The document discusses various topics related to renal alterations, electrolyte disturbances, intravenous fluid therapy, and neurological alterations. It provides objectives, definitions, signs and symptoms, causes, and treatments for various conditions including acute renal failure, electrolyte imbalances, intravenous fluid types, and more. The document is an educational review intended to enhance understanding of critical care nursing concepts.

8. The Kidney

9. The Nephron

13. Urine Formation

24. Pre-Renal or Intra-Renal?

29. Electrolyte Disturbances Na+ Ca++ Cl- Mg+ K+ PO 4 NH 3 Cu HCO 3 - NaCl

37. Sine Wave

64. 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

67. Effect on Cells

68. 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

69. 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

70. 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

71. Intracellular (2/3) Extracellular (1/3) Solids 40% of Wt H 2 O H 2 O Na

72. Intra-vascular( 1/4) E.C . F . COMPARTMENTS Interstitial (3/4) H 2 O H 2 O Na Na Colloids & RBC’s

76. 1 liter 5% Albumin Intravascular=1 liter Total body water ECF

77. 1 Liter 0.9% saline Total body water ECF=1 liter ICF=0 Intravascular =1/4 ECF=250 ml Interstitial=3/4 of ECF=750ml

78. 1 liter 5% Dextrose Total body water ECF=1/3 = 300ml ICF=2/3 = 700ml Intravascular =1/4 of ECF~75ml

82. The Human Brain

83. Cerebral Spinal Fluid The serum-like fluid that circulates through the ventricles of the brain, the cavity of the spinal cord, and the subarachnoid space

87. Brain Circulation

88. Arterial Circulation in the Brain

93. Arterio-Venous Malformation

119. Stroke

120. Stroke

147. 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

149. DIC

168. Homeostasis Gets Lost