Medical SurgicalTTMP.pdf

Medical Surgical Study online at https://quizlet.com/_dwqkqo 1. Sodium (Na+): 135-145 mEq/L 2. Potassium (K+) 3.5 -5.0 mEq/L 3. Calcium (Ca++) 9.0-10.5 mg/dL 4. Magnesium (Mg++) 1.3 - 2.1 mEq/L 5. Phosphorus (PO4) 3.0 - 4.5 mg/dL 6. Chloride (Cl) 98 -106 mEq/L 7. As you are get-...

Medical Surgical Study online at https://quizlet.com/_dwqkqo 1. Sodium (Na+): 135-145 mEq/L 2. Potassium (K+) 3.5 -5.0 mEq/L 3. Calcium (Ca++) 9.0-10.5 mg/dL 4. Magnesium (Mg++) 1.3 - 2.1 mEq/L 5. Phosphorus (PO4) 3.0 - 4.5 mg/dL 6. Chloride (Cl) 98 -106 mEq/L 7. As you are get- Fluid is lost from the blood (low volume = low B/P) ting dehydrated • Blood becomes more osmotic (concentrated or thicker) The BODY senses it: it starts to draw fluid from the tissues (EC compartment) If you still don't replace the fluid the tissues become more concentrated than the cells the cells sense it and start to lend fluid to equalize the EC compartment concentration leading to cellular dehydration • If nothing is done cells become dehydrated: The shifting is all done towards the blood volume to try to save us or we will die 8. a compensatory survival mechanism mechanism 9. Blood PH 7.35-7.45 10. Nurses must • Maintain have a basic • Detect understanding of • Correct them Fluid's & Lytes to help: 11. Homeostasis Is the process of Maintaining relatively constant conditions in fluid compartments of the body 1 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo To maintain internal balance body must be able to regulate fluids • 50 -60% of the body is made up of H2O Delivery of O2, glucose, to the cells • Removal of Co2, and waste products from the cells • When the body cannot maintain homeostasis- we get sick 12. Body Fluid Com- intracellular and extracellular partments 13. Intracellular fluid fluid within cells (ICF) 14. Extracellular flu- fluid outside the cells; includes intravascular and interstiid (ECF) tial fluids; fluid transports nutrients/wastes 15. Intravascular flu- In blood vessels in the form of plasma or serum id compartment (IV compartment) 16. Interstitial fluid (IS) fluid surrounding cells, includes: • lymph • Digestive secretions • Cerebrospinal fluid 17. Electrolytes • Sodium Na+ • Potassium K+ • Chloride Cl• Calcium ca++ • Magnesium mg+ 18. Non-electrolytes • Urea • Creatinine • Protein • Bilirubin • Glucose 19. K+ is for cardiac electro-conductivity 2 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo Potassium (K+) (Cardiac Conductivity) • Found mainly in the intracellular fluid: (inside the cell) • Is major intracellular cation (98-99%) • Maintains fluid osmolality and volume within the cell • Essential for normal membrane excitability: • Important for transmitting nerve impulses • Needed for: • protein synthesis • Synthesis and breakdown of glycogen, • maintain plasma acid-base balance • Single most important electrolyte of the body • Low K+ Leads to cardiac irregularities (R on T phenomenon) • Death by chemicals or by electrocution • Babies: No "K+" before "P" = • the pt will become severely hyperkalemic • you will kill the pt's kidneys, 20. Na+ is for muscular activity & coordination Sodium (Na): (Neuro-muscular activity) • Most abundant electrolyte • primary electrolyte in extracellular fluid (EC) • Major role is in regulating: • body fluid volumes, • muscular activity, • nerve impulse conduction, • and acid-base balance • Remember: • water goes where sodium is (water follows sodium) • Patients with HYPERNATREMIA: retain water (edema) • Salt gets taken away from the diet • Meds can be given to rid of excess sodium (Lasix: diuretic) 21. C++ is for muscle contraction & relaxation • Usually combined with phosphorus • Forms mineral salts for bones and teeth • 99% concentrated in the bones and teeth; • 1% is in the extracellular fluid • Protein bound calcium (Stored) • Ionized calcium (circulating) (Chvostek's sign and trousseau's sign) • Mexican attack (L/T Alkalosis---lowers circulating (ionized) C+) • Ingested through the diet and absorbed through the intestine • Promotes transmission of nerve impulses; • helps regulate muscle contraction and relaxation, • plays a role in clotting. • Calcium and phosphorous have: • an inverse property or reciprocal relationship • Calcium is up/ phosphorous is down •What is phosphorous (fizz in coke) The body is vigilant about calcium • If serum calcium 3 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo levels falls • More calcium is absorbed in the GI tract • Kidneys will reabsorb more • Or pulled out of the bones • To restore blood levels 22. Mg+ is for metabolism plays a role in other electrolytes • 50% to 60% found in the bone, • 39% to 49% in the intracellular fluid, • 1% in the extracellular fluid • Responsible for : • metabolism of carbohydrates and proteins, • storage and use of intracellular energy, and neural transmission • Important in heart, nerve, and muscle function • Excreted thru the kidneys • Rate of excretion is controlled by : • sodium and calcium excretion • EC fluid volume • Parathyroid hormone • Mag: keeps potassium in the body • If K+ is low check Mag+ level 23. Chloride is for dehydration/fluids Extracellular anion • Bound with other ions, sodium or potassium • Regulates osmotic pressure between fluid compartments • helps in regulating acid-base balance • Was not common to see hypo-chloremia • Now more common due to bottled water • Nsg Home pts frequently have chloride deficiency • what kind of water do we give them? 24. Substances dissolved in the body fluids include • Urea • protein • glucose • Creatinine • bilirubin These solutes do not carry an electrical charge • Very important diagnostically • Measured in mg/dL 25. Do not give bo- dialysis patient luses or potassium to 4 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo 26. Transport of Wa- • Membranes ter and Elec• Selectively permeable membranes trolytes • Separate fluid compartments • control movement of water and certain solutes • Maintain unique composition of each compartment of the body while allowing transport of nutrients and wastes to and from cells • Some solutes cross membranes more easily than others • The larger the molecule, the slower it will travel 27. Diffusion The random movement of particles in all directions 28. Natural tendency: - a substance moves from an area of high concentration to an area of lower concentration EX: 02 moves from alveoli to capillary : alveoli (O2 hi conc) to capillaries (O2 lo conc) & transported to the body 29. Facilitated diffu- • A carrier protein transports the molecules through memsion : branes • toward an area of lower concentration 30. Active transport: Requires a carrier protein • Transports substances from an area of equal or greater concentration • Electrolytes: glucose, sodium, potassium are actively transported across cell membranes • EX: sodium pump: • Sodium concentration is greater outside the cell • When the sodium is inside the cell, active transport is needed to pump the Na+ out of the cell into an area of higher concentration 31. Hyperkalemia > 7.0 Potassium Blocks the heart rate 32. T wave resting heart rate 33. Hypokalemia < 2.0 Potassium Throws irregular beats (should be dead) 5 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo 34. Filtration: Transfer of water and solutes through a membrane from an area of high pressure to an area of low pressure • AKA: Hydrostatic pressure • A combination of pressures of: • the force of gravity on the fluid • the pumping action of the heart • Needed to: • Move fluid out of capillaries into tissues • Filter plasma through the kidneys • B/P 35. Respiratory Alkalosis Low Paco2 with a resultant rise in pH Most common cause of respiratory alkalosis is hyperventilation Medical treatment • Major goal of therapy: treat underlying cause of condition; sedation may be ordered for the anxious patient Nursing care • Intervention • In addition to giving sedatives as ordered, reassure the patient to relieve anxiety • Encourage patient to breathe slowly, which will retain carbon dioxide in the body Body retains too many hydrogen ions or loses too many bicarbonate ions; with too much acid and too little base, blood pH falls • Causes are starvation, dehydration, diarrhea, shock, renal failure, and diabetic ketoacidosis • Signs and symptoms: changing levels of consciousness, headache, vomiting and diarrhea, anorexia, muscle weakness, cardiac dysrythmias • Medical treatment: treat the underlying disorder Nursing care • Assessment of the patient in metabolic acidosis should focus on vital signs, mental status, and neurologic status • Emergency measures to restore acid-base balance. Administer drugs and intravenous fluids as prescribed. Reassure and orient confused patientsIncrease in bicarbonate levels or a loss of hydrogen ions • Loss of hydrogen ions may be from prolonged Nasogastric suctioning, excessive vomiting, diuretics, and electrolyte disturbances • Signs and symptoms: headache; irritability; lethargy; changes in level of 6 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo consciousness; confusion; changes in heart rate; slow, shallow respirations with periods of apnea; nausea and vomiting; hyperactive reflexes; and numbness of the extremities Medical treatment • Depends on the underlying cause and severity of the condition Nursing care • Assessment • Take vital signs and daily weight; monitor heart rate, respirations, and fluid gains and losses • Keep accurate intake and output records, including the amount of fluid removed by suction • Assess motor function and sensation in the extremities; monitor laboratory values, especially pH and serum bicarbonate levels Intervention • To prevent metabolic alkalosis, use isotonic saline solutions rather than water for irrigating Nasogastric tubes because the use of water for irrigation can result in a loss of electrolytes • Provide reassurance and comfort measures to promote safety and well36. Respiratory Alkalosis Low Paco2 with a resultant rise in pH • Most common cause of respiratory alkalosis is hyperventilation • Medical treatment • Major goal of therapy: treat underlying cause of condition; sedation may be ordered for the anxious patient Nursing care • Intervention • In addition to giving sedatives as ordered, reassure the patient to relieve anxiety • Encourage patient to breathe slowly, which will retain carbon dioxide in the body 37. Respiratory Aci- Respiratory system fails to eliminate the appropridosis ate amount of carbon dioxide to maintain the normal acid-base balance • Caused by pneumonia, drug overdose, head injury, chest wall injury, obesity, asphyxiation, drowning, or acute respiratory failure • Medical treatment • Improve ventilation, which restores partial pressure of 7 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo carbon dioxide in arterial blood (Paco2 ) to normal Nursing care • Assess Paco2 levels in the arterial blood • Observe for signs of respiratory distress: restlessness, anxiety, confusion, tachycardia • Intervention • Encourage fluid intake • Position patients with head elevated 30 degrees 38. Magnesium Imbalance Hypomagnesaemia: • Causes: • decreased gastrointestinal absorption • excessive gastrointestinal loss, • usually from vomiting and diarrhea, • increased urinary loss (alcoholics) • Often associated with: • Hypokalemia (magnesium keeps potassium in the body) • Hypocalcemia • Hyper-magnesemia: • excessive use of magnesium-containing meds • intravenous solutions in patients with renal failure • preeclampsia of pregnancy 39. Chloride Imbalance Usually bound to other electrolytes; • Associated with other electrolyte imbalances • Hyper-chloremia • Usually found in metabolic acidosis • Hyper-chloremia • Usually occurs with sodium loss • Because it's bound with sodium • Also seen persistent N/V • Uncontrolled DM Controlled by parathyroid glands (PTH) • Hypocalcemia results from: • diarrhea, inadequate dietary intake of calcium or vitamin D, • multiple blood transfusions : • banked blood contains citrates that bind to calcium • In other some including hypoparathyroidism • LOW SERUM CA++ LEVELS : • L/T PTH SECRETION • PTH L/T CA++ RETENTION IN THE KIDNEYS • WITH PHOSPHOROUS EXCRETION BY THE KIDNEYS • THE GI TRACT INCREASES CA++ABSORPTION • BONE RELEASES CA++ FROM THE BONE S/S of hypocalcemia: • Neuromuscular irritability, • Paresthesias: face and hands • Muscle cramps • Critical hypocalcemia: • Convulsions • Arrhythmias • Tetany • Stridor • Spasms Hypercalcemia results from: • High calcium or vitamin D intake, • Hyperparathyroidism, • Immobility - causes release of calcium into the blood8 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo stream (bone resorption) • Continuous hypercalcemia leads to: • Kidney stones • Calcium deposits in they eyes and circulatory system 40. Hyperkalemia High serum potassium • Patients at risk: decreased renal function HD • Pts in metabolic acidosis, • Pts taking potassium supplements • A serious imbalance because of the potential for lifethreatening dysrythmias • Severe traumatic accidents (crush injuries) • Release a lot of K+ - crushed cells • Multiple blood transfusions of old blood • Consider Renal pts Signs and symptoms • Explosive diarrhea and vomiting; • muscle cramps and weakness, • paresthesias, • irritability, anxiety, • abdominal cramps, and • decreased urine output Medical treatment • Correct the underlying cause • Restrict potassium intake • Polystyrene Sulfonate (Kayexelate) • Intravenous calcium gluconate • Insulin • D50 • Sodium bicarbonate • Lasix • albuterol lokelma Nursing care • Patients with low urine output or those taking potassium-sparing diuretics must be monitored carefully for signs and symptoms • K+ sparing diuretics • Renal funx • Carefully monitor flow rate of IV fluids, • Monitor IV site • which should not exceed 10 mEq/hr through peripheral veins • Cardiac monitor • Screen the results of laboratory studies 41. Rule of 100 > 100 HR Check vital signs (possibly febrile or in pain) First < 100 Systolic Blood Pressure (Dehydrated, OD, Heart issue) > 100° Temperature (febrile) > 100 DBP (Diastolic Blood Pressure) (stress, stroke) 9 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo 42. Hypokalemia Low serum potassium • May result in gastrointestinal, renal, cardiovascular, and neurologic disturbances • Can cause abnormal, potentially fatal, heart rhythm • Signs and symptoms • Anorexia, abdominal distention, • vomiting, diarrhea , muscle cramps, • weakness, dysrythmias (abnormal cardiac rhythms), • postural hypotension, Dyspnea, shallow respirations, • confusion, depression, Polyuria (excessive urination), and nocturia • K+ wasting diuretics • corticosteroids Medical treatment • Potassium replacement by the IV or oral route • Nursing care • Monitoring at-risk patients for decreased bowel sounds, • a weak and irregular pulse, • decreased reflexes, and decreased muscle tone • Cardiac monitors may be used to detect dysrythmias • Administer oral or IV potassium • Urine output should be no less than 30 ml/hr Nsg care: • Monitor BS • Cardiac rhythm • If on dig - low K+ increases R/F dig toxicity • Adm K+ supplement with full glass of water • To decrease gastric irritation • Straw (stains teeth) • Enc fruits/veggies see chart 14-6 43. Hypernatremia Higher than normal concentration of sodium in the blood • Very serious imbalance; can lead to death if not corrected • Occurs with: • excessive loss of water (EC Fluid vol deficit) • excessive retention of sodium • Leads to fluid shifting • L/T- water coming out of the cell - cellular dehydration • Causes: • N/VD, profuse sweating, insufficient ADH Signs and symptoms • Thirst, • flushed skin, • dry mucous membranes, • low urine output, • restlessness, • increased heart rate, 10 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo • convulsions, • postural hypotension Medical treatment • Oral or IV replacement of water to restore balance • A low-sodium diet often prescribed • Monitor IVF (especially in renal or cardiac pts) • Nursing Care: • Teach I/O & S/S • Diet restrict Hi sodium foods (see box 14-5) • Salt substitute is encouraged (know is K+ is restricted) 44. Hyponatremia Lower than normal sodium in the blood serum • Can be actual deficiency of sodium or increase in body water that dilutes the sodium excessively • Assessment • Symptoms: headache, muscle weakness, fatigue, apathy, confusion, abdominal cramps, and orthostatic hypotension • Take blood pressures with the patient lying or sitting and then standing to determine if a significant drop Causes: • Excess fluid intake without Na+ • Excess Na+ loss • NVD or diaphoresis with only water replacement • Use of distilled water as irrigant in body cavities • Excess ADH secretion: head injuries, severe stress • SIADH • CHF • Liver cirrhosis • Nephrotic syndrome • Na+ holds water in EC compartment Causes: • Low serum sodium • Too much water in the EC compartment • Cells become more concentrated • Water will then go into the cells to even compartments out • Cell swells (cellular edema) • Brain cells are most sensitive • Fluid accumulates in the brain cells • Leads to ICP • c/o: H/A's, weakness, fatigue, apathy, alt LOC, confusion, abd cramps, orthostatic hypotension • How do you do orthostatic blood pressures? Medical treatment • The usual treatment is restriction of fluids while the kidneys excrete excess water • Diuretic: Furosemide (Lasix) • Sodium replacement therapy • IVFNS or L/R • Less than 115 sodium leads to convulsions an death • Hypertonic sodium chloride 3% • Nursing care • Administer prescribed medications and IV fluids • 11 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo Measure fluid intake and output and assess mental status Medical treatment • SIADH: • Find cause • Diuretics • Vaptans - block ADH • Demeclocycline • Lithium • Urea's - induce water loss without excess sodium loss • Ns for irrigations, give meds /IVF • I & O • Assess LOC • safety 45. If BP drops to 70 Kidney failure Systolic or below 4+ hours 46. Fluid Imbalances • Excess fluid volume • An increase in body water • Extracellular fluid excess • Isotonic fluid excess • Intracellular water excess • Hypotonic fluid excess • From renal or cardiac failure with retention of fluid, • increased production of Antidiuretic hormone or Aldosterone, L/T water retention • overload with isotonic IV fluids, or administration of dextrose 5% in water (D5W) after surgery or traumaExcess fluid volume: • Body compensates for excess fluid vol • Increased renal filtration (Na+ and water excretion) • Decreased prod of ADH • S/S: • Depend on how fast it occurs • Sudden - L/T cardiac failure and Pulm edema • Fluid retention or excess or hypotonic fluid adm (Nsg) • Confusion • Act intolerance - impaired gas exchange due to Pulm edema • R/F injury- LOC • Impaired skin integrity - edema • Ineffective tissue perfusion R/T -low CO and heart failure Deficient fluid volume • Less water than normal in the body • 2 types: • Isotonic extracellular fluid deficit • Hypovolemia • Hypertonic extracellular fluid deficit • Dehydration • Causes: • Decreased intake, abnormal fluid losses, or both - loss of water from excessive bleeding, - severe vomiting/diarrhea, - severe burns s/s: • R/T how fast deficient volume develops • Gradual loss is insidious • Sudden: • Body compensates: de12 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo creased U/O • Tachycardia • Hypotension R/T low blood volume • Txtmt: • Depends on causes and s/s 47. Water travels everywhere; electrolytes don't. 48. Deficient fluid volume • Causes : • Inadequate fluid intake • Excess fluid loss • Hyperglycemia • Inadequate ADH production or effect (no renal response) • Fever • Altered cap permeability (sepsis) • S/S: • Alt LOC- cerebral perfusion constipation • Fatigue-tissue perfusion hyperthermia • All are a R/F injury R/F impaired skin integrity -poor perfusion • Ineffective peripheral tissue perfusion • R/T - low CO due to low bld volume 49. Diagnostic Tests Urine studies: • Urine pH : kidney function (4.5 - 8.0) • and Procedures Determines if kidney's respond appropriately to metabolic acidbase imbalances • Fresh urine is > acidic early am • Urine more alkalotic after eating • Diet affects PH: fruits/veggies- alkaline meat: acidic • If urine has to go to lab - >1-2 hours (frig) (>four hrs = alkaline) • Urine specific gravity • Norm: 1.016 - 1.022 • A measure of urine concentration, good indicator of fluid balance • Hi - concentrated - def fluid vol • Low - excess fluid vol • Also used to asses renal function Urine studies: • Osmolality : measures renal function • Done with specific gravity • Measures the number of dissolved particles in a solution • More accurate measurement of kidney's ability to concentrate urine • Dilute: fluid excess or kidneys cant concentrate urine • In aging renal failure, the urine will be concentrated Urine Creatinine clearance tests • Detect glomerular damage in the kidney • A 24-hour specimen is required • Know how to start the test and how to maintain • Restrictions (exercise, coffee, protein, tea, colas) • Results higher in males vs females (muscle mass based) • Urine sodium: diagnostic for: • Sodium intake and fluid volume status • Higher the Na+ intake the higher the number • With good 13 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo GFR • Na+ increases during the day • In Na+ restriction urine sodium will be low Urine potassium • A measure of renal tubular function • 24 hr urine collection • Excretion is higher during the noc • Normal levels are 25-125 mEq/24 hours Blood studies • Serum hematocrit • Percentage blood volume composed of red blood cells • Hi HCT = deficient fluid vol - dehydration (bld concentrated) • Low HCT = excess fluid vol R/T dilution • Levels different in males and females • Serum Creatinine • A metabolic waste product • Indicator of renal function (hi levels = bad kidneys • 0.6 - 1.1 (very small # - any changes are important) • Blood urea nitrogen (BUN) • A measure of renal function/age related • Increases with dehydration or deficient fluid vol • Low = fluid vol overload • Serum osmolality: • Measures blood concentration • Hi osmo - R/T deficient fluid vol • Low osmo R/t fluid excess • Serum albumin • A plasma protein that helps maintain blood volume • creates colloid o 50. interstitial com- Where edema is located. partment 51. Crenation is a term used in biology to describe the formation of uneven notched corners on cells caused by osmosis water loss. 52. Assessment of Fluid and Electrolyte Balance Assessment of Fluid and Electrolyte Balance • Health history • Does the pt. have conditions that contribute to fluid or electrolyte imbalances • Vomiting, diarrhea, kidney diseases, • diabetes, Salicylate poisoning, burns, • congestive heart failure, cerebral injuries, • ulcerative colitis, hormonal imbalances; • On drugs: diuretics and cathartics; • DM Stroke or trauma • medical interventions: such as gastric suctioning • Complaints of : • fatigue, palpitations, dizziness, edema, • muscle weakness or cramps, Dyspnea, • confusion may be associated with fluid imbalances Assessment of Fluid and Electrolyte Balance • Vital signs • Pulse , respiration, temperature, and 14 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo blood pressure • may point towards changes in fluid and electrolyte balance. • Fever : • can be associated with fluid volume excess or deficit. • Pulse rate and quality: • may change in response to blood volume alterations; • electrolyte affect heart rate and rhythm. • H/R goes up with low volume (comp mech) • Blood pressure: • is directly related to blood volume. • Respirations are minimally affected by electrolyte changes. • Will be affected by excess fluid vol, heart failure, pulmonary edema Assessment of Fluid and Electrolyte Balance • Intake and output • Accurate I & O • All fluids entering or leaving documented • A changing urine output • reflect attempts by the kidneys to maintain or restore balance, • reflect a problem that causes fluid disturbances • Low U/Odehydration • Hi U/O - volume excess (30cc/hr or 1 mg/kg) • Urine color, give clues to fluid balance • Clear, pale urine reflects the excretion of excess water, • Darker, concentrated urine indicates the kidneys are retaining water • Body wt: 1 liter of fluid = 2.2 lbs • Pt may accumulate 10 lbs of fluid before pitting edema is noticeable Assessment of Fluid and Electrolyte Balance • Skin • Characteristics • Moisture, turgor, and temperature reflect fluid balance. • Dry, flushed skin—dehydration. • Pale, cool, clammy skin—severe fluid volume deficit that occurs with shock. • Moist, edematous tissue seen with excess fluid volume • Facial characteristics • Severely dehydrated patient : • has a pinched, drawn facial expression. • Soft eyeballs and sunken eyes = severely deficient flui 53. Distribution of fluid: • Women have more fat, (some): • Less water content (fat carries less water) (54% water) • Men tend to have more muscle (lean) (some): • Have More water content (60% water) • Infants have a higher percent of total body water: • 75% total water content • Dehydrate easier • Smaller bodies • If child has diarrhea and vomiting (spells trouble) 15 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo • Fever and milk (milk raises fever, increases phlegm) • Vomiting and milk ( rest period in between) 54. Electroyte Com- Water position • 50-60% • Solutes: (particles in the water) • Electrolytes (carry a charge) • Sodium Na+ • Potassium K+ • Chloride Cl• Calcium ca++ • Magnesium mg+ • Non-electrolytes: • Urea Creatinine • Protein bilirubin • Glucose • Concentrations are Measured in milliequivalents mEq's 55. Main food for the Glucose brain 56. Osmolality Concentration of solution determined by number of dissolved particles per kg water • Hi osmolality = very concentrated • Lo osmolality = dilute • The more water a solution has, the less concentrated • Osmolality: • Controls water movement and distribution by : • regulating the concentration of fluid in each body fluid compartment • The osmolality of intracellular fluid and extracellular fluid tends to equalize because of the constant shifting of water Changes in osmolality of ICF affects the osmolality of ECF, and vice versa • The osmolality of IC fluid is maintained by K+ • The osmolality of EC fluid is maintained by Na+ • Note : osmolality is a term referring to concentration of particles in water • Blood • Urine 57. Kidneys 16 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo Main regulators of fluid balance adjustments • Adjusts fluid: • Fluid volume • Distribution • composition • Adjustments are made by: • Kidney • Circulatory system • Triggered by: sympathetic Nervous system, hormones and thirst center. Main regulator of fluid balance: • Controls EC fluid by adjusting: • Concentration of electrolytes • Osmolality of body fluid • Volume of EC fluid • Blood volume • PH • Controlled by hormones • Nephron: • The functioning unit of the kidney (works by filtration) • Glomerulus is the filtering portion of the Nephron, • The tubules are responsible for secretion and reabsorbtion Nephrons: conduct work of the kidney through filtration, re-absorption, and secretion Filtration primary function of the Nephron: • About 20% of plasma filtered into Glomerulus capsule • Most remaining plasma leaves kidney through the renal vein • Filtrate (the fluid that does not leave the kidney) • then moves through the tubules, • where it is transformed into urine by: • tubular reabsorption and secretion Tubular reabsorption (a secondary filtering) • Tubules will select what will be excreted • Most of the glomerular filtrate is returned to the circulation as needed • Water and selected solutes move from the tubules into the capillaries • Remain in tubules for excretion, 17 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo • most water and sodium is reabsorbed into the bloodstream • Tubular reabsorption: • Adjusts volume • Adjusts what will be excreted or kept • Prevents excessive fluid loss through the kidneys Tubular secretion • The last phase in the work of the kidneys • Filtrate turns into urine • Various substances are excreted • drugs, hydrogen ions, • potassium ions, Creatinine, • Histamine, other waste products • This Process: • eliminates some excess substances to maintain fluid and electrolyte balance, • as well as metabolic waste products 58. Hormones • Hormones that affect fluid volume • Renin : • Hormone secreted when blood volume or B/P drops • Renin goes to liver: • • Starts to constrict blood vessels to bring up B/P • Aldosterone: • Acts on kidney tubules • increases reabsorption of sodium • decreases reabsorption of potassium (excretes K+) • Because Sodium retention causes water retention, • Remember H20 follows Na+ • Aldosterone acts as a volume regulator • Aldosterone can be triggered by: • Hi K+ levels • Lo sodium levels Antidiuretic hormone (ADH) • Produced by hypothalamus, • triggers the Pituitary to release ADH into the blood stream • ADH Causes kidneys to reabsorb more water, • Less water is excreted (urine is more concentrated) • Also In increase in blood osmolality stimulates ADH release 18 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo • Other factors that trigger release of ADH: • Stress • Hypotension • Pain • Surgery • meds Atrial natriuretic factor (ANF) • Hormone released by the atria • Made in response to stretching of the atria by increased blood volume • Fluid overload • Stimulates excretion of : • sodium and water by the kidneys, • decreased synthesis of Renin, • decreased release of Aldosterone, • induces vasodilation • Reduces blood volume • lowers blood pressure 59. Thirst Regulates fluid intake • Increased plasma osmolality (concentrated blood/dehydration) • stimulates osmoreceptors in the hypothalamus to trigger the sensation of thirst • Hi sodium and less water in the body make a person thirsty • Person then drinks more water; • kidneys will conserve water until osmolality returns to normal 60. Fluid Gains and In healthy adult, • 24-hour fluid I&O approximately equal • Losses Fluids gained : • by drinking and eating and • Fluids lost • through the kidneys, skin, lungs, and GI tract • The usual adult urine volume: • is between 1 and 2 L/day, or 1 ml/kg of body weight per hour • In kidneys, • water loss varies: • with the amount of solute excreted • And with the level of Antidiuretic hormone circulating Insensible losses: • Losses through the: • skin occur by sweating • lungs by evaporation at 300 to 400 ml/day • GI tract, the usual loss of fluid is about 100 to 200 ml/day 61. Age-Related Changes Affecting Fluid Balance Aging kidney : • slower to adjust to changes in acid-base, fluid, and electrolyte balances • Older adult : • has a reduced sense of thirst • may be in a state of chronic dehydration • Total body water declines with age; • greatest 19 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo loss is from the intracellular fluid compartment • Cellular dehydration - "why is grandpa acting weird?" • s/s of fluid imbalances in the elderly: • Disorientation • Confusion • Constip • Falls (postural hypotension) • Hx of cardiac or renal insufficiency • Chronic conditions affect mental status and mobility • Acute fluid deficits R/T: • Trauma NPO status • INFXN Meds • Fever Flu • Skin turgor - sternum/forehead • Limited reserves to maintain fluid balance when abnormal losses happen • Anti-hypertensive's, diuretics, and antacids can also contribute to imbalances • Unless contraindicated, • fluid requirements for older adults, • based on ideal body weight, are 30 ml/kg for ages 55 to 65 25 ml/kg 65 years and older 62. sodium is extra- extracellular cellular or intracellular? 63. Potassium is ex- intracellular tracellular or intracellular? 64. When you have Reduce your sodium intake and take a diuretic. edema; what's the first thing you're told at the hospital? 65. Water follows? Sodium 66. Hyponatremia deficient sodium in the blood 67. Lasix (furosemide) Classification: Loop Diuretic Therapeutic Effects: Diuresis. Lowering of blood pressure Adverse Reactions & side effects: Dehydration, hypochloremia, hypokalemia, hypomagnesaemia, hyponatremia, hypovolemia, metabolic alkalosis Nursing Implications & teaching: Monitor for thirst, dry mouth, lethargy, weakness, hypotension, oliguria and no20 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo tify physician. Monitor K+, Ca++, Mg. Can increase BUN, glucose and creatinine, TAKE WITH FOOD 68. Before you give Check the potassium levels and blood pressure. Lasix; what do you need to look at? 69. Chvostek's sign spasm of the facial muscles produced by sharply tapping over the facial nerve in front of the parotid gland and anterior to the ear; suggestive of latent tetany in patients with hypocalcemia 70. Sodium at 128 mEq/L Sluggish and low energy 71. Worst acuity be- Hyponatremia tween Hyponatremia and Hypernatremia is worse? 72. Most sodium is found outside the cell 73. Potassium is found inside the cell 74. Six PVCs or more EKG Call Charge Nurse to call the doctor 75. Hypochloremia deficiency of chloride in the blood plasma 76. Hyperchloremia an excess of chloride in the blood plasma 77. Any "shock" dilation of blood vessels 78. Bolus rate is raise blood pressure wide open to the prescribed mL 21 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo 79. Microdrip 60 gtt/mL 80. Anti-hypertensives diuretics, beta blockers, calcium channel blockers 81. Single most im- R on T phenomenon portant electrolyte of the body 82. Normal range of 60 - 80 bpm heart should be 83. The weakest part ventricular fibrillation of the heart's life is the T wave 84. Calcium channel pregnant women blockers can be given to 85. When calcium is Is phosphorus high calcium is low high phosphates are low 86. Why is it bad Phosphorus fizz causes calcium to drop; children require for kids to drink calcium for bone development and growth. Teeth loss may coke? be a byproduct. 87. Parathyroid gland regulates Calcium 88. Calcium probtotal calcium; ionized calcium attach to protein bound. Ionlems; what's or- ized calcium floats around and deposits calcium where it's dered. needed. Fortunately. Ionized calcium is most important. 89. Tetany Laryngospasm (voice box spasms), which can cause difficulty breathing. Bronchospasms (when the muscles that line the airways in your lungs tighten). 22 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo Painful, generalized muscle cramps. Vomiting. 90. Chvostek's __________ sign is muscle spasms and twitching around mouth, throat, and cheeks associated with hypocalcemia 91. Another way of hand folds inward and contracts. finding out a patient is hypocalcemic 92. What's a treatbrown paper bag ment for alkalosis 93. Trousseau's sign arm/carpal spasm associated with hypocalcemia and hypomagnesemia 94. Severe Hypocal- Tetany cemia 95. Signs of hypocalcemia Chvostek's sign, Trousseau's Sign 96. Calcium: Causes Inadequate intake of calcium or vitamin D of Deficiency Hypoparathyroidism Malabsorption syndrome 97. Hypercalcemia muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, shallow respirations, emergency! 98. magnesium foods leafy vegetables, nuts, seeds, legumes, whole grains, seafood, peanut butter, cocoa 99. Potassium is low magnesium is low 100. 21% oxygen room air 101. lungs 23 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo best place to appreciate diffusion 102. How do you Hyperbaric rid high carbon monoxide in blood 103. facilitated diffu- Movement of specific molecules across cell membranes sion through protein channels 104. Active transport Energy-requiring process that moves material across a cell membrane against a concentration difference 105. Food for brain glucose 106. Intracellular compartment the fluid space of the body that is contained within cells 107. Extracellular compartment the fluid space of the body that exists outside the cells 108. paracentesis surgical puncture to remove fluid from the abdomen 109. thoracentesis surgical puncture to remove fluid from the pleural space 110. Paricardiocente- surgical puncture to aspirate fluid from the sac surroundsis ing the heart 111. lasix Furosemide Diuretic 112. Potassium spar- spironolactone, triamterene, amiloride ing diuretics 113. Potassium wast- End in - X ing diuretics (exception Diuril) "Any diuretic ending in - X , exits out potassium" Loop Diuretics as well 24 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo 114. Best test to determine how good your kidneys are Creatinine Test 115. BUN 10-20 mg/dL 116. If BUN is elevat- Dehydration ed and creatinine is normal 117. Creatinine should be Higher in the urine and lower in the blood 118. Creatinine 0.6-1.2 mg/dL nitrogenous waste excreted in the urine 119. Renin hormone secreted by the kidney; it raises blood pressure by influencing vasoconstriction (narrowing of blood vessels) 120. RAAS (renin-angiotensin-aldosterone system) - decrease perfusion to kidneys releasing renin converts to angiotensin I to angiotensin II which vasoconstrict & increase aldosterone - keep K and H2O 121. • Liver releases angiotensin I 122. • Angiotensin I goes to the lungs and converted to angiotensin II 123. Angiotensin II (very powerful vasoconstrictor) Angiotensin II also releases Aldosterone by adrenals 124. Aldosterone function causes kidneys to retain sodium to increase blood pressure, water retention 125. Aldosterone side •Hyperglycemia effects • Hypokalemia • Hypocalcemia 25 / 26 Medical Surgical Study online at https://quizlet.com/_dwqkqo • Hypertension • Hypernatriumia • Edema -moon face and buffalo hump • Decrease immune system, increase infection • Peptic Ulcer problems 126. Aldosterone in kidney -activated when blood pressure and blood volume are low -steroid hormone regulated by renin-angiotensin-aldosterone system -increases sodium reabsorption in the DCT and collecting duct -this increases water reabsorption -results in increased blood volume (and pressure) -no change in blood osmolarity 26 / 26