Body Fluids Flashcards
Body fluids compartments
Intracellular- inside cell
Interstitial- fluid outside cell
Intravascular- fluid within the blood vessel
Extracellular- Fluid outside the cell
Transcellular- synovial fluids, pleural fluid in chest, digestive juice in stomach, special areas
Intracellular major cations
Positive
- potassium, magnesium
- major anion: phosphate
Extracellular major cation
Positive
- cations- sodium
- anions (negative)- chloride, bicarbonate
Diffusion
Moves- molecules
From area of- high concentration
To area of- low concentration
Active transport
Moves- molecules
From area of- low concentration
To area of- high concentration
Osmosis
Moves- water
From area of- low concentration
To area of- high concentration
Filtration
Moves- water/small particles
From area of- high pressure
To area of- low pressure
Hypovolemia
- deficient fluid volume
- dehydration is decreased fluid, water in extracellular, intracellular, intravascular
- causes: blood loss, diarrhea, sweating, increase urinary output, not eating or drinking enough
- Labs: BUN goes up if dried out, HCT, specific gravity
- just remember: less fluid ratio of particles, go up
- What will you see:
- thirsty- 1st signal
- weakness
- tired/fatigue
- headaches
- heart rate goes up
- confused
- constipated
- concentrated urine
- dry skin, skin will be warm
- not as much water in body causes heart rate to go up and to begin with their blood pressure will go up but then eventually blood pressure will lower due to not enough fluid
- decrease urinary output
Hypervolemia
- too much excess fluid
- increase fluid and sodium in extracellular fluid
- causes: kidney failure, CHF, overload on IV fluids, swell if there is increase NA
- what will I see?
- increased BP
- crackles/ shortness of breath
- increase respiratory rate, shallow
- assessment findings: distended neck veins(JVD), they are swole up so edema
- dilute urine, high urine output
- weight increase, measure their weight everyday
- LABS: BUN, HCT, specific gravity: decrease
- fluid in lungs/edema- crackles, low respiratory rate
Isotonic
- main one
- goes into vascular space and stays there
- stays where I put it
- uses: hypotension, hypovolemia, fluid resuscitation( replacing fluids)
- examples: Normal saline 0.9%- half normal saline .45%, Lactated ringers
Hypotonic
- goes into vascular space and then shifts out into the cells to replace cellular fluid- shift out and go into cells
-uses: diabetic ketoacidosis, hypernatremia( too much sodium)
Examples: D5W(sugar water), 1/2 normal saline, 0.33% normal saline, 0.2% normal saline - do not give for burns or traumas, we don’t want to much fluid to come out
Hypertonic
- volume expander that pulls fluid and electrolytes from interstitial and intercellular spaces and puts in vascular space
Uses: stabilize blood pressure, increase urinary output, decrease edema( not sitting in the tissues anymore-excess water)
Examples: D5NS, D5 1/2 normal saline, D5LR- dextrose in LR, D10W, D20W- dextrose in water- sugar in it
Fluid balances/ lab values
MG- 1.3- 2.1
K- 3.5-5.0
Ca- 8.5-10.0
Na-135-145
CL- 95-105
Hypernatremia
High sodium in blood- 135-145
- first think: water/fluid, brain/ nervous
- too much sodium not enough water
- causes: excessive sodium intake, water loss through sweating, heat stroke, water deprivation, administration of hypertonic tube feeding
- signs and symptoms: thirst, elevated temp, dry mouth, if it’s serious irritability, seizures, lethargy occur
- treatments: monitor sodium level, restrict sodium in the diet, increase water intake, administer IV solutions that do not contain sodium
Hyponatremia
- range 135-145
- too much water not enough sodium
- causes: diuretics, GI fluid loss, adrenal insufficiency, excessive intake of hypotonic solutions, such as water or D5W IV fluids, syndrome of inappropriate ADH
- signs and symptoms: weakness, confusion, muscle cramps or twitching, seizures, nausea, and vomiting
- treatments: monitor sodium level, increase oral sodium intake, administer IV saline infusion and take seizure precautions
Hyperkalemia
Range- 3.2- 5.0
- excreted by kidneys. If kidneys don’t work, potassium increases
- never give IV push with potassium
- first think: heart/cardiac
Causes: renal failure, excessive potassium intake, potassium sparing diuretics, major trauma, hypoaldosteronism( shortage of aldosterone)
- signs and symptoms: muscle weakness, dysrhythmias, flaccid paralysis( loose limbs), intestinal colic, tall T waves on ECG
- treatment: monitor potassium level, caution about potassium rich intake in patients with elevated creatinine levels
Hypokalemia
Low potassium
Range: 3.5-5.0
-Causes- diuretics, GI fluid loss through vomiting, diarrhea, gastric suction, steroid administration, hyperaldosteronism( make too much aldosterone) , anorexia or bulimia
-Signs and symptoms: fatigue, anorexia, vomiting, muscle weakness, decrease GI motility, dysrhythmias, flat T wave on ECG
- treatments: intake of potassium rich foods, administer potassium supplements, if client is taking digoxin, monitor pulse and observe for toxicity
Hypercalcemia
High levels of calcium- vitamin D
Range- 8.5-10.0
- first think- muscles
- causes: hyperparathyroidism( remember thyroid is tied in with this, overproduction of hormones resulting in high levels of calcium), malignant bone disease, prolonged immobilization, excess calcium supplementation, thiazide diuretics
-Signs and symptoms: muscle weakness, constipation, nausea, polyuria, kidney stones, bradycardia
- treatment: encourage fluid intake to prevent stone formation, encourage fiber to prevent constipation, eliminate calcium supplements, renal dialysis may be required
Hypocalcemia
Range- 8.5-10.0
Low calcium
- causes: hypoparathyroidism, malabsorption, pancreatitis, vitamin D deficiency
- signs and symptoms: diarrhea, numbness and tingling, muscles cramps, cardiac irritability, positive trousseaus ( spasm caused by inflating the blood pressure cuff to a level above systolic pressure for 3 minutes), Chvosteks (the twitching of the facial muscles in responses to tapping over the area of the facial nerve)
- treatment: calcium intake, administer calcium supplements, monitor input and outtake,
Hypermagnesemia
Range- 1.3-2.1
- first think- muscles
- causes: renal failure, adrenal insufficiency, excess replacement
- signs and symptoms: flushing and warmth of skin, hypotension, bradycardia, drowsiness, hypoactive reflexes, depressed respirations
- treatment: monitor vital signs, monitor reflexes, avoid magnesium based antacids and laxatives, restrict intake of foods rich in magnesium
Hypomagnesemia
Range- 1.3-2.1
- first think- muscles
- causes: chronic alcoholism, malabsorption, diabetic ketoacidosis, prolonged gastric suction
- signs and symptoms: neuromuscular irritability, disorientation, mood changes, dysrhythmias, increase sensitivity to digitalis
- treatment: monitor I & O, encourage foods high I’m magnesium, avoid alcohol intake
Lab values
Increase sodium= decrease potassium Increased calcium= decreased phosphate Increased calcium= increased vitamin D Decrease Mg= decreased calcium Decrease Mg= decrease potassium Decrease Mg= increase phosphate
Blood transfusions
- assess: vital signs, lung sounds, start off slow on rate and first hour documenting every 15 min and can not delegate 1st 15 min RN stays in room
- AB- can give to: AB- can receive from: AB,A,B,O
- A- can give to: A,AB- can receive from A,O
- B- can give to: B, AB- can receive from B,O
- O- can give to: AB,A,B,O- can receive from O
Blood transfusions
Whenever there is a reaction present STOP. Unless it is the circulatory overload then you my slow down rather then STOP
- allergic: allergy to blood being transfused
- S/S: itchy, wheezing, rash, look red/flushed, if really bad might have anaphylaxis - bacterial: contamination of the blood
- S/S: fever, chills, vomiting, diarrhea, blood pressure will go up - febrile: temp elevation due to sensitivity of WBCs, plasma proteins, or platelets
- S/S: fever, chills, feel warm, flushed skin, achy - hemolytic: destruction of RBCs incompatible blood
- S/S: fever, chills, dyspnea(shortness of breath), cheat pain, blood pressure decrease, heart rate increase - circulatory overload: administering too much or too fast- back down on rate instead of stopping completely
- S/S: crackles in lung sounds, JVD, coughing, increase blood pressure
Hematoma
A localized mass of blood outside the blood vessel
Infiltration
The seepage of nonresident solution or medication into surrounding tissues
Extravasation
Seepage of a vesicant substance into the tissue( a vesicant is a solution that causes the formation of blisters and subsequent tissue sloughing and necrosis)
Phlebitis
Inflammation of the vein
Thrombophlebitis
Thrombosis and inflammation
Local infection
Microbial contamination of the cannula or IV site
Nerve injury
A nerves is inadvertely injured during ventipuncture (direct) or is compressed
Septicemia
The presence of microorganisms or their toxic product is in the circulatory system
Fluid overload
Infusing excessive amounts of IV fluids or administering fluid too rapidly
Air embolus
A rare complication involving the introduction of air into the vascular system
Catheter embolus
A piece of catheter breaks off and travels through the vascular system
