Term
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Definition
| water portion of body fluids |
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Term
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Definition
| are the particles dissolved in the fluid |
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Term
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Definition
| Movement of fluid through a cell or blood vessel membrane because of pressure differences |
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Term
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Definition
Movement of particles (solute) from area of higher concentration to area of lower concentration
Whenever moving molecule strikes pore in capillary membrane that is large enough for it to pass through, diffusion occurs |
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Term
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Definition
| a device, usually constructed of plastic, used to regulate the flow of IV solution. |
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Term
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Definition
| the expanded portion of intravenous tubing into which fluid falls, where the rate of flow can be monitored if necessary. |
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Term
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Definition
| a device, usually made of plastic, equipped with a small roller that may be rolled counterclockwise to close off primary IV tubing or clockwise to open it. |
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Term
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Definition
| a medical device used for the administration of insulin or other physician approved medicine into the subcutaneous tissue (the tissue layer just below the skin). The device is similar to infusion sets used by insulin pumps, except it is configured to receive a syringe instead of a tubing system. |
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Term
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Definition
| fluid flowing due to the forces of gravity alone and not to an applied pressure head. |
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Term
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Definition
Process by which only water molecules (solvent) pass through a selectively permeable membrane
Water moves to more concentrated solute area until there is an equal concentration of solute on both sides of the membrane |
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Term
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Definition
| consists of a short catheter (a few centimeters long) inserted through the skin into a peripheral vein (any vein not inside the chest or abdomen). |
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Term
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Definition
| flow through a catheter with its tip within a large vein, usually the superior vena cava or inferior vena cava, or within the right atrium of the heart. |
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Term
| An intravenous (IV) piggyback is |
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Definition
a way to administer medication through an intravenous line that is inserted into a patient's vein.
The IV piggyback is aptly named because it is given on top of the main intravenous solution. This allows for the intermittent infusion of medications at specific times. The piggyback infusion is usually hung higher than the main IV solution; it is then connected to a port in the main tubing above the IV pump. |
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Term
| Concentration of solutes in body fluids is expressed as |
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Definition
mEq/L (milliequivalents)
mmol/L (millimoles)
mOsm/L (milliosmoles) |
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Term
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Definition
| #of milliosmoles in a liter of solution |
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Term
| Normal osmolarity of body fluids = |
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Definition
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Term
| Lactated Ringer's solution is |
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Definition
| a solution that is isotonic with blood and intended for intravenous administration. |
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Term
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Definition
Opposing forces must exist for nutrients to move out of capillaries and wastes to move in
These forces are known as Starling’s forces |
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Term
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Definition
| CAPILLARY HYDROSTATIC PRESSURE |
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Term
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Definition
| Interstitial fluid hydrostatic pressure |
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Term
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Definition
| Capillary osmotic pressure (pulling) |
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Term
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Definition
| Interstitial fluid osmotic pressure |
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Term
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Definition
Secreted by adrenal cortex
Prevents sodium loss (and because sodium pulls water, it prevents water loss)
Juxtaglomerular cells sense low serum sodium – secrete renin
Renin converts angiotensinogen to Angiotensin I
Angiotensin-converting-enzyme (ACE) converts Angiotensin I to Angiotensin II
Angiotensin II causes vasoconstriction and secretion of aldosterone |
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Term
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Definition
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Term
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Definition
| Atrial Natriuretic Peptide |
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Term
| Atrial Natriuretic Peptide |
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Definition
Secreted by specialized cells in atria in response to Blood volume and BP
ANP effects opposite of aldosterone
Inhibits reabsorption of sodium (and water)
urine output and blood volume and osmolarity |
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Term
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Definition
| 55-60% total adult body weight |
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Term
| % of total fluid is extracellular |
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Definition
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Term
| % of total fluid is intracellular |
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Definition
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Term
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Definition
(15L or 40%)
Interstitial fluid, blood plasma, lymph, special places (CSF, synovial fluid, peritoneal fluid, pleural fluid) |
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Term
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Definition
Kidneys
GI tract
Drainage from fistulas, drains
Insensible loss (15-20 mL/Kg/day)
Skin
Lungs
Insensible loss cannot be measured – is pure water |
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Term
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Definition
| A fistula is an abnormal connection between an organ, vessel, or intestine and another structure. |
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Term
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Definition
refers to water loss due to:
Transepidermal diffusion: water that passes through the skin and is lost by evaporation, and Evaporative water loss from the respiratory tract |
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Term
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Definition
| an abnormally rapid rate of breathing (more than 20 breaths per minute in adults), such as seen with hyperpyrexia. Also spelled tachypnoea. |
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Term
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Definition
| an electrolyte disturbance that is defined by an elevated sodium level in the blood. |
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Term
| Assessment of Fluid and Electrolyte Balance |
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Definition
I&O and serial daily weights
Types of foods and fluids ingested
All sources of output
Medications
Diuretics
Laxatives |
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Term
| Physical assessment (Fluids) |
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Definition
Skin turgor
Moist mucous membranes and conjunctiva
Tearing
Weight
Urine output
Heart rate
Blood pressure |
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Term
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Definition
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Term
| Physical assessment (electrolytes) |
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Definition
Neuromuscular
Muscle tone and strength
Coordination
Tremors
Cardiac
Rate, strength of contractions, dysrhythmias
GI system
Peristalsis |
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Term
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Definition
| Peristalsis is a series of organized muscle contractions that occur throughout the digestive tract. |
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Term
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Definition
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Term
| Urine Specific Gravity normal range |
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Definition
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Term
| DEHYDRATION ASSESSMENT TESTS |
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Definition
Serum electrolyte levels
Blood urea nitrogen
Glucose
Creatinine
pH
Bicarbonate level
Osmolarity
Hemoglobin/hematocrit
Urinalysis (especially specific gravity) |
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Term
Fluid volume deficit
Three types |
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Definition
Isotonic H20/ELECTROLYTES =
Hypertonic+H20 LOSS
Hypotonic +ELECTROLYTE LOSS |
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Term
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Definition
Most common blood loss
Loss of isotonic fluids from ECF
No shift in fluid between compartments
circulation blood volume
Inadequate tissue perfusion
Caused – inadequate intake or loss of isotonic |
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Term
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Definition
2nd most common type
Water loss from ECF is > electrolyte loss
Plasma becomes hypertonic
Fluid shifts into ECF from ICF
Cells shrink
ECF volume becomes normal so no signs of hypovolemiaCauses
perspiration
Hyperventilation
Ketoacidosis
Prolonged fever
DI |
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Term
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Definition
Least common
Excessive loss of Na and K from ECF
Decreased osmolarity
Water moves from plasma into cells
Cells swell
Neurologic problems from swollen brain cells
Caused by renal failure |
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Term
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Definition
Age – elders and small children
Weight
1 liter of water weighs 2.2 pounds
Other changes
Tightness clothes
Palpitations
Postural hypotension
Urine output
Fluid intake |
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Term
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Definition
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Term
| dehydration assessment Neurologic |
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Definition
| Changes in temperature and mental status |
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Term
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Definition
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Term
| Renal dehydration assessment |
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Definition
Volume and composition of urine
Output <500 ml/day is cause for concern
Weight loss > ½ pound per day is fluid |
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Term
| dehydration assessment LAB |
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Definition
Isotonic and hypotonic (with volume loss) show hemoconcentration
Urine concentrated |
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Term
Dehydration - interventions
Mild to moderate – |
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Definition
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Term
| Dehydration - interventions severe |
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Definition
IV re-hydration
Type of fluid depends on type of dehydration |
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Term
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Definition
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Term
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Definition
Combination of dehydration and hyperthermia
Elderly in hot environments
Young – strenuous exercise in heat
Life-threatening
Cool and hydrate |
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Term
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Definition
Excess of body fluid
Isotonic – osmolarity unchanged – ECF compartment is expanded – no fluid shifts – can lead to CHF
Hypotonic – water intoxication- osmolarity of ECF ’s – fluid moves into intracellular space – electrolyte disturbances caused by dilution
Hypertonic – rare- caused by excessive sodium intake – plasma osmolarity ’s – water is pulled from ICF into ECF. (ECF expands and ICF contracts) |
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Term
| OVERHYDRATION INTERVENTIONS |
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Definition
Drug therapy
Diuretics, usually osmotic diuretics
Diet therapy
Possible fluid and sodium restriction
Monitoring I&O Urine – amount, specific gravity, color
Weights |
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Term
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Definition
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Term
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Definition
Are ions (carry an electrical change)
Cations – positive
Anions – negative
Body fluids are electrochemically neutral – have equal = and –
Distribution of ions differs from ECF to ICF
Helps maintain membrane excitability and transmit impulses |
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Term
| Sodium Plasma concentration |
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Definition
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Term
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Definition
Enters body in foods and fluids
Intake ~ 6 to 12 grams/day
Regulated by kidney systems
Low levels inhibit ADH and ANP and stimulate aldosterone
High levels inhibit aldosterone and stimulate ADH and ANP |
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Term
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Definition
Major cation of ICF
Plasma – 3.5 to 5.0 mEq/L
Functions
Regulation of protein synthesis
Regulation of glucose use and storage
Action potentials in excitable membranes |
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Term
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Definition
Found in foods
Intake ~ 2 to 20 grams/day
Controlled by
Sodium-potassium pump
Kidney
Excreted by kidney |
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Term
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Definition
Divalent cation
2 forms bound and ionized (free)
Ionized (free) is the active form
Serum calcium – 9.0 to 10.5 mg/dL
Enters body by dietary intake (requires vitamin D to be absorbed)
Excreted by kidneys
Regulated by parathyroid hormone (PTH) and thyrocalcitonin (TCT) |
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Term
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Definition
Enhances activity of enzymes/reactions
Increases skeletal muscle contraction
Increases cardiac muscle contraction
Nerve impulse transmission
Assists blood clotting
Bone strength |
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Term
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Definition
Major intracellular anion
Most found in bones
Serum level 3.0 to 4.5 mg/dL
Found in nuts, legumes, dairy, red meats, bran, grains
Reciprocal relationship with calcium
Regulated by parathyroid hormone |
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Term
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Definition
Activating B-complex vitamins
Formation of ATP
Assisting in cell division
Carbohydrate, protein, and lipid metabolism
Acid/base buffering
Calcium homeostasis |
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Term
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Definition
Intracellular cation
Serum levels1.2 to 2.0 mg/dL
In many foods – nuts, vegetables, fish, grains
Regulated by parathyroid hormone |
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Term
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Definition
Skeletal muscle contraction
Carbohydrate metabolism
Activating ATP
Activating B-complex vitamins
DNA synthesis
Protein synthesis
Coagulation |
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Term
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Definition
Major anion ECF
Serum level 90 to 110 mEq/L
Most diets contain enough to meet needs |
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Term
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Definition
Low K level.
Minor changes in plasma potassium cause major changes in cell membrane excitability
Serum K+ below 3.5 mEq/L
Relatively common
Potentially life-threatening
’d ECF potassium makes a bigger difference between ECF and ICF potassium - ’s excitability of cell membranes |
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Term
| Hypokalemia - manifestations |
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Definition
Musculoskeletal
Skeletal muscles weak (grips)
deep tendon reflexes (DTRs)
Severe – flaccid paralysis
Respiratory
Muscle weakness shallow resps
Cardiovascular
Pulse thready and weak
Dysrhythmias
Orthostatic hypotension
Neurologic
Mental status changes
Sensory awareness
Gastrointestinal
peristalsis
Distention
Labs – serum K= <3.5 mEq/L
ECG – ST depression, flat or inverted T waves, U waves --- dysrhythmias |
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Term
| Hypokalemia - interventions |
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Definition
Potassium supplements
PO for slight or moderate
Tastes horrible
IV for severe –CAUTIONS!!!!!!
Too fast, too much === cardiac arrest
Irritating to veins/tissues
Potassium-sparing diuretics
Diet – increase potassium
Constipation – laxatives, fiber, liquids
Monitor respirations |
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Term
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Definition
5-10 mlEq/hour
risk of cardiac arrest. |
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Term
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Definition
excessive K
Serum potassium > 5.0 mEq/L
serum K+ potassium difference between ECF and ICF cell excitability
Rare in people with normal kidney function |
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Term
| Hyperkalemia - manifestations |
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Definition
Cardiovascular – bradycardia, hypotension
ECG – tall, peaked T waves, prolonged PR intervals, flat P waves, wide QRS, ectopic beats, heart block, ventricular fibrillation
Paresthesias, muscle twitching
Increased peristalsis
Labs = K+ > 5.0 mEq/L |
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Term
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Definition
T-WAVE changes
hyper = higher
hypo = lower |
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Term
| Hyperkalemia - interventions |
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Definition
Stop potassium administration – lo potassium diet
Potassium-excreting diuretics
Kayexalate
Insulin/glucose causes K+ to move into cells
Cardiac monitoring |
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Term
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Definition
Serum Na < 135 mEq/L
Sodium imbalances associated with fluid imbalances
sodium changes ECF/ICF concentration gradient – slower membrane response
Na hypotonic fluid moves to ICF cells swell
Causes = loss of sodium (burns, crush injuries) or dilution by excess water (hypotonic IV) |
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Term
| hyponatremia manifestations |
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Definition
Cerebral – behavioral from cerebral edema
Neuromuscular – muscle weakness and decreased DTRs
Gastrointestinal –increased motility
Cardiovascular – changes in (ECF) blood volume – weak pulses, flat neck veins, postural hypotension
Replace sodium carefully
If hypovolemia – replace fluids
If hypervolemia – osmotic diuretics
Diet – increase sodium intake and restrict fluids |
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Term
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Definition
Serum sodium > than 145 mEq/L
Changes ICF/ECF concentration gradient - ’d membrane excitability
’d osmolarity = water moves from cells to ECF |
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Term
| Hypernatremia - manifestations |
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Definition
Cerebral – short attention span, agitation, mania, seizures
But if fluid overload – lethargic, drowsy
Neuromuscular – twitching, progressive rigid paralysis
Cardiovascular – decreased contractility, pulse rate but thready, hypotension |
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Term
| Hypernatremia - interventions |
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Definition
Restore fluid balance – hypotonic fluids (0.225% or 0.45% sodium chloride)
Diuretics that promote sodium loss
Diet – adequate fluid intake, restrict sodium |
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Term
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Definition
Total serum calcium < 9.0 mg/dL
Calcium is a membrane stabilizer so low calcium allows more excitability
Can also weaken bone
Reduced absorption from GI tract, increased loss, decreased parathyroid function
History – diet history, recent thyroid surgery, head/neck radiation |
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Term
| Hypocalcemia - manifestations |
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Definition
Neuromuscular- paresthesias, muscle twitching, cramps, Trousseau’s and Chvostek’s signs
Cardiovascular – hypotension, ECG changes
GI – increased peristalsis |
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Term
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Definition
| A skin sensation, such as burning, prickling, itching, or tingling, with no apparent physical cause. |
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Term
| hypocalcemia interventions |
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Definition
Calcium supplements
Drugs that enhance absorption of calcium
High-calcium diet
Reduction of environmental stimuli
Seizure precautions
Fracture prevention |
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Term
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Definition
Total serum calcium > 10.5 mg/dL
Excitable tissues are less responsive to stimulation
Faster clotting times
Causes:
Increased absorption
Decreased excretion
Increased bone resorption |
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Term
| hypercalcemia manifestations |
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Definition
Cardiovascular – risk for dysrhythmias, risk for clot formation
Neuromuscular – severe muscle weakness, ’d DTRs
GI – decreased peristalsis, abdominal distention
Renal - ’d urine output (dehydration), kidney stones |
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Term
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Definition
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Term
| hypercalcemia interventions |
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Definition
Stop calcium administration
Volume replacement (Normal saline)
Diuretics that enhance calcium excretion
Chelators (bind to calcium)
Dialysis
Cardiac monitoring |
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Term
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Definition
Serum phosphorus less than 3.0 mg/dL
Most of effects related to decrease in energy metabolism and calcium/phosphorus reciprocal relationship
Causes: absorption, excretion, intracellular shift |
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Term
| Hypophosphatemia - manifestations |
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Definition
Symptoms are related to the decreased availability of high-energy ATP
Cardiovascular - cardiac output, slow, weak pulses
Musculoskeletal –weakness, respiratory failure, bone density, fractures
Central nervous system – when severe – irritability, seizure activity |
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Term
| hypophosphatemia interventions |
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Definition
Discontinue meds that cause hypophosphatemia
Oral replacement of phosphorus |
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Term
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Definition
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Term
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Definition
Serum magnesium < 1.2 mg/dL
Effects are increased sensitivity of excitable membranes and accompanying calcium and potassium imbalances
Caused by absorption of dietary magnesium or renal excretion |
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Term
| hypomagnesemia manifestations |
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Definition
Neuromuscular - release of acetylcholine at nerve synapses nerve impulse transmission
Hyperactive DTRs, tetany, + Trousseau, + Chvostek, seizures
Central nervous system – depression, psychosis, confusion
GI – decreased motility |
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