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minimal knowledge 7

by: Lydia

minimal knowledge 7 HSC 201

GPA 4.0
Pathophysiology 1
Heather Mautino

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Minimal Knowledge 7 Lecture: Fluids, Electrolytes, and Acid-Base Balance
Pathophysiology 1
Heather Mautino
Class Notes
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This 29 page Class Notes was uploaded by Lydia on Wednesday September 30, 2015. The Class Notes belongs to HSC 201 at Illinois State University taught by Heather Mautino in Fall 2015. Since its upload, it has received 12 views. For similar materials see Pathophysiology 1 in Nursing and Health Sciences at Illinois State University.

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Date Created: 09/30/15
Fall 2015 Minimal Knowledge Lecture Fluids Electrolytes and AcidBase Balance 1 Fluid Volume Intravenous therapy complications of IV therapy Arterial Line for fluid volume imbalances 2 Electrolyte Are chemical that dissolve in water amp dissociate into their and ions They consist of potassium sodium calcium which are the most common The help regulate osmolarity of the body fluid helps with the concentration of fluids 3 Acidbase Balance 0 Buffer system prevents drastic changes in pH 0 pH maintained by buffer system using body fluids respiratory system most responsive and renal system 4 Intracellular vs Extracellular Fluid amp examples of each fluid 0 6075 of your body weight is fluids Intracellular ICF with in your cells 23 fluid volume within cells Extracellular ECFoutside your cells 13 fluid volume Blood plasma lymph tissue fluid Specialized fluids CSF Cerebral Spinal Fluid synovial aqueous humor serous fluid like digestion excretions Fluids move between compartments Total body fluids ICF ECF Example 200 lb person Fluids 60 75 of your body weight 23 ICF 80 100 pounds 13 ECF 40 50 pounds Nonfluids 25 40 50 80 pounds 5 Intake amp Output IampO Total Intake qd 2500 ml a Ingestion 1600 ml b Food 700 ml c Metabolic water 200 ml Total Output qd 2500 ml d Urine 1500 ml e Sweat 500 ml f Exhalation 300 ml g Feces 200 ml Recorded by nursing staff on graphic flow chart Commonly Monitored every 8 hours Totaled every 24 hours 24 hour period determined by PP Policies amp Procedures 6 Ingestion is the consumption of a substance by an organism a Ingestion 1600 ml 7 Metabolic water Water created inside an organism through metabolism a Metabolic water 200 ml 8 Urine Liquid waste produced by the kidneys a Urine 1500 ml 9 Sweat Transparent colorless acidic fluid with a peculiar odor that is secreted from the skin by the sweat glands It contains some fatty acids and mineral matter a Sweat 500 ml 10 Exhalation An amount of vapor or fumes given off a Exhalation 300 ml 11 Feces Waste matter discharged from the bowels after food has been digested a Feces 200 ml 12 Liter vs ml Liter vs Pounds Kilogram vs Pounds 1 Liter 1000 ml 1 Liter 22 pounds 22 pounds 1 Kilogram 13 Osmolarity Concentration of dissolved materials present in fluid 14 Dehydrationhypovoemia Increase in osmolarity more dissolved in fluid higher concentration less fluid in the body 15 Fluid Overload hypervolemia Decrease in osmolarity less dissolved in fluid lower concentration more fluid in the body 16 HH amp its relationship to Dehydration amp Fluid Overload Hypervolemia May be documented as 1 Fluid Overload 2 Fluid Retention 3 Hypervolemia 4 Transfusion Associated Circulatory Overload TACO Etiology some causes of hypervolemia 1 Renal not having enough output Renal Insufficiency Renal Failure 2 Extrarenal Congestive Heart failure Pulmonary edema Cirrhosis Blood transfusion SSx 1 Weight gain 2 Edema Localized edema Peripheral Feet ankles hands Periorbital Ascites Pulmonary Edema Pulmonary congestion cough rales Anasarca 3 L Hct hematocrit L Hgb hemoglobin dilution 4 L Urine specific gravity dilution Dx Testing 1 CXR 2 CBC 3 UA Rx 1 Diuretics 2 Restrict fluid intake IV po Note less in than out 17 Fluid Retention Water retention also known as fluid retention refers to an excessive build up of fluid in the circulatory system body tissues or cavities in the body 18 Renal Insufficiency Defective function of the kidneys with accumulation of waste products particularly nitrogenous in the blood 19 Renal Failure Kidneys suddenly become unable to filter waste products from your blood When your kidneys lose their filtering ability dangerous levels of wastes may accumulate and your blood39s chemical makeup may get out of balance 20 Congestive Heart Failure CHF A weakness of the heart that leads to a buildup of fluid in the lungs and surrounding body tissues 21 Pulmonary Edema Condition caused by excess fluid in the lungs This fluid collects in the numerous air sacs in the lungs making it difficult to breathe 22 Cirrhosis A chronic disease of the liver marked by degeneration of cells inflammation and fibrous thickening of tissue It is typically a result of alcoholism or hepatitis 23 Blood transfusion The transfer of blood or blood components from one person the donor into the bloodstream of another person the recipient Blood transfusion may be done as a lifesaving maneuverto replace blood cells or blood products lost through bleeding or due to depression of the bone marrow 24 Edema A condition characterized by an excess of watery fluid collecting in the cavities or tissues ofthe body 25 Peripheral Edema Most commonly occurs in the feet and legs where it is referred to as peripheral edema The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues 26 Periorbital Ede ma Also known as quotpuffy eyesquot or swelling around the eyes refers to the appearance of swelling in the tissues around the eyes called the orbits It is almost exclusively caused by fluid buildup around the eyes 27 Pulmonary Congestion An excessive accumulation of fluid in the lungs usually associated with either an inflammation or congestive heart failure 28 Ascites The accumulation of fluid in the peritoneal cavity causing abdominal swelling 29 Ana sa rca Medical condition characterized by widespread swelling of the skin due to effusion of fluid into the extracellular space 30 Urine specific gravity 6 is a measure of the concentration of solutes in the urine It measures the ratio of urine density compared with water density and provides information on the kidney39s ability to concentrate urine A urinary specific gravity measurement is a routine part of urinalysis 31 CXR Chest xray 32 CBC Complete Blood Count 33 UA or UA Urinalysis 34 Diuretic chiefly of drugs causing increased passing of urine 35 Fluid restriction The limitation of oral fluid intake to a prescribed amount for each 24hour period This therapeutic measure is indicated in patients who have edema associated with kidney disease such as nephrosis and glomerulonephritis or La nnec39s cirrhosis and also in certain patients with pulmonary edema 36 IV How much fluid they give you intravenously 37 poquot How much fluid they give you by mouth 38 Fluid deficit Also called hypovolemia is excessive loss of water and electrolytes in equal proportion vascular cellular or intracellular dehydration 39 Volume depletion Is a reduction in extracellular fluid volume that occurs when salt and fluid losses exceed intake on a sustained basis 40 Hypovolemia A decreased volume of circulating blood in the body May be documented as 1 Dehydration more fluid is being removed than being replaced 2 Fluid deficit 3 Volume depletion volume depleted your fluid number has decreased 4 Hypovolemia Etiology Diuretics Diaphoresis Fever Vomiting Diarrhea Severe burns Hemorrhage Inadequate fluid replacement Diabetes Insipidus Sx Dry mucous membranes Sunken soft eyes L skin turgor Rapid thready pulse L BP possibly Orthostatic Hypotension T Hct T Hgb concentration T Urine specific gravity concentration Rx Fluid replacement IV po 41 Hemorrhage An escape of blood from a ruptured blood vessel especially when profuse 42 Diabetes Insipid us Is an uncommon disorder characterized by intense thirst despite the drinking of fluids polydipsia and the excretion of large amounts of urine polyuria 43 Mucous membranes They become dry 44 Skin turgor o Skin39s going to be kind of flaky and dry 0 Is a sign used by health care workers to assess fluid loss or dehydration Fluid loss can occur from common conditions such as diarrhea or vomiting Infants and young children with vomiting diarrhea and decreased or no fluid intake can rapidly lose a significant amount of fluid 45 Orthostatic Hypotension Is a form of low blood pressure that happens when you stand up from sitting or lying down Orthostatic hypotension can make you feel dizzy or lightheaded and maybe even faint 46 Fluid Replace ment Is the medical practice of replenishing bodily fluid lost through sweating bleeding fluid shifts or other pathologic processes IV Therapy AKA IV Replacement Therapy includes both fluids amp elytes Used for 1 Hypovolemias m 2 to support of normal fluid balance in NPO or fluid restricted patients All types of IV Therapy has to be ordered by physician The tests that you do before the lab and the UA that s going to determine what type of IV Therapy is ordered because if you don t have a lot of electrolytes or need them replaced that s what39s going to determine what therapy is ordered Depends on what you need to replenish 47 NPO Nothing by Mouth 48 Hyperalimentation hyperal o Vitamins and nutrients with the IV fluid 0 Artificial supply of nutrients typically intravenously 49 TPN Total Parenteral Nutrition Fluids sugars proteins fats electrolytes and all the nutrients you would need 50 Peripheral Situated away from the center as opposed to centrally located 51 Peripheral Venous Line few days therapy a Common Hand forearm antecubital scalp in infants b Rare footankle 52 Arterial Line Is NOT an IV site note used for any fluid infusion amp replacement 53 Central Venous Line long term therapyweeks months a Subclavian b Internal jugular 54 Antecubital area pertaining to the surface ofthe arm in front of the elbow CEPHALIC VEIN 1 quotUsquot 4m BASILIC VEIN l 151 39 l s 1319 MEDIAN CUBITAL 2quot 45min VEIN I 139 I Intermediate median antebrachialvein CEPHALIC 39 v u l 39 I My BASILIC VEIN VEIN 55 Subclavian Vein A continuation of the axillary vein and runs from the outer border of the first rib to the medial border of anterior scalene muscle From here it joins with the internal jugular vein to form the brachiocephalic vein also known as quotinnominate veinquot Terminates in Superior Vena Cava or Right Atrium Purpose Longterm IV therapy Specific medications Poor peripheral veins Heart pressure monitoring without fluid administration 56 Internal Jugular Vein A major blood vessel that drains blood from important body organs and parts such as the brain face and neck Anatomically there are two of these veins that lie along each side of the neck Terminates in Superior Vena Cava or Right Atrium Purpose Longterm IV therapy Specific medications Poor peripheral veins Heart pressure monitoring without fluid administration 57 Various IV solutions know all words for abbreviations 1 5 DextroseWater 0 500 DW o D5W 2 5 Dextrose Normal Saline o 5D095 0 50oDNS o D509 o D5NS 3 5 Dextrose Lactated Ringers o 5 DLR 4 Lactated Ringer s Solution LR 5 Normal Saline NS 0 09 saline 6 12 Strength Saline o 045 saline 0 Usually with 5D 7 3 Saline 8 10 amp 20 Dextrose 58 Butterfly vs Intra cathAngiocath vs PICC Line Winged Needle infusion set a AKA butterfly needle b Purpose in small fragile veins c Use Shortterm IV therapy IV push drugs Overtheneedle Catheter d AKA Intracath Angiocath e Purpose Long term therapy f Use Longterm therapy for active patients PICC Line g Peripherally Inserted Central Catheter h Commonly used for long term therapy 59 Difference between peripheral and central venous lines 0 Peripheral venous lines are only used for a few day The most common would be hand forearm actecubital scalp for infant rare footankle 0 Central venous line are used for long term therapyweeks months The common would be suclavian and internal jugular 60 Phlebitis Inflammation of the walls of a vein a may develop Cellulitis with Phlebitis o swelling redness pain around the IV site skin infection b Factors 0 Drugsolution 0 pH high low o Osmolarity high 0 Length of time how long the IV been in 0 Remove IV 0 Warm compresses 0 Switch locations more IV to the other arm 0 Sometimes it takes time to heal May occur with central venous line 61 Cellulitis Inflammation of subcutaneous connective tissue 62 Infiltration amp Extravasation a Def leaking of fluid ampor meds into tissue Infiltration then tissue damage Extravasation 0 Highly acidic or alkalinic osmolarity 0 Possibly necrosis 0 Remove IV STAT 0 Possible warm compresses 0 Depending in drug 0 Possible reversal agents in specific cases 0 Possible skin grafts 63 Necrosis Death of the tissue and its eating your tissue from the inside out the death of most or all of the cells in an organ or tissue due to disease injury or failure of the blood supply 64 STAT Immediately 65 Reversal agents My give you a drug to stop effect or my need skin grafts 66 Catheter dislodge ment Movement of the catheter into and out of the insertion site Causes of catheter dislodgement include inappropriate securement of the catheter and motion of the extremity neck or shoulder Catheter dislodgement may cause occlusion of the catheter and lead to a change in the catheter tip location Signs and symptoms of catheter dislodgement include changes in the external length of the catheter clinical signs of local catheter infection and inability to flush or infuse via the catheter Rx remove IV to another spot Can occur with central venous lines 67 Occlusion Flow interrupted Rx remove IV Can occur with central venous lines 68 Hemato ma A semisolid mass of blood in the tissues caused by injury disease or a clotting disorder At andor near insertion site may have a bruise or clot at that site Rx remove IV warm compresses Can occur with central venous lines 69 Thrombosis The formation or presence of one or more blood clots that may partially or completely block an artery or vein At andor near insertion site may have a bruise or clot at that site Rx remove IV warm compresses Can occur with central venous lines Sluggish IV flow Infusion of irritating solutions Repeated or longterm use of same vein 70 Phlebitis Inflammation of the walls of a vein Can occur with central venous lines 71 Thrombophlebitis a Inflammation of the vein could cause injury to that location from the IV 0 Rx Remove IV warm compresses Can occur with central venous lines 72 Air embolism Is when an air bubble or air bubbles enter a vein or artery and block it These air bubbles can travel to your brain heart or lungs and cause a heart attack stroke or respiratory failure Intake of air during insertion or tubing change 0 When air gets in the vein and can travel 0 Rx Xray amp treat 0 Medical emergency Can occur with central venous lines 73 Severed catheter A piece of the catheter has broken off and that piece can travel Rx Xray amp retrieval Medical emergency Can occur with central venous lines 74 Single vs Double vs MultipleLumen catheters Central Venous Lines using this avoids frequent IV starts especially for Chemo therapy patients Short term Single lumen catheters Double lumen catheters Multilumen catheters Longterm Groshong catheter Hickman catheter Broviac catheter PICC Peripherally inserted central catheter 75 Pneumothorax Lung punctured Dx CXR Rx Thoracentesis 76 Thoracentesis A surgical procedure in which a needle is inserted through the chest wall in order to withdraw fluid blood or air 77 Hemothorax a Large blood vessel puncture with bleeding inside ampor outside of lung b Dx CXR c Rx Thoracentesis 78 Hydrothorax a Infusion infiltrates into lung b Dx CXR c Rx Thoracentesis 79 Hemopneumothorax A medical term describing the combination of two conditions pneumothorax or air in the chest cavity and hemothorax also called haemothorax or blood in the chest cavity A hemothorax pneumothorax or both can occur if the chest wall is punctured 80 Arterial Line A thin catheter inserted into an artery It is most commonly used in intensive care medicine and anesthesia to monitorthe blood pressure realtime rather than by intermittent measurement and to obtain samples for arterial blood gas measurements 81 Art line A line Arterial Line 82 Radial Artery rarely femoral A major artery in the human forearm It is close to the surface of the underside of the forearm when the palm of the hand is pointing upwards so is the radial artery The radial artery supplies the arm and hand with oxygenated blood from the lungs Purpose Monitor BP Obtain ABGs Not for IV fluid administration 83 Hemorrhage vs bleeding Hemorrhage a large uncontrolled loss of something valuable the loss of blood from a ruptured blood vessel either internally or externally o Bleeding loss of blood from the body as a result of illness or injury 0 From catheter dislodgment 84 Arterial Spasm Stops flow 85 Blood Backfiow in Aline or IV 0 Could cause death quickly and it39s not used very often 0 Blood leaks back into the chambers ratherthan flowing fonNard through the heart or into an artery In the United States backflow most often is due to prolapse quotProlapsequot is when the flaps of the valve flop or bulge back into an upper heart chamber during a heartbeat Prolapse mainly affects the mitral valve 86 Cation vs Anion o Cations positive o Anions negative 87 K Potassium 88 Hypo ka lemia Serum K below normal Etiology 200 mEq body store loss Normal dietary intake 50 100 mEq Diuretic therapy V Diarrhea Starvation Liver amp renal diseases Alkalosis T secretion of K by distal tubule Etiologic factors Fatigue confusion Cardiac arrhythmias Possible cardiac arrest K level lt35 mEq Below normalquot Poss EKG changes Cardiac arrhythmias po ampor IV KCL Rx 40 100 mEq qd Prevention po 20 mEq qd Identify etiologic factors Monitor K level 89 Diuretic Therapy Taking a water pill 90 Alkalosis T secretion of K by distal tubule 91 Cardiac arrest Major symptom of low potassium 92 IV KCL Intravenous potassium chloride 93 Prevention vs Treatment 0 Prevention the action of stopping something from happening or arising 0 Treatment the management and care of a patient 94 Hyperkalemia 0 Serum K above normal not excreting enough K Etiology 0 Renal failure 0 Rx of hypokalemia o Acidosis o K moves to extracellular space 0 Addison s Disease deficiency of adrenocortical hormones o Weakness N V 0 Cardiac arrhythmias o Poss cardiac arrest 0 Serum K level gt55 mEq o If K gt65 0 Cardiac monitoring 0 IV soln Glucose Insulin Na Bicarb a Temporarily forces K into cells 0 Kayexalate prescription for potassium o po or enema x30quot 0 Exchanges Na for K at bowel cell wall amp is excreted via colon 0 Monitor K level 95 Acidosis K moves to extracellular space too much 96 Na Bicarb Antacid Temporarily forces K into cells 97 Na Sodium 98 Hyponatremia Serum Na levels below the lab normal hypotonic is another word for it Causes a Na deficit b Extracellular volume excess 0 Hypervolemia Note dilution of normal Na by excessive fluid Etiology Diaphoresis V amp diarrhea Adrenal insufficiency Use of diuretic drugs with a low salt diet Excessive fluid intake Possibly iatrogenic Impaired nerve conduction Tachycardia L BP Vertigo confusion weakness Severe coma seizures confusion shock L Serum Na levels PE symptomatology Monitor Serum Na 3 saline if lt12 hrs IV saline if gt12 hrs 99 Hypotonic Another word for Hypeonatremia 100 Hypervolemia amp Hyponatremia Extra sodium in the extra cellular fluid too much fluid you have a low dilution to your cellular volume dilution of normal Na by excessive fluid Serum Na below lab normal 101 Iatrogenic Excessive fluid intake 102 Vertigo Dizziness 103 Coma Severe symptoms could lead to hyponatremia 104 Shock Severe symptoms could lead to hyponatremia 105 Sympto matology The set of symptoms characteristic of a medical condition or exhibited by a patient 106 Hypertonic Saline A saline solution that contains 1 to 234 sodium chloride compared with normal saline solution at 09 Hypernatremia excess water loss higher concentration loosing water 107 Watery diarrhea Stools that are liquid or watery are always abnormal and considered diarrheal 108 Diabetes Insipid us A rare form of diabetes caused by a deficiency of the pituitary hormone vasopressin which regulates kidney function 109 SIADH Syndrome of Inappropriate Antidieretic Hormone 110 Na restriction referring to intake Cut salt restrictions and watch how much salt you39re ingesting 111 Ca Calcium 1 12 Hypoca Ice mia 0 Not enough calcium Etiology a Hypoparathyroidism b L CA intake Vit D deficiency Sx c Neuromuscular irritability leading to Tetany o Carpopedal spasm o Laryngospasm d Anxiety depression e Cardiac arrhythmias Dx f Serum CA level L normal Rx g Treat the cause 113 Hypoparathyroidism Diminished concentration of parathyroid hormone in the blood which causes deficiencies of calcium and phosphorus compounds in the blood and results in muscular spasms 114 Vitamin D deficiency 0 Low blood calcium hypocalcemia low blood phosphate hypophosphatemia rickets softening of the bones during childhood and osteomalacia softening ofthe bones in adults 0 Is defined as a lower than normal vitamin D level that has no visible signs or symptoms 115 Neuromuscular irritability Your nerves and muscles which are directly related to blood calcium levels may spasm or twitch If your blood test results indicate hypocalcemia you may notice muscle cramps in your legs or your arms 116 Teta ny 0 Continuous tonic SPASM of a muscle steady contraction of a muscle without distinct twitching o It is due to abnormal CALCIUM metabolism and occurs with hypofunction of the PARATlIYROID GLANDS VITAMIN D deficiency and ALKALOSIS and also as a result of ingestion of alkaline salts 117 Carpopedal spasm A spasmodic contraction of the muscles of the hands and feet or especially of the wrists and ankles in disorders such as alkalosis and tetany 118 La ryngospasm A brief spasm of the vocal cords that temporarily makes it difficult to speak or breathe The onset of vocal cord spasms is usually sudden and the breathing difficulty can be alarming 119 Hypercalcemia Etiology a Hyperparathyroidism b Malignant bone tumors c Milk Alkali syndrome would come from taking a supplement to prevent osteoporosis o Vit D excess withT Ca absorptionso you have too much calcium in your system as well as vitamin D Sx d Muscle weakness e Bone fragility f Possible kidney stones Dx g Serum CA level T normal Rx h Treat the cause i Give Phosphates to bind to Ca 120 Hyperparathyroidism An abnormally high concentration of parathyroid hormone in the blood resulting in weakening of the bones through loss of calcium 121 Malignant bone tumors Are much less common than benign tumors They are also much more dangerous The term quotmalignantquot indicates that there is moderate to high probability that the tumor will spread beyond the site where it initially develops These tumor cells can travel through the blood stream or through lymph vessels The most common site where malignant bone tumors spread is the lungs There are approximately 5000 to 6000 new malignant bone tumors each year in the United States 122 Renal Calculi Another term for kidney stone 123 Normal arterial blood pH 735745 intracellular fluid is 6870 124 ArterialAcidosis pH below 735 commonly above normal levels of C02 125 Arterial Alkalosis pH above 745 commonly below normal levels of C02 126 Metabolic Acidosis o A condition that occurs when the body produces excessive quantities of acid or when the kidneys are not removing enough acid from the body 0 Excess amount of metabolite acid in system which could lead to diabetic acidosis or kidney disease Metabolic Acidosis Condition hietahnlic Acidosis h Ietabelic Alkalesis Res pirate Acidosis Res Jil t l zi Alkalesis Causes Diabetic Ketcsis Kidney disease 1Ieds Gastric suction Bicarh nreringestinn Jr Resp ratefefficiency Respiratory diseases pneumonia obesity T Respirator rate anxiety high a ltitnde 127 Respiratory Acidosis Compensation T Respirations to exhale CO Jr Respiratiens to retain CD Kidneys excrete H inns reabsnrb Na H1303 inns Kidneys retain H ions 839 excrete Na 839 HCU3 inns Too much C02 decreased respirator rate A condition that occurs when the lungs cannot remove all of the carbon dioxide the body produces This causes body fluids especially the blood to become too acidic 128 Rebreather bag Retains C02 A flexible bag attached to a mask It may function as a reservoir for anesthetic gases during surgery or for oxygen during resuscitation


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