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Intracellular (ICF)
fluid within (inside) each cell and has equal amounts. ICF contains potassium, magnesium, phosphate ions & protein
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Extracelluar (ECF)
are found outside of the body cells and are the body’s transportation system. ECF contains sodium, chloride, calcium, hydrogen, & bicarbonates, plus oxygen, glucose, fatty acids & amino acids. ECF also contain blood plasma and interstitial fluids
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Intravascular Fluids
the space within the blood vessels whose main function is to carry blood, blood plasma, RBC, WBC, & platelets.
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Interstitial Fluids
Fluid that is everywhere in the body between the cells and vascular compartments; the function is to carry nutrients & waste products between the cells and blood vessels.
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Transcellular Fluids
found in the spaces in the cerebrospinal canals in the brain, lymph, tissue, synovial joints, and eyes
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What is an Electrolyte?
Exert a major influence on the movement of water between compartments on enzyme reaction, on the neurmuscular activity, and on acid base regulation. This movement is also known as homeostasis.
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Normal pH of blood is....
7.35 - 7.45
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What is pH?
A measurment of effective hydrogen ion concentration
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What level of pH is incompatible with life?
<6.8 or >7.8
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What pH level does acidosis occurs?
<7.35
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What pH level does Alkalosis occur?
>7.45
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What is the normal values of PaCO2?
35-45 mmHg
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What is the normal values of HCO3?
22-26 mEq/L
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What is acidosis?
Systemic increase in hydrogen ion concentration; occurs when lung can't eliminate CO2, or if diarrhea causes loss of bi-carbs anions, or if kidneys fail to reabsorb bi-carb or secrete hydrogen ions
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What is Alkalosis?
body-wide decrease in hydrogen ion concentration caused by hyperventilation and loss of non vital acids during vomiting or from excessive ingestion of base
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what are some developmental factors for infant and children that affects fluids?
Highest grow nad metabolic activity; immature renal system; a decrease ability to concentrate urine which leads to increase fluid loss
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what are some developmental factors for Adolescents that affects fluids?
Increase hormonal activity and excercise; pregnant teenagers have an increase demand on the fetus during a time when their own body's needs have increased
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what are some developmental factors for Older Adults that affects fluids?
At the highest risk for fluid imbalances because of chronic diseases; decrease thirst mechanism; decrease renal function r/t aging and they take more meds with side effects of vomiting and diarrhea
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What is Fluid volume deficit (FVD) ?
A decreased intravascular, interstitial and/or intercellular fluid below normal range (dehydration, waterloss, and lost in electrolytes without a change in sodium)
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What is sodium "Na+"?
major ECF that regulates renin-angiotensin-aldosterone system (retains absorbed Na+ and H2O) excess sodium in the ECF may cause edema or conditions in which H2O loss exceeds Na loss
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What are some risk factors for hypernatremia?
- Presence renal disease
- HTN
- Cv problems
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What are some risk factors for Hyponatremia?
- Decrease of sodium in the ECF
- Can result in an acidic enviroment
- May be due to severe vomiting & diarrhea
- May cause muscle weakness
- decrease skin turgor
- tremors
- seizures
- Low salt diet
- Sweating
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What is Potassium "K+"
(3.5 – 5 mEq/L) – major ICF that regulates renin-angiotensin-aldosterone system (kidneys excrete K+ in exchange for Na+); extracellular lost from metabolic or respiratory acidosis
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What are the risk factors for hyperkalemia?
- excess potassium in the blood; due to dehydration, diet, or renal failure
- Can result in muscle weakness
- or cardiac failure
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What is hypokalemia?
- Potassium deficiency diarrhea, vomiting, diabetic acidosis, severe malnutrition, diet low in K+. GI suctioning, excessive use of laxatives or diuretics
- Can result in Cardiac abnormalties (tachycardia)
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What is calcium?
4.5 - 5.5 mEq/L; decrease calcium is r/t to hypoparathyroidism; increase calcium is r/t increase bone loss because of immobility, cancer, and multiple fractures
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What is magnesium?
- 1.5 - 2.4 mEq/L;
- decrease in magnesium r/t alcoholism & malnutrition
- Increase magnesium r/t renal disease
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What is phosphate?
- 1.2 - 3.0 mEq/L
- Decrease in phosphate is r/t hyperparathryroidsm and malnutrition
- Increase in phosphate is r/t massive trauma, strokes, and renal failure
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What are some other NANDA statements?
(North American Nursing Diagnosis Association)
- Impaired gas exchange
- Impaired oral mucous membrane
- Fluid volume Excess (Hypervolemia)
- Fluid Volume Deficit (Hypovolemia)
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What will you notice in a client that might have FVD?
- weight - loss greater than 2lbs in 24hrs
- B/P - Low
- Temp. - Elevated or normal
- Pulse - Weak, Rapid, Shallow
- RR - Rapid, Shallow
- Urine - Scant, Dark yellow
- Stool - Dry, Smallvolume
- Skin - Warm flushed, Dry poor skin turgor
- Eyes - Sunken
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What will you notice in a client that might have FVE?
- Weight - weight gain more than 2lbs in 24hrs (edema)
- Temp. - normal
- Pulse - full, Bounding
- Urine - Light, polyuria (if kidneys are working normally)
- Stool - bulky
- Skin - Cool, pale, moist, pitting edema
- Eyes - Swollen
- Lung/Breathing - Crackels, gargles, dyspnea, increase RR, labored breathing, orthopnea
- Neck vein distention
- Lab findings - decreased hematocrit level <38% and decrease BUN level <10mg/100mL (hemodilution)
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Clear breath sounds are consistent with.....?
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What are some nursing interventions and comfort measures?
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How many mL of water the body requires per day?
1,200 - 1,500 mL of water
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What percentage of our body weight is water?
60%
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What is the Crystalloid Solutions?
Its a type of IV solution that is water and other crystals (ex. Salts and sugars) - NS, Dextrose & water, Lactated Ringers.
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What is a Colloid Solution?
An IV solution that is water, molecules of a suspended substances (ex. Blood cells & Blood products; Albumin and plasma)
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