NURS 158 Objectives: Ch 17 Fluid and Electrolyte - Med Surg Objectives PDF

**NURS 158 OBJECTIVES: CH 17 Fluid and Electrolyte** **Key Terms and Concepts** 1. **Active Transport**: Movement of ions or molecules across a cell membrane from a region of lower concentration to a region of higher concentration, requiring energy (ATP). 2. **Blood Urea Nitrogen (BUN)*...

**NURS 158 OBJECTIVES: CH 17 Fluid and Electrolyte** **Key Terms and Concepts** 1. **Active Transport**: Movement of ions or molecules across a cell membrane from a region of lower concentration to a region of higher concentration, requiring energy (ATP). 2. **Blood Urea Nitrogen (BUN)**: A measure of the amount of nitrogen in the blood that comes from the waste product urea. It is used to assess kidney function. 3. **Cations & Anions**: Cations are positively charged ions (e.g., Na⁺, K⁺), while anions are negatively charged ions (e.g., Cl⁻, HCO₃⁻). 4. **Buffers**: Substances that help maintain the pH balance in the body by neutralizing excess acids or bases. 5. **Creatinine**: A waste product produced by muscle metabolism, commonly measured to assess kidney function. 6. **Diffusion**: The passive movement of molecules or ions from an area of higher concentration to an area of lower concentration. 7. **Extracellular Fluid (ECF)**: Fluid outside the cells, including interstitial fluid, plasma, and transcellular fluid. 8. **Filtration**: The process by which water and solutes are forced through a membrane by hydrostatic pressure. 9. **Fluid Volume Deficit (FVD)**: A condition where there is a decrease in the volume of fluid in the body, often due to dehydration or blood loss. 10. **Fluid Volume Excess (FVE)**: A condition where there is an increase in the volume of fluid in the body, often due to heart failure or kidney disease. 11. **Homeostasis**: The body\'s ability to maintain a stable internal environment despite changes in external conditions. 12. **Hydrostatic Pressure**: The pressure exerted by a fluid due to its weight, important in the movement of fluids between compartments. 13. **Hypertonic**: A solution with a higher concentration of solutes compared to another solution, causing cells to shrink. 14. **Hypotonic**: A solution with a lower concentration of solutes compared to another solution, causing cells to swell. 15. **Hypernatremia**: Elevated sodium levels in the blood, often due to dehydration or excessive salt intake. 16. **Hyponatremia**: Low sodium levels in the blood, often due to excessive water intake or loss of sodium. 17. **Hyperkalemia**: Elevated potassium levels in the blood, often due to kidney failure or excessive potassium intake. 18. **Hypokalemia**: Low potassium levels in the blood, often due to diuretics or excessive loss through vomiting or diarrhea. 19. **Hypercalcemia**: Elevated calcium levels in the blood, often due to hyperparathyroidism or malignancy. 20. **Hypocalcemia**: Low calcium levels in the blood, often due to hypoparathyroidism or vitamin D deficiency. 21. **Hyperphosphatemia**: Elevated phosphate levels in the blood, often due to kidney failure or excessive phosphate intake. 22. **Hypophosphatemia**: Low phosphate levels in the blood, often due to malnutrition or alcohol abuse. 23. **Hypermagnesemia**: Elevated magnesium levels in the blood, often due to kidney failure or excessive magnesium intake. 24. **Hypomagnesemia**: Low magnesium levels in the blood, often due to malnutrition or chronic alcoholism. 25. **Hypovolemia**: A decrease in the volume of blood plasma, often due to dehydration or blood loss. 26. **Hypervolemia**: An increase in the volume of blood plasma, often due to heart failure or kidney disease. 27. **Interstitial Space**: The space between cells in a tissue, filled with interstitial fluid. 28. **Intracellular Fluid (ICF)**: Fluid within the cells. 29. **Isotonic**: A solution with the same concentration of solutes as another solution, causing no net movement of water. 30. **Oncotic Pressure**: The osmotic pressure exerted by proteins, primarily albumin, in the blood plasma that tends to pull water into the circulatory system. 31. **Osmosis**: The movement of water across a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration. 32. **Osmotic Pressure**: The pressure required to prevent the flow of water across a semipermeable membrane. 33. **Passive Transport**: The movement of ions or molecules across a cell membrane without the need for energy, driven by concentration gradients. 34. **Edema/Pulmonary Edema**: The accumulation of fluid in the interstitial spaces, leading to swelling. Pulmonary edema refers to fluid accumulation in the lungs. 35. **Plasma**: The liquid component of blood, containing water, electrolytes, proteins, and other substances. 36. **Fluid Spacing**: The distribution of body water in different compartments. First spacing refers to normal distribution, second spacing to abnormal accumulation in interstitial spaces (edema), and third spacing to fluid accumulation in areas where it is not easily exchanged with ECF (e.g., ascites). 37. **Transcellular Fluid**: Fluid contained within epithelial-lined spaces, such as cerebrospinal fluid, pleural fluid, and synovial fluid. **Nursing Assessments for Fluid Deficit and Fluid Overload** **Fluid Deficit (Dehydration)**: - **Assessment Findings**: Dry mucous membranes, decreased skin turgor, hypotension, tachycardia, decreased urine output, concentrated urine, weight loss. - **Interventions**: Oral or IV fluid replacement, monitoring vital signs, assessing urine output, daily weights, monitoring electrolyte levels. - **Evaluation**: Improvement in vital signs, increased urine output, normalization of electrolyte levels, weight gain. **Fluid Overload (Hypervolemia)**: - **Assessment Findings**: Edema, weight gain, hypertension, bounding pulse, jugular venous distention, crackles in lungs, shortness of breath. - **Interventions**: Fluid restriction, diuretics, monitoring vital signs, daily weights, assessing lung sounds, monitoring electrolyte levels. - **Evaluation**: Reduction in edema, weight loss, normalization of vital signs, improved respiratory status. **Fluid Shifts in the Body** Fluid shifts occur due to changes in hydrostatic and oncotic pressures, osmotic gradients, and membrane permeability. For example, in dehydration, fluid shifts from the intracellular to the extracellular space to maintain blood volume. **Aldosterone and Antidiuretic Hormone (ADH) in Fluid Regulation** - **Aldosterone**: Increases sodium and water reabsorption in the kidneys, increasing blood volume and blood pressure. - **ADH**: Promotes water reabsorption in the kidneys, reducing urine output and increasing blood volume. **Effects of Diuretics on Body Fluids** Diuretics increase urine output by inhibiting sodium and water reabsorption in the kidneys, leading to a reduction in blood volume and blood pressure. **Types of Intravenous Fluids (IVF)** **Intravenous fluids** are used to maintain or restore fluid balance in patients. They are categorized based on their tonicity: 1. **Isotonic Fluids**: - **Examples**: 0.9% NaCl (Normal Saline), Lactated Ringer\'s. - **Uses**: To treat fluid volume deficit, dehydration, and shock. They have the same osmolarity as blood, so they do not cause fluid shifts between compartments. 2. **Hypertonic Fluids**: - **Examples**: 3% NaCl, Dextrose 10% in water (D10W). - **Uses**: To treat severe hyponatremia and cerebral edema. They have a higher osmolarity than blood, drawing water out of cells into the extracellular space. 3. **Hypotonic Fluids**: - **Examples**: 0.45% NaCl (Half Normal Saline). - **Uses**: To treat hypernatremia and intracellular dehydration. They have a lower osmolarity than blood, causing water to move into cells. **Clinical Manifestations and Management of Fluid Volume Deficit** - **Manifestations**: Dry mucous membranes, decreased skin turgor, hypotension, tachycardia, decreased urine output. - **Management**: Fluid replacement (oral or IV), monitoring vital signs, assessing urine output, daily weights, monitoring electrolytes. - **Priorities**: Restoring fluid balance, monitoring for signs of improvement. - **Evaluation**: Improved vital signs, increased urine output, normalization of electrolytes, weight gain. **Clinical Manifestations and Management of Fluid Volume Excess** - **Manifestations**: Edema, weight gain, hypertension, bounding pulse, jugular venous distention, crackles in lungs. - **Management**: Fluid restriction, diuretics, monitoring vital signs, daily weights, assessing lung sounds, monitoring electrolytes. - **Evaluation**: Reduction in edema, weight loss, normalization of vital signs, improved respiratory status. **Foods Rich in Iron, Vitamin C, Calcium, Potassium, and Sodium** - **Iron**: Red meat, beans, spinach. - **Vitamin C**: Citrus fruits, strawberries, bell peppers. - **Calcium**: Dairy products, leafy greens, fortified foods. - **Potassium**: Bananas, oranges, potatoes. - **Sodium**: Table salt, processed foods, canned soups. **Potential Causes of Electrolyte Imbalances (continued)** - **Hypernatremia**: Dehydration, excessive salt intake, certain medications. - **Hyponatremia**: Excessive water intake, diuretics, heart failure. - **Hyperkalemia**: Kidney failure, excessive potassium intake, certain medications. - **Hypokalemia**: Diuretics, vomiting, diarrhea. - **Hypercalcemia**: Hyperparathyroidism, malignancy, excessive calcium intake. - **Hypocalcemia**: Hypoparathyroidism, vitamin D deficiency, chronic kidney disease. - **Hypermagnesemia**: Kidney failure, excessive magnesium intake. - **Hypomagnesemia**: Malnutrition, chronic alcoholism, certain medications. **Normal Lab Values** - **Sodium**: 135-145 mEq/L - **Potassium**: 3.5-5.0 mEq/L - **Calcium**: 8.5-10.5 mg/dL - **Magnesium**: 1.5-2.5 mEq/L **Common Clinical Manifestations of Electrolyte Imbalances** - **Hypernatremia**: Thirst, confusion, muscle twitching, seizures. - **Hyponatremia**: Nausea, headache, confusion, seizures. - **Hyperkalemia**: Muscle weakness, cardiac arrhythmias, fatigue. - **Hypokalemia**: Muscle weakness, cramps, cardiac arrhythmias. - **Hypercalcemia**: Nausea, vomiting, constipation, confusion. - **Hypocalcemia**: Muscle cramps, tingling, seizures. - **Hypermagnesemia**: Nausea, vomiting, muscle weakness, cardiac arrhythmias. - **Hypomagnesemia**: Muscle cramps, seizures, cardiac arrhythmias. **Objectives CH 17: Acid-Base Imbalances** **Key Terms and Concepts** 1. **Acid**: A substance that releases hydrogen ions (H⁺) in solution. 2. **Base**: A substance that accepts hydrogen ions (H⁺) in solution. 3. **Bicarbonate (HCO₃⁻)**: A major buffer in the blood that helps maintain pH balance. 4. **Carbon Dioxide (CO₂)**: A waste product of metabolism that can combine with water to form carbonic acid. 5. **Hydrogen Ions (H⁺)**: Positively charged ions that determine the acidity of a solution. 6. **Metabolic Acidosis**: A condition characterized by a decrease in blood pH due to an accumulation of acids or loss of bicarbonate. 7. **Metabolic Alkalosis**: A condition characterized by an increase in blood pH due to an accumulation of bicarbonate or loss of acids. 8. **Respiratory Acidosis**: A condition characterized by a decrease in blood pH due to an accumulation of CO₂ from hypoventilation. 9. **Respiratory Alkalosis**: A condition characterized by an increase in blood pH due to a decrease in CO₂ from hyperventilation. 10. **Arterial Blood Gas (ABG)**: A test that measures the levels of oxygen, carbon dioxide, and pH in arterial blood to assess respiratory and metabolic function. **Reading ABG Results** - **Metabolic Acidosis**: Low pH, low HCO₃⁻. - **Metabolic Alkalosis**: High pH, high HCO₃⁻. - **Respiratory Acidosis**: Low pH, high CO₂. - **Respiratory Alkalosis**: High pH, low CO₂. - **Uncompensated**: pH is abnormal, and either CO₂ or HCO₃⁻ is abnormal. - **Partially Compensated**: pH is abnormal, and both CO₂ and HCO₃⁻ are abnormal. - **Fully Compensated**: pH is normal, but both CO₂ and HCO₃⁻ are abnormal. **Regulation of Acid-Base Balance** - **Respiratory System**: Regulates pH by controlling the levels of CO₂ through breathing. - **Renal System**: Regulates pH by excreting or reabsorbing H⁺ and HCO₃⁻. **Pathophysiology of Acid-Base Imbalances** - **Respiratory Acidosis**: Caused by hypoventilation, leading to CO₂ retention (e.g., COPD, sedative overdose). - **Respiratory Alkalosis**: Caused by hyperventilation, leading to CO₂ loss (e.g., anxiety, pain). - **Metabolic Acidosis**: Caused by an accumulation of acids (e.g., diabetic ketoacidosis) or loss of bicarbonate (e.g., diarrhea). - **Metabolic Alkalosis**: Caused by an accumulation of bicarbonate (e.g., excessive antacid use) or loss of acids (e.g., vomiting). **Potential Causes of Acid-Base Imbalances** - **Respiratory Acidosis**: Hypoventilation, COPD, sedative overdose. - **Respiratory Alkalosis**: Hyperventilation, anxiety, pain. - **Metabolic Acidosis**: Diabetic ketoacidosis, renal failure, diarrhea. - **Metabolic Alkalosis**: Vomiting, excessive antacid use, diuretic therapy. **Objectives: Review from Fundamentals** **Key Terms and Concepts** 1. **Colloid Solution**: A solution containing large molecules that do not pass through cell membranes, used to expand plasma volume (e.g., albumin). 2. **Crystalloid Solution**: A solution containing small molecules that can pass through cell membranes, used for fluid replacement (e.g., Normal Saline). 3. **Keep Vein Open (KVO)/To Keep Open (TKO)**: A slow infusion rate to keep an IV line patent. 4. **Phlebitis**: Inflammation of a vein, often due to IV therapy. 5. **Peripheral Venous Access**: Insertion of an IV catheter into a peripheral vein for fluid or medication administration. **Best Practices for IV Insertion, Maintenance, and Removal** - **IV Insertion**: Use aseptic technique, choose an appropriate vein, secure the catheter. - **IV Maintenance**: Regularly check the IV site for signs of infection or infiltration, ensure the IV is patent. - **IV Removal**: Use aseptic technique, apply pressure to the site after removal to prevent bleeding. **Assessing for IV Infiltration** - **Clinical Manifestations**: Swelling, pain, redness, coolness at the IV site, decreased flow rate. - **Interventions**: Stop the infusion, remove the IV catheter, elevate the affected limb, apply a warm or cold compress. **Electrolyte Imbalances** **Electrolytes** are minerals in your blood and other body fluids that carry an electric charge. They are essential for various bodily functions, including muscle contractions, nerve signaling, and maintaining fluid balance. Here are some common electrolyte imbalances: 1. **Hypernatremia** (High Sodium): - **Causes**: Dehydration, excessive salt intake, certain medications. - **Symptoms**: Thirst, confusion, muscle twitching, seizures. - **Management**: Gradual rehydration with hypotonic fluids, monitoring sodium levels. 2. **Hyponatremia** (Low Sodium): - **Causes**: Excessive water intake, diuretics, heart failure. - **Symptoms**: Nausea, headache, confusion, seizures. - **Management**: Fluid restriction, hypertonic saline in severe cases, monitoring sodium levels. 3. **Hyperkalemia** (High Potassium): - **Causes**: Kidney failure, excessive potassium intake, certain medications. - **Symptoms**: Muscle weakness, cardiac arrhythmias, fatigue. - **Management**: Diuretics, dialysis, medications to lower potassium levels. 4. **Hypokalemia** (Low Potassium): - **Causes**: Diuretics, vomiting, diarrhea. - **Symptoms**: Muscle weakness, cramps, cardiac arrhythmias. - **Management**: Potassium supplements, dietary changes, monitoring potassium levels. 5. **Hypercalcemia** (High Calcium): - **Causes**: Hyperparathyroidism, malignancy, excessive calcium intake. - **Symptoms**: Nausea, vomiting, constipation, confusion. - **Management**: Hydration, medications to lower calcium levels, treating underlying cause. 6. **Hypocalcemia** (Low Calcium): - **Causes**: Hypoparathyroidism, vitamin D deficiency, chronic kidney disease. - **Symptoms**: Muscle cramps, tingling, seizures. - **Management**: Calcium supplements, vitamin D, treating underlying cause. 7. **Hypermagnesemia** (High Magnesium): - **Causes**: Kidney failure, excessive magnesium intake. - **Symptoms**: Nausea, vomiting, muscle weakness, cardiac arrhythmias. - **Management**: Diuretics, dialysis, medications to lower magnesium levels. 8. **Hypomagnesemia** (Low Magnesium): - **Causes**: Malnutrition, chronic alcoholism, certain medications. - **Symptoms**: Muscle cramps, seizures, cardiac arrhythmias. - **Management**: Magnesium supplements, dietary changes, treating underlying cause. **Types of Intravenous Fluids (IVF)** **Intravenous fluids** are used to maintain or restore fluid balance in patients. They are categorized based on their tonicity: 1. **Isotonic Fluids**: - **Examples**: 0.9% NaCl (Normal Saline), Lactated Ringer\'s. - **Uses**: To treat fluid volume deficit, dehydration, and shock. They have the same osmolarity as blood, so they do not cause fluid shifts between compartments. 2. **Hypertonic Fluids**: - **Examples**: 3% NaCl, Dextrose 10% in water (D10W). - **Uses**: To treat severe hyponatremia and cerebral edema. They have a higher osmolarity than blood, drawing water out of cells into the extracellular space. 3. **Hypotonic Fluids**: - **Examples**: 0.45% NaCl (Half Normal Saline). - **Uses**: To treat hypernatremia and intracellular dehydration. They have a lower osmolarity than blood, causing water to move into cells.