chapter 40 - fluid and electrolytes Flashcards
what are the functions of water in the body?
medium for transport needed for cellular metabolism solvent for electrolytes maintains body temperature aids in digestion and elimination acts as a lubricant
what makes up what percent of adult body weight?
55-60%
what is the average output per hour to maintain renal function?
30-60mL/hr
What is the hypothalamus responsible for?
thirst receptors
monitors serum osolarity
what does the pituitary regulate?
releases ADH in response to increasing serum osmolarity
intracellular fluid
the fluid inside the cell
2/3 of the body’s water is in the ICF
extracellular fluid & types
fluid on the outside of the cell
1/3 of the body’s water
the body is more prone to loss of this fluid
how does the body gain water
ingestion of liquids and foods (2300 mL/day)
during cellular respiration and dehydration synthesis (200mL/day)
how does the body lose water
through the: kidneys (1500mL/day) evaporation from the skin (600 mL/day) the exhalation from the lungs (300mL/day) feces (100mL/day)
interstitial fluid
the fluid around/between cells
lymph
intravascular fluid
The fluid in the blood vessels (plasma)
transcellular fluid
CSF, synovial fluid, pleural fluid, cardiac fluid, etc
osmosis
water (solvent) passes from an area of lesser solute concentration and more water to an area of greater solute and less water concentration
osmolarity
the concentration of particle in a solution
isotonic
remains in the intravascular space without any net flow across the semipermeable membrane
isotonic = same osmolarity as plasma
Hypotonic
moves out of the intravascular space into the ICF, causing cells to swell and possibly lyse
less osmolarity than plasma
Hypertonic
water moves out of the cells and in drawn into the intravascular compartment, causing cells to shrink
has greater osmolarity through plasma
name hypertonic fluids
5% dextrose in Lactated Ringer’s
5% dextrose in 0.9% NaCl
name isotonic fluids
0.9% NaCl (normal saline)
Lactated Ringer’s solution
name Hypotonic solutions
- 33% NaCl (1/3 strength normal saline)
0. 45% NaCl (1/2 strength normal saline)
Diffusion
solutes move freely throughout a solvent. Moves from an area of higher concentration to an area of low concentration
ex. O2 and CO2
active transport
the process that requires energy for the movement of substances through a cell membrane, against the concentration gradient from an area of lesser solute to a higher area of solute
*uses ATP
Filtration
the passage of fluid through a permeable membrane from an area of high pressure to low pressure
Fluid Volume Deficit
Loss of water and electrolytes from ECF
causes of fluid volume deficit
increased output hemorrhage vomiting diarrhea burns or thirs spacing
what is third spacing
a distributional shift of body fluids into the transcellular compartment
Dehydration
the loss of or deprivation of water from the body or tissues
Hypovolemia
fluid loss. can also be termed dehydration
Causes of Hypovolemia
loss of fluid from anywhere hemorrhage Trauma Vomiting/diarrhea Third spacing: burns & ascites Polyuria: Diabetes, Diuretics
signs and symptoms of hypovolemia
flat neck veins increased HR increased R increased Urine Specific Gravity low BP low cardiovascular pressure decreased weight decreased skin turgor decreased urine output dry muscous membranes increased Hematocrit increased sodium increased BUN *thirst
treatment/considerations for Hypovolemia
fluid replacement (PO or IV)
monitor for fluid overload
risk for falls due to orthostatic hypertension
daily I&O and weights
Hypervolemia
fluid volume overload (over hydration)
causes of Hypervolemia
Heart Failure
kidney dysfunction
cirrhosis
increased sodium intake
Signs and Symptoms of Hypervolemia
distended neck veins increased HR increased BP increased weight increased cardio vascular pressure *edema polyuria decreased urine specific gravity decreased hematocrit decreased sodium decreased BUN
treatment/considerations for Hypervolemia
low sodium diets
daily I&O and weight
Diuretics
high fowlers/semi fowlers position for ease of breathing
Sodium
controls and regulate the volume of body fluids
normal: 135-145 mEq/L
major cation
regulated by the kidneys/hormones
needed for nerve impulses and muscle fiber transmission
Hypernatremia signs and symptoms
hint: fried salt
sodium >145 mEq/L flushed skin restlessness, anxious, confused, irritable increased BP & fluid retention Edema (pitting) Decreased Urine output Skin flushed & dry Agitation Low grade fever Thirst (dry mucous membranes)
risk factors of hypernatremia
increased sodium intake via ingestion, IV administration
loss of fluids: diarrhea, diabetes insipidus, excessive diaphoresis, infection
decreased sodium excretion: kidney problems
treatment of Hypernatremia
administer IV fluids
give diuretic to promote sodium loss
restrict sodium and fluid intake as perscribed
Hyponatremia signs & symptoms
hint: Salt loss
sodium < 135 mEq/L Stupor/coma Anorexia (N/V) Lethargy (weakness/fatigue) Tachycardia (thready pulse) Limp muscles (muscle weakness) Orthostatic hypotension Seizures/headaches Stomach cramping (hyperactive bowels)
Risk factors for hyponatremia
hint: 4 D’s
increased sodium excretion: Diaphoresis Diarrhea & vomiting Drains (NGT suction) Diuretics SIADH adrenal insufficient inadequate sodium intake kidney disease heart failure
treatment of Hyponatremia
hint: add salt
Administer IV sodium chloride infusions for hypovolemia
Diuretics
Daily weights
Safety - risk for falls (othrostatic hypertension)
Airway protections (NPO) increased risk of aspiration
Limit water intake
Teach about foods high in sodium
Potassium (K)
main electrolyte of ICF normal: 3.5- 5 mEq/L major mineral in all cellular fluids aids in muscle contraction, nerve impulse conduction, regulates enzyme activity, regulate IC water content regulated by: kidneys/hormones inversely proportional to Sodium
Hyperkalemia signs and symptoms
hint: murder
serum > 5 mEq/L Muscle cramps and weakness Urine abnormalities Respiratory distress Decreased cardiac contractility (low HR low BP) ECG changes Reflexes (high DTR)
risk factors of Hyperkalemia
Medications (ACE inhibitors, NSAIDs Potassium sparing diuretics) excessive potassium intake Kidney disease or those on dialysis Adrenal insufficiency tissure damage acidosis hyperuricemia Hypercatabolism
Hyperkalemia management and treatment
Monitor ECG Discontinue IV and PO potassium Initiate a potassium restricted diet prepare PT for dialysis avoid use of salt substitutes or other potassium containing substances
Hypokalemia signs and symptoms
serum < 3.5 mEq/L thready weak and irregular pulse orthostatic hypertension shallow respirations anxiety, lethargy, confusion, coma Parethesias Hyporflexia Hypoactive bowel sounds (constipation) N/V - abdominal distension ECG changes
Hypokalemia Risk Factors
actual total body potassium loss
inadequate potassium intake (NPO/fasting)
movement of potassium from the extracellular fluid to the intracellular fluid (alkalosis)
Dilution of serum potassium
Hypokalemia Management and treatment
oral potassium supplements
liquid potassium chloride
potassium retaining diuretic
NEVER ADMINISTER BY IV PUSH
