Renin-Angiotensin-Aldosterone Angiotensin II 1. Stimulates production of aldosterone 2. Acts directly on arterioles to cause vasoconstriction 3. Stimulates Na + /H + exchange in the proximal tubule Aldosterone 1. Stimulates reabsorption of Na + and excretion of K + in the late distal tubule 2. Stimulates activity of H + ATPase pumps in the late distal tubule
IV Solutions D5NS D51/2 NS NS ½ NS D50W D10W D5W Hypotonic in the body D5W Hypertonic Hypertonic Isotonic Hypotonic Hypertonic Hypertonic Isotonic Hypertonic Hypertonic Hypertonic Hypertonic Hypertonic Isotonic Hypertonic PRBC’s Hetastarch Dextran Albumin D5LR LR 3% NaCl
IV Solutions Pulls fluid into vascular space Hypertonic Solutions Hydrates extracellular compartment Isotonic Solutions Used for cellular dehydration Not used with head injuries Hypotonic Solutions Hypotonic in the body D5W
Daily Fluid Balance Intake: 1-1.5 L Insensible Loss - Lungs 0.3 L - Sweat 0.1 L Urine: 1.0 to 1.5 L
Intracellular (2/3) Extracellular (1/3) Solids 40% of Wt H 2 O H 2 O Na
Intra-vascular( 1/4) E.C . F . COMPARTMENTS Interstitial (3/4) H 2 O H 2 O Na Na Colloids & RBC’s
Caused by over-activation of the clotting pathways
Causes widespread fibrin deposits
Bleeding and renal failure are most common manifestations
Treating the underlying disease is the most important step
Disseminated Intravascular Coagulation Systemic activation of coagulation Intravascular deposition of fibrin Depletion of platelets and coagulation factors BLEEDING Thrombosis of small and midsize vessels with organ failure
Khurana, V. G., Friedman, J. A., Meyer, F. B. (2004). Chapter 11: Biology of Cerebral Blood Vessels and Blood Flow. In Le Roux, P. D., Winn, H. R., Newell, D. W. (eds). Management of Cerebral Aneurysms, Philadelphia, WB Saunders, pp 139-167, 2003.
Marino, P. L. (2006, September). The ICU Book. Lippincott Williams & Wilkins: Philadelphia.
Metheny, N. (2000). Fluid and Electrolyte Balance: Nursing Considerations (4th ed.) Philadelphia: Lippincott Williams & Wilkins; (4)158-200.
Nettina, S. M. (2005). Diseases and Disorders in Lippincott Manual of Nursing Practice Handbook (3rd ed.), page 414.
Rivers, E. P. (2006, February). Early goal-directed therapy in severe sepsis and septic shock: converting science to reality. Chest; 129(2):217-8.
Rucker, D. (2006, June). Diabetic Ketoacidosis. Retrieved Feb 28, 2007 from http://www.emedicine.com/emerg/topic135.htm.
Schmidt, T. (2000). “Assessing a Sodium and Fluid Imbalance”, Nursing 2000; (30) Number 1, p18.
Sterns, R.H., Silver, S. M., Spital, A., Robertson, G. L., Seldin, D. W., Giebisch, G. (2000). The Kidney: Physiology & Pathophysiology. Philadelphia PA: Lippincott Williams & Wilkins, Inc; pgs. 1133–52 & 1217–38.
Thelan, L. A., Urden, L. D., Lough, M. E. (2006). Critical care: Diagnosis and Treatment for repair of abdominal aortic aneurysm. St. Louis, Mo.: Mosby/Elsevier. pg 145-188.
Urden, L., Lough, M. E. & Stacy, K. L. (2005). Thelan's Critical Care Nursing: Diagnosis and Management (5th ed). S