FLUIDS AND ELECTROLYTES 1.

Isotonic: Hypovolemia – loss of fluids in the

intravascular space

IV FLUIDS  Water loss = electolye loss

 Iv Fluids: give isotonic

ISOTONIC
2. Hypertonic: High con
- same concentration/ osmolarity/ osmolarity
to blood  Water loss is greater than electrolyte loss
 IV fluids: Give Hypotonic
- stays in intravascular
3. Hypotonic: Low Con
HYPERTONIC
- high concentration
- fluids (cells) move into blood
- “slow infusion”

 Water loss less than electrolyte loss

 IV fludis : Give hypertonic

HYPOTONIC
- low concentration
- slow infusion

Fluid Volume Deficit

Fluid OVlume Excess
1. Isotonic “Hypervolemia”
 Excess fluid in the intravascular
 Drug of choice: Diuretics
 Potassium “ Pota Arte”
 Normal value: 3.5 -5 mEq/L “kalbumin”
 Major intracellular cation
K (cells) – blood = Hypekalemia
K (blood) – cells = Hypokalemia

2. Hypertonic – High Con : Hypernatremia  Increases muscosketal contraction

 High Na (1st): H2O retention K + muscle – direct

 Management: Na + H2O restriction  Abnormality can cause cardiovascular
 Drug of choice: loop diuretics – U K Na irregularity (decreased)
Mg
U – Up uric acid
K Na Mg – wasting/ Decreases
3. Hypotonic – Low Con
 Water intoxication (1st) = Low Na
 Management: H2O restriction
ECG CHANGES:
 Drug of choice: Osmotic diuretics –
removal of H2O
Sodium “ magic 35-45”
- PCO2 – 35-35; pH 7.35 – 7.45
 Normal vale: 135-145 mEq/L
 Major intravascular cation
 Major determinant for concentration of
blood High Na = hypertonic blood / Low
sodium = hypotonic blood
 Regulates neuromuscular activity
 Sodium and H2O are not mutual
A. high NA (1st) = High H2O / Low Na (1st ) –
Low H2O
B. High H2O (1st) = low Na / Low H2o (1st) =
High Na
Calcium
 Normal value: 9-10 mg/dl “Calsyampo”
 Major components of the bones
Ca (bones) – blood= hyper
Ca (blood) – bones = hypo
 Muscoskeletal contraction
Muscle + Ca = inverse
Heart + Ca = direct
 Cardiac muscle contraction
 Abnormality can cause dysrhythmia
 Excess in the kidneys can cause
supersaturation and osmotic diuresis
High Ca – kidneys – renal calculi
- polyuria – Fluid Volume Deficit
 Phosphorus
 Normal value: 2.5 – 4.5 mg/dl
 Inversely proportional calcium

Magnesium Hypo: high cal = low phosphrus

 Normal value: 1.5 – 2.5 mEq/L Hyper: low cal = high phosphorus
 Vasodilator – high blood flow, low BP, hot
= flushed
 Neuromuscular effects are similar to those

ABG Analysis
 Blood ph: 7.35 – [ 7.40] – 7.45
 PaCO2: 35-45 mmHg
 HCO3: 22-26 meq/L
 PaO2: 80-100 mmHg
 O2 saturation: 95-100%

of
Calcium
ACUTE AND CHRONIC RENAL FAILURE Low GFR – Low remove: High BUN = High
creatinine= uremia = azolemia –“poisoning”
Acute Kidney Injury / Acute Renal Failure
- renal mencephalopathy
 Sudden or progressive loss of kidney
function
 Reversible or irreversible

Causes:
1. Prerenal: Low blood – kidneys
2. Intrarenal/ Intrinsic: Damage - kidney
3. Postrenal: obstruction of urine

Chronic Kidney Disease / Chronic Renal

Failure
 Sudden or progressive loss of function of
the kidneys
 Reversible or irreversible
 GFR - <30/ min
 Duration – 3 months or more
Phases of Acute Kidney Injury “memorize 90, minus 30, ½, ½”
Onset > oliguric > diuretic > Recovery

1. Onset/ Initiation: Start of injury/trauma

- without signs and symptoms
2. Oliguric Phase (8-15 days):
- <30 mL/hr = <400ml /day
GFR – remove: BUN = creatinine
H2O – urine
Electrolytes
Froduction of Calcitriol (Vit D) - Abs of Ca
Reabsorptoion of HCO3 (Alk) – low HCO3 –
Metabolic Acidosis
Clinical Manifestations  Vital signs: BP =/ HR
Early signs: “Polyuria”  Monitor: Nuromuscular
 Diet: Low Mg
Kidney (right) if left kidney destroyed  Medications
- High work load - Ca Gluconate
- Avoid: Mg based
- High GFR – High urine output
- Diuretics – Loop

5. Hypephosphaemia: Oliguric / CKD

 Diet: Low Phos
 Medication: Aluminum Hydroxide

6. Hypocalcemia: Oliguric/ CKD

 Diet: high Ca
 Supplement: Vitamin D

7. Metabolic Acidosis: oliguric/ CKD

 Medication: Sodium Bicarbonate ( Na
Management: HCO3)

1. FVE – oliguric/ CKD 8. Anemia: CKD

 Body weight: monitor daily  Laboratory: Hgb=/ HCT

 I & O: monitor  Medication: Epocitin Alfa (epogen)
 Vital signs: monitor  Supplements: iron =/ folic acid
 Lung sounds: auscultate  Procedure: BT ( Hgb7 Px will go to
 Fluid intake: restrict heaven)
 Diet: Low Na 9. Uremia and Azotemia: Oliguric / CKD
 Meds: Diuretics  Monitor: BUN, creatinine =/ LOC
 Avoid: Sedatives
2. FVD: diuretic  Diet: Low protein and high carbs
 Activity: Bed rest
 Body weight: monitor daily
 I & O: monitor
 Vital signs: monitor
 Skin
- dry
- poor skin turgor/tenting
 Fluid intake: replace

3. Hyperkalemia: oliguric / CKD

 Vital signs: monitor HR/PR – irreg – report
 Diet: Low K
 Medication
- Diuretics – loop
- Insulin with dextrose
- Salbutamol
- Calcium Gluconate
- Sodium polysterase sulfnate
4. Hypermagnesemia: CKD
 2. Internal: “gold standard, very fragile,
several weeks to mature”
 AV fistula: most common
 AV graft: artificial
 WOF: arterial steal syndrome. Hematoma,
aneurysm
- decrease arterial flow – hand – pallor
-report
- increase venous flow

Management:

1. Body temperature (Post)

 Elevated – normal
 Feer: infection – report
2. Laboratory: BUN, creatinine =/ CBC
3. Body weight
Before – FVE Nursing Responsibilites: “Arm Precaution”
During – FVD
1. Assess for patency:
After - FVD  Palpate – thrill normal/patency
4. Monitor signs of bleeding  Auscultate – bruit
5. Meals are allowed during meals Absent – Report
6. Withold – H2O soluble (ex. Anti – HTN =/ 2. Avoid – “PP”
Vit. C =/ B  Pressure
7. Complications: Stop =/ Report  Puncture
3. Cannula clamp – exteAV shunt – low
bleeding
Vascular Access:
4. Occlusive dressing – ext (temporary)
1. External (Port) – “portal of entry”
 Subclavian, jugular, and femoral: short
term/ initial / temporary
 AV shunt: can be used immediately
 WOF: infection, bleeding, clotting, skin
erosion
Peritoneal Dialysis Glomerulonephritis
 Semipermeable membrane: peritoneum  Definition: inflammation of the kidneys
 Dialysate (glomerulus)
Content – h2o =/ sugar (hypertonic)  Classification: Autoimmune
Sterile  History: 2 weeks prior – infection
 Insertion site: below the umbilicus (skin/threat)
(Avascular)  Triggering Agent – GABHS
Complications:
1. Peritorvtis
2. hypoglycemia – due to over dwell

Management:
1. Pre-insertion instruction – empty bladder
=/ bowel
2. Warm dialysate: dry heating = dry heating
= vasodilation = inc bood – inc urea excretion
(heating pad) low
abdominal cramps – creatinine = normal
3. Drainage appearance:
- cloudy: infection
- pink / clear / yellow: normal
- red: bleeding
- brown: perforated bowel
- urine/amber: perforated bladder

4. Position – semi fowlers

5. If the drainage stops: “obstruction”
- check patency
- turn the patient side to side – Inc outflow
6. Post monitoring – urine / blood – glucose
Management:
Kidney Transplant 1. Classification: Autoimmune
1. Graft Rejection – “report”  DOC: Immunosuppresant
 Immune response – fever, malaise, inc Ex: strerroids “SONE” PredniSONE
WBC
 Inflammatory response – pain/ tenderness
– incision CKD (oliguric) 2. Fluid Imbalance: FIVE
2. Medications – immunosuppressant –  Monitor: daily monitor
lifetime  Diet: Low Na
 Fluid Intake: restrict
- WOF: infection
 DOC: Diuretics
3. Health teaching – “avoid prolonged
contact to ill person”
3. BP: HTN ( RAAS) Shocked
 DOC: Ace inhibitor “Pril” – anti  Pallor
hypertension  Moist/diaphoresis
4. BUN & Creatinine: high
 Protein: low Disgusted
 Carbohydrate: high  Nausea or Vomiting
 Activity: Bed rest

Most common complication:

5. Lipids: High
Urine obstruction
 Diet: Low fats
 DOC: anti- lipids “statin” - urine statis
- increase bacteria

Renal Calculi / Kidney stone - infection

- high substance =/ H2O- supersaturation

Causes: Management:

 Diet 1. Monitor
o High Calcium  Vital signs: body temp
High Na =/ High Protein – Push Ca  Intake and output: Retention
– kidneys  Strain: retrieve the stone – identify
o High oxalate composition
o High purine – uric acid
 Activity – immobility – Ca (bones) – blood
– hypercalcemia 2. Pain
 Fluid – FVD/ DHN  Analgesics
 Illness – UTI – “struvile store”  Warm compress

Clinical Manfestation 3. Promote Passage of stone

Renal Colic (Kidney)  Fluids: High
 Pain: Dull  Activity: Frequent Ambulation
 Location: Lumbar  Position: Frequent Turning
 Radiating: Umbilicisu
Male: testes
Female: Bladder 4. Diet
 Purine (uric acid) – avoid – “organ meat”
Ureteral Colic  Calcium (Ca phosphate) – avoid – milk,
 Pain: sharp/ wave-like dairy, Na =/ protein
 Location: flank  Oxalate (Ca oxalate) – avoid –
 Radiating: thigh “black/dark”, roots, nuts, soy, grain
- no fruits =/ meat source = spinach
“The client peed, then was shocked and
disgusted”
Peed
 Hematuria
 Frequent retention
 Endocrine Disorders
Increased Hormones – Inc functions > signs
and symptoms < management

“Hypersecretion or Hyposecretion”

A. Pituitary > TSH > TG > Thyroid Hormones

Negative Feedback: 1. T3 - metabolism Parathyroid Gland

Inc TH = Dec TSH - GIT 1. PTH: Inc Ca (blood)
Dec TH = Inc TSH 2. T4 – Heat : Dec Ca (bone)
- Skin : Ca (bonus) – blood
3. Enhance – SNS
Findin Hyperthyroidism Hypothyroidism 2. Calcitonin: Dec Ca (Blood)
gs
Cause - graves disease - Hashimoto’s Disease : Inc Ca (Bone)
> auto immune > autoimmune
> Hyperactive TG – Inc > destroy – T – Dec TH : Ca (Blood) – Bones
TH
Appea - Inflammation / Edema - dec metabolism
rance > fat pads behind the > Inc mucopolusaccharide
eyes > skin (attracts H2O)
“Exophthalmos” “ Myxedema”

Hyperpara Hypopara
- Inc Ca - Dec Ca
- Bone or Kidneys - “TwiTching Spasm”
 2. Mineralocoticoids/ Salt – Aldosterone
“SOREPOEX”
 Na and H2O – retention
 K – excretion

3. Androgen/ Sex – Male characteristics

- facial hair
- inc muscle

Adrenal Glands
PartsL
1. Medulla – Catecholamine
 Epinephrine SNS
 Norepinephrine

2. Cortex – Steroids – GMA/ SSS

 Glucocoticoids/ Sugar
 Mineralocorticoids/ Salt
 Androgen/ Sex

Adrenal Cortex

1. Glucocorticoids/ Sugar – cortisol

 Natural release – high (morning)
 Sugar – Inc.
 Stress – Inc cortisol – “resistance to
stress”
 Suppress – Immune system
 Breakdown – protein (muscle & skin)
 Blocks – absorption of Ca
ADH/ Vasopressin
Dec H2O – P. Pituitary – ADH – Kidneys
H2O retention
- dec urine output
- Inc urine specific gravity
- concentrated = dark

SUMMARY:

SIADH
- sobra – ADH, H2O, USG
- soaked insie – FVE or Low Na
- swollen inside – C. Edema

DI
- dec – ADH, H2O, USG
- dry inside – FVD or Inc Na
- dami inom
- dami ihi
- diluted ihi