Exam 3: Fluid, Acid-Base, Patho, and Pharm Principles

Isotonic fluid excess (FVE)

gain of TBW with proportional change in concentration of electrolytes

Diffusion

movement of particles

Osmosis

movement of fluids from low concentration to high of solutes

Recommended intake for fluids

around 3.7L for men 2.7L for women

How to assess hydration

color of urine (pale yellow = adequate hydration)

Things that affect hydration

climate, physical activity, dietary intake

S&S that would indicate dehydration

dry mouth, thirst, dark urine, fatigue, dizziness, headaches

ICF

intracellular fluid

ECF

extracellular fluid

Primary electrolyte inside the cell (ICF)

Potassium (K+)

Primary electrolyte outside the cell (ECF)

Sodium (Na+)

Osmolality

normal concentration of solutes in water

Tonicity

concentration of IV fluid

Hypertonic tonicity

higher than body

Isotonic tonicity

equal

Hypotonic tonicity

lower than body

RAAS system

renin-angiotensin-aldosterone system; allows body to release fluid

Aldosterone

tells kidney to reabsorb sodium and water

Renin

released by kidney when BP drops

Activation of angiotensin II

causes vasoconstriction

Isotonic fluid

equal water with equal sodium

Isotonic fluid loss (FVD)

loss of total bod water w proportional change in concentration of electrolytes

Hypertonic alterations

high sodium, fluid loss, hypernatremia and water deficit

Hypotonic alterations

high water, low sodium, hyponatremia and water excess

Fluid volume deficit (FVD) S&S

low BP, hypotension, orthostatic hypotension, tachycardia, dizziness, thirst, poor skin turgor, weakness (seen in veins and arteries)

Fluid volume deficit (FVD) causes

vomiting, diarrhea, burns, hemorrhage, drainage from NG suctioning, not enough fluid intake, NPO status

Fluid volume deficit (FVD) treatment

IV fluid (bolus), oral fluids

Fluid volume excess (FVE) S&S

high BP, bounding pulse, pulmonary congestion, JVD, edema (seen in veins and arteries)

Fluid volume excess (FVE) causes

Kidney failure, high sodium intake, excessive fluid replacement or intake, heart failure or liver failure

Fluid volume excess (FVE) treatment

Assess lung sounds and VS, strict I&O, fowlers position

Example of hypotonic fluids

pure water, dilute saline solutions (lower osmolality than body)

Example of isotonic fluids

normal saline, 5% dextrose in water (equal osmolality)

Example of hypertonic fluids

concentrated saline solutions, 10% dextrose in water (higher osmolality than body)

Hypotonic in RBCs

bloat and burst

Isotonic in RBCs

conditions are ideal

Hypertonic in RBCs

cause to shrivel and may die

Hypotonic movement

move water into cells causing to swell

Isotonic movement

remain in bloodstream w/out significant fluid shifts

Hypertonic movement

draw water out of cells causing them to shrink

Hypotonic move fluid

into cells

Hypertonic move fluid

out of cells

Osmosis is how water moves between

IC and ECG compartments

Causes of edema

poor circulation, med side effects, pregnancy, heart failure, kidney disease, liver disease, high sodium intake

Manifestations of edema

swelling, potential pitting

Treatment of edema

address underlying cause, reduce salt intake, elevate affected areas, compression stockings, diuretic meds to remove excess fluid

Sodium normal levels

136-145 mEq/L

Sodium signs of deficit

muscle cramping, memory loss, anorexia, seizure

Hyponatremia (low sodium) treatment

restrict water intake

Hypernatremia (high sodium) treatment

hypotonic solution, encourage fluids, restrict sodium

Potassium normal levels

3.5-5.0 mEq/L

Potassium signs of deficit

dysrhythmias

Potassium treatment

replacement - dietary, PO, never IV push, IM or SubQ

Hypokalemia (low potassium) treatment

replace orally and/or intravenously

Hyperkalemia (high potassium) treatment

polystyrene sulfonate

Normal pH

7.35-7.45

pH below 6.8

death

pH above 7.8

death

pH <7.35

acidosis

pH >7.45

alkalosis

Normal PaCO2

35-45

Normal HCO3

22-26

If CO2 matches pH

respiratory (high is acid/acidosis)

If HCO3 matches pH

metabolic (high is base/alkalosis)

Systems that help regulate the acid-base balance

Respiratory and renal

System increase in H+ concentration

acidosis

System decrease in H+ concentration or excess of base

alkalosis

HCO3 less than 22 mEq/L

metabolic acidosis

Metabolic acidosis symptoms

hyperventilation, nausea, vomiting

Metabolic acidosis causes

lactic acidosis, renal failure, diabetic ketoacidosis, diarrhea, starvation

Metabolic acidosis treatment

buffering solution, treat underlying cause, correct sodium and water deficits

HCO3 greater than 26 mEq/L

metabolic alkalosis

Metabolic alkalosis symptoms

dysrhythmias, confusion restlessness, hypoventilation

Metabolic alkalosis causes

NG tube suctioned out acid in stomach, vomited out acid, hyperaldasteronism w hypokalemia, diuretic therapy

Metabolic alkalosis treatment

add acid back into body, give sodium chloride and potassium

PaCO2 greater than 45 mmHg

respiratory acidosis

Respiratory acidosis symptoms

shallow breathing, headache, dysrythmias

Respiratory acidosis causes

respiratory depression, muscle paralysis, disorders of chest wall, cannot breath out acid, high potassium

Respiratory acidosis treatment

restore adequate ventilation, mechanical ventilation, oxygen therapy

PaCO2 greater than 35 mmHg

respiratory alkalosis

Respiratory alkalosis symptoms

high pH, hyperventilation, tachycardia, hypokalemia

Respiratory alkalosis causes

panic attack, not enough oxygen in air, hyperventilating, fever, low RBCs

Respiratory alkalosis treatment

slow respirations, rebreathe CO2, paper bag, treat hypoxemia and hypermetabolic states

During RAAS activation, what gland releases aldosterone?

adrenal cortex

Hypertension, shortness of breath, and JVD are all signs of

fluid volume excess

pH 7.51, bicarbonate (HCO3) 26 mEq/L, carbon dioxide (PaCO2) 30 mm Hg

respiratory alkalosis

A client comes into ED and appears to be having a panic attack, is very anxious, and is breathing very rapidly, until she finally passes out. What is the client's acid-base imbalance?

respiratory alkalosis

What type of fluid is Dextrose 5% in 0.9%NS

hypertonic crystalloid that causes fluid to shift back into the vascular circulation

What type of fluid is 0.45%NS

hypotonic that causes fluid to move into the cells from the bloodstream

What type of fluid is Lactated Ringers?

isotonic crystalloid that helps replenish lost fluids and electrolytes

Pathophysiology

study of functional changes in cells, and organs altered by disease and/or injury

Pathos

suffering

Logos

discourse

Physio

function of organisms

Pathology

study of structural alterations in cells, tissues, and organs that help identify cause of disease

Pathogenesis

pattern of tissue changes associated w development of disease

Etiology

study of cause of disease

Idiopathic

diseases w no identifiable cause

Iatrogenic

diseases as a result of medical intervention

Clinical manifestations

signs and symptoms

Nosocomial

hospital acquired infection