Fluids and Acid Base

What is our total body water (TBW) in intracellular fluid (inside of cells)

40%

what is in extracellular fluid

what two areas does it consist of

what percent of fluid is in each

- interstitial fluid: outside of cells = 15%

-intravascular fluid: veins/arteries = 5%

what is diffusion

movement of particles

what is osmosis

how WATER moves between ICF and ECF

how does osmosis move fluid

moves fluids from an area of LOW concentration of solutes to an area of HIGH concentration of solutes

how can we assess if someone is properly hydrated

-intake/output

-skin turgor

-blood pressure

what are our primarily electrolyte solutes that drive osmosis and where are they found

-Potassium (K+): found inside of cell (ICF)

-Sodium (Na+): found outside of cell (ECF)

how can our body compensate for changes in fluids/electrolytes

-our body will conserve water/become thirsty

-hormonal response: ADH

when does ADH get released and what releases it

-when there is an increase in osmality or decrease in circulating blood volume, which causes water reabsorption

-posterior pituitary gland releases ADH

if ADH does not keep us hydrated what does our body do to guarantee water absorption (maintains vascular permeability)

body will use renin-angiotension system

how does renin angiotension-aldosterone system (RAAS) work

-BP/fluid volume drops

-renin is released from kidneys

-renin acts on angiotensinogen to form angiotensin I

-ACE converts angiotensin I to angiotensin II

-angiotensin II acts on adrenal gland to release aldosterone

-aldosterone causes kidneys to stimulate reabsorption of salt (NaCl) and water (h20)

what releases aldosterone

adrenal gland

what is osmality

body natural concentration of solutes

what is homeostasis

osmotic equilibrium between compartments (natural balance)

what is tonicity

concentration of IV fluids

what is hypotonic

lower osmality than natural body

what is isotonic

equal concentration as body (normal saline)

what is hypertonic

higher osmality than body

what regulates sodium

aldosterone and natriuretic peptides

-aldosterone = increases sodium and water reabsorption to raise BP

-natruretic peptide = promotes sodium and water excretion to reduce blood volume/pressure

what is the primary solute that drives osmosis

sodium

what is chloride bonded to and where is it mostly seen

-chloride is bonded to sodium

-ECF anion (negatively charged)

what maintains osmotic pressure

chloride

(chloride maintains osmotic pressure by balancing sodium and retracting water, which allow fluid to stay in the right compartment)

what two electrolytes are involved in muscle function and enzyme activity

calcium and magnesium

what is the osmality like if there is a hypertonic alterations

osmlatiy in ECF has more sodium concentrates and less water

what are the solutes like in fluid FVD

solutes will be concentrated due to less fluids

where is the first place to see symptoms in FVD

vascular compartment (veins/arteries)

when trying to relieve FVD, what solutions to you give

always give isotonic first, then add hypotonic concentration to restore fluid volume (get back to baseline)

what are symptoms of Fluid volume deficit (FVD)

-low BP

-hypotension/orthostatic

-compensatory tachycardia

-dizziness

-dry mouth

-thirst

-weak thready pulse

what are late symptoms of fluid volume deficit (FVD)

-poor skin tugor

-weakness

-electrolyte imbalance

what is the treatment for FVD

-give isotonic fluid first in vascular space

-then give a measured amount of hypotonic bc too much can cause overload

what are the hypotonic saline solutions

-0.45% NS

-0.25% NS

what are the salines in isotonic (same osmality as ours)

-give normal saline: 0.9%

-Lactated Ringer (LR saline)

wha are the hypertonic salines

-D5% with .45% NS

-D5% with 0.9% NS

how do fluids shift in hypotonic solutions

shifts fluid OUT of vascular into cells

how do fluids shift in isotonic solutions

-no fluid shifts

-stays in vascular space

-sodium here for electrolyte balance

how do fluids shift in hypertonic solutions

pulls water out of cells into vascular space

-ICF to ECF

-replace electrolytes/cause vascular expansion

what are symptoms of fluid volume excess (FVE)

-high bp

-bounding pulse

-pulmonary congestion

-shortness of breath

-jugular vein distention

what are the later symptoms from fluid volume excess

edema from accumulation of fluid in the interstituim

how do we treat fluid volume excess (FVE)

-diuretics

-sodium restriction

-hypertonic fluids

-goal: get fluid pulled to kidneys to excrete out of body

what are nursing interventions for FVE

-stop the fluids

-monitor BP, renal status/congestion

what panel are all electrolytes found in

basic metabolic panel (BMP)

what is normal sodium and its function

-136-145

-maintains fluid volume

-causes neuromuscular changes

-nerve impulses

what does sodium mirror

sodium mirrors chloride

what is hyponatremia

-sodium:

what are symptoms of hyponatremia

-dryness

-cramps

-lethargy/neuro changes

-headache

-confusion

-SEIZURES

how do we treat hyponatremia

-restrict free water

-sodium replacement (0.9% NS or 3% NS)

why do we give a sodium replacement for someone with hyponatremia

it will correct any neuro issues to prevent a potential seizure

what are symptoms of hypernatremia

-thirst

-weakness

-restlessness

-elevated temp

-dry swollen tongue

what is hypernatremia (>145) caused by

-water loss (FVD)

-excess sodium

-diabetes insipidus

-heat stroke (lose all fluids, so sodium=concentrated

-too much hypertonic IV's were given

how do you treat hypertremia

-hypotonic solutions

-encourage free water PO/IV

-restrict sodium

what must the nurse monitor if someone has hypernatremia

-fluid intake

-dietary intake of salt

-EKG

-neurochecks

what does potassium do (3.5-5.0)

-maintains fluid volume INSIDE of cells

-conducts nerve impulses

-creates normal cardiac rhythms

-cause smooth/skeletal muscle contractions

what are sources of potassium

-oranges

-dried fruits

-tomatoes

-avocados

-dried peas

-meats

-broccoli

-bananas

-dairy products

-meat

-whole grains

-potatoes

what are symptoms of hypokalemia

-fatigue

-anorexia

-MUSCLE CRAMPS

-DYSRHYTMIAS (depressed/flattened T waves)

how do we treat hypokalemia

-replace potassium orally

-give dietary potassium

what can be given PO for hypokalemia

-citrate

-chloride

-bicarbonate

-gluconate

what do we never give to treat hypokalemia

-never IV push potassium

-always give 10 mEq/hr, diluted in NS, never exceed 40 mEq

what is hyperkalemia and what is it caused by

potassium >5.0

-increased intake

-shifts from ICF to ECF

-metabolic acidosis

-diabetes

what are symptoms of hyperkalemia (potassium 5.0)

-peaked T waves on ekg

-tingling in lips/fingers

-severe muscle weakness

-confusion/irritability

-diarrhea

how do you treat hyperkalemia

-give polystyrene sulfonate (kayexalate) to moves potassium out through bowels

-buffered solutions (isotonic/insulin)

-dialysis

-IV calcium gluconate

range for calcium

9.0-10.5

what are signs of hypocalcemia (

-paresthesia

-facial spasms

-SEIZURES

-circumolar numbness

-muscle tremors

-trousseaus

-chovesteks

-hyperactive DTR

-tetany/spastic

how do you treat hypocalcemia

IV calcium gluconate

what must we monitor for people with hypocalcemia

their parathyroid to make sure the glands aren't whats causing a calcium imbalance

what should we monitor for someone with hypocalemia

-serum levels

-PTH levels

-respiratory

-neuro

what are signs of hypercalcemia (>10.5)

-constipation

-anorexia

-bone pain

-slurred speech

-heart block

-thirst/polyuria

how do you treat hypercalcemia (>10.5)

-treat underlying cause

-check parathyroid

-GIVE FLUIDS PO (calcium = water soluble, so it'll wash out of body)

-isotonic IV fluids

-BIOPHOSNATES, phosphates, calcitonin

-diuretics

-glucocortoids

what must we monitor for hypercalemia

-serum levels

-PTH levels

-I & O

-respiratory

-neuro

what do we do when electrolytes are too HIGH or too LOW

-HIGH: add fluids

-LOW: restrict fluids

what is normal arterial blood pH from ABG sampling

7.35-7.45

what is acidosis pH

-pH less than 7.35 (LOW)

-systemic increase in H+ concentration

what is alkalosis pH

pH greater than 7.45 (HIGH)

-systemic decrease in H+ or excess of base

pH below 6.8 and pH above 7.8 indicates what

death

respiratory function in acid base balance

lungs will decrease carbonic acid by exhaling carbon dioxide

if______ is abnormal, it is most likely a respiratory issue

PaCO2 (carbon dioxide)

what are normal levels of PaCO2 (carbon dioxide)

35-45 mmHg

what is the renal function is acid base balance

absorb bicarbonate, produce more acidic or more alkaline urine by holding on to extra bicarb or expelling it

if ____is abnormal, it is most likely a renal issue

HCO3 (metablic)

what are normal levels of HCO3 (metabolic)

22-26

how does potassium move during acidosis (LOW pH)

potassium moves from ICF to ECF in exchange for hydrogen

what is metabolic acidosis

acid from other than our lungs, body's blood becomes to acidic from too much acid or loss of bicarbonate

manifestations of metabolic acidosis

-pH less than 7.35

-PaCO2 is normal

-HC03 is less than 22 mEq/L

what causes metabolic acidosis

-lactic acidosis

-renal failure

-diabetetic ketoacidosis

-diarrhea

-starvation (too much ketones in body)

how do we treat metabolic acidosis

-buffering solution (sodium bicarb)

-treat underlying cause

-correct sodium/water deficit

what are symptoms of metabolic acidosis

-headace

-low bp

-muscle twitching

-flushed skin

-decreased muscle tone

what are labs of metabolic alkalosis

-pH greater than 7.45

-PaCO2 normal

- HCO3 greater than 26 mEq/L

what causes metabolic alkalosis

- prolonged vomiting or gastric suctioning

- excessive bicarbonate intake

- hyperaldosteronism with hypokalemia

- diuretic therapy

how do we treat metabolic alkalosis

sodium chloride

- potassium

- chloride IV

(HCO3- is replaced by CI-)

what are symptoms of metabolic alkalosis

restlessness, dysrhythmias, hypoventilation, confusion

what is respiratory acidosis and what are its labs

-can breathe out acid

-pH less than 7.35

-PaCO2 greater than 45 mmHg (too much acid)

-HCO3 is normal

what causes respiratory acidosis

-depression of respiratory center

-respiratory muscle paralysis

-alveolar hypoventilation

-can be caused by anything that relaxes respiratory center (opiods)

what is the treatment of respitory acidosis

restore ventilation

-mechanical ventilation

-oxygen therapy

goal: get acid out of body

what are symptoms of respiratory acidosis

-shallow breaths

-low bp with vasodialation

-dysrhytmias

-hypoventilation causing hypoxia

what is respiratory alkalosis levels

-pH is greater than 7.45

-PaCO2 is less than 35

-HC03 is normal

what are causes of respiratory alkalosis

-high altitude

-hypermetabolic state

-fever

-anemia

-hyperthyroid

-hyperventilation

what is the treatment for respiratory alkalosis

-paper bag (rebreathe CO2)

-treat hypoexemia and hypermetabolic states