unit 3 Flashcards
aldosterone
adrenals, prevents water and sodium loss in kidney nephrons, increase blood vol
antidiuretic hormone-ADH, vasopressin
pituitary, retaind water in kidney tubules and collecting ducts
natriuretic peptides
heart, released due to increase BP and vol, increases urine output
angiotensinogin 2
converted by ACE, activated by low BP and sodium, vasoconstriction, triggerd by shock and stress, manage HTN
important labs w ACE
BUN, Cr, protein, K, glucose
dehydration elderly
less total body water, lower thirst sensation, poor motor skill for obtaining water, meds that increase fluid excretion
dehydration symptoms
wt loss 0.5 lb day
increse-HR, RR, urine specific gravity (1.030), Hct, Hgb, glu, BUN, serum osmolarity
decrease- BP, urine (less 500 mL)
-orthostatic hypotension, confusion, fever, flat veins, dry skin
dehydration treatment
monitor vitals, falls, fluid replacement 2-4 oz /hr, weigh q 8, treat underlying issues, oral hydration solutions
fluid overload symptoms
increase- pulse, BP, veins, weight, RR, GI, liver
decrease- pulse pressure, shallow resp, SOB, muscle
moist crackles, skin pale and cool, altered LOC, headache, visual disturbances
hemodilution on labs
decrease HnH and serum protein levels
fluid overload interventions
skin breakdown, lasix, (electrolytes)conivaptan or tolvaptan, EKG, Na and K q8, restrict Na and H2O, Iand O, urine specific gravity less than 1.005
weight 1 lb
500mL
weight gain and fluid overload
more than 2 lbs a day or 3 lbs a week
hyponatremia causes
diuretics, heart failure, SIADH, kidney disease, diaphoresis, GI wound drainage
hyponatremia assessment
cerebral edema- confusion, seizures, death
muscle weakness, diarrhea/cramping, weak rapid pulse
hyponatremia nursing care
low Na and volume-normal saline
if severe low Na- hypertonic saline 3%
low Na and high volume (SIADH)- conivaptan or tolvaptan
Na in diet
high in processed and preserved foods, low in fresh fish, poultry, and most fruits and veg
hypokalemia causes
excess loss, cell damage, diuretics, digitalis (toxicity), corticosteroids, high aldosterone, cushing syndrome, diarrhea/vomit, wound drainage
hypokalemia assessment
respiratory status
decrease- muscle, cardiac, GI (constipation/vomit)
neuro- irritable to lethargic
-ST segment depression, flat or inverted T wave, increase U wave
potassium infusion
max of 1/10ml, rate no faster than 5-10 hr (never more than 20), large vein w high flow, no hands, check q 1 hr, stop w pain, burn, infiltration
potassium sparing diuretics
spironolactone, triamterene, amiloride
hypocalcemia meds
direct Ca replacement, vit D, aluminum hydroxide, calcium chloride, calcium glutonate
hyperglycemia meds
normal saline, lasix, plicamcin, penicillamine, phosphates, corticosteroids, aspirin
hypomagnesium causes
malnutrition, starvation, diarrhea, celiac, crohns, ethanol
heart failure
fluid overload, edema, abdominal distension, dyspnea, tachypnea, increase BNP, diuretics, digoxin, ACE inhibitors
albumin infusion
fluid overload
respiratory acidosis
CO2 retention, not breathing, oxygenate
respiratory alkalosis
hyperventilating, decrease respirations
metabolic alkalosis
retainig HCO3 arrythmias
meabolic acidosis
excreting HCO3, renal failure
D5W
isotonic, hypernatremia
1/2 normal saline
hypotonic, does not replace electrolytes
normal saline
isotonic, replace ECF loss
3% normal saline
hypertonic, hyponatremia
