Adult: Electrolyte/Fluid Balance Flashcards
What are the reasons that edema occurs ?
- decreased oncotic pressure (low plasma protein/albumin)
- increased hydrostatic pressure (fluid overload, obstruction (clot/tourniquet)
- increased interstitial oncotic pressure
What is the third space ?
fluid accumulation in non-functional areas between cells where it is difficult/impossible to move back into cells or blood vessels
- pleural cavity, or peritoneal cavity
Where does the blood plasma get the oncotic pressure ?
- protein
- albumin
How does fluid stay in the vascular system ?
capillaries/veins/arteries hold it in
- oncotic pressure pulls the fluid into the blood vessels
What does Anti-Diuretic Hormone (ADH) control ?
how much fluid the body holds onto
- activated by stress, decreased BP, and pain
What can disrupt and cause the imbalance in overall body fluid ?
- alterations in ADH
- thirst mechanism (may decline with age)
- kidney function (responsible for making urine)
- GI changes (N,V,D)
What are special considerations about fluid balance for older adults ?
- can lose the function of thirst mechanism
- hormonal changes can increase risk of fluid and electrolyte imbalances
- loss of subQ tissue can lead to increase loss of moisture
What is hyperosmolarity ?
> 295 mOsm/kg
- increased solute (Na) and decreased water
- deficit
What is hypoosmolarity ?
< 275 mOsm/kg
- decreased solute (Na) so increased water
- excess
What are causes of Fluid Volume Deficit ?
- hemorrhage
- H20 loss/perspiration
- inadequate fluid intake
- overuse of diuretics
- GI loss ( vomit, diarrhea, or suctioning)
- osmotic diuresis ( increased glucose levels)
What are some signs and symptoms of Fluid Volume Deficit ?
- thirst
- dry mucous membranes
- cold, clammy skin
- weight loss
- decreased urine output and concentrated urine
- decreased skin turgor
- postural hypotension
- tachycardia and increased respirations
- seizures/coma
- confusion and restlessness
What is the best indicator for fluid volume gain/loss ?
daily weights
- 1 L of fluid= 1 kg body weight
- weight everyday preferable in the morning
What are other ways to assess fluid volume status ?
- I and O’s
- skin turgor
- urine specific gravity
- serum/blood osmolality
What does urine specific gravity say about fluid volume status ?
normal= 1.010-1.025
- elevated= urine is concentrated (fluid deficit)
- low= urine is dilute (fluid excess)
What does serum/blood osmolality say about fluid volume status ?
- elevated= fluid deficit
- low= fluid excess
What is normal plasma osmolality ?
280-295 mOsm/kg
What is hyperosmolality ?
greater than 295 mOsm/kg
- increased solute (Na), too little water (water deficit)
What is hypoosmolality ?
less than 275 mOsm/kg
- decreased solute (Na), too much water (water excess)
What does an elevated Blood Urea Nitrogen (BUN) tell you ?
not enough urine to excrete the urea/nitrogen
- so the levels are elevated
- sign of dehydration of renal insufficiency
What are some causes of fluid volume excess ?
- excess Iso/Hypotonic IV fluids
- heart failure
- renal/kidney failure
- syndrome of inappropriate ADH
- polydipsia
- cushing syndrome
- corticosteroids
What are some S&S of fluid volume excess ?
- weight gain
- peripheral edema
- jugular venous distension
- respiratory crackles, dyspnea
- S3 heart sound
- bounding pulse
- elevated BP
- seizures/coma
- confusion & changed in LOC
- HA
If you have fluid volume excess, how may your RBCs appear ?
RBCs counts may appear low due to dilution of the blood
What is tx for fluid volume excess ?
- diuretics
- fluid restriction
- paracentesis or thoracentesis if fluid is in the peritoneal or thoracic cavity
- skin care
- elevate edematous extremities (not if pt’s has HF because it puts extra work on the heart and fluid goes to the heart)
What are some facts about Furosemide (Lasix) ?
Loop diuretic
- Assessments: I&O’s, BP (can decrease), assess for fluid excess/deficit, Potassium levels
- Admin: given PO or IV push (when IV push give slow if not it can cause ototoxicity so it can cause ears to ring and temporary hearing loss)
- Adverse Effects: dehydration (too much urine output), Hypokalemia
For Hypotonic fluids, does the water move into or out of the cells ?
will move water into the cells
- cells swell
For Hypertonic fluids, does the water move into or out of the cells ?
will move water out of the cells
- cells shrink
For Isotonic fluids, does the water move into or out of the cells ?
there is no water shift
- fluid has the same osmolality as the cell interior
- only fluid that can be given fast
- preferred for fluid volume deficit
What is the Isotonic fluid ,0.9% Sodium Chloride (NaCl) for ?
can increase Na and Cl levels if given in large amounts or if those levels were low
What is the Isotonic fluid, Lactated Ringer’s for ?
contains Na, K, Cl, Ca and lactate
- good for patient’s experiencing trauma or major GI loss (post-trauma, surgery, etc.)
What types of fluids are Isotonic ?
- 0.9% Sodium Chloride (NaCl) aka Normal Saline
- Lactated Ringer’s
What is the Hypotonic fluid, 0.45% Sodium Chloride “1/2 NS” for ?
preferred for hypernatremia or for continuous, slow hydration
What is the Hypotonic fluid, Dextrose 5% in water for ?
preferred for pt needing some dextrose/calories and continuous slow cell hydration, also for hypernatremia
- dextrose is quickly absorbed so you are basically giving straight water
What is the Hypertonic fluid, 3% Sodium Chloride for ?
preferred for severe hyponatremia or traumatic head injury
- only given in progressive/intensive care
What is the Hypertonic fluid, Dextrose 10% in water for ?
preferred for patient with hypoglycemia or risk for hypoglycemia
What are some adverse effects for Hypertonic fluids ?
- hypernatremia
- extracellular fluid volume overload
- Assess BP, lungs, and Na levels
- these solutions are vesicants so give via central line if possible
What types of fluids are Hypertonic ?
3% Sodium Chloride, Dextrose 10% in water
What types of fluids are Hypotonic ?
0.45% Sodium Chloride “1/2 Normal Saline”, and Dextrose 5% in water
What are colloids used for ?
to expand volume in the vasculature (blood vessels)
What types of fluids are colloids ?
Albumin (25% most common) & Packed Red Blood Cells
What is the Colloids fluid, Albumin used for ?
preferred for cirrhosis (low protein) patients, burns, ascites
- may be given in lower concentrations to increase the plasma volume (5% will not pull fluid in)
What does Albumin do in the body ?
it’s a protein product from blood plasma that helps pull fluid into the blood vessels
What is the Colloid fluids, Packed Red Blood Cells used for ?
preferred for pt who has lost blood
What is the normal values of Sodium and Potassium ?
- Na: 135-145 meq/L
- K: 3.5-5 meq/L
How does Sodium affect the body ?
- primary determinant in the way fluid shifts in the body
- helps generate/transmit nerve impulses
- primary determinant of osmolality
- impacts both neuro like (muscles and brain function)
How does Potassium affect the body ?
- main factor in resting potential of nerve and muscle cells
- impacts neuromuscular and cardiac function
- excreted via urine so kidney function is key to proper excretion of K
What role does Insulin have in Potassium ?
insulin is needed to pull K back into the cells
Does a lack of insulin cause Hypo or Hyperkalemia ?
hyperkalemia
What EKG changes does hypokalemia cause ?
- flattened T Waves
- prolonged QRS
What EKG changes does hyperkalemia cause ?
- tall/peaked T waves
- wide QRS
Why don’t we give IV Potassium IV push or fast ?
can cause cardiac arrest
Before giving someone supplemental K, what do we have to ensure the pt is doing ?
have to be voiding because we get rid of excess Potassium through excretion
If a pt is experiencing Hyperkalemia then what meds should we give ?
- Meds to decrease K levels: Diuretics (Furosemide), Sodium Polystyrene (Kayexalate), and Sodium Zirconium (Lokelma)
- Calcium Gluconate is also given to protect the cardiac cells from serious dysrhythmias
What foods are rich in Potassium ?
- potato
- broccoli
- banana
- tomato
What are some facts about Sodium Polystyrene (Kayexalate) ?
Cation Exchange Resin: exchanges K+ ions for Na ions in the intestine
- excretes the K+ by way of GI tract (pt will poop)
- Assessments: output and K+ levels
- Adverse Effects: abdominal cramping, diarrhea, Hypernatremia, loss of Mg and Ca
- Admin: given orally (liquid), NG tube, or enema
What are some causes of hypokalemia ?
- GI loss (N/D) and skin loss (diaphoresis)
- renal loss/urination, and suctioning
- dialysis
- poor diet/starvation, fasting
- Meds: diuretics (furosemide), and insulin (in large amounts)
What are some S&S of hypokalemia ?
- leg cramps/muscle weakness
- irregular pulse
- fatigue, irritability
- EKG changes: flattened T-waves, prolonged QRS
- shallow respirations
- decreased muscle tone/reflexes
What are some causes of Hyperkalemia ?
- excessive K+ intake
- rapid admin of IV fluids with K+
- renal/kidney disease
- adrenal insufficiency
- Addison’s disease
- Meds: ACE inhibitors “prils”, K+ sparring diuretics (spironolactone)
- lack of insulin
What are some S&S of hyperkalemia ?
- muscle cramps/twitching
- urine abnormalities (oliguria)
- respiratory distress
- decreased cardiac contractility and palpations
- EKG changes: tall/peaked T-Waves, wide QRS)
- reflexes (hypo or hyper-reflexive)
What are some tx for hyperkalemia ?
- encourage excretion via diuretic or bowel movement
- severe kidney failure pt’s may need dialysis
- insulin IV push will draw K+ back into the cells and B-agonist (albuterol) for more effectiveness (with D50 to prevent hypoglycemia)
What are some causes of hyponatremia ?
- GI loss (V/D)
- diuretics, adrenal insufficiency
- burns, draining wounds
- excessive hypotonic IV fluid
- polydipsia
- diseases causing fluid retention (heart failure and cirrhosis)
What are some S&S of hyponatremia ?
- confusion
- fatigue and feeling of weakness
- low BP
- loss of consciousness
- convulsions/seizures
- N and V
What are some causes of hypernatremia ?
- hypertonic IV fluid or excessive isotonic
- hypertonic tube feed without enough H2O
- insufficient H2O intake and drowning in salt water
- loss of pure H2O like in high fevers, heatstroke, prolonged hyperventilation
- Endocrine related syndromes: Cushing’s syndrome, Diabetes Insipidus, hyperaldosteronism
What are some S&S of hypernatremia ?
- flushed skin and fever (low grade)
- restlessness, irritable, anxious and confused
- increased BP and fluid retention
- edema (peripheral) and pitting
- decrease urine output and dry mouth
- thirst
