NURSE-UN 240 AE1- Exam 2 Week 5 Latest updated 2022
• Fluid regulation important in maintaining homeostasis
o Influenced by various body systems
▪ Cardiac
▪ GI
▪ Pulmonary
▪ Pituitary
▪ Renal
• Fluid compartments
o Extracellular – 1/3
▪ Interstitial, intravascular
o Int...
NURSE-UN 240 AE1- Exam 2 Week 5 Latest updated
2022
• Fluid regulation important in maintaining homeostasis
o Influenced by various body systems
▪ Cardiac
▪ GI
▪ Pulmonary
▪ Pituitary
▪ Renal
• Fluid compartments
o Extracellular – 1/3
▪ Interstitial, intravascular
o Intracellular – 2/3
• Hydrostatic = pushing force
o Osmotic = pulling force
• Edema – accumulation of or excess fluid in interstitial space
o Develops with changes in normal hydrostatic pressure
differences
• Average daily fluid intake 2300-2600 mL
• Abnormal fluid output – vomiting, wound drainage, hemorrhage
• Aldosterone – secreted by adrenal cortex when extracellular
sodium levels are low
o Prevents both water and sodium loss nephrons
reabsorb them form urine
• ADH (vasopressin) – secreted by posterior pituitary in response to
changes in blood osmolarity
o Water is returned to blood circulation, decreased water
secretion
• Natriuretic peptides (ANP) – secreted by cells lining atria and
ventricles of heart in response to stretch of heart tissue due to
increased blood volume and BP
o Filtration increased to produce more urine
• RAAS
o Renin released by kidneys due to decreased BV going to
kidneys converts angiotensinogen (from liver) to
angiotensin 1 ACE (secreted by lungs) converts it to
angiotensin 2 leads to
▪ Vasoconstriction increase BP
▪ Aldosterone secretion increases sodium
and water reabsorption increase BV and BP
▪ ADH secretion further increases water reabsorption
increase BV and BP
• Weight change of 1 lb = fluid volume change of about 500 mL
Electrolyte imbalances
• Sodium – 135-145 mmol/L (neurological)
o Hyponatremia:
, ▪ Causes: sodium loss (vomiting, diarrhea, diuretic
use) or sodium dilution (inappropriate
administration of hypotonic IVF)
▪ Signs and symptoms:
• Neurologic issues sudden onset of acute
confusion, increased confusion
• Seizures
• Neuromuscular changes general muscle
weakness, decreased deep tendon reflex
• Cardiovascular
• Dependent on type:
o Hypovolemia – signs and symptoms of
dehydration
o Hypervolemia – signs and symptoms
of fluid overload
o Hypernatremia:
▪ Causes: increased intake, inappropriate
administration of IVFs that contain sodium,
corticosteroids, hyperaldosteronism, Cushing
syndrome
▪ Signs and symptoms
• Short attention span and confusion
• Lethargic, drowsy
• Skeletal muscle muscle twitching and
irregular muscle contractions
• Cardiovascular impaired cardiac function
due to decreased contractility
• Potassium – 3.5-5.0 (cardiac)
o Control over intracellular osmolarity and volume
o Regulate protein synthesis, glucose use and storage
o Hypokalemia:
▪ Skeletal muscle weakness, thready and weak pulse
o Hyperkalemia:
▪ EKG changes, increase GI motility, parenthesis
(pins and needles, tingling)
• Calcium – 9.0-11.0 (skeletal)
o Stored in bones
o Absorption requires active form of vitamin D
o Hypocalcemia:
▪ Muscle spasm, positive Trosseau (arm) and
Chvostek (face) signs
o Hypercalcemia:
▪ Mild – increase heart rate and BP
▪ Severe – depressed cardiac conduction and slowed
heart rate
• Phosphorus – 2.5-4.5
o Found in bones
, o Activates vitamins and enzymes, assists in cell growth and
metabolism
o Plasma levels of calcium and phosphorus balanced
reciprocal relationship
o Hypophosphatemia:
▪ Decreased cell membrane excitability
o Hyperphosphatemia:
▪ Increased cell membrane excitability
• Magnesium – 1.5-2.5
o Critical for skeletal muscle contraction, carbohydrate
metabolism, ATP
formation, vitamin activation, cell growth
o Hypomagnesemia
▪ Increased cell membrane excitability
o Hypermagnesemia
▪ Decreased cell membrane excitability
• Chloride – 96-106
o Imbalance occurs as result of other electrolyte imbalances
▪ Especially sodium hyponatremia most like =
hypochloremia
o Treat underlying electrolyte imbalance or acid-base problem
• Older adults are more at risk for electrolyte imbalances
o Age-related organ changes
o Have less total body water
• Lungs excrete carbonic acid
o Kidney excrete all other acids
• Nursing assessment
o Age: very young and old at risk
o Environment: excessively hot?
o Dietary intake: fluids, salt, foods rich in potassium,
calcium, and magnesium
o Lifestyle: alcohol intake history
o Medications: include over-the-counter (OTC) and herbal,
in addition to prescription medications
• Anesthesia slows down peristalsis and urine output
• Enteral – by mouth
• Parenteral – by IV (anything that isnt by mouth)
o TPN total parenteral nutrition
o Crytalloids – small enough to pass through membrane
o Colloids – too big to do so
• Types of IVF solutions – described by tonicity in relation to plasma
o Isotonic: 0.9% NaCl (normal saline), lactated ringer’s
o Hypotonic: 0.45% NaCl (half normal saline), 0.33% NaCl
o Hypertonic: 3% NaCl, Dextrose 10% in water (D10W)
▪ Osmotic diuretic – reduces increased intracranial
pressure (cerebral swelling or meningitis)
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