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What are the 2 main imbalances
- Fluid/electrolyte
- Acid/base
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What is intracellular fluid
- All fluids within the cells
- composes about 42% of total body weight
- about 2/3 of total body water
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What is extracellular fluid
- All fluids outside the cell
- About 17% of total body weight
- about 1/3 of body water
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What are 3 kinds of extracellular fluid
- Interstitial fluid
- Intravascular fluid
- Transcellular fluid
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what is interstitial fluid
fluid b/t the cells and outside the blood vessels
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what is intravascular fluid
blood plasma
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what is transcellular fluid
- fluid separated from other fluids by a cellular barrier
- Ex = CSF, pleural, GI, intraocular, synovial
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What is osmosis
- Movement of a pure solvent across a semipermeable membrane
- low to high concentration
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what is the osmosis rate dependent upon
- concentration of solute
- temp of solution
- electrical changes of the solutes
- osmotic pressure
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What is diffusion
- solute movement across a semipermeable membrane
- high to low concentration
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What is filtration
- movement of solvent and solute particles across a membrane
- driver is pressure (high to low)
- ex = kidneys
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What is active transport
- Transport of substances across cell membranes
- requires expenditure of energy (ATP)
- ex = sodium/potassium pumps, interaction between insulin and glucose
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What drives the thirst mechanism
osmoreceptors in hypothalamus
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What is hypertonic
Water loss is greater than electrolyte loss
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What is hypotonic
electrolyte loss is greater than fluid loss
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what is the most common fluid and electrolyte imbalance in the US
dehydration
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What is mild dehydration
loss of 1-2 L of water (2% body weight)
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What is moderate dehydration
loss of 3-5 L of water (5% of body weight)
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What is severe dehydration
loss of 5-10 L of water (8% of body weight)
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What is the average daily fluid intake for adults
1500-2000mL and 800mL from solids
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What are some causes of dehydration
- lack of fluid intake (cognitive and physical impairments)
- impaired thirst mechanism
- Excess fluid losses (diuretics, vomiting, diarrhea, fever, blood loss)
- third spacing to peritoneal, pericardial, pleural, joint cavities (arthritis, fluid locked in space)
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What are some clinical manifestations of dehydration
- weight loss
- decreased urine output/increased concentration
- decreased b/p
- increased hr
- dry mucous membranes
- decreased skin turgor
- sunken eyes
- muscle weakness
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What are some causes of fluid overload
- too much fluid
- failure to excrete fluid
- renal disorders
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what are some clinical manifestations of fluid overload
- in lungs: coughing, crackles, dyspnea, pallor, cyanosis, decreased O2 sat, anxiety
- cardiovascular: jugular venous distention, cap refill>5sec, bounding pulse, elevated b/p
- interstitial: edema, rapid weight gain
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what is the normal range for pH
7.35-7.45
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What is the normal range for PaCO2
35-45
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What is the normal range for PaO2
80-100
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What is the normal range for Bicarb
22-26
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What is respiratory acidosis
- decreased pH
- increased PaCO2
- Decreased PaO2
- normal or increased bicarb
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what is respiratory acidosis due to
result of hypoventilation (overdose on drugs, CNS trauma, cystic fibrosis)
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what is respiratory alkalosis
- increased pH
- decreased PaCO2
- normal or decreased bicarb
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What is respiratory alkalosis caused by
hyperventilation (anxiety)
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What is metabolic acidosis
- decreased pH
- normal decreased PaCO2
- decreased bicarb
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what is metabolic acidosis caused by
severe diarrhea or renal disease
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what is metabolic alkalosis
- increased pH
- normal or increased PaCO2
- increased bicarb
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what are the causes of metabolic alkalosis
vomiting, gastric suctioning (most common)
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what is a solvent
solution in which a solute is dissolved
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What is the solute
electrolyte or item that is dissolved
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What is hypernatremia and how is it caused
- Too high of sodium
- caused by excess salt intake, excess aldosterone, diabetes, water deprivation
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what are the S/S of hypernatremia
extreme thirst, dry and flushed skin, postural hypotension, fever, agitation, convulsions, restlessness, and irritability
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what is hyponatremia and how is it caused
- too low sodium
- caused by vomiting diarrhea, NG suction, burns, excessive sweating
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what are the S/S of hyponatremia
apprehension, personality change, postural hypotension, postural dizziness, N/V, tachycardia, dry mucous membranes, coma
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What is hyperkalemia and what are the causes
- high potassium
- causes include renal failure, fluid volume deficit, massive burns, rapid infusion of bloo
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What are the S/S of hyperkalemia
anxiety, dysrhythmias, paresthesia, weakness, abdominal cramps and diarrhea
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What is hypokalemia and what are the causes
- too low of potassium
- causes include vomiting, diarrhea, NG, polyuria, extreme sweating
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what are the S/S of hypokalemia
weakness and fatigue, muscle weakness, N/V, decreased DTR
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What is hypercalcemia and what are the causes
- Too high of calcium
- cases include osteoporosis, hyperparathyroidism, prolonged immobilization
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What are S/S of hypercalcemia
N/V, muscle weakness, fatigue, kidney stones, hypoactive reflexes
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what is hypocalcemia and what are the causes
- too low of calcium
- Caused by decreased cardiac output, increased urinary excretion of calcium
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what are the S/S of hypocalcemia
hyperexcitability, hypotension, dysrhythmias, trousseau's and chvosteks.
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The nurse is providing care to a client with dehydration. The nurse notes that the morning laboratory values reveal an elevated blood urea nitrogen (BUN) and creatinine plus a decrease in the urine output. While
discussing these results with the physician, the nurse should request which order?
Decrease IV fluids from 150 mL/hr.
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The nurse is completing an assessment on a client and notes distended neck veins while the client was in high Fowler's position. What should the nurse expect to find upon further examination?
Bounding pulse and an elevated blood pressure
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An 82-year-old male client admitted 3 days ago for dehydration has the following orders: vital signs per floor routine, regular diet encourage fluids, IV fluids at 150 mL/hr, ambulate TID. Interpret the following assessment data: disoriented to time, BP 160/85, P 96 and bounding, hyperactive bowel sounds and complaints of cramping. What should the nurse suspect?
Hyponatremia
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Which client is at risk for hypertonic dehydration?
- 56-year-old man with diabetes mellitus in ketoacidosis
- (Hypertonic dehydration occurs when there is more fluid lost in the vascular space than electrolytes, leaving the solution hypertonic. The body starts a fluid shift to equal out the concentration and improve the circulatory volume. Ketoacidosis contributes to the excess fluid loss through increased respiratory effort and decreased electrolyte loss. When a client loses blood volume, the client loses fluid and electrolytes together, so the dehydration is more isotonic. In heart failure, there is more fluid in the vascular space and no electrolyte loss so there is no dehydration.
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A client with a history of hypertension has recently started diuretic therapy. Today the client complains of muscle weakness and irritability.What should the nurse suspect is the cause of the muscle weakness and irritability?
Hypokalemia
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Which clinical manifestation indicates that a client's treatment for hyperkalemia is effective?
Pulse rate is 80 and regular.
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A client with diabetes mellitus is having difficulties controlling his blood sugar. This client is also at risk for:
hypokalemia
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While taking the blood pressure on the right arm of a client, the nurse notes the right hand in flexion contraction. What action should the nurse take?
Remove the blood pressure cuff and administer oxygen.
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A client is admitted with diabetic ketoacidosis (DKA). The nurse would expect the following arterial blood gas (ABG) results:
pH 7.28, PCO2 36, HCO3 18
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A client's ABGs indicate diabetic acidosis. The nurse knows that, of the following, the least likely to cause metabolic acidosis is:
hypokalemia.
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The client has the following ABG values: pH 7.50, HCO3 – 22 mEq/L, PCO2 30 mm Hg, PO2 96 mm Hg. What condition is most likely causing the respiratory alkalosis?
Anxiety-induced hyperventilation
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A client has a nasogastric tube for decompression that is draining a green fluid. The nurse notes the drainage has been consistently 200 mL or greater for three shifts. What action should the nurse take?
Monitor for signs and symptoms of metabolic alkalosis.
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A client has had an elevated temperature (between 101 and 102 degrees F) for the several days. Despite receiving supportive care, the fever persists. The nurse is monitoring the client's laboratory values. Which result would the nurse anticipate?
Metabolic acidosis
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A young male client is brought to the nursing unit after falling 30 feet from the outside of a building. X-ray study shows multiple fractured ribs. His respiratory effort has increased and his exhaled volume has decreased. The nurse assists the client to apply nasal cannula oxygen.
This action assists in preventing which acid-base disorder?
Respiratory acidosis
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The nurse is reviewing the blood gas results from an adult client. The results are pH 7.28, CO2 45, HCO3 24. What symptom should the nurse expect to find when assessing the client?
An increase in the respiratory rate
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A male client is admitted with a history of diabetes and diarrhea. His respiratory rate is elevated as a compensatory mechanism. What acid-base balance should the nurse expect?
Metabolic acidosis
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What is also called extracellular fluid volume deficit (ECFVD)
Dehydration
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What is severe dehydration, seen in older adults and in those who have extreme fluid losses
Cellular dehydration
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What can also be called ECFVE and is seen in both the vascular spaces and interstitial spaces
fluid overload
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What is most often caused by over administration of hypotonic IV solutions
water intoxication
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What is physiologically useless fluids found in areas such as the pleural cavity, periotoneal cavity, or pericardial sac
third spacing
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what are signs that a pt is dehydrated
- dry mucous membranes
- sunken eyes
- decreased skin turgor
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A pt with inadequate fluid volume would have which signs
- decreased bp
- weak pulse
- decreased central venous pressure
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what fluids are considered hypotonic
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What fluids are considered isotonic
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What fluids are considered hypertonic
3% saline
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