NRSG 2300 unit 8

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fluids and electrolytes

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110 Terms

1
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What % of solids make up the body based on gender

female is 45% and male 40%

2
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What % of fluids make up the body based on gender

female is 55% and male is 60%

3
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What % of fluid in the body are ICF

2/3

4
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What % of fluid in the body is ECF

1/3

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What makes up ECF fluid

80% is interstitial fluid and 20% is plasma 

6
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Interstitial fluid

fluid in-between cells and intravascular fluid/plasma

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Balance of fluid in the body is maintained by what

input and output

8
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When you get older, you have a decrease in what

thirst sensation aka are dehydrated more

9
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Fluid and electrolyte balance is maintained thru 3 main mechanisms

  1. Diffusion

  2. Osmosis

  3. Hydrostatic pressure aka filtration

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Diffusion

movement of solutes form an area of greater/higher concentration to an area of lesser/lower concentration. It is not pushed but it attracted which makes it move. Makes it so both sides of the permeable membrane are equal in solutes

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Diffusion rate increases as concentration on one side ____

increases (this means that the more concentrated side of solutes, the faster they rush out)

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Diffusion rate also depends on _______

solubility (aka the smaller the molecule the more rapidly they can cross the barrier of the membrane)

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Osmosis

the movement of water from a diluted solution/low concentration of a solute to a more concentrated or high concentration of a solute solution. Basically, there will then be either less particles with less fluid on one side or more particles with more fluid on the other side.

14
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Another word for osmolarity

concentration

15
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How to achieve homeostasis with osmosis

water will move from an area w low osmolarity or concentration thru the permeable membrane to an area of high osmolarity

16
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The movement of water between intracellular and plasma spaces is dependent upon what

osmolarity of compartments 

17
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True or false, can you do a test to test plasma osmolarity

true

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True or false, the space w the highest concentration of solutes and the lowest concentration of water will have the lowest osmotic pressure/pull

false, the space w the highest concentration of solutes and lowest concentration of water will have the GREATEST osmotic pressure/pull

19
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Hydrostatic pressure/filtration

when hydrostatic pressure overcomes the opposing osmotic pressure. AKA pressure that is measured in the amount of pressure. 

20
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What determines hydrostatic pressure

pressure and vascular resistance 

21
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Hydrostatic pressure and Osmotic pressure act in a _____ manner to control the movement of fluid form the INTRAVASCULAR SPACE to the INTERSTITIAL SPACE

opposing

22
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Fluid volume deficit

occurs when there is a NEGATIVE fluid balance aka body uses more fluid than what is consumed

23
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Excessive loss of fluid can result in what

dehydration aka losing just water, and volume depletion aka blood loss from losing water and sodium

24
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For each liter that someone experiences in the intracellular space contributes a _____ amount while intravascular space contributes a ______ amount

GREATER, SMALLER

25
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Fluid volume deficit risk factors

young kids decompensate QUICK, Gi bleeding vomiting and diarrhea, diabetes, burns, excessive sweating, third-spacing, illness, injury, diuretics, altered intake, age older than 65

26
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Fluid volume deficit findings

hypotension that leads to tachycardia, confusion, increased rr, oliguria/dark urine, dry mucus and poor skin turgor, increase in BUN serum osmolality and urine osmolality. 

27
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With fluid volume deficit, Hgb and Hct are elevated if FVD is from

WATER LOSS. 

28
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With fluid volume deficit, Hgb and Hct are low if FVD is due to

BLOOD LOSS

29
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Fluid volume deficit on overall health

organ and tissue damage and failure, cerebral hypo perfusion, safety, morbidity, client ed

30
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Nursing care with fluid volume deficit

use fall prevention measures, pt ed, daily weights (most accurate way to assess fluid loss or gain), increase fluids and sodium intake, put pt in trendelenburg position if in hypovolemic shock

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Outcomes with fluid volume deficit

look for vital signs so increased hr and rr but decreased bp, labs, urine output should be 0.5mL/kg/hr, they recover once the cause of the imbalance is identified and appropriate fluid replacement I used, monitor for hypovolemic shock

32
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Fluid volume excess

occurs from total body sodium content (decrease, normal, or increased levels)

33
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What can occur disease wise with fluid volume excess

heart failure, liver cirrhosis, and kidney disease/injury, and IV use

34
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Risk factors of fluid volume excess

cardiac, liver, endocrine, and renal disorders. Pregnancy, excessive IV use, and older adults 65 and older

35
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Findings with fluid volume excess

HTN, bounding pulses, jugular vein distention, water intoxication leads to low sodium, decreased LOC, crackles, pulmonary congestion, hypoxia, polyuria, pitting edema, ascites, decreased BUN and Hgb and Hct

36
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Nursing care w fluid volume excess

use fall prevention measures, pt ed, do daily weights (most accurate way to assess fluid loss or gain), restrict fluid and sodium intake, place in semi or high fowlers position

37
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Outcomes of fluid volume excess

respiratory status, edema, cardiac status, BNP, monitor for pulmonary edema

38
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Electrolytes that could be imbalanced

sodium, potassium, calcium, and magnesium

39
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Sodium is in what space

extracellular space

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Potassium is in what space

intracellular space

41
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Sodium

the major electrolyte and cation/positive charged ion. The main electrolyte that is found int he extracellular fluid/interstital space and extracellular intravascular space. Water flows in the direction of sodium concentration and the extracellular fluid sodium level influences fluid retention, excretion, and movement

42
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Sodium helps maintain what

osmolality of plasma and intravascular space and is the main regulator of water balance in the body cause water follows sodium. 

43
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Inside cells, sodium is ____ because potassium is ____ in cells

LOW, HIGH

44
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Hyponatremia

when there is not enough sodium outside the ell so when there is more sodium inside the cell (aka this isn’t normal), then water will go into the cell and makes it SWELL. Sodium is less than 130

45
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Hypernatremia

if we have too much sodium outside the cell in our blood, then fluid pulls out of the cell and SHRINKS the cell. Sodium is more than 150

46
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What can cause hyponatremia

hypovolemic (low volume normal sodium), euvolemic (normal volume low sodium), and hypervolemic (too much fluid and dilute sodium)

47
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What can cause hypernatremia

hypertonic sodium gain, pure water loss, hypotonic fluid loss

48
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Hyponatremia lab findings

low blood sodium, blood osmolarity, urine sodium, and urine gravity

49
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Hypernatremia lab findings

increased blood sodium, osmolarity, and urine gravity and osmolarity

50
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Risk factors for hyponatremia

too much sweat, diuretics, wound drainage, NG suction, hyperlipidemia, kidney disease, NPO, hyperglycemia, low sodium diet, cerebral salt wasting syndrome

51
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Risk factors for hyponatremia from sodium being diluted

hypotonic fluid excess, freshwater accident, kidney and heart failure, SIADH, SSRI meds, older adults

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Hyponatremia findings

hypothermia, tachycardia, hypotension, headache, confusion, lethargy, seizures, dizzy, increased motility, abdominal cramps

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Hyponatremia nursing care

don’t use salt if CKD, use high salt foods and hypertonic fluids, use 0.9% isotonic and ringers IV fluids, monitor I/O, monitor vital signs, maintain open airway

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Hypernatremia risk factors

kidney failure, cushions syndrome, aldosteronism, glucocorticosteroids, excessive intake of oral sodium

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Hypernatremia nursing care

monitor consciousness, vital signs and heart, assess lungs, provide oral hygiene, monitor I/O and potassium, encourage water intake, administer diuretics/loops

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Sodiums main function is to

help maintain electrical membrane excited

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Potassium

the main cation of intracellular fluid, plays a vital role in cell metabolism and transmission of nerve impulses and heart, and acid base balance. Has reciprocal action of sodium when if they are HIGHER in one area and if they cross over then they are HIGHER in the other area

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Hypokalemia risk factors

diuretics, aldosterone, Cushings syndrome, vomit and diarrhea, ng suction, NPO status, kidney disease

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Hypokalemia findings

low bp and weak pulse, altered mental status and anxiety, ECG), hypoactive bowel sounds, n/v, constipation, weak and deep tendon reflexes reduced, shallow breathing

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Hypokalemia nursing care

give K+ replacement, look for diminished breath sounds, monitor for cardiac rhythm, digoxin toxicity, level of consciousness, bowel sounds, oxygen sat, DTRs assess, muscle weak and falls, have high potassium foods (salt subs), IV potassium (SLOW drip), never administer by IV bolus (high risk of cardiac arrest)

61
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Potassiums main function is to

support heart and skeletal function as well as neuromuscular activity

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Hyperkalemia risk factors

older adults, eating too much K+, excessive or fast K+ replacement, RBC transfusions, adrenal insufficiency, ACE inhibitors, kidney failure

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Hyperkalemia risk factors from relative K+ excess

extracellular shift from decreased insulin, acidosis, tissue damage, hyperuricemia

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Hyperkalemia findings

slow pulse, hypotension, restless, irritable, weak, paresthesia, ECG, diarrhea, increased motility with GI, oliguria

65
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Hyperkalemia nursing care

EKG changes and monitor close, assess for muscle weakness, avoid using salt subs. Treatments to decrease K+ are: IV fluids w dextrose and insulin, sodium polystyrene sulfonate, loop diuretics, albuterol

66
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Calcium

used for bones, cellular function, nerve conduction. Balance is achieved when amount we absorb in the Gi is equal to the amount excreted by the kidneys. 

67
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Hypocalcemia risk factors

renal failure, decreased parathyroid hormone, not enough calcium or Vitamin D, sepsis, diarrhea, steatorrhea, end stage kidney disease, wound drainage

68
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Hypocalcemia findings

tetany, paresthesia of fingers and lips, muscle twitch, seizure, charley horses, hyperactive DTRs, positive chvosteks and trousseaus sign, prolonged QT interval, hyperactive bowels

69
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Hypocalcemia nursing care

give calcium and vitamin D sups, use seizure and fall measures, avoid overstimulation, have emergency equipment, have foods high in calcium

70
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Hypercalcemia risk factors

excessive parathyroid hormone (malignancy and hyperparathyroidism), hypervitaminosis D, and immobility

71
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Hypercalcemia findings

encephalitis greater than 14 and life threatening at greater than 15

72
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If calcium is too high, give ____ to lower it

phosphate

73
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If phosphorus is too high, give ____ to lower it

calcium oral 

74
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Hypocalcemia can cause

depression, anxiety, osteoporosis, use supplements

75
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Hypercalcemia cause cause

renal calculi, renal failure, bone pain

76
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Magnesium

helps w cellular function and nerve conduction. Extracellular mag and intravascular is important for cardiac function. Cardiac dysrhythmias are a possible complication of decreased mag. Primarily absorbed in the GI

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Hypomagnesemia risk factors

celiac disease or crohns, malnutrition, ethanol ingestion, diarrhea and steatorrhea, citrate from blood, myocardial infarction or heart failure, some meds, older than 65

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Hypermagnesemia risk factors

decreased excretion in the kidneys, excessive intake of lax and antacids, hyperparathyroidism, hypothyroidism, older than 65

79
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Hypomagnesemia findings

muscel tetnany, seizures, paresthesia, hyperactive DTRs, positive chvostek and trousseaus signs, depressed mood, hypoactive bowels

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Hypermagnesemia findings

depress CNS, muscle weakness, respiratory depression, cardiac arrest, hypotension

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What should the nurse do with hypomagnesemia

encourage diet mag sups, eat mag rich foods like sports drinks, s/s of mag toxicity

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What should the nurse do with hypermagnesemia

restrict sources of excessive magnesium intake, monitor urinary output with IV mag, fall prevention, client ed on mag toxicity

83
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Kidneys function by

remove waste thru urine. Have fluid and electrolyte balance with renin to maintain BP and regulates plasma and serum osmolarity. Does erythropoietin and promotes bone integrity

84
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What should be the acid-base blood pH of kidneys:

7.25-7.35

85
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Erythropoietin w kidney function

produces RBCs

86
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Kidney lab assessment

BUN, urine gravity (measures urine concentration), serum creatinine (Cr), glomerular filtration rate (GFR)

87
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Normal urine output

at least 0.5mL/kg/hour

88
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Polycystic kidney disease

a congenital disorder where clusters of fluid-filled cysts develop in the nephrons. And heart healthy tissue is replaced by multiple non-functioning cysts. Is heredirary from genetic mutation.

89
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2 forms of PKD

autosomal dominant and autosomal recessive

90
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Autosomal dominant polycystic kidney disease

most common form and cysts begin to multiply when pt is age 30

91
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Autosomal recessive polycystic kidney disease

multiple cysts are present at birth

92
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PKD what to find

flank pain, polyuria, nocturne, and hematuria, palpable kidney masses, hypertension, proteinuria

93
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PKD lab tests

blood creatinine, BUN, creatinine clearance, CT, MRI, ultrasound

94
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PKD nursing care

needle aspiration and drain cysts, HTN control, pain management, infection prevention, monitor BP and weight daily, notify if increased temp, adhere to low sodium diet, inform the provider if there are any changes in urine or bowel movements

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CKD

a progressive, irreversible kidney disease, dialysis or kidney transplantation can maintain life but can’t cure CKD, comorbidities, epidemiology

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End-stage kidney disease

is when it is progressed from CKD and 90% of nephrons are destroyed and are no longer able to maintain fluid and electrolytes

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CKD risk factors

acute kidney injury, diabetes, HTN in African Americans, NSAIDS, chronic glomerulonephritis, polycystic kidney disease

98
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CKD expected findings

n/v, fatigue, involuntary movement of legs, depression, intractable hiccups, lethargy, slurred speech, tremors, fluid overload, HTN, SOB, tachypnea, kussmaul respirations, crackles, anemia, petechiae, ulcers in mouth, blood in stools, thin fragile bones, urine that contains protein and blood, erectile dysfunction

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CKD labs

UA, blood creatinine, BUN, CBC, electrolytes

100
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CKD diagnostics

cystoscopy, retrograde pyelography, kidney biopsy, imaging, ultrasound, KUB, CT, MRI