Fluid and Electrolytes Flashcards
where is most of the fluid located
-intracellular - in the cells
2/3 of total
Extracellular Fluid
- 1/3 of total volume and this is outside the cells in the
1. interstitial - between the cells
2. intravascular- in the veins and artery, blood plasma
5 ways in which fluid is taken out of body
- urine via kidneys
- lungs
- feces
- sweat
- skin
where does edema have fluid
extracellular
insensible vs sensible loss
insensible- cannot be measured
sensible- something we can measure
3 factors that maintain fluid balance
- fluid intake- 2- 3 Liters
- fluid distribution- osmosis (moving fluid from one to the other- passive)
- fluid output- kidneys, GI, Skin, lungs
fluid intake - what stimulates the thirst mechanism
5 points
- inc plasma osmolality
- angiotensin II- helps release aldostrone which retains Na and water
- dry mucus membranes- really important to assess this for old and young kids bc these groups manifest dehydration with behavioral changes
- psychological factors- habit and social factors, trauma, burns etc
- dec volume of plasma- hemorrhage
is alcohol considered a form of oral intake?
no- bc it make you dehydrated
total intake vs total output and what about prolonged exercise
-2-3 L intake
-2 L about as much as you put it if you pee more then 2.5 could be polyuria output
when you are exercising a lot you may have increased out put to even 6600 ml
name some factors of insensible water loss 4
- diarrhea
- dry, hot weather
- fever
- mechanical ventilation - you might have the ventilation set at a higher level and this is causing alot f water loss
muscle mass and older adults water levels
older people have less muscle and therefore less water
women and water levels
less water bc they have more fat
ADH also called
function
released from where
urine change?
- vasopressor
- retains water
- released from the posterior pituitary
- kidney uptake water and less urine output
aldosterone
released
function
- released by adrenal cortex
- retain of Na and water
- more K AND H is released
ANP
what is it
where is it located
what does it do?
- aterial natural peptide
- in response to volume in the blood
- atrium of the heart detects it
- when body has congestion so heart released ANP from atria and when heart is stretched out this ANP signals fluid overload, telling kidney to excrete more fluid, stops aldosterone, ADH and tells the vessels to dilate
Na normal levels
135-145
Na function 6
- PRIMARY EXTRACELLULAR FLUID CATION
- regulates osmotic forces
- neuromuscular irritability
- acid base
- cellular chemical reactions
- membrane transport
Hyponatremia 2 causes
- what IV could cause this?
- too much water so Na gets diluted (hemo-dilution),
- Na loss
- hypotonic IV administration
Hyponatremia manifestations
- Nausea and vomiting
- Headache
- Confusion
- Loss of energy and fatigue
- Restlessness and irritability
- Muscle weakness, spasms or cramps
- Seizures
- Coma
if Na loss causes HYPO NA then what symptoms
- hypovolemia signs and symptoms
if hypo na due to dilutional
- fluid overload signs
hyper na
- na gain - too much hypertonic IVF, Cushing syndrome-more mineral-corticoids like aldosterone which causes ratian of Na
- water loss- via diabetes inspidus bc not enough ADH and you are peeing alot but you have alot of Na left in the body
hyper Na symptoms
lethargy, confusion
hyper na due to Na gain what symptoms
fluid over load
hyper na symptoms due to water loss
hypovolemia
K levels
3.5- 5.0
k main functions
cardiac and nerve impulses
intracellular water balance
main cation in cel
Causes bradycardia HyperK
Poor kidney function and K levels
-hyper K bc you cant excrete it
what dec K levels
vomiting, diarrhea, alot of pee
nursing diagnosis for electrolyte imbalances
- risk for electrolyte imbalance
- complication for seizures, coma
- dysrthymias
- fracture
intravenous fluid therapy 3 types
- isotonic- same level as body normal .9%
- hypotonic- more dilute then whats in body 1/2 saline
- hypertonic- more stuff then the body has 3%
what does hypotonic solution due to cells and when it is used?
- cell is dehydrated so you want water to go in the cell
- it causes cell swelling
hypertonic solution do to the cell and the
take water out of the cell
done when cells were swollen like in cerebral edema or pulmonary edema
to give lactate ringers what do you have to have
- good liver function
- has more electrolytes
assessment of fluid status
lips mucous membranes skin pulse bp weight
skin turgur is what kind of indicator for fluid retention
its bad in old people
you wanna weight yourself
vascular access dievce
- central and peripheral
- used for repeated acess to the vascular system
hypertonic over 500 or over miliosmols can you use central?
yes! this is the only one we can use
pH gauge which line?
central
peripheral catheters
short term use and mild solutions
PICC lines life
- one year
- long term
- central vein that goes front he brachial line all the way to the superior vena cava
central lines
PICC and triple lumen you always do an X-ray after to make sure its in the right spot
used for chemo
parental nutrition and other concentrated formulas
electronic infusion devices also called what
also called: IV pumps, infusion pumps
how do they work? EID
- uses positive pressure to deliver a measured amount of fluid during a specific time frame
what are complications of IV therapy 6
- circulatory overload
- infiltration
- extraversion
- phlebitis
- local/systemic infections
- bleeding at venipuncture site
infiltration what happens how do we rate it? temp pain appearance 2 points
catheter gets dislodged and the stiff goes into the subcutaneous area not in the vein
you can see it via edema and reddness outside
they have a scale from 0-4 4 being the higher
cool to touch with or without pain
extravasation
what is
how does it look
serious form of infiltration, its when the skin breaks down bc the catheter gets logded and damages tissues bc of the medicine (vesicant) meaning they have low pH and when the catheter leaks the stuff it causes damage
phlebitis
how does it look? 4
what intervention
do you rate it?
vein is inflamed , red, pain, tender, warm throughout the whole vein, and could even be showing like a rope going up
take it out but if you need another one in the same extremity then put it proximal to the area.
scale from 0-4 the higher the number the more serious
central line associated bloodstream infection
- involves an intravascular catheter that terminates at or close to the heart
- usually in people ho stay at the hospital for long time
- inc cost
- serious infections that could cause death
- need proper insertion and proper management
Chlorehexdine gluconate cloth aka CHG baths
use this to clean the Central lines 2% nvr use on face and gentiles or less then 2 months wipe from proximal to distal and one wipe for one swipe
