Post on 04-Feb-2022
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Unit VII Fluids and ElectrolytesUnit VII Fluids and ElectrolytesN141N141
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YouTubeFluid & Electrolytes Part 1 through 3 10”each CampbeliteachingOsmosis and Diffusion Part 1-4 10”Rec’d Acid-Base Balance Part 1,2, 3 davidlaw888 (ATI)
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Fluid & ElectrolytesFluid & ElectrolytesFunction of fluidFunction of fluid
Transport of nutrients to & wastes from Transport of nutrients to & wastes from cellscellsHelps maintain normal body temp.Helps maintain normal body temp.Lubricates & cushionsLubricates & cushionsFacilitates digestion & eliminationFacilitates digestion & eliminationMaintains vascular volumeMaintains vascular volumeSolvent for electrolytesSolvent for electrolytes
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Fluid & ElectrolytesFluid & Electrolytes
Function of electrolytesFunction of electrolytesBody water regulation & Body water regulation & osmolalityosmolalityAcidAcid--base balancebase balanceEnzyme activityEnzyme activityNeuromuscular activityNeuromuscular activity
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Fluid & ElectrolytesFluid & ElectrolytesBody fluid distributionBody fluid distribution
Water & electrolytesWater & electrolytes60% of weight (adult & children>2yrs.)60% of weight (adult & children>2yrs.)
ICF ICF –– intracellular fluid = 40%intracellular fluid = 40%ECF ECF –– extracellular fluids = 20%extracellular fluids = 20%
Intravascular 5%Intravascular 5%Interstitial 15%Interstitial 15%
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ElectrolytesElectrolytesPlasmaPlasma CationsCations + = 154+ = 154
Sodium (Na) 142Sodium (Na) 142Potassium (K) 5Potassium (K) 5Calcium (CaCalcium (Ca22) 5) 5Magnesium (MgMagnesium (Mg22) 2) 2
Plasma AnionsPlasma Anions –– =154=154Chloride (Chloride (ClCl) 104) 104Bicarbonate(HCOBicarbonate(HCO33) 26) 26Phosphate (HPOPhosphate (HPO44) 2) 2Sulfate (SOSulfate (SO44
22) 1) 1Organic acids & Organic acids & proteinateproteinate 2222
ICF CationsCations += 200PotassiumPotassium 150150Magnesium 40Magnesium 40Sodium 10Sodium 10
ICF Anions ICF Anions -- = 200= 200Phosphates Phosphates Sulfates (150)Sulfates (150)Bicarbonate 10Bicarbonate 10ProteinateProteinate 4040
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AcidAcid--Base BalanceBase BalancepH – H+ ion concentration in bloodHydrogen is a product of metabolismNormal pH 7.35 – 7.45Chemical buffer systems
Remove or release Hydrogen ionsECF buffers – phosphates & plasma proteinsICF buffers – phosphates, proteins, & HemoglobinBicarbonate – Carbonic acid buffer system Acid – donates H+ ionsBase – accepts H+ ions
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AcidAcid--Base Base
AlkalosisAcidosis
DeathDeath
7.35 7.45
7.806.80
1 part acid 20 parts baseH2CO3
1.2mEq/LHCO3
24mEq/L
H2O + CO2 H2CO3 H + HCO3
K I DNEYS
LUNGS
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Body Fluid BalanceBody Fluid BalanceRoutes of Gains & LossesRoutes of Gains & Losses
GainsFood 800-1000mlFluid intake 1100-1400mlOxidative metabolism
300ml
LossesLungs 400mlSkin 500-600mlG.I tract 100-200
Small intestine absorbs fluid
Kidneys – 1200-1500
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Fluid RegulationFluid RegulationOsmolalityOsmolality (Tonicity) = concentration(Tonicity) = concentration
IsoIso--osmolarosmolar, hypo, hypo--osmolarosmolar, , hyperosmolarhyperosmolarNormal serum Normal serum osmolalityosmolality = 280= 280--295mOsm/kg 295mOsm/kg of Hof H22OO
Semi permeable membrane
Isotonic
Iso-osmolar
Isotonic
Iso-osmolar
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Fluid Regulation Fluid Regulation -- OsmosisOsmosisOsmosisOsmosis
Osmotic pull by particles /unit of water Osmotic pull by particles /unit of water ((OsmolalityOsmolality))Movement of fluid from area of < Movement of fluid from area of < concentration to area of > concentrationconcentration to area of > concentration
Semi permeable membrane
Hypertonic
HyperosmolarHypotonic
Hypo-osmolar
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Fluid Regulation Fluid Regulation -- OsmosisOsmosisOsmosisOsmosis
Osmotic pull by particles /unit of water Osmotic pull by particles /unit of water ((OsmolalityOsmolality))Movement of fluid from area of < Movement of fluid from area of < concentration to area of > concentrationconcentration to area of > concentration
Semi permeable membrane
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Fluid RegulationFluid RegulationThirst mechanism
Thirst Center
Plasma Omolality
Angiotensin II
Dry oropharyngealMucous membranes
Plasma Volume
Psychologicalfactors
Dec.Potassiumor
Inc.Sodium
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Fluid Regulation Fluid Regulation –– KidneysKidneysRetention & ExcretionRetention & Excretion
Regulation of ECF volume & osmolalityby selective retention & excretionHydrostatic pressureFiltration = excretion of urine/waste productsGFR = 125ml/minuteNormal urine output – 20-30ml/hr
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ReninRenin--AngiotensinAngiotensin--AldosteroneAldosterone SystemSystem
Glomerulus
Renin secretion
BP or Na
Liver
Angiotensinconverted to Angiotensin I
Lungs
Angiotensin I converted to Angiotensin II
Adrenals produce aldosterone
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AldosteroneAldosteroneNa & H2O retention =
fluid volume & Na levels
Angiotensin II –adrenals* secrete aldosterone
*
Kidneys retain Na & H2O 18
AntidiureticAntidiuretic Hormone (ADH)Hormone (ADH)
Plasma Osmolality
Hypothalmus Osmoreceptors
BrainADH
Kidney
H2O retention
Urine volume
Urine concentration
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Electrolyte Balancing ActElectrolyte Balancing Act
Active transportActive transportATP ATP –– solutes move from solutes move from area of < concentration to area of < concentration to areas of > concentrationareas of > concentration
The body expands energy to The body expands energy to maintain the extracellular Na maintain the extracellular Na and the intracellular K by and the intracellular K by means of cell membrane means of cell membrane Sodium Sodium –– Potassium pump.Potassium pump.
+ -
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Sodium BalanceSodium BalanceNormal serum sodium (Na+)
135 –145 mEq/L (Cl 95 - 108)95% in ECF Primary role
Control H2O distribution & volumeNormal intake 50-90mEq as NaClKidney conserves or excretes Na prn
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Potassium ( KPotassium ( K++))FunctionFunction
Regulation of ICF osmolalityPromotes transmission/conduction of nerve impulsesPromotes contraction of skeletal, cardiac, & smooth muscleMaintenance of acid-base balance
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Potassium ( KPotassium ( K++))
Major intracellular cation–150mEq/LNormal se levels – 3.5–5mEq/LPoor storage – daily requirement needsKidneys excrete 80-90% of K+
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Dietary Sources of KDietary Sources of K
MeatsMeatsVegetablesVegetablesFruitsFruitsDried fruits, nuts, Dried fruits, nuts, seedsseedsChocolateChocolate
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CalciumCalcium
Se Ca++
Total 8.5 –10.5 mg/dL (100ml)Bound with protein & ionized
Ionized – 4 – 5 mEq/L99% in bones & teeth
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Calcium Calcium -- FunctionFunctionTransmission & conduction of nerve impulsesStimulates skeletal, smooth, & cardiac muscle contractionPromotes coagulationBone & teeth formationHormone secretion
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Calcium Calcium –– RegulationRegulation
Vitamin DPhosphates
PO3-
Inverse relationship with Calcium
PTHCalcitonin
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Magnesium Magnesium Distribution
2/3 found in bones1/3 found in ICF1% in ECF
Absorbed in small bowelExcreted by kidneysFunction
Intracellular metabolismNeuromuscular - similar to calcium
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BicarbonateBicarbonateHCO3-
Major chemical buffer in ECF & ICFRegulated by kidneysArterial measurement
20-26 mEq/LVenous measurement
CO2 content 24-30 mEq/L
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ABG ValuesABG ValuespH 7.35 – 7.45
<7.35 >7.45
PaCO2 35-45 mmHg<35 (hypocapnia)>45 (hypercapnia
HCO3 20-26 mEq/L<20 (acidosis)>26 (alkalosis)
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AcidAcid--Base Base
AlkalosisAcidosis
DeathDeath
7.35 7.45
7.806.80
1 part acid 20 parts baseH2CO3
1.2mEq/LHCO3
24mEq/L
H2O + CO2 H2CO3 H + HCO3
K I DNEYS
LUNGS
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AcidAcid--Base Base --AcidosisAcidosis
AlkalosisAcidosis
DeathDeath
7.35 7.45
7.806.80
Gain of acid
H2CO3
H2O + CO2 H2CO3 H + HCO3
HCO3
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AcidAcid--Base Base --AcidosisAcidosis
AlkalosisAcidosis
DeathDeath
7.35 7.45
7.806.80
Loss of baseHCO3
H2O + CO2 H2CO3 H + HCO3
H2CO3
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Metabolic Acidosis Metabolic Acidosis ––MechanismMechanism
Accumulation of fixed acids
Lactic acidosisRenal failureKetoacidosisIngestion
ASAAntifreeze
Loss of baseLoss of baseRenal tubular acidosisCarbonic anhydraseinhibitors
DiamoxDiarrhea
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Metabolic Acidosis Metabolic Acidosis --SymptomsSymptoms
pH HCO3
Hyperventilation (PaCO2 )compensatoryLethargy/weaknessHyperkalemiaHypotension & myocardial depression
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Respiratory AcidosisRespiratory AcidosisCauses
Inadequate excretion of CO2
Acute or chronic respiratory alterationsRisk factors favoring hypoventilation
ObesityTight binders/dressingsPostoperative painAbdominal distention
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Respiratory Acidosis Respiratory Acidosis ––SymptomsSymptoms
ABG’spH PaCO2
HCO3 ( compensatory)HeadacheHypertensionHyperkalemiaHypoxemia
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AcidAcid--Base Base
AlkalosisAcidosis
DeathDeath
7.35 7.45
7.806.80
1 part acid 20 parts baseH2CO3
1.2mEq/LHCO3
24mEq/L
H2O + CO2 H2CO3 H + HCO3
K I DNEYS
LUNGS
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AcidAcid--Base Base --AlkalosisAlkalosis
7.806.80 AlkalosisAcidosis
DeathDeath
7.35 7.45
Loss of acid
H2CO3HCO3
H2O + CO2 H2CO3 H + HCO3
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AcidAcid--Base Base --AlkalosisAlkalosis
7.806.80
Gain of base
AlkalosisAcidosis
DeathDeath
7.35 7.45
H2CO3HCO3
H2O + CO2 H2CO3 H + HCO340
Metabolic Alkalosis Metabolic Alkalosis --CausesCauses
Fixed acid lossVomiting/G.I suctionHypokalemia
Excess bicarbonate intakeAlkali ingestionI.V. NaHCO3
Excess bicarbonate reabsorption
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Metabolic Alkalosis Metabolic Alkalosis ––SymptomsSymptoms
ABG’spH HCO3
PaCO2 ( compensatory)HypoventilationDecreased LOCHypokalemiaHypochloremiaTetany/paresthesia
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Respiratory AlkalosisRespiratory AlkalosisCauses relate to hyperventilation
AnxietyHigh feverThyrotoxicosisHypoxemiaSalicylate intoxication (early)
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Respiratory AlkalosisRespiratory Alkalosis-- SymptomsSymptomsABG’s
pH PaCO2 HCO3 ( compensated)
Lightheadedness/confusionInability to concentrateParesthesiaPalpitationsDry mouth 44
Influencing Factors in Total Body WaterInfluencing Factors in Total Body WaterBody fatBody fat
Fat cells contain less waterSexSex
Women less body fluid than menAgeAge
Infants 70-80% body weight (Adult 60%)50% extracellular (Adult 20%)
Older adult% of body weight
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Influencing FactorsInfluencing Factors
ElderlyElderlyDiminished thirst responseDiminished thirst responseAltered ADH responseAltered ADH responseDecreased ability to concentrate urineDecreased ability to concentrate urineChronicityChronicityDebilitationDebilitationChanges in cognitionChanges in cognition
Infant Infant -- child, more risk for dehydration, child, more risk for dehydration, esp. if vomiting and diarrheaesp. if vomiting and diarrhea
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Risk FactorsRisk FactorsCompromised regulatory mechanismsCompromised regulatory mechanisms
Congestive heart failureCongestive heart failureRenal failureRenal failureCirrhosisCirrhosisSteroid excessSteroid excess
ADH stimulationADH stimulationExcess sodium containing fluids/foodsExcess sodium containing fluids/foodsIV solutionsIV solutions
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Alterations in fluid intake & Alterations in fluid intake & outputoutput
MedicationsMedicationsG.IG.I
DysphagiaDysphagiaNausea/vomitingNausea/vomitingDiarrheaDiarrheaInsufficient intakeInsufficient intakeG.I. suctionG.I. suction
RestraintsRestraints
SkinSkinDiaphoresisDiaphoresisWounds/burnsWounds/burns
FeverFeverIncrease in Increase in metabolismmetabolismTachypneaTachypnea
Blood lossBlood loss48
History and InterviewHistory and InterviewAgeAcute illnessRespiratory/Cardiovascular disordersChronic illnessRenal / G. I. disordersEnvironmentDiet/ lifestyleMedications
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Normal FindingsNormal FindingsGeneralVSWeightIntake & OutputUrineSkin turgor
Mucous membranesThirstEdemaNeck VeinsNeuromuscular signs
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Diagnostic TestsDiagnostic Tests
Serum electrolytes
SodiumPotassiumChlorideCO2
Serum osmolalityABG’sHematocrit
BUNCreatinineBUN:creatinineratioSpecific gravityUrine osmolality
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Isotonic Imbalance Isotonic Imbalance -- Fluid Fluid Volume Deficit (FVD)Volume Deficit (FVD)
Decrease in intravascular & Decrease in intravascular & interstitial fluids = interstitial fluids = hypovolemiahypovolemiaIsotonic FVD Isotonic FVD
Equal water & Equal water & lytelyte losslossHemorrhageHemorrhageDiaphoresisDiaphoresisDiureticsDiuretics
Na 140Na 140
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Fluid Volume Deficit Fluid Volume Deficit -- IsotonicIsotonicS&S
BPHeart rateMucous membranesSkin turgorWeightVenous fillingUrine outputLOC
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Assessment Assessment --FVD FVD ––SymptomsSymptoms
ThirstThirstMuscle weaknessMuscle weaknessDecreased skin Decreased skin turgorturgorDry mucous membranesDry mucous membranesSoft & sunken eyeballsSoft & sunken eyeballsDecreased temperature if no sepsisDecreased temperature if no sepsisTachycardiaTachycardiaNarrowed pulse pressureNarrowed pulse pressurePostural hypotensionPostural hypotensionDecreased urinary output, weight lossDecreased urinary output, weight lossNeurological changes Neurological changes –– apprehension, apprehension, headache, confusionheadache, confusion 54
FVD FVD -- Diagnostic TestsDiagnostic Tests
Serum Na+
BUN
⇒ or ⇑ 145
⇑ >25
Hematocrit ⇑ >50%
Specific gravity ⇑ > 1.025
Increased solute to solvent
Hemo-concentration
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Extracellular Fluid Volume Extracellular Fluid Volume Excess (FVE)Excess (FVE)
Abnormal fluid retention in intravascular & interstitial spacesSecondary to serum NaSodium & Water retained in proportion
NA 140mEq/L
ISOTONIC
FLUID
NORMAL VOLUME EXCESS VOLUME56
Isotonic Fluid Volume ExcessIsotonic Fluid Volume ExcessCauses
Congestive heart failureRenal failureExcessive sodium intakeIncreased serum aldosterone levelsSteroids
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Isotonic Fluid Volume ExcessIsotonic Fluid Volume ExcessS&S
WeightEdemaBPUrine outputVenous fillingBreath sounds
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FVE FVE –– ManifestationsManifestationsCardiovascularCardiovascular
B.P.B.P.Pulse qualityPulse qualityPitting edemaPitting edema
SacralSacralPeripheralPeripheral
Weight gainWeight gainDistended veinsDistended veinsSS33 heart soundheart sound
RespiratoryRespiratoryConstant, Constant, irritating coughirritating coughCrackles (Crackles (RalesRales))DyspneaDyspneaCyanosisCyanosisPleural effusionPleural effusion
NeurologicalNeurologicalLOCLOC
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FVE FVE –– Diagnostic TestsDiagnostic Tests
Serum sodiumSerum sodiumHematocritHematocrit (% (% RBCRBC’’ss in plasma)in plasma)Urine specific gravityUrine specific gravityBUNBUN
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OsmolarOsmolar ImbalancesImbalances
HyperosmolarHyperosmolar FVDFVDWater loss > Water loss > lytelyte lossloss
HypoHypo--osmolarosmolar FVEFVEWater gain > Water gain > lytelyte gaingain
Na 150Na 140
Water Excess
Dehydration
Na <135Na 140
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HypoHypo--osmolarosmolar Imbalance Imbalance ––HH22O excessO excess
CausesCausesExcessive amounts of hypotonic (hypo-osmolar)solutions
D5W0.45% saline
Excessive intake of free water
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Intracellular Fluid Volume Intracellular Fluid Volume Excess (ICFVE)Excess (ICFVE)
Fluid shift from extracellular spaces to intracellular Due to serum hypo-osmolalityCellular edema
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Effect of Na Imbalance on CellEffect of Na Imbalance on Cell
H2O
Hypernatremia:
Na > 145mEq/L
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Effect of Na Imbalance on CellEffect of Na Imbalance on Cell
H2O
Hypernatremia:
Na > 145mEq/L
Cell shrinks as water is pulled out into ECF
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Effect of Na Imbalance on CellEffect of Na Imbalance on CellHyponatremia:
Na < 135mEq/L Due to excess water gain or Na loss
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Effect of Na Imbalance on CellEffect of Na Imbalance on CellHyponatremia:
Na < 135mEq/L H2O
H2O
H2O
H2O
Cell swells as water is pulled in
from ECF
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HypernatremiaHypernatremia –– SymptomsSymptomsS&S of FVE or FVDS&S of FVE or FVDThirst?Thirst?Temperature?Temperature?Mucous membranes?Mucous membranes?Restlessness, weakness with mild to Restlessness, weakness with mild to moderate moderate NaNaDisorientation, delusions, hallucinations Disorientation, delusions, hallucinations with severe with severe NaNaLethargy, stupor, comaLethargy, stupor, comaMuscle irritability and convulsionsMuscle irritability and convulsions 68
HyponatremiaHyponatremia
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HyponatremiaHyponatremia –– SymptomsSymptomsRelate to Na levelRelate to Na level
120120--125mEq/L125mEq/LNauseaNauseaMalaiseMalaise
115115--120 120 mEqmEq/L/LHeadacheHeadacheLethargyLethargyObtundationObtundation
<110<110--115 115 mEqmEq/L/LSeizuresSeizuresComaComa
Volume statusECF depletion
WeaknessFatigueMuscle crampsPostural dizziness
Lab dataSe Na?Ua Na?Se osmolality?
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HYPOKALEMIAHYPOKALEMIASerum KSerum K+ + < 3. 5 < 3. 5 mEqmEq/L/LCausesCauses
Inadequate nutrient intakeInadequate nutrient intakeG.I. LossesG.I. LossesRenal lossesRenal lossesStress Stress –– increased increased cortisolcortisol levelslevelsSteroidsSteroidsAlkalosisAlkalosis
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HypokalemiaHypokalemia –– SymptomsSymptomsMusculoskeletal
WeaknessParalysisLeg cramps
G.I.IleusAnorexiaVomiting
RespiratoryRespirations?SOBApnea
RenalPolyuria
Cardiovascular
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HyperkalemiaHyperkalemia Se KSe K++> 5.0 > 5.0 mEqmEq/L/LCauses
Decreased potassium excretionOliguric renal failurePotassium sparing diuretics
High potassium intakeExcess oral potassium supplementsExcessive or rapid IV K+ replacement
Shift of K out of cellsAcidosis, tissue trauma, malignant cell lysis(chemotherapy)
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HyperkalemiaHyperkalemia –– SymptomsSymptomsCardiovascular
EKG changesDysrhythmiasWeakened contractilityTachycardia then bradycardiaCardiac arrest
GINauseaIntestinal colicHyperactive bowel sounds
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HyperkalemiaHyperkalemia -- SymptomsSymptoms
NeuromuscularVague muscle weaknessFlaccid muscle paralysisParesthesia
RenalOliguriaanuria
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HypercalcemiaHypercalcemia –– CausesCauses
Metastatic CancerImmobilizationHyperparathyroidismIntake
Thiazide diuretics, LithiumExcess intake of Ca2
+ antacidsExcess intake of Vitamins A or D
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HypercalcemiaHypercalcemia –– SymptomsSymptomsNeuromuscular weaknessRenal
Polyuria (DI)Hypercalcuria
GIN & V
peristalsisConstipation
CardiovascularImpaired cerebral functioning
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HypocalcemiaHypocalcemia –– SymptomsSymptomsNeuromuscular
Tetanythreshold potential – less stimulus
required for action potentialHyperexcitability of motor & sensory nervesParesthesiaTrousseau’s signChvostek’s sign
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HypermagnesemiaHypermagnesemia ––SymptomsSymptoms
Diminished neuromuscular transmissionDecreased muscle functionHypotensionRespiratory depressionCardiac arrest
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HypomagnesemiaHypomagnesemia <1.8mg/dL<1.8mg/dLCausesCauses
Losses from G.I tractAlcoholismRapid administration of citrated bloodMedications
Loop diureticsCisplatin
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Nursing DiagnosisNursing DiagnosisFluid volume excessFluid volume deficitIneffective breathing patternImpaired mobilityImpaired skin integrityAltered oral mucous membranes
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NursingNursing InterventionsInterventionsAssess fluid volume statusObtain daily weights
1 liter = 1 kg.(2.2lb.)Measure & calculate I & OMonitor lab valuesProvide frequent mouth careAdminister tube feedings &/or IV fluidsProtect skin integritySafety – implement measures to prevent fallsPulmonary toiletOffer fluids as appropriateMedications 82
Fluid TypesFluid TypesOral rehydration.Oral rehydration.Intravenous solutionsIntravenous solutions
Isotonic electrolyte solutions to treat Isotonic electrolyte solutions to treat hypotensive hypotensive patient patient –– expands plasma volume.expands plasma volume.
Lactated RingerLactated Ringer’’s.s.O.9% Normal Saline.O.9% Normal Saline.
Hypotonic solutions Hypotonic solutions –– provides free water & provides free water & lytes lytes ––allows kidneys to select & retain needed amounts. allows kidneys to select & retain needed amounts. Decreases intravascular Decreases intravascular osmolalityosmolality..
0.45%N.S.0.45%N.S.DD55%/0.2%N.S.%/0.2%N.S.
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Parenteral Parenteral FluidsFluidsPurposes of Fluid Therapy
Maintenance NeedsFluidsElectrolytes
ReplacementCorrection of electrolyte disturbances
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Parenteral Parenteral FluidsFluidsAssessment
I & ODaily body weightsVital signsSkin turgorUrinary specific gravityLaboratory valuesI.V. site
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CrystalloidsCrystalloidsDextrose Solutions
D5WIsotonic HypotonicD5W is 5% dextrose in water is hypotonic so it moves fluid into the cells out of the circulation
Free water to aid renal excretion of solutesCalories 50 grams DextroseAvoid excess
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CrystalloidsCrystalloidsSodium Chloride solutions
Isotonic Saline (0.9% NaCl)Expands extracellular fluidDoes not enter the ICFUse
ECF deficitsHyponatremiaHypochloremiaMetabolic alkalosis
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CrystalloidsCrystalloids0.45% NaCl
HypotonicProvides Na, Cl, free waterBasic fluid for maintenanceUses
MaintenanceHypovolemia with hypernatremia
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CrystalloidsCrystalloidsBalanced electrolyte solutions
Lactated Ringers (Na, Cl, K, Ca, lactate)Lactate BicarbonateMetabolic acidosisThird spacingFluid resuscitation
NormosolIsolytePlasma-Lyte
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ColloidsColloidsProtein or starch molecules in fluidIncrease osmotic pressure – volume expansionAlbumin
5%– equivalent to plasma25% - hyperoncoticPlasma expander
DextranLow molecular weight (dextran 40)High molecular weight (dextran 70)
HetastarchSupplemental fat emulsions (Lipids)
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Adverse effects of IV therapyAdverse effects of IV therapyFluid Volume Excess/DeficitActivity intoleranceImpaired skin integrityImpaired tissue perfusionRisk for dysrhythmiasRisk for injuryElectrolyte imbalances (specify)Altered nutritionIneffective breathing patterns
Study GuideList assessment findings for fluid volume deficit. List assessment findings for fluid volume excess. Identify fluid and electrolyte issues for infants and elderly.Know the compensating mechanisms most likely to occur in the presence of respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic acidosis.Be aware of causes and symptoms of potassium imbalances, sodium imbalances.List ways to assess for fluid retention.Identify the signs that indicate that fluid replacement is needed.