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Insensible loss
loss from skin and lungs that can't be measured
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Sensible loss
fluids lost during urination, defecation, wounds, and other means that can be measured
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Several pairs of opposite charged ions are so closely linked that problem with one ion causes problem with other:
Na+ and Cl-, Ca+ and phos -
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Anion Gap
test--distinguishing types and causes of acit base imbalances bc reflects serum anion cation balance
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Sodium levels
135-145 mEq/L
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Serum osmolality
275-295 (# of solutes dissolved in a solution)
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Urine specific gravity
1.010-1.035
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Extracellular compartments
All fl outside cells
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Interstitial fluids
- Fl between cells and the blood vessels
- Reserve fluid replacing either fluid in bl vessels or cells depending on need (shift in or out)
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Intracellular compartment
- All fluid inside cells
- *Most boyd fluids are inside the cells
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Intravascular fluid or plasma
- Fluid within blood vessels
- Liquid portion of blood
- Transports O2 and nutrients to cells and waste products away from cells
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Least stable fluid (compartment)
Vascular fluid--quickly lost or gained in response to fluid intake and losses
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Na+
What it does
Something wrong =
- Helps nerve and muscle cells interact
- Numbness, tingling, seizures
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Cl-
What does it do?
- Helps maintain osmotic pressure
- Gastric mucosal cells--need to produce HCL acid for food breakdown
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Ca+
What does it do?
- Stabilizes cell membrane and reduces permeability to Na+
- Transmits nerve impulses
- Contract muscles
- Coagulates blood
- Forms bones and teeth
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INTRACELLULAR:
K+--what does it help with?
- Cell excitability refulation
- Nerve impulse conduction
- Muscle contraction and myocardial membrane respnsiveness
- Intracellular osmolality control
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Intra
Phosphate--phosphorus
- Energy metabolism
- Combines with Ca+--key role w bone and tooth mineralization
- helps maintain acid-base balance
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Magnesium
- *cardio and nervous
- Enzyme reactions
- neuromuscular contractions (more)
- *given to calm nervous in prego women--preeclampsia--give mag sulfate
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Isotonic
- Same solute concentration as another solution (NS is one)
- NS 0.9%, LR--same concentration
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Hypotonic
(IV)
- Lower solute concentration than another solution
- 0.45% NaCl--lower solute concentration plasma--swell and H2O move in
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Hypertonic
(IV)
- Higher solute concentration than another solution
- (solutes greater than pts blood)
- D 5% in 0.45% NS, D5 in 0.9% nS
- Greater # of solutes than plasma--H2O drawn out of solution
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Tonicity
Effect of osmotic pressure of solution on cells within that solution
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Nursing implications r/t hypotonic and hypertonic solutions
- hypo= may cause too much fl to move from veins into cells and cells can swell
- hyper=may cause too much fl to be pulled from cells into blstream and cells can shrink
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Osmosis
Passive movement fl across membrane from area of lower solute concentration and high fluid to area of higher solute concentration and less fluid
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Osmolality
- Concentration of all solutes within a body fluid compartment
- Normal of both ICF and ECF= 275-295
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Diffusion
- Solutes move from area of higher solute concentration to area of lower solute concentration
- Passive transport
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Diffusion types (2)
- Simple (random movement solutes)
- Facilitatied (large H2O soluble mol)
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(capillary bl movement)
Filtration
- H2O and colutes move across capillary membranes driven by fluid pressure (hydrostatic)
- Movement of greater pressure to lesser pressure
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Hydrostatic pressure
Created by pumping action of ht by gravity
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Reabsorption
Process prevents too much fl from leaving the capillaried no matter how much hydrostatic pressure exists in capillaries
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Albumin
- Protein that remainds behind in the diminishing volume of water when fl enters thru a capillary
- Can't pass thru cap membranes
- Albumin is a "WATER MAGNET" it keeps water in intravascular space
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Active Transport
- Allows molecules to move across cell membranes into are of higher solute concentration -- like swimming upstream
- May need energy ATP
- Sodium potassium pump
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Body fluid regulation
- Thirst (altered LOC vulnerable)
- Kidneys (primary respon ofregulation of fl and elc balence)
- -Nephron--forms urine and is workhouse of kidneys (glomerulous and tubule) filters 1-2 L/day.... Nephron reabsorbs remaining 178 L/day
- Antidiuretic hormone *Vasopressin* Body hold H2) when fl levels drop--releases ir when fl level rises
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Disorders of ADH affects:
Urine output
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Diabetes insipidus=
- ADH not produced
- Impaired reabsoprtion in kidney-result copious dilute urine output
- Thirst mechanism stim--drinks additional fluids--maintaining high urine output
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Syndrome of inappropriate ADH secretion (SIADH)
Excess ADH released--more reabsorbed - fl col increases and urine output scant and concentrated
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Renin-Angiotensin-Aldosterone system (along with fl regulation)
- Helps maintain intravascular fluid bal and bp
- Fall in bp-- basically constricts bl vessels and increases bp and thirst--release aldosteron from adrenal cortex which retains Na+ and H2), which restores bl volume
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Atrial Natiruetic peptide (ANP) (Along with thirst mech)
- released from atria--response to stretching from fl overload
- Inhibits renin secretion--opposing renin angiotensin aldosteron system and effects of aldosteron
- Result=promotes Na+ and H2O loss and causes bl vessesl to dilate--decreasing bp and reducing intravasculat bl volume
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Fl vol deficit
- s&s
- fatigue, tachy, weak thready p
- Labs
- inc serum osmolality, hematocrit, urine spec gravity
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fl vol excess
- s&s
- htn, tachy, full bounding p, inc resp rate, crackles, wheezes, dependednt edema
- Labs
- dec serum o, hematocrit, u spec gravity
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Third Spacing
injury, inflamm which causes cap permeability allowing fl and elec and protein to leak from vessels--- ascites
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Fluid Challenge
- Lg amt of fl given rapidly over short amt of time; NS or LR (crystalloids) followed by prbcs------
- has low bp, urine output and watch output to see therapeutic response and challange kidneys
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Loop diuretics
- Ferosemide (Lasix)
- pg 106=more
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Thiazide diuretics
Hydrochlorothiazide
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Potassium-sparing diuretics
Spironolactone (Aldactone)
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Hyponatremia
- Less than 135
- Affects function of col and invol muscles, Headache, hyperreflexia, musc twitching
- Monitor lithium levels (bipolar meds)
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Hypernatremia
- H2O moves out of cell= cellular dehydration
- Dehydration in brain cells= neurologic s&s confusion and dec LOC
- Cellular dehydration= dry, sticky mucous membranes
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