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Med Surg I > Ch 14: Fluid and Electrolytes Quiz > Flashcards

Ch 14: Fluid and Electrolytes Quiz Flashcards

1
Q

Osmosis

A

movement of water across semi-permeable membrane from low solute concentration to high solute concentration.

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2
Q

Osmolality

A

of particles of solute in a unit of fluid based on weight (blood, urine)

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3
Q

Osmolarity

A

of particles of solute in a unit of fluid based on volume. (Spec. gravity)

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4
Q

Tonicity

A

ability of solutes to cause an osmotic driving force and promote water movement from one compartment to another.

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5
Q

Adrenal gland

A

releases aldosterone in response to decreased Na+, or increased K+ or renin.

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6
Q

Parathyroid

A

regulates calcium and phosphate. Secretes PTH which causes bone resorption, calcium absorption from intestines, calcium reabsorption from renal tubules.

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7
Q

Renin-Angiotensin-Aldosterone System

A
  • Renin = enzyme that converts angiotensinogen into angiotensin I. (liver)
  • Renin is released by the juxtaglomerular cells of kidneys in response to decreased renal perfusion
  • ACE converts angiotensin I to angiotensin II
  • Vasoconstriction increases arterial perfusion pressure and stimulates thirst.
  • Sympathetic nervous system stimulates release of aldosterone in response to increase renin
  • Aldosterone regulates volume
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8
Q

Atrial Natriuretic Peptide (ANP)

A

opposite of renin-angiotensin-aldosterone system

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9
Q

Gerontologic considerations for increased risk of F&E disorders

A
  • decreased renal and pulmonary function
  • altered ratio of body fluid to muscle mass
  • Altered response to F&E changes
    * Atypical
    * Rapid onset
  • Changes in acid-base balance
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10
Q

Gerontologic Assessment Considerations

A
  • Thirst mechanism
  • NPO risk
  • Test preps
  • Cardiac, kidney, lung, adrenal function
  • Attention to intake/output and DAILY WEIGHTS
  • Medication effects
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11
Q

Fluid gains/losses

A 
Gain: PO, IV, SQ, Enteral
Loss: Kidneys: 1500mL/day - urine
         **normal u/o = 1 ml/kg/day
Insensible loss:
        *Skin 600 mL/day
        *Lungs 400 mL/day
        * GI tract 100-200 mL/day
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12
Q

S/S of hypovolemia

A
  • weight loss
  • thirst, dry mucous membranes
  • poor skin turgor
  • Decreased LOC
  • HR, orthostatic hypotension
  • Hemoconcentration, increased urine spec. grav., decreased u/o.
  • flat jugular veins, time for veins to fill
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13
Q

Causes of hypovolemia

A
  • decreased intake
  • blood loss/ hemorrhage
  • GI: V/D/ GI suction
  • Renal: diuretics, Addison’s, diabetes insipidus, osmotic diuresis
  • 3rd space shift: decreased oncotic pressure
  • Ascites
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14
Q

The nurse would best assess the adequacy of fluid volume replacement in a patient with hypovolemia by monitoring:

A

Vital signs and daily weights

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15
Q

S/S of hypervolemia

A
  • rapid weight gain
  • Ascites, decreased serum proteins
  • Decreased serum and ua osmolality
  • decreased urine Na+
  • Dyspnea
  • HTN, edema, JVD, time for veins to empty
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16
Q

Causes of hypervolemia

A
  • excess fluid intake
  • excess Na+ intake
  • increased retention of sodium & water
    - renal failure
    - SIADH (increased ADH)
  • heart failure
  • liver failure
  • decreased serum proteins
    - liver failure
    - malnutrition
    - burns
    - nephrotic syndrome
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17
Q

Normal Sodium levels

A

135-145 mEq/L

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18
Q

Functions of Sodium

A
  • # 1 ECF cation
  • Major determinant of ECF osmolality
  • Muscle contraction/nerve impulse transmission
  • Controls water distribution
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19
Q

Hyponatremia

A

Sodium less than 135

Severe = less than 120

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20
Q

Causes of hyponatremia

A
  • Na+ deficit
  • net gain of water (w/o salt)
  • *Causes of Na+ deficit
    • decreased intake
    • increased loss
      • diuretics
      • GI suction
      • Excess sweating
    • decreased aldosterone
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21
Q

S/S of hyponatremia

A

s/s dependent on:
rate of fall
duration of low Na+ levels
ECF volume

  • GI: anorexia, N/V, cramping
  • Neuro: h/a, lethargy, confusion, seizures caused by H2O moving into brain cell
  • Low serum and urine osmolality
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22
Q

Hypernatremia

A

sodium level greater than 145

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23
Q

Causes of hypernatremia

A
  • decreased fluid intake
  • hypertonic tube feeding without adequate water
  • increased water losses
  • increased insensible losses
  • diabetes insipidus (decreased ADH)
  • Increased sodium
  • increased aldosterone
  • corticosteroids
  • excess sodium bicarb. or sodium chloride
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24
Q

S/S of hypernatremia

A
  • thirst
  • dry mucous membranes
  • elevated temp, flushed skin
  • change of LOC
  • seizures
  • 3rd spacing: edema
  • hypotension
  • increased deep tendon reflexes
  • increased serum and urine osmolality
25
Q

Potassium

A

Normal values 3.5-5.5 mEq/L

26
Q

Function of potassium

A
  • # 1 intracellular cation
  • active transport I Na+-K+ pump
  • muscle contraction
  • nerve impulse transmission
  • acid/base blanace

Regulated by:
kidneys
aldosterone

27
Q

Hypokalemia

A

potassium (K+) less than 3.5

28
Q

Causes of hypokalemia

A 
decreased intake
IV fluids w/o K+
Increased losses
    -GI
    -diuresis (thiazides)
    -increased aldosterone
-K+ shifting from ECF to ICF
    -alkalosis
    -insulin excess
29
Q

S/S of hypokalemia

A
  • anorexia, N/V
  • ileus
  • muscle weakness or cramps
  • paresthesia
  • digoxin toxicity
  • dysrhythmias: PVCs, V-tach
30
Q

Hypokalemia memory jogger

A 
S - skeletal muscle weakness
U - u wave (ECG change)
C - constipation
T - toxic effects of digoxin
I - irregular, weak pulse
O - orthostatic hypotension
N - numbness (paresthesia)
31
Q

Hyperkalemia

A

K+ greater than 5.5

32
Q

Causes of hyperkalemia

A
  • increased intake
  • decreased loss
    • renal failure
    • decreased aldosterone
  • K+ shifting from ICF to ECF
    • hemolysis
    • burns
    • crushing injury
    • chemotherapy
    • acidosis
    • insulin deficiency
33
Q

S/S hyperkalemia

A
  • N/V/D
  • abdominal cramps
  • muscle weakness
  • decreased reflexes
  • paresthesias
  • paralysis
  • acidosis: decreased pH
  • insulin deficit: increased glucose
  • EKG: peaked t waves, prolonged PR interval, Wide QRS, V-tach
34
Q

Calcium

A

Normal levels are 8.5 - 10.5
-plasma proteins affect level
Has an inverse relationship with phosphorus

35
Q

Causes of hypocalcemia

A
  • decreased intake
  • decreased absorption
    • laxative abuse
    • diarrhea
    • malabsorption
    • decreased vit d
    • decreased PTH
    • increased phosphorus
  • increased losses
    • diuresis
    • pancreatitis
  • decreased albumin
  • alkalosis
  • blood transfusion
36
Q

S/S of hypocalcemia

A
  • paresthesia
  • tetany
  • Chovostek’s sign
  • Trousseau’s sign
  • increased deep tendon reflexes
  • seizures
  • laryngeal stridor
  • irritability
  • anxiety
  • impaired clotting
  • alkalosis
37
Q

Chvostek’s sign

A

An indicator of hypocalcemia. It is a twitch of the facial muscles following gentle tapping over the facial nerve in front of the ear that indicates hyperirritability of the facial nerve.

38
Q

Trousseau’s Sign

A

An indication of latent tetany in which carpal spasm occurs when the upper arm is compressed by a bp cuff or the like for 3 minutes. An indicator of hypocalcemia.

39
Q

Hypercalcemia

A

Calcium greater than 10.5

40
Q

Causes of hyeprcalcemia

A 
increased calcium resorption from bones
increased calcium absorption from gut
decreased calcium excretion by kidneys (most common)
Acidosis
Decreased PO4
41
Q

S/S of hypercalcemia

A
  • Anorexia, N/V
  • abdominal pain, cramping
  • Ileus
  • constipation
  • confusion
  • decreased LOC from lethargy to coma
  • decreased reflexes
  • hypertension
  • bone pain
  • risk of digoxin toxicity
  • increased u/o with thirst
  • decreased PO4
  • EKG: short QT interval
42
Q

Magnesium

A

Normal levels 1.5-2.5 mg/dL

-competes with calcium for GI absorption

43
Q

Functions of magnesium

A 
nerve/muscle function
allows heart and vascular relaxation
protects heart from ischemia
metabolic processes
needed for absorption and utilization of K+
Regulated by GI absorption and kidneys.
44
Q

Hypomagnesemia

A

Mg+ less than 1.5 mg/dL

45
Q

Causes of hypomagnesemia

A

decreased intake
decreased GI absorption
increased GI losses
increased renal losses

46
Q

S/S of hypomagnesemia

A

muscle weakness, twitching, tremors, tetany
dysphagia
altered LOC: confusion, hallucinations, seizures
Increased reflexes
Chovostek’s sign
Trousseau’s sign
Common to have low K+ and Ca++ concurrently
EKG changes: prolonged QT, wide QRS, V-tach

47
Q

Hypomagnesemia memory jogger

A 
Seizures
Tetany
Anorexia, arrhythmias
Rapid heart rate
Vomiting
Emotional lability
Deep tendon reflexes increased
48
Q

Hypermagnesemia

A

Mg+ greater than 2.5 mg/dL

49
Q

Causes of hypermagnesemia

A 
renal failure
increased intake (pills)
50
Q

S/S of hypermagnesemia

A 
weakness
decreased reflexes
decreased LOC: confusion, lethargy, coma
Resp. depression > 15
N/V
decreased b/p, decreased HR
51
Q

Muscular twitching & hyperirritability of the nervous system indicate tetany. The nurse would identify these as symptoms (sx) of which electrolyte imbalance?

A

Low calcium level

52
Q

Phosphorus

A

Normal level is 2.5 - 4.5

  • functions: ATP energy production, nerve/muscle activity, promotes release of oxygen from Hgb
  • regulated by kidneys (primary), PTH, vit d
53
Q

Hypophosphatemia

A

Phos less than 2.5 mg/dL

54
Q

Causes of hypophosphatemia

A

decreased intake/absorption
increased losses
increased phosphate utilization

55
Q

S/S of hypophosphatemia

A

altered LOC: lethargy irritability, apprehension, confusion
Muscle weakness: respiratory, cardiac
Ileus
belly surgery, reintroduction of food = increased risk for hypophosphatemia.

56
Q

Hyperphosphatemia

A

Phos greater than 4.5 mg/dL

57
Q

Causes of hyperphosphatemia

A

decreased excretion
increased intake
phosphate shifting from ICF to ECF

58
Q

S/S of hyperphosphatemia

A

Dry, itchy skin

s/s of hypocalcemia from Ca++ binding with PO4-

59
Q

Chloride

A

Normal levels = 96-106
Function: regulates acid/base balance by combining with other ions
Imbalances associated with sodium and/or acid/base imbalances.

Med Surg I (3 decks)

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