avid two Ira Ote cand Mfc id BASee Inobalances S ShiftsofPlasmatointerstitalFluid Edema Anaccumulation offluid intheinterstitalspaceoccursif venoushydrostatic pressure risesplasmaoncoticpressure d orinterstitaloncoticpressurerises Edema mayalsodevelop it an obstructionof lymphaticoutflow causes a removalof interstitialfluids ofAvenouspressureinclude Causes HF Liverfailure ofvenousreturntotheheart Obstruction Venousinsufficiency Elevationofvenous hydrostaticpressure Tthepressureatthevenousendofthe capillaryinhibitsfluidmovementbackintothe capillary Decrease in plasmaoncoticpressure Fluidremains intheinterstitalspace if the plasmaoncoticpressureistoolowtodraw fluidbackintothecapillary lowplasmaproteincontentd oncotic pressure Resultsfrom Proteinlossrenaldisorders disease I I1 y u l d ie Malnutrition Elevationofinterstitalonloticpressure Traumasbumsandinflammationcan damage capillarywallsand allowplasmaproteins to aaumilateintheinterstitalspace This P interstitaloncotic pressuredrawsfluidintotheinterstitalspaceandholds it there Shifts of interstital fluidto Plasma T in plasma osmotic onloticpressuredrawsfluidintotheplasmafromtheinterstital space Thiscouldhappen with administration of Colloids Dextran Hypertonic solutions Wearingelasticcompression gradientstockings orhowto d peripheraledema is atherapeutic applicationofthis effect Fluidspacing Firstspacing Describesthenormal distribution offluidin ICFand Elf compartments Second spacing refersto an abnormalaccumilation ofinterstitalfluidedema Thirdspacing Occurs whenexcessfluidcollects inthe nonfunctionalareabetweencells bloodvessels Thirdspacingoccurswithascitesfluidleakingintotheabdominalcavity withperitonitisor pancreatitisandedema associatedwithbumstraumasepsis Hypothalamic PituitaryRegulation Abodyfluiddeficitor T in plasma osmolarityactivatesosmoreceptors in the hypothalamus whichstimulatethirstandthereleaseofADItfromtheposterior pituitaryglandADIt acts onthedistaltubulesandcollecting ducts inthekidneybymakingthemmore permeableto H2O ADIt isonlyableto regulate howmuchH2othebody holdsonto LBP nauseapainhypoglycemiaandhypoxemiastimulate ADArelease In postoperativepatientthestress responsetosurgeryandrelieving analgesicsandanesthesia causeADAreleaseandd osmolarity osmolarity Impaired or cognitivelyimpairedptis at t riskforfluiddeficitandhyper ofaninabilitytoexpressthirstandacton it because RenalRegulation Thekidneysfilterthetotalplasmavolume Kidneysabsorbabout991offiltrateproducing 1.5Lofurineperday Undertheinfluence ofADHaldosterone andotherhormonesselectivereabsorption andsecretion of H2oandelectrolytes intherenaltubulesresultin urinethatis differentincompositionand concentrationfrom plasma Thisprocesshelpsmaintainnormal plasma osmolarityelectrolyte balancebloodvolumeandacidbasebalance Withseverely impairedrenalfunction Edema Potassium Acidosis retention d p in is Adrenalcorticalregulation toregulateH2Oandelectrolytes Releaseshormones Glucocorticoidsteroids Cortisol s Mineralocorticoid Aldosterone Cardiacregulation NatriureticpeptidesareantagoniststotheRAAS bycardiomyocytes inresponseto 4Atrialpressure They suppresssecretion ofaldosterone Renin andADIt to d bloodvolumeandpressure Hormonesmade GlRegulation Oralintakeaccountsfor mostHao Small amountseliminatedbyGltractinfeces Diarrheaandvomitingcanleadtosignificantfluidandelectrolyteloss Gerontologic Considerations Structuralchanges inkidneysdecreaseabilitytoconserveH2O Hormonalchanges d inRenin Aldosterone I Tin ADH Pin AND Fluid and electrolyte Imbalances byillnessordisease Directly caused Bums HF Resultoftheraputicmeasures Colonoscopy preparation Diuretics Extracellular FluidVolumeImbalances Hyporolemia Abnormallossof bodyfluidsinadequatefluidintake or plasma tointerstitalfluidshift Dehydration Lossof purewaterwithoutcorrespondinglossofsodium InterprofessionalcareforEFC deficits Correcttheunderlying causeandreplacewaterandelectrolytes Nursingdiagnosis Orally Bloodproducts Balanced solutions Fluidimbalance Impairedco Acuteconfusion Potentialcomplication Hyporolemic shock I dis ons Hypervolemia offluidsorintestital to plasma Excessintake abnormalretention fluidshift NursingDiagnosis imbalance Manifestationsweightgain Fluid Impairedgasexchange Potentialcomplications pulmonaryedema Impairedtissueintegrity Ascities Activityintolerance Nursingimplementations Disturbedbodyimage DW orcare skincare Ilo's RTcare skinturgo Interprofessionalcare tabs safety Removefluid w outchangingelectrolyte composition orosmolarity Diuretics Fluidrestrictions Sodium restrictions Removal offluidtotreatascities or plueraleffusion hyponatremia hyperNatremia InadequateH2ointake loss ofsodium containingfluids H2oexcess Excess H2Oloss or sodiumgain Manifestations Primaryprotection Mildheadache Manifestations Irratibility isthirstphyyy Changes inmentalstatus Drowsiness seizurescoma tachycardia Restlessness posturalhypotension confusion Sodium Efcvolumeconcentration.MYfractility Difficulty concentrating Moresevere confusion vomiting I rgy gl Editinga dbasebalance NursingDiagnosis s Cma g NursingDiagnosis Electrolyteimbalance Electrolyteimbalance Fluidimbalance Riskforinjury Riskforinjury Acuteconfusion Treatment Isotonicfluids Potentialcomplicationseizurescoma Treatment severecases 5 dextrose in Hao thatblock Vasopressorsldings shouldnot activityof ADH bbymorethan1815meall in an 8 hr period conivaptancNpreventhoex Quicklyreducinglevelscancausecerebral tovaptan HF levelsshouldnottmorethance12min Edema perhrinthefirst24hrsandI8mEqlL orlessperhrthefirst48hr5 hyperkalemia hypokalemia lowsemmktcausedby Highsemmpotassiumcanadby ShiftfromICF ECF flossof ktviarenal Gl Tshift of Kt from ECF ICF mostcommoncauseRenalFailure Dietaryktdeficency impairedrenalexcretion Manifestations Dynamics 22397 3.5 1 Renal lossfrom diuretics Manifestations Fatigueconfusion or Tetnaymusclecramps skeletalmuscles legs weakness Weakparalyzed skeletalmuscles Weaknessof Resp muscles Abdominalcrampinganddiarrhea tail motility NursingDiagnosis Hyperglycemia I yl g m g ElectrolyteImbalance Activityintolerance Impairedco Activityintolerance Potentialcomplication Impaired CO Potentialcomplication dysrhythmias dysrhythmias Nursing implementation stopintake of Kt NursingImplementation KclsupplementsDOIN I excretion Diuretics Thiazide Alwaysdilutelvka Dialysis NeverPushORBolusKcl Veltessa shouldnotexceedlomeall Kayexalate Usean infusionpump ForcektfromECF ICFby potassium IVinsulin w dextroseanda B a'growth maintenanceof rhythm necessaryfor gation Restingmembranepotential ofnerveand adrenergicagonistorsodium bicarbonate bykidneys BUNcreatinine Regulated StabalizeCalciumcellmembrane w labs urineoutput 0.5mikgperhour calcium gluconate IV Usecontinuous ECGmonitoring hyperphosphatemia hypophosphatemia by Highsemm Poy caused low semm 17043 caused by Acutekidneyinjuryor chronicdisease malnourishment malabsorption Excess intake of phosphate or Vitamin D diarrhea Hyperparathyroidism Manifestations Tethay Useof phosphate bindingantiacid 30 Inadequate replacementduring Cul5umEall musclecramps parentreal nutrition Manifestations I y y seizures hypocalcemia cist Calcified deposition in softtissuesuch Muscleweaknessandpain as joints arteriesskinkidneysandcomeas Resp and HF Ricketsand osteomalacia causeorgan dysfunction Management management Restrictintake oral supplementatio Oralphosphatebindingantacids Ingestion offoods tin phosphorus N administration of sodiumorkt Hemodialysis Volumeexpansionandforced diuresis monitorhmm calciumlevels every 6 12hr Correct any hypocalcemia Phosphate byparathywidism controlled PrimaryanionICF renal Requiresadequate NStunct formusclefunctionRBC production Essential AvidbasebutteringsystemATP cellularuptakeofglucowicarbmetabolism hypercalcemia hypercalcemia Highlevels of semm calciumcausedby Hyperparathyroidism Two thirdsofcases Cancer Manifestations MmmÉ lowsemmCalciumlevelscaused I production ofPat by Multiplebloodtransfusions Alkalosis Fatigue coma Lethargy Dysrhythmias Weakness Bonepainfractures Postivetrousseau's orchrostels's confusion Nephrolithiasis Laryngealstridor Hallucinations Polyuriadehydration seizures NursingDiagnosis ElectrolyteImbalance confusion Pcalciumloss Manifestations Dysphasia Numbness and tingling around themouthorintheextremities Dysrhythmias is g g Impairedphysicalmobility ElectrolyteImbalance Potentialcomplication Dysrhythmias Impaired breathing ActivityIntolerance NursingImplementation lowcalciumdiet Potentialcomplication fracture Tweightbearingactivity Resparrest NursingImplementation Tfluidintake Hydration w Isotonicsalineinfusion Treat cause Bisphosphonates goldstandard CalciumandVitamin D Calcatonin supplements Calcium oprenntinbones plasma Fomationofteethandbone controlledbyparathyroid Bloodclotting Needvitamin1 toabsorb Transmissionotheweimpulses ochangesinalbuminettect levels Myocardialcontractions musclecontractions N calcium gluconate Rebreatherinto paperbag Treatpainandanxietytopreven hyperventilationinduced Resp Alkalosis hypermagnesemia hypomagnesemia HighsemmMg caused by LowsemmMgcanadby Tintake ofproducts containing Prolongedfastingorstarration Mgwhenrenalinsufficencyor chronicalcoholism failureis present Fluidlossfromattract Excess NMg administration Manifestations Eql hdmn Prolongedparenteralnutritionwout supplementation hypotension.hnflushing13 Diuretics PPI's Lethargy Hyperglycemic osmoticdiuresis Nauseaandvomiting manifestations impaireddeeptendonreflexes Resembleshypocalcemia Muscleparalysis Muscle crampstremors Cardiacarrest tendon I p ai Management dp Chrosteksitrousnan's signs Restrict Mgintake contusionVertigoseizures NCactorcalciumgluconateit Dysrhythmias Management symptomatic FluidsandNfurosemidetopromote oralsupplements urinaryexcretion Adietaryintake Parenteral NorIM magnesium Dialysis magnesium bykidneys metabolism cofactorinenzymefor ofcarbs DNAproteinsynthesis Bloodglucosecontrol BP regulation Myoneuraljunction excreted Nomalerfunctionoabroybefinal whensevere