Fluid and Electrolytes Flashcards
what are isotonic fluids
same concentration as plasma
cause no fluid shifts
osmotic pressure is the same in and out of cells
cells do not shrink or swell with movement
intravascular dehydration
stays in intravascular compartment
expands intravascular compartment
what is hypotonic fluids
has less concentration of particles than plama
water moves out of intravascular compartment into the cells (osmotic pressure)
RBC swell
cellular dehydration
what is hypertonic solutions
greater concentration than plasma
osmotic pressure shifts fluid from the cells
RBC shrink
intravascular dehydration
what does fluid balance consist of
fluid intake and absorption
fluid distribution
fluid output
examples of fluid intake
drinking
eating foods
thirst and habit
movement of fluid among its various compartments equal
fluid distribution
what regulates fluid intake
thirst- 2300ml/day
what are hormonal influences for fluid intake
antidiuretic hormone
renin-angiotensin-aldosterone mechanism
atrial natiuretic peptides
what is insensible loss
water loss through the skin and lungs, which is not measurable
what is sensible loss
water loss through feces, urine, wound drainage, which is measurable
where do fluid output happen
kidney, skin, lungs and GI tract
abnormal fluid output
vomiting, wound draining, hemorrhage
fluid output influenced by
antidiuretic hormone
renin-angiotensin-aldosteron system
atrial natriuretic peptides
what is adrenal cortical regulation
hormones released by the adrenal cortex help regulate both water and electrolyte
what is renal regulation
kidney regulate water balance through adjustment in water volume
the hypothalmic are
thirst receptors
what is pituitary regulation
posterior pituitary release ADH which regulates water retention by kidneys
what are the functions of electrolytes
regulate water distribution muscle contraction nerve impulse transmission blood clotting regulate enzyme reactions regulate acid-base balance
what are electrolytes
most enter body from ingested food
substances that when in solution separate into electronically charged particles called ions
can be negatively charged anions
can be positively charged cations
cations include
sodium
potassium
calcium
magnesium
anions
chloride
bicarbonate
phosphorus
sodium
major catio abundant in ecf control water balance condution of nerve impulses 135-145 mEq/L
hyponatremia
less than 135mEq/L
results from excess water or loss of Na
signs and symptoms of hyponatremia
muscle weakness vomiting lethargy confusion seizures
treatments of hyponatremia
foods high in Na
diuretics
0.9Z%NaCi
hypernatremia
greater than 145 mEq/L
results from Na excess or water loss
water moves out of cells into vascular space-cellular dehydration
signs and symptoms of hypernatremia
thirst
dry mucous membranes
flushed skin
treatment of hypernatremia
fluids (hypotonic solution)
0.33% NaCi
low Na diet
additional signs and symptoms of hypernatremia
increased fluid retention restlessness and irritability elevated BP edema decreased urinary output
potassium
3.5-5.0 mEq/L
most abundant in icf
major mineral in all body fluids
aids in muscle contraction, nerve impulse condution, regulates enzyme activity
fruit, banana, oranges, vegetable, and meats
hypokalemia
less than 3.5 mEq/L
results from loss via GI tract and potassium depleting diuretics
life threatening
signs and symptoms of hypokalemia
muscle weakness leg cramp u wave cramps constipation cardiac dysrhythmias thigoxin irregular weak pulse orthostatic hypotension
treatment for hypkalemia
replace K diet meds add KCL to IV monitor EKG
hyperkalemia
greater than 5 mEq/L
result from renal failure, excessive intake, trauma, crush injuries, burns
sign and symptoms
muscle weakness
cardiac changes
parathesia of face/finger/tongue
treatment of hyperkalemia
insulin
IV
dialysis
what are some K+ deficits
alkalosis shallow respirations irritability confusion, drowsiness weakness, fatigue arrhythmias (irregular rate, tachy) lethargy thready pulse drecreased intestinal motility
calcium
8.5-10.5 99% in teeth and bones needed for nerve transmission, muscle contraction, and blood clotting inverse relationship with phosphate vitamin D needed for Ca absorption
hypocalcemia
Ca less than 8.5 mEq/L
loops diuretics, parathyroid disorders, renal failures, hypoparathyroidism
signs and symptoms of hypocalcemia
osteoporesis cardiac dysrhythmias tetany fractures tingling chovstek sign (+) trousseau sign (+)
hypercalcemia
Ca greater than 10.5 mEq/L
causes multiple fractures, hyperthyroidism, some cancers, TUMS, immobiliztion
signs and symptoms of hypercalcemia
muscle weakness, renal calculi, decreased GI motility, cardiac changes, CNS changes
chloride
98-106 mEq/L
combine with Na to form slats maintains water balance
most abundant anion in ECF
hypochloremia
less than 98 mEq/L
results from prolonged vomitting and suctioning
signs and symptoms of hypochloremia
metabolic alkalosis, nerve excitability, muscle cramps, twitching
hyperchloremia
greater than 106 mEq/L
results from excessive intake or loss via kidneys and dehydration
signs and symptoms of hyperchloremia
arrhythmias, decreased cardiac output, LOC changes, kussmals respiration
phosphate
2.7-4.5 mg/dl
needed for acid-base balance, neuroligical and muscle function, energy transfer and metabolism of carbs/proteins/lipids
hypophosphatemia
less than 2.7 mg/dl
results from decreased intestinal absorption and increased excretion
signs and symptoms of hypophosphatemia
bone and muscle, pain, mental changes, chest pain, respiration failure
hyperphosphatemia
greater than 4.5 mg/dl
results from renal failure, large intake of calcium
signs and symptoms of hyperphosphatemia
neuromusculare changes (tetany), EKG changes, parathesia finger tips/mouth
what is electrolyte homeostasis
to maintain balance to control by balancing the dietary intake of elctrolytes with the renal excretion and reabsorption of electrolytes
daily weights
is the most accurate indicator of water balance
hematocrit
increases with dehydration, and decreases with overhydration
hematocrit
percentage of cells in 100 ml blood
males 42-52%
females 37-47%
osmolarity
serum and urine osmolarity both increase with dehydration
urine specific gravity
1.010-1.025
increases with dehydration
urine PH
4.6-8.0
serum sodium
increases with excessive fluid losses
decreases with excessive fluid intake
serum albumin
3.5-5.0g/dl
helps maintain osmotic pressure
cannot pass thru cell membranes
peripheral edema
smooth, shiny, pale, cool skin
swelling especially in legs
weight gain
pulmonary edema
constant cough
dyspnea
moist rales in lungs
bounding pulse
infiltration
fluid leaked out of vein to surrounding tissue
swellin, coolness, discomfort, pallor, slowed rate, pain , pale to color(blanching skin)
phlebitis
swelling, warmth, redess, tenderness, red streak
fluid overload
SOB, distended neck veins, elevated BP, crackles in lungs, tachycardia
fludi volume deficit
aka hypovolemia
dehydration
elevated hemaocrit
major cause is fluid shift of vascular space
hemorrhage, vomiting, diarrhea, burns, crushing injuries
signs and symptoms of hypovolemia
increased HR, decreased BP, thirst, decreased motility decreased CNS activity decreased output dry mouth, poor turgor
fluid volume excess
aka hypervolemia
intercellular tissue
loss of ecf from vacular to other body compartments
fluid volum excess causes
increased Na/H2O retention excessive intake of Na/H2O fluid shifting from icf to ecf renal failure congestive heart failure
signs and symptoms of fluid volume excess
anxiety dyspnea crackes tachypnea increased BP distended jugular veins edema third spacing weight gain
what is the primary body fluid
water
what is fluid balance
fluids gained each day= fluids lossed each day
2.5L/day
what maintain proper fluid balance
skin, kidney and lungs
what is fluid
water that contains dissilved or suspended substances such as glucose, mineral, salts, and proteins
fluid concentration equals
osmolality
degree of acidity equal
Ph
elderly people
lower percentage of total body fluid than young adults due to higher body fat
women
lower percentage total body fluid than men due to higher body fat
fat cells
contain less water than muscle cells
risk factors for older adults
decreased thirst sensation
affects oral intake of fluids
increased risk of dehydration
decreased in gfr and number of filtering nephrons
decrease the ability to maintain normal electrolyte level
decreased excretion of meds
what is intracellular fluid
fluid insid the cell
2/3 of total body water
what is extracellular fluid
fluid outside the cell
1/3 ot total body water
what is interstitial fluid
around and between cells
what is intravascular
plasma fluid in blood vessels
what is the total body water volume
40L, 60% body weight
what is the fluid volume for intracellular
25L, 40% body weight
what is the fluid volume for extracellular
15L, 20% body weight
what is the fluid volume for interstitial
12L. 80% of ECF
what is the total plasma volume
3L, 20% of ECF
what is osmolarlity
the number of particles
what is solvent
liquid with a substance in solution
what is solute
the substance in the solution
what is active transport
movement of ions against osmotic pressure to an area of higher pressure ; requires energy
what is diffusion
passive movement of electrolytes or other particles down the concentration gradient from higher to lower concentration
what is osmosis
movement of water or other solute from an area of lesser to one of greater concentration
what is filtration
movement across a membrane under pressure from higher to lower pressure
types of isotonic solutions
dextrise 5% in water
0.9 normal saline
lactated ringers
types of hypotonic solutions
- 45% NS
0. 33% NS
types of hypertonic solution
0.45% NS
0.9% NS
D 10 W
what is body fluids
water and electrolytes
what type of client should be monitiored closely
patients that are not eating, drinking or NPO
who are high risk population for fluid and electrolytes
infants
older adults
patient with cardiac and renal problems
older adults has less body fluid as there is an
increase in fat cells with aging (muscle cells turn into fat cells)
for osmosis to occur a
membrane must separate two fluid compartments- at least one compartment must contain a solute that cannot move thru the membrane- this creates a concentration gradient of the solute
because of osmosis
water will move from the compartment with less solute to the are with more soute until an equilbrium exists and pressure is equal on both sides of the membrane
what is osmotic pressure
the pull of particles
the osmotic pressure and number of particles is what
makes up different types of IV solutions
what happens when a patient takes a diuretic
patient loses fluid and electrolytes
