X Fluid & Electrolytes Flashcards
Only administer Insulin in ….
an Insulin syringe
IM injections given at ? degrees
90degrees
Heparin used for?
Anticoagulant
do not aspirate Heparin or Insulin
??? WHY
Recombinant DNA
DNA made in the lab by combining different genetic material from multiple sources, creating sequences that would not otherwise be found in biological organisms.
ADH released by pituitary in response to …
thirst or concentrated blood. stops kidneys from producing urine
Solutes (glucose, protein, NaCL) in blood attract….
H2O
Diabetes Insipidus causes
polyurea
fluid passes thru to quickly. dilute urine
SIADH
- Syndrome of Inappropriate ADH.
- Body produces too much ADH. Kidney gets message to pull back fluid too much.
- Urine [ ], DWN urine output, UP BP, edema w/ fluid seeps into interstitial space
RAAS system (Renin Angiotensin Aldosterone System)
- Renin secreted by JGA in response to Low BP
- Renin enters blood stream, causes conversion of Angiotensinogen to Angiotensin I
- Angiotensin I (in lungs) converted to Angiotensin II (vasoconstrict)
- Angiotensin II stimulates release of Aldosterone from Adrenal Cortex. (signals kidney to pull back Na, then fluid)
ACE inhibitor
Angiotensis Converting Enzyme. Given to patients who release to much and HTN
(blocks conversion of Angiotenisin I to II)
ANP
Atrial Natriuretic Peptide
- released in response to overstretching of Atria during fluid overload.
- Tells kidney to release Na and let o of water to decrease water.
BNP
Brain Natriuretic Peptide
-secreted by the ventricles of the heart in response to excessive stretching of heart muscle cells (cardiomyocytes)
LOW BP, LOW BV, UP Blood Osmolality
then ADH =
UP BP, UP BV, LOW Blood Osmolality
Aldosterone released (by Adrenal Cortex) in response to ….
UP K.
if kidney normal, high K indicates dehydration
ADH deals with H2O, Aldosterone deals with ?
solids, (K)
Serum Osmolality & Specific Gravity indicates ? about kidneys
- how effective kidney is at producing urine
- if serum UP, USG usually UP too.
Filtration: Hydrostatic pressure does ?
pushes fluid out of artery
FIltration: Osmotic pressure does?
attracts fluid back into veins. Excell fluid picked up by Lymph or it will cause edema.
All plasma protein made ?
Liver
Hypervolemia symptoms
Na & H20 retention
- bounding pulse
- tachycardia
- UP resp rate
- Distended neck veins
- UP BP
- Heart failure
- Weight gain
- crackles
- Osmolality DOWN
- U Specific Grav DOWN
- Fluid retention
- HTN
- DOWN HCT
- dependent edema
Hypovolemia
decreased BV
Hypovolemia Causes
- 3Ds (diarrhea, diuresis, diaphoresis)
- internal bleeding
- obstetric emergency
- dehydration
- vomit, fever
Hypovolemia Symptoms
tachycardia weak/thready pulse anxiety/confused thinking fatigue weight loss DOWN BP dry skin/mucous membrane poor skin turgor [ ] dark urine risk for fall (orthostatic hypotension) risk for skin breakdown
Leading cause of hospital admissions?
Dehydration, Hypovolemia
Hypovolemia Treatment
restoring BV???
Hypovolemia (dehydration), Nursing Implications
- Acute renal failure
- coma
- shock
- osmolality UP
- hematocrit UP
- BP DOWN
- Urine SG UP
- dry mucous membrane
- poor skin turgor
- ADH released
- thirst
Isotonic solution in veins
no movement in out of vein (salinity is same as body .9%
Hypertonic solution in veins
water moves into vein
Hypotonic solution in veins
water moves out of vein
Dependent Edema
edema on lowest part of the body.
Histamines cause capillaries to become ?
leaky.
Water Excess (clinical manifestations) Hypervolemia
- LOW blood through kidney
- LOW cardiac output
- Kidney disease
- LOW Hematocrit
- LOW Hemoglobin
- LOW Serum Osmolality
- UP Capillary permeability (histamines)
- UP Capillary hystrostatic pressure
- release ANP (fr atria) and BNP (fr ventricle)
SIADH
Syndrome of Inappropriate ADH
- not making urine
- fluid stays in vascul?
- hypervolemic
- UP Urine Specific Gravity
Diabetes Insipidus
not enough ADH
- polyurea
- LOW specific gravity
- risk for dehydration
Vasopressin
aka ADH
Desmopressin
Synthetic version of Vasopressin
ANP(from atria) /BNP (from ventricle) released in response to ….
stretching of heart chambers. Tells kidney to release Na and water follows.
purpose: to INCREASE urine.
How and why ADH released?
Hypothalmus activated Pituitary Gland to secrete ADH in response to hypovolemia. Low BP
1) LOW BP - JGA releases Renin
2) in BLOOD: Renin becomes Angiotensin
3) in LIVER: Angiotensin I meets ACE (Angiotensin converting enzyme)
Angiotensin I becomes Angeiotensin II
Angiotensin II (potent vasoconstrictor, as circulates though body. everywhere it touches vasoconstricts.
4) Angiotensin II RAISES BP (patient still needs fluids though)
5) Angiotensin II stimulates Adrenal gland to release ALDOSTERONE.
6) Aldosterone tells kidneys to take Na out of GF so water follows (see diagram in notes)
ADH and Aldosterone raise BP by….
removing water from urine output
Loop Diuretics do what?
ANP/BNP increase urine. As Na at loop of Henley attracting water creating more GF
Anti HTN meds
- Diuretics , get rid of fluids
- ACE Inhibitors ( stops angiotensin I to II)
- Direct vasodilator (open pipe so pressure goes down)
Symptoms: faint because veins dilated, low bp, not circulating well.
Hyponatremia (LOW Na) symptoms
- Hypervolemia?
- 3Ds
- burns
- SIADH
- too much too quick hypotonic fluid iv.
Nursing Implications
Muscle weakness
LOW HR and peristalsis rate
Potential Siezures
LOW temp
Hypermatremia
CAUSES
- Dehydration
- diabetes insipidus
- [ ] enteral fee
NURSING IMPLICATIONS -muscle twitching Thirst Poor skin turgor Dry sticky mucous membrane Potential for edema HTN (concentrated blood attracts water)
HypoCalcemia
CAUSES
Post menopause
LOW vitD
Thyroid removal
NURS IMPLICATIONS
- Tetany, twitches, carpal pedal spasms (truseaus)
- Facial twitching (chvosteks sign)
- Risk for fractures, pathological (just breaks from weakness, no trauma)
- risk for osteoporosis
TREAT
Ca/VitD supplement
HyperKalemia
CAUSE
dyrhytmia
Muscle spasms/cramps
Weakness
NURSE IMPLICATIONS
- Kayexelate (binds K in gut)
- Given as last resort to ESRD to have on hand in case of emergency, binds in gut causes diarrhea
HypoKalemia
LOW K
CAUSES
3Ds
(Diuresis, Diarrhea, Diaphoresis)
NURSE IMPLICATIONS dysrhythmia Muscle weakness Muscle cramps/spasms LOW peristalsis LOW vasodilation/constriction
TREAT
replace electrolytes (Gatorade)
K IV, dilute, very slow, NEVER push IV. NEVER IM
Used in lethal injection
K rich foods (bananas, dried fruit, citrus, peanuts, tomatoes)
HypoMagnesemia
CAUSES
ETOH (alcohol abuse)
Malnourished
LOW GI absorption
NURSE IMPLICATIONS
Neuromuscular excitability
Seizures
TREAT
HyperCalcemia
CAUSES
Immobility
UP serum because of leaching from bones
Multiple Myloma (bones hollow and snap)
NURSE IMPLICATIONS Risk for Kidney stones Lethargic Muscle weakness/slow Dysrhythia
TREAT
HyperMagnesemia
CAUSES
Renal failure
Excess intake
Anyone who received Mg as a drug (mom?)
NURSIN IMPLICATIONS
Bradycardia
Respiratory Depression
Drug on hand (rescue med, Calcium Gluconate)
Hypophosphatemia
CAUSES
Malnutrition
LOW gut absorption
NURSING IMPLICATIONS
Risk for infection
Risk for wounds
LOW healing
Hyperphosphatemia
CAUSES
Renal failure
NURSING IMPLICATIONS
- ESRD
- Phosphate binder with all meals at same time as food.
- if UP P, LOW Ca
- LOW Ca = osteoclasts break down bone to put Ca back in serum
*** RENAL OSTEODYSTROPHY
Phosphorous is in
All living things
Insensible fluid loss
Evaporation from skin and lungs
Sweat
Breath
Pressure inside artery is ?
Hydrostatic pressure
Filtration, water pushed out
(See pic)
Percentage of interstitial fluid
Back in vein
Into Lymph
90 / 10
Normal pH of body
7.35 - 7.45
Acidosis starts at pH..
7.34 and BELOW
retention of CO2
(CO2 + H2O = H2CO3) carbonic acid
Alkalosis starts at pH…
7.46 and UP
Respiratory Acidosis
buildup of CO2
CAUSES/PATIENTS
-COPD:
Asthma (narrowing of airway)
Emphysema (alveolar lose elasticity, stretch balloon)
Chronic Bronchitis (mucus plugs)
-Hypo ventilation: stroke, opiates, Mg OD
RENAL COMPENSATION retains bicarbonate (HCO3)
what neutralizes Carbonic Acid
Carbonic Anhydrase
Respiratory Alkalosis
loosing too much CO2
CAUSES/PATIENTS
- Hyperventilation (hysterical person, crying baby, mom in labor)
- Ventilator patients
TREATMENT
re-breath CO2, paper bag
Metabolic Acidosis
CAUSES
- Loss of pancreatic bicarbonate (loss of alkaline, you will become acidic)
- Diabetic KetoAcidosis
BODY COMPENSATION
- Kidneys retain bicarbonate
- automatically body starts Kussmul Respiration (respiratory compensation) prolonged breathing to get rid of excess CO2
Diabetic KetoAcidosis (what is happening)
see pic
- if pancreas stops making insulin, cells die slowly.
- cells become hungry because glucose in blood but no cells getting fed. the more the patient eats because the body said it’s hungry, the more glucose builds up in blood and doesn’t get to cells.
sugary blood attracts water causing
3Ps: Polyphagia (UP hunger), Polydypsia (UP thirst), Polyurea (UP urine)
Gluconeogenesis
Gluconeogenesis (GNG) is a metabolic pathway that results in the generation of glucose from non-carbohydrate carbon substrates such as pyruvate, lactate, glycerol, and glucogenic amino acids. While primarily odd-chain fatty acids can be converted into glucose, it is possible for at least some even-chain fatty acids.
SEE PIC
TriGlycerides (fats)
GLYCEROL
FA FA FA
Glycerol used to make sugar from brain because glucose ingested not being used to feed cells. When body removes top glycerol from triglyceride, the remaining Fatty Acids become ketones making system acidic.
Which way does fluid move (hypotonic, hypertonic)
from hypo - hyper tonic
Hyperventilating (losing CO2) creates what pH?
alkaline
Respiratory Acidosis common in pts w …
COPD
retaining too much CO2
Long term COPD effects
LOW O2 becomes trigger to breath instead of acidosis in body. When body is acidic for so long, body gets used to it.
In COPD pts, what setting for O2 flow rate?
2L/minute
most common cause of Metabolic Acidosis
1) Diarrhea (loss of bicarbonate)
2) Diabetic KetoAcidosis (body uses glycerol to make glucose and leaves 3 Fatty Acids. Body does this because glucose in food is not being used to feed body and only sits in blood. (fruity breath)
Body compensation for Metabolic Acidosis
- Kidneys hold back bicarbonate to neutralize acid
- Kussmaul Respiration (prolonged exhale to get rid of excess CO2)
Body compensation for Respiratory Acidosis
- kidneys hold back bicarbonate.
- body can’t fix respiratory problems with respiratory fix.
- have to consciously teach pts pursed lip breathing.
When P UP….then Ca
Ca LOW
-inverse relationship
in ESRD pts, Hyperphosphotemia would be treated by giving what?
a P binder with every meal. Prevents P from reaching blood stream. Goes out with food.
HypoCalcemia causes Renal….
Renal Osteodystrophy
inverse of Hyperphosphotemia
pituitary stimulates osteoclasts to release Ca from bones.
Normal levels, K
3.5 - 5 meq/L
hypo: DOWN 3.5
hyper: UP 5
Normal Levels, Na
135 - 145 meq/L
Hypo: DOWN 135 meq/L
Hyper: UP 145 meq/L
ADH released from ?
Hypothalmus stimulates pituitary gland to secreet ADH.
Diabetes insipidus has how much ADH?
not enough
polyurea
dilute urine
NURSE IMPLICATIONS
increase electrolytes
provide water because patient drinks alot
every 3 bottles water, 1 bottle gatorade
Adenoma
Gland/Tumor
can secrete ADH
Who takes ACE inhibitors
The body reacts to slight drops in BP for some people by starting RAAS process. Not necessary, so these patients take ACE inhibitors to prevent it.
RAAS system stimulated by?
Low BP
Sudden Shock
(loss of limb/blood) or
Anaphalactic Shock (fluid shift out of blood into interstitial fluid, possible from leaky capillaries due to histamine)
Most fluid in the body is in which cells?
1st) Intra cellular
2) Extra cellular (blood, interstitial)
1L fluid = ? lbs
1L fluid = ? KILO
1L fluid = 2.2 lbs
1L fluid = 1 Kilo
1oz = 30ml
1TB = 15ml 2TB = 1oz 1tsp = 5ml
When taking Daily Weigh, what should be the same
same scale
same time
same clothes
Normal Urine output
30cc/hour
15cc (renal insufficiency, not enough to clear out waste)
Metabolic Alkalosis (7.46UP)
Vomiting
Secution (gastric)
too much proton pump inhibitor
Allen’s Test
press down on both ulnar and radial artery (wrist), then release ulnar, keeping pressure on radial. If blood flows back in, there is no blockage and the radial artery can be stuck. (injection)
ABG
Arterial Blood Gas test
Amount of Calories?
Protein, Carb, Fat
Protein = 4 cal Carb = 4 cal Fat = 9 cal
Normal Na ingested per day
500mg
Fat or Water soluble?
Vit A, D, E, K
Fat
Normal Fluid intake
2500ml
Third Spacing
shift of fluid from vascular space into are where not available to support normal physiologic processes.
Main cause of fluid excess
HyperNatremia
normal pH = 7.35 - 7.45
normal pCO2 = 35 - 45 (retain CO2, UP Acid)
(respiratory)
normal HCO3 = 22 - 26 (Bi-carb)
(metabolic)ACID ——————ALKALINE
pH 7.35 - 7.45
CO2 + H2O =
HCO3
Carbonic Acid
