Fluid and electrolytes

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Fluid and electrolytes
2010-03-05 16:36:57

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  1. Insensible loss
    loss from skin and lungs that can't be measured
  2. Sensible loss
    fluids lost during urination, defecation, wounds, and other means that can be measured
  3. Several pairs of opposite charged ions are so closely linked that problem with one ion causes problem with other:
    Na+ and Cl-, Ca+ and phos -
  4. Anion Gap
    test--distinguishing types and causes of acit base imbalances bc reflects serum anion cation balance
  5. Sodium levels
    135-145 mEq/L
  6. Potassium
  7. Calcium
  8. Serum osmolality
    275-295 (# of solutes dissolved in a solution)
  9. Urine specific gravity
  10. Extracellular compartments
    All fl outside cells
  11. Interstitial fluids
    • Fl between cells and the blood vessels
    • Reserve fluid replacing either fluid in bl vessels or cells depending on need (shift in or out)
  12. Intracellular compartment
    • All fluid inside cells
    • *Most boyd fluids are inside the cells
  13. Intravascular fluid or plasma
    • Fluid within blood vessels
    • Liquid portion of blood
    • Transports O2 and nutrients to cells and waste products away from cells
  14. Least stable fluid (compartment)
    Vascular fluid--quickly lost or gained in response to fluid intake and losses
  15. Na+
    What it does
    Something wrong =
    • Helps nerve and muscle cells interact
    • Numbness, tingling, seizures
  16. Cl-
    What does it do?
    • Helps maintain osmotic pressure
    • Gastric mucosal cells--need to produce HCL acid for food breakdown
  17. Ca+
    What does it do?
    • Stabilizes cell membrane and reduces permeability to Na+
    • Transmits nerve impulses
    • Contract muscles
    • Coagulates blood
    • Forms bones and teeth
    K+--what does it help with?
    • Cell excitability refulation
    • Nerve impulse conduction
    • Muscle contraction and myocardial membrane respnsiveness
    • Intracellular osmolality control
  19. Intra
    • Energy metabolism
    • Combines with Ca+--key role w bone and tooth mineralization
    • helps maintain acid-base balance
  20. Magnesium
    • *cardio and nervous
    • Enzyme reactions
    • neuromuscular contractions (more)
    • *given to calm nervous in prego women--preeclampsia--give mag sulfate
  21. Isotonic
    • Same solute concentration as another solution (NS is one)
    • NS 0.9%, LR--same concentration
  22. Hypotonic
    • Lower solute concentration than another solution
    • 0.45% NaCl--lower solute concentration plasma--swell and H2O move in
  23. Hypertonic
    • Higher solute concentration than another solution
    • (solutes greater than pts blood)
    • D 5% in 0.45% NS, D5 in 0.9% nS
    • Greater # of solutes than plasma--H2O drawn out of solution
  24. Tonicity
    Effect of osmotic pressure of solution on cells within that solution
  25. Nursing implications r/t hypotonic and hypertonic solutions
    • hypo= may cause too much fl to move from veins into cells and cells can swell
    • hyper=may cause too much fl to be pulled from cells into blstream and cells can shrink
  26. Osmosis
    Passive movement fl across membrane from area of lower solute concentration and high fluid to area of higher solute concentration and less fluid
  27. Osmolality
    • Concentration of all solutes within a body fluid compartment
    • Normal of both ICF and ECF= 275-295
  28. Diffusion
    • Solutes move from area of higher solute concentration to area of lower solute concentration
    • Passive transport
  29. Diffusion types (2)
    • Simple (random movement solutes)
    • Facilitatied (large H2O soluble mol)
  30. (capillary bl movement)
    • H2O and colutes move across capillary membranes driven by fluid pressure (hydrostatic)
    • Movement of greater pressure to lesser pressure
  31. Hydrostatic pressure
    Created by pumping action of ht by gravity
  32. Reabsorption
    Process prevents too much fl from leaving the capillaried no matter how much hydrostatic pressure exists in capillaries
  33. Albumin
    • Protein that remainds behind in the diminishing volume of water when fl enters thru a capillary
    • Can't pass thru cap membranes
    • Albumin is a "WATER MAGNET" it keeps water in intravascular space
  34. Active Transport
    • Allows molecules to move across cell membranes into are of higher solute concentration -- like swimming upstream
    • May need energy ATP
    • Sodium potassium pump
  35. Body fluid regulation
    • Thirst (altered LOC vulnerable)
    • Kidneys (primary respon ofregulation of fl and elc balence)
    • -Nephron--forms urine and is workhouse of kidneys (glomerulous and tubule) filters 1-2 L/day.... Nephron reabsorbs remaining 178 L/day
    • Antidiuretic hormone *Vasopressin* Body hold H2) when fl levels drop--releases ir when fl level rises
  36. Disorders of ADH affects:
    Urine output
  37. Diabetes insipidus=
    • ADH not produced
    • Impaired reabsoprtion in kidney-result copious dilute urine output
    • Thirst mechanism stim--drinks additional fluids--maintaining high urine output
  38. Syndrome of inappropriate ADH secretion (SIADH)
    Excess ADH released--more reabsorbed - fl col increases and urine output scant and concentrated
  39. Renin-Angiotensin-Aldosterone system (along with fl regulation)
    • Helps maintain intravascular fluid bal and bp
    • Fall in bp-- basically constricts bl vessels and increases bp and thirst--release aldosteron from adrenal cortex which retains Na+ and H2), which restores bl volume
  40. Atrial Natiruetic peptide (ANP) (Along with thirst mech)
    • released from atria--response to stretching from fl overload
    • Inhibits renin secretion--opposing renin angiotensin aldosteron system and effects of aldosteron
    • Result=promotes Na+ and H2O loss and causes bl vessesl to dilate--decreasing bp and reducing intravasculat bl volume
  41. Fl vol deficit
    • s&s
    • fatigue, tachy, weak thready p
    • Labs
    • inc serum osmolality, hematocrit, urine spec gravity
  42. fl vol excess
    • s&s
    • htn, tachy, full bounding p, inc resp rate, crackles, wheezes, dependednt edema
    • Labs
    • dec serum o, hematocrit, u spec gravity
  43. Third Spacing
    injury, inflamm which causes cap permeability allowing fl and elec and protein to leak from vessels--- ascites
  44. IVs
    lokk up pg 100!!!!
  45. Fluid Challenge
    • Lg amt of fl given rapidly over short amt of time; NS or LR (crystalloids) followed by prbcs------
    • has low bp, urine output and watch output to see therapeutic response and challange kidneys
  46. Loop diuretics
    • Ferosemide (Lasix)
    • pg 106=more
  47. Thiazide diuretics
  48. Potassium-sparing diuretics
    Spironolactone (Aldactone)
  49. Hyponatremia
    • Less than 135
    • Affects function of col and invol muscles, Headache, hyperreflexia, musc twitching
    • Monitor lithium levels (bipolar meds)
  50. Hypernatremia
    • H2O moves out of cell= cellular dehydration
    • Dehydration in brain cells= neurologic s&s confusion and dec LOC
    • Cellular dehydration= dry, sticky mucous membranes