Fluid and Electrolytes Flashcards
ICF
Intracellular Fluid
fluid inside the cells
ECF
Extracellular Fluid
fluid outside of the cell
intake for 24hrs
2600 ml
fluids: 1500 ml
solids: 800 ml
oxidation: 300 ml
output for 24hrs
2600ml
kidneys: 1500 ml
lungs: 400 ml
skin: 600 ml
intestines: 100 ml
particles with pulling power (oncotic pressure)
sodium, glucose, albumin
isotonic solution
same solute concentration as another solution
balanced
hypotonic solution
amount of solute concentration is lower than another solution
lower osmolality
make cells swell (swollen like a hippo)
hypertonic solution
amount of solute concentration is higher than another solution
higher osmolality
pulls fluid from intracellular space
causes cells to shrink
body regulation of fluids
thirst
ADH
Renin-Angiotensin-Aldosterone System
BNP
ADH
antidiuretic hormone “vasopressin”
- hypothalamus senses low blood volume or increased osmolality
- signals pituitary gland to secrete ADH
- ADH causes kidneys to retain water
- blood volume increases and osmolality decreases
Renin-Angiotensin-Aldosterone system
- blood flow to glomerulus drops
- juxtaglomerular cells secrete renin
- renin goes to liver and converts angiotensinogen to angiotensin I
- angiotensis I goes to lungs and gets converted to angiotensin II by ACE
- angiotensis II goes to adrenal glands and stimulates them to make aldosterone
- aldosterone increases resorption of Na and water
- retention leads to increased volume which increases BP
BNP
brain natriuretic peptide cardiac hormone secreted when ventricles stretch used to assess HF normal <100 pg/ml
dehydration
fluid loss > fluid intake
increased tonicity
cells shrink
dehydration risk factors
confused comatose bedridden elderly infants kidneys can't concentrate highly concentrated tube feedings without adding water
dehydration causes
anything that accelerates fluid loss -DI -prolonged fever GI: diarrhea, emesis, NG drainage renal failure hyperglycemia meds: diuretics, laxatives excessive diaphoresis fistulas
cardiac sx of dehydration
TACHYCARDIA DECREASED BP weak, thready pulse orthostatic hypotension diminished peripheral pulses
neuromuscular sx of dehydration
MENTAL STATUS CHANGES SEIZURES DIZZINESS WEAKNESS EXTREME THIRST FEVER
renal sx of dehydration
DECREASED URINE OUTPUT
integumentary sx of dehydration
DRY SKIN
POOR SKIN TURGOR
DRY MUCOUS MEMBRANES
GI sx of dehydration
WT LOSS
THIRST
constipation
decreased bowel sounds
lab findings for dehydration
*increased osmolality
*increased HCT
*increased Na
*increased urine specific gravity
increased BUN
dehydration tx
replace fluids PO preferred AVOID hypertonic solutions IV replacement --hypotonic preferred --isotonic if low BP --replace slow to avoid cell swelling (cerebral edema)
hypervolemia
excess of isotonic solution
cells expand
can cause HF and pulmonary edema
cardiac sx of hypervolemia
BOUNDING, RAPID PULSE INCREASED BP DISTENDED VEINS (JVD) S3 SOUNDS **progressed: decreased BP and decreased CO
respiratory sx of hypervolemia
increased RR
dyspnea
crackles
pulmonary edema
neuromuscular sx of hypervolemia
altered LOC
HA
visual disturbance
renal sx of hypervolemia
increased urine output if kidneys can compensate
integumentary sx of hypervolemia
pitting EDEMA
GI sx of hypervolemia
diarrhea
WT GAIN
ascites
lab findings for hypervolemia
decreased osmolality decreased HCT normal Na+ decreased BUN decreased K+ pulmonary congestion on xray
hypervolemia tx
restrict fluid and sodium
meds to prevent HF and pulmonary edema (furosimide)
tx cause
monitor I&O
Na+
sodium 135--145 mEq/L major cation of ECF helps maintain acid-base balance activate nerve/muscle cells loss and gain coincide with water loss and gain
hyponatremia value
Na+ <135 mEq/L
serum Na decreases = ECF moves into cells
less Na available to depolarize nerves
CNS cells most vulnerable
hypovolemia and hyponatremia sx
POOR SKIN TURGOR DRY, CRACKED MUCOUS MEMBRANES WEAK, RAPID PULSE LOW BP ORTHOSTATIC HYPOTENSION
hypervolemia and hyponatremia
EDEMA
HTN
WT GAIN
RAPID, BOUNDING PULSE
lab findings for hyponatremia
Na+ <135 mEq/L
serum osmolality <280 (dilute blood)
urine specific gravity < 1.010
elevated HCT and plasma protein
hyponatremia tx
hypervolemia: restrict fluids, PO Na supplements
hypovolemia: isotonic IV (NS), high sodium foods
severe: ICU, hypertonic solutions slowly with diuretics
hypernatremia causes
inability to ingest fluids hypothalmic disorders water deficit HHNS DI excess intake meds: kayexelate Cushing's excess IV fluid
hypernatremia sx
neuro: huge impact on brain;
neuromuscular:
Early: twitch, hyperreflexia, ataxia, tremors, restless, anorexia, N/V
Late: weak, lethargic, confusion, stupor, seizure, coma
fever, flushed skin, intense thirst
if Na gain: hypervolemia, increased BP, bounding pulse, dyspnea
if water loss: hypovolemia, dry mucous membranes, oliguria, orthostatic hypotension
FRIED: fever, restless, irritable/increased BP and increased fluid retention, edema, decreased urine output and dry mouth
lab findings for hypernatremia
Na+ > 145 mEq/L
urine specific gravity > 1.030
serum osmolality > 300
hypernatremia tx
correct underlying cause PO fluid, IV if needed fluids over 48 hrs IV--salt free (D5W) restrict sodium intake diuretics with fluids
potassium
3.5--4.5 mEq/L main ICF cation skeletal/cardiac muscle contraction nerve impulse transmission exchanged for H+ ions for pH
hypokalemia causes
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