-
1. fluid movement after burn treatment
2. IV administration of hypertonic fluid
3. Use of albumin or other plasma proteins
causes of fluid shifting into intravascular space
-
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
Signs and symptoms of Hypervolemia
-
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)
Labs for Hypervolemia
-
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
Signs of Fluid Volume Deficits
-
Fluid inside the cell, comprises 40% of total body weight about .5 L for normal 160 lb adult male
Intracellular fluid (ICF)
-
Fluid outside of the cell, 20% of body weight about 15 L of which 5 L of blood
Extracellular Fluid (ECF)
-
The liquid constituent of blood, make where we check our levels (Na make assumptions on Intracellular space
Intravascular Fluid (IVF):
-
liquid constituent outside of the blood Vessel
Extravascular Fluid (EVF)
-
Extra Weight Gain from fluid
Generalized
Pt needs to be on Fluid & Salt Restrictions
Anascara
-
1. Respiratory System
2. Renal System (Kidneys)
3. Chemical Buffers
Systems that work to create an acid-base balance
-
1. Bicarbonate
2. Phosphate
3. Ammonium
4. Protein
Buffers
-
-
Normal pH range
7.35-7.45
-
Measures H+ concentration
pH
-
any substance that can reduce the hydrogen ions in a solution
Base (Alkali)
-
the pH is normal, doesn’t mean there isn’t an acid-base disturbance
Changes in oxygenation can provoke changes in acid/base as well
-
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
-
PaCO2 > 45 mm Hg
indicated alveolar hypoventilation respiratory acidosis
Hypercapnia
-
Hyperventilation lowers the PaCO2 (<35 mm Hg) and produces
respiratory alkalosis
-
instantly combine with the offending acid or base, Neutralizing harmful effects until other regulators take over
Chemical buffers
-
Uses Hypo/Hyperventilation to regulate acid excretion or retention
Within Min. of pH change
Respiratory System
-
Excrete or Retain more acids or bases as needed
Restores normal balance within hours or days
The Kidneys
-
Used to assess
breathing effectiveness
acid-base balance
a pts response to tx
ABG (arterial blood gas) analysis
-
pH less than 7.35 reflects
acidosis
-
pH >7.45 reflects
alkalosis
-
H2CO3 (Carbonic acid) deficit exists 3 things occur
-
1.respiratory rate decreases
- 2.CO2 is retained
- 3. more carbonic acid is formed
-
increased alveolar ventilation to 4 to 5 times the normal level
Academia
-
decreases alveolar ventilation to 50% to 75% of the normal level
Alkalemia
-
mechanism is 50 to 70% effective in healthy lungs
compensation
-
indicates the amount of blood buffers
Abnormally high values reflect alkalosis and low values reflect acidosis
BE +2, Base Excess
-
aids in the excretion of H+ in the renal tubules
Phosphate
-
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
greater renal excretion of H+ in the urine
-
Buffer that is Present in cells, blood, and plasma
Protein
-
most important protein buffer
Hemoglobin
-
24mEq/L
Range 22-26 mEq/L
HCO3- (Bicarbonate)
-
major renal component
most important buffer in the body
HCO3-
-
ratio of bicarbonate with carbonic acid
20:1
-
indicate metabolic acidosis
the decreased level could be compensation for respiratory alkalosis
Decreased levels HCO3- <22 mEq/L
-
indicate primary metabolic alkalosis
the elevated level could be compensation for respiratory acidosis
Elevated levels HCO3- > 26 mEq/L
-
Excess H+ is excreted in the urine and HCO3- (an anion) is retained to maintain
- 1:20 ratio respectively
- (20:1 ratio, Balance between H2CO3 and HCO3-)
-
manufactured by renal tubules may be influenced by pH levels
HCO3-
-
indirect measurement of H+ concentration
Arterial pH
-
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
4 step ABG analysis
-
95 mmHg Range: 80-100 mmhg
PaO2
-
95%-99% Range: 93%-100%
SaO2
-
spares K + & eliminates Na+
Spironolactone (Aldactone)
-
One value indicates the primary sourse of the pH change
The other indicates the bodies effort to compensate for the disturbance
change in PaCO2 & HCO3 values
-
Occurs when the body so effectively compensates that pH falls within NORMAL range
Complete compensation
-
Compensation when PH remains outside of the normal range
Partial compensation
-
which 2 ABG values rise and fall together?
HCO3- & pH
-
Reflects the body's ability to pick up oxygen from the lungs
indicates when to make adjustments to O2 concentration given to patient
PaO2
-
Represents Hypoxemia
can cause Hyperventilation
Low PaO2
-
If molecules in the body remain intact
Non- electrolytes or colloids
-
Urea
Glucose
Proteins
Non- electrolytes or colloids
-
· Regulation of H2O distribution
· Regulation of acid-base balance
· Transmission of nerve impulses
· Clotting of blood
· Generation of ATP
Chief functions of electrolytes
-
PCO2 or HCO3- doesnt match the PH
1 value is normal
Non-compensation
-
-
1. Same time each day (morning)
2. after voids b4 BM
3. in same atire
4. on same scale
Factors that make Daily Weight the most accurate measure of Fluid imbalances after I&O
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