Extracellular fluids (Interstitial or intravascular)
Tissue fluid; the fluid between cells, in tissue spaces
Interstitial fluid
That portion of the total body fluid contained within blood and lymphatic vessels
Intravascular fluid
True or False: Movement through selectively permeable membranes does so to maintain homeostasis
TRUE!
In regards to fluid intake, the Institute of Medicine recommends ___ mL/day
2700
__% of fluid is taken in from food and metabolism
20
___ is a major regulator of fluid intake
Thirst
What is the main intake method of fluids?
Drinking them
What is the normal amount of fluid elimination through urine daily?
1500mL/day
What is the normal amount of fluid elimination through feces daily?
100-200 mL/day
What are the two types of insensible loss of fluids?
Skin - perspiration
Lungs - Exhalation
Note* Patients with pneumonis, COPD, fevers, etc. are losing a larger amount of fluids upon exhalation due to their excessive respiration. It is important to monitor these patients.
A hormone that increases the reabsorption of sodium and water and the release (secretion) of potassium in the kidneys
Aldosterone
This increases blood volume, and therefore increases blood pressure
Aldosterone
Commonly referred to as arginine vasopressin; is a 9 amino acid peptide secreted from the posterior pituitary
Antidiuretic hormone (ADH)
The excretion of abnormal amounts of sodium in the urine
Natriuresis
One of the peptides that causes natriuesis
Natriuretic Peptides
The arrangement of blood vessels in the body or any part of it, including their relationship and functions
Vasculator
This is produced by the heart and vasculator
Natriuretic Peptides
Secreted largely by the atrial myocardium in response to dilation
A-type natriuretic peptides
Manufactured mainly by the ventricular myocardium
B-type natriuretic peptides
Produced by endothelial cells that line the blood vessels
C-type natriuretic peptides
Acidosis due to excess ketone bodies; it occurs in individuals who do not produce adequate insulin to sustain normal fat metabolism
Ketoacidosis
A decreased blood volume that may be caused by internal or external bleeding, fluid losses, or inadaquate fluid intake
Hpyovolemia
2 Risk factors of fluid volume deficit
1. Hypovolemia
2. Dehydration
A result of fluid volume deficit: An abnormally rapid heart rate, greater than 100bpm in adults
Tachycardia
A result of fluid volume deficit: A fine, scarcely perceptible pulse
Thready pulse
A result of fluid volume deficit: A decrease of the systolic and diastolic pressure to below normal
Hypotension
A result of fluid volume deficit: Abnormally rapid respiration
Tachypnea
A result of fluid volume deficit: An oxygen deficiency in body tissues
Hypoxia
The following are a result of what?
Thirst, dry furrowed tongue, nausea, vomitting, acute weight loss, weakness, confusion, dizziness, cool clammy skin, sunken eyeballs, flattened neck veins:
Fluid volume deficit
A result of fluid volume deficit: Urinary output of less than 400mL/day; this can result in renal failure if it is not reversed
Oliguria
A result of fluid volume deficit: Transient loss of consciousness accompanied by an inability to maintain an upright posture
Syncope
A result of fluid volume deficit: Profuse sweating
Diaphoresis
Hct stands for ___.
Hematocrit
Laboratory findings that support fluid volume deficits are:
Increased Hct, Osmolality greater than 300, increased sodium; specific gravity of urine increased
Lab finding in support of fluid volume deficit: Osmotic concentration; the characteristics of a solution determined by the ionic concentration of the dissolved substances per unit of solvent
Osmolality
2 risk factors of fluid volume excess:
1. Hypervolemia
2. Overhydration
An abnormal increase in the volume of cirrculating blood
Hypervolemia
A result of fluid volume excess: An abnormally rapid heart rate, greater than 100bpm in adults
Tachycardia
A result of fluid volume excess: A pulse that reaches a higher intensity than normal, then disappears quickly; best detected when the arm is held aloft
Bounding pulse
A result of fluid volume excess: Abnormally high BP in relation to the patient age and condition
Hypertension
The following are a result of what?
Confusion, muscle weakness, crackles, weight gain, edema, distended neck veins:
Fluid volume excess
A result of fluid volume excess: The abnormal accumulation of fluid in the peritoneal cavity
Ascites
A result of fluid volume excess: Abnormally rapid respiration
Tachypnea
A result of fluid volume excess: Air hunger in labored or difficult breathing, sometimes accompanied by pain
Dyspnea
A result of fluid volume excess: Labored breathing that occurs when lying flat and improves when standing or sitting up (classic symptom if left ventricular heart failure - can also occur in other cardiac or respiratory illnesses)
Orthopnea
Laboratory findings that support fluid volume excess:
Decreased Hct, electrolytes, BUN, Creatinine, Osmolsrity (less than 270 Mosm/L)
Type of fluid replacement: Same solute concentration, expands vascular volume:
Isotonic (administered thru IV normal saline, Lactated Ringers, blood, etc.)
Type of fluid replacement: Higher solute concentration - pulls fluid into the blood stream and out of the cells - increases vascular volume
Hypertonic (treated with Albumin, Dextran - large molecules that expand volume)
Type of fluid replacement: Lower solute concentration - pulls fluid into the cells and out of the blood stream - decreases vascular volume
Hypotonic (treated with .45% saline, D5W)
A nurse is collecting data from an older client who states he has had vomiting and diarrhea for he last 48 hours. What findings should indicate to the nurse that the clients is hypovolemic? (Select all that apply)
a. Bradycardia
b. Hypertension
c. Tachypnea
d. Furrowed tongue
e. Sunken eyeballs
c, d, e
A nurse is providing teaching about a healthy lifestyle for a group of young adults who are training for a marathon. What should the nurse include in the teaching session?
B. Increase fluid intake in dry climates
A nurse on a medical-surgical unit has been assigned to care for four clients. Which of the following clients is at risk for fluid volume excess (hypervolemia)?
B. A client who has heart failure
Salts and minerals are examples of what?
Electrolytes
___ regulate fluid balance, strengthen skeletal structures, and act as catalysts for conduction, contraction, and metabolism
Electrolytes
Electrolytes are distributed in the ___ & ___.
ICF and ECF
___ can be measures within the plasma but not within the cells.
Electrolytes
What is the normal range of sodium in the blood?
135-145mEq/L
What is the major electrolyte in the ECF?
Sodium
True or false: Sodium is reabsorbed in the pancreas.
FALSE! Sodium is reabsorbed in the kidney
True or False: Sodium regulates the fluid volume.
TRUE!
___ is essential for active and passive transport mechanisms.
Sodium
True or False: Sodium is essential for irritability and conduction of nerve and muscle tissue, and maintaining acid-base balance.
TRUE!
What are some of the major sources of sodium?
table salt, cheese, milk, butter, ketchup, nuts, canned products, etc.
A decreased concentration of sodium in the blood.
Hyponatremia (NA+ < 135mEq/L)(Osmolarity < 280)
In regards to electrolyte imbalances, what are the following indicitive of?
Anorexia, nausea, vomiting, weakness, lathargy, confusion, muscle cramps or twitching, and seizures
Hyponatremia
What are the treatment options for hyponatremia?
Monitor I&O, Monitor sodium level, Increase oral sodium intake, Administer IV saline infusion if severe (hypertonic then isotonic therapy)
What are some common causes of hyponatremia?
Diuretics, GI fluid loss, Adrenal insufficiency, Excessive intake of hypotonic solutions such as water or D5W IV fluids
An elevated concentration of sodium in the bloodstream.
Hypernatremia (Na+ > 145mEq/L)(Osmolarity > 300)
In regards to eletrolyte imbalances, what are the following indicitive of?
Thirst, elevated temperature, dry mouth, sticky mucous membranes; if severe --> hallucinations, irritability, lethargy, seizures
Hypernatremia
What are the treatment options for hypernatremia?
Monitor I&O, Monitor sodium lever, Monitor vital signs and level of consciousness, Restrict sodium in the diet, Beware of hidden sodium in foods and medications, Increase water intake, Administer IV solutions that do not contain sodium (Hypotonic then Isotonic therapy)
What are some common causes of hypernatremia?
Excessive sodium intake, Water deprivation, Increased water loss through profuse sweating, heat, stroke, or diabetes insipidus, Administration of hypertonic tube feeding
What is the normal range for potassium?
3.5-5.0mEq/L
___ is a major cation in the ICF
Potassium
True or False: Potassium is eliminated by diaphoresis.
FALSE! Potassium is eliminated by the kidneys
True or False: Potassium has a reciprocal action with sodium.
TRUE!
___ is essential for cell metabolism, transmission of nerve impulses, functioning of cardiac, lung, and muscle tissue, and acid-base balanve
An abnormally low concentration of potassium in the blood
Hypokalemia (K= < 3.5mEq/L)
In regards to electrolyte imbalances, what are the following indicitive of?
Fatigue, Anorexia, Nausea, Vomiting, Muscle weakness, Decreased GI motility, Dysrhythmias, Paresthesia, Flat T wave on ECG, Increased sensitivity to digitalis
Hypokalemia
What are some common causes of hypokalemia?
Diuretics, GI fluid loss through vomiting, gastric suction, or diarrhea, Steroid administration, Hyperaldosteronism, Anorexia, or Bulimia
What are the treatment options for hyopkalemia?
Monitor potassium level, If client is taking digoxin-monitor pulse and observe for toxicity, Encourage foods rich in potassium, Administer potassium supplements (*note: IV supplements must be well diluted and asministered slowly; never give bolus)
An excessive amount of potassium in the blood
Hyperkalemia (K+ > 5.0mEq/L)
In regards to electrolyte imbalances, what are the following indicitive of?
Muscle weakness, Dysrhythmias, Flassid Paralysis, Intestinal colic, Tall T waves on ECG
Hyperkalemia
What are some common causes of hyperkalemia?
Renal failure, Potassium-sparing diuretics, Hypoaldosteronism, High potassium intake coupled with renal insifficiency, Acidosis, Major trauma, Hemolyzed serum sample produces pseudohyperkalemia
What are the treatment options for hyperkalemia?
Monitor potassium level, Caution about potassium-rich food intake in patients with elevated creatinine levels, Cautiously administer IV potassium supplements, If severe, monitor ECG; prepare to administer a cation exchange resin and glucose and insulin, Renal dialysis may be required
What is the normal range for calcium?
9.0-10.5mg/dL
___ is essential for blood clotting, bone and teeth formation, cardiovascular/neuromuscular/endocrine function
Calcium
True or False: Chronic insufficiency of calcium leads to osteoporosis.
TRUE!
What are some major sources of calcium?
Dairy products, green leafy veggies, fish, etc.
Abnormally low blood calcium
Hypocalcemia
In regards to electrolyte imbalances, what are the following indicitive of?
Diarrhea, Numbness and tingling of extremities, Muscle cramps, Tetany, Convulsions, Laryngeal spasms, Cardiac irritability, Positive Trousseau's and Chostek's signs
Hypocalcemia
What are some common causes of hypocalcemia?
Hypoparathyroidism, Malabsorption, Pancreatitis, Alkalosis, Vitamin D deficiency, ESRD
What are the treatment options for hypocalcemia?
Monitor serum calcium, Encourage increased calcium intake, Administer calcium supplements, If severa-monitor patency of airway, institute seizure and safety precautions, and administer calcium
An excessive concentration of calcium in the blood.
Hypercalcemia
In regards to electrolyte imbalance, what are the following indicitive of?
Muscle weakness, Constipation, Anorexia, Nausea, Vomiting, Polyuria, Polydipsia, Kidney Stones, Bizarre behavior, Bradycardia
Monitor I&O, Encourage fluid intake to prevent stone formation, Encourage fiber to prevent constipation, Eliminate calcium supplements and limit calcium-rich foods, Avoid calcium-based antacids, Renal dialysis may be required
Abnormally low production of cortisol. Primary ___ ___ results inadequate cortisol production by the adrenal glands, such as Addison's disease. Secondary ___ ___ results from a decrease in the production of adrenocorticotropic hormone (ACTH) or its release from the pituitary gland.
Adrenal insufficiency
Loss of appetite
Anorexia
Excessive and insatiable appetite
Bulimia
Excessive urination caused either by inadequate amounts of circulating vasopressin (antidiuretic hormone) in the body (hypothalamic DI) or by failure of the kidney to respond to antidiuretic hormone (nephrogenic DI). Urinary output is often massive (e.g., 5 to 15 L/day), which may result in dehydration in patients who cannot drink enough liquid to replace urinary losses (e.g., those with impaired consciousness). The urine is dilute (specific gravity is often below 1.005), and typically the patient's serum sodium level and osmolality rise as free water is eliminated as urine. If water deficits are not matched or the urinary losses are not prevented, death will result from dehydration.
Diabetes insipidus (abbrev. DI)
What is gastric suction (aka gastric lavage, stomach pumping, NG tube suction)
A test performed to remove excess medications, or other harmful poisons or materials from the stomach, OR to clean the stomach before an upper endoscopy if the patient has been vomiting blood, OR to collect stomach acid, OR to releive pressure if the patient has had a blockage in the intestines. It is done by inserting a tube through the nose or the mouth down the esophogus and into the stomach
The excessive production of aldosterone by the adrenal gland.
Hyperaldosteronism
Abnormal, disordered, or disturbed rhythm.
Dysrhythmia
An abnormal or unpleasant sensation that results from injury to one or more nerves, often described by patients as numbness or as a prickly, stinging, or burning feeling.
Paresthesia
An antiarrhythmic and cardiotonic drug, derived from the dried leaves of Digitalis purpurea, the common foxglove. It is also found in smaller quantities in the leaves of other plants, such as rhododendrons.
Digitalis
The most frequently prescribed digitalis glycoside. It may be used orally or intravenously to treat patients with congestive heart failure, atrial fibrillation, atrial flutter, and supraventricular tachycardias.
Digoxin
A condition characterized by decreased aldosterone in the blood associated with hypotension and increased salt excretion.
Hypoaldosteronism
An actual or relative increase in the acidity of blood due to an accumulation of acids (as in diabetic acidosis or renal disease) or an excessive loss of bicarbonate (as in renal disease). The hydrogen ion concentration of the fluid is increased, lowering the pH.
Acidosis
Acidosis due to an excess of ketone bodies. It occurs in individuals who do not produce adequate insulin to sustain normal fat metabolism.
Ketoacidosis
Paralysis in which there is loss of muscle tone, loss or reduction of tendon reflexes, and atrophy and degeneration of muscles. It is caused by lesions of the lower motor neurons of the spinal cord.
Flaccid Paralysis
Abdominal colic, typically associated with intestinal obstruction or ileus.
Intestinal colic
A condition caused by an insufficient or absent secretion of the parathyroid glands.
Hypoparathyroidism
Inflammation of the pancreas, sometimes accompanied by damage to neighboring organs such as the bowel, lungs, spleen, or stomach, or by a systemic inflammatory response.
Pancreatitis
An actual or relative increase in blood alkalinity due to an accumulation of alkalies or reduction of acids.
Alkalosis
Intermittent tonic muscular spasms that typically involve the arms or legs.
Tetany
A muscular spasm of the hand and wrist resulting from pressure applied to nerves and vessels of the upper arm. It is indicative of latent tetany, usually as a result of hypocalcemia.
Trousseau's sign
A spasm of the facial muscles following a tap on the facial nerve; seen in hypocalcemic tetany.
Chvostek's sign
What is the normal range of Magnesium?
1.3-2.1mE/L
Magnesium is mostly found in the ___ but small amounts are found in body cells and the ___.
bones & ECF
___ is essential for carbohydrate metabolism and muscle contraction.
Magnesium
What are some major sources for magnesium?
Dairy products & dark green veggies
Decreased magnesium in the blood.
Hypomagnesemia
In regards to electrolyte imbalance, what are the following indicitive of?
Neuromuscular irritability, Disorientation, Mood changes, Tachycardia, Increased sensitivity to digitalis
What are the treatment options for hypomagnesemia?
Monitor I&O, Encourage foods high in magnesium, Acoud alcohol intake, If client is taking digoxin, monitor pulse and observe for toxicity, Institute safety precautions
DTR stands for what?
Deep tendon reflex
Abnormally decreased amount of phosphates circulating in the blood.
Hypophosphatemia
In regards to electrolyte imbalance, the following are indicitive of what?
Paresthesia, Joint stiffness, Seizures, Cardiomyopathy, Impaired tissue oxygenation
Hypophosphatemia
What are some common causes for hypophosphatemia?
Refeeding after starvation, Alcohol withdrawel, Diabetic ketoacidosis, Respiratory acidosis
What are the treatment methods for hypophosphatemia?
Monitor serum phosphate level, Monitor calcium levels as phosphate is replaced, Start TPN slowly to avoid drops in phosphate
An abnormal amount of phosphorus in the blood.
Hyperphosphatemia
In regards to electrolyte imbalance, what are the following indicitive of?
Short term: tetany symptoms-tingling of extermities and cramping; Long term: calcification in soft tissue
Hyperphosphatemia
What are some common causes of hyperphosphatemia?
Renal failure, Hyperthyroidism, Chemotherapy, Excess use of phosphate-based laxitives
What are the treatment methods for hyperphosphatemia?
Monitor serum phosphate level, Monitor for tetany, If severe, administer aluminum hydroxide with meals to bind phosphorus
A nurse is reviewing the laboratory findings for a group of clients. Which of the following findings should be reported to the provider?
C. Serum calcium 8.5 mg/dL (WE NEED THIS CONFIRMED WITH JELFO - PPT DIFFERS FROM BOOK)
A nurse on a medical-surgical unit is caring for a client who is hypernatremic. Which of the following should be included in the plan of care?
