Chapter 08: Fluids and Electrolytes (1)

bilaterally 쌍방의
Hyperkalemia : Tall peaked T waves, widened QRS waves, bradycardia
Chvostek's sign 은 hypocalcemia의 대표적인 증상이다.
mEq : miliequivalent = activity of an electrolyte
 
substance : 물질
solution : 용매제
lonize : 이온화되다
molecule : 분자
dissociate : 해리, 해체되다
 
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compartment : 구역, 구획
interstitial : 세포 사이, 틈새
ICF : Intracellular fluid
ECF : Extracellular fluid
 
Third - spacing : accumulation of trapped extracellular fluid ,, ex) ascites
accumulation : 축적, 쌓임
premeability : 투과성
dissociate : 해리되다, 분리되다
 
diffusion : 확산
semipermeable : 반투과성의
osmosis : 삼투
gradient : 기울기
 
fever ? water loss → 대사항진 및 땀배출 
breathing ( lungs ) ? water loss → 호흡시에도 수분배출
 
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- Adrenal glands : aldosterone control extracellular fluid / Sodium reabsorption - 신장 위 부신피질
- Antidiuretic hormone ( pituitary gland ) : regulates osmotic pressure of extracellular fluid by water reabsorption from kidney.
 
If the client has afluid or an electrolyte imbalance, the nurse must closely monitor the client's cardiovascular, respiratory, neurological, musculoskeletal, renal, integumentary, and gastrointestinal status.
 
pituitary gland : 뇌하수체
homeostatis : 항상성
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Dehydration
 
treatment goal ? restore fluid volume, replace elctrolytes, eliminate the cause of the fluid volume deficit.
 
- Isotonic 등장성 dehydration : hypovolemia.The most common type of dyhydration. Decrease circulating blood & inadequate tissue perfusion   Ex) bleeding
 
- Hypertonic 고장성 dehydration : more water loss → electrolyte loss. Cellular dehydration and shrinkage
→ Ketoacidosis, prolonged fevers, diarrhea, diabetes insipidus 요붕증
수분 부족으로 전해질만 남아버림
 
- Hypotonic dehydration :  electrolyte loss → water loss. Cell swelling
→ excessive fluid replacement ( hypotonic fluid,, Ex) 5%DW ) , chronic malnutrition
 
hyper/hypo-tonic dehydration은 호르몬 등 내과적 문제 로 발생
 
tissue
perfusion
 
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Overhydration or Fluid overload
 
- Isotonic overhydration : hypervolemia, circulatory overload, interstitial edema, pulmonary edema 
→ Kidney disease, long term steroid, heat failure,, ESRD, Dialysis patient
 
- Hypertonic overhydration : excessive sodium intake, ICF → ECF
→ Excessive sodiumingestion,rapid infusion of hypertonics
 
- Hypotonic overhydration : water intoxication, all body fluid compartments expands ECF → ICF
→ HF, Syndrome of inappropriate antidiuretic hormone secretion, isotonic fluid replacement, irrigation of wounds and body cavities,,
→ 보통뇌하수체 문제, wound irrigation 시에도 발생 가능.
 
A client with acute kidney injury, chronic kidney disease,and heart failure is at high risk for fluid volume excess.
 
intoxication : 중독
 
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fluid overoad 인 경우 Liver enlargement →  우심방으로 들어가는 정맥귀환량이 많을 경우 상대정맥 (SVC)이 정체되어 상대정맥과 연결된 Liver 붓게된다.(당연히 하대정맥 IVC 압 상승 ) lab을 본다면 간수치 상승.

orthostatic hypotension : 기립성 저혈압
lethargy : 무기력
skin turgor : 피부 팽압
tenting : 꼬집었을 경우 텐트처럼 피부 늘어남ltation
moist crackles : 악설음(나음), 대표적인 pulmonary endema 증상.auscultation : 청진법compenstate : 보상하다