NU 236 EXAM 1 (FLUID & ELECTROYLYTES)
Terms
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- TO HELP REMIND, NA=
-
NEURO EFFECTS (AFFECTS BRAIN)
=NOT ALERT - AS NURSE:WHAT IS TO BE DONE FOR FVE
-
REDUCE NA
GIVE DIURETICS -
WHAT IS THE CAUSE OF HYPOMAGNESIA ?
AS NURSE:WHAT IS TO BE DONE? -
ALCOHOL,MALABSORPTION MEDS
-CAN POTENTIATE DYSRYTHMIAS
-GIVE IT IV VERY SLOWLY
-CAN BE GIVEN DURING PRE-TERM LABOR - WHAT CAUSES METABOLIC ALKALOSIS?
-
-TOO MUCH BASE OR TOO LITTLE ACID
-TOO MUCH USE OF ANTACIDS
-**VOMITING MOST COMMON CAUSE**(CAUSES LOSS OF ACID) - WHAT CAUSES METABOLIC ACIDOSIS?
- LOSS OF BASE W/DIARRHEA
- S/S OF FLUID VOLUME DEFICIT:
-
POOR SKIN TURGOR,DRY MUCOUS MEMBRANE,PT C/O THIRST,LOW U/O,LOW WT.,POSTURAL HYPOTENSION (ORTHOSTATIC)-SYS BELOW 15 & DIASTOLIC BELOW 10 (DUE TO CHANGE IN POSITION)
-PT C/O DIZZINESS, HIGH URINE SPEC GRAV,HIGH HCT,HIGH BUN,HIGH ALBUMIN -
IF DIABETIC ACIDOSIS,__ IS TO BE GIVEN
IF RENAL FAILER,GIVE__ -
1.INSULIN
2.DIALYSIS - ADH
-
VASOPRESSIN-POSTERIOR PITUITARY
-HIGH OSMOLALITY LEADS TO HIGH ADH RELEASE
-KIDNEYS
-URINE MORE CONCENTRATED, BLOOD LESS CONCENTRATED - CAPILLARY HYDROSTATIC PRESSURE=
- PRESSURE OF FLUID ON CAPILLARY WALLS
- WHAT CAN DEPRESS RESPIRATIONS DURING RESPIRATORY ACIDOSIS?
- INEFFECTIVE AIRWAY CLEARANCE,RESPIRATORY ILLNESS,MEDS
- WHAT IS THE CAUSE OF RESPIRATORY ACIDOSIS ?
- TOO MUCH CO2 RETAINED
- CONTROL MECHANISMS OF FLUID & ELECTROLYTES ARE:
-
1.ADH
2.ALDOSTERONE
3.THIRST - INTERVENTIONS FOR FLUID VOLUME EXCESS:
-
**I & O **
**DAILY WTS**
-CHECK LUNG SOUNDS-FVE CAN LEAD TO PULMONARY EDEMA
-INCREASE HOB,ASSESS EDEMA,TEACHING - MOVEMENT OF ECF BETWEEN INTRAVASCULAR & INTERSTITIAL COMPARTMENTS IS DETERMINED BY AN INTERACTION OF:
-
1.PLASMA ALBUMIN CONCENTRATION
2.CAPILLARY HYDROSTATIC PRESSURE
3.CAPILLARY PERMEABILITY - WHAT CAUSES FLUID VOLUME EXCESS?
- KIDNEY FAILURE, CONGESTIVE HEART FAILURE,PT OVERLOAD W/ IV FLUIDS,CORTICOSTEROIDS
- S/S OF FLUID VOLUME EXCESS:
-
BOUNDING PULSE,HIGH BP,LOW BUN,NECK VEINS DISTENDED
-1L OF WATER= 1KG (2.2 LBS)
-500 CC= 1 LB - WHATS THE CAUSE OF RESPIRATORY ALKALOSIS?
-
LOSS OF CO2-HYPERVENTILATION
DUE TO EARLY SHOCK,HEAD INJURY - WHOS AT RISK FOR FLUID VOLUME EXCESS ?
- ELDERLY AND INFANTS
- S/S OF METABOLIC ALKALOSIS:
-
-HYPOVENTILATION-RESP SHALLOW & SLOW
-PH ABOVE 7.45
-PCO2 NORMAL OR HIGH (RETAIN CO2 TO COMPENSATE0
-HCO3 HIGH (TOO MUCH BASE)
-**ALL VALUES ARE HIGH** - ALDOSTERONE
-
ADRENAL CORTEX
-ACTH-ANTERIOR PITUITARY
-REABSORPTION OF NA >>> WATER
LEASES TO LOSS OF K+ - CAUSE OF FLUID VOLUME DEFICIT (FVD):
- N/V/D, 3RD SPACE SHIFTING
- AS NURSE:ASSESSMENT FOR RESPIRATORY ALKALOSIS
-
LIGHT HEADED
-TINGLING IN FINGERS & FEET
-PH HIGH,LOW PCO2 (BLOWING OFF HCO3 NORMAL OR LOW TO COMPENSATE) - MAGNESIUM NORMAL VALUES:
- 1.5-2.5
-
HYPERCALCEMIA CAN CAUSE:
AS NURSE:WHAT IS TO BE DONE? -
***CANCER MOST COMMON**
-MALIGNANCY AFFECTING BONES
-GIVE LASIX TO FLUSH OUT HIGH CA
-CANCER PT TO HAVE LOW CA DUE TO ALBUMIN GIVEN - LUNGS-CO2 AS MECHANISM TO REGULATE PH
-
HYPERVENTILATE-BLOW OFF ACID
HYPOVENTILATE-RETAIN ACID - WHAT TRIGGERS 3RD SPACE SHIFTING?
-
BURNS,CIRRHOSIS,PERITONITIS,
ABDOMINAL SURGER,ALLERGIC RXN,SEPTIC SHOCK - WHAT ARE THE 3 MECHANISMS THAT REGULATE PH ?
-
1.CHEMICAL (BLOOD) BUFFERS
2. LUNGS-CO2
3.METABOLIC REGULATOR-KIDNEY - WHAT TELLS US WHEN INCREASED OSMOLALITY ?
- HYPOTHALAMUS..ALERTS THIRST
- POTASSIUM BELOW 3.5=
-
HYPOKALEMIA
CAUSE:LOOP DIURETICS EXP,LASIX
VOMITING,DIARRHEA,METABOLIC ALKALOSIS,HEART PROB (ARRYTHMIAS) - SODIUM ABOVE 145=
-
HYPERNATREMIA
-TOO MUCH ALDOSTERONE
-LOSS OF WATER W/ NA
-DIABETES INSIPIDUS - K+ ABOVE 5 =
-
HYPERKALEMIA
CAUSE:**RENAL FAILURE** MOST COMMON CAUSE
METABOLIC ACIDOSIS
HIGH K+ CAN LEAD TO CARDIAC ARREST - WHERE DOES 3RD SPACE SHIFTING TAKE PLACE?
-
INTERSTITIAL
-HIDES IN TISSUES
-WHERE IT IS NOT USABLE - AS NURSE: WHAT MUST BE DONE WHEN GIVING K+ ?
-
K+ MUST BE DILUTED
-GIVE NO MORE THAN 20 MEQ/HR (40-80/L)
-WE GIVE 10MEQ/100 CC
-PT WILL C/O OF BURING/IRRITATION IF GIVEN TOO FAST - WHAT OCCURS DURING 3RD SPACE SHIFTING?
-
ECF SHIFTS
-INTRAVASCULAR>>>INTERSTITIAL
-CAPILLARY BECOMES PERMEABLE & FLUID LEAKS OUT>>>EDEMA
- NORMAL POTASSIUM VALUE=
- 3.5-5
- TXT FOR RESPIRATORY ALKALOSIS:
-
-VENTILATION
-LOWER ANXIETY
-TREAT SHOCK - WHAT ARE THE NORMAL VALUES OF PH,PCO2,PO2,HCO3?
-
1.PH= 7.35-7.45
2.PCO2= 35-45
3.PO2= 80-100
4.HCO3= 22-28 - CAUSE OF 3RD SPACE SHIFTING:
-
INCREASED CAPILLARY PERMEABILTIY
-ALBUMIN LEAKS OUT>>INTERSTITAL SPACE
-LEADS TO FLUID VOL DEFICIT - SODIUM LESS THAN 135=
-
HYPONATREMIA
S/S:N/V,DIARRHEA,LOSS OF ALDOSTERONE - WHAT DOES HYPOCALCEMIA CAUSE?
-
TETANY & SEIZURES
LOW CA++=CONVULSIONS (TETANY)
=CHVOSTEKS (TOUGH CHEEK;CHECK FOR TWITCHING
=TROUSSEAUS SIGN (BLD PRESSURE)
-CAN LEAD TO COMA
- NORMAL CALCIUM VALUE=
- 8.5-10 MEQ
- 50% OF CALCIUM IS BOUND TO __ AND THE OTHER 50% OF CALCIUM IS BOUND TO __ ?
-
1.IONS (USABLE FORM)
2.ALUBUMIN - WHAT ARE THE 2 PHASES OF 3RD SPACE SHIFTING?
-
1ST PHASE-OCCURS BET 1ST 24 HRS AFTER SURGER
2ND PHASE-OCCURS 48 HRS - INTERSTITIAL (INTERCELLULAR TISSUE FLUID)
- AROUND THE CELL
- HOW DOES ONE DO A CHECK TO FIND OUT TYPE OF IMBALANCE?
-
1.1ST CHECK PH
HIGH=ALKALOSIS..LOW=ACIDOSIS
2.2ND CHECK PCO2
HIGH=RESPIRATORY..LOW=METABOLIC
3.3RD CHECK HCO3
4.CHECK PARTIAL PRESSURE OF 02 - PLASMA ALBUMIN CONCENTRATION=
-
-COLLOID OSMOTIC PRESSURE OR OSMOTIC PRESSURE
-HOW MUCH ALBUMIN IS IN SERUM
-IF YOU LOSE ALBUMIN, YOU LOSE FLUID - IN A HYPOTONIC SOLUTION, THE CELL WILL __
- SWELL
- CAPILLARY PERMEABILITY TO ALBUMIN=
- NORMALLY ALBUMIN SHOULD ONLY BE IN VESSELS
- ELECTROLYTE DISTURBANCES THAT LEAD TO DIG TOXICITY ARE:
- LOW K+, HIGH CA++, LOW MG
-
FLUID=__ ?
2/3 INTRACELLULAR=
1/3 EXTRACELLULAR= -
1.WATER
2.ICF
3.ECF - METABOLIC ACIDOSIS COMPENSATION:
-
1.HYPERVENTILATE
2.KUSSMAULS RESP-RAPID & DEEP RESP
3.HYPERKALEMIA-CONCERNED ABOUT HEART - INTRAVASCULAR
- IN THE VESSELS (ARTERIES,VEINS,CAPILLARIES)
- HOW DOES FLUID MOVE?
-
1.ACTIVE TRANSPORT-NEED ENERGY
2.PASSIVE TRANSPORT-NO ENERGY - WHICH ABG'S HAVE TO DO WITH GAS EXCHANGE?
- PCO2,PO2,HCO3
- ASSESSMENT AS NURSE:FOR 2ND PHASE OF 3RD SPACE SHIFTING
-
48-72 HRS LATER,FLUID STARTS TO REABSORB >>> DIURESIS
U/O >200 CC/HR
-S/S FLUID VOL EXCESS - AS NURSE:INTERVENTIONS FOR FLUID VOLUME DEFICIT
-
** I & O
** DAILY WT
-CHECK U/O-SHOULD BE > 30CC/L OF H20= 2.2 LBS
-TXT FOR S/S SHOCK
-ADVISE PT TO RISE SLOWLY - DIFFUSION
- MOVEMENT OF DISSOLVED SUBSTANCES (SOLUTES) FROM AN AREA OF HIGH CONCENTRATION TO AN AREA OF LOW CONCENTRATION
- CHEMICAL BLOOD BUFFERS
-
BASE BICARBONATE:CARBONIC ACID
20:1 - METABOLIC REGULATOR-KIDNEYS AS A MECHANISM TO REGULATE PH:
-
SECRETE OR RETAIN ACID (H+) IONS OR BICARBONATE (BASE)
-TAKES SEVERAL HRS TO DAYS TO COMPENSATE - OSMOSIS
- MOVEMENT OF *WATER* FROM LOWER CONCENTRATION TO HIGHER CONCENTRATION OF IONS THROUGH A SEMI PERMEABLE MEMBRANE
- ASSESSMENT AS NURSE:FOR 1ST PHASE OF 3RD SPACE SHIFTING
-
S/S FVD
-LOW U/O BUT NO WT LOSS
-24 HR INTAKE > OUTPUT
-WT GAIN,EDEMA - S/S OF METABOLIC ACIDOSIS:
-
PH BELOW 7.35
PCO2 NORMAL OR LOW (BLOWING OFF CO2)
HYPERVENTILATE
KUSSMAULS RESP
HCO3 DECREASES (LOSS OF BASE)
**ALL VALUES LOW**
METABOLIC ACIDOSIS MAY LEAD TO VOMITING - IN A HYPERTONIC SOLUTION,THE CELL WILL __
- SHRINK
- WHAT ARE S/S OF RESPIRATORY ACIDOSIS?
-
RESTLESSNESS,CONFUSION
LATER-HEART PROB
LOW PH,HIGH CO2,HIGH PCO2
ELEVATED OR NORMAL BICARBONATE LEVELS (TO COMPENSATE) - EXAMPLES OF HYPOTONIC SOLUTION:
-
D5 1/2 NS
-IF GIVEN TOO MUCH, SWELLING IN BRAIN
-MAKE SURE GIVE NA WITH D5 IN WATER - SODIUM NORMAL LEVEL
- 135-145
- AS NURSE: WHAT IS DONE FOR HYPERKALEMIA
- PT GIVEN KAYEXALATE TO LOWER K+
- WHEN IS CALCIUM GIVEN?
-
DURING REMOVAL OR SWELLING OF PARATHYROID
EXP: NECK SURGERY - WHAT IS THE CAUSE OF HYPERMAGNESIA?
- KIDNEY FAILURE
- FLUID IS ONLY VISIBLE IN __ AND __
- IN CELL OR IN VESSELS
- INTAKE MUST EQUAL __ ?
- OUTPUT
- ISOTONIC MEANS ?
- NO CHANGE IN FLUID
- AS NURSE:WHAT IS TXT FOR RESPIRATORY ACIDOSIS ?
-
-IMPROVE VENTILATION
-SUCTION
-INCREASE HOB
-O2 GIVEN
-COUGH & DEEP BREATH