capillaries
- Caused by: GI loss, decreased fluid intake. Risk factors; DI, adrenal insufficiency, hemorrhage, coma
- water out of cells, cells shrink
- osmolarity >300 mOsm/L
reflects the concentration of fluids that affects the movement of water between fluid compartments by osmosis
"pusHing force" out of capillaries into interstitial tissues.
Chloride, bicarb, phosphate, and sulfate
- 0.9% NaCl (NS)
- D5W (5% DEXTROSE IN WATER)
- Higher concentration of solutes.
- 5% Dextrose in .45% NaCl
- 10% Dextrose in water
- 5% dextrose in 0.9% NaCl (NS)
ONLY insulin you can give IV
drugs ability to INITIATE BIOLOGIC ACTIVITY as a result of binding to receptor site.
combines with recpetors and initiates biochemical and physiologic changes.
Treatment for allergic reactions?
Epi- stimulates alpha and beta-adrenergic receptors causing bronchial dilation and relieving congestion in bronchial mucosa and pulmonary vessels.
what drugs must be always be checked with a second nurse?
thirst factor driven by?
- decreased BVol & intracellular dehydration
- located in hypothalamus (makes ADH)
- Na-142- 146- 15
- K- 5- 5- 150
- Ca- 5- 3- 27
- Mg- 2- 1- 27
- Caused by: excess water loss (water deprivation) or excess NA intake (hypertonic), DI, excess insensible water loss (heatstroke).
- S/S: NEURO, seizures, H/A, increased Temp & Thirst, r & w
- TTT: 0.3 NaCl, D5W
- Caused by: GI losses, starvation, DEcrease in Mg++, polyuria, Hyperaldosteronism, digoxin tox., use of diuretics.
- S/S: MUSCLE weakness/cramps, fatigue, dysrhythmias, DTRs.
- TTT: K replacement (IV PO), K diet: milk, eggs, grain, coffee, tea, fruits, veggies. Ca Gluconate (severe), monitor EKG & ABGs
- Caused by renal failure, hypoaldosteronism, Addisons Disease, Burns, meds such as K Cl-, ACE inhibitors, NSAIDs, K sparing diuretics. Pseudohyperkalemia, acidosis.
- S/S: muscle weakness and paralysis, dysrhythmias, anxiety
- occurs < hypokalemia, but this is more dangerous.
- TTT: Kayexalase, EKG, Dialysis, Limit K diet, IV Ca gluconate
- EFC < 8.6 mg/dL
- Caused by: Malabsorption, deficient Vit D, hypoparathyroidism, excess Ca loss, pancreatitis.
- S/S: NM. Numbness/tingling of fingers, mouth, feet. Trousseau & Chevosteks sign, seizures, mental changes, muscle cramps.
- TTT: Vit D, Ca Gluconate in D5W Bolus, weight bearing excerises.
- Severe is life threatning
- EFC >10.5 mg/dL
- Caused by: cancer and hyPERparathyroidism, bone loss due to immolbilization, Excess Vit D & Ca
- S/S: (NM) Cardiac arrest, muscle weakness, slurred speech/confusion, deep bone pain, polyuria, N & V
- TTT: 0.9 NaCl, Lasix, PO4++, encourage walking, 3-4 L/daily fluids, monitor EKG.
- < 1.5 mEq/L
- Caused by: GI losses, Chronic alcoholism, AMI, Decreased K and Ca, HYPER: parathyroidism & aldosteronism, malabsoption, diuretics
- S/S: NM irritability, muscle weakness, seizures, heart block, DTRs, resp paralysis, Trousseau & Chevostecks, Increased BP
- TTT: Diet high in Mg: green leafy veggies, nuts, grains, seafood.
- > 2.5 mEq/L
- Caused by: renal failure, excessive Mg intake, DKA, hypothyroidism, loss of DTRs
- S/S: NM. N&V, weakness, Dc BP, resp depression, coma, cardiac arrest. Flushed skin.
- TTT: Ca Gluconate, NaCl LR, Lasix
- < 1.8 mEq/L
- caused by: Decreased K, Mg, Vit D, hyperventilation, alcohol withdrawl, DKA, refeeding
- S/S: NM. Cardiomyopathy, resp failure, seizures, confusion, bone pain, muscle weakness
- TTT: Sodium Phosphase, potassium phosphate, milk
- > 2.6 meq/L
- Caused by: renal failure, excess Vit D & phosphate, chemotherapy
- S/S: tetany, muscle spasms/weakness, tachycardia
- TTT: Renegel (binds to phosphate to excrete it in GI), avoid laxatives and enemas.
- < 96 mEq/L
- Caused by: Addisons disease, Loss of Na & K cause Cl loss, diuretics
- S/S: NM, muscle cramps, tetany, seizures, coma, shallow resp
- TTT: 0.45 NS, avoid free water, Cl- diet
- > 108 mEq/L
- caused by: Ic Na (Cl- follows Na), Head injury, dehydration, diuretics
- S/S: NM, Dc cardiac output, tachycardia, coma, edema, dysrhythmias.
- TTT: diuretics (lower Na, lowers Cl), hypotonic IV LR, sodium bicarb
K replacement: peripherally & centrally?
- NEVER GIVE K+ IV PUSH
- No more than 40 mEq/L peripherally
- No more than 60 mEq/L centrally
- Max 10 mEq/Hr peripherally
- Max 20 mEq/Hr centrally