Test 2 Flashcards
What is “Third Spacing”?
Loss of extracellular fluid into space that doesn’t contribute to equilibrium. It isn’t increasing blood volume, or carrying nutrients or oxygen, or doing anything useful, just hanging out in the tissues outside of the cells.
The difference between osmosis and diffusion is what? How do they both differ from the sodium/potassium pump?
Osmosis is the movement of water across a membrane, diffusion is the movement of stuff across the membrane, and the Na/K pump uses ATP while the other two don’t.
How do people lose fluids and electrolytes?
How do they gain them?
LOSS:
Kidneys- pee everything out
Skin- sweat/burns
Lungs - respiration (300ml /day with increased rr)
GI - large losses due to diarrhea
Heart - increases blood flow to kidneys
GAIN:
Drinking and eating
What is average healthy urine output?
60ml/hr
If Na is high, do we make more or less ADH? If it’s low? Why?
If Na is high we want to dilute it, so we make more ANTIdiuretic Hormone to hold on to the water. If it’s low, we make less so that we don’t further dilute it.
What is the importance of the RAAS?
Renin-Angiotensin-Aldosterone System:Primary way we balance our bp. It is a chain of chemicals released to help body increase BP & blood volume (vasoconstriction, sodium/water retention)
What are gerontological considerations regarding fluid homeostasis?
Kidney don’t work as well, hold on to the K, don’t release Na
Skin turgor is no longer as reliable an indicator of dehydration.
Fluid deficit actually causes delirium
They don’t want to pee, so they don’t drink
What is the difference between fluid volume deficit and dehydration?
FVD you lose everything- all the fluid and the electrolytes therein. Dehydration, you lose the fluid, keep the electrolytes.
The Three Major kinds of shock are :
One has subsets, what are they?
Shock is literally your body’s response to cells not getting what they need to function-
That happens 3 ways:
Hypovolemic shock- there is no blood to move to cells
Cardiogenic shock - there is no working pump to move the blood
Distributive Shock - The heart is pumping, and there exists enough blood, but there is a hitch in the get along. Hitches are : Sepsis, Neurogenic, and Anaphylactic
What is the only thing that can go in the same line as blood?
Normal Saline
What are the symptoms of FVE?
1 Edema/weight gain
2 Distended neck veins /bounding pulses
3 Crackles
4 Increased RR and Urine output as the body tries to pee it out and breathe it off
What’s the classic sign of fluid volume deficit?
Orthostatic hypotension
What are the symptoms of FVD?
1) Orthostatic Hypotension
2) Weight loss
3) Decreased skin turgor
4) Thirst
5) Oliguria and cool skin as your body vasoconstricts to keep fluid central
6) Fatigue/weakness/cramps
What is nursing management of FVD?
I&O at least every 8 hours, sometimes hourly
Daily weight
Vital signs closely monitored
Skin and tongue turgor, mucosa, urine output, mental status
Measures to minimize fluid loss
Administration of oral fluids
Administration of parenteral fluids
What is nursing management of FVE?
I&O and daily weights; assess lung sounds (crackles), edema, other symptoms; monitor responses to medications i.e. diuretics
Promote adherence to fluid restrictions, patient teaching related to sodium and fluid restrictions
Monitor, avoid sources of excessive sodium, including medications
Promote rest
Semi-Fowler’s position for orthopnea
Skin care, positioning/turning
How does medical management of FVE differ from FVD?
FVE means diuretics, Na restrictions and possibly diallysis, FVD is basically fluid replacement.
What is the definition of hyponatremia? What does it look like? Why does that make sense?
Def: Na < 135
It looks like dehydration, which makes sense because where Na goes, H2O goes, and the Na isn’t here.
Symptoms: headache, confusion/neuro probs, poor skin turgor, dry mouth, drop in BP, nausea, abd cramping
How does hyponatremia usually occur in the hospital?
Over hydration of surgical patient
What organ is most affected by Na imbalance? Different question, What should you think of when you think of Na?
The brain. Too high or low and people start acting real weird.
Think water when you think Na.
How is hyponatremia treated?
Treat underlying condition
Water RESTRICTION - it looks like dehydration but isn’t- we don’t want to dilute the blood any more
Same as fluid imbalances- daily wieght, Is&Os, watch labs, CNS changes
Replace Na
Possible ADH receptor antagonists (pee more)
Watch for Li intoxication if patient is on lithium and has low Na, also diuretics can cause hyponatremia, so double check orders
What is the definition of hypernatremia? What does it look like?
Na > 145
Also looks like dehydration which also makes sense because there is elevated Na in dehydration
Hypo is cool because vasoconstriction, Hyper is elevated temperature,
SWOLLEN dry tongue, sticky mucus membranes, lethargy, restlessnes SEIZURES, N/V/A -
Looks a lot like low Na - High has seizures, elevated temps, and swollen tongue that Low doesn’t have.
Pts in both cases are confused and generally ADR
Neurogenic shock looks like what?
Activation of the parasympathetic nervous system.
LOW hr, low bp, dry warm skin
Mnemonic for hyPERcalemia:
Stones, bones, groans, thrones, and moans
The mnemonic painful bones (abnormal bone remodeling), renal stones (kidney stones from hypercalciuria), abdominal groans (hypercalcemia-induced ileus and abdominal pain), thrones (urinary frequency), and psychic moans (depression) can be used to recall the common symptoms of hypercalcemia
Mnemonic for hyPERkalemia
MURDER
Muscle weakness
Urine: oliguria, anuria
Respiratory distress
Decreased cardiac contractility
EKG changes: peaked T waves; QRS widening
Reflexes: hyperreflexia or areflexia (flaccid)