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40 Cards in this Set
- Front
- Back
Diffusion
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"goes with the flow"
Solutes move from higher to lower concentration |
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osmosis
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"let's fluids through"
Passive movement of fluid across a membrane from lower to higher concentrations. Stops when concentration is equal on both sides |
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Hypotonic
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hyposmotic
any solution with a solute concentration lower than the blood or normal body fluds ex: 1/2 NS |
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Isotonic
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isosmotic
any solution with a solute concentration equal to osmolarity of normal body fluids or normal saline ex: NS |
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Hypertonic
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hyperosmotic
any solution with a solute concentration greater than that of normal body fluids ex: D5NS |
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Hormonal regulation of fluid
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Renin, angiotensin, aldosterone(RAA) increases blood volume and blood pressure
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Renin
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produced in kidneys
enzyme that acts on angiotensinogen to convert angiotensin I to angiotensin II |
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Angiotensin II
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vasoconstrictor
controls aldosterone release |
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Aldosterone
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triggers kidneys to reabsopb sodium. sodium retension inhibits fluid loss, increasing blood volume and thus, BP
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Anti diuretic hormone (ADH)
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vasopressin
produced in brain stored in post pituitary makes kidney tubules more permeable to water. Increases water reabsorption, more water returned to blood=decrease in blood osmolarity |
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Sensible routes of fluid loss
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measurable
oral, parenteral, enema, urine, emesis, feces, irrigation fluids, drainage |
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Insensible routes of fluid loss
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immeasurable
solid food, metabolism, perspiration, lung vaporization |
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Normal physical assessment for fluid loss
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moist eyes, moist mucous membranes, input equals output
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Abnornal physical assessment for fluid loss
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cotton mouth, no tearing, wt. loss, decreased output, poor skin turgor
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Places to check for skin turgor
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sternum, forehead, back of hand(not reliable in elderly patients d/t loss of elasticity)
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3 types of dehydration
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isotonic, hypertonic and hypotonic
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Isotonic dehydration-def.
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most common
fuid loss from ECF space no shift of fluids (ICF remains normal) hypovolemia and inadequate tissue perfusion |
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Isotonic deydration assessment
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Wt loss
hypotension (orthostatic) rapid, weak pulse oliguria poor skin turgor dry mucous membranes elevated urine specific gravity altered LOC increased hematocrit (except in hemorrhage) increased serum protein and BUN |
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hypertonic dehydration-def.
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2nd most common
water loss from ECF is greater than electrolyte loss increases osmolarity of remaining plasma (hypertonic) causes water to move from ICF to plasma causing cellular dehydration and shrinkage |
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hypertonic dehydration assessment
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thirst
decreased skin turgor dry mucous membranes HYPERACTIVE DTR's increased urine spec. gravity increased serum Na and osmolarity pitting edema NO CARDIAC CHANGES NO S/S SHOCK |
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hypotonic dehydration-def.
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less common
caused by fluid shift causing a decrease in plasma volume excessive loss of K and Na from ECF water moves from plasma into cells causing plasma volume deficit and cells swell |
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hypotonic dehydration assessment
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hypotension
tachycardia changes in LOC low serum Na and low serum osmolarity |
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Isotonic overhydration assessment
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wt gain
distended neck veins polyuria hypertension ful bounding pulses crackles, SOB elevated RR ascites periperal edema decreased hematocrit and BUN(hemodilution) liver enlarged |
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hypertonic overhydration assessment
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elevated BP
elevated CVP and JVD full, bounding pulses thirst (d/t cell shrinkage) high serum osmolarity decreased output ( retaining water to dilute Na) high urine Na levels ( can lead to disorientation, lethargy and coma) |
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Hypotonic overhydration assessment
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s/s r/t low Na levels and fluid shifts, causing cellular swelling --increased intercranial pressure
overall H/A and photophobia confusion and disorientation muscle twitching hyperirritability N/V Polyuria convulsions and coma polyuria diarrhea nonpitting edema cardiac dysrhythmias assoc with electrolyte dilution projectile vomiting |
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Hypokalemia causes
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<3.5mEq/L
excess potassium can be lost thru kidneys(K wasting diuretics) or GI tract (vomiting or diarrhea), inadequate intake, shift to cells (alkalosis) |
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hypokalemia sx
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cardio-dysrhythmia, EKG changes
GI-N/V, anorexia, decreased bowel sounds, ileus musculoskeletal-weakness, cramps |
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hypokalemia Tx
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Potassium supplements
K rich foods- monitor K levels, cardiac monitoring, digitalis, antidysrhythmics |
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hyperkalemia causes
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>5.0mEq/L
impaired renal excretion, renal failure, K sparing diuretics, adrenal insuff., excessive K intake |
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hyperkalemia sx
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cardio-tall peaked T waves, widened QRS, dysrhythmia, cardiac arrest
Gi- N/V, ABD cramping, diarrhea neuromuscular-weakness, paresthesia, flaccid paralysis |
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hyperkalemia Tx
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dialysis
Calcium gluconate IV regular insulin and glucose ( to promote K uptake of cells) monitor I&O, K, BUN, creatinine |
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hypocalcemia causes
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<8.5 mEq/L
parathyroidectomy or neck surgery, acute pancreatitis, inadequate intake, lack of sun exposure (vit D), lack of wt. bearing, drugs, calcitonin, alchohol abuse |
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hypocalcemia Sx
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neuromuscular-tetany, spasm,positive Chvotek's, positive Trousseau's, anxiety, confusion
cardio-dysrhythmias, hypotension GI ABD cramping |
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hypocalcemia Tx
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oral or IV Ca, vit D may be given to increase absorption
monitor resp status seizure precautions diet |
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hypercalcemia causes
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>10mEq/L
hyperparathyroidism, CA, immobilization, Paget's, excess milk intake |
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hypercalcemia Sx
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bradycardia, various heart blocks, cardiac arrest
muscle weakness,AMS, decreased LOC, ABD pain, constipation, anorexia, N/V, dysrhythmia, hypertension,thirst |
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hypercalcemia Tx
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calcitonin rapidly lowers Ca
low Ca diet sodium phosphate in emergency IV fluid to aid excretion |
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hypomagnesemia causes
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<1.6mEq/dl
alchoholism, intestinal suction, impaired absorption |
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hypomagnesemia Sx
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muscle weakness, tremors, tetany, seizures, dysphagia, anorexia, N/V/D, tachycardia, hypertension, mood changes
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hypomagnesemia Tx
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increase intake of Mg rich foods May givee IV mag sulfate if severe
Tx for alchoholism |