FLUID AND ELECTROLYTE IMBALANCES Flashcards
y constantly adjusting to
internal and external stimuli.
Homeostasis
EXAMPLES OF HOMEOSTASIS IN THE BODY
Thermoregulation
● Blood glucose regulation
● Baroreflex in blood pressure
property of particles in a solution to
dissociate into ions
OSMOLARITY
Enhances or intensifies the original stimulus
POSITIVE FEEDBACK
reverses an original stimulus
for the body to regain physiologic balance.
NEGATIVE FEEDBACK
Maintains homeostasis through feedback loops. Using
nerves and neurotransmitters
Blood clotting after an injury -
what kind of feedback?
positive
Blood pressure control
-Maintenance of normal body
temperature
kind of feedback?
Negative
major cations in the body fluid are
sodium, potassium, calcium, magnesium,
and hydrogen ions
major anions are
chloride,
bicarbonate, sulfate, and proteinate ions.
intracellular fluid refers to all fluids including
cytosol as well as fluid in the cell
nucleus.
stimulates or
inhibits the desire for a person to drink
thirst center in the hypothalamus
regulates the amount of water the kidney tubules
absorb and is released in response to low blood
volume
ADH ANTIDIURETIC HORMONE
controls fluid volume, in which when
the blood volume decreases
RENIN ANGIOTENSIN ALDOSTERONE SYSTEM (RAA SYSTEM)
heart also plays a role in correcting overload
imbalances by releasing
ANP from the right atrium.
series of
interconnected brain structures that act as a central
hub to control fluid levels in the body
lamina terminalis (yellow)
fluid-filled compartments in the brain, called
ventricles (blue).
ADH known as
VASOPRESSIN
ability of a membrane to allow molecules to pass
through.
PERMEABILITY
membranes allow almost any food or waste
substance to pass through.
PERMEABILITY OF MEMBRANES FREELY PERMEABLE MEMBRANES
only certain specific
substances to pass through.
SELECTIVELY PERMEABLE
from an area of higher
concentration to an area of lower concentration.
DIFFUSION
transport of water and dissolved materials
concentration already exists in the cell.
FILTRATION
ACTIVE TRANSPORT MECHANISMS examples
Phagocytosis of bacteria by Macrophages.
● Movement of Ca?* ions out of cardiac muscle cells.
● Transportation of amino acids across the intestinal
lining in the human gut.
urine output of male, female and infant
Male void - 300 - 500ml/day
● Female void - 250 ml/day
● Infants void - 5-40 Xa day
● Preschool children are void - every 2 hrs.
are the
body’s major chemical buffers.
Sodium bicarbonate and carbonic acid a
e basic components in the body,
and the kidneys
Bicarbonate ions
change in the pH of a solution by one pH unit
means a
tenfold change in hydrogen
concentration.
causes high anion gap metabolic
acidosis and respiratory alkalosis.
Aspirin
CO2 or HCO3 normal
Uncompensated:
: Nothing is normal in abg
Partially Compensated:
pH is normal (7.4 baseline/neutral)
Compensated
values for
Sodium
Potassium
Calcium
Magnesium
Phosphate
S: 135-145 mEq/L
P: 3.5-5.0 mEq/L
C: 8.8.-10.4 mg/dL
M: 1.8-2.6 mg/dL
P: 3.4-4.5 mg/dL
SIADH means
/ SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC
HORMONE
DISORDER OF IMPAIRED WATER EXCRETION CAUSED BY THE
INABILITY TO SUPPRESS THE SECRETION OF ANTIDIURETIC HORMON
SIADH
treat hyponatremia by
stimulating free water excretion.
AVP receptor agonists.
decrease fluid volume in FVE,
Diuretics.
If serum potassium levels are
dangerously elevated, it may be necessary
IV calcium gluconate
used to lower the
serum calcium level and is particularly useful for
patients with heart disease
Calcitonin.
enhance
conservation of water by increasing the
permeability of collecting ducts to water
Avp/ Vasopressin is a vasopressin receptor
agonist
predisposing factors of FLUID VOLUME DEFICIT (FVD)
Diabetes Insipidus
● Adrenal insufficiency
● Osmotic diuresis
● Hemorrhage
● Coma
movement of fluid from
the vascular system to other body spaces f
Third-space fluid shifts o
SIGNS AND SYMPTOMS of FVD (INFANT AND YOUNG CHILDREN)
Crying without tears
● No wet diapers for three hours or more
● Being unusually sleepy or drowsy
Decreased ability to concentrate urine due to
ADH deficit or nephron resistance to ADH
Diabetes Insipidus
decreased
PLASMA VOLUME and makes the RBCs
concentrated
increase Hematocrit level
Elevated BUN indicates?
out of proportion with
creatinine Because Urea
Appearance of wakefulness, awareness of the self
and environment
ALERT (CONSCIOUS)
mild reduction in alertness
LETHARGY
moderate reduction in alertness. Increased response
time to stimuli
OBTUNDATION
aroused only by vigorous
and repetitive stimulation.
STUPOR
(Unarousable unresponsiveness,
eyes closed)
COMA (UNCONSCIOUS)
a measure of pressure in the vena cava, can
be used as an estimation of preload and right atrial
pressure.
CENTRAL VENOUS PRESSURE
NORMAL Central venous pressure?
2-5 mmHg
3 STAGES OF HYPOVOLEMIC SHOCK
Stage 1: 15% blood loss
(750 mL or about 25 ounces).
● Stage 2: 15% to 30%
(750 mL to 1,500 mL or up to almost 51 ounces)
● Stage 3: 30% to 40% of your blood
(1,500 to 2,000 mL or up to 68 oz.)
caused by
the abnormal retention of water and sodium
HYPERVOLEMIA
SIGNS & SYMPTOMS (PULMONARY)
of FVE
Pulmonary Congestion: crackles, rales
● Change in respiratory pattern
buildup of,
nitrogenous products
Azotemia
Normal urine specific gravity levels are
1.010 and 1.020
right ventricular third heart sound. It is
usually heard best where
right or left lower sternal edge, in the
epigastrium, or rarely over the jugular veins
swelling that occurs prior to
a woman’s menstrual cycle
Premenstrual edema
disorder that causes excess
excretion of protein in the urine
Nephrotic syndrome
major extracellular fluid cation.
Sodium (Na)
urine specific gravity of hypernatremia
> 1.025
SIGNS AND SYMPTOMS (TOO MUCH SALT)
Skin flushed
● Agitation
● Low grade fever
● Thirst
NURSING MANAGEMENT of hypernatremia
Monitor level of consciousness, muscular strength,
tone, & movement
very brisk, hyperactive, with
clonus
4+
3+ DTR RESPONSE
Brisker than average, slightly
hyperreflexic
2+ DTR
Average, expected response;
normal
Somewhat diminished, low
normal DTR
1+
No response, absent
0
SIGNS AND SYMPTOMS (LOSS) FOR HYPONATREMIA
Limp muscles
● Orthostatic hypotension
● Seizures
● Stomach cramping
Hypertonic 0.3% NS - slow IV infusion via central
line.
***Watch out for fluid overload!
Nursing managment for what type of hyponatremia
HYPOVOLEMIC HYPONATREMIA
Caused by SIADH antidiuretic hormone problems:
fluid restriction or treated with antidiuretic hormone
EUVOLEMIC HYPONATREMIA
Restrict fluid intake and in some cases administer
diuretics to excretion the extra water
nursing management for what type of hyponatremia
. FOR HYPERVOLEMIC HYPONATREMIA
antidiuretic hormone
antagonists called
Declomycin (don’t give with food
especially dairy or antacids
e major cation in the intracellular
fluid (ICF)
Potassium K+.
= mild hyperkalemia
5.1 mEq/L to 6.0 mEq/L
moderate hyperkalemia
6.1 mEq/L to 7.0 mEq/L =
severe hyperkalemia
● above 7 mEq/L
increased when potassium
is lost from the tissue
glycogen
synthesis
SIGNS AND SYMPTOMS for Hyperkalemia
MURDER
Muscle weakness/cramps
● Urine, oliguria, anuria
● Respiratory distress
● Decrease cardiac contractility
● EKG changes
● Reflexes ( hyper or areflexia)
Treatment for Hyperkalemia
“C BIG K DROP”
Calcium gluconate (stabilizes cardiac membrane)
● Beta-2-agonist(albuterol neb q2-4hrs), Bicarb (shift
K+ to the cell)
● Insulin
● Glucose
● Kayexalate(Na polystyrene sulfonate)- to excrete K+
out
● Drop
- DIURETICS(Furosemide) - to excrete K+
SEVERE HYPERKALEMIA IS TREATED IN 3 STEPS
CIH:
Calcium infusion
Insulin
Hemodialysis
associated with shifting of K+ into cells, K+ loss
from GI and biliary tracts, renal K+ excretion and
reduced K+ intake
HYPOKALEMIA
causes kidneys to excrete
K
CUSHING’S SYNDROME
SIGNS & SYMPTOMS (7L’S) of hypokalemia
Lethargy
● Low, shallow breathing
● Lethal cardiac arrest
● Loss of urine
● Leg cramps
● Limp muscles
● Low BP & HR
TREATMENT (STOP K+ LOSSES!)
for Hypokalemia
Discontinue diuretics, laxatives
● Don’t give LASIX
Use rather potassium-sparing diuretics /Aldactone,
T (PREVENTION AND CORRECTION OF POTASSIUM DEFICIENCY;)
● with alkalosis
use potassium chloride
PREVENTION AND CORRECTION OF POTASSIUM DEFICIENCY; acidosis
use potassium acetate,
Serum calcium is regulated by?
PTH and Calcitonin
important for neuromuscular activity &
blood coagulation
Ionized calcium
plasma calcium is bound to serum proteins -
albumin
Bound calcium
the remaining plasma is combined with
nonprotein ions: phosphate, citrate, & carbonate.
Complex calcium
SIGNS & SYMPTOMS (BACKME)
hypercalcemia
BACKME
Bone Pain
● Arrhythmias
● Cardiac Arrest
● Kidney Stones
● Muscle Weakness
● Excessive Urination
S/S of Hypercalcemia too weak
Absent reflexes, disorientated, abdominal distention
from constipation
● Kidney Stone formation
most common ECG findings
of hypercalcemia are
a short QT interval secondary
to a shortened ST segment. There may also be a
widened or flattened T wave
hypercalcemia can cause ECG changes that mimic
acute myocardial infarction.
Hypercalcemia has also been known to cause an
ECG finding mimicking hypothermia
known as an
Osborn wave ( J wave). Ventricular fibrillation and
arrest for extreme hypercalcemia.
adrenal
glands above the kidneys, produces too little
cortisol and too little aldosterone.
Adrenal insufficiency (Addison’s Disease)
decreased with Thiazide*
diuretics & renal failure, cancer of the bones
Calcium excretion
causes
phosphate to decrease and calcium to increase
Lithium usage (affects the parathyroid
COMMON MEDICATIONS AND SUPPLEMENTS THAT CAN CAUSE
HYPERCALCEMIA
Hydrochlorothiazide
Lithium.
● Excessive intake of vitamin D
treatment for hypercalcemia
Forced Diuresis
Loop DIURETICS
Glucocorticoids:
Saline administration will cause
renal elimination/ to decrease calculi formation.
Forced Diuresis
reduces intestinal absorption and
tubular reabsorption of calcium
Glucocorticoids:
refers to the total
concentration of dissolved substances in drinking
water
– TOTAL DISSOLVED SOLIDS TDS
calcium deposits in the kidney that
causes poor kidney function
Nephrocalcinosis -
COMPLICATIONS OF LONG-TERM HYPERCALCEMIA
Nephrocalcinosis -
Kidney failure.
● Kidney stones.
● High blood pressure (hypertension).
determines a reduction of calcium
due to a decrease in the fraction bound to proteins
Hypoalbuminemia
reduced response of the target tissues
to parathyroid hormone (PTH) and /
reduction in ionized calcium
SIGNS & SYMPTOMS of hypocalcemia
TCT
Tetany
● Chvostek’s sign
● Trousseau’s sign
symptom characterized by the
involuntary contraction of muscles
Tetany i
Common symptoms of tetany
umbness around the mouth, muscle
cramps, a
hallmark of acute hypocalcemia is
neuromuscular irritability
TAPPING ON THE COURSE OF FACIAL NERVE,
BETWEEN ZYGOMATIC ARCH & ANGLE OF
MANDIBLE
chvostek sign
BP CUFF WHEN INFLATED HIGHER THEN
PERSON’S SYSTOLIC BP FOR ____ minutes
2 minutes: Trousseau’s sign
SIGNS & SYMPTOMS (“CATS GO NUMB” MNEMONIC) HYPOCALCEMIA
Convulsions (seizures)
● Arrhythmias (prolonged QTc)
● Tetany
● Spasms, Stridor (laryngospasm)
● Numbness [perioral, acral (hands, feet)
might be a collapsing of the larynx
most likely caused by decalcification. I
STRIDOR
refers to a burning or prickling
sensation that is usually felt in the hands, arms,
legs, or feet, b
Paresthesia
Hypocalcemia may lead to what ecg finding also refers to complete heart block
torsades de pointes
Hypocalcemia may lead to what ecg finding also refers to complete heart block
torsades de pointes
CAUSES (POSSIBLE CAUSES) of hypocalcemia
Hyperparathyroidism
Vitamin D deficiency:
Kidney failure:
CAUSES (CERTAIN MEDICATIONS) Hypocalcemia
Pseudohypoparathyroidism:
Bisphosphonates,
Hypomagnesemia:
Pancreatitis:
CAUSES (CERTAIN MEDICATIONS) Hypocalcemia
Pseudohypoparathyroidism:
Bisphosphonates,
Hypomagnesemia:
Pancreatitis:
an inherited
disorder that causes your body to not respond
properly to the normal amount of parathyroid hormone
(PTH)
Pseudohypoparathyroidism:
abundant intracellular cation.
Mg++
MAGNESIUM
function
CONSTIPATION RELIEF
REDUCES ECLAMPTIC SEIZURES
Significant symptoms and signs are seen when serum
Mg is
s < 1.2 mg/dl (0.5 mmol/l)
Significant symptoms and signs are seen when serum
Mg exceeds
4.8 mg/dl (2 mmol/l)
relationship of DTR and Magnesium
High DTR = Low magnesium
phosphorus found in the extracellular fluid
space is in the form of
form of inorganic phosphate.
HYPOPHOSPHATEMIA
SIGNS & SYMPTOM
Anemia, bruising
● SZ, Coma
● Constipation
● Muscle weakness
● Hypoactive bowel sounds
● Mild: asymptomatic
DIAGNOSIS (LAB RESULTS) phosphate
↓ phosphate
● ↑ calcium
● ↓ vitamin D
● ↑ parathyroid hormone
causes of hypophosphatemia
Increased kidney excretion
Decreased intake, absorption through GI tract
Transcellular shift
Insulin treatment in diabetic ketoacidosis;
COMPLICATIONSHYPOPHOSPHATEMIA
Rhabdomyolysis, kidney dama
when damaged muscle tissue
releases its proteins and electrolytes into the blood.
Rhabdo
occurs when the pituitary gland
produces too much growth hormone (GH)
Acromegaly
TREATMENT hyperphospatemia
Calcium carbonate and calcium citrate
Fluid resuscitate
For acute or chronic Hyperphosphatemia: consider
forced diuresis
