foundations

exam 3 final

Normal sodium

135-145

Renal fcts

Filter blood/waste

Excrete urine

Maintain fluid, electrolyte, acid-base balance

Urine pathway

Kidney filter

Ureters collect

Bladder holds

Urethra connects to outside

Fluid balance impacts

GI, GU (renal), cardiac, pulmonary, skin integrity

I and O

Intake and output

Anything that goes in - anything that goes out

Fluid I and O

Intake

Oral fluids (anything that melts in room temp)

IV fluids

Enteral or parenteral nutrition (tube feedings, made in pharmacy)

Output

Urine

Perspiration

Respiration

Feces and vomit

ADH

Promotes water reabsorption by the kidneys

Aldosterone

Promotes sodium and water retention

ANP

Promotes sodium and water excretion

Heart=stretch 

1 excess L of fluid in body

Weights 2.2 lbs

Heart failure

Causes fluid retention (edema, pleural, lung fluid accumulation)

Kidney disease

Affects filtering and excretion

Liver diseases

Alters protein levels, leading to fluid shifts out of the vascular compartment

Monitor for.. means fluid retention

Weight gain 2-3 lbs in a day, 5 lbs a week

Burns or trauma

Increases fluid loss through damaged skin

DM or DI

can lead to dehydration from excessive urination

Diuretics

Increase fluid loss

Steroids

Increases sodium and water retention

Laxatives or chemotherapy drugs

May increase fluid loss

Infants

Higher percentage of body water and faster turnover

• higher risk for imbalance

Older adults

reduced thirst sensation and kidney efficiency

• high risk for dehydration

High salt

Causes water retention

High protein/sugar

Increase water needs for metabolism and excretion

Protein/albumin

Maintains osmotic pressure, holds water where it needs to be

ICF

Makes up 2/3 of bodys fluids

Fluid INSIDE the cell

ECF

Fluid OUTSIDE the cell

More prone to loss

Interstitial fluid

Fluid around/btw cells

25%

Intravascular fluid

Plasma - fluid in vessels

7%

Transcellular fluids

CSF, synovial fluid

1%

Hydrostatic pressure

Pushes water

Osmotic pressure

Pulls water

Third spacing

Occurs when too much fluid moves from the intravascular space (blood vessels) into the interstitial or ‘third’ space - the nonfunctional area btw cells

The movement of bodily fluid from the blood, into the spaces btw the cells

• can cause problems like edema, hypotension, and decreased cardiac output

Can occur in brain as well

Shift of fluid into interstitial tissues decreases overall circulating volume → decreases BP

NG tube

Decompress or drain stomach of fluid or unwanted stomach contents

Used to allow GI tract to rest before or after abdominal surgery to promote healing

Insert to monitor GI bleeding

1 ounce

30 c

Why cath

Monitor critically ill pts

Urinary retention

Obtaining sterile urine specimen

Surgery

Not for incontinent pt unless extreme case

Cath balloon port

Will tell you how much to put in (and take out)

Straight cath

No balloon

Temporary

Balloon

Will hold the cath in place

Normal urine output

.5cc/kg/hr

30cc per hour for adult

Size of catheter

French system

Larger the number, bigger the catheter

Dysuria

Pain when urinating

Polyuria

Excessive urine, very diluted

Glycosuria

High sugar in urine, common in diabetes pts

Pyuria

Pus or WBC in urine

anuria

lack of urine

Oliguria

Low urine output

Infection

Biggest risk of indwelling urinary caths

CAUTI

Catheter Associated Urinary Tract Infection

UTI = most common HAI

Preventable

BUN normal range

5-20

Cr normal range

.5-1.5

K+ normal range

3.5-5.0

Na normal range

135-145

GFR value

High = better

Over 60 = good

Over 90 = amazing

BUN

Renal/liver fct

Urea is formed in liver as the end product of protein metabolism

Increase can indicate renal disease (or GI bleed, dehydration)

Low can indicate liver failure (or malnutrition or over-hydration)

Creatinine

Breakdown of creatine, an important component of muscle

Can be converted to ATP

Daily production depends on muscle mass

GFR

Test used to check how well the kidneys are working

Determines what stage of kidney failure

Na

Sodium is the main extracellular cation

Necessary for B

Hyponatremia

Most common electrolyte disorder in US

Can be risk factor for seizures

• can be caused by cirrhosis, vomiting, SIADH

Hypernatremia

Diabetes insipidus, Cushings Syndrome

Salt or sodium bicarb ingestion

Routine Urinary Elimination Assessment questions

Any problems, urgency, burning, retention?

Color?

The amt if measured

How long since voided?

Nocturia

Increased frequency in the night

Stool concerns

Amt, soft, consistency

red vs black vs black tar vs brown

Ileostomy

Surgical opening (stoma) created in the ileum (end of small intestine)

Located in RLQ

Stool consistency liquid to semi-liquid

Almost continuous output

HIGH RISK for dehydration

• Encourage increased fluid intake 

Colostomy

Surgical opening (stoma) created in the colon (large intestine)

Located in varied quadrants

Stool consistency more formed and predictable

Inflammatory bowl disease

UC or Chron’s Disease

Ostomies are common

Pt would need an ostomy

Bowel Disease

IBD

Diverticulitis

Cancer

Bowel Obstruction

Stoma Assessment

Stoma should be pink to red and moist

Assess for cuts, ulcerations, or abnormal findings

Assess skin around stoma

Note redness or irritation

Diarrhea

Passing liquid with increased frequency

Due to:

Infectious agents, malabsorption, inflammatory process