FLUIDS AND ELECTROLYTES Flashcards
VOLUME COMPOSITION
Body Fluids
- water
- electrolytes
- non electrolytes
- dextrose
- urea
- creatine
FLUID COMPARTMENTS
INTRACELLULAR (within cells)
EXTRACELLULAR (outside of cell membrane)
- Plasma
- Interstitial
- Lymphatics
FLUID MOVEMENT
Permeability of cell membrane
OSMOSIS - movement of fluid from an area of higher H2O concentration to lower H2O concentration
Terms applied to Particle Concentration (these are particles and not fluid)
- Hypertonic
- Hypotonic
- Isotonic
MOLECULE/PARTICLE MOVEMENT
DIFFUSION
FACILLITATED DIFFUSION
PASSIVE TRANSPORT
ACTIVE TRANSPORT
DIFFUSION
-Molecules Dispose and reach uniform concentration
(across cellular membrane CO2 + O2 cross membrane across capillaries)
ex. blood gases
FICILLITATED DIFFUSION
carrier molecule (lipid) moves particle
-lipid = fat
PASSIVE TRANSPORT
ions cross influenced by chemical or electrical gradients = electrochemical gradients
ex. ions cross a cellular membrane
Na/K+ pump
ACTIVE TRANSPORT
- requires energy
- primary requires ATP directly (mitochondria)
- secondary involves co-transport or counter-transport
ADENOTRIPHOSPHATE = ATP
HYPOKALEMIA
cause: vomiting, NG suction, dirrhea, incresed renal loss of water
s/s: fatigue, anorexia, N/V, muscle wasting, decreased GI activity, Fla Twave, dysrhythmia
tx: prevention, dietary intake, IV supplement
K+ cant get reabsorbed d/t water taking K+ away (when water leave K+ leaves also)
EKG see flat Twaves then dysrhythmia
OJ, Bananas, Brazil nuts, processed meats, dried apricots, dried peaches and preservatives have a lot of K+ in them
HYPERKALEMIA > 5mEq/l
CAUSES: increased dietary intake, decreased renal output (K+ >8 chronic or acute renal failure)
s/s: muscle weakness, N/V, diarrhea, peaked T waves, dysrhythmias
Tx: dietary restriction, Kayexalate, CA gluconate, NAHCO3 (sodium hydroxide)
(forcing the K+ back into the cell)
EKG - peaked Twaves and dysrhythmias
- Chronic renal failure pts have this
- Eating a lot of bananas
HYPONATREMIA
cause is DILUTIONAL PERCEPTION of body (body perceives it don’t have enough Na in it)
s/s: anxiety, anorexia, muscle cramps, exhaustion, Severe: lethargy, confusion, muscle twitching, convulsions, sternal edema,
decreased BP and increased P
Tx: normal volume or hypervolemia, H2O restrictions and diuretics
-Neurologic symptoms - 3% NaCL IV (this % is very dangerous have to watch your pts when this is infusing)
sodium concentration, concentration of Na and H2O in the body
HYPERNATREMIA >145 mEq/l
Causes: deprivation of water, patients cannot perceive or respond to thirst
S/S: restlessness, weakness, disorientation, hallucinations, swollen tongue, sticky mucosa, increased T waves, increased BP, increased weight, increased urine SG, rubbery firm skin, as brain shrinks - subarachnoid hemorrhage
TX: gradual decrease in Na, D5W or D51/4NS
**pt very dehydrated
SIADH
Metabolic Problem
Cause: neurologic, pulmonary, excess hypotonic IV fluids, stress, medication, psychogenic polydipsia, edematous states (CHF)
s/s: s/s: anxiety, anorexia, muscle cramps, exhaustion, Severe: lethargy, confusion, muscle twitching, convulsions, sternal edema, decreased BP and increased P
Tx: underlying cause, normal volume or hypervolemia, H2O restrictions and diuretics
-Neurologic symptoms - 3% NaCL IV (this % is very dangerous have to watch your pts when this is infusing)
*neurologic and pulmonary
HYPOCALCEMIA
Thyroid glands control Ca
causes: parathyroid disease, thyroid disease
s/s: Positive Chvostek’s and Trousseau’s
Tx: calcium replacement
Vitamin D
*Ca stored in bones, teeth, serum
parathyroid being removed
CHVOSTEK’S
TROUSSEAU’S
- CHVOSTEK = taping on cheek 5th cranial nerve facial nerves twitching
TROUSSEAU = BP cuff on blown up and spasms occur with cuff being blown up
HYPERMAGNESEMIA > 2.5mEq/l
cause: excessive intake, impaired excretion, endocrinopathies
s/s: much like hypokalemia; s/s: fatigue, anorexia, N/V, muscle wasting, decreased GI activity, Fla Twave, dysrhythmia
Tx: withhold source, promote excretion, calcium salts, hemodialysis
HYPOMAGNESEMIA
causes: impaired absorption, increased loss, renal, diuretics, endocrinopthies, hypercalcemia
s/s: much like hypokalemia ;s/s: fatigue, anorexia, N/V, muscle wasting, decreased GI activity, Fla Twave, dysrhythmia
tx: magnesium salts
CELLULAR HOUSEKEEPING
ENDOCYTOSIS AND EXOCYTOSIS
ENDOCYTOSIS: cells engulf materials from surroundings areas
- PINOCYTOSIS = small particles “drinked”
- PHAGOCYTOSIS = large particles “eaten”
EXOCYTOSIS: secretion of intracellular substances into the extracellular spaces (waste removal)
ONCOTIC PRESSURE
Omolarity of a particular body fluid. The amount of pressure a molecule exerts in a space. Regarding particles when you have a lot of particles you don’t have a lot of water.
OSMOTIC PRESSURE
ex. DKA pt with sugar in blood stream and the osmotic pressure is elevated 300 -400 glucose particles in blood stream is dense, water moves in from interstitial spaces and dehydrates the tissues the pt then goes into a hyperosmolar state.
HYDROSTATIC PRESSURE
Venus and arterial state. Pump pressure away from the heart pump.
The closer you are to pump pressure the higher the arterial pressure.
The further away you are from the pump pressure the lower the arterial pressure.
PRESSURE GRADIENTS/FLUID MOVEMENT
ARTERIAL LEVEL -Heart pump = 32 mmHg force -Albumin (Fat) pressure = 22 mmHg -Pressure difference +10 mmHg...fluid leaves the vascular tree (these are normal values)
CAPILLARY LEVEL
- Heart pump 12 mmHg
- Albumin 22mmHg
- Pressure difference -10mmHg…fluid retuns to vascular tree
*Albumin = Fat molecule used a sponge (pulls in fluid)
22mmHg is normal value
ex.