Fluid and electrolytes 1 Flashcards
(286 cards)
1
Q
Hypotonic solution is to
A
Dilute ECF and rehydrate cells of hypertonic fluid imbalances.
2
Q
Hypotonic solution
A
< 250 mEq/L
3
Q
Solutions of hypotonic
A
D5W, 2.5% dextrose in water
4
Q
Hypotonic solutions do what to cells
A
Cells swell
5
Q
Do not give hypotonic solution to
A
Hypotension pt., infants, or patients with head injury
6
Q
Isotonic solutions normal range is
A
250-375
7
Q
Lactated Ringer’s and 0.9% NS is
A
Isotonic solutions
8
Q
Isotonic solutions are for
A
Fluid rewsuscitation, keep vein open, dilute mess, expand volume
9
Q
Hypertonic solutions is greater than
A
375
10
Q
D10W, D5LR, and D51/2NS are all
A
Hypertonic solutions
11
Q
Hypertonic solutions do what to cells
A
Shrink
12
Q
Na is for
A
Volume replacement of hypertonic solutions
13
Q
D51/2NS is fo
A
Severe hyponatremia and cerebral edema
14
Q
Hypertonic solutions have to be infused
A
Slow
15
Q
Be aware for checking patient that is given hypertonic solutions
A
BP,HR, lung sounds, urine output
16
Q
Hyponatremia is
A
Low sodium in the cells to where water shifts for ECF to ICF
17
Q
Euvolemic hyponatremia
A
Water increases, Na+ levels stays same
18
Q
No edema
A
Na+ is diluted due to increase H2O levels
19
Q
Hyponatremia causes
A
SIADH (syndrome of inappropriate antidiuretic hormone), DI ()diabetes insipidus), adrenal insufficency
20
Q
Hyponatremia
A
Serum Na+ < 135mEq/L
21
Q
Hyponatremia results from
A
Excess of water or loss of Na+
22
Q
In Hyponatremia, water shifts from
A
ECF into cells
23
Q
Hyponatremia you will have
A
No edema
24
Q
Hypervolemia hypernatremia
A
Na+ and h20 levels increase in the body. Fluid volume overload.
25
Hypervolemia hypernatremia
Na+ and h2o levels are regulated differently and independently of each other in the human body
26
Causes of hypervolemia hypernatremia
CHF, kidney failure, excessive infusion of saline solution or liver failure.
27
Sodium-Na+ Range is
135-145 mEq/L
28
Is sodium a major cation or anion
Cation
29
Chief electrolyte of extra cellular fluid is
Na+
30
Cation is a positive or negative charge
Postive
31
Sodium regulates
Volume of body fluids by maintaining osmotic pressure
32
Sodium is needed for
Nerve impulse and muscle fiber transmission (Na/K pump)
33
Major muscle fiber that would be affected by sodium
Heart muscle
34
Sodium is regulated by
Kidneys/hormones
35
Sodium is
Outside of the cell in the ECF
36
Most common electrolyte disturbances is
Hyper and Hyponatremia
37
Hyper and Hyponatremia is
Most abundant in extracellular fluid and therefore more prone to fluctuation
38
Osmosis
Movement of water from an area of lesser to one of greater concentration through a semi-permeable membrane
39
Diffusion
Passive movement of electrolytes or other particles down the concentration gradient (from higher to lower concentration)
40
Filtration
Movement across a membrane, under pressure from a higher to lower pressure
41
Filcilatated diffusion
Carrier from higher to lower
42
Active transport
Metabolic energy is expended, movement from less concerntated solution to more concentrated one
43
Osmotic pressure
An inward-pulling force caused by particles in the interstitial and intracellular fluids
44
Hydrostatics pressure
The major force that pushes water out of the vascular system at the capillary level and into interstitial fluid
45
Extracellular fluid
Found outside the cells and accounts for about 1/3 of total body fluid
46
Intracellular fluid
Found within the cells of the body
47
Intravascular fluid
Plasma, accounts for approx 20% of the ECF
48
Interstitial fluid
Surrounds the cells, 75% of the ECF
49
Cation
Positively charged ion
50
Anion
Negatively charged ion
51
Causes of hyponatremia
"NO NA+"
52
"No NA+" N is
N-Na+ excretion increased with renal problems, NG suctioning, DI, aldosterone secretion, diuretics, sweating
53
"NO NA+" O is
Overload of fluids-CHF, hypotonic IVF, liver failure, will dilute sodiumm
54
"NO NA+" N is
Low intake of Na+, low Na+ diet, NPO, elderly
55
NO NA+" A is
Antidiuretic hormone over secreted
56
Signs and symptoms of Hyponatremia
"SALT LOSS"
57
" SALT LOSS" STANDS FOR
S-seizures and stupor
A-abdominal complaint, attitude change (confusion)
L-lethargic
T-tendon reflexes diminished, trouble concentration
L-loss of urine, appetite
O-orthostatic hypotension, overactive bowel sounds
S-shallow breathing late sign (shallow breathing, skeletal muscle weakness)
S-spasm of muscles
58
Nursing interventions for hyponaterima
Monitor cardiac, respiratory, neuro, renal and GI systems
59
Hypovolemic hyponaterima
Give IVF to restore balance of fluids and sodium (hypertonic solution; 3%), given too fast fluid volume overload.
60
Hypervolemia hyponatremia
Restrict fluids, possibly diuretics, renal failure-dialysis
61
SIADH
Restrict fluids, antidiuretic hormone antagonist; declomycin-not given with food especially dairy. Also conserves lithium when sodium levels are increased.
62
For sodium loss
Instruct patients to consume sodium rich foods. (Canned foods, bacon, table salt, processed foods)
63
What are some medical conditions that may cause a dilution all hyponatremia
Heart disease, renal disease, adrenal insufficiency
64
What are some conditions that might cause actual loss of sodium from the body
GI losses- nasogastric suctioning, vomiting, diarrhea
Certain diuretic therapies
Polydipsia
65
Permanent neurological damage can occur when serum Na levels fall below 120 mEq/L. Why?
Hypotonic environment swells cells, increasing ICP-brain damage
66
Hypernatremia Serum level Na+
>145mEq/L
67
Hypernatremia results from
Na+ gained in excess of water Or Water is lost in excess of Na+
68
Hypernatremia water shifts from
Cells to ECF
69
S/S: hyperosmolity of ECF
```
Cellular dehydration,
thirst
dry mucous membranes and lips
Oliguyria
Increased temp and pulse
Flushed skin
Restlessness
```
70
Treatment of hypernatremia
IV therapy; hypotonic or isotonic solution
| Diet
71
Causes of hypernatremia- HIGH SALT
H-hypercortisolism overproduction of cortisol (Cushings disease and hyperventilation)
I-increased salt (IV and oral)
G-GI tube feedings without adequate water supplements
H-hypertonic solutions (3% saline)
S-sodium excretion decrease (ex. Corticosteroids)
A-aldosterone problems (^ reabsorption)
L-loss of fluid (dehydration) fever, seweating
T- thirst impairment (access to clean water)
72
S/S of hyernatremia-No "FRIED" foods for you
```
F-fever, flushed skin
R-restless, really agitated
I-increased fluid retention
E-edema, extremely confused
D-decreased urine output, dry mouth and skin
```
73
Nursing interventions for hypernatremia
Restrict Na+
Safety
MD order hypotonic or isotonic IVF (0.45% Na+)-give slowly (hydrating cells)-many cause cerebral edema
Educated patient about diet and S/S of increase sodium levels.
74
Potassium K+ serum level
3.5-5.0 mEq/L
75
Chief electrolyte of intracellular fluid is
Potassium K+
76
Potassium is the major mineral in
All cellular fluids
77
Potassium AIDS in
Muscle contraction,
nerve and electrical impulse conduction,
regulates enzyme activity,
Regulates intracellular fluid H2O content
Assists in acid-bade balance
78
Potassium is regulated by
Kidneys/hormones
79
Potassium is inversely proportional to
Na+- Sodium, too much or to little is deadly
80
Hypokalemia serum level
<3.5 mEq/L
81
Hypokalemia results from
Decreased intake, loss via GI/Renal and potassium depleting diuretics f
82
Hypokalemia is life threatening to
All body systems affected
83
S/S of Hypokalemia
Muscle weakness and leg cramps
Decreased GI motility
Cardiac Arrhythmias
84
Treatment of Hypokalemia is
Diet
Supplements
IV therapy-
85
Causes of hypokalemia "your body is trying to "DITCH potassium"
D-drugs (laxatives, diuretics, corticosteroids)
I-inadequate so sumptuous of Potassium (NPO, anorexia)
T-too much water intake (dilutes the potassium)
C-cushing's syndrome (high secretion of aldosterone)
H-heavy fluid loss (NG suction, vomiting, diarrhea, wound drainage, sweating)
-(other causes: when the potassium moves from the extracellular to the intracellular with alkalosis or hyperinsulinism (this is where too much insulin in the blood and the patient will have symptoms of hypoglycemia).
86
7 L's for hypokalemia
- LETHARGY (confusion)
- LOW, SHALLOW RESPIRATIONS (due to decreased ability to use accessory muscles for breathing)
- LETHAL CARDIAC dysrhythmias
- LOTS of urine
- LEG cramps
- LIMP muscles
- LOW BP and Heart
87
Nursing interventions for hypokalemia
Watch heart rhythm (place on cardiac monitor...most already on telemetry), respiratory status, Nero, GI, urinary output and renal status (BUN and creatinine levels)
> watch other electrolytes like Magnesium (will also decrease...hard to get K+ to increase if Mag is low), watch glucose, sodium, and calcium all go hand-in-hand and play a role in cell transport
lad minister oral supplements for potassium with doctor's order: usually for levels 2.5-3.5...give with food can cause GI upset
>IV potassium for levels less 2.5*****NEVER GIVE POTASSIUM VIA IV PUSH OR BY IM OR SUBQ ROUTES!!!!!!!!!!!
>Give according to the bag instruction don't increase the rate...has to be given SLOW...patients given more than 10-20 mEq/HR should be on a cardiac monitor and monitored for EKG changes
lac use phlebitis or infiltrations
>don't give LASIX, demanded, or thiazides (waste more Potassium) or Digoxin (cause digoxin toxicity) if potassium level low...notify MD for further orders)
>physician will switch patient to a potassium sparing diuretic Dpironolactone (Aldactone), Dyazide, Maxide, Triamterene.
88
For hypokalemia instruct patient to eat
```
"Potassium" rich foods
P-POTATOES, PORK
O-ORANGES
T-TOMATOES
A-AVOCADOS
S-STRAWBERRIES
S-SPINACH
I-fIsh
U-mUSHROOMS
M-MUSK MELONS: CANTALOUPE
A-ALSO INCLUDED ARE: CARROTS, RAISINS, BANANAS
```
89
Potassium is dangerous when
It is too low! Serum K+ < 3.5mEq/L
90
What are some medical conditions that may cause hypokalemia
Renal disease,
Heart failure
Metabolic alkalosis
91
What are some conditions that might cause actual loss of potasaasium from the body
GI losses-nasogastric suctioning, vomiting, diarrhea
| Certain diuretic therapies
92
Cardiac arrest may occur when serum K levels fall below 2.5 mEq/L. Why?
Increased cardiac muscle irritability leads to PACs and PVCs, then AF
93
Hyperkalemia serum level
> 5 mEq/L
94
Hyperkalemia results from
```
Excessive intake,
Trauma
Crush injuries
Burns
Renal failure
Adrenal insufficiency
Acidosis
```
95
S/S of hyperkalemia
Muscle weakness
Cardiac changes
N/V
Paresthesia of face/fingers/tongue
96
You treat hyperkalemia with
Diet
Med's
IV therapy
Possible dialysis
97
Causes of hyperkalemia: the body "CARED" too much about potassium
C-cellular movement of potassium from intracellular to extracellular (burns, tissue damages, acidosis)
A- adrenal insufficiency with Addison's Disease
R-renal failure
E-excessive potassium intake
D-drugs (potassium-sparing drugs like Aldactone (spiraled acetone), Triamterene, ACE inhibitors, NSAIDS (good at retaining)
98
S/S: "MURDER"
M-muscle weakness
U-urine production little or none (renal failure)
R-respiratory failure (due to the decreased ability to use breathing muscles or seizures develop)
D-decreased cardiac contractile the (weak pulse, low blood pressure)
E-early signs of muscle twitches/cramps...late profound weakness, flaccid
R-rhythm changes: Tall peaked T waves, flat p waves, widened QRS and prolonged PR interval
99
Hyperkalemia interventions;
```
Monitor cardiac, respiratory, neuromuscular, renal, and GI status
> stop IV potassium if running and hold any PO potassium supplements
> initiate potassium restricted diet and remember foods that are high in potassium; "POTASSIUM"
-potatoes, pork
Oranges
Tomatoes
Avocados
Strawberries
Spinach
Fish
Mushrooms
Musk melons: cantaloupe
--Also carrots, raisins, bananas
```
100
For hyperkalemia instruct patient not to eat
Potassium rich foods, "POTASSIUM-A"
101
SIGNS of hyperkalemia
```
Muscle twitches-> cramps-> paresthesia
Irritability and anxiety
Decreased BP
EKG changes
Dysrhythmias-irregular rhythm
Abdominal cramping
Diarrhea
```
102
What are some medical conditions that may cause hyperkalemia
Renal disease
Burns trauma
Metabolic acidosis
103
What are some conditions that might cause potassium levels to rise in the body
Certain diuretics
| Excessive intake
104
Cardiac arrest may occur when serum K levels rise above? MEq/L. Why?
Decreased electrical impulse conduction leads to bradycardia and eventual a systole.
105
When administering IV potassium:
Monitor the IV sites for phlebitis
Place on cardiac monitor if > 10 mEq
Assure of adequate mixing of K in solution
Monitor for elevated K levels
Monitor for decreased Na levels
NEVER-administer potassium by slow IV push method
106
Calcium Ca+ total serum levels:
9-11 mg/deciliter, ionized calcium (in serum unbound) 4.25 to 5.25 mg/dL.
107
Calcium is most abundant
In the body but: 98-99% in teeth and bones
108
Calcium is needed for
Nerve transmission
Vitamin B12 absorption
Muscle contraction and blood clotting
109
Calcium has a inverse relationship with
Phosphorus
110
Calcium is needed for Vitamin D for
Gut
111
Calcium is needed for magnesium for
Bones
112
Hypocalcemia serum Ca level
< 9 mg/dL
113
Hypo alchemical results from
```
Low intake,
Blood transfusions
Loop diuretics
Parathyroid disorders (decreased PTH)
Hypoalbuminemia
```
114
S/S: of hypocalcemia
```
Osteomalacia
EKG changes
Numbness/tingling in fingers,
Muscle cramps/tetany
Seizures
Chovstek sign and Trousseau Sigh
```
115
Treatment for hypocalcemia
Diet/ IV therapy
116
Calcium regulation;
Parathyroid detects Too little Ca in blood
| Releases PTH,
117
PTH assists in making
Vitamin D, reabsorption Ca in kidneys
| Ca absorption in intestines and reabsorption from bones.
118
chovstek
Twitching in cheek
119
Trousaseau
Apply pressure hand curls up then Postive for low calcium
120
What are a some medical conditions that may caused hypocalcemia
Hypoparathyroidism
Acute pancreatitis
Crohns diease
Hyperphosphatemia
121
What are some other conditions that might cause low Ca
GI losses-nasogastric suctioning, bomiting, diarrhea, long term immobilization, lactose intolerance
122
If hypocalcemia is prolonged
The body will utilize stored Ca from bones
123
What complication might arise from hypocemia
Fractures ( late sign)
124
Hypercalcemia serum level
> 11 mg/dL
125
Hylpercalemia results from
Hyperarathyroidism
Bone Maligqancies
Prolonged immolation
Drug toxicity (lithium)
126
S/S of hypercalcemia
```
Muscle weakness
Renal calculus
Motility
Altered LOC
Decreased GI motility
Cardiac c
Constipation
N/V
Polyuria
```
127
Treatment of hypercalcemias
Medication/ IV therapy
128
What are some medical conditions that. At cause hypercalcemia
Hyperparathyroidism
Paget's disease
Some cancers-multiple myleoma
Chronic alcoholism
129
What are some other conditions that might cause low Ca
Excessive intake of Ca or Vitamin D
| Excessive intake of OTC antacids
130
If hypercalcemia is unccorrected,
AV block and cardiac arrest may occur
131
Magnesium Mg2+ serum level
1.5-2.5 mERq/L
132
Magnesium is most located
Within intracellular fluid
133
Magnesium is most needed for
Activating enzymes, electrical activity
Metabolism of carbs do/proteins
DNA synthesis
134
Magnesium is reglulated by
Intestinal absorption and kidney
135
Hypomagnesemia serum level
1.5 mEq/L
136
Hypomagnesemia results from
Decreased intak,
Prolonged NPO status
Chronic alcoholism aND NASOGASTRIC SUCTIONING
137
S/S: of hypomagnese
Muscle weakness
Cardiac changes
Mental changes
Hyperactive reflexes and other hypocalcemia S/S
138
Treatment of hypomagnesemia
Replacement IV therapy restore normal Ca levels (Mg mimics Ca)
Seizure precations
139
Hypomagnesemia is common in
Critically ill patients
140
Hypomagnesemia is associated with
High mortality rates
141
Hypomagnesemia
Increases cardiac irritability and ventricular dysthymia -especially in patients with recent MI
142
Maintenance of hypomagnesemia
With adequate serum Mg has been shown to reduce mortality rates post MI
143
Hypomagnesemia is
An uncommon variant of ventricular tachycardia
| The rhythm is usually self-terminating but may degenerate into ventricular fibrillation
144
Hypermagnesemia serum level is
> 2.,5 mEq/L
145
Hypermagnesemia results from
Renal failure
| Increased intake
146
S/S do hypermagnesemia
```
Flushing
Lethargy
Cardiac changes (decreased HR)
Decreased resp
Loss of deep tendon reflexes
```
147
Treatment of hypermagnesemia
Restrict intake diuretic rx
148
Chloride Cl- serum level
95-1-05 mEq/L
149
The most abundant anion in extracellular fluid
Chloride Cl-
150
Chloride maintains
Osmotic pressure
Acid-base balance
And AIDS in digestion (forming hydrochloride acid in then stomach
151
Chloride is regulated by
Kidneys
152
What is most always found with chloride
Sodium Na
153
When serum level in < 95 mEq/L in chloride it is
Hypochloremia
154
Hypochloremia results from
Prolonged vomiting, diarrhea and suctioning
155
S/S of Hypochloremia are
Paresthesia of face and extreme ties
Muscle spasm
Tetany
156
Treatment for Hypochloremia consist of
Diet
| IV therapy
157
Hyperchloremia starts at what serum level
> 105 mEq/L
158
Hyperchloremia results from
```
Diarrhea
Renal failure
Overactive parathyroid glands
Metabolic acidosis and
Respiratory alkalosis
```
159
S/S of hyperchloremia are
Muscle weakness
Increased thirst
Kussmauls's Respirations (short rapid Respirations)
160
You treat hyperchloremia by
IV fluids
Diuretics
And treat the cause
161
Interventions for fluid and electrolyte balance consist of
```
Assess patient carefully-note changes
Monitor I & O (intake & output)
Monitor weight changes
Monitor urine
Monitor VS
Monitor lab results and dx test
Maintain proper IV therapy
```
162
Sodium which is outside the cell in extracellular fluid consist of
90% of ECF cations
163
Sodium has a
Positive charge
164
Sodium always hangs out with its
Negative anion friends-chloride and bicarbonate
165
Interstitial sodium surrounds
Cells of the body
| Circulatory or inter vascular fluid for glucose
166
Decreased Na is caused by
Dilution as a result of excess H2O or increase Na loss
167
Some situations of hyponatremia
```
Gastrointestinal suctioning
Vomiting
Diuretics
Mannitol/fluid shift from ICF to ECF by hypertonic solutions which leads to dilution all Hyponatremia
Inadequate salt intake
Diarrhea
```
168
S/S of Hyponatremia
```
Lethargy
headache
Confusion
Apprehension
Seizures
Coma
```
169
The highest priority of life
Homeostasis
170
Concept of homeostasis is
Dynamic processes involved in the maintenance of body functioning
171
Homeostasis is
The way our internal body system responses to maintain stability or steady state
172
Imbalance is
Not compatible with Life
173
Homeostasis related to volume and composition of body fluids with which internal body organs
Kidneys
Heart and
Lungs
174
Factors that are involved in helping to maintain the homeostasis of the volume of the vascular system are
Hormones such as antidiuretic hormone
| The renin-angiotensin-aldosterone system and atrial natriuretic factor
175
Homeostasis is
The state of dynamic equilibrium of the internal environment of the body that is maintained by the ever-changing process of feedback and regulation in response to external or internal changes
176
Homeostasis is only stagnet at
Death
177
Fluids in the body
```
Blood
Serum
Saline
Albumin
Bile
Urine
Hormones
Cerebrospinal
```
178
Electrolytes in the body are
Charged ions capable of conducting electricity
179
Body fluid composition of water in infant is
70-80%
180
Body fluid composition of water in older adults is
45-55%
181
The average adult body fluid composition of water is
50-60%
182
The Role of water is
```
Medium for transport and & exchange of nutrients
Medium for elimination of wastes
Medium for metabolic processes
Regulates body temperature
Insulation/lubrication
```
183
Total body weight is determined
0.6 x body weight
184
ECF fluid volume is
1/3 of total body weight
185
ECF is further broken down to
Interstitial fluid with 3/4 of ECF
Plasma 1/4 fo ECF
Transcellular fluid
186
Fluid compartments of ECF
Vascular-3 L
Interstitial- 1 L
Transcellular
And intracellular ICF- 28 L
187
Fluid compartment output through
```
Kidneys
Lungs
Feces
Sweat
Skin
```
188
Ions is
A substance that when dissolved in water dissociates and becomes ions (charged)
189
Cations:
Positively charged
190
Anions:
Negatively charged
191
Electrolytes
Work with fluids to keep the body healthy and in balance
192
Electrolytes are
So lutes that are found in various concentrations and measured in terms of milliquivalent (mEq) units
193
Electrolytes are typically
Gained and lost in equivalent amounts
194
For homeostasis body needs:
Total body ANIONS = total body CATIONS
195
Electrolytes in cations-positive charge
Sodium Na+- mental status
Potassium K+ - heart
Calcium Ca++- bones
Magnesium Mg++
196
Most important electrolytes of cations are
Sodium
Potasaasium
Calcium
197
Electrolytes in anions-negative charge
Chloride Cl-
Phosphate PO4-
Bicarbonate HCO3-
198
Electrolyte imbalances are caused by
Abnormal losses; nasogastric suctioning
Hemorrhage
Vomiting and /or diarrhea
199
Electrolyte imbalances are also caused by
Abnormal gains;
Polydipsia- overload fluid
Increased salt intake
Heart/kidney dysfunction
200
Mechanisms of fluid and electrolyte movement
Diffusion
Osmosis
Filtration
And active transport
201
Diffusion is
Passive movement of electrolytes or other particles down the concentration gradient (from higher to lower concentration
202
Facilitated diffusion
Requires a carrier molecule
| And accelerates rate of diffusion
203
Filtration
Movement across a membrane under pressure from a higher to lower pressure
204
Osmosis
Movement of water from an area of lesser to one of greater concentration through a semi-permeable membrane
205
Active transport
Movement of ions against the osmotic pressure to an area of higher pressure: requires energy
206
Two major factors regulate the movement of water and electrolytes from one fluid compartment to another they are
Hydrostatic pressure
| And osmotic pressure
207
Hydrostatic pressure
Arterial side pushing out to a lesser; vascular and capillary
208
Osmotic pressure
Venous side sucking from lesser to higher; interstitial to vascular
209
Cation in ICF
Potassium
| Magnessium
210
Cation in ECF
Sodium
| Calicum
211
Anion in ECF
Chloride
| Bicarbonate
212
Anion in ICF
Phosphorus
213
Electrolytes in ECF are
Sodium chloride bicarbonate
| Calicum
214
Electrolytes in ICF are
Potassium
Magnessium
Phosphate
215
Na and Cl form a
Perfect valance NaCl
216
PO4- and Ca form a
Perfect valance
217
Potassium K+
3.5-5
218
Magnessium Mg+
1.5-2.5
219
Sodium Na
135-145
220
Calcium Ca
9-11
221
Chloride Cl-
95-105
222
Phosphate PO4-
2.5-4.5
223
Bicarbonate HCO3-;buffer
22-26
224
Serum osmolality
280-300 mOsm/kg
225
Urine osmolality
200-800 mOsm/kg
226
Urine specific gravity
1.005-1.030
227
CBC
40-50 cells to plasma
228
Molarity is
Fluid outside
229
Maloality is
Fluid inside
230
Osmotic pressure
An inward- pulling force caused by particles in the interstitial and intracellular fluids
231
Any condition that changes osmotic pressure in either ICF or ECF compartments will cause a
Redistribution of water
232
_________ is required to stop the osmotic flow of water
Pressure
233
The major colloid in the vascular system contributing to the total osmotic pressure is
Protein (Albumin) = colloid osmotic pressure
234
Hydrostatic pressure is the ________ force
Pushing
235
Colloid Osmotic pressure is the _____ force
Pulling
236
What represents the "push" and "pull" required to maintain homeostasis between the interstitial and intravascular spaces
Hydrostatic pressure and colloid osmotic pressure
237
You have to be careful with patients with
CHF and Renal disease
238
Osmosis molecules
Go through a semipermeable membrane; just water
239
Molecules move around
To creat equilibrium
240
Diffusion molecules
Spread out over a large area; everything but water
241
First spacing
Normal distribution of fluid in ICFG and ECF
242
Second spacing
Abnormal accumulation of interstitial fluid (edema)
243
Third spacing
Most problematic; fluid accumulation in part of body where it is not easily exchanges with ECF
244
Fluid shifts-plasma-to-interstitial fluid shift results in edema; causes
Elevation of hydrostatic pressure
Decrease in plasma colloid osmotic pressure
Elevation of interstitial colloid osmotic pressure
245
Edema
Fluid build up under the skin
246
Subcutaneous pitting edema
You can push on skin where fluid is accumulated and it keeps an indention.
247
Fluid shifts- interstitial fluid to plasma
```
Fluid drawn into plasma space with increase in plasma osmotic or colloid osmotic pressure
And
Diuretics (pulls fluid into vascular) and compression stockings (pushes back into plasma) decrease peripheral edema
```
248
Third-space fluid shift/third "spacing"
Loss of ECF into a space that does not contribute to equilibrium between ICF and ECF
249
Examples of third spacing can be seen in
```
As cites
Burns
Peritonitis
Bowel obstruction
Massive bleeding
Liver failure
```
250
Belly and gut are
Very permeable
251
Ascites
Abdominal swelling caused by accumulation of fluid, most often related to liver disease
252
Fluid intake is regulated by
Thirst mechanism in the brain
253
Fluid output is regulated by
Kidneys-skin-lungs-GI tract; urine, sweat, metabolism,
254
Hormones are regulated by
ADH-Aldosterone
255
Intake equals
Output
256
Oral fluid intake daily
1200 mL
257
Solid food intake daily
1000 mL
258
Oxidative metabolism intake
300 mL
259
Total intake per day
2500 mL
260
Output of kidney/urine
1500 ML
261
GI/feces
100 mL
262
Insensible loss (SKIN/LUNGS)
900 ML
263
Total output per dasy
250 mL
264
Osmolality
Refers to the solute concerntration in fluid by weight. The number of millions old (mOsm/kg) in a kilogram of solution. Fluid inside the body.
265
Osmolarity
Refers to the solute in concentration in fluid by volume. The number of milolosmols (mOsm/L) by liter. Pertains to fluids outside of the body.
266
Changes in water content causes cells to
Either swell or shrink
267
Normal serums (plasma) osmolality is
290mOsm/kg
268
Toxicity of a solutions can be IV
Hypotonic, isotonic and hypertonic
269
Hypotonic
< 250
270
Isotonic
290 same as the normal plasma serum
271
Hypertonic
> 375
272
Lactate ringer LR
For fluid resecetation
273
D5W
Is isotonic until it reaches the body then turns hypotonic
| No babies or head injury patients
274
0.9% NS NaCl
Expand volume, dilute medication and keep vein open
275
Intravenous fluids can change the fluid compartments in one of the following ways:
Expand the intravascular compartment,
Expand the intravascular compartment and deplete then intracellular and interstitial compartments,
Expand the intracellular compartment and deplete the intravascular compartment
276
Intravenous solutions of hypotonic and RBCs
Because inside is higher concentration it will swell
277
RBSc in a isotonic solution will
Stay the same because of same concentration inside and outside
278
RBSc in a hypertonic solution will
Shrink because inside concentration is less than outside of the cells
279
Hypotonic solution has
Low osmolality in relation to plasma (<250)
Provides more weather than electrolytes
Dilutes the ECF and produces movement of water from the ECF to the ICF (moves water into the cells)
280
Hypotonic solution is administered to expand the
Intracellular space. Commonly infused top dilute extracellular fluid and rehydrate the cells of patients who have hypertonic fluid imbalances and to treat gastric fluid loss and dehydration from excessive diuretics.
281
Hypotonic solution
5% dextrose in water (this is technically isotonic, but once the dextrose is absorbed then it acts on the body as if it were hypotonic)
-0.45% NS
Do NOT GIVE TO HYPOTENSIVE PATIENTS
282
Isotonic solutions
Have same osmolality in relation to plasma (290)
No fluid shifts
Expands the body's fluid (extracellular fluid) flume without causing a fluid shift, replaces fluid loss, expands intravascular (plasma) volume
283
Isotonic solution
0.9% NaCl
| Lactate do Ringers solution
284
Hypertonic solutions are
High osmolality in relation to plasma (>375)
Fluid shifts from ICF top ECF compartments
Draws water from the cells (ICF) into the vascular and interstitial spaces (ECF)
Used to treat patients who have severe Hyponatremia
285
Hypertonic solutions
```
D5NS- 5% dextrose in 0.9% sodium chloride
D5LR- 5% dextrose in lactate do ringers
D10W- 10% dextrose
5% dextrose in 0.45%
Monitor patients closely.
```
286
7 regulations of water balance in maintaining homeostasis
```
Hypothalamic regulation
Pituitary regulation
Adrenal cortical regulation
Renal regulation
Cardiac regulation
Gastrointestinal regulation
Insensible water loss
```
