N313 - EXAM 1 Fluid, Electrolytes, and IV solutions

What is homeostasis?

Normal internal space environment

How much body water do we have?

50-60%

Intracellular fluid is

fluid INSIDE cells

Intracellular fluid in the body is

2/3rds of 50-60%

Extracellular fluid includes

• interstitial fluid

• Intravascular fluid

• Transcellular fluid

Interstitial fluid is

• fluid NOT in intracellular fluid

• Third spacing (bad)

What is third spacing

• too much water into our third spacing → swelling

What are three diseases that cause third spacing?

• Heart failure

• Liver failure

  • cirrhosis

  • hepatitis

• Renal failure

Intravascular fluid is

• blood

• VS includes BP

Transcellular fluid is

• GI tract

• Spinal fluid

Electrolytes include

• Cations (positive)

• Anions (negative)

Cations include

• Arcations

• Sodium

• Potassium

• Calcium

• Magnesium

Sodium is located…

in the ECF

Sodium helps function which organ

Brain

What is hyponatremia?

• less than 135

• more water than salt

What is hypernatremia?

• more than 145

• dehydration

Hyponatremia AND hypernatremia can cause…

• seizures

• coma

• confusion

• possibly swelling

Potassium is located in…

in the ICF

Potassium affects which organ?

Heart

Hypokalemia and hyperkalemia may cause

dysrythmias

Calcium helps with…

muscle contraction of the heart

Magnesium helps with…

• muscle and nerve function

  • helps with blood pressure

Anions include

• HCO^3-

  • bicarbonate

• Cl-

• HPO₄^3-

  • phosphorus

HCO^3- (bicarb) function

reverses acidosis

What does it mean if a PTs HCO^3- is low?

bicarb is low → low pH → acidotic

Cl^- function includes

• fluid balance

• nerve

• muscle function

Cl^- is located in what space?

ICF

HPO₄^3- (Phosphorus) is located…

ICF

What is diffusion

• Movement of molecules from areas of high concentration to lower concentration

• Does not require energy

What is facilitated diffusion?

• Facilitated diffusion

  • Protein carrier

  • Doesn’t require energy

What is active transport?

• Molecules moving against a concentration gradient

• Requires energy

• Sodium potassium pump

What do we want if there is too much K+ in intravascular?

want to get it in

What do we want if there is too much K+ in intracellular?

want to get it out

What is osmosis

• Osmolality

  • Measure of concentration of plasma, urine, and body fluids to our molecules

• Movement of water

What is osmolality and how does it move?

Moves down a lower solute concentration gradients TO an area of higher concentration gradient → called osmolality

What molecule does osmosis/osmolality affect?

sodium

HYPOosmolality is

• Concentrations of solutes are lower → more water + less molecules ( ex. sodium)

What does HYPOosmolality cause?

• seizures

• confusion

• coma

What does HYPERosmolality cause?

More molecules + less water

Hypotonic means

More solutes in the cell (ICF) compared to ECF → less water

• Cell SWELLING

Isotonic means

• Homeostasis

• Good balance of fluid and electrolytes

Hypertonic means

More solutes in solution → get fluid from IC to EC → Cell shrinkage

What is hydrostatic pressure

Pushes water OUT

Hydrostatic pressure and HTN

a lot of fluid in the intravascular spaces

Why would a PT on dialysis experience hydrostatic pressure?

Dialysis → not urinating → pulling fluid out → filters blood → low BP; increase BP by giving albumin

When do we give albumin and WHY?

• Dialysis PTs

• Forces (m)oncotic pressure to work → pulls fluid from interstitial third space to cell

• Increases (m)oncotic by pulling back into intravascular and increases in inter

What is osmotic pressure

pulling water back IN

At the arterial end?

hydrostatic pressure greater

At the venous end..

Moncotic is greater

What factors affect water balance?

• Hypothalamic pituitary gland

• Renal regulaiton

• Adrenal corticol regulation

• Cardiac regulation

How does hypothalamic pituitary gland affect water balance?

• ADH

  • Anti diuretic hormone → Tells kidneys not to dyurese (urinate) → Conserve low BP

How does adrenal cortical regualtion affect water balance?

• Glucocorticoids

  • Anti-inflammitory

  • Cortisol

    • Released due to swelling or infection

    • Salmedrol

    • Sugar

      • Steroids → Raises blood sugar levels

• Mineralocorticoids

How do mineralcorticoids affect water balance?

• Causes sodium and water retention

• Aldesterol → tells kidneys to reabsorb water and salt → leads to waking

How does cardiac regulation affect water balance?

• BNP

• Helps with fluids and electrolytes

• Vertical stretching → released BNP 9B type neuretic peptide) works against RASTH (?) pathway → allows for more water/fluid loss

Sodium electrolyte imbalances & their osmolality include..

hyponatremia

• HYPOosmolality

hypernatremia

• hyperosmololic

What nursing intervention do we do for a hyponatremic PT?

• place on fluid restriction

What nursing intervention do we do for a hypernatremic PT?

• fluid replacement

What should we monitor for for sodium imbalances?

• seizures

• confusion

• coma

Na waterloss

• hypernatremia, hyperosmolality

• Fluid replacement

Na watergain

• hyponatremia

• hypoosmolalic

Potassium affects the…

heart → muscle contraction

What foods contain potassium?

• Bananas

• Vegetables

• Potatoes

What would we see on an EKG for a hyperkalemic PT?

PEAKED T waves

What treatment is available for a hyperkalemic PT

• sodium zirconium (lokelma)

• Kayexalate

How is potassium excreeted?

feces

What is Acoctale?

Made up of insulin, D50, calcium glutonate

What does each component of acoctale do?

• Insulins → shifts it back into the cell

• D50 is sugar → give bc we gave insulin → dont want hypoglycemia

• Calcium glutonate → helps with heart concentration

If we replace calcium glutonate with sodium bicarbronate, what would occur as a result?

• Replace calcium glutonate with Sodium bicarbonate → reverses acidosis

What kind of PTs would experience hyperkalemia?

Renal failure PTs due to build up of potassium

What drugs can cause hyperkalemia?

• Beta blockers

• Ace inhibitors

• Arbs

  • losartan

What can hypokalemia lead to?

Cardiac arrest

What may we see on an EKG of a hypokalmeic PT?

Depressed/shallow T waves (turns upside down)

Why may a PT’s postassium levels lower?

• vomitting

• diarrhea

• diuretics

What treatment is available for the replacement of potassium?

• VIA IV

• PIGGYBACK DONT PUSH IT

• BURNS peripherally; central does not

• 10-20 mEq

• Potassium IV infusion

• Hemodialysis

What are some common labs?

• Serum osmolality

• Urine osmolality

• CBC

• ABG

• Electrolytes (BMP/CMP)

• Blood urea nitrogen (BUN)

• Serum Creatinine

Why is urine osmolality looked at?

To see if they're excreting large amounts of fluid or electrolytes or both

Why is CBC looked at?

• WBC

• Platelets

• Hematocrit

• Hemoglobin

• RBC

Why are ABGs looked at?

Determine respiratory distress

How would we know if a PT is experiencing respiratory distress based off their labs?

• CO2

  • 80-100

  • Bicarb 22-28

• PCO2

  • Higher

• O2

Why is a BUN looked at?

• Renal failure → they are both higher

  • Creatnine

  • BUN

• Liver failure

  • AST

  • ALT

  • Cirrhosis

    • Hepatitis

    • Drinking

What kind of nursing care would we implement for fluid & electrolyte imbalances?

• Daily weights

  • Concerned fs → 2-3 lb weight gain in a day or 3-5 in a week

• Is and Os

  • Specifically urine output

• Fluid replacement

  • Parenteral vs enteral

• Fluid restriction

• Medication

  • Tolvactin

    • Sodium pill → helps maintain sodium levels

• Important to check sodium labs

  • Remove slowly → if increases too fast → cerebral edema

  • Give D5 → lowers sodium

What pill helps maintain sodium levels

Sodium pill → helps maintain sodium levels

When replacing sodium via therapy, why do we want to remove it slowly?

• if it increases too fast, cerebral edema may occur

What does D5 do to sodium?

Lowers it

Isotonic IV fluids include

• Normal saline (0.9%NS)

• Lactated Ringers (LR)

• Dextrose 5% in water (D5W)

• 5% albumin

• isolyte

• Plasmlyte

NS EBP

Shows its compatible with effectiveness and any medications given with it

What is NS made of?

Sodium → can cause hypernatremia

When do we want to use NS?

• Expands extracellular fluid (intravascular)

• When a PT is dehydrated

• When we lose a lot of water and salt

Why would we give LR instead of NS?

• When a PT’s sodium levels are too high

What is the purpose of D5W?

• Volume filler for extracellular fluid and ensures sodium levels come down

• Dehydrated, too much sodium → brings down sodium levels if too high

What is the purpose of 5% albumin?

• Increase oncotic pressure → more blood volume in intravascular → increasing blood pressure

• Pulls in from interstitial (3rd space)

• Hydrostatic pressure goes up (pushes from interstitial to intravascular)

• Surgeon love this when expecting a little blood loss

What are some examples of hypotonic IV fluid?

• ½ NS (0.45% NaCl)

• D5 ½ NS (Dv0.45% NaCl)

• 0.33% NaCl

• Dextrose 2.5% in water (D2.5%W)

What is the purpose of hypotonic IV fluids?

• causes fluid shift from extracellular → intracellular

• May cause swelling

What are some indications for hypotonic IV fluids?

• Hypoosmolarity

• hyponatremia

What do we need to monitor when giving hypotonic IV fluids?

• ECF to ICF

• cell swelling

• Blood pressure

What is the purpose of hypertonic IV fluids?

• Expand intravascular fluid

  • fluid shift from ICF → ECF

Examples of hypertonic IV fluids include…

• Dextrose 5% in NS

• Dextrose 5% in LR

• 3% NaCl

• 25% albumin

• Dextrose 10% in water

What are some indications for 3% NaCl?

• ICU immediately

• Monitor for

  • Seizures

  • Coma

  • Confusion

Why do we give D10%?

• Hypoglycemia

• NPO pts

  • surgery

• Sugar levels can spike up

  • ACU checks to monitor

What are some indications for hypertonic IV fluids?

• Trauma

  • brain

  • brain swelling