What is the difference between an ECV imbalance and an osmolality imbalance?
ECV: sodium and water are equally lost or gained
osmolality: sodium OR water are lost OR gained
what are four causes for post-operative fluid gain?
- IV fluids
- feeding tubes
- fluid retention from PSR
- blood transfusion
Which electrolyte most affects water balance within the body?
sodium
Which electrolyte is most abundant intracellularly?
potassium
what is an example of hyponatremia from decreased sodium intake?
sodium restricted diet
what is an example of hyponatremia from increased renal sodium loss?
thiazide diuretics, adrenal insufficiency
what is an example of hyponatremia from increased GI sodium loss?
vomiting, NG suctioning, diarrhea
what is an example of hyponatremia from increased water intake?
pure water intake to replace body fluid losses, too much hypotonic IV fluids
what is an example of hyponatremia from decreased water loss?
elevated ADH (caused by PSR, HF, SIADH)
How does hyperglycemia contribute to hyponatremia?
hyperglycemia pulls fluid out of cells and into the blood (ECF) which dilutes sodium concentration in plasma (early response)
How does hyperglycemia contribute to hypernatremia?
hyperglycemia causes osmotic diuresis, water gets lost with the glucose in the urine, sodium gets more concentrated (later response)
Does ascites count as fluid floss or gain?
LOSS: because fluid is shifting out of the intravascular space and into body cavity
What is the tonicity of sweat
hypotonic–> it starts off as an isotonic fluid when produced in the sweat gland, but electrolytes get resorbed as the sweat reaches the skin surface
Which hormone increases blood volume and pressure, but decreases blood sodium concentration?
ADH
Which hormone causes renal sodium and water resorption, and potassium loss?
aldosterone
which hormone causes renal sodium and water loss?
natriuretic peptide
Is it possible to gain water if you have sodium gain-related hypernatremia?
yes, you just have to be gaining more sodium than water
how does adrenal insufficiency cause hyponatremia?
aldosterone insufficiency leads to losing sodium in the urine
Explain how vomit/ng/diarrhea be isotonic and still cause hyponatremia?
if sodium and water are lost in the same amount there will be a decrease in fluids, ADH is released in response to volume loss causing renal water resorption
Client has headache/confusion. Why is this related to hyponatremia?
Low ECF osmolality (from water loss), water shifts by osmosis from the ECF to the ICF which causes cellular swelling —> when brain cells swell causes headache/confusion
What happens to the RMP of cells when hyponatremia occurs?
sodium concentration gradient is needed for depolarization/AP gen.
* hyponatremia makes depolarization slower
What are the clinical manifestations of hyponatremia?
- Neuro: headache, N/V, confusion, ataxia, seizures, coma (severe)
- skeletal muscle: cramps/weakness
- GI smooth muscle: constipation (severe)
What are the signs and symptoms related to hyponatremia from vomiting? (hypovolemic hyponatremia)
Increased HR
orthostatic hypotension
weak pulse
What are the signs and symptoms related to hyponatremia from heart failure? (hypervolemic hyponatremia)
edema, dyspnea, weight gain
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Module 3 Post-Op Pain29
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Module 1 Perioperative Environment20
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Module 1 PSR26
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Module 2 Inflammation and Arthritis30
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Module 2 Osteoarthritis18
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Module 4 Tissue Integrity11
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Module 4 Post-Op Infection19
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Module 5 Elimination38
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Module 5 Elimination Part 217
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Module 6 Antibiotics12
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Module 7 Thermoregulation25
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Module 8 Venous Thrombosis34
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Module 9 Sodium33
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Module 9 Potassium18
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Module 10 CAD/Angina/MI52
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Module 11 Cancer Part 145
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Module 11 Cancer Part 229
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extra questions for final19
