Fluid And Electrolytes Made Easy

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Fluid And Electrolyte Nursing 101

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A liquid such as water that can hold another substance in a solution.
A substance that is either dissolved or suspended in a solution.
A solution that has the same concentration of solutes as another solution.
Isotonic Solution
A solution that has MORE solutes than another solution.
Hypertonic Solution
A solution that has FEWER solutes than another solution.
Hypotonic Solution
0.9 Sodium Chloride or NS is an example of ______ used in a hospital setting.
Isotonic Solution
Elements or compounds that dissolve in water and separate into ions that carry an electric current.
What is the percentage of body water in a young adult, the elderly, and infants.  (3 answers)
Young Adult: 60% Elderly: 45% Infants: 80%
An infants BSA is greater than that of an adult relative to his/her weight, with that and a high metabolism and Immature kidneys, these factors puts the infant at a risk for:
Fluid Volume Defecit
This is triggered by the hypothalamus.  As we age it becomes diminished, putting the elderly at risk for fluid volume defecit.
Thirst Mechanism
What electrolyte mainy controls the distribution of water throughout the body?
What is the dominant Cation in ICF?
Pottasium (K+)
What is the dominant Anion in ICF?
Phosphorous (PO4-)
What is the dominant Cation in ECF?
Sodium (Na+)
What is the dominant Anion in ECF?
Chloride (Cl-)
What amount of body water is intracellular fluid?
What amount of body water is extracellular?
Estracellular fluid consists of two compartments.  What are they?
Interstitial Fluid Intravascular Fluid
What four processes do solutes and solvents move across the membranes?
Diffusion Osmosis Filtration (Hydrostatic Pressure) Active Transport (requires energy)
The MOVEMENT OF WATER through a semipermiable membrane from a solution with a lower solute concentration to one with a higher solute concentration.
What is the pulling power of a solution for water?
Osmotic Pressure
Term used to express osmotic pressure?
Osmolality* *The higher the osmolality the greater the pulling power of water
What is the Normal Serum Olsmolality Level?
280-300 mOsm/kg
The process by which large particles, such as protien, that can pull fluid from tissues into the vessels by osmosis?
Colloidal Osmotic Pressure
The movement of a solute in a solution across a semipermable membrane from an area of higher solute concentration to a area of lower solute concentration until both sides are equal.
This requires energy to move substances across cell membranes.  It allows larger molecules to enter the cell moving thise particles uphisl from areas of lower concentration to areas of higher concenteration.
Active Transport
This hormone is manufactured in the hypothalamus and is stored in the posterior pituitary gland .  It makes the kidneys more permable to water.
This hormone is realesed by the Adrenal Cortex it causes the kidneys to reabsorb Na+ and water while exreting K+.
Because Sodium retention leads to water retention, Aldosteron acts as a _______.
Volume Expander
The production of Aldosterone is stimulated by: Decreased _____ _____ _____ _____ and increased _____
Decreased: B/P, Blood Volume, Sodium (Na+) Increased: Potassium (K+)
Aldosterone is NOT produced with Increased _____ _____ _____ _____ and decreased _____
Increased: B/P, Blood Volume, Sodium (Na+) Decreased : Potassium (K+)
The average adult releases ____-____ ml of fluid output daily
2600-3600 ml
With what four organs does fluid ouput occur?
Kidneys 1500 ml/day (Sensible) Skin 600ml/day (Insensible lungs 400ml/day (Insensible) GI tract 100 ml/day (Sensible)
When fluid loss is not perceived b the individual, it is called _________
Insensible Fluid Loss
When fluid loss is perceived by the individual, it is called ________
Sensible Fluid Loss
What is the functioning unit of the kidney?
The nephron filters blood at a rate of _______/min
What amounf of uring/kg of body weight/hour is produced by all ages.
1 ml/hr
Name two common fluid imbalances in the body.
Edema and Dehydration
When water and electrolytes gained or lost in equal proportion
Isotonic fluid imbalances
When only water is gained or lost
Osmolar fluid imbalances
What occurs when water and electrolytes are lost in equal proportions?
Isotonic Dehydration
Fluid losses are primarily in the ____ (the least stable fluid compartment)
Extra Cellular Fluid (ECF)
This occurs when more water is lost than electolytes
Osmolar Dehydration
A lower Serum Osmolality suggests...
Fluid Overload
A higher Serum Osmolality suggests...
Fluid Dehydration
These two values are often high due to Hemoconcentration.
Hct and BUN
Normal Serum Soduim Level
135-145 mEq/L
Normal Serum Potassium Level
3.5-5.0 mEq/L
Normal Serum Calcium Level
Normal Serum Chloride Level
95-108 mEq/L
Normal Serum Phosphate Level
2.5-4.5 mg/dL
Normal Serum Magnesium Level
1.4-2.1 mEq/dL
Normal Serum Bicarbonate Level
22-26 mEq/dL
Name the 3 types of IV Solutions
Isotonic (NS 0.9) Hypotonic (1/2 NS 0.45) Hypertonic (D5NS)
What is the main role of Na+
To control water distribution and maintian normal fluid balance
Sodium dilution from increased volume states
Dilutinal Hyponatremia
This is caused by excessive administration of hypotonic fluids, diseases that add increased volume, an increase in ADH, drining excessive amounts of water, excessive Na+ losses from profuse perspiration , GI losses, and Diuresis
Signs and symptoms of Hyponatremia
Water shifts from vascular space into the cells causeing headache and altered mental status Abdominal cramps, anorexia, nausea, and diarrhea.
This is caused by Excess sodium intake, or excessive infusion of sodium fluids, decreased sodium loss, excessive water loss, Renal failure, increased aldosterone
Signs and symptoms of Hypernatremia
Whater shifts from Cells (cellular dehydration) into the vascular space.  Dry mucous membranes, thirst, decreased urin ouput, agitation , dosorentation , seizures
What is the main role of K+
maintain cell membrane electric potential.  Neuromuscular function
Duretics, excessive loss of GI fliuds, increase secretion of Asldosterone, and high glucose levels leading to diuresis leads to
Signs and symptoms of Hypokalemia
Weak thready pulse, EKG changes, Paralytic ileus and Muscle weakness: leg cramps
This is caused by excessive intake from foods, salt substitues, IV infusion of KCL, decreased secretion due to renal failure, adrenal insufficiency, ACE inhibitors, decreased Aldosterone, massive Tissue trauma and it is rare in those individuals with normally functioning kidneys
Signs and symptoms of Hyperkalemia
EKG changes, Irregular slow heart rate, Increased peristalsis, causeing nausea, vomiting or diarrhea
Principle functions of this elecrolyte include enhanced bone strength, normal clotting of the blood and regulation of neuromuscular irritability
Hypoparathyroidism , decreased magnesium leves inadequate Vitamin D, increased Phosphorus levels cause this
Signs and Symptoms of Hypocalcemia
Decreased blood pressure and decreased myocardial contractility, increased bleeding, nubness of fingers and toes, Tetany, positive Chvostek's sign and Positive Trousseau's sign
Positive Chvostek's sign is described as
Tapping on the face at the point just anterior to the ear and just below the cheek bone.  Positive if twitching of the facial muscles occurs
Positive Trousseau's sign is described as
inflating a B/P cuff above systolic blood pressue for several minutes.  Positive if flexion of the wrist and metacarpophalageal joints and hyperesxtension of the fingers and flexion of the thumb on palm occurs
Bones stones and grones, hyperparathyroidism, metastic cancer and decreased phosphourus levels are significant in patients with
this is clossaly associated with serum sodum levels, principle functions include  serum osmolality and water balance, regulation of pH of stomach
Chloride (Cl-)
Caused by decreased intake or absorption, prolonged vomiting , sweating, diarrhea, or GI drainage, Na+ and K+ deficiency
Caused by certain drugs that lead to retention, usually associated with increased Na+ levels
Thees two elecrolytes have an inverse relationship when one is up the other is down
Calcium and Phosphorus
This causes Increased Serum Calcium Levels (hypercalcemia) and Decresed  Serum Phosphorus Levels(hypophosphatemia)
This causes Decreased Serum Calcium Levels (hypocalcemia) and Increased Serum Phosphorus Levels (hyperphosphatemia)
Name the common complications with IV therapy
Infiltration Phlebitis/Thrombophlebitis Infection (local or systemic) Fluid Overload Bleeding