Adult Health Notes Week 1 Day 2

 Hypertonic solutions used in critical care patients

 Regulation of Water balance
o ADH and Aldosterone
o ADH secretes more water
o Diabetes insipidus- patient secrete more ADH and goes into polyuria
o Aldosterone comes from the adrenal glands
o Aldosterone regulates fluid and electrolytes and BP
 Fluid Spacing
o First- normal
o Second- abnormal (edema)
o Third- fluid accumulation in part of body where it is not easily exchanged with
extracellular fluid
 Fluid Volume Deficit
o Hypovolemia
o Abnormal loss of body fluids, inadequate intake, or plasm to interstitial fluid shift
o Loss of vascular volume
o Replace water and electrolytes with balanced IV solutions
o Symptom of Hypovolemic Shock- Oliguria
o Normal urine output 30mL/hr
 Fluid Volume Excess
o Hypervolemia
o Abnormal retention of fluids
o Impaired gas exchange
 Look for concept, key words, and read last sentence of question
 Loop Diuretics: Furosemide or Lasix
 Sodium 135-145
o Parallel changes in osmolality
o Hyponatremia
 Too much water, not enough Sodium, Causes by Vomiting, sweating, ingesting
too much water
 S/S headache, seizure, coma
 Treatment: Na replacement, no water. 3% or 5% NS
o Hypernatremia
 To much sodium. Causes hyperventilation, heat stroke
 S/S dry mouth, thirsty, swollen tongue
 Treatment: restrict Na, fluids, daily weights, I/O
 Potassium 3.5-5.0
o Sources: fruits and veggies
o Salt subs
o Medications
o In blood
 o Regulated by kidneys and excreted by them
o Hyperkalemia
 Aldactone retains potassium
 Shift from ICF to ECF
 Most common renal failure
 Cramping
 Tall T wave
o Hypokalemia
 Shallow T wave
o Never push IV k, always on a pump
o Assess urine output before
 Calcium 9.0-10.5
o Hypocalcemia
 Chvostek’s- tap cheek
 Trousseau- hand flex when taking BP
o Hypercalcemia
 Prolonged immobilization. Calcium not moving in bones
 Calcium has inverse relationship with Phosphorus
o Acute pain
o Ineffective breathing
o Falls
 Phosphate- 2.4-4.4
o Serum levels controlled by parathyroid hormone
o Hyperphosphatemia- neuromuscular, irritability, and tetany
o Hypophosphatemia- malnourishment, alcohol withdrawal
 Give oral supplement
 Ingestion foods high in phosphorus
 Administer sodium or potassium phosphate
 Magnesium- 1.2-2.1
o Hyper- S/S- deep tendon reflexes, flushing, weak BP, vasodilation
 Isotonic- Normal saline 0.9%
o Lactated ringers
 Hypertonic- D5 .05
o D10W
 Plasma Expanders