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Intracellular fluid – _______________ Extracellular fluid – ___________ Homeostasis – _________________ Solutes – ________________Â
Osmolarity – ______________
Fluid/Electrolyte Movement
Filtration – ____________ moves by pressure ïƒ heart pumps, maintains blood pressure ïƒ kidneys filter (no concentration difference)
Osmosis – ____________ moves passively from __________ concentration to __________ concentrationÂ
Diffusion – _____________ move passively from ___________ concentration to ___________ concentrationÂ
Active Transport – __________ move from ______________ concentration to ______________concentration (moved forcefully)
Tonicity
Isotonic – The solution is ______________ concentration to that of intracellular fluid. (I-so-chill)
Hypotonic – The solution is _____________ concentrated than intracellular fluid. Cell = ___________ concentration ïƒ fluid moves into the cell.
Hypertonic – The solution is ___________ concentrated than intracellular fluid. Cell = ___________ concentration ïƒ pulls fluid out of the cell.Â
Fluid Tonicity Helpful Hint Conditions
.9% Normal Saline (NS)
5% Dextrose in Water (D5W)
Ringer’s Lactate (RL)
_______________
Abbreviations are all “basic” fluids Blood loss, trauma, dehydrationÂ
.45% Normal Saline (1/2 NS)
.2% Normal Saline (1/4 NS)
.33% (1/3 NS)
2.5% Dextrose in Water (D2.5W)
________________
Abbreviations are all fractions (hypo =Â
smaller numbers than the basics)
Diabetic ketoacidosis (our cells areÂ
dehydrated)
ALL cells will swell, use caution ifÂ
patient is at risk for cerebral edemaÂ
or elevated ICP (intracranialÂ
pressure)
10% Dextrose in Water (D10W)
5% Dextrose + NSS or RLÂ
3% Saline or >
________________
These fluids are usuallyÂ
given via central line and inÂ
intensive care settings
Abbreviations have high numbersÂ
(hyper = higher numbers orÂ
combining fluids)
HyponatremiaÂ
Increased ICP
We want to pull fluid out of the cellÂ
We want the sodium to be releasedÂ
from the cell back into the bloodÂ
stream (water follows sodium andÂ
vice versa)
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Hormonal Regulation
Antidiuretic Hormone (ADH) -Â
Prevents the body from __________________ (retain water)
Produced by the hypothalamus, stored and released by the posterior pituitary glandÂ
When blood pressure or blood volume ______________ ïƒ ADH is secreted ïƒ ADH tells the kidneys to _______________ ïƒ increases the bloodÂ
volume or fills up the vessels to increase blood pressure
This can also work in the opposite direction – an _______________ blood volume may suppress ADH and the patient has diuresisÂ
*Also known as _______________________
Renin-Angiotensin -Â
Causes _________________ and therefor an increased BP
Renin is secreted, which activates Angiotensin II
Blood pressure ______________ ïƒ Renin secreted ïƒ activates angiotensin I conversion to angiotensin II ïƒ causes ___________ and productionÂ
of _____________ ïƒ blood pressure ________________
Aldosterone -Â
________________________, fluid balance, and electrolyte balance by controlling absorption of _______________ and ____________ in theÂ
nephron
Secreted by the adrenal cortex
Blood pressure _____________ ïƒ Aldosterone secreted ïƒ sodium and water reabsorbed ïƒ blood pressure _____________ as vessels fill withÂ
fluid
Natriuretic Peptides (ANP/BNP) -Â
Cardiac hormone released when atrial pressure (BP) is ________________
Blood pressure ______________ ïƒ ANP/BNP released ïƒ stops renin-angiotensin and aldosterone production ïƒ blood pressure ____________Â
and intravascular blood volume _________________Â
Kidneys & Fluid Balance
Nephrons – filter blood ïƒ creates __________________
Nephrons control the amount of fluid retained (or not retained) based on the amount of ________________, _____________, andÂ
_____________________ concentration
Thirst & Fluid Balance
Regulated by the ______________________Â
Increase in osmolarity of the __________________ and/or dry mucous membranes ïƒ stimulates ____________ïƒ person drinks fluids
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Dehydration – fluid volume deficit
Causes: (1) fluid intake is not _____________________ or (2) Fluid is ______________________________________________________Â
Dehydration – Who is at risk?Â
Infants, young children, and elderly are the most vulnerable populations
*Infants – kidneys are immature ïƒ cannot ___________________ urine; ________________________ than an adult
*Young children – kidneys aren’t as efficient as an adult; higher metabolic rate than an adult
*Elderly (as the brain ages) – the ________________, located in the brain, doesn’t react as quickly (decreased thirst sensation); elderly have less totalÂ
body water than younger adults; change in mobility ïƒ hard time getting to bathroom (so they don’t drink), fine motor skills decrease (can’t pick up a cup),Â
medications that flush fluids (diuretics and blood pressure medications)
Dehydration – Types of Loss
Insensible loss – ____________________ (diaphoresis, humidity, body surface area, respirations)Â
Sensible loss – _______________________ (urine output, feces, vomit, wound drainage)Â
Dehydration – Assessment:
Ask client about food and fluid intake
__________________ – best indicator of hydration status – 1 L of fluid = 2.2lbs; no weight change before a change in intake and output)
Review medications (prescribed, OTC, herbal, illicit)Â
Review past medical history (kidney disease, endocrine disease)
Vital Signs (________________ BP/orthostatic hypotension, ______________ HR with ____________ peripheral pulses, ____________ RR,Â
_______________ temp)
Neuro status (decreased ___________ïƒ confusion, light-headedness, dizziness) **Neuro changes common 1st sign of dehydration in older adultsÂ
Flattened veins, poor skin turgor/prolonged skin tenting, mucous membranes dryïƒ may have a coating or cracks
Urine is ________________, strong odor
Labs: ________________ Na, ________________ K (*goes back to the vegetable soup – less broth, looks like more vegetables)Â
Dehydration – Nursing Care:
_______________________ (if possible, following dietary restrictions); offer _________________every 2 hours
Encourage oral intake even if patient is incontinent or has IV fluids
Infuse IV fluids as ordered; includes _______________ peripheral IV site assessmentÂ
Strict ____________________ïƒ ensure fluids ingested and IV therapy calculated by weight for children
Frequent physical assessments and monitoring of VS to prevent ____________________
Â
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Overhydration – excess amount of fluid
Causes: 1) ________________________ or (2) ___________________ of fluid greater than the body requires or _______________ excretion of fluids.Â
______________________ – Excessive fluid in the extracellular spaceÂ
Overhydration – Who is at risk?Â
Older adults
Patients with cardiac, kidney or pulmonary problems (late phase kidney failure and syndrome of inappropriate antidiuretic hormone (SIADH))
Patients with liver problems
Patients receiving __________________________ (_______________________________________________________________________)Â
Water intoxicationÂ
Medications (long term corticosteroid use)Â
Overhydration – Assessment:
Ask client about food and fluid intake/Assess IV therapy the patient has been receivingÂ
____________________- best indicator of hydration status – 1 L of fluid = 2.2lbs; no weight change before a change in intake and output)
Review medications (prescribed, OTC, herbal, illicit)Â
Review past medical history (kidney disease, endocrine disease)
Vital Signs (___________________ HR with ___________________ pulses, ___________________ BP, ________________ and shallowÂ
respirations)
Shortness of breath; lung sounds – crackles on auscultationÂ
Distended neck veins, distended veins on the back of hands, engorged varicose veins
Pitting edema; pale, cool skin
Altered LOC, headache
Labs: __________________ decrease first, followed by decrease in __________________________Â
Overhydration – Nursing Care:
Q 2-hour assessments – _________________ lung sounds, increasing ______________ edema, _______________ urine outputÂ
Frequent _____________ assessment and pressure reducing therapy (turns, special mattress)
Medications as ordered to remove excess fluid (diuretics); decrease __________________
Dietary consult (chronic issues – proper diet)
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Electrolytes (Most important)
Electrolyte *Value Range Dietary Sources Sign/symptoms too HIGH Signs/symptoms too LOW
_________Â
(Ca+)
______________Â
mg/dL
Dairy products
Kale
Sardines (w. bone)
BroccoliÂ
___________CALCEMIA:
Increased thirst and urination; AbdominalÂ
pain; Bone pain; Muscle weakness,Â
confusion, and fatigue.
___________CALCEMIA:
Trousseau’s sign:Â
Tip for remembering Trousseau = twitch
Chvostek’s sign:Â
https://youtu.be/kvmwsTU0InQÂ
Tip for remembering Chvostek’s = cheekÂ
___________
(Mg+)
______________Â
mEq/L
Dark leafy greens, nuts, seeds,Â
fish, beans, whole grains,Â
avocados, dried food, darkÂ
chocolate, yogurt, and bananasÂ
_________magnesemia:Â
Decreased DTR
Decreased resp effort
Decreased LOC
____________magnesemia:
Will probably have a Ca deficiency as well.
Muscle cramps, tremors, anxiety, dizziness,Â
fatigue, difficulty swallowing, and confusion.
___________
(K+)
______________Â
mEq/L
Avocado, spinach, sweet potato,Â
banana, chocolateÂ
__________KALCEMIA:
cardiac dysrhythmias (often Vfib),Â
n/v, numbness, palpitations
treatment: polystyrene (absorbs excess KÂ
and excretes it through the stool)
___________KALCEMIA:
Hyporeflexia, muscle weakness (musclesÂ
are not able to contract), cardiacÂ
dysrhythmia
___________
(Na+)
______________Â
mEq/L
Salt, celery, beets, milk, processed/Â
packaged foods, soup
_____________natremia:
This is a water problem, not a sodiumÂ
problem (remember, we have less fluid, soÂ
it looks like an increased sodium level -Â
vegetable soup)Â
Causes: vomiting, nausea, dehydration,Â
weaknessÂ
S/S: obtundation, abnormal speech,Â
irritability, confusion, seizures, tremorsÂ
_____________natremia:
Water toxicity
Signs of cerebral edema: Headache,Â
nausea, vomiting, lethargy, confusion,Â
seizures, coma, death, fluid overload
* Please note that every resource and every facility will have a slightly different range of normal values. The goal is for you to remember a general range. MostÂ
questions won’t ask you about a lab value that is only .1 off, it will be easily distinguishable. It is more important to understand the cause of electrolyte imbalance,Â
how to notice an electrolyte imbalance, and what to do about that imbalance.
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SCIENCE
HEALTH SCIENCE
NURSING
NUR 102
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