Fluids & Electrolytes Notes (COPY)

Same electrolytes in ICF as in ECF, we always measure the extracellular space

(info)

3+ Pitting Edema characteristics:

-Deep pit (6mm) -Remains several seconds after pressing -Skin swelling obvious by general inspection

4+ Pitting Edema characteristics:

-Deep pit (8mm) -Remains for a prolonged time after pressing, possibly minutes -Frank swelling

2+ Pitting Edema characteristics:

-Deeper pit after pressing (4mm) -Lasts longer than 1+ -Fairly normal contour

Nursing Implications: Calcium

-Monitor pts at risk, especially those with hyperparathyroidism, cancer, or longer term bed rest. -Ambulate pts as soon as possible to prevent calcium mobilization from the bone -Have the pt drink 3-4L of fluids daily (if not contraindicated) to stimulate renal Ca excretion

1+ Pitting Edema characteristics:

-Slight indention (2mm) -Normal contours -Associated with interstitial fluid volume 30% above normal

What are some functions of body fluid?

1. Maintain healthy living conditions for body cells. -clearing cellular waste -transport: *nutrients, enzymes and hormones *red blood cells (oxygenation) *white blood cells (protection) 2. Regulate body temperature 3. Medium for food digestion and chemical reactions.

What is the purpose of electrolytes?

1. Maintaining fluid balance 2. contributing to acid-base regulation 3. Facilitating enzyme reaction 4. Neuromuscular reactions

What are some functions of electrolytes?

1. promotion of neuromuscular irritability 2. maintenance of body fluid osmolality 3. regulation of acid-base balance 4. regulation of distribution of body fluids among the body fluid compartments

What is the normal limit of Magnesium?

1.5-2.5 mEq/L

How much of body water is extracellular?

1/4

How much fluid do we get from food?

1000 mL

How much fluid do we gain from water consumption?

1200 mL

What is normal Sodium values?

135-145mEq/L

What is the volume of ECF?

14 L with 11 as interstitial, and 3 as intervascular

How much water is lost through the feces

150 mL

What is the DRI of Sodium?

1500

How much water is lost through the kidneys?

1500 mL

How much body weight is fluid?

2/3

What percent of body weight is ECF?

20% with 15% being interstitial, and 5% being intervascular

What is the volume of ICF?

28 L

What is the normal level of potassium?

3.5-5.0 mEq/L

How much of your body weight is intracellular?

3/4

How much fluid is gained from oxidation?

300 mL

How much water is lost through the lungs?

350 mL

What is the fluid requirements for an infant?

350-550mL/day

How much potassium should we ingest daily?

40 mEq

What percent of body weight is ICF?

40%

What is the fluid requirements for a newborn?

50-300mL/day

How much water is lost through the skin?

500 mL

What is the fluid requirements for a child?

500-1000mL/day

What is the fluid requirements for an adolescent?

700-1400mL/day

How much potassium is excreted by the kidneys?

80%

What is a normal Calcium limit for one's body?

85-10.5 mg/dL

This hormone is released in response to low pressure in vascular system. Tells kidneys to hold ONTO fluid.

ADH (anti-diuretic hormone)

Pressure in vascular space sends signals to brain (ADH). Stretching of atrial walls causes release of this:

ANF (atrial natriuretic factor). It signals kidneys to release Na+ and H2O

This hormone, from the adrenal cortex, holds onto Na+ and K+ (et H2O) in distal tubule.

Aldosterone

What hormone controls amount of sodium and K+ the body holds?

Aldosterone (adrenal cortex) where sodium goes, so does water

Bicarb, Cl, phosphate, Sulfate, proteinate, and organic acid are what kind of ions?

Anions (- charged)

Example of imbalances that occur when gains are greater than losses:

CHF, kidney failure, fluid overload

Sodium, potassium, calcium, and sodium, and magnesium are what kind of ions?

Cations (+ charged)

This hormone, from the adrenal cortex, increases retention of Na+ and excretion of K+

Cortisol

What is the most common type of hyponatremia?

Dilutional

Treatment for Fluid Volume Excess:

Diuretics, I/O, daily weights, fluid restrictions, monitor VS, skin assessment, Na+ restrictions, neuro checks

What are some s/s of hyponatremia?

HA, anxiety, impending doom, postural hypotension

_____________ (like antidiuretic hormone, aldosterone and parathyroid hormone) also help regulate electrolyte balance.

Hormones

How do you treat Hypomagnesemia?

Magnesium replacement

S/S of Fluid Volume Excess:

NEUROLOGICAL: HA, confusion, lethargy, seizures, coma CARDIAC: peripheral edema, jugular venous distention, bounding pulse, increased BP, increased CVP RENAL: plyuria RESPIRATORY: dyspnea, crackles, pulmonary edema OTHER: muscle spasms, weight gain

S/S of Fluid Volume Deficit

NEUROLOGICAL: restlessness, drowsiness, lethargy, confusion, seizures, coma, dizziness CARDIAC: postural hypotension, increased pulse, decreased CVP RENAL: decreased urine output, concentrated urine RESPIRATORY: increased respiratory rate INTEGUMENT: dry mucous membranes, decreased skin turgor, decreased capillary refill OTHER: weight loss, thirst, weakness

The hormone, from the Hypothalamus, that produces ADH effects (water retention with dilution of Na+ concentration).

Oxytocin

Hypermagnesemia Memory Jogger; RENAL

R-reflexes decreased (plus weakness and paralysis) E-ECG changes (bradycardia) and hypotension N-nausea & vomiting A-appearance flushed L-lethargy (plus drowsiness and coma)

This hormone decreases perfusion of kidneys - renin released from glomeruli. Converts angiotensin I to angiotensin II. Holds onto Na+ and H2O in nephron, stimulates release of aldosterone in adrenal cortex.

Renin-Angiotensin

Hypomagnesemia Memory Jogger; STARVED

S-seizures T-tetany A-anorexia and arrythmias R- rapid heart rate V-vomiting E-emotional liability D-deep tendon reflexes increased

What are common s/s of hypernatremia? (SALT)

Skin flushed Agitation Low grade fever Thirst

What is the most abundant electrolyte and cation in the body?

Sodium

Bile, gastric and pancreatic secretions of what?

Sodium (Na+)

So many sports drinks have _____ ____ or potassium chloride added to them.

Sodium Chloride

The electrolytes in sodium chloride are:

Sodium ion (Na+) - cation Chloride ion (Cl-) - anion

In our body the major electrolytes are as follows (9)

Sodium, potassium, chloride, calcium, magnesium, bicarb, phosphate, sulfate, hydrogen

The hormone that increases BMR that results in increased HR and CO leading to increased filtration in kidneys (increased urine output).

Thyroid Hormone

What hormone regulates metabolic rate, cardiac output?

Thyroid Hormone (thyroid)

Electrolyte imbalances can be summarized by the following two causes:

Too much (excessive ingestion or diminished elimination) Not enough (inadequate ingestion or excessive elimination)

What is Chvostek's Sign?

a contraction of facial muscles in response to a tap over the facial nerve in front of the ear.

What factors can disrupt fluid & electrolyte imbalances?

age-related physiological changes, illness, injury, medications, surgery, various treatment interventions

What is filtration?

an area of higher pressure to low pressure (water and dissolved substances)

Ions that move to the anode (______) are negatively charged.

anions

What hormone causes the kidneys to hold on to fluids triggered by pressure sensors in vascular system and kidneys?

antidiuretic hormone (pituitary gland)

NURSING WARNING about thyroid surgery & hypocalcemia:

any patient who has had thyroid or neck surgery must be closely observed post-operatively for s/s of hypocalcemia because of the proximity of the parathyroid gland to the thyroid gland

Homeostasis is controlled & regulated by the body's physiological processes and electrolytes play a vital role in maintaining that __________.

balance

Pancreatic secretions contain high concentrations of what?

bicarbonate (HCO3-)

What are some meds that can cause Hyperkalemia?

birth control pills, some diuretics, heparin, NSAIDs

Electrolytes are present in ________, urine, in the fluids inside the body's cells and in the the fluid in the space surrounding the cells.

blood

How do you treat Hypocalcemia?

calcium replacement po or IV

What are some symptoms of hypokalemia?

cardiac changes, muscle flaccidity, starts in the legs

Ions that move to the cathode (_____) are positively charged.

cations

What causes hyperkalemia?

cell wall destruction, increased intake, renal failure, burns, surgery, and chemotherapy

What is the first sign of hyponatremia?

confusion

How do you treat hypovolemia?

correct underlying cause and replace water and electrolytes

How do you treat hypervolemia?

correct underlying cause. Remove fluid without compromising electrolyte balance or ECF osmolality

How do you treat Hypercalcemia?

decrease calcium intake, increase fluids

What causes Hypocalcemia?

decreased calcium intake, increased phosphate levels, renal disease, acute pancreatitis, hypoparathydroidism

What is diffusion?

diffusion is the movement of solutes from an area of higher concentration to lower concentration until the concentration is equal on both sides

How do you treat hyperkalemia?

diuretics, kayexalate, calcium gluconate, insulin, hemodialysis

What does Hypertonic parenteral fluid do?

draws fluid out of intracellular space leading to increased extracellular volume in both vascular and interstitial spaces.

The foods we eat and fluids we drink contain mineral salts, which form _______ when they dissolve in the fluids in our bodies.

electrolytes

When children vomit or have diarrhea, they lose ______.

electrolytes

The human body seeks homeostasis, a state of _________ in its internal environment.

equilibrium

What causes Hypomagnesemia?

excessive dietary intake of Ca or Vitamin D, GI fluid losses, Diuretics, malnutrition, pancreatitis, alcoholism

What causes dilutional hyponatremia?

excessive fluid intake

What are some causes of hypervolemia?

excessive fluid intake, heart or renal failure, Cushings, corticosteroid use, SAIDH

Fluid found outside the cells

extracellular

The movement of a substance from an area of high concentration to one of low concentration using membrane proteins acting as carrier molecules is referred to as what?

facilitated diffusion

The body has to perform delicate balancing acts to keep ________ and electrolyte levels just right.

fluid

What is hypovolemia?

fluid volume deficit (abnormal losses of body fluids)

What is hypervolemia?

fluid volume excess

What is true hyponatremia?

from fluid and sodium loss

Electrolytes are essential for many _____, nerve and muscle functions.

heart

What are some causes of hypovolemia?

hemorrhage, GI losses, diuretic use, inadequate fluid intake, third spacing

Nursing assessment of fluid and electrolyte balance requires a review of the patient's _______ and ______ data as well as careful clinical observations.

history, lab

What does Isotonic parenteral fluid do?

hydrates extracellular compartment; replaces vascular fluid volume. USE: fluid loss, Na+ replacement, vascular fluid replacement

Gastric secretions contain high concentrations of what?

hydrogen ions (H+)

This type of pressure is produced by pumping action of the heart, pushing extra water out within a closed system

hydrostatic pressure

What are symptoms of Hypocalcemia?

hyperactive deep tendon reflexes, neurological changes, paresthesia, arrythmia

How does Sodium affect neurologic function?

impulse transmission for nerves and fibers normal is 135-145 120-seizures below 100 permanent damage

Where is potassium absorbed?

in the GI tract

Treatment of Hypermagnesemia:

increase fluids (po/IV), diuretics, dialysis

What increases calcium levels in blood?

increased bone resorption increase GI and renal absorption

What causes Hypercalcemia?

increased intake, hyperparathyroidism, immobilization, cancer

What are some symptoms of Hypomagnesemia?

increased muscle cell irritability and contractility, low BP, arrhythmias

How does potassium affect the muscles?

increases irritation of heart, diaphragm, GI tract, and skeletal muscle

What decreases calcium levels in blood?

increasing Ca deposits into bone decreasing GI absorption increasing renal excretion

What are some kinds of extracellular fluid?

interstitial, plasma, CSF, lymph, synovial

Fluid within cells cytosol

intracellular

What are the two major fluid compartments?

intracellular, extracellular

What are some symptoms of hyperkalemia??

irritable muscles

What is oncotic pressure?

keeping the extra fluid in vascular space

The ________ filter electrolytes from the blood & work to keep their levels in the blood constant.

kidneys

What is hypotonic solution?

less sodium than normal body fluid

Assessment findings, Hypermagnesemia:

lethargy & drowsiness, depressed neuromuscluar activity, depressed respirations, sensation of warmth throughout the body, hypotension, bradycardia, cardiac arrest, coma

Electrolytes also play an important role in keeping fluid ____ normal in different body compartments.

levels

What is the most common cause of hypernatremia

loss of fluid without loss of sodium, excessive sodium intake, not enough water intake, may occur with full strength protein tube feedings

What is abnormal loss?

loss that occurs during illness or injury (vomiting or diarrhea, burns, wound drainage, hemorrhage, abscess)

What is sensible loss?

losses that can be measured (urine output)

What is insensible loss?

losses that cannot be measured (sweat and respiration

What is hypertonic solution?

more sodium than normal body fluid

What is active transport?

moves solutes from low concentration to high concentration is a chemical activity that uses energy for carrier mediated transport mechanism moves against concentration gradient

What does an increased potassium level cause?

muscle spasms

The number of osmols (the standard unit of measure) per liter of solution is referred to as what?

osmolality

What are examples of passive transport?

osmosis diffusion filtration

What regulates calcium levels in the body?

parathyroid, calcitonin, vitamin D is needed for absorption

What are some causes of hypokalemia?

prolonged v/d, deficient intake, diuretics, laxatives, malnutrition, surgery

Nursing implications for Hyperkalemia?

pt teaching, monitor I/O, monitor VS, esp pulse rate & rhythm & BP, assess bowel sounds, monitor motor & sensory function, cardiac monitoring (telemetry) for pts with K >5

What does Hypotonic parenteral fluid do?

pulls fluid from vascular space into cellular space. USE: dilute ECF, hydration of cells

What are some symptoms of dehydration?

rapid pulse and respirations, dry mucus membrane, sunken fontanel, sunken and soft eyes, poor skin turgor, absent tearing and salivation, irritable, lethargic, comatose, and convulsions, body weight losses-5% mild, 6-10% moderate, >10% severe

What does calcium do in the body?

regulates muscle contraction and relaxation, nerve impulse transmission, and it's necessary for coagulation, aids in the absorption and utilization of B12

The most common reason for any patient to have a significant imbalance is due to __________ impairment.

renal

What are some causes of Hypermagnesemia?

renal failure, excessive magnesium intake, excessive use of magnesium containing products: antacids (mag hydroxide), cathartics (epsom salts - magnesium sulfate), or MOM (magnesium hydroxide)

What are symptoms and treatment of dilutional hyponatremia?

s/s: confusion and edema treatment: decrease fluid intake

What are symptoms and treatment of true hyponatremia?

s/s: dry tissue treatment: replace sodium and water

What is isotonic solution?

same as body fluid

What are symptoms of Hypercalcemia?

sedation, decreased muscle tone, arrhythmia

What effect does calcium have on nerve cells

sedative effect

What is the rate of diffusion determined by?

size of the molecule concentration temperature

Where is fluid usually lost from?

skin, GI tract, kidneys, and lungs

These are the most common electrolytes in the human body:

sodium, calcium, chloride, magnesium & potassium

What is an example of active-transport?

sodium-potassium pump

Pediatricians do NOT recommend giving ______ drinks to a sick child!!

sports

What is a solvent?

substance (fluid) that dissolves the solute

What is a solute?

substance that is dissolved in a solution

When you exerise heavily, you lose electrolytes in your _______, particularly ______ and _______.

sweat, sodium, potassium

What is Trousseau's Sign?

this refers to carpal spasms induced by inflating a blood pressure cuff on the arm.

Body fat + age =

total body water (TBW), more fat equals less TBW