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Med-Surg > Adult: Electrolyte/Fluid Balance > Flashcards

Adult: Electrolyte/Fluid Balance Flashcards

1
Q

What are the reasons that edema occurs ?

A
  • decreased oncotic pressure (low plasma protein/albumin)
  • increased hydrostatic pressure (fluid overload, obstruction (clot/tourniquet)
  • increased interstitial oncotic pressure
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2
Q

What is the third space ?

A

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

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3
Q

Where does the blood plasma get the oncotic pressure ?

A
  • protein
  • albumin
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4
Q

How does fluid stay in the vascular system ?

A

capillaries/veins/arteries hold it in
- oncotic pressure pulls the fluid into the blood vessels

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5
Q

What does Anti-Diuretic Hormone (ADH) control ?

A

how much fluid the body holds onto
- activated by stress, decreased BP, and pain

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6
Q

What can disrupt and cause the imbalance in overall body fluid ?

A
  • alterations in ADH
  • thirst mechanism (may decline with age)
  • kidney function (responsible for making urine)
  • GI changes (N,V,D)
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7
Q

What are special considerations about fluid balance for older adults ?

A
  • 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
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8
Q

What is hyperosmolarity ?

A

> 295 mOsm/kg
- increased solute (Na) and decreased water
- deficit

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9
Q

What is hypoosmolarity ?

A

< 275 mOsm/kg
- decreased solute (Na) so increased water
- excess

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10
Q

What are causes of Fluid Volume Deficit ?

A
  • hemorrhage
  • H20 loss/perspiration
  • inadequate fluid intake
  • overuse of diuretics
  • GI loss ( vomit, diarrhea, or suctioning)
  • osmotic diuresis ( increased glucose levels)
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11
Q

What are some signs and symptoms of Fluid Volume Deficit ?

A
  • 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
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12
Q

What is the best indicator for fluid volume gain/loss ?

A

daily weights
- 1 L of fluid= 1 kg body weight
- weight everyday preferable in the morning

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13
Q

What are other ways to assess fluid volume status ?

A
  • I and O’s
  • skin turgor
  • urine specific gravity
  • serum/blood osmolality
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14
Q

What does urine specific gravity say about fluid volume status ?

A

normal= 1.010-1.025
- elevated= urine is concentrated (fluid deficit)
- low= urine is dilute (fluid excess)

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15
Q

What does serum/blood osmolality say about fluid volume status ?

A
  • elevated= fluid deficit
  • low= fluid excess
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16
Q

What is normal plasma osmolality ?

A

280-295 mOsm/kg

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17
Q

What is hyperosmolality ?

A

greater than 295 mOsm/kg
- increased solute (Na), too little water (water deficit)

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18
Q

What is hypoosmolality ?

A

less than 275 mOsm/kg
- decreased solute (Na), too much water (water excess)

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19
Q

What does an elevated Blood Urea Nitrogen (BUN) tell you ?

A

not enough urine to excrete the urea/nitrogen
- so the levels are elevated
- sign of dehydration of renal insufficiency

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20
Q

What are some causes of fluid volume excess ?

A
  • excess Iso/Hypotonic IV fluids
  • heart failure
  • renal/kidney failure
  • syndrome of inappropriate ADH
  • polydipsia
  • cushing syndrome
  • corticosteroids
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21
Q

What are some S&S of fluid volume excess ?

A
  • weight gain
  • peripheral edema
  • jugular venous distension
  • respiratory crackles, dyspnea
  • S3 heart sound
  • bounding pulse
  • elevated BP
  • seizures/coma
  • confusion & changed in LOC
  • HA
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22
Q

If you have fluid volume excess, how may your RBCs appear ?

A

RBCs counts may appear low due to dilution of the blood

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23
Q

What is tx for fluid volume excess ?

A
  • 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)
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24
Q

What are some facts about Furosemide (Lasix) ?

A

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

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25
Q

For Hypotonic fluids, does the water move into or out of the cells ?

A

will move water into the cells
- cells swell

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26
Q

For Hypertonic fluids, does the water move into or out of the cells ?

A

will move water out of the cells
- cells shrink

27
Q

For Isotonic fluids, does the water move into or out of the cells ?

A

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

28
Q

What is the Isotonic fluid ,0.9% Sodium Chloride (NaCl) for ?

A

can increase Na and Cl levels if given in large amounts or if those levels were low

29
Q

What is the Isotonic fluid, Lactated Ringer’s for ?

A

contains Na, K, Cl, Ca and lactate
- good for patient’s experiencing trauma or major GI loss (post-trauma, surgery, etc.)

30
Q

What types of fluids are Isotonic ?

A
  • 0.9% Sodium Chloride (NaCl) aka Normal Saline
  • Lactated Ringer’s
31
Q

What is the Hypotonic fluid, 0.45% Sodium Chloride “1/2 NS” for ?

A

preferred for hypernatremia or for continuous, slow hydration

32
Q

What is the Hypotonic fluid, Dextrose 5% in water for ?

A

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

33
Q

What is the Hypertonic fluid, 3% Sodium Chloride for ?

A

preferred for severe hyponatremia or traumatic head injury
- only given in progressive/intensive care

34
Q

What is the Hypertonic fluid, Dextrose 10% in water for ?

A

preferred for patient with hypoglycemia or risk for hypoglycemia

35
Q

What are some adverse effects for Hypertonic fluids ?

A
  • hypernatremia
  • extracellular fluid volume overload
  • Assess BP, lungs, and Na levels
  • these solutions are vesicants so give via central line if possible
36
Q

What types of fluids are Hypertonic ?

A

3% Sodium Chloride, Dextrose 10% in water

37
Q

What types of fluids are Hypotonic ?

A

0.45% Sodium Chloride “1/2 Normal Saline”, and Dextrose 5% in water

38
Q

What are colloids used for ?

A

to expand volume in the vasculature (blood vessels)

39
Q

What types of fluids are colloids ?

A

Albumin (25% most common) & Packed Red Blood Cells

40
Q

What is the Colloids fluid, Albumin used for ?

A

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)

41
Q

What does Albumin do in the body ?

A

it’s a protein product from blood plasma that helps pull fluid into the blood vessels

42
Q

What is the Colloid fluids, Packed Red Blood Cells used for ?

A

preferred for pt who has lost blood

43
Q

What is the normal values of Sodium and Potassium ?

A
  • Na: 135-145 meq/L
  • K: 3.5-5 meq/L
44
Q

How does Sodium affect the body ?

A
  • 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)
45
Q

How does Potassium affect the body ?

A
  • 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
46
Q

What role does Insulin have in Potassium ?

A

insulin is needed to pull K back into the cells

47
Q

Does a lack of insulin cause Hypo or Hyperkalemia ?

A

hyperkalemia

48
Q

What EKG changes does hypokalemia cause ?

A
  • flattened T Waves
  • prolonged QRS
49
Q

What EKG changes does hyperkalemia cause ?

A
  • tall/peaked T waves
  • wide QRS
50
Q

Why don’t we give IV Potassium IV push or fast ?

A

can cause cardiac arrest

51
Q

Before giving someone supplemental K, what do we have to ensure the pt is doing ?

A

have to be voiding because we get rid of excess Potassium through excretion

52
Q

If a pt is experiencing Hyperkalemia then what meds should we give ?

A
  • 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
53
Q

What foods are rich in Potassium ?

A
  • potato
  • broccoli
  • banana
  • tomato
54
Q

What are some facts about Sodium Polystyrene (Kayexalate) ?

A

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

55
Q

What are some causes of hypokalemia ?

A
  • 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)
56
Q

What are some S&S of hypokalemia ?

A
  • leg cramps/muscle weakness
  • irregular pulse
  • fatigue, irritability
  • EKG changes: flattened T-waves, prolonged QRS
  • shallow respirations
  • decreased muscle tone/reflexes
57
Q

What are some causes of Hyperkalemia ?

A
  • 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
58
Q

What are some S&S of hyperkalemia ?

A
  • 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)
59
Q

What are some tx for hyperkalemia ?

A
  • 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)
60
Q

What are some causes of hyponatremia ?

A
  • GI loss (V/D)
  • diuretics, adrenal insufficiency
  • burns, draining wounds
  • excessive hypotonic IV fluid
  • polydipsia
  • diseases causing fluid retention (heart failure and cirrhosis)
61
Q

What are some S&S of hyponatremia ?

A
  • confusion
  • fatigue and feeling of weakness
  • low BP
  • loss of consciousness
  • convulsions/seizures
  • N and V
62
Q

What are some causes of hypernatremia ?

A
  • 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
63
Q

What are some S&S of hypernatremia ?

A
  • 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

Med-Surg (7 decks)

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