Electrolyte and fluid balance - things in red Flashcards
Factors that affect total body water?
Age - newborn is 80% TBW
Gender - Women 50%; men 60%
Body fat - Fat tissue essentially water free
A typical adult needs approximately how many mL per day of water?
Therefore, how many 8 oz glasses of fluid intake would a 158.5lb adult need?
30-40 mL/day*kg
- 5lb / 2.2 = 72.045kg
- 045kg * 30 mL/kg*day = 2161.36 mL/day
2161 mL/day * 1oz/30mL = 72.045 oz
72.045oz * 1glass/8oz = 9 glasses
Sodium normal range?
135-145 mmol/L
Potassium normal serum range?
3.5-5.0 mmol/L
Calcium normal serum range?
2.2-2.58 mmol/L
Chloride normal serum range?
95-105 mmol/L
Phosphate normal range?
0.97-1.45 mmol/L
When measuring fluid input, what are examples of foods that become liquid at room temp?
Jello, Popsicles, ice cream, yogurt
What is the minimum urinary output?
30 mL/hr or 0.5 mL/hrkg ()
What should the minimum urinary output be for a 150lb adult?
150lb / 2.2 lb/kg = 68.18 = 68.2kg
68.2kg * 0.5 mL/kg*hr = 34.1 mL = 34 mL/hr
What are the normal hematocrit levels for males and females?
Males - 0.37-0.49
Females - 0.36-0.46
What is the normal serum osmolality value?
280-300 mmol/kg
What is the normal urine osmolality value?
500-800 mmol/kg
What is the normal urine specific gravity?
1.01-1.025
When taking ABGs, it is important to do this?
Apply pressure at the puncture site for 5 mins
What are the six measurements of ABGs?
pH PaO2 (arterial blood) PaCO2 (arterial plasma) Bicarb (HCO3-) Base excess - BE SaO2 (oxygen saturation)
What are the normal ABG values?
pH = 7.35-7.45 PaCO2 = 35-45 bicarb = 22-26
What is the normal PaO2 at RA in adults under the age of 60?
80-100
When the blood pH is acidic, how does the respiratory system conpensate?
Respiratory rate increases
If bicarb caused the acidosis or alkalosis, it is ________
If CO2 caused the acidosis or alkalosis, it is _______
if carbon dioxide and bicarb caused the acidosis or alkalosis, it is _________
metabolic
respiratory
combined
Differentiated between uncompensated, partially compensated, fully compensated, and corrected
Uncompensated - abnormal pH and change in one blood parameter
Partially compensated - all 3 values are off
Fully compensated - pH normal, bicarb and CO2 off
Corrected - all three normal
Respiratory acidosis values?
pH < 7.35; PaCO2 > 45
Respiratory alkalosis values?
pH > 7.45; PaCO2 < 35
Metabolic acidosis values?
pH < 7.35; bicarb < 22
Metabolic alkalosis values?
pH > 7.45; bicarb > 26
ABG results:
pH: 7.26
PaCO2: 42
HCO3-: 17
acidosis
metabolic
uncompensated
ABG results:
pH: 7.49
PCO2: 30
HCO3-: 23
alkalosis
respiratory
uncompensated
ABG results
pH: 7.26
PCO2: 52
HCO3-: 34
acidosis
combined
partially compensated
ABG results:
pH: 7.45
PCO2: 51
HCO3-: 29
combined, fully compensated
Urine pH
- in metabolic acidosis, urine pH _______
in metabolic alkalosis, the pH _______
decreases
increases
Hypovolemic shock
What is the difference between absolute and relative fluid loss? Gives examples of each.
Absolute - fluid volume loss - i.e. outside of the body
- e.g. external hemorrhage; gross dehydration (vomiting), diabetes insipidus
Relative - fluid volume shift
- internal hemorrhage
- increased vascular permeability - e.g. sepsis
What is always a part of the treatment for hypovolemic shock?
Support breathing - OXYGEN ALWAYS (may require mechanical ventilation)
What is a late sign of neurogenic shock?
Decreased tissue perfusion leading to decreased cap refill, pallor, cold (LATE)
What are the important preventive treatments for anaphylactic shock?
Ensure that allergies are PROPERLY DOCUMENTED IN THE CHART - KNOW THEM
What are the most important drug treatments for anaphylaxis?
Epinephrine
Dimenhydramine
Bacteremia/fungemia/viremia/parasitemia - presence of viable bacteria/fungi/virus/parasites in the ______.
blood
Sepsis = _____ + _____
SIRS + infection
a general inflammation in organs remote from the initial insult.
SIRS - systemic inflammatory respones syndrome
severe sepsis + acute circulatory failure (Severe hypotension unexplained by other causes)
septic shock
Sanchia Bulgin case:
What went wrong? What type of shock?
How could this have been prevented?
Nurse didn’t report the low blood pressure to the charge nurse or physician
Most likely hypovolemic shock - relative type - internal hemorrhage was the culprit
- decrease in BP, tachycardia and tachypnea (Sympathetic compensation are consistent)
- anxiety and agitation are also consistent
Prevention:
- stop the blood loss - may include trip to OR
- restore circulating volume - IV fluids, blood
- OXYGEN
- support BP
Which of the following would you include in the nursing management of hypovolemic shock?
A -Client/family teaching re: blood product safety
B - Establish a large bore IV
C - Monitor fluid status
D - All of the above
A - blood transfusion often a treatment - will need to teach
B - large bolus of fluids is often necessary
C - mainstay of treatment
D - CORRECT ANSWER as a result
Which of the following are common sources of nosocomial infections? A - Bloodstream B - Lungs C - Urinary tract D - All the above
All of these contains bodily fluids and can thus cause hospital acquired infections
D is correct
Which of the following can increase the client’s risk of developing sepsis? Select all that apply. A - Prednisone (steroids) B - MRSA C - Myocardial infarction D - Total parenteral nutrition
A - corticosteroids reduce inflammation and immune system
D - direct entry to bloodstream
A, D
