Chapter 29 - Fluid, Electrolytes, Flashcards
includes cerebrospinal, synovial, peritoneal, pleural, and pericardial fluids
transcellular
movement across cell membranes
osmosis
sodium normal levels (Na)
135-145
Potassium (K) normal levels
3.5-5.0
O+ antigen present
Rh
O- antigens present
none
A+antigens present
A. Rh
A- antigens present
A
B+ antigens present
B, Rh
B- antigens present
B
AB+ antigens
A, B, Rh
AB- antigens
A, B
two blood types most likely to cause a transfusion reaction
ABO and Rh groups of antigents
universal donors
O
universal recipients
AB
moves into the cell by pump. Serum levels regulated by the kidneys though reabsorption or excretion
Potassium
moves OUT of cell by pump. Regulated by secretion of aldosterone and ANP
sodium
when is whole blood used
massive hemmorrhage
dehydration percentages
2% mild
5% moderate
8% severe
15%life threatening
fluid volume excess
2% gain is mild
5% gain is moderate
8% gain is severe excess
occurs when the sodium level is decreased in relation to body water
hyponatremia
occurs when the serum sodium levels is greater than 145 mEq/L
hypernatremia
what are the four primary causes of edema
hydrostatic pressure due to fluid overload, decreased production of circulating plasma proteins, obstruction of lymphatic drainage, increased capillary permeability due to tissue damage
also known as third spacing, develops when fluid moves into a tissue at a faster rate than it can be reabsorbed into the intravascular spaace
edema
pressure exerted by a fluid within a compartment, such as blood within the vessels. moves fluid from an area of greater pressure to an area of lesser pressure
hydrostatic pressure
continual intermingling of molecules with movement of molecules from a solution of higher concentration to a solution of lower concentration
diffusion
what is true about the ration of patients fluid intake to output
intake should be slightly more than output
what BEST reflects fluid and electrolyte imbalance in older adults
serum lab values. I/O only reflects FLUID
remove and intravenous catheter by withdrawing it along
the same path of its insertion to minimize injury
not enough sodium
hyponatremia
too much sodium
hypernatremia
not enough potassium
hypokalemia
too much potassium
hyperkalemia
clinical manifestations of ?
lethargy, confusion, weakness, muscle cramping, seizures, anorexia, nausea, vomiting,
hyponatremia
clinical manifestions of?
thirst, dry sticky mucous membranes, weakness, elevated temp, severe causes confusion and irritability, decreased levels of consciousness, hallucinations and convulsions
hypernatremia
clinical manifestations of?
weak, irregular pulse, fatigue, lethargy, anorexia, nausea, vomiting, muscle weakness and cramping, decreased peristalsis, hypoactive bowel sounds, cardia dysrhythmias, increased risk of digitalis toxicity
hypokalemia
clinical manifestions of?
anxiety, irritability, confusion, dysrhythmias, including bradycardia and heart block, muscle weakness, flaccid paralysis, paresthesia, abdominal cramping
hyperkalemia
with excess fluid volume the amount of circulating blood volume increase resulting in
full bounding peripheral pulses, heart rate increase
normal levels of sodium
135-145
Normal levels of potassium
3.5-5
normal levels calcium
8.5-10.5
normal levels of magnesium
1.3-2.1
_________ focus is CNS. Seizures. Excessive fluid (hypervolemia), intestinal fluid loss, redundant diaphoresis (sweat), excessive diuretic, solutions such as hypotonic
hyponatremia. normal values is 135-145
what happens with low serum albumin
fluid seeps into interstitial spaces (edema), weight gain, pulmonary congestion, weak and thready pulse, tachycardia,
rapid onset:. hypertonic, excessive sweating,. Slow onset: CHF, renal failure,
hypernatremia
when do you never administer a potassium IV bolus
hypokalemia
anorexia, regular enemas, diuretics, ileostomy, alcoholism causes
hypokalemia
deep tendon reflex, leg cramps, GI hypoactive
hypokalemia
Cardiac arrest, GI hyperactive, muscle weakness
hyperkalemia
confusion, muscle cramps that progress to convulsions, cardiac dysrhythmias, positive Ckvostek and Trousseau signs
hypocalcemia
lethargy, decreased muscle strength and tone, constipation, dysrhythmias
hypercalcemia
irritable nerves and muscles, seizures, altered LOC, hallucinations
hypomagnesemia
warm flushed appearance, vomiting, lethargy, slow, shallow respirations, dysrhythmias
hypermagnesemia
pH
7.35-7.45
PaCO2
35-45 mm Hg
HCO3
22-26
PaO2
80-100
O2
95-100
2% loss of volume
mild dehydration
5% loss of volume
moderate dehydration
8% loss of volume
severe dehydration
15% loss of volume
life threatening, death
0.33% NS, and 0.45% NS
hypotonic IV
D5W, o.9% NS, D5 0.2% NS, Lactated ringer
isotonic IV
D5 0.45% NS, D5 0.9% NS, D5 LR, 3% NS
hypertonic IV
IV provides sodium, choloride, and free water. allows kidneys to select amount of electrolyte to rain or excrete
hypotonic. 0.33% NS
considered isotonic but becomes free water after dextrose is metabolized, then acts as hypotonic solution. Because it does not contain sodium, continued use can lead to hyponatremia. Useful in IV medication administration
D5W
commonly used to reestablish normal extracellular fluid levels in patients with hypovolemia. Not used as a maintenance fluid, continued use can lead to hypernatremia
0.9% NS
most commonly resembles blood plasma. contains sodium, potassium, calcium, chloride, and lactate. Used where there is a loss of fluid and electrolytes, as in burns or severe diarrhea
lactated ringer
prolong use of NS leads to
hypernatremia
prolong use of D5W primary infusion leads to
water intoxication
for blood transfusions use what type of IV
Y type
before beginning IV infusion
gather supplies, check solution, 18-20 gauge
never piggyback meds into
blood transfusion
