2 fluid compartments of body
intracellular
extracellular
3 parts of extracellular fluids
interstitial
intravascular
transcellular
diffusion
movement of molecules from area of higher concentration to an area of lower concentration
no energy required
facilitated diffusion
requires a protein carrier
no energy required
ex: glucose transportation
active transport
molecules move against the concentration gradient
uses energy
ex: sodium-potassium pump
osmosis
movement of water down the concentration gradient
from area of lower concentration to area of higher concentration
no energy
normal Na+ level
135-145 mEq/L
normal K+ level
3.5-5.0 mEq/L
normal Ca+ level
8.5-10.2 mEq/L
normal Mg+ level
1.3–2.1 mEq/L
normal PO4- level
1.7–2.6 mEq/L
normal Cl- level
95–105 mEq/L
edema
accumulation of fluid in the interstitial spaces
S/SX of FVD
hypotension
weak, thready pulse
tachycardia
S/SX of low protein
weight gain, pulmonary congestion, edema, hypotension, increased HR, weak pulse
causes of FVD
diarrhea, hemorrhage, inadequate intake, shift from plasma into interstitial space, diuretics, third spacing, insensible loss
causes of FVE
excessive IV fluids, HF, Renal failure, SIADH, Cushing,
S/SX of FVD
restless, lethargic, thirst, dry mucous membranes, decreased skin turgor, decreased cap refill, increased HR and RR, postural hypotension, seizure, weight loss
S/SX of FVE
bounding pulse, increased BP, HA, peripheral edema, dyspnea, crackles, weight gain, muscle spasms
interventions for fluid imbalances
monitor I/O, cardio, respiratory, neuro, daily weight, skin turgor
Causes of hypernatremia
IV fluids hypertonic tube feedings near-drowning in saltwater excessive Na+ intake diabetes insipidus Cushing
Causes of hyponatremia
GI losses diuretics burns wound drainage fasting diet SIADH HF
S/SX of hypernatremia
restless, agitated thirst decreased BP, increased pulse flushed peripheral edema
S/SX of hyponatremia
irritability, confused, dizzy
tremors, increased pulse, cold, clammy
N/V, diarrhea, cramps
Causes of hyperkalemia
excessive intake K+ containing/sparing drugs tumor lysis crush syndrome renal disease ACE inhibitors, NSAIDs
Causes of hypokalemia
D- diuretics, diarrhea, drugs I- inadequate intake T- too much water intake C- Cushing's syndrome H- heavy fluid loss (vomit, sweat, wound drainage, NG suction)
corticosteroids, diuretics, laxatives, chemotherapy
S/SX of hypokalemia
"7 Ls" Lethargic low, shallow RR lethal cardiac changes loss of urine leg cramps limp muscles low BP/HR confusion constipation hypoactive bowel abdominal distention decreased DTR
S/SX of hyperkalemia
"MURDER" M- muscle weakness U- urine production low/absent R- respiratory failure D- decreased cardiac contractability (decreased HR) E- early signs of muscle twitch (cramps) R- rhythm changes S- seizures
causes of hypercalcemia
"HIGH CAL" H-hyperparathyroidism I- increased intake of Ca G- glucocorticoids H- hyperthyroidism C- calcium excretion decreased (thiazides, renal failure, bone cancer) L- lithium usage
S/SX of hypercalcemia
"WEAK" W-weak muscles E- EKG changes (short QT, long ST) A- absent reflexes, absent minded K- kidney stones
constipation, N/V, anorexia, lethargic, stupor, coma
causes of hypocalcemia
"LOW CALCIUM" L- low PTH O- oral intake inadequate W- wound drainage system C- Celiac's Crohn's (malabsorption) A- acute pancreatitis L- low vitamin D intake C- chronic kidney disease I- increased phosphorus level U- using meds (laxative abuse) M- mobility issues
chronic diarrhea
increased PO4
S/SX of hypocalcemia
"CRAMPS" C- confusion R- Reflexes hyperactive (increased DTR) A- arrhythmia M- muscle spasms/cramps/tetany P- positive Trousseau S- sign of Chvostek
numbness, tingling of extremities, laryngospasm, seizure