MS Exam 1--WK1

sodium

135-145 mEq/L

potassium

3.5 - 5 mEq/L

chloride

98-106 mEq/L

bicarbonate

24-31 mEq/L

calcium

8.8-10.5 mg/dL

phosphorus

2.5-4.5 mg/dL

magnesium

1.8-3.6 mg/dL

Hydrostatic pressure:

pressure of fluid pushes on the walls of the blood vessels

Osmotic Pressure

pulls fluid by protein in plasma

Osmosis

diffusion of water from area of low to high concentration of solute

Diffusion

solute moves from higher to lower area of concentration (electrolytes moves)

Filtration

water moves solutes from high hydrostatic to low hydrostatic pressure

Active Transport

Sodium Potassium Pump

\*Maintains high concentration of extracellular sodium, & intracellular potassium.

Anti Diuretic Hormone

Retains fluid

Aldosterone

Increases sodium reabsorption & potassium excretion. \---\> retain fluid

Baroreceptors

Decreased pressure\---\> increased sympathetic response

RAAS

senses decreased renal perfusion & releases renin

Natriuretic peptides

opposite of RAAS.

Decreased sodium retention.

Natriuretic peptides

Released by atrial (ANP) or ventricle (BNP) due to increased pressure.

**used to check for heart failure**

Suppresses action of RAAS.

Osmolality: serum

measures concentration of osmoles of serum & reflects sodium

normal 275-290

Osmolality: urine

measures osmoles of urine & reflects uria, urine, uric acid.

normal 200- 800

Specific gravity

measures the kidneys ability to excrete or conserve water

normal 1.005- 1.03

High SG

denser urine, dehydration

elevated serum Na, decreased ADH (not holding onto water)

diabetes insipidus

Low SG

less dense urine (more dilute), fluid overload

increased ADH (holds onto water) = SIADH (syndrome of inappropriate antidiuretic hormone secretion)

diuretics

BUN

10-20 mg/dL

Creatine

less than 1.4

Creatine

muscle breakdown that occurs at a constant rate

who will have higher creatine?

dialysis patients

Hematocrit

measures the % of RBC in whole blood

Hct males

42%-52%

Hct females

35% - 47%

albumin

made by the liver

protein that exerts osmotic pressure in the vessel (pulls fluid)

counteracts hydrostatic pressure

keeps fluid w/ in vasculature

albumin

3.5-5.5

Fluid Volume Deficit (FVD): hypovolemia

Causes:

§ Abnormal fluid loss: V/D, sweating, GI suctioning

§ Decreased intake: Nausea, lack of access to fluids

§ Third space shifts: due to burns, ascites

§ Additional causes: diabetes insipidus, adrenal insufficiency, hemorrhage

FVD (hypovolemia) clinical manifestations:

V/S changes: hypotension, tachycardia, fever,

Dizziness, syncope, weakness, fatigue, thirst, acute wt loss, tenting of skin, current s/s of electrolyte imbalance, Oliguria* low urine volume* (

FVD (hypovolemia)--what do you need to do?

*check skin turgor: forehead, sternum, clavicle*

FVD (hypovolemia) Nursing Management:

I&O Q8hrs, daily Wt, V/S, skin & tongue turgor, mucosa, urine output, mental status, measure to minimize fluid loss, admin oral fluids, admin IV fluids.

Fluid Volume Excess (FVE): hypervolemia

Causes:

· Fluid overload or diminished homeostatic mechanisms

· Heart failure, kidney injury/ failure

· Cirrhosis of liver

· Consumption of excessive amounts of table salt or sodium salts

· Excessive admin of sodium containing fluid

FVE (hypervolemia) clinical manifestations:

§ V/S changes: hypertension, tachycardia, tachypnea

§ Distended neck veins (JVD)

§ Ascites or anasarca

§ Dysnpnea or crackles

§ Peripheral edema w/ wo pitting

§ Wt gain

Parenteral (IV) Fluid Therapy

ALL ARE CRYSTALLOID FLUIDS

Isotonic

Normal Saline or Lactated Ringers

o Osmolality is close to ECF

o RBCs do not shrink or swell

§ D5W does not include electrolytes & can cause imbalances

Hypotonic

½ NS, D5W

o Osmolality is less than ECF

o Replace cellular fluid

o Tx hypernatremia

o RBCs swell

Hypertonic

3% or 5% NS

o Osmolality is more than ECF

o Shrink cell & fluid will push off. *Ex cerebral edema (push water off by excretion of kidneys)

o Assess for hyponatremia

Crystalloids fluids

volume expanders

o NS, ½ NS, LR

o Water & electrolytes

o General rule of thumb is that only 25% of crystalloids will remain in the vasculature

Colloids

solutions contain large molecules that provide oncotic/osmotic pressure

o Albumin is the most common colloid

Hypovolemic shock

severe blood or fluid loss.

Heart unable to pump enough blood to the body, can lead to organ hypoperfusion, cellular dysfunction & death.

Hypovolemic shock

o BP: decreased

o HR: increased

o RR: increased

o Urine output: decreased

Heart is sensitive to...

K

\** EKG changes

Brain is sensitive to...

Na

\** Neuro changes

Muscles are sensitive to...

Mg & Ca

\** Reflex changes, Trousseau & Chevostek

Trousseau's sign

arm/carpal spasm associated with hypocalcemia

Chevostek's sign

-Contraction of facial muscles in response to light tap over the facial nerve in front of ear

-USED FOR HYPOCALCEMIA

what works inversely?

Na & K

Ca & P

Hyponatremia pneumonic

SALT LOSS

Stupor/coma

Apprehension, headache confusion, depression convulsion, n/v

Lethargy

Tendon reflexes decreased

Limp muscles (weakness)

Orthostatic hypotension

Seizures/headache

Stomach cramping

Hyponatremia

· Loss of concentrated fluids (sweat, diarrhea, vomit), diuretics, renal disease, gain of water

· Watch out for NPO pt on IV fluids not containing Na

· Labs: decreased serum & urine sodium, Decreased urine specific gravity & osmolality.

Hypernatremia pneumonic

"you are FRIED"