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NU 236 EXAM 1 (FLUID & ELECTROYLYTES)

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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
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