Fluid and electrolytes notes from class week one

Nursing prevention for fluid and electrolytes

Diet and education And also monitoring I& o which are key fluid and electrolytes

What's something we identify in fluid and electrolytes

Assessment and we use labs especially for sodium, edema, dehydration, kidneys

edema is most common in

The legs

Why is dehydration, important? Why?

How much did you input, tenting, dry, mucus membranes?

Kidneys - Identify

Manages fluid and electrolytes

How does your body respond to imbalance?

Well, if you're dehydrated, you will need fluid and if there's an imbalance effect you need to check your diet and if there is a edema, you can use diuretics such as furosemide

How much fluid is in the intracellular?

2/3

What are the three compartments of the extracellular?

Intravascular in interstitial, which are very important and also transcellular, which includes spinal and joint fluid which we don't focus too much but it's so important it's more in level three and level four

Positive cations

sodium, potassium, calcium, magnesium

Negative anions

chloride, phosphate, bicarbonate

Hydrostatic pressure

How hard your left ventricle is pumping into the arteries

How is hydrostatic pressure read

Read it by blood pressure

When you have high hydrostatic pressure

You're going to have a high heart rate, edema, and a high blood pressure the high pressure will damage and can cause atherosclerosis

A low hydrostatic pressure

Is a low heart rate, poor circulation, low blood pressure

A low hydrostatic pressure can cause

Poor circulation, and can essentially kill the cell or a body part

Normal sodium levels

135-145 mEq/L

What happens when we don't have osmotic fluid?

There's not enough sodium, not enough for and they can be epidemic

Tonicity

the ability of a surrounding solution to cause a cell to gain or lose water or how salty or sugary the fluid is

Parathyroid issues can affect what electrolytes

Calcium and phosphorus

Do we give a hypotonic solution?

Because there's way too much saw in their system, so I have to dilute that all and it will make the the cell swell

85% of the ECF is

Sodium

For a hypertonic solution

The cells are going to shrink

Or a hypotonic solution

The cells are going to expand

An example of when to give a hypertonic solution

When a client is in a car accident or has a concussion they are going to be swollen so you're going to give a hypertonic

Would we give solutes fast or slow?

You're going to give them slow

What's the perfect iv solution?

0.9 normal saline or lactated ringers

What happens when aldosterone is on?

It keeps H2O and sodium, which can lead to edema, chronic heart failure, and hypertension

What happens if aldosterone is off?

You lose water and sodium, which can lead to dehydration

Aldosterone is a type of

Steroid

In Addison's disease, is there more aldosterone or less?

There will be less so a lack of the steroid

What does aldosterone do?

Increases reabsorption of sodium and increases secretion of potassium

Let's say you have a patient with a heart issue Hypertension what will the rAAS look like in the Aldosterone?

The RASS system is turning on the ALDOSTERONE , keeping it on. That's why the patient will look EDEMIC sometimes it's not just hydrostatic pressure.

Another example of aldosterone being on

Congestive heart failure

The RAAS system

Renin is produced by the kidneys in response to impaired blood flow & tissue perfusion, and converts angiotensinogen in the blood to angiotensin I; ACE converts angiotensin I to angiotensin II in the lungs. Angiotensin II then vasoconstricts and stimulates the release of aldosterone. Aldosterone then promotes Na and water retention as well as K excretion.

Does the RAAS hold volume?

yes and decreases cardiac output

When there's to much fluid what medication can you give?

Diuretics help take some of that fluid out

What does the pituitary gland secrete?

ADH and it tells the kidneys to hold onto H2O and response to thirst

Atrial natriuretic peptide (ANP)

(Comes from muscle cells) hormone secreted from atrial cells of the heart in response to atrial stretching and an increase in circulating blood volume. ANP has been identified as a diuretic that causes sodium loss and inhibits the thirst mechanism

What is brain natriuretic peptide (BNP)?

Secreted by (ventricle cells) cardiac muscle when heart failure develop or worsen; normal < 100 pg/ml; measure serum BNP helpful determine if patient symptom result of CHF or such COPD; TX diuretic, positive inotropic agents.

What is geriatric considerations for fluid and electrolytes?

Dehydration is common, low renal function, electrolyte imbalance, and we have to watch their I&O's

What is serum osmolality?

a measure of the solute concentration sodium ,BUN ,glucose of the blood

What does high serum osmolality mean?

It means there's more solute which means it's more concentrated

What does it mean when serum osmolality is less?

There's less solutes, and it is diluted

Serum Osmolality

275-290 mOsm/kg water

Urine osmolality

200-800 mOsm/kg

Factors, increasing serum osmolality

-severe dehydration
-free water los
-diabetes insipidus
-hypernatremia
-hyperglycemia
-stroke or head injury
-acute tubular necrosis
-Consumption of methanol or ethylene glycol (antifreeze)
-High ion gap metabolic acidosis
-Advanced liver disease
-alcoholism
-Burns

Factors decreasing serum osmolality

fluid volume excess, SIADH ,acute kidney injury,diuretic use, adrenal, insufficiency, hyponatremia, overhydration, paraneoplastic syndrome associated with lung cancer

What is urine osmolality?

a measure of how concentrated the urine is (urea, creatine, uric acid, kidney failure)

What causes urine osmolality to be high?

The volume deficit, SI,ADH, congestive heart failure, acidosis, perennial, kidney injury

What causes urine osmolality to be low?

Fluid volume excess ,diabetes insipidus, hyponatremia, Aahar, pyelonephritis, tubular, necrosis

High specific gravity

More concentration (+1.030)

Less specific gravity

Less "dilute" (-1.005)

When Urine serum gravity is high

There is a loss of flu, which include dehydration, nausea, vomiting, SIADH

Why is SIADH more concentrated in urine specific gravity?

Because he only manipulates water you have to fix this first

When urine sodium gravity is low

There's excess hydration, kidney issues, DI

How does diabetes insipidus happen?

There is damage to the territory and can't produce ADH

If a patient comes in and is feeling sick and is saying that they have been vomiting for three days and you do the specific gravity what would it be?

Specific gravity would be more concentrated Which means the urine specific gravity would be high

Why is it with patients with SIADH it is more concentrated

They don't pee so much because there's a lot of ADH, and ADH only manipulates water not electrolytes

What is the urine sodium gravity going to be in diabetes insipidus

Going to be less concentrated for DI

BUN levels

10-20 mg/dL

creatnine levels

0.7-1.4/100ml

Creatine

Is not a waste of product

Creatinine

nitrogenous waste excreted in the urine

High BUN, and high creatinine, that means

There is some kidney problems and you can probably see edema

What is hematocrit (Hct)?

Percent of red blood cells(RBC) in a volume of whole blood

hematocrit level female

35-47%

Hematocrit men

45-52%

high hematocrit

dehydration, burns, diarrhea

low hematocrit

anemia, blood loss, micronutrient deficiency, chronic infection

What if a patient came in with massive diarrhea? Losing our fluid what level would you check?

You would check the urine specific gravity and the serum osmolality , and they would be more concentrated

If you have excess hydration, what will my serum osmolality look like?

You're specific gravity would be low in your serum will be low diluted

Patient comes in feeling sick. I've been feeling low and I've been vomiting. You ask how long they vomiting and they tell you three days. What are the specific gravity results going to be?

Concentrated (high)

What is DI dry inside?

Lack of ADH, can't retain water it's going out and sodium gravity is less concentrated

How do the kidneys look like when they have damage?

High bun and high creatine

Some patients have nerve damage so they can't

Contract so it just sits there and it causes urinary retention and if it's not the bladder. Well it's a kidneys.