Electrolyte Two

8/3/2019 Electrolyte Two

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(def)

fluid found within the body cells


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intracellular fluid


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How does being dehydrated affect blood pressure and pul

pressure?


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-Systolic blood pressure decreases

-Diastolic blood presssure increases or stays the same

-Pulse pressure narrows and is severe


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(def)

fluid that surrounds the cells


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interstitial fluid


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How does overhydration affect blood pressure and pulse pres


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-Systolic Blood pressure increases (late sign)

-Diastolic blood pressure decreases

-Pulse pressure widens


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(def)

plasma; the fluid portion of blood


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intravascular fluid


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How does heart rate (pulse) change due to dehydration?


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It Increases.


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(def)

atoms or group of atoms that carry a positive or negative cha

electrolytes


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ions


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How does heart rate (pulse) change due to overhydration


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It decreases.


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(def)

fluid loss that is not perceptible to the individual


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insensible fluid loss


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How does pulse amplitude affected by dehydration?


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It decrease to a +1


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(def)

fluid found outside the body cells


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extracellular fluid


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How does pulse amplitude affected by overhydration?


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It increases to a +3


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(def)

chemical substances that develop an electric charge and are ab

conduct an electric current when placed in water; ions


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electrolytes


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How is the respiration rate affected by dehydration?


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It increases.


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(def)

the presence of excess interstitial fluid in the body


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edema


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How is the respiration rate affected by overhydration?


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It stays the same and a late sign is it increases.


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(def)

the mixing of molecules or ions of two or more substances as a

of random motion


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diffusion


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How are the neck veins affected by dehydration?


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They are flat.


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(def)

movement of substances across cell membranes against th

concentration gradient


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active transport


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How are the neck veins affected by overhydration?


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They are distended.


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(def)

substances dissolved in a liquid


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solutes


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How does dehydration affect the eyes?


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The eyes have a soft appearance and are sunken.


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(def)

the liquid in which a solute is dissolved


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solvent


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How does overhydration affect the eyes?


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There is periorbital edema.


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(def)

a membrane that prevents the passage of some substances but

the passage of others based on differences in the size, charge

lipid-solubility of the substance


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semipermeable membrane


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How does dehydration affect breath sounds?


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They are clear.


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(def)

pressure exerted by the number of nondiffusible particles in

solution


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osmotic pressure


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How does overhydration affect the breath sounds?


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They can be clear or have adventitious wet sounds.


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(def)

the concentration of solutes in body fluids


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osmolality


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How are the mucus membranes affected by dehydration?


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They are dry.


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(def)

the pressure in a compartment that results in the movement of

and substances dissolved in fluid out of the compartment


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filtration pressure


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How are the mucus membranes affected by overhydration


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They are wet.


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(def)

the pressure a liquid exerts on the sides of the container that ho

also called filtration force


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hydrostatic pressure


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How is the skin affected by dehydration?


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It is dry.


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(def)

a pulling force exerted by colloids that help maintain the wa

content of blood


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colloid osmotic pressure (also known as oncotic pressure


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How is the skin affected by overhydration?


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It is moist or can be taut and shiny.


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(def)

a hormone that decreases the production of urine by increasin

reabsorption of water by renal tubules


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antidiuretic hormone (ADH)


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How does dehydration affect skin temperature?


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It is warm or hot to the touch.


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(def)

an abnormal reduction in blood volume


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hypovolemia


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How does overhydration affect skin temperature?


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It is cool to the touch.


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(def)

insufficient fluid in the body


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dehydration


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What happens to skin turgor in a state of dehydration?


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It is sluggish or tenting.


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(def)

passage of a solvent through a semipermeable membrane fro

area of lesser solute concentration to one of greater solute

concentration


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osmosis


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What happens to skin turgor in a state of overhydration?


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It is supple.


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(def)

a neuron in the hypothalamus that is sensitive to the relativ

fluid/solute concentration in the blood plasma and that regulat

secretion of ADH


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osmoreceptor


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How does capillary refill change during dehydration?


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It is decreased and slower.


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hypernatremia


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How does capillary refill change during overhydration?


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It is good < 3 seconds.


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(def)

deficiency of sodium in the blood plasma


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hyponatremia


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How are the muscles affected by dehydration?


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There is muscle weakness present.


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(def)

the predominant intracellular cation; helps to regulate neuromu

excitability and muscle contraction


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potassium


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How are the muscles affect by overhydration?


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Muscle cramping.


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(def)

a mineralocorticoid steroid hormone produced by the adrenal c

with action in the renal tubule to retain sodium, conserve wat

reabsorption, and increase urinary excretion of potassium


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aldosterone


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How is the body affected neurologically by marked and sev

dehydration?


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Marked- drowsy, lightheaded, and lethargic

Severe- restlessness, irritability, and seizures


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(def)

a renal proteolytic enzyme, produced by and stored in the

juxtaglomerular apparatus; affects the blood pressure by catal

the change of angiotensinogen to angiotension I, which is th

converted to angiotensin II


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renin


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How is the body affected neurologically by early and progres

overhydration?


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Early- Headache, nausea and vomiting

Progressive- irritability and confusion


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(def)

a polypeptide in the blood that causes vasoconstriction, incre

BP, and the release of aldosterone from the adrenal corte


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angiotensin


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How does thirst change during dehydration?


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It increases.


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Approximately what % of the average healthy adult's weigh

water?


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60%


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How does thirst change during overhydration?


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It decreases.


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How is weight affected by dehydration?


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It decreases.


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Water is vital to health and normal cellular function, serving a

7 things?

- a medium for metabolic reactions within cells


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- a transporter for nutrients, waste products, and other substa- a lubricant

- an insulator and shock absorber

- one means of regulating and maintaining body temperatu

- a medium for food digestion- maintains blood volume


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How is weight affected by overhydration?


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It increases.


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Infants have the highest proportion of water, accounting fo

___-___% of their body weight.


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70-80%


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How is urine output affected by dehydration?


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It decreases.


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Which type of tissue, muscle or fat, requires more water?


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muscle


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How is urine output affected by overhydration?


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It increases.


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The body's fluid is divided into what two major compartmen


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- intracellular fluid

- extracellular fluid


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How does urine concentration change during dehydration


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Its more concentrated.


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Intracellular fluid constitutes what % of total body fluid in an


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40%

(lecture says 40%, book says 2/3rds)


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Extracellular fluid accounts for what % of total body fluid in a


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20%

(lecture says 20%, book says 1/3rd)


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How does urine concentration change during overhydratio


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Extracellular fluid is subdivided into what 2 major compartm


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- intravascular fluid (plasma)

- interstitial fluid


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How does I&O change during dehydration?


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I


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How does I&O change during overhydration?


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I>O


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Intravascular fluid (plasma) accounts for what percentage of E


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25%


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How does Na+ values change during dehydration?


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They increase.


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Interstitial fluid accounts for what percentage of ECF?


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75%

(d f)


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(def)

fluids found in other parts of the body that don't have signifi

gains or losses


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transcellular fluids


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How does Na+ values change during overhydration?


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The decrease.


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How does serum osmolality change during dehydration?


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It is increased >280


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- cerbrospinal fluid

pericardial fluid


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- pericardial fluid- pancreatic fluid

- pleural fluid

- intraocular fluid

- synovial fluids


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How does serum osmolality change during overhydration


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It is decreased


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What is "third spacing"?


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phenomenon of the trapping of fluid in the interstitial spaces; c

caused by trauma to the capillary membrane, protein imbalanc


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How does hemoglobin and hematocrit change during dehydra


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It is increased.


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What is the "fourth compartment" phenomenon?


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fluid where it isn't supposed to be, i.e. an abscess or boil


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How are electrolytes measured?


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in milliequivalents per liter of water (mEq/L)


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How does hemoglobin and hematocrit change during overhydr


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It is decreased.


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How does the albumin levels change during dehydration


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They are the same or increased.


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What is the major electrolyte outside of the cell?


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Sodium (Na+)


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How does the albumin levels change during overhydration


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They are normal or decreased.


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What is the major electrolyte inside of the cell?


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Potassium (K+)

(def)


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a positively charged ion


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cation

H d h BUN l l h i d h d i ?


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How do the BUN levels change in dehydration?

Th i


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They increase.

(def)


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a negatively charged ion

i


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anion

H d th BUN l l h i h d ti ?


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How do the BUN levels change in overhydration?

They are decreased or are in normal range


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They are decreased or are in normal range.

How is the urine specific gravity affected by dehydration


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How is the urine specific gravity affected by dehydration

It increases


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It increases.

What are the principle electrolytes found in extracellular fluid


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What are the principle electrolytes found in extracellular fluid

- sodium- chloride


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- chloride

- bicarbonate

How is the urine specific gravity affected by overhydration


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How is the urine specific gravity affected by overhydration

It decreases


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It decreases.

Which compartment of ECF is considered protein-rich? What


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most abundant protein found in this compartment?

- Plasma, contains large amounts of albumin


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Plasma, contains large amounts of albumin

What are the primary electrolytes found in intercellular fluid


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What are the primary electrolytes found in intercellular fluid

- potassium

- magnesium

h h t


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- phosphate

- sulfate

What type of IV fluids would you give a patient if they we

d h d t d?


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dehydrated?

-Isotonic dehydration (hypovolemia)->Isotonic fluids

H l d h d ti >H t i IV fl id


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-Hyperosmolar dehydration->Hypotonic IV fluids

Each fluid compartment in the body is separated by what


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p y p y

a selectively permeable membrane


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What type of IV fluids would you give a patient if they we

overdehydrated?


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overdehydrated?

-No isotonic fluids-Hyperosmolar overhydration->Hypertonic IV solutions


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-Volume expanders->Albumin

(def)

movement of molecules/solutes in a solvent moving freely in


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directions from an area of high concentration to an area of lo

concentration until there is an equal concentration of solut

diffusion


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What are the nursing interventions that should be done for b

dehydration and overhydration?


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dehydration and overhydration?

Take vital signs, monitor I&O, daily weight (same scale, timeclothes), monitor lab values, skin care, oral care, safe environ


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document neurological problems, and monitor IV fluids

(def)

movement of solutes from an area of lower concentration to a


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movement of solutes from an area of lower concentration to a

of higher concentration; require ATP

active transport


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What are the nursing interventions that should be done fo

dehydration?


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y

Force fluids, clear liquids and a regular diet


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(def)

passive movement of fluid across a membrane from a les


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p

concentrated solution to a more concentrated solution

osmosis


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What are the nursing interventions that should be done fo

overhydration?


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y

Restrict fluids, low sodium diet, loop diuretic therapy


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What are the 3 compartments of body fluids?


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-Intracellular (ICF)-Extracellular (ECF)

-Transcellular


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-Transcellular

When does osmotic pressure develop?


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when two solutions of different concentrations are separated semipermeable membrane


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The osmotic pressure of a solution is called its ________


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osmolality


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What is the composition of Intracellular fluid and it's compartm


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-Fluid within the cells

-42% of body weight-Most prevalent cation is K+

M t l t i i PO4 ( h h t )


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-Most prevalent anion is PO4- (phosphate)

What is the composition of Extracellular fluid and it'scompartments?


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-Fluid in the spaces between cells AKA interstitial fluid

-Most prevalent anion is Cl- (chloride)-Most prevalent cation is Na+ (sodium)

-It expands and contracts


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p

-2/3 of ECF is interstitium

What is the solvent in the body? What are the solutes?


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- water is the solvent- electrolytes, oxygen, carbon dioxide, glucose, urea, amino a

and proteins are the solutes


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p

(def)

the total number of dissolved particles per liter of solven


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osmolality


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What is the composition of Transcellular fluid and it'scompartments?


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-Small, but important fluid compartment

-Approximately 1L-Includes the fluid in: cerebrospinal fluid, GI tract, pleural sp

synovial spaces and peritoneal spaces


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synovial spaces, and peritoneal spaces.

Describe the 2 components in body fluids.


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Electrolytes- element that when dissolved can carry an electr

current, cations (+), anions (-), they affect neuromuscular fun

and acid-base balanceMinerals- ingested compounds, serve as catalysts in nerve resp

muscle contraction and metabolism of nutrients in foods reg


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muscle contraction, and metabolism of nutrients in foods, reg

electrolyte balance

How is osmolality measured/reported?


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in osmols or milliosmols per kg (mOsm/kg)


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The term _________ may be used to refer to the osmolality solution.


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tonicity


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What is diffusion?


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Fluids move from an area of higher concentration to an area ofconcentration till even distribution is attained


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Solutions given in a clinical setting are defined/termed in whcategories?


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1. isotonic solution

2. hypertonic solution

3. hypotonic solution


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What is facilitated diffusion?


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(def)

solution that has the same osmolality as body fluids


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isotonic solution


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What is active transport?


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Able to move larger molecules and go from a lesser concentrata greater concentration using energy


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(def)

solution that has a higher osmolality than body fluids


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hypertonic solution


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What is osmosis?


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Movement of pure solvent through a semipermeable membrana solution of lower concentration to higher.


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(def)

solution that has a lower osmolality than body fluids


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hypotonic solution


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What is hydrostatic pressure?


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It is the force within a fluid compartment, it's the major forcepushes water out of the vascular system at a capillary leve


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Isotonic, Hypertonic, or Hypotonic solution?:

Normal Saline, 0.9%


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Isotonic


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What is colloidal oncotic pressure?


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Osmotic pressure excerted by the colloids in the solution (coll

osmotic pressure), protein is a major colloid (Albumin), it drfluid from the surrounding tissues and extravascular spaces in

blood vessels.


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3% sodium chloride


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Hypertonic


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What is filtration pressure?


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Water and diffusible substances move together in response topressure


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one-half normal saline, 0.45% sodium chloride


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Hypotonic


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The amount and direction of fluid movement in capillariesdetermined by what?


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Capillary hydrostatic pressure, plasma ocotic pressure, Intershydrostatic pressure, Interstitial oncotic pressure


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How does Hypothalamic regulation regulate the body's flubalance?


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The osmoreceptors located in the hypothalamus sense a fluid d

or increase in plasma osmolarity, it stimulates thirst and the reof ADH which results in increased free water and decreased p

osmolarity


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D5W (Dextrose 5%)


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Hypotonic

(Reasoning: Osmolarity of D5W is 252 mOsm/L. The fluidisotonic when in the container. After administration, the dextr

quickly metabolized in the body, leaving only water - a hypo

fluid.)


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How does pituitary regulation affect the body's fluid balanc


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Under control of the hypothalamus it causes the posterior pitui

release ADH. It can be triggered by stress, nausea, nicotine, morphine which also stimulate ADH


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Lactated ringer's (LR)


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Isotonic


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(def)

the osmotic pressure in the blood vessels exerted by colloids (p

proteins) which holds fluid in the intravascular space


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Colloid Osmotic Pressure (Oncotic Pressure)


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How does adrenal cortical regulation affect the body's fluid ba


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Adrenal cortex releases hormones to regulate both water an

electrolytes: glucocorticoids and mineralcorticoids *Aldosteromineralcorticoid with a potent sodium-retaining and potassi

excreting capability


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(def)

a process whereby fluid and solutes move together across

membrane from one compartment to another


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filtration


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How does renal regulation affect the body's fluid balance


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Kidneys are the primary organs for regulating fluid and electr

balance, selective reabsorption of water and electrolytes, excre

electrolytes occurs here, renal tubules are sites of action of AD

aldosterone


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(def)

the pressure in a compartment that results in the movement of

and substances dissolved in that fluid out of that compartm


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filtration pressure


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How does cardiac regulation affect the body's fluid balanc


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The heart atria release atrial natriuetic factor (ANF) which stim

and increase in atrial pressure because of increased blood volu

targets the blood vessels and kidneys causing vasodilation anincreased excretion of Na+ and water. It effects the plasma vo

osmolarity by decreasing plasma volume and increasing osmo


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How does gastrointestinal regulation affect the body's fluid ba


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The GI tract accounts for the most of the water intake, and sm

amounts of water are eliminated by the GI tract in feces


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The ________ pressure of blood is the force exerted by blood a

the vascular walls.


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hydrostatic pressure


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Describe insensible water loss and sensible water loss.


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Insensible- invisible vaporization from lungs and skin,

approximately 900 mL lost per day, no electrolytes lostSensible- excessive sweating, leads to water loss and electroly


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If the hydrostatic pressure of blood is higher than that of th

surrounding tissue, why does blood not seep out of the vess


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because the colloid osmotic/oncotic pressure opposes the hydr

pressure and keeps the blood within the vascular compartm


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What body system assists with the return of excess fluid back

circulation?


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Lymphatic system


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What is the etiology, clinical manifestations, and effects of

values caused by hypervolemia?


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Etiology: may result from excessive intake of fluids, abnormretention of fluids (CHF), or interstitial-to-plasma shift

S&S: increased circulating volume (HTN), cough, SOB, JV

bounding pulse, rales or crackles noted on ausculation, feelin

fullness, weight gain, pulmonary edema, pitting edema toextremities, puffy eyelids, tight shiny skin, peripheral edem

restlessness, anxiety, change in LOC

Lab Values: decreased hemoglobin and hematocrit, altere


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electrolytes

How does active transport differ from osmosis and diffusio


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substances are moving to an area of higher concentration A

metabolic energy is expended


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What are the nursing interventions for hypervolemia?


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-Monitor location and extent of edema

-Weigh patient daily

-Assess patient

-Observe V/S changes

-Monitor labs

-Neuro checks

-Provide or teach proper diet

-Administer medication


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Active transport is particularly important in maintaining th

differences of what 2 electrolytes?


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sodium and potassium


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What is the etiology, clinical manifestations, and lab values

hypovolemia?


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Etiology: Can occur with loss of normal body fluids (diarrhea,

drainage, or plasma-to-interstitial fluid shift)S&S: decreased urine output, increased urine concentration, ol

weakness, sudden wieght loss, decreased venous filling, decre

pulse volume/pressure, increased body temp, decreased skin tu

dry mucus membranes, dry skin, thirsty*ORTHOSTATIC HYPOTENSION = HYPOVOLEMIA

**Decreased C/O = Low BP = SHOCK

Lab Values: high urine specific gravity, increased hematoc

i bl l l i bl i l i d


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variable serum electrolytes, variable urine volume, increased urea nitrogen (BUN), increased osmolality

To maintain homeostasis, the body obtains water from wha

sources?


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1. ingested liquids

2. water in food3. water from metabolic oxygenation


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What are the nursing interventions for hypovolemia?


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-Look for causative factors

-Monitor I&O

-Monitor daily weights

-Observe V/S changes-Assess skin turgor

-Ensure patient safety with position changes

-Administer medication & IVF


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What are 4 sources of water loss in the body?


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1. urine

2. intestinal tract

3. lungs4. skin


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What is the primary regulator of fluid intake?


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the thirst mechanism


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Where is the thirst center located?


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in the hypothalamus of the brain


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What are 3 examples of stimuli that may trigger the thirst cen


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1. increased osmotic pressure

2. low vascular volume

3. the presence of angiotensin (hormone released in responsdecreased blood flow to the kidneys)


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What is the major avenue of fluid loss in the body?


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urine


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(def)

fluid loss that occurs through the skin and lungs; usually nnoticeable and cannot be measured


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insensible loss


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What is the primary regulator of body fluids and electrolyte ba


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kidneys


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Approximately how many liters of blood is filtered through

kidneys per day? Of this, what amount is excreted?


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180 L filtered per day, only 1.5 L of urine is excreted


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What hormone regulates water excretion from the kidneys


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ADH (Antidiuretic horomone)


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Where is ADH synthesized?


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the hypothalamus


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What part of the kidney does ADH work on?


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the collecting ducts of the nephrons


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What is produced when serum osmolarity rises? What action

this have on the body?


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- ADH is produced, which causes the collecting ducts of the ki

to become more permeable to water. This action allows more

to be reabsorbed in the blood.


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What happens to ADH when serum osmolarity decreases? W

action does this have on the body?


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ADH is suppressed, causing the collecting ducts to become

permeable to water, which increases urine output.


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In addition to serum osmolality, what are other factors that affe

production and release of ADH?


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- blood volume

- temperature

- pain

- stress

- drugs (opiates, barbituates, nicotine)


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The receptors located in the juxtaglomerular cells of the kid

nephrons are responsible for activating what system?


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the renin-angiotensin-aldosterone system


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The activation of the renin-angiotensin-aldosterone system

response to what?


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decreased blood flow/pressure to the kidneys


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In the renin-angiotensin-aldosterone system, decreased blood f

the kidney prompts the kidney to release what?


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renin


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What does renin do?


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prompts the conversion of angiotensinogen to angiotensin


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What converts angiotensin I to angiotensin II?


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angiotensin-converting enzyme


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What does angiotensin II do?


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acts directly on nephrons to promote sodium and water reten

AND stimulates the release of aldosterone from the adrenal c


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What does aldosterone do?


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promotes sodium retention in the distal nephron


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What is the net effect of the renin-angiotensin-aldosterone sys


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restoration of blood volume, thus an increase in blood press


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(def)

the loss of both water and electrolytes from the ECF in simproportions, thus the decreased volume of fluid remains isot


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hypovolemia


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(def)

a water loss greater than that of the solutes


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hyperosmolar (aka dehydration)


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Hypovolemia, of Isotonic loss, generally is a result of what?


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- loss of plasma or whole blood (burns, hemmorrhage)

- loss from the GI tract (diarrhea, vomiting, gastric suction, fi

drainage)- fluid movement into body cavities (third space syndrom


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Hyperosmolarity, or dehydration, is generally a result of wha


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- decreased oral intake of fluids (anorexia, nausea, inability to

access to fluids, inability to swallow)

- loss of water (excessive sweating, fever, diarrhea, polyuria

diuretics, diabetes)- increased solute intake (salt, sugar, protein), the administrati

hypertonic fluids, concentrated tube feedings


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Marked dehydration is identified as a loss of ___-___% of b

weight.


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5-8%


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Severe dehydration is identified as a loss of > ___% of body w


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> 8%


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Marked or Severe dehydration?:

Weakness, drowsiness, and lightheadedness


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marked


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abnormal thirst


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marked


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weight loss of 3-5 liters


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marked


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dry mucous membranes


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marked


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sluggish skin turgor, dry skin, dry tongue, dry lips


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marked


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low-grade temperature


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marked


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weak, rapid pulse


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marked


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tachypnea


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marked


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marked


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slow filling of hand veins


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marked


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sunken, soft eyeballs


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marked


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fluid intake < output


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marked


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decreased urine output


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marked


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weight loss of 5-10 liters


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severe


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skin flushed


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severe


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narrowing pulse pressure


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severe


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decreased systolic BP


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severe


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electrolyte disturbances


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severe


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behavioral changes, like restlessness, irritability, disorientat


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severe


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seizures


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severe


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coma


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severe


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- increased serum sodium

- increased serum osmolality

- increased Hgb and Hct

- increased BUN- increased urine specific gravity


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What type of nursing interventions would you implement fo

patient experiencing dehydration? (8)


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- monitor vital signs

- accurate I & O

- force fluids

- daily weights

- skin and mouth care

- provide a safe environment- monitor diagnostic tests

- document client care


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(def)

extracellular fluid volume excess; increased body fluid volume

interstitial or intravascular space


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hypervolemia


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(def)

gaining of solutes and water in equal proportion


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isotonic excess


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What are 2 causes of isotonic excess in the intravascular spa


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- excessive fluid and sodium (such as rapid administration of is

saline, blood or plasma infusions) (excessive dietary salt inta

(steroid usage)

- decreased function of homeostatic mechanisms (CHF, renal fcirrhosis of the liver)


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What are 4 causes of isotonic excess in the interstitial spac

(edema)?


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- rise in blood hydrostatic pressure (CHF, interference with ve

return)

- damage to capillary walls (tissue injury, allergic reactions, b

- decrease in colloid osmotic pressure and plasma protein

(malnutrition, chronic diarrhea, cirrhosis of liver, burns, los

protein via kidneys)- obstruction in lymphatic drainage (cancer of lymph syste

removal of lymph nodes)


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What type of assessment findings would you expect to see i

person experiencing isotonic fluid excess? (11)


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- acute weight gain

- distended neck and hand veins

- rapid vital signs- bounding pulse

- increased blood pressure

- tachypnea

- dyspnea

- constant irritated cough

- periorbital edema

- shiny, taut skin

- pale, cool, moist mucous membranes


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(def)

edema that leaves an indention when pressed


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pitting edema


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(def)

edema associated with gravity


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dependent


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(def)

non-dependent edema unresponsive to treatment


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refractory edema


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(def)

severe generalized edema


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anasarca


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(def)

accumulation of fluid in the peritoneal cavity


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ascites


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(def)

collection of fluid in the pleural cavity


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hydrothorax


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(def)

edema where the skin swells so much that fluid cannot be disp


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Brawny edema


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What type of diagnostic test results might you see in a pers

experiencing edema?


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- decreased HgB and Hct

- serum albumin < 3.5

- serum sodium WNL


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person experiencing extracellular fluid volume excess, or

hypervolemia?


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(def)

increased body fluid volume in relation to sodium


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intracellular fluid volume excess, also called overhydration

hypoosmolar imbalance


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What are 4 causes of overhydration?


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1. administration of D5W

2. overproduction of ADH

3. compulsive polydypsia

4. kidney dysfunction


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What are 3 early signs of overhydration (intracellular fluid vo

excess)?


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- nausea/vomiting

- excessive perspiration

- acute weight gain


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What are 3 changes you will see in a person as overhydrati

progresses?


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1. personality changes (apprehension, confusion, irritabilit

2. weight gain

3. muscle cramps


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What are 3 late signs of overhydration?


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1. increased BP

2. bradycardia

3. increased respirations


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What type of diagnostic test findings would you see in a per

experiencing overhydration?


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- serum sodium


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person experiencing overhydration? (10)


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- monitor vital signs

- accurate I & O

- monitor neurological status- restrict fluid intake

- osmotic diuretics

- daily weight

- careful monitoring of IV fluids- monitor diagnostic tests

- provide safe environment

- document client care


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Dehydration or Overhydration?:

Low BP


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Dehydration


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High BP


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Overhydration


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Weak Pulse


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Dehydration


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Bounding Pulse


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Overhydration


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Increased heart rate


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Dehydration and Overhydration


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Respiratory rate the same or increased


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Both


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Flat neck veins


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dehydration


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Distended neck veins


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overhydration


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Sunken, dry eyes


477/561

dehydration


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Periorbital edema


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overhydration


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Dry, pale mucous membranes


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dehydration


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Moist mucous membranes


483/561

overhydration


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dry skin


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dehydration


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shiny, taut skin


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overhydration


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increased skin temp; warm/hot


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dehydration


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cool skin


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overhydration


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sluggish, tented skin turgor


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dehydration


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495/561

overhydration


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497/561

dehydration


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capillary refill


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overhydration


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muscle weakness, fatigue


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dehydration and overhydration


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muscle cramping


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overhydration


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drowsy, lightheaded, confused, restless, delirium, disorienta


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dehydration


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headaches, nausea, vomiting, irritability, confusion


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overhydration


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weight loss


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dehydration


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weight gain


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overhydration


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hyperosmolar urine


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dehydration


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hypoosmolar urine


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overhydration


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intake greater than output


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overhydration


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sodium usually increased


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dehydration


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sodium WNL or slightly low


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overhydration


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serum osmolality increased


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dehydration


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serum osmolality decreased


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overhydration


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hemoglobin and hematocrit increased


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dehydration


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hemoglobin and hematocrit decreased


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overhydration


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bilateral breath sounds clear (unless secondary cause prese


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dehydration


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bilateral breath sounds clear or possibly adventitious


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overhydration


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serum albumin increased or the same


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dehydration


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serum albumin WNL or decreased


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overhydration


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BUN increased


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dehydration


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BUN stays the same


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overhydration


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urine specific gravity increased


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dehydration


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urine specific gravity WNL


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overhydration


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What type of diet would an overhydrated client likely be o


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low sodium


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What type of medication is commonly prescribed to overhyd

clients?


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diuretics (loop, osmotic)


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Force fluids


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dehydration


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restrict fluids


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overhydration


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What are some contributing factors to fluid and electrolyt

imbalances?


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-illness and conditons

-interventions and treatment measures


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What are the common manefestations of electrolytes imbalan

-vital sign changes

cardiac arrhythmias


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-cardiac arrhythmias-gastrointerstinal S/S

-alteration in muscle function

-neurological S/S

-hyperactice or flaccid reflexes


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What are the geriactric changes that take place that effect he

and electrolyte balance?

-structural changes to the kidney and decreased renal perfus

decreased glomerular fultration rate and creatinine clearence,

ability to concentrate urine and conserve water

-hormonal changes: decrease in renin and alderosterone, and in

in ADH and ANP


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in ADH and ANP

-body changes: loss of subq tisue and dermis tissue which caus

of moisture and inability to respond to temperature quickl

-sensory change: decreased thirst mechanism

-musculoskeletal: decresased mobility and stiffness in han-mental status changes: confusion, disorientation and decrea

memory

Electrolyte Two

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Transcript of Electrolyte Two