fluid and electrolytes

1. fluid movement after burn treatment
2. IV administration of hypertonic fluid
3. Use of albumin or other plasma proteins

1. Tachypnea
2. Dyspnea
3. Crackles
4. Bounding, Rapid pulse
5. HTN (unless heart is failing)
6. Increased CVP, PAP, & PAWP
7. Distended jugular and hand veins
8. Acute weight gain
9. Peripheral edema
10. S3 gallop
11. Pulmonary edema

1. low HCT (hemodilution)
2. Normal Serum Na+ level
3. Lower K+ and BUN (hemodilution)
4. High K+ & BUN (renal failure/impaired renal perfusion
5. low O2
6. Pulmonary congestion (X-rays)

1. Sluggish skin turgor
2. Dry,sticky mucous membranes
3. Increased temperature
4. Hypotension
5. CVP decreased
6. Rapid, weak pulse
7. Decreased UOP
8. Weight loss
9. Excess

Fluid inside the cell, comprises 40% of total body weight about .5 L for normal 160 lb adult male

Fluid outside of the cell, 20% of body weight about 15 L of which 5 L of blood

The liquid constituent of blood, make where we check our levels (Na make assumptions on Intracellular space

liquid constituent outside of the blood Vessel

Extra Weight Gain from fluid
Generalized
Pt needs to be on Fluid & Salt Restrictions

1. Respiratory System
2. Renal System (Kidneys)
3. Chemical Buffers

1. Bicarbonate
2. Phosphate
3. Ammonium
4. Protein

What's normal pH?

Normal pH range

Measures H+ concentration

any substance that can reduce the hydrogen ions in a solution

the pH is normal, doesn’t mean there isn’t an acid-base disturbance

40mm Hg
Range 35-45mm Hg
respiratory component
reflects the partial pressure of CO2 in arterial blood
adjusted by changes in pulmonary ventilation
Excess H2CO3 breaks down to H2O and CO2, the respiratory rate increases

PaCO2 > 45 mm Hg
indicated alveolar hypoventilation respiratory acidosis

Hyperventilation lowers the PaCO2 (<35 mm Hg) and produces

instantly combine with the offending acid or base, Neutralizing harmful effects until other regulators take over

Uses Hypo/Hyperventilation to regulate acid excretion or retention
Within Min. of pH change

Excrete or Retain more acids or bases as needed
Restores normal balance within hours or days

Used to assess
breathing effectiveness
acid-base balance
a pts response to tx

pH less than 7.35 reflects

pH >7.45 reflects

H2CO3 (Carbonic acid) deficit exists 3 things occur

1.respiratory rate decreases

increased alveolar ventilation to 4 to 5 times the normal level

decreases alveolar ventilation to 50% to 75% of the normal level

mechanism is 50 to 70% effective in healthy lungs

indicates the amount of blood buffers
Abnormally high values reflect alkalosis and low values reflect acidosis

aids in the excretion of H+ in the renal tubules

After an acid load, ammonia (NH3+) is produced by the renal tubular cell and is combined with H+ in the renal tubule to form ammonium (NH4+). This process allows

Buffer that is Present in cells, blood, and plasma

most important protein buffer

24mEq/L
Range 22-26 mEq/L

major renal component
most important buffer in the body

ratio of bicarbonate with carbonic acid

indicate metabolic acidosis
the decreased level could be compensation for respiratory alkalosis

indicate primary metabolic alkalosis
the elevated level could be compensation for respiratory acidosis

Excess H+ is excreted in the urine and HCO3- (an anion) is retained to maintain

manufactured by renal tubules may be influenced by pH levels

indirect measurement of H+ concentration

1. Examine the PaO2 and SaO2
2. Determine if pH is normal
3. Study the PaCO2 and HCO3- values
4. Determine which compensatory mechanism is working

95 mmHg Range: 80-100 mmhg

95%-99% Range: 93%-100%

spares K + & eliminates Na+

One value indicates the primary sourse of the pH change
The other indicates the bodies effort to compensate for the disturbance

Occurs when the body so effectively compensates that pH falls within NORMAL range

Compensation when PH remains outside of the normal range

which 2 ABG values rise and fall together?

Reflects the body's ability to pick up oxygen from the lungs
indicates when to make adjustments to O2 concentration given to patient

Represents Hypoxemia
can cause Hyperventilation

If molecules in the body remain intact

Urea
Glucose
Proteins

· Regulation of H2O distribution
· Regulation of acid-base balance
· Transmission of nerve impulses
· Clotting of blood
· Generation of ATP

PCO2 or HCO3- doesnt match the PH
1 value is normal

2.2 kbs= Kg?

1. Same time each day (morning)
2. after voids b4 BM
3. in same atire
4. on same scale