F&E Flashcards
Osmolality
Osmolality are particles in a given weight of fluid
Osmolarity
are particles in a given volume of fluid
A serum osmolarity, Normal range, too high, too low?
is a method of determining if someone is overhydrated or dehydrated
- Normal range is roughly 280 to 300
- Too high indicates dehydration
- Too low indicates fluid overload
- For our purposes they will be interchangeable
Intracellular
is the fluid inside the cell
-2/3 of fluid volume
Primary electrolytes
Potassium
Phosphate
Sulfate
Extracellular
is the fluid outside the cell
1/3 of fluid volume
Primary electrolytes
Sodium
Chloride
Bicarbonate
What is the fluid called that is inside the blood vessels?
intravascular
What is the fluid called in-between the cells?
interstitial
What three components determine the fluid balance in these compartments?
- Protein– keeps fluid invascualr space (colloid oncontic pressure)
- Blood vessel integrity – keeps fluid in vascular space
- Hydrostatic pressure- pushes fluid into interstitial space
Osmotic Pressure is impacted by what?
Osmolality- Pressure exerted to prevent movement of water out of the intravascular space
Colloid Oncotic pressure- Proteins attract water and hold onto water
Hydrostatic Pressure
Arterial blood pressure (higher)
Venous pressure (lower)
Rate of blood flow
Filtration Pressure
-Process that transfers nutrients and oxygen to cells
Hydrostatic minus osmotic
-At the arterial end of the capillary the fluid is pushed into tissues
-At the venous end the fluid is brought back into circulation
Tonicity
Concentration of fluid
Isotonic
Equal concentration of water and electrolytes
Hypertonic
- Concentration of electrolytes outside cell is higher
- Concentration of water outside cell is lower
Hypertonic solution : cause cells to shrink
Hypotonic
- Concentration of electrolyte outside cell is lower
- Concentration of water outside cell is higher
Hypotonic solution cause cells to swell
Hypotonic Solutions (<250 mOsm/ L)
- 0.45% sodium chloride also known as “half normal saline”
- Used for: hypernatremia and diabetic ketoacidosis. Due to tonicity can cause hypotension
Isotonic (250 – 375 mOsm / L)
- 0.9% sodium chloride also known as “normal saline”
- Most common fluid used for hydration. Only solution used with blood product administration
- Lactated Ringers
- Used with surgery, trauma, burns. Not recommended for patients with renal problems
Hypertonic (> 375 mOsm/L)
-3% sodium chloride
Used in emergency situations for cerebral edema
Dextrose 5% in 0.45% sodium chloride or called “D5 ½ normal saline”
-used for hypovolemia with hypernatremia
D5 normal saline- used with electrolyte and fluid loss
Crystalloids
-Aqueous solution with electrolytes
Hypotonic, isotonic, and hypertonic solutions (chart from last slide)
Colloids
-Contain large molecules that do not transport outside of the intravascular space
Also called “volume expanders”
Blood products
A fluid type only administer normal saline with blood!
Functions of Colloids
- Function to increase the osmotic pressure in the intravascular space leading to fluid being pulled into the intravascular space
- Albumin, Dextran, Hetastarch
Nursing consideration of colloids
-Must be administered carefully or can cause signs of fluid volume excess (listed out on the fluid volume excess slide)
Packed RBCs
Used for blood loss
- 1 unit roughly increases hemoglobin by 1 g/dL
- Usually reserved for a hemoglobin less than 7 or 8 g/dL
Platelets
Given when there is a reduced level of platelets
Fresh, Frozen, Plasma
-Used for trauma, burns, shock, or bleeding and clotting disorders
Cryoprecipitate
Used for clients with hereditary disorders that lead to inadequate clotting
Nursing Considerations for Blood products
-Should consent be obtained before administering blood products
-Blood type and Rh factor protein are determined to match a person with the right type of donor
Type and crossmatch performed
-A consent must be obtained before administration of any blood products
Universal Donor
O neg
Universal Recipient
AB positive
Signs for Transfusion reaction
- Fever, chills
- Altered blood pressure
- Respiratory difficulty
- Signs of an allergic reaction
Dehydration
Loss of body water but electrolytes remain consistent
Fluid Volume Deficit
- Loss of both fluid and electrolytes.
- Can also include a loss of circulating blood volume and perfusion to tissues
- Hypovolemia
Fluid volume excess
-Electrolytes are same or altered
Edema
-Can relate to both deficit and excess
Dehydration Causes
- Inadequate water intake
- Increased GI losses
- Fever
- SSRIs and Benzo decrease thrist mechanism
- DKA
Dehydration lab tests
- Elevated serum osmolality
- Elevated creatinine
- Elevated BUN
- Increased urine specific gravity
- Hypernatremia: why is this one if electrolytes remain consistent?
- Electrolyte level is constant, but the amount of body fluid is reduced. The serum is more concentrated and electrolyte levels will be higher due to concentration
Fluid Volume deficit s/s
Hypotension Tachycardia Orthostatic hypotension Decreased urine output Flat neck veins Weak pulse
What is Third spacing
Too much fluid in interstitial space and not enough in the intravascular space
TX for deficit and third spacing
Replacement of fluids
Safety education: Advise patient to sit or stand slowly
For third spacing:
- Give protein IV: albumin and it comes in diff %
- Give Hypertonic solution
What causes a reduced colloid oncotic pressure?
-Reduced levels of albumin
What does Protein do
-keeps fluid in intravascular space
What happens to the fluid when there is a reduced colloid oncontic pressure?
Fluid leaves the intravascular space and into interstitial space
-edema occurs
Mechanism of edema: increased hydrostatic pressure causes
- elevated BP
- Fluid overload
- decreased cardiac output
Causes of decreased oncotic pressure
Malnutrition, Liver failure, Nephrosis
Causes of blocked or removal of lymph nodes
Mastectomy and Lymphoma
causes of increased capillary permeability
allergies, septic shock, pulm edema
How can someone have a fluid volume deficit if they have too much fluid somewhere?
- ECF and ICF need a certain level of fluid to function
- Tx can just be moving fluid from one area to another within a compartment rather than giving more fluid overall
Causes of Excess Fluid Volume
- HF, Renal Failure, Cirrhosis, Excess IV fluid, Medications that cause sodium and water retention
S/s of Fluid volume excess
Weight gain of more than 0.5 kg a day Hypertension Bounding pulse Distended neck veins AKA jugular venous distention Dyspnea Crackles Orthopnea
Treatment for Fluid Volume Excess
- Diuretics: Furesomide, Spirnoalctone, butanamide, hydrochlorothiazide
- Fluid restriction on patinets door
Funcitons of Electrolytes
Maintaining balance of water in the body
Balancing the blood pH
Moving nutrients into the cells
Moving wastes out of the cells
Maintaining proper function of the body’s muscles, heart, nerves, and brain
Potassium range and fxn
range: 3.5-5.0
Fxn: Cardiac, neuro, and muscular fxn controlled by aldosterone and insulin
Sodium range and fxn
range: 135-145
Fxn: Reflection of body’s water balance
-supports neuro and muscular fxn
- Blood Pressure regualtion
Calcium range and fxn
range: 8.9-10.5 serum
ionized: 4.5-5.6
F: Synaptic transmission, wound healing, muscle contractility, teeth and bone structure.
- Controlled by PTH hormone
Calcium as an inverse relationship with?
Phosphorus
Magnesium range and Fxn
- 8-2.3 mg/ dL
- 3- 2.1 mEq/L
- NM and Cardiac activity
Hypokalemia Causes
Diuretics Metabolic alkalosis Folic acid deficiency Gastrointestinal losses Decreased intake of potassium Chronic kidney disease
Hypokalemia S/s (LOW and SLOW)
Mild: cardiac arrthymias, constipation, fatigue
Severe: Respiratory paralysis, paralytic ileus, tetany, hypotension, rhabdomyolysis, life threatening arrythmias
Hypokalemia Tx
-Potassium supplementation, potassium sparing diuretics, making dietary changes, IV potassium
Do you push Potassum IV?
-NEVER! Give it slowly can cause burning in patients
Hyperkalemia Causes
- Acute renal failure
- Dehydration
- diabetes
- Burns
- Acidosis
- Blood Transfusion
- CPR
Hyperkalemia S/s (Tight and Contracted)
Mild: N/v, muscle aches, weakness, dysarrthymias
Severe: Paralysis, HF, Death
Hyperkalemia TX:
- Hemodialysis for acute renal failure
- Calcium Gluconate or calcium chloride for heart
- loop diuretics if renal failure is not present
- Sodium polysstyrene sulfonate: binds to K and excretes it
- Intravenous insulin: Insulin helps to push K into cell but glucose needs to be monitored
Hyponatremia Causes
Severe vomiting or diarrhea Drinking excess water Excess alcohol intake Thiazide diuretics Liver or Heart disease
Hyponatremia S/S Depressed/ Deflated
Mild
Nausea, feeling unwell
Severe
Cerebral edema, lethargy, confusion, irritability, seizure, coma
Hyponatremia Tx
- Raise sodium levels slowly
- If hyponatremia was caused due to excess fluid use a fluid restriction
-Cause is due to thiazide diuretics:
Isotonic IV fluids
-Hypertonic is only used in cerebral edema
-
Hypernatremia Cause
Dehydration and things that cause a state of dehydration Vomiting Chronic kidney disease Diabetes Impaired thirst response Consumption of high sodium items
Hypernatremia S/s: Big and Bloated
Similar to hyponatremia
Hypernatremia Tx
- Restore fluid status
- Give isotonic fluids
- IF BP is low or in shock give hypotonic
- -Water is not used for treatment
- Educate clients on dietary measures to reduce sodium
Hypocalcemia Cause
Inadequate vitamin D Decreased estrogen production Hypoparathyroidism Renal disease Low albumin levels Stimulant laxatives Chronic steroid use Proton pump inhibitors
S/s of hypocalcemia (spastic)
Chest pain Dysrhythmias Renal calculi Numbness and tingling Muscle cramping Confusion Osteopenia Dental problems
What 2 signs can you see with hypocalcemia
- Chvosteks and Trousseau sign
Ionized Calcium
- Serum calcium accounts for all calcium, whether it is in the free ionized form or if it is bound to proteins.
- it can detect unbound and active which leads it to be the most accurate
- Serum is used more commonly though
- Ionized is performed if signs/symptoms or abnormal serum levels of calcium suggest a calcium issue
Hypocalcium TX
Calcium and vitamin D supplementation
Increased dietary intake
Calcium injections
Hypercalcemia Cause
Cancer
Hyperparathyroidism
Vitamin D toxicity
What over the counter medication for heartburn contains calcium carbonate?
Tums, too much can contribute to hypercalcemia
Hypercalcemia s/s (slow and swollen)
Mild symptoms Constipation Abdominal pain Nausea Vomiting
Severe symptoms Confusion Renal failure Arrhythmias Coma Death
Hypercalcemia TX
- IV Phosphate bolus
- loop diuretic
- hemodialysis in severe cases
Hypomagnesium cause
Crohn’s disease or celiac disease Diarrhea or pancreatitis Type 2 diabetes In the presence of hypokalemia and hypocalcemia Decreased intake Increased renal excretion
S/s of hypomagnesium (Buck Wild)
Mild symptoms
Decreased appetite, fatigue, nausea, weakness
Severe
Muscle cramps, numbness and tingling, seizures, tetany, and personality changes
Hypomagnesium Tx
Oral or intravenous magnesium
Educate clients on foods high in magnesium
What might have to be treated first before magnesium can be given?
Restore calcium or potassium balance
Hypermagnesium Cause
Kidney disease
Acidosis
Hypothyroidism
Trauma
Medications that increase dwell time of food in the intestines (opioids or anticholinergics)
Laxatives or antacids that contain magnesium
Hypermagnesium S/s (Calm and quiet)
-Mild symptoms
Dizziness, nausea, weakness, confusion
-Severe symptoms
Confusion, blurred vision, headache, bladder paralysis, bradycardia, reduced respiratory rate, loss of deep tendon reflexes, death
Hypermagnesium TX
- Calcium chloride and gluconate for cardiac issues
- IV saline w/ diuretics
- Severe: Hemodialysis
Sources of Sodium
-Sodium chloride, MSG, soy sauce
Sources of potassium
-Fruits ( bananas), veggies (avocado), orange juice, tomato juice
Calcium sources
-Dairy and green dark veggies and salmon, oysters
Magnesium sources
-Nuts and peanut butter, egg yolk, milk
Phosphorus sources
Dairy, meat, fish, bran and wheat cereals
