1) Fat contains little water. So a fat person has a lower percent of fluid weight 2) Percent of water weight decreases with age 3) More muscle high percent of fluid weight

Very abnormal, Fluid accumulates in areas that normally have no fluid or minimal amounts of fluid. (ascites, edema with burns, massive bleeding into a joint) We can't get at that fluid and need to pull the fluid out

Paracentesis is a procedure to remove fluid that has accumulated in the abdominal cavity

In the capillary membranes,

hydrostatic pressure forces solutes into cells,

osmotic pressure of plasma proteins pulls fluids back into the intravascular space. Occurs in the glomerulus and the arterial end capillaries

1) ADH ( Antidiuretic Hormone) Pituitary Gland

2) Aldosterone (Mineral Corticoid from Adrenal Gland)

3) Renin (Enzyme) angiotensin

Counteracts the angiotension cycle Myocardium puts out this hormone

Stimulates the excretion of sodium and water by the kidneys

1) Causes absorption of calcium from the intestines
2) Release of calcium from the bones
3) Excretion of phosphate ions by the kidneys If calcium level is low it kicks in to increase calcium levels

Lactated Ringers

Normal Saline

D5W until dextrose metabolized by the body then hypotonic

Contain less sodium more water then intracellular fluid
Example: 1/2 NS
(Osmosis) Cause water to move inside the cells Used to treat gastric fluid loss and dehydration Risk for cerebral edema - increase intercranial pressure

Contain more sodium less water than intracellular fluid Examples: 3%NS, D5LR

Used to increase ECF volume Assists in removing intracellular Fluid

Give slow and cautious because can still cause we can put to much volume in ECF

Peripheral – use distal first, leg veins rare because of risk of DVT

With mastectomy – use other arm because of impaired lymph flow – bracelet Central Veins – subclavian, internal jugular , high risk of infection PICC / Midline Always time tape Complications – fluid overload, air embolism, infection

Loss of intravascular, interstitial, and or intracellular fluid (dehydration)

Water and electrolytes are often lost in the same proportion.

Hypovolemia Flow Chart

Low Volume in the Blood

Low Blood Pressure

- HgB Rise (Low Fluid volume increases concentration)
- Hct Rise  (Hemoconcentration)
- Elevated serum NA
- Decreased K+ (Potassium) related to losing the fluid because when we give a diaretic causes loss of potassium
- Lower CVP (Central Venous Pressure)
(Flat Neck Veins)
- Urine specific gravity > 1.025

Fluid replacement (isotonic=NS,LR,D5W)
Teaching
Frequent vital signs
I & O
Monitor labs
Reposition
Change positions slowly

1) Hypervolemia (High Blood Pressure)

    1a) Kidney inhibits renin, angiotensin I & II

        1aa) Adrenals inhibit aldosterone

    2a) Pituitary inhibits ADH

    3a) Heart Releases atrial natriuetic hormone

2) Body excretes sodium and water

3) Homeostatis returns

Sodium is the chief cation(+) in the ECF
Maintains Fluid Balance and Osmotic Pressure
Normal serium sodium (135 - 145 mEq/L)
Sodium Functions Include:

Transmission of Nerve Impulses

Maintain Acid-Base balance

Regulate Water reabsorption

Regulate Water excretion from the kidney tubule

To much sodium outside the cell or to little inside the cell NA < 135 mEq/l

Note: 1 TBS Table Salt = 800mg

Hyponatremia

serum sodium (less than 135meq/L) serum osmolality (decreased as water shifts into cells)

24 hour urine - Get rid of first void in the morning and record urine for the rest of the day

Drink to much water without the electrolytes

Anorexia, Nausea, vomiting, abdominal cramping Headache Altered mental status, confusion Decreased reflexes Muscle cramps, weakness, tremors Seizure, coma

Hyperactive bowel sounds

Risk for imbalanced fluid volume

Risk for decreased intracranial adaptive cap.

Risk for injury Fatigue

Sodium IVs/sodium po – isotonic solution Furosemide (Lasix) – rid fluid if SIADH

Increased sodium intake-restrict fluid safer than sodium administration

Strict I/O, daily wts Treat symptoms Teaching

Serum Na greater than 145 mEq/l

Gain of sodium in excess of water or by a loss of water in excess of sodium.

Sodium concentration increases and the increased concentration pulls fluid out of the cell and into the vascular system

Hypotonic IVs (allows for gradual reduction in serum sodium levels)

Oral care,

Strict I/O,

daily weights

Seizure precautions

Potassium < 3.5 mEq/L

Reglates regular heart rhythm

Conducts neromuscular impulses

Decreased cardiac output

Activity intolerance

Altered health maintenance

Risk for imbalanced fluid volume

Dysrhythmias/ECG changes

N & V

Anorexia

Decreased bowel sounds/ileus

Muscle weakness & Leg cramps

Confusion, lethargy

ECG

Oral or IV potassium supplement (*ALWAYS using IV pump to monitor flow, *NEVER IV push) Teaching potassium-rich foods

Assist with self-care

Ambulate with care

ST Wave Depression for Hypokalemia

acidosis,  renal failure,  intake Spironolactone,

administration of aged blood, adrenal insufficiency

•Cardiac arrhythmias (V-fib). Heart block, bradycardia
•Diarrhea
•Abdominal cramping
•Anxiety
•Paresthesia-disruption conduction
•Irritability, muscle tremors, twitching
•Progresses to weakness, bradycardia
•Monitor labs for renal failure

Hypoparathyroid or parathyroid removal

Alkalosis

Bowel disorders-can’t absorb Calcium

Inadequate vit D-need for absorption

Furosemide, dilantin, gentamicin

Positive Chvostek’s sign (facial spasm)

Positive Trousseau’s sign (wrist curls)

Deep tendon reflexes/Tetany

Hypotension

Dysrhythmias-need calcium for cardiac contractions

Diarrhea/cramping Laryngospasm!!! – neuromuscular irritability

Risk for injury

Decreased cardiac output

Ineffective breathing pattern

Disturbed thought processes

Oral calcium with vitamin D

Monitor labs: Mg can be low & PO3 can be elevated

Frequent ECG

Seizure precautions

hyperparathyroidism, malignancy

(causes Ca to be released from bones, and makes kidneys and bowel retain Ca),

prolonged immobility,

excess calcium antacids,

excess milk

Nursing Assessments for Hypercalcemia