Water Characteristics
where metabolic reactions & cellular process occur
carries nutrients, waste products, enzymes, & blood cells
Facilitates movement of body parts
Intracellular fluid
inside the cells
Extracellular Fluid
fluid outside the cells
Interstitial fluid
between the cells (tissue)
intravascular fluid
inside the blood vessels
transcellular fluid
third space
which includes peritoneal, pleural & pericardial cavities
cerebrospinal fluid
fluid in the joint spaces, lymph system, eyes & gastrointestinal tract
osmosis
movement of water across a semi-permeable membrane
Tonicity
osmotic pressure of two solutions separated by a semipermeable membrane
Isotonic
equal solute concentrations causes no fluid shifts
Hypotonic
lower solute concentrations causing fluids to shift out
-cause fluid to shift from the intravascular out to the intracellular space
Hypertonic
Higher solute concentrations causing fluids to shift in
- cause fluid to shift from the intracellular into the intravascular space
Isotonic IV solution
0.9 % saline, lactated ringers
Hypotonic IV solution
0.45% saline
Hypertonic IV solutions
5% dextrose in 0.9% saline, 3% saline
What are a few ways to lose fluid
urine
feces
insensible losses (breathing/sweating)
What are 3 ways to have fluid excess
edema
Hypervolemia (fluid volume excess)
Water intoxication
Edema
excess fluid in the interstitial space (tissues)
Hypervolemia
(fluid volume excess)
excess fluid in the intravascular space
Water intoxication
excess fluid in the intracellular space
What are a few causes of Fluid Excess
Excessive sodium / water intake
Inadequate sodium / water elimination
What are some ways that excessive sodium / water intake can cause fluid excess
high-sodium diet
psychogenic polydipsia(excessive water ingestion, brain function)
hypertonic fluid administration
free water (no water to infants)
enteral feedings (tube feedings)
What are some ways that inadequate sodium / water elimination cause fluid excess
renal failure ( kidneys are unable to eliminate fluid or waste products)
What are some manifestations of Fluid Excess
Peripheral edema
Periorbital edema
Anasarca
Cerebral edema
Dyspnea
Bounding pulse
Tahcycardia
Jugular vein distension
HTN
Polyuria
Rapid weight gain
Bulging fontanelles (Baby)
Anasarca
swelling from Head to toe
What is the best way to monitor for Fluid excess
weight gain
What are 2 ways of having Fluid deficit
Dehyration
Hypovolemia (fluid volume defict)
Hypovolemia
decreased fluid in the intravascular space
What are 2 causes of Fluid Deficit
inadequate fluid intake
excessive fluid / sodium losses
What are some examples of fluid deficit from inadequate fluid intake
poor oral intake
inadequate IV fluid replacement
What are some examples of fluid deficit from excessive fluid / sodium losses
Gastrointestinal losses (v/d)
excessive diaphoresis
Prolonged Hyperventilation (fever & hyperventilation together)
Hemorrhage
Nephrosis
DM / Diabetes Insipidus (pee alot)
Burns
Open wounds
Ascites (3rd spaces)
Effusions
Excessive use of diuretics
Osmotic
What are some manifestations of fluid deficit
thirst
altered lOC
hypotension
tachycardia
weak & thready pulse
flat jugular veins
dry mucous membranes
decreased skin turgor
oliguria
weight loss
sunken fontanelles (babies)
Oliguria
not urinating
Electrolyte
are minerals with electrical charges that are found in the blood, urine, & other body fluides
What are some examples of electrolytes
sodium
chloride
potassium
calcium
magnesium
phosphorus
Cations
are positively charged Electrolytes
anions
negatively charged Electrolytes
Electroylytes play a role in
muscle & neural activity
acid-base & fluid balance
What is the normal range for Sodium
135 - 145 mEq/L
Sodium
most significant cation & prevalent electrolyte of extracellular fluid
controls serum osmolality & water balance
facilitates muscles & nerve impulses
plays a role in acid-base balance
Where do we get our main source of Sodium
dietary intake
What regulates Sodium
Kidney's
excreted through the kidneys and GI tract
Hypernatremia
excessive sodium levels
What is the range for hypernatremia
> 145 mEq/L
Most Know
Anywhere sodium goes, what follows
WATER
What are the 2 causes of Hypernatremia
Excessive Sodium
Deficient water
What are some causes of Hypernatremia from Excessive Sodium
excessive sodium ingestion
hypertonic IV saline (3% saline)
Corticosteroid use
What are some causes of Hypernatremia from deficient water
decreased water ingestion
loss of thirst sensation
inability to drink water
3rd spacing
vomiting/ diarrhea
excessive sweating
Prolonged episode of hyperventilation
diuretic use
Diabetes Insipidus
What are some manifestation of deficient water
increased temperature
warm & flushed skin
dry & sticky mucous membranes
weak & thready pulse
decreased urine output
DECREASED BP
What are some manifestations of excessive sodium
dysphagia
edma
INCREASED BP
What are some manifestations of hypernatremia (both excessive sodium & water deficit
increased thirst
weakness
headache
Acute glomerulonephritis and pyelonephritis may advance to
Intrarenal failure.
The nurse would expect to see which common pathogen on the urine culture and sensitivity (C & S) of a patient with a urinary tract infection?
E. Coli.
Anemia frequently found in persons with chronic renal failure can best be explained in terms of:
Failure of the kidneys to activate or produce erythropoietin
Which one of the following age groups is most susceptible to renal damage caused by medications?
Older adults.
End-stage renal disease is characterized by which of the following alterations?
Increased serum blood urea nitrogen.
Glomerulonephritis is most accurately described as representing
An inflammatory process involving the glomerular structures of the kidney
A person with acute pyelonephritis would most typically have:
Fever.
Stress incontinence is characterized by:
Involuntary loss of urine associated with activities such as coughing or squatting.
A patient presents to the emergency department with generalized edema and dyspnea. A history reveals multiple infections over the last six months. Diagnostic test reveals proteinuria, hyperlipidemia, hypoalbuminemia. The health care provider should realiz
Nephrotic syndrome.
Etiologic factors in the development of urolithiasis include:
Urinary stasis.
Hyponatremia
sodium < 135 mEq/L
serum osmolarity decreases
What are the 2 types of hyponatremia
Deficient sodium
Excessive Water
What are some causes of deficient sodium in reference to hyponatremia
diuretic use
Gastrointestinal losses
Excessive sweating
dietary sodium restrictions
What are some causes of excessive water in reference to hyponatremia
hypotnoic intravenous saline (0.45% saline)
hyperglycemia
excessive water ingestion
renal failure
heart failure
What are some manifestations of hyponatremia
blood pressure changes
pulse changes edema
muscle weakness
how does Na+ affect blood pressure in regards to hyponatremia
decreases BP
how does excessive water affect blood pressure in regards to hyponatremia
increases BP
How does Na+ affect the pulse in regards to hyponatremia
increases pulse
What is the normal range of chloride
98 - 108 mEq/L
What is the range for hyperchloremia
>108 mEq/L
What is the range for hypochloremia
<98 mEq/L
3.5 - 5 m mEq/l is the normal range for
Potassium
Potassium
plays a role in electrical conduction, acid-base balance
excreted through the kidney's & GI tract
Hyperkalemia
potassium >5 mEq/L
What are some causes of hyperkalemia
deficient excretion
Excessive intake
increased release from cells
What can cause deficient excretion (hyperkalemia)
renal failure
certain medications
What can cause excessive intake (hyperkalemia)
oral potassium supplements
salt substitues
rapid intravenous administration of diluted potassium
What can cause increased release from cells (hyperkalemia)
acidosis
blood transfusions
burns / any other cellular injuries
What are some manifestations of hyperkalemia
paresthesia
flaccid paralysis
bradycarida
dysrhythmias
electrocardiogram changes
Cardiac arrest
respiratory depression
abdominal cramping
n/d
What must you do before treating potassium
do a EKG
What are some treatments for Hyperkalemia
correct acidosis (Sodium bicarbonate)
decrease dietary K+ intake
dialysis
kayexalate
intravenous fluids
Potassium-losing diuretics
insulin
Hypokalemia range is
Potassium <3.5 mEq/L
What are some causes of Hypokalemia
excessive loss
deficient intake
increased shift into the cell
What can cause excessive loss of potassium
v/d
nasogastric suctioning
fistulas
laxatives
potassium-losing diuretics
cushing's syndrome
corticosteroids
What can cause deficient intake of potassium
malnutrition
extreme dieting
alcoholism
What can cause an increased shift of potassium into the cell
alkalosis
insulin excess
What are some manifestations of hypokalemia
muscle weakness
paresthesias
hyporeflexia
leg cramps
weak & irregular pulse
hypotension
dysryhthmias
electrocardiogram changes
DECREASED BOWEL SOUNDS
ABDOMINAL DISTENSION
CONSTIPATION
ILEUS & CARDIAC ARREST
Identigy & manage underlying cause along with potassium replacement (PO / IV) is the treatment for which potassium disorder
Hypokalemia
What is the normal range for Calcium
4 - 5 mEq/L
Hypercalcemia is considered
calcium > 5 mEq/L
Calcium <4 mEq/L
Hypocalcemia
What is the normal range for phosphorus
2.5 - 4.5 mg/dL
What is the range for Hyperhphosphatemia
phosphorus > 4.5 mg/dL
What is the range for hypophosphatemia
phosphorus < 2.5 mg/dL
What is the normal range for magnesium
1.8 - 2.5 mEq/L
What is the range for Hypermagnesemia
magnesium > 2.5 mEq/L
What is the normal range for hypomagnesemia
magnesium < 1.8 mEq/L
What is the normal serum of pH
7.35 - 7.45
What maintains pH (acid-base balance)
body fluids
kidney's
lungs
Subtle changes can cause serious effects
pH regulation
pH reflects hydrogen concentrations
Hydrogen is an acid or a base
acid
the more hydrogen the lower the pH
What are buffers
chemicals that combine with an acid or base to change the pH
Bicarbonate-Carbonic acid system
?????
What 2 elements move interchangeably in & out of cells to balance pH
potassium
hydrogen
Potassium imbalances can lead to
pH imbalances
look at both
pH imbalances can lead to
potassium imbalances
look at both
Resiratory regulation of pH
alters carbon dioxide excretion
What will speeding up respiration do
excrete more carbon dioxide
decreasing acidity
What will slowing down respiration do
excrete less carbon dioxide
increasing acidity
Renal regulation of pH
alters the excretion of retention of hydrogen or bicarbonate (alkaline)
How does the body compensate if the problem causing the pH imbalance originates in the lungs
the kidneys initiates efforts to correct it
How does the body compensate if the problem causing the pH imbalance originates outside the lungs
the lungs initiates efforts to correct
compensation
the body never overcompensates
Metabolic Acidosis
anything but the lungs is the problem
results from a deficiency of bicarbonate / an excess of hydrogen
What are some causes of metabolic acidosis
bicarbonate deficit
acid excess
Bicarbonate deficit
intestinal & renal losses
acid excess
tissue hypoxia resulting in lactic acid accumulation, ketoacidosis, drugs, toxins & renal retention
What are some manifestation of metabolic acidosis / metabolic alkalosis
appear as regulatory systems fail to maintain pH w/in normal range
occur in combination with manifestations of underlying conditison
Some general manifestations of metabolic acidosis might appear
headache
malaise
weakness
fatigue
letharygy
coma
warm & flushed skin
n/v
anorexia
hypotension
dysrhythmias,
shock
kussmaul's respirations
hyperkalemia
Metabolic Alkalosis
excess bicarbonate / deficient acid / both
excess bicarbonate
excessive antacid use
use of bicarbonate containing fluids hypcholoremia
constipation
deficient acid
gastrointestinal loss
hypokalemia
renal loss
hypovolemia
hyperaldsteronism
Some general manifestations of metabolic alkalosis might appear
mental confusion
hyperactive reflexes
paresthesia
tetany
seizures
respiratory depression
dysrythmias
coma
Respiratory Acidosis
carbon dioxide retention
which increases carbonic acid
What is respiratory acidosis caused by
hypoventilation
decreased gas exchange
What can cause hypoventilation or decreased gas exchange
acute asthma exacerbations
COPD
airway obstructions
pulmonary edema
pneumonia
drug overdose
respiratory failure
CNS depression
What are some possible manifestations of respiratory acidosis
headach
blurred vision
tremors
muscle twitching
vertigo
irritablitly
disorientation
lethargy
coma
tachycardia leading to bradycardia
bp fluctuations
diaphoresis
Respiratory Alkalosis
excess exhalation of carbon dioxide
which leads to carbonic acid deficits
What can cause respiratory alkalosis
hyperventilation
What are some issues that can cause hyperventilation
acute anxiety
pain
fever
hypoxia
gram-negative septicemia
aspirin overdoes
excessive mechanical ventilation
hypermetabolic states
pH
serum hydrogen concentration
indicates acid-base status
PaCo22
partial pressure of carbon dioxide
indicates the adequacy of pulmonary ventilation
CO2
HCO3
bicarbonate (base)
indicates the activity in the kidneys to retain or excrete bicarbonate
If the pH is > 7.4 it is
B for basic
Make note if it is when normal range
If the pH is < 7.4 it it
A for acidic
Make note if it is when normal range
If the PaCo2 is > 45 mm Hg
A for acidic
Make note if it is when normal range
If the PaCO2 is < 35 mm Hg
B for basic
Make note if it is when normal range
If the HCO3 is > 26 mEq/L
B for basic
Make note if it is when normal range
If the HCO3 is < 22 mEq/L
A for acidic
Make note if it is when normal range
2 A's = acidosis
if one is the following
CO2(PaCO2) =respiratory disorder
HCO3 = metabollic disorder
2 B's = alkalosis (basic)
if one is the following
CO2(PaCO2) =respiratory disorder
HCO3 = metabollic disorder
3 A's or B's = mixed disorder
mixed respiratory & metabolic acidosis
If the unpaired results is within normal range
uncompensated
each of the 3 results is either an A or a B
The unpaired result is the opposite letter of the pairs but the pH is still normal
partially compensated
The unpaired result is the opposite letter and the pH has returned to normal range
fully compensated
The main source of serum bicarbonate is obtained from:
The kidneys.
While performing an admission assessment on a patient with the diagnosis of bone cancer, you determine that your patient has a history of Paget's disease. The patient's family informs you that the patient has had some recent muscle weakness and personalit
Hypercalcemia.
The major physiologic stimulus for thirst is:
Hypovolemia.
Which of the following would be appropriate treatments for the patient with respiratory alkalosis:
Breath into a paper bag.
The health care provider orders an infusion of a hypertonic solution. The nurse knows an appropriate intravenous solution to administer would be:
5% dextrose lactate ringers (D5LR).
The body compensates for metabolic alkalosis by:
Hypoventilation.
Which of the following serum electrolyte values is abnormal?
Calcium 15.0 mEq/L
Which of the following signs would indicate a fluid deficit?
Tachycardia, acute loss of body weight, weakness, and dry mucous membranes
While assessing a patient with heart failure and renal impairment, the nurse notices 3+ pitting edema in his feet, a bounding pulse, and severe shortness of breath. This patient probably experiencing which of the following:
Fluid volume excess.
What does the urinary system regulate
Fluid volume
BP
Metabolic waste & drug excretion
Vitamin D conversion
Acid-base Balance
Hormone Synthesis
What is the normal range for pH
7.35 - 7.45
What is the normal range for PaCo2
35-45
What is the normal range for HCo3
22-26
Urination is
a voluntary activity
What is the normal urine output
1,500 mL
Each kidney contains between 1 - 2 mil of these
nephrons
responsible for filtering specific substances
Bowman's capsule
double membrane that surrounds the glomerulus
What is the glomerulus
cluster of capillaries
GFR
Glomerular filtration rate
(rate of blood flow through the glomerulus)
What is the best indicator of renal function
GFR
What is the normal GFR
125 mL/min
What is the treatment for Chronic Renal Failure
manage & prevent complications & alternative medication dosing
What are the major manifestations of Chronic renal failure
HTN
anemia
electrolyte imbalances
sudden weight change
Azotemia
Azotemia
a build up of waste products
-Presence of increased amounts of nitrogenous waste products, esp. urea, in the blood
What are the 3 stages of chronic renal failure
renal impairment
renal insufficiency
end-stage renal disease
In which stage do waste products begin to accumulate
renal insufficiency
75% of nephrons are lost and GFR reduces by 20%
In which stages is there 90% of nephron destruction & a GFR drops to 10 mL/min
end-stage renal disease
What are the main causes of chronic renal failure
Gradual loss of renal function that is irreversible
diabetes mellitus
HTN
Renal diseases
What are treatments for acute renal failure
correct fluid & electrolyte imbalances
dialysis
a diet high in calories & restricted in protein sodium potassium & phosphates
HTN mgmt
anemia treatment with synthetic erythropoietin
infection prevention strategies
What are the manifestations of the recovery phase
symptoms begin to resolve
increased urine output, electrolyte distrubances, dehydration, & hypotension are manifestations of which phase of acute renal failure
diuretic phase
What are the manifestations of the oliguric phase of acute renal failure
decreasing urine output
electrolyte distrubances
fluid volume excess
azotemia
metabolic acidosis
What are 3 phases of acute renal failure
oliguric phase
diuretic phase
recovery phase
Oliguric phase
daily urine output decreases to approximately 400 mL or less & waste products accumulaate
diuretic phase
daily urine output increases to as much as 5 L
recovery phase
glomerular function gradually returns to normal
Prerenal conditions, intrarenal conditions, postrenal conditions are causes for
acute renal failure
prerenal conditions
extremely low blood pressure / blood volume
Heart dysfunction