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FLUIDS & ELECTROLYTES:

intracellular- contained within cells K & Mg, P & S

extracellular- outside cells Na, Cl, bicarb, albumin


interstitial- spaces between the body cells edema
intravascular- plasma within the blood
transcellular- specialized fluid

third spacing- fluid is trapped in the third compartment—vesicles


produced by a burn wound

osmosis- movement of water across a membrane from an area of


less concentrated solution to an area of more concentrated solution
solute- substance dissolved in body fluid
crystalloids- solutes that readily dissolve
colloids- larger molecules that do not dissolve readily
osmolality (tonicity)- concentration of solutes in body fluid
istonic- same osmolality as blood
hypotonic- lower osmolality than blood water moves from
vascular system into cells
hypertonic- higher concentration of solutes than blood water
moves by osmosis from the cells into the ECF

diffusion- passive process by which molecules of solute move


through a cell membrane from an area of higher concentration to
an area of lower concentration cream into coffee

filtration- movement of both water and smaller particles from an


area of high pressure to low pressure

active transport- molecules move across cell membranes from an


area of low concentration to an area of high concentration ATP
urine- greatest amount of fluid loss

skin- perspiration & diffusion through skin

lungs- lungs

feces- water loss in stool

ADH- causes kidneys to retain fluid if fluid volume is low more


ADH is released

renin- when ECF is decreased, kidneys release renin which


converts angiotensin to angiotensin II—acts on nephrons to retain
Na & H2O

aldosterone- promotes reabsorption of Na & excretion of K in


kidneys

Na- regulates fluid volume, interacts with Ca to maintain muscles


contraction

K- maintains ICF osmolality, assists with acid-base balance,


regulates conduction of cardiac rhythm

Ca- regulates muscles contraction, maintains cardiac automaticity

Mg- regulates BP

IV Fluids:

½ %NS- hypotonic, water replacement, hypertonic dehydration,


Na & Cl depletion, watch for increased ICP & 3rd space shifting

0.9% NS- isotonic, shock, hyponatremia, blood transfusions,


metabolic alkalosis, replace ECF, watch for ICP & hypervolemia
5% D5W- isotonic, fluid loss, dehydration, hypernatremia, watch
for ICP & cerebral edema

lactated ringers- isotonic, dehydration, burns, lower GI losses,


acute blood loss, watch for ICP & cerebral edema

Fluid volume deficit (hypovolemia): body loses water &


electrolytes from ECF
interv—assess v/d, weight, turgor, veins, mucous
membranes, bowel sounds, breath sounds, monitor I &O, monitor
daily weights, monitor labs, administer fluids PO & IB, mouth
care, skin care & safety with mobility
causes—decreased fluid intake, bleeding, excessive diuretic
or laxative use, fever, hemorrhage, v/d, abdominal surgery

Fluid volume excess (hypervolemia): body retains water & sodium


interv—monitor daily weight, vital signs, I&O, assess edema,
assess v/s, monitor labs, chest xray, fluid restrictions, Na
restrictions, diuretics ordered, client teaching
causes—excessive intake of salt, CHF, renal failure, liver
cirrhosis

Dehydration: water lost from body (drawn into intravascular space)


interv—assess v/s, weight, turgor, veins, mucous membranes,
bowel sounds, breath sounds, monitor I &O, monitor labs,
administer fluids (isotonic NS or LR or hypotonic fluids), monitor
LOC, assist with mobility, safety, skin care, mouth care
causes—decreased water intake, decreased thirst sensation,
prolonged fever, acidosis, inadequate production of ADH, brain
injuries

Overhydration: water intoxication (water is drawn into cells


causing them to swell
interv—assess LOC, limit water intake, allow Na in diet,
safety, irrigate with saline, v/s, I &O, labs, daily weight
causes—fluid & electrolyes lost but only water is replaced,
inappropriate ADH, malignant tumors, head injury

hypokalemia: <3.5
loss of K (vomiting, gastric suction, diarrhea, diaphoresis, K
wasting diuretics, poor intake (alcoholics, malnourished,anorexia)
S&S: muscles weakness, leg cramps, fatigue, n/v, decreased
bowel sounds, cardiac dysrhymias
SUCTION skeletal muscles weakness, U wave on EKG,
constipation, toxicity of dig, irregular pulse, Orthostatic hypo,
Numbness
interv—monitor heart rate, admin suppl orally with food, do
not abuse laxatives or diuretics

Hyperkalemia: >5.0
decreased K excretion (renal failure, potassium sparing diuretics),
excessive intake of K salt subs, infections, burns or acidosis
S&S: GI hyperactivity, diarrhea, irritability, confusion,
cardiac dysrythmias, muscles weakness, no reflexes, numbness in
extremities
interv—cardiac status, admin diuretics & glucose, insuln as
needed, hold K suppl, avoid foods high in K, monitor K levels

hypocalcemia <8.5
decreased Ca intake, decreased vitamin D, increased Ca excretion
(renal failure, diarrhea, wound drainage), endocrine disorders
S&S: numbness, tingling of ext and around mouth, muscle
tremors, cramps, severe= tetany & seizures, confusion
interv—monitor resp & cardiac status, safety for confusion,
admin suppl carefully

hypercalcemia >10.5
prolonged immobilization, hyperparathyroidism, renal impairment,
excessive intake antacids
S&S: lethargy, weakness, n/v, anorexia, constipation,
polyuria, kidney stones, heart blocks
interv—increase movement & fluid intake, increase fiver &
limit foods high in Ca, I&O, prune or cran juice

hypomagnesemia <1.5
excess GI loss, long term drug use, chronic alcoholism,
pancreatitis, malnutrition, starvation ,burns
S&S: cardiac dys, twitching, cramps, tetany, seizures,
agitation ,confusion
interv—monitor for cardiac dys, assess for dig tox, seizure
precautions & safety, Mg admin, monitor K levels also

hypermagnesmia >2.5 RARE

Potassium’s Role:
Acidosis- cells push K out & take H+ (hyperkalemia)
Alkalosis- cells take in K & make room for more H + to bond
(hypokalemia)

Interpretation:
What is pH? acidosis or alkalosis
What is PCO2? Is it moving with pH or opposite
What is HCO3? Moving with pH or not?
Resp. cause moves opposite pH, metabolic moves with pH
Is there compensation?
complete- pH normal range
partial- opp. system moved but pH not normal still
uncompensated- no change occurring

Resp Acidosis:
interv—patent airways, v/s, cardiac, resp, neuron status, improve
ventilation, O2, electrolytes (K), ABG, pulse ox, avoid sedatives,
Kayexelate (if K is too high)

Resp Alkalosis:
interv—treat underlying disorders, patent airway, emotional
support, electrolytes, meds, v/s

Met Acidosis:
interv—v/s, neuron status, I&O, safety, monitor K closely,
diabetes treatment, renal treatment

Met Alkalosis:
interv—patent airway, v/s, I&O, monitor muscle weakness, safety
for tetany & seizures, cardiac monitoring