Fluids and Electrolytes

intracellular

inside the cells

makes up approx 40% of body weight

majority of electrolytes in the cells are potassium

extracellular

outside the cells

makes up 20% of body weight

consist of mostly sodium

osmosis

movement of water from itnernal to external

moves from an area of low concentration into areas of high concentration

concentration

molecules in a solution

diffusion

movement of molecules

sodium and potassium moving back and forth

kidneys

filter wast water electrolytes

excrete 1-2L/day

prevents body from fluid overload

skin

body shivers which helps the body sweat the fever off

sweating too much can cause dehydration

lungs

eliminates water through the mouth

lungs excrete 300 mL of fluid a day

GI tract

breaks down and absorbs water and nutrients

water in the GI helps move the stool

osmolality

how much particles are in the urine

high levels of osmolality

dehydration

low levels of osmolality

fluid overload

urine speciffic gravity

shows the concentration of the urine

high levels of urine specific gravity

high concentrated urine

low levels of urine specific gravity

fluid overlaod

creatinine

tells how well the kidneys are functioning

levels of creatinine

varies depending on what else is going on

high hematocrit and hemoglobin

dehydration, fluid loss

low hematocrit and hemoglobin

fluid overload

hpertonic

high in sodium

moves sodium in and out of the cells

what fluid is hypertonic

3% normal saline

who needs hypertonic

hyponatremia and has high potassium

isotonic

same amount of sodium and water as our blood

adds volume

who needs isotonic fluid

dehydrated or on morphine and BP is low

what fluid is isotonic

normal saline lactated ringer

hypotonic

low in sodium

moves sodium and water in and out of the cells

what fluid is hypotonic

half normal saline and D5 to hydrate the patient

hypovolemia

dehydration or body fluid deficit

low volume in the blood

risk facotrs of hypovolemia

vomiting, diarrhea, fistulas, fever, excess sweating, burns, blood loss, GI suctioning, nausea, anorexia

basically anything that makes the body lose fluids

s/s of hypovolemia

decreased bp and increased heart rate, temperature and SpO2, weight loss, pronlonged capillary refill, flattened neck veins, dizziness, thirst, confusion, muscle craps, sunken eyes, oliguria, skin tinting

labs for hypovolemia

high h and h, high serum/urine osmolaltiy and specific gravity, low urine sodium, elevated BUN/creatinine

hypervolemia

excess fluid volume excess

risk factors of hypervolemia

kidney failure, alcoholics, heart failure, increase sodium input, stress

s/s of hypervolemia

pitting edema, weight gain, distended jugular veins, SIB, high BP, RR, urine output and CVP, crackles, bounding pulse and cough

labs for hypervolemia

low h and h, serume.urine osmolality, sodium and specific gravity

sodium imbalances

found mostly int eh ECF with water

neurological symptoms

hyponatremia

gain of water and dilution of sodium, fluid overload

s/s of hyponatremia

alter LOC, seizures, coma, headache, lathargy, vital changes

vital signs of hyponatremia

low BP and tachycardia

hyponatremia diagnostics

low sodium levels, urine specific gravity and osmolality

medical treatment of hyponatremia

fix the cuase

watcch water intake

IV fluids

what fluid are given to hyponatremia patients

isotonic to fix the BP and volume issues

nursing intervention of hyponatremia

strict i/o and daily weights

hypernatremia

excess water loss and sodium gain

risk factors of hypernatremia

dehydration diarrhea intake of sodium corticosteroids

s/s of hypernatremia

dehydration, irritability, seizures, vital changes, hallucinations, restlessness

vital signs of hypernatremia

high BP and low HR

hypernatremia diagnostics

high sodium levels, urine specific gravity, osmolality

medical treatment of hypernatremia

fix the cause IV fluids and diuretics

what fluids are given to hypernatremia patients

hypotonic

less in sodium and high in water

why do hypernatremia patients need diuretics if they need to keep in water

they only need it if they have too much sodium

nursing interventions of hypernatremia

strict i/o daily weights low sodium diet

potassium imbalances

found in the ICF

cardiovascualr symptoms and ABG disturbances

hypokalemia

low potassium

risk factors of hypokalemia

medication, NG tube suctioning, vomiting

what medication is a risk factor of hypokalemia

furosemide

s/s of hypokalemia

dysrhythmias GI disturbances nausea/vomiting fatigue

hypokalemia medical treatment

fix the cause potassium replacement diet

what diet does a hypokalemia patient need

high potassium diet

hyperkalemia

high potassium

risk factors of hyperkalemia

intake of K some endocrine disorders renal impairment

s/s of hyperkalemia

arrhythmias irritability tachycardia

hyperkalemia diagnostic

high K levels and arterial blood gasses

hypokalemia diagnostics

low K levels and arterial blood gasses

nursing interventions for hypokalemia

cardiac monitor and monitor vitals

why does hypokalemia patients need a cardiac monitor

know how thier heart is functioning continuously

hyperkalemia medical treatment

fix the cause K diet restrictions medications

what medication does hyperkalemia patients need

IV calcium sodium insulin dextrose and abluterol, furosemide and albuterol

IV calcium

dows everything muscle related

helps the heart slow down

IV sodium

decrease high K

IV insulin and dextrose

takes K that is outside of the cells back into the cells

give dextrose (sugar) if patient is not diabetic

loop diuretics

furosemide to push K out

albuterol

for asthma and decrease K

nursing interventions of hyperkalemia

cardia monitor monitor i/o and vitals and diet

calcium imbalances

found mostly in the bones

muscular symptoms

risk factors of hypocalcemia

hypoparathyroid malnutrition and osteoporosis

what is hypocalcemia patients malnutrition in

calcium and vitamin D

s/s of hypocalcemia

tetany chevostek and trousseau sign change in LOC hyperactive reflexes cardiac issues and seizures

tetany

muscles tighten and numbness/tingling in fingers and around the mouth

chvostek sign

spasms of the face

trousseau sign

inflate BP cuff and arm starts to constrict into itself

hypocalcemia diagnostics

low calcium levels

medical treatment of hypocalcemia

fix the cause give calcium and vitamin D

nursing interventions of hypocalcemia

high calcium diet, seizure precautions

hypercalcemia risk factors

hyperparathyroid overuse of calcium immobilization kidney stones

s/s of hypercalcemia

thirst polyuria muscle weakness GI disturbances change in LOC coma

hypercalcemia diagnostics

high Ca levels and x rays

why look at an x ray for hypercalcemia

looks at bones to see fractures or stones

medical treamtent for hypercalcemia

iv fluids and posphate furosemid calcitonin

why iv fluids for hypercalcemia

flushes calcium out of the bone

why iv phosphate for hypercalcemia

fixes hypercalcemia

why furosemide for hypercalcemia

flushes excess Ca

why calcitonin for hypercalcemia

takes Ca on the exterior of the bone and pushes it into the bone

nursing intervention of hypercalcemia

encourage ambulation push fluids telemetry