Fluid and electrolytes theraputics
Terms
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- Extracellular fluids (ECF) is located where in the body?
- Interstitial fluid, a solution which bathes and surrounds the cells and in Intravascular fluid -the blood plasma, or the fluid in the circulatory system, which includes the heart and the blood vessels
- Hypernatremia- Assessment
- Decreased cardiac output, Thirst, Muscle irritability and convulsions, Skeletal muscle weakness, Lethargy, stupor or coma, Elevated body temperature, Increased specific gravity, Decreased urine output, Dry, flaky skin, Restlessness, disorientation
- Hyperkalemia-Causes
- Excessive potassium intake, Decreased potassium excretion - Renal failure, adrenal insufficiency, potassium sparing diuretics, Movement of potassium from ICF to ECF - Tissue damage, acidosis, hypercatabolism
- Sodium Food Source
- Table salt, Soy sauce, Cottage cheese, American cheese, Milk butter, Ketchup, Mustard, bacon, Snack food, Canned food, Lunch meat, White & whole bread, Hotdogs, Processed food, Cured pork
- Lungs
- 400cc output
- Anions
- Chloride, bicarbonate, phosphate
- Hypokalemia-Causes
- Inadequate potassium intake-NPO, Movement of K* from ECF to ICF, Dilution of serum potassium
- Calcium and effect in coagulation
- Needed for coagulation, -clotting cascade
- Hypercalcemia-Interventions
- Monitor all systems-cardiac monitor, Discontinue solutions containing Calcium, DC thiazide diuretics, Give IV normal saliene, Give meds to inhibit calcium resorption: Phosphorus, calcitonin, biphosphonates, aspirin
- Solid food
- 800-1000cc
- Kidneys
- 1200-1500cc output
- Oral fluid
- gains 1100-1400cc
- Hypokalemia-Assessment
- Weak, thready pulse, Peripheral pulse difficult to palpate, ECG changes, Shallow respirations, Anxiety, lethargy, confusion, coma, Decreased GI motility, Nausea, vomiting, Constipation, Abdominal distention, Paralytic ileus, Decreased specific gravity, Increased urine output
- Rhondomyleytis
- Hypocalcemia cause decrease movement of muscles, leading to acute muscle breakdown, thus Rhondomyleytis.
- Hypercalcemia-Causes
- >10mg/dl, Increased calcium absorption - Excessive oral intake calcium & vitamin D, Decreased calcium excretion - Renal failure, thiazide diuretics, Increased bone resorption of calcium- Malignancy, immobility, hyperthroidism, Hemoconcentration- Dehydration, adrenal insufficiency, lithium
- Isotonic
- Same osmolality as body fluids -ex. Lactated ringers, D5W, NS
- Hypotonic
- Less osmolality than body fluids -ex. 1/2 NS
- HHNK intervention
- give small amount of insulin with tons of fluids,
- Sensible loss
- measurable fluid loss i.e. urine, gastointestinal juices, diahrrea
- Hypocalcemia-Assessment
- Decreased heart rate & contractility, Cardiac dysrhythmias, Hypotension, Tetany/seizures, Positive Trousseau's & Chvostek's sign, Hyperactive bowel, Abdominal cramping & diarrhea
- Hypokalemia-Interventions
- Monitor systems, Monitor electrolyte values, Give IV or PO K* supplement, Institute safety measures for pt with muscle weakness, Instruct patient and family about food choices, Instruct patient and family about foods that are high fiber to prevent constipation
- Nonionized form
- 40% is bound to albumin, 15% is complexed to anions including phosphate, lactate, citrate & bicarbonate
- Hyponatremia Interventions
- Monitor systems, If hypovolemia- IV saline infusion, If hypervolemia - diuretics are administered to promote excretion of water rather than sodium, If ADH problem- may give drugs, Instruct patient to increase oral intake
- Hypokalemia-Causes
- Inappropriate or excessive medications, Increased secretion of aldosterone, Vomiting, Diarrhea, Wound drainage- esp. GI, Prolonged nasogastric suction, Heat-induced diaphoresis, Renal disease
- Hyponatremia-Causes
- Increased sodium excretion, Excessive diaphoresis, Diuretics: thiazide type, Wound drainage: esp GI, Hyperlipidemia, Renal disease, Inadequate sodium intake, Dilution of serum sodium, Renal failure, excessive ingestion of hypotonic fluids, Freshwater drowning, Hyperglycemia , Congestive heart failure
- Purpose of Bicarb, HCO3
- use for buffering used to suck up extra hydrogen,since more H+ will more acidotic, HCO3 sucks it up
- Skin
- 500-600cc output
- Hypercalcemia? Hypophosphotemia
- Effects lathargic, due to the large amounts of calcium in extracellular fluid, needs more for firing skeletal and neurological
- Hyperkalemia-Assessment
- Irregular heart rate, slow weak pulse, Decreased blood pressure, EKG changes, Dysrhythmias, Profound weakness of muscles, Respiratory failure, Muscle twitches, cramps, Hyperactive bowel, diarrhea
- Hyponatremia
- Na < 135 meq/l, Associated with fluid volume imbalances, Cell swells as H2O is pulled into cell, Diluted ECF
- Calcium 8.5-10.0 mg/dl cation
- Essential to action potentials & muscle contractions, A cofactor in many enzyme systems, Critical to metabolism, Clotting factor, Required for synaptic release of neuro-transmitters
- Hypernatremia
- Na>145 meq/l, Gain of sodium, Shrinkage of cells, Excess water loss, Overall sodium excess
- Solutions
- Hypertonic, Isotonic, hypotonic
- Type and type 2 can occur with DKA? true or false?
- True
- Sodium
- cation: Na 135-145 meq/l, Most plentiful electrolyte in the ECF, Na in ECF accounts for 95% of body's physiologically active sodium, Main role: control water distribution
- Increase in HR=increase in CA=
- increase in contractility=increase in CO
- Osmosis
- is the diffusion of a solvent (frequently water) through a semi-permeable membrane, from a solution of low solute concentration (high water potential) to a solution with high solute concentration (low water potential), up a solute concentration gradient
- Metabolism
- 300cc
- Hypernatremia-Causes
- Decreased water intake, Increased water loss- fever, hyperventilation, diarrhea, infection, etc, Increased sodium intake, Decreased sodium excretion-renal failure, corticosteroids, Cushing's syndrome
- Ionized calcium
- Constitutes 45% of total calcium, Physiologically active form of calcium, Varies directly with plasma albumin concentration, Ph changes vary calcium
- Hypercalcemia-Assessment
- Increased heart rate which changes to bradycardia and cardiac arrest, Increased blood pressure, Bounding peripheral pulses, Ineffective respiratory movement, Profound muscle weakness, Increased urine output, renal calculi, Decreased GI motility, anorexia, distention
- Hypertonic
- Greater osmolality than body fluids -ex. D5W in LR
- Hypocalcemia-Interventions
- Monitor systems esp. cardiac, Oral calcium supplements or IV calcium, Give medications that reduce nerve & muscle excitability, Seizure precautions, Monitor patient for fractures, Instruct patient in high calcium foods
- Hypomagnesemia-Causes
- <1.6mg/dl , Insufficient magnesium intake -Diarrhea, celiac disease, crohn's disease -Increased magnesium secretion - Diuretics, alcoholics, malnutrition ; Intracellular movement of magnesium - Sepsis, Insulin administration, hyperglycemia
- Hypokalemia
- K* below 3.5 meq/l, Potentially life threatening because every body system is affected., 80% excreted daily from kidneys, 15% lost through bowel, 5% is lost through sweat glands, Adults need 40-80meq/l per day
- Hypernatremia-Interventions
- Monitor systems, If from fluid loss-IV glucose & H2O (D5W), If from inadequate renal excretion of sodium- diuretics that promote sodium loss, Dialysis if needed, Restrict sodium & fluid intake
- Calcium effects
- normally used for extracellular, edoplasmic reticulum, mainly neurological firing and skeletal muscle contractions and cardiac contractions
- Hypocalcemia < 8.6mg/dl Causes
- Inhibition of calcium absorption in GI tract - Lactose intolerance, renal failure, malnutrition; Increased calcium excretion - Renal failure, diarrhea, wound drainage; Decreased ionized fractions of calcium - Hyperproteinemia, alkalosis, pancreatitis, Immobility, hyperphosphatemia
- Hyponatremia Assessment
- -Weak , rapid pulse; Respiratory arrest; Pulmonary edema; Skeletal muscle weakness; Muscular twitching & seizures; anorexia; Headache; Personality change-lethargy & confusion; Increased motility of GI system; Nausea & vomiting; Abdominal cramping
- GI
- 100-200cc output
- Hyperkalemia-Interventions
- Monitor all systems- place on cardiac monitor, Discontinue any potassium supplements, Potassium-restricted diet, Potassium excreting diuretic, Kayexalate, Possible dialysis- monitor renal function
- Insensible loss
- unmeasurable fluid loss i.e. respiration, skin, metabolism
- Positive Trousseau's & Chvostek's sign
- hypocalcemia, hypomagnesium, hypophosphotemia
- Cations are
- Sodium, potassium, calcium & magnesium
- Cations
- Positively charged electrolytes, Interchange occurs when one cation replaces another, Cell maintains electrical neutrality
- Magnesium 1.6-2.6 mg/dl cation
- Appears in blood stream only in small amounts, Essential for neuromuscular function, Excreted primarily from kidneys, Many uses as a smooth muscle relaxer
- Cation:Potassium
- The principle cation in the intracellular compartment (98% of K* inside cell), K* 3.5-5 meq/l, Regulates many metabolic activities & necessary for:Glycogen deposits in the liver & skeletal muscles, Transmission & conduction of nerve impulses, Cardiac contraction
- Hypomagnesemia-Assessment
- Dysrhythmias Hypertension Decreased GI motility Anorexia Nausea Abdominal distention Shallow respirations Seizures Tetany Confusion Psychosis Facial twitches Positive Trousseau Positive chvostek