NRSG 102- Water and Electrolytes
Hypertonic IV fluids?
Thicker than body fluid Shift fluid into blood plasma; pulls fluid from tissue cells; CELLS SHRINK To replace electrolytes or hyponatremia FLUID OVERLOAD is a risk 3% NS D51/2NS D10W
Hypotonic IV fluids
Thinner than body fluid; shift fluids from intervascular to tissue cells; to HYDRATE CELLS but can deplete circulatory center 1/2 NS
What does decreased protein cause?
Third spacing
NV for pH?
7.4
NV for calcium?
9-10.5; transmission of nerve impulses, heart and muscle contractions, blood clotting, formation of teeth and bone; requires vitamin D for absorption
Why are creatinine. glucose and urea not electrolytes?
They don't have an electrical charge; don't dissociate in water but DO affect water balance
What are the NVs for BUN and creatinine and what do they tell us?
BUN 6-20 Creatinine 0.6-1.3 Tell us about kidney function; sometimes numbers aren't completely accurate bc numbers are based on hydration and water percentages
NV for chloride?
(104) 96-106; works with sodium to maintain osmotic pressure; increased with poor kidney function; decreased with excessive diarrhea or vominting
NV for sodium?
(140) 135-145; determines whether water is retained or excreted; imbalances cause neural problems
NV for potassium
(4) 3.5-5; increased with poor kidney function; decreased with excessive urination, diarrhea, vomiting; imbalances cause cardiac problems
What is daily fluid intake need?
2000-3000 ML
What does the balance of phosphate (3-4.5) intertwine with?
Calcium
What does aldosterone do?
Causes reabsorption of sodium in the blood, increases K excretion in the urine; increases serum osmo; prevents us from losing too much sodium
What does sodium always go with?
Chloride; important for acid base balance
Isotonic IV fluids?
Equal to body fluid; keep fluid in intravascular fluid; replacement or maintenance fluid D5W: if given too quickly will become hypotonic bc dextrose is rapidly metabolized into H2O and Co2 LR (lactated ringer)
What does the hypothalamus sense and do?
High serum osmo or high Na Triggers release of ADH (vasopressin) from posterior pituitary
What causes edema?
Increased hydrostatic pressure, fluid overload, heart failure, tourniquette, low protein and renal problems, capillary walls are damaged and protein accumulates
What is the phrase to remember normal levels?
Little Maggie is 1.5 to 2.5 years old (magnesium). She ate 3.5 to 5 bananas (potassium) and drank 8.5 to 10.5 oz of milk (calcium). Then she took a 135- 145 minute nap after swimming in the ocean (sodium).
What are insensible losses?
Losses that can't be measured
What are the NVs for hematocrit levels?
Male: 42-52% Female: 37-47%
What is the major IC electrolyte?
Potassium
What does the kidney do when juxtaglomerular cells sense low blood volume or low sodium?
Release renin; converts angiotensinogen to angiotensin I, which converts to angiotensin II; stimulates the release of ALDOSTERONE
What does ADH do?
Retains water in blood; concentrates urine; mildly constricts blood vessels; decreases serum osmo
What is the major EC electrolyte?
Sodium
What does osmo measure?
The concentration of dissolved particles (sodium, glucose, BUN); solute to water ratio
