Fluid/Electrolytes Flashcards
Intake
addition of Fluid and electrolytes into the body
Absorption
movement of fluid and electrolytes into the bloodstream
Distribution
process of moving fluid between compartments
output
removal of Fluid and Electrolytes from the body via normal or abnormal routes
Fluid Balance
extracellular volume and osmolarity
electrolyte balance
extracellular fluid volume, body fluid osmolarity and plasma electrolyte concentration on a continuum
Osmolarity
concentration of molecule per weight of water
- number of dissolved particles per unit of water*
- When the amount of water decreases in relation to # particles, the osmolality increases and becomes concentrated
- When the amount of water increases relative to solutes the osmolality decreases and becomes more diluted
- The primary particle responsible for regulating osmolality is sodium
hyper-osmolarity
Cells shrinking
ex: dehydration
Hypo-osmolarity
cells swelling-water gain
Methods of Fluid intake
Oral IV insertion into rectum NG tubes infusion into body cavities bone marrow (intraosseous)
Mechanism for oral intake
Thirst- stimulated by increased osmolarity and receptors for hypovolemia
Electrolyte Intake ( except IV)
must be absorbed by the body
CA+( calcium) absorbed in intestine (duodenum); and requires vitamin D
MG++( magnesium) absorbed by the intestinal epithelium of ileum
Total body water Average for adult
60%
Intracellular fluid
- 40% inside the cell,
- mostly skeletal muscle cells
- function- keep you hydrated
Extracellular fluid
20 %
- -Interstitial: outside the vessel and outside the cells (EDEMA) :contains little to no protein
- Intravascular: inside the vessel
- Transcellular: Outside the cell, outside the vessel – example intra-optic fluid synovial fluid
Hydrostatic Pressure
- Influence by blood pressure and blood Volume
- Pushes fluid out of capillary
Colloidal Osmotic Pressure
(Constant unless problems w/ protein)
- Exerted by plasma proteins
- Draws fluid back into capillary
- *Direction of fluid depends on the difference of the opposing forces**
Protein Dificiency
Think ~ LIVER
- inadequate intake
- protein loss
- decreased protein synthesis
Signs of low protein
- Decrease muscle mass (measured by weight loss)
- slow wound healing
- edema
- lethargy/fatigue
- anemia
- low hemoglobin
- shortness of breath
EDEMA
- Pitting
- Dependent
- Weeping
- Anasarca
- Other (ascites, plural effusion)
What do you do for Protein deficiency???
- Diet high in carbs and protein (increase carbs so they don’t use the protein for energy)
- IV or tube feedings with amino acids.
Distribution of Sodium
High extracellular pool concentration
-reflects osmolarity
Distribution of Potassium
high intracellular pool concentration
Distribution of Calclium
Bone pool
-parathyroid-intracellular and bone pool
Distribution of Magnesium
Intracellular and bone pool
What factors influence Distribution
Hormones, diet, diseases/conditions
Sodium ( NA+)
135 - 145 mEq/L
What it does:
Water Retention, fluid volume regulation
Manifestation:
S/s hydration/dehydration
Chloride (Cl-)
97 - 107 mEq/L
What it does: for Acid/Base balance, fluid, hydrocholric acid in stomach
Manifestation:
S/s Kidney problems
Potassium (K+)
3.5 - 5.0 mEq/L
What it does: Na-K pump, cardiac**, role in muscle activity -Primarily inside the cell, high intracellular conc.
Manifestation:
lef cramps, arrhythmias
Calcium (Ca++)
8.2 - 10.2 mg/dL
important to bones Coagulation; clotting factors, muscle contractions, slows peristalsis
Manifestations:
Muscle contractions, twitching
Hyperkalemia= kidney stones, arrhythmias, *clotting factor
Phosphorus (PO4-)
2.5 - 4.5 mg/dL
What it does: Acid/Base, ATP formation, *antagonist to calcium
Manifestations:
S/s Calcium Imbalance
Magnesium (Mg++)
1.6 - 2.6 mg/dL
What it does: Neuromuscular excitability, reflexes, Nerve conduction to muscles (problems with muscles affect the diaphragm); THINK RESPIRATORY
Manfestation:
Change in respiratory status
Bicarbonate (HCO3-)
22 - 26 mEq/L
Acid/Base; produced by kidneys
Normal Excretory Routes
- Kidneys should produce - 30mL/HR
( this is an average if you know nothing about the patient)
Ideal: 1-2ml/kg/hr
(below 1 indicates kidney failure/disfunction)
- Skin
o Sensible Perspiration (sweat, can see it)
o Insensible Perspiration (almost like evaporation, skin) 200-300/day (lose more with pyrexia) - Lungs ( increased respiration-more fluid loss)
- gastrointestinal Tract - POOOOOOOOP
Abnormal excretory routes
Emesis
Hemorrhage
Drainage ( fistulas, tubes, etc.)
Renal Excretion
Antidiuretic hormone (ADH) - regulates excretion for water only (posterior pituitary)
Aldosterone- retians NA+ and water and promotes renal excretion of K+ ( Adrenal Cortex)
Calculation of Fluid Loss
1L = 2.2 lbs = 1kg
Hemostasis is achieved by
- Renal System
- Hormonal System
- Respiratory System
Common Diagnostic Labs
- CBC ( Complete Blood Count)
- Electrolytes
- Serum Creatinine
- BUN
- Plasma Proteins
- Routine UA
CBC
o Red blood cells (oxygenation) o White blood cells (infection) o Hematocrit (concentration= reflection of hydration) o Plasma o Platelets
Serum Creaetinine
0.5 – 1.2 mg/dL
Kidney Function
High = Impaired /renal disease
BUN ( Blood, urea, Nitrogen)
waste products – Kidney Function, but because its mixed with blood- ratio; concentration, Reflection of hydration (increase= dehydration, high=fluid overload)
o 8-21mg/dL
Plasma Protein
o Total Proteins: 6.4-8.3g/dL
o Albumin: 3.5 – 5.0 g/dL
low in pts. with edema
Routine UA
o Specific Gravity – 1.005-1.030
o PH
o Ketones
o Blood
Inside the cell
K+, MG++, PO4-
Outside the cell
NA+, HCO3, CA++
Respiratory Acidosis
Causes: ( increased HCO3 and Increased CO2 )
- Cardiac/Resp. Distress
- overdose of sedatives
- not coughing/deep breathing after surgery
S/S:
Mental Changes headache restlessness dizziness Coma (SEVERE)
WDYD:
improve ventilation
*DIS BREATHING HARDDDDDDD
Respiratory Alkalosis
Causes: ( Decreased CO2, Decreased HCO3) hyperventilation aftermath of extreme exercise anxiety not enough CO2 ( High flow O2)
S/S:
- hear palpatations
- lightheadedness
- sweating
- drymouth
- N/V
- Epigastric pain
WDYD:
- Eliminate cause
- control breathing
- breath into a closed system ( paperbag)
BASIC BITCH BREATHING PROBLEM- ANXIETY AND HYPERVENTILATION**
Metabolic Acidosis
Causes: ( Decreased PH, Decrease in HCO3) too much acid
- Chronic Renal Failure
- ketoacidosis
- diarrhea ( loosing bicarb)
- KyperKalemia
S/S:
- headache
- Increased RR ( excess of acid-lungs trying to excrete)
- weakness
WDYD:
- IV bicarb
- fix underlying problem
- observe for Hyperkalemia
Metabolic Alkalosis
Causes: Increase in HCO3 and Increase in PH ( too much bicarb)
- vomiting
- gastric suctioning
- antacids
- kypokalemia
S/S:
- dizziness
- irritability
- tingling digits
- Decreased RR ( not enough acid, RR decreases to build up CO2)
WDYD:
- Increase Cl to absorb NA resulting in HCO3 Excretion
- Observe for hypokalemia
- reverse underlying disorder
Hyponatremia
Causes:
Loss of NA+
-Hypervolemia
S/S:
- mental status changes
- headaches
- lethergy
WDYD:
- isotonic IV
- hypotonic IV
- Restrict H2O intake
- monitor for CNS changes
Hypernatremia
Causes:
- too much sodium intake
- Dehydration
- hypovolemia
S/S:
- tachycardia
- thirst
- decreased urine output
- hypoxia
- decreased body weight
WDYD:
- limit NA intake
- isotonic or hypotonic IV
- Monitor for mental status changes
Hypochloremia ( Cl-)
SAME AS - NA!!!!! ( SODIUM CHOLRIDE)
Causes:
- Metabolic Alkalosis
- loss of NA
S/S:
- mental status changes
- headache
- lethargy
WDYD:
- Isotonic IV
- Hypertonic IV
- Monitor CNS
EAT FOODS HIGH IN CHLORIDE:
- processed meats
- canned veggies
- bananas
- tomatoes
- foods high in salt
Hyperchloremia ( Cl-)
Causes:
- similar to hypernatremia
- metabolic acidosis
- fluid volume excess
S/S:
- tachycardia
- thirst
- decrease urine output/weight
- hypoxia
WDYD:
-increase bicarb
Avoid FOODS HIGH IN CHLORIDE:
- processed meats
- canned veggies
- bananas
- tomatoes
- foods high in salt
Hypomag ( MG++)
Causes:
- alcoholism
- malnutrition
- diarrhea
S/S:
- hyperactive reflexes
- tetany
- increased HP and BP
WDYD:
- mag replacement ( same as IV K+ : SLOWWWWWW IV DRIP)
- monitor cardiac sxs
Increase foods high in Magnesium:
- Chocolate
- soybeans
- spinach
- almonds
- avocado
- oatmeal
- flax seed
HyperMAG
Causes:
- Renal Failure
- Excessive MG++ intake
S/S: - Flush skin -sense of warmth -N/V -Decreased reflexes SEVERE: respiratory and Cardiac Depression
WDYD:
- dialysis for kidney failure
- calcium intake
- monitor for cardiac sxs
Decrease foods high in Magnesium:
- Chocolate
- soybeans
- spinach
- almonds
- avocado
- oatmeal
- flax seed
Hypokalemia ( K+)
Causes:
- N/V/D
- Hyper-aldosteronism
- too little potassium intake
S/S:
- HEART ISSUES
- tachycardia
WDYD:
- give K+ ( SLOWW, IV DRIP)
- increase intake
- pt. education
Eat foods high in K+:
- banana
- avocados
- spinach
- green leafy veggies
- potatoes
- squash
- white beans
- citrus FRUITS
Hyperkalemia (K+)
Causes:
- excessive potassium intake (salt substitutes)
- potassium sparing diuretics
- renal failure
- Metabolic Acidosis
S/S:
- dirrhea
- cramping
- cardia issues ( Peak T-waves)
WDYD:
- limit potassium intake
- give calcium to alleviate heart issues
- regular insulin and glucose
- Kayexalate
Hypophosphatemia
SEESAW WITH CALCIUM
(hypercalcemia)
Causes:
- Hyperparathyroidism
- chronic Diarrhea
S/S:
- numbness
- weakness ( from increase CA)
- decreased cardiac output
- mental status changes
WDYD:
- replace PO4-
- assess calcium levels
- diet
Eat foods high in phosphate:
- meat
- poultry
- fish
- beans
- nuts
- dairy
HyperPhosphatemia
hypocalcemia
Causes:
- renal failure
- hypo-PTH
- excessive intake
S/S:
- tingling fingers
- muscle spasms
WDYD:
- IV Calcium ( FLUSH BEFORE and AFTER, NO IM injections)
- Treat underlying disorder
Avoid foods high in phosphate:
- meat
- poultry
- fish
- beans
- nuts
- dairy
HypoCalcemia
Seesaw with PO4
(hyperphosphatemia)
Causes:
- renal failure
- hypoparathyroidism
- too little Vitamin D
S/S: "CATS" -Confusion/Convulsions -Arrhythmias -Tetany/Trousseau's sign/ Chvosteks sign -Spasms/ Stridor (in the lungs)
WDYD:
- increase vitamin D
- IV Calcium ( FLUSH BEFORE and AFTER, NO IM injections)
Increase foods high in Calcium:
-milk, dairy, green leafy veggies, broccoli
Hypercalcemia
BONES, STONES, GROANS
Causes:
- hyperparathyroidism
- immobility (leaching from bones)
- over use of calcium products
- malignancies
S/S:
- kidney stones
- muscle weakness
- bradycardia ( weak heart beats slow)
- fatigue
- constipation ( weak muscles= decreased peristalsis)
WDYD:
- IV phosphorus
- IV fluids
- GET THE PATIENT UPPPPP
- Low calcium diet:
decrease milk, dairy, leafy veggies and broccoli
What electrolytes are lost with vomiting
H+
NA+
K+
Cl-
Think: upper GI looses hydrochloric acid from stomach
What electrolytes are lost with diarrhea
HCO3
NA+
K+
Cl-
Think: Lower GI looses BICARB from instestines
(bicarb out the butt)
What CAN’T a UAP do
can’t take initial vitals
no teaching
no assessing
nothing invasive
What Can’t an LPN do
Can’t do initial assessment
can NOT initiate teaching
can NO do things with IVs!!!
5 Rights of delegation
- Task
- Circumstance.Concern
- Person
- Directions/Communication
- Supervision ( reporting back to RN)
Hypotonic IV solutions
lower osmolarity than cells
-increases volume of cell, increases pressure
- D5W
- 45% NS
- 25% NS
Isotonic IV solutions
-Same osmolarity as blood and bodily fluids
.9 NS
Lactated Ringers
hypertonic IV Solutions
Higher osmolarity than cells
- any saline higher than .9
- 25% dextrose in water
-decreases volume of cell, decreases pressure
Renin-Angiotensin-Aldosterone system
Kicks in when blood pressure is low or if serum sodium.
Purpose: Regulating blood pressure
Renin releases into blood from kidneys and angiotensinogen from liver make angiotensin 1 which mixes with ACE enzymes in the lungs which makes angiotensin 2 (which is a potent vasoconstrictor)
Angiotensin 2 does 4 things
- hypothalamus kicks in thirst mechanism
- adrenal cortex releases aldosterone (increases reabsorption of sodium, decrease potassium)
- Blood vessels constrict
- ADH secretion from pituitary
all 4 things increases blood pressure
ADH
Is released from the posterior pituitary in response to increased osmolarity (high blood concentration and increased sodium), decreased BP or Decreased blood volume
synthesized in hypothalamus and released by posterior pituitary
- makes the kidnesy reabsorb water and puts this water back into the vascular system thus decreasing the concentration of the blood and increasing blood volume
( output of concentrated urine , peeing out more electrolytes than water) =HIGH specific gravity
Aldosterone
increases sodium
decreases potassium
Naturitic Peptide Hormone
in response to increased blood volume or increased blood pressure is released from specialized cells in the heart and DILATES the vasculature, thus decreasing blood pressure
