" Oxygenation, body temperature digestive processes, nutrients, respiration, and medications "
When you have a fever what happens in your body?
"vasodilation (decreased blood pressure), sweating (Na+ and water loss), evaporation, increase cellular metabolism (increased 13% for every degree Celsius), increased heart rate and respiration rate to meet demands for nutrients and oxygen (and increase respiration rate leads to increased flow of loss), if additional oxygen demand is not met will lead to a hypoxia, increased and products of cellular metabolism "
What are the functions of water in the body?
" Transport and exchange O2, CO2, nutrients ways; medium metabolic reactions; regulate body temperature through evaporation and perspiration; body structure and shock absorber; insulation; lubricant "
" Through the longs skin and feces (can increase significantly and exercise, high environmental temperatures, illnesses that increase respiration, perspiration, GI losses or diarrhea "
Regulate fluid & electrolyte balance; Control excretion water & electrolytes; Filter 170 L plasma/day; Reabsorb 99 %; Only about 1500 mL urine in 24 hours
"Decrease blood flow/blood pressure(BP) to kidneys, stimulates nephron to produce Renin (enzyme); Renin converts Angiotensinogen (plasma protein) into Angiotensin I; Angiotensin I travels to lungs converted into Angiotensin II by Angiotensin-Converting Enzyme (ACE); Angiotensin II potent vasoconstrictor (Increases BP; Stimulates thirst mechanism, Acts on kidneys to retain water & Na+, Stimulates Adrenal Cortex to release Aldosterone); increase Promotes Na+ & water retention in distal nephron; Restores blood volume"
Antidiuretic Hormone (ADH)
"Released by posterior pituitary; Regulate water excretion from kidneys; Osmoreceptor hypothalamus respond to: (Increased serum osmolality, Decrease blood volume, Stimulate ADH release); Acts on distal tubules kidney (More permeable to water, Increased water reabsorption, Decreased urine output); Blood volume restored; *also released in response to stress, pain, surgery, anesthesia, morphine, barbiturates, mechanical ventilation"
Atrial Natriuretic Peptide (ANP)
"Released by atrial muscle cells in response to distention; Inhibits Renin secretion, blocking Aldosterone secretion; Promotes Na+ wasting & diuresis; Causes vasodilation "
Changes in the older adult
% of total body water lower; Lean muscle mass lower; % body fat higher; Water decrease to 50% total body weight (TBW) in males; water decrease to 45% TBW in females; Sodium regulation less efficient; Renal blood flow & glomerular filtration decreased; Kidneys less able to concentrate urine and conserve Na+ & water; Perception of thirst decreased (interfering with thirst mechanism); Aging effects temperature regulation; Fear of incontinence (self-limiting fluid intake); Physical disabilities limit access to fluids; Cognitive impairment interfere with recognition thirst & ability to respond
"Most abundant cation in extracellular fluids; Dietary requirements: 500 -2400 mg/day; Important in water balance, nerve impulse transmission, regulation of acid-base, cellular chemical reactions; 135-145 mEq/L; Cerebral cells are very sensitive to changes in sodium levels; Regulated by dietary intake and kidney excretion; Posterior pituitary and adrenal gland also help regulate sodium levels; Aldosterone and cortisone increase serum sodium by increasing tubular absorption; ADH (antidiuretic hormone) increases sodium and water reabsorption; Frequently accompanied by decreased chloride levels"
"Principle cation in intracellular fluid; 3.5 5.0 mEq/L, small changes can have profound effects; Kidneys eliminate K, do not conserve with decreased intake, must consume 2-20 grams daily; H+ and K+ shift back and forth between ICF and ECF to maintain pH; Maintains action potentials in excitable cells of muscles, neurons and other tissues; Assists in controlling cardiac rate and rhythm, conduction of nerve impulses, skeletal muscle contractions and smooth muscle and endocrine function TOO MUCH OR TOO LITTLE K CAN RESULT IN CARDIAC ARREST; Regulation of protein and glycogen synthesis; Helps regulate ICF osmolarity and fluid volume; Sodium-potassium pump (3 Na ions from cell for 2 K ions that return, fueled by ATP breakdown)"
"Normal serum concentrations 8.5 10.5 mg/dL, ionized calcium 4.0 6.0 mg/dL; Major cation, found mostly in hard part of bones, kept constant by calcium pump"
"Evaluate calcium and albumin together because changes in protein level can cause changes in calcium level; 3 forms in body: 45% bound to albumin, 40% ionized, 15% bound to phosphate, citrate or carbonate; Some calcium in blood is bound to proteins (usually about ½ the total in the blood); Decrease of 1 gram of Albumin means total Calcium is 0.8 mg less , because it is the ionized calcium that is more active, albumin associated lows do not cause symptoms"""
Functions of calcium
"Enzyme activation; Skeletal and cardiac muscle relaxation, activation, excitation and contraction; Calming effect on nerve cells; Impulse transmission; Role in blood clotting (esp. conversion of prothrombin to thrombin; Helps with acid-base balance; Firmness and rigidity to teeth and bones"
Calcium System interaction
"Parathyroid hormone (PTH) raises plasma calcium level by promoting transfer from bones; Calcium is dependent on calcitriol (active form of vitamin D) by promoting absorption and making calcium and phosphate available for new bone formation; Calcitonin - Ca lowering hormone secreted by thyroid, opposite effect of PTH, transfers calcium into bones thereby decreasing serum levels; Calcium interferes with the absorption of iron; Calcium has inverse/reciprocal relationship with phosphorus"
"Second most abundant cation, absorbed in small intestine; 1.4 2.1 mEq/L; Major role in >300 enzyme reactions; Powers sodium-potassium pump; Converts ATP to ADP; Transmits electrical impulses across nerves and muscles; Maintains normal heart rhythm; Fights tooth decay by binding calcium to tooth enamel; Relaxes lungs to open airways and relaxes other smooth muscles by blocking acetylcholine"
"2.5 4.5 mg/dL, levels greater infants & children, level varies throughout day; Most exists PO4- in body; 2nd most abundant mineral, 85% combined with calcium teeth & bones, 14% ICF; Reciprocal balance with calcium, assists to regulate calcium; Essential function of muscles, RBCs, nervous system, involved in metabolism macronutrients; Teeth & bone formation; Role renal regulation of acids/bases phosphate buffer system; Cell membrane integrity phospholipids; Excreted kidneys, kidneys can conserve when needed; Found red & organ meats, fish, poultry, eggs, milk, milk products. legumes, whole grains & nuts"
Typical adult fluid gain in 24 hr
Oral fluid intake 1200 ml; Water in food 1000 ml; Water as by-product food metabolism 300 ml
"Replacement; increase sodium foods, salt tablets; Possibly water restriction if euvolemic; LR or NS if hypovolemic; Isotonic solutions for irrig; Possibly 3% hypertonic saline for acute episode; loop diuretics, salt & fluid restrictions, dialysis as dictated by condition; Monitor labs, I/O, wts; Monitor for confusion lethargy, seizures; Safety; Assess muscle strength and DTR"
Management of Hypernatremia
"Decrease sodium intake; Fluid replacemnt; Promote sodium excretion; Monitor labs, I/O. wt; Monitor CNS/neurological changes: agitation, hallucinations, seizures; Safety; Restore balance; Keep clocks, calendar, familiar objects at bedside to aid orientation; "
"Replacement therapy; IV or IM Magnesium sulfate, oral magnesium salts, dietary intervention; Monitor magnesium levels, along with other electrolytes, neuromuscular function, GI function, bowel sounds, cardiovascular function, EKG"
Causes of Hypomagesemia
"alcoholism, prolonged IV therapy without supplementation, inflammatory bowel disease, resection, GI cancer, chronic pancreatitis, or some meds (gentamicin, cisplatin, lasix, edecrine), hyeraldosteronism, & diabetes"
"Major extracellular anion, 95-108 mEq/L, closely associated serum sodium levels & acid-base balance; Help maintain cellular integrity- balance between ICF & ECF; With H ion plays important role digestion - HCL, regulates pH stomach & helps digestion protein; Helps Ca & Mg in nerve transmission, muscle contraction & relaxation"
"slow, shallow respirations; hypotension, muscle tremors and twitching; Decreases usually accompanied by decrease sodium & potassium"