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fluids and electrolytes
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What % of solids make up the body based on gender
female is 45% and male 40%
What % of fluids make up the body based on gender
female is 55% and male is 60%
What % of fluid in the body are ICF
2/3
What % of fluid in the body is ECF
1/3
What makes up ECF fluid
80% is interstitial fluid and 20% is plasma
Interstitial fluid
fluid in-between cells and intravascular fluid/plasma
Balance of fluid in the body is maintained by what
input and output
When you get older, you have a decrease in what
thirst sensation aka are dehydrated more
Fluid and electrolyte balance is maintained thru 3 main mechanisms
Diffusion
Osmosis
Hydrostatic pressure aka filtration
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
Diffusion rate increases as concentration on one side ____
increases (this means that the more concentrated side of solutes, the faster they rush out)
Diffusion rate also depends on _______
solubility (aka the smaller the molecule the more rapidly they can cross the barrier of the membrane)
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.
Another word for osmolarity
concentration
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
The movement of water between intracellular and plasma spaces is dependent upon what
osmolarity of compartments
True or false, can you do a test to test plasma osmolarity
true
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
Hydrostatic pressure/filtration
when hydrostatic pressure overcomes the opposing osmotic pressure. AKA pressure that is measured in the amount of pressure.
What determines hydrostatic pressure
pressure and vascular resistance
Hydrostatic pressure and Osmotic pressure act in a _____ manner to control the movement of fluid form the INTRAVASCULAR SPACE to the INTERSTITIAL SPACE
opposing
Fluid volume deficit
occurs when there is a NEGATIVE fluid balance aka body uses more fluid than what is consumed
Excessive loss of fluid can result in what
dehydration aka losing just water, and volume depletion aka blood loss from losing water and sodium
For each liter that someone experiences in the intracellular space contributes a _____ amount while intravascular space contributes a ______ amount
GREATER, SMALLER
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
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.
With fluid volume deficit, Hgb and Hct are elevated if FVD is from
WATER LOSS.
With fluid volume deficit, Hgb and Hct are low if FVD is due to
BLOOD LOSS
Fluid volume deficit on overall health
organ and tissue damage and failure, cerebral hypo perfusion, safety, morbidity, client ed
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
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
Fluid volume excess
occurs from total body sodium content (decrease, normal, or increased levels)
What can occur disease wise with fluid volume excess
heart failure, liver cirrhosis, and kidney disease/injury, and IV use
Risk factors of fluid volume excess
cardiac, liver, endocrine, and renal disorders. Pregnancy, excessive IV use, and older adults 65 and older
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
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
Outcomes of fluid volume excess
respiratory status, edema, cardiac status, BNP, monitor for pulmonary edema
Electrolytes that could be imbalanced
sodium, potassium, calcium, and magnesium
Sodium is in what space
extracellular space
Potassium is in what space
intracellular space
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
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.
Inside cells, sodium is ____ because potassium is ____ in cells
LOW, HIGH
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
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
What can cause hyponatremia
hypovolemic (low volume normal sodium), euvolemic (normal volume low sodium), and hypervolemic (too much fluid and dilute sodium)
What can cause hypernatremia
hypertonic sodium gain, pure water loss, hypotonic fluid loss
Hyponatremia lab findings
low blood sodium, blood osmolarity, urine sodium, and urine gravity
Hypernatremia lab findings
increased blood sodium, osmolarity, and urine gravity and osmolarity
Risk factors for hyponatremia
too much sweat, diuretics, wound drainage, NG suction, hyperlipidemia, kidney disease, NPO, hyperglycemia, low sodium diet, cerebral salt wasting syndrome
Risk factors for hyponatremia from sodium being diluted
hypotonic fluid excess, freshwater accident, kidney and heart failure, SIADH, SSRI meds, older adults
Hyponatremia findings
hypothermia, tachycardia, hypotension, headache, confusion, lethargy, seizures, dizzy, increased motility, abdominal cramps
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
Hypernatremia risk factors
kidney failure, cushions syndrome, aldosteronism, glucocorticosteroids, excessive intake of oral sodium
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
Sodiums main function is to
help maintain electrical membrane excited
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
Hypokalemia risk factors
diuretics, aldosterone, Cushings syndrome, vomit and diarrhea, ng suction, NPO status, kidney disease
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
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)
Potassiums main function is to
support heart and skeletal function as well as neuromuscular activity
Hyperkalemia risk factors
older adults, eating too much K+, excessive or fast K+ replacement, RBC transfusions, adrenal insufficiency, ACE inhibitors, kidney failure
Hyperkalemia risk factors from relative K+ excess
extracellular shift from decreased insulin, acidosis, tissue damage, hyperuricemia
Hyperkalemia findings
slow pulse, hypotension, restless, irritable, weak, paresthesia, ECG, diarrhea, increased motility with GI, oliguria
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
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.
Hypocalcemia risk factors
renal failure, decreased parathyroid hormone, not enough calcium or Vitamin D, sepsis, diarrhea, steatorrhea, end stage kidney disease, wound drainage
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
Hypocalcemia nursing care
give calcium and vitamin D sups, use seizure and fall measures, avoid overstimulation, have emergency equipment, have foods high in calcium
Hypercalcemia risk factors
excessive parathyroid hormone (malignancy and hyperparathyroidism), hypervitaminosis D, and immobility
Hypercalcemia findings
encephalitis greater than 14 and life threatening at greater than 15
If calcium is too high, give ____ to lower it
phosphate
If phosphorus is too high, give ____ to lower it
calcium oral
Hypocalcemia can cause
depression, anxiety, osteoporosis, use supplements
Hypercalcemia cause cause
renal calculi, renal failure, bone pain
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
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
Hypermagnesemia risk factors
decreased excretion in the kidneys, excessive intake of lax and antacids, hyperparathyroidism, hypothyroidism, older than 65
Hypomagnesemia findings
muscel tetnany, seizures, paresthesia, hyperactive DTRs, positive chvostek and trousseaus signs, depressed mood, hypoactive bowels
Hypermagnesemia findings
depress CNS, muscle weakness, respiratory depression, cardiac arrest, hypotension
What should the nurse do with hypomagnesemia
encourage diet mag sups, eat mag rich foods like sports drinks, s/s of mag toxicity
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
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
What should be the acid-base blood pH of kidneys:
7.25-7.35
Erythropoietin w kidney function
produces RBCs
Kidney lab assessment
BUN, urine gravity (measures urine concentration), serum creatinine (Cr), glomerular filtration rate (GFR)
Normal urine output
at least 0.5mL/kg/hour
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.
2 forms of PKD
autosomal dominant and autosomal recessive
Autosomal dominant polycystic kidney disease
most common form and cysts begin to multiply when pt is age 30
Autosomal recessive polycystic kidney disease
multiple cysts are present at birth
PKD what to find
flank pain, polyuria, nocturne, and hematuria, palpable kidney masses, hypertension, proteinuria
PKD lab tests
blood creatinine, BUN, creatinine clearance, CT, MRI, ultrasound
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
CKD
a progressive, irreversible kidney disease, dialysis or kidney transplantation can maintain life but can’t cure CKD, comorbidities, epidemiology
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
CKD risk factors
acute kidney injury, diabetes, HTN in African Americans, NSAIDS, chronic glomerulonephritis, polycystic kidney disease
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
CKD labs
UA, blood creatinine, BUN, CBC, electrolytes
CKD diagnostics
cystoscopy, retrograde pyelography, kidney biopsy, imaging, ultrasound, KUB, CT, MRI