Ch 40: Fluid and electrolytes Flashcards
fluid and electrolytes are involved in almost every what
What is the # 1 indicator of fluid retention
Fluid and electrolytes involved in almost every cellular reaction and function
1 indicator of fluid attention = weight
What is the most important nutrient in the body
What are the primary functions of water
- transport (5)
- facilitate what
- act as a what for who
- what is maintained
- body processes (2)
Water = most important nutrient in body
Transport nutrients and waste ,hormones, enzymes, blood
Facilitate cellular metabolism and proper chemical functioning
Act a solvent for (non)electrolytes
Maintain body temperature
Digestion and elimination
Give the body fluid compartments (ICF/ECF)
-give exact locations for ECF
ICF(in cells): 70% (2/3) 40%
ECF (outside cell): 30% (1/3) 20%
- intravascular (plasma) 5%
- interstitial (tissue and lymph) 10-15%
Variations in fluid Content
healthy person water distribution
What factors determine water distribution (three)
How does fluid Content vary in an infant
-what are they more prone to
What do women and obese people have less of and why
-what is lean tissue rich in
Healthy person: 50 to 60% total body weight = water
Factors that determine water distribution:
- persons age
- body fat
- sex
infants have more body fluid and ECF v adult
-infants more prone to fluid volume deficit
Women and those obese have less body water/more body fat
-lean tissue (muscle) is rich in water
What is fluid intake primarily regulated by where is it located
-what is it stimulated by
Define dehydration
Define hypovolemia
What is the desirable amount of water / day
what is average amount of water per day
- Fluid intake regulated by thirst mechanism
- located in the hypothalamus
- stimulated by dehydration
Dehydration: lost/deprivation of water in body
Hypovolemia: loss of water + loss of electrolytes
Desirable: 1500 to 3500 mL/day
average 2600 mL/ day
What is the average fluid output per day
What do you want between your I&O’s and what comes about if there’s a deviation
Through losses: give your insensible end sensible losses
average fluid output: 2500 to 2900 mL per day
I&Os should be balanced if there’s a deviation there’s a concern about imbalance
Insensible losses: non-measurable through skin and respiration
Sensible losses: miserable: pee, poop, exudate 
What are the different sources of water comes from
Water sources:
- liquid
- greatest provider
- Food
- Second largest
- Metabolism byproducts
Define Electrolytes
Define ions
name for positive and negative ions 
Give the ECF ions
give the ICF ions
What does mill equivalents describe
Electrolytes: substance that can break into particles called ions
Ions: Atom or molecule caring electrical charge
(+) cation
(-): anion
What ions are mostly found ECF
-Na, Cl, Ca, bicarb
what ions are mostly found ICF
- K, phosphorus, Mg
mEq describes chemical activity “ Chemical combining power”
What are fluid and electrolyte balance is maintained by
What is the shifting(aka what) regulated by (4)
Define solvents
Define solutes
what is almost every organ and system in the body help to
Fluid and electrolyte balance are maintained by shifting fluids and solutes between ECF and ICF
Shifting (transport) regulated by:
- osmosis
- diffusion
- active transport
- capillary filtration
Solvents: fluid that holds substance (H2O)
Salute: substance dissolved in water
((Non) electrolytes)
Almost every organ and system in the body helps maintain fluid homeostasis
What characters about cell membranes allow solutes to pass through the cell
What is the heaviest relied route for transport
What is the process of osmosis
-Ultimate goal?
Define osmolarity
So membranes are semi permeable that allow solutes to pass through cell membrane
Osmosis is the heaviest relied on route for transport
Osmosis: movement of water from an area of less solutes to more solutes
•EQUILIBRIUM
Osmolarity: concentration

For modes transportation of fluid
define osmosis
define diffusion
define active transport
-against what
define capillary filtration
-what does it need
Osmosis:
-moving a water from area of ⬇️ solutes to ⬆️ solutes
•EQUILIBRIUM
Diffusion:
- freely movement of solutes through a solvent
- ⬆️ to ⬇️ conc until equilibrium
Active transport: NEEDS ENERGY!!!🔋
-movement from ⬇️ solute concentration to ⬆️ solute concentration v concentration gradient
Capillary filtration: fluid through permeable membrane from higher to lower pressure
•NEEDS
-colloid osmotic pressure: pushing force
-hydrostatic static pressure: pulling force

Isotonic solution
-what does it have the same concentration of
•give the numerical number
-give Fluid examples 
 hypertonic solution
- what is the concentration
- give Fluid examples
Hypotonic solution
- what is a concentration
- give fluid examples

Isotonic solution = concentration of plasma • 275 to 295 mmol per deciliter -D5W -NS -LR
 hypertonic (shrink) solution: greater concentration V plasma
- 3% NaCl
- D5NS
- TPN
Hypotonic (swell) solution: less concentration V plasma
-0. 33% NS
-0.45% NS

Give your normal values
Na K Ca Mg  phosphorus Cl
Na : 135 to 145 mEq/ L K : 3.5 to 5 mEq/L Ca : 8 to 10 mg/dL Mg: 1.3 to 2.3 mEq / L Cl: 97 to 107 mEq per liter
Sodium
Normal levels
Causes of hypo/hyper natremia
Greatest manifestations hypo/hyper Natremia
Treatments for hypo/hyper natremia
Sodium: Na
Normal: 135 to 145 mEq/L
 Hypo natremia:
• causes
-diuretics( sodium loss or water gain)
• manifestations:
-confusion
-cerebral edema
-seizures
•Treatment:
-hypertonic oral and IV solutions
-Salt
Hypernatremia: •causes -fluid deprivation • manifestations -thirst -decrease LOC/disoriented -SZ • treatment: -water intake -low sodium -diuretics

Potassium
Normal levels
Causes of hypo/hyper Kalemia
Greatest manifestations hypo/hyper Kalemia
Treatments for hypo/hyper Kalemia
Potassium: K
Normal: 3.5 to 5mEq/L
Hypokalemia •Causes -vomiting -gastric suctioning •Manifestations ! Cardiac dysrhythmias! -*Muscle weakness -*leg cramps •Treatment -Foods high in potassium -slow IV push
Hyper kalemia •causes -Renal failure •Manifestations ! Cardiac dysrhythmias! -Muscle weakness/nausea •Treatment -Loop diuretics -Sodium polystyrene sulfate 
Calcium

Normal levels
Causes of hypo/hyper Calcemia
Greatest manifestations hypo/hyper calcemia
Treatments for hypo/hyper calcemia
Calcium: Ca
8 to 10 mg/dL
Hypocalcemia •Causes -Inadequate intake •Manifestations -Numbness tingling -cramps •Treatment -Calcium Food/IV -Vitamin D supplements
Hypercalcemia: •Causes -Hyper parathyroidism •Manifestations -lethargy/confusion -Increased risk for kidney stones -n/v •Treatment -Calcium restriction -Increase fluids
 Magnesium
Normal levels
Causes of hypo/hyper Magnesemia
Greatest manifestations hypo/hyper Magnesemia
Treatments for hypo/hyper Magnesemia
Magnesium: MG
1.3 to 2.3 mEq per liter
Hypomagnesemia •Causes -NG section -alcohol •Manifestations -Muscle weakness -HYPERactive DTR •Treatment -Foods high in magnesium/IV
Hyper Magnesemia •Causes: -Renal failure •Manifestations -Lethargy -LOSS OF DTR •Treatment -Loop diuretics
If calcium increases what has an inverse relationship
If potassium decreases what else decreases
If calcium ⬆️ phosphorous will ⬇️ and vice versa
If potassium ⬇️ chloride ⬇️
Why must your body maintain the acid base balance (3)
What are a few things that can alter the acid balance
 what does acid contain that can be shared or released
What can bases do what is an example of a base 

Your body must maintain the acid base balance to sustain
- health
- homeostasis
- life
Conditions like infection and trauma can alter acid base balance
Acid contains hydrogen + they can be liberated or released
Alkali (base) A substance that can accept or trap H+ such as bicarb ions
What is a buffer (what does it prevent)
-how does it prevent it
What are buffer systems that help with the acid-base imbalance

Buffer:
- substance that prevents body fluids from becoming overly acidic or alkaline
- combines with excess acid/base to prevent major pH changes
Buffer system: * carbonic acid sodium bicarbonate - phosphate -protein • respiratory/renal mechanism
When do acid-base imbalances occur
Metabolic imbalances
-occur as a result of what (disturbance in what level)
How do the lungs and kidneys compensate

Acid-base imbalances occur when carbonic acid or bicarb levels become disproportionate
Metabolic imbalance is occur from a disturbance in the bicarb level in the ECF
Lungs and kidneys compensate by excreting or retaining CO2 (Lungs) or bicarb and hydrogen ions (Kidneys)
Metabolic acidosis
What causes metabolic acidosis
How does a body respond
What causes metabolic acidosis
How does a body respond
Metabolic acidosis
By
-excessive loss of bicarb⬇️ or +in H+
Bodies response
- lungs excrete CO2 by TACHYPNEA 
Metabolic alkalosis
By:
-excessive acid loss
body‘s response
-body retains CO2 with BRAYDYPNEA
• slow and shallow may have periods of apnea
Why do respiratory in balances occur and what does it alter
How does a body compensate for respiratory disturbances
Respiratory in balances as a result of respiratory disturbances
Respiratory imbalances altar CO2 and carbonic acid in the ECF
Body compensates for respiratory disturbances by
- lung retaining or eliminating CO2
- can you try to restore balance with formation or excretion of bicarb
What is respiratory acidosis caused by
What is a body‘s response to respiratory acidosis

What is respiratory alkalosis caused by
What is the body‘s response to respiratory alkalosis
Respiratory acidosis
Too much CO2 equals a long compensates (increased respiratory rate)
Not enough = body retains CO2
Respiratory alkalosis
Caused by:
-hyperventilation not enough CO2
Body response
- Bradypnea
- slower shallow breaths
 describe what is lost in fluid volume deficit
What are components of fluid volume deficit
Who is of highest risk for hypovolemia and dehydration
What is third space fluid shift and where does it go
-What is present

Influe volume deficit there’s a loss of water and solutes in the same proportion
Components of fluid volume deficit: (2)
- hypovolemia
- dehydration
Highest risk for hypovolemia/dehydration
- children
- elder
- sickly
Third spacing fluid shift a.k.a. intracellular dehydration
- shift of fluids into the transcellular (interstitial compartment)
- with third spacing Edema is present with dehydration

What happens during fluid volume excess
What are the two components of fluid volume excess
What will accumulate in the interstitial space

during full volume excess there’s a retention of both sodium and water in the extracellular fluid
Two components of the volume excess:
- Hypervolemia (intravascular accumulation)
-  Overhydration
Edema accumulates in the fluids of the interstitial space
What are components of the nursing history and physical assessment
Assess the skin makes membranes, vital signs, neurological assessment
Assess for symptoms such as:
- excessive thirst
- N/V/D,
- drainage
- other fluid losses
Get fluid intake and output
Get daily weight
Get your lab studies
- CBC,
- serum electrolytes,
- BUN,
- creatinine
- urine pH,
- specific gravity
- ABGs

When do you want to get patients weights
What are parameters for getting patients weights
How do you know if a patient is retaining water
What is the most accurate way to assess fluid retention
Get a patient’s weight in the morning
Must be same time, same clothes, same scale
A patient is retaining water if they gain 2.2 pounds (1 L) in 1 to 2 days
 wait is the most accurate way to assess for Florida attention
What questions you wanna ask during the nursing history
Illnesses
Abnormal fluids
Damage ? (3)
Therapies that what
Ask the patient if they’ve had questions:
-acute/chronic illnesses
• DM,CHF,renal failure
-abnormal losses of body fluids
-Burns
-trauma
-surgery
- therapies that may just wrecked fluid and electrolyte balance
• chemo, diuretics, steroids
What are components of the physical assessment you want to do
Assess skin turgor/ tongue turgor
Moisture and oral cavity
Tearing and salvation
Appearance of skin and skin temperature
facial appearance
edema
pulse, respirations,blood pressure
what does a ⬆️ BP indicate
what does ⬇️ BP indicate
What may kidney function tell you
Give the normal for the ABGs
⬆️ BP: Hypervolemia
⬇️BP: hypovolemia
Kidney function can tell you the origin of electrolyte imbalances
ABG normals:
PH: 7.35 to 7.45
CO2: 45 to 35
HCO3: 22 to 26
What are nursing diagnosis is related to imbalances
(Fluid, electrolyte, acid base disturbances as the problem)
- Excess/Deficient fluid volume
- Risk for deficient fluid volume
- Ineffective breathing pattern
Fluid and electrolyte disturbances as etiologies:
•Ineffective breathing pattern related to compensatory mechanism by lung hypo ventilation or hyperventilation
•Impaired oral mucous membrane integrity related to fluid volume deficit
•Risk for impaired skin integrity related to deficient flu of volume or excess fluid volume    
What is the goal for fluid and electrolyte assessments
The goal for fluid and electrolyte assessments is to maintain and restore optimum functioning related to fluid, electrolyte and acid base balance
+
Alleviate symptoms and side effects of disease or treatment and prevent complications
How do you wanna teach and develop a dietary plan
What do you wanna provide the patient
Teach by involving patient and person who prepares the meal on the nutritional plan
Provide the patient with a list of written foods to avoid or include in diet

What are nurses responsibility when it comes to IV fluid therapy
What do you do to the iv
Orders
Concerns
Understand what
Initiate monitor and discontinue therapy
Evaluate a patient orders before administration
Notified provider of any concerns related to the order
Understand the rationale for using Ivy therapy, types of solution, desire to effect, potential ADR
 What are vascular access devices used for
Describe peripheral venous catheters
- type
- duration
Describe central venous access device is
- types
- duration
How long are implanted porch used for who are they placed by
Vascular access devices available for delivery of solution and medications to vein   Peripheral venous catheters -most common to use ! -used short term
Central venous access devices -PICC line -Central lines -peripherally inserted central catheter‘s -tunneled central venous catheter‘s -ports (surgical) • used long-term
Implanted ports used for very long-term placed by surgeon

Where does a nurse insert peripheral venous access
What do you consider when inserting a peripheral venous access (site selection)
When do you need to change the IV site
Nurse puts pressure venous access (most common) in the safest most appropriate location for patient
Consider for site selection:
- accessibility of vain
- condition of vain
- type of fluid to be infused
- anticipated duration of infusion
Change IV site every 72 hours and get a new catheter
IV therapy complications
Infiltration Extravasation Phlebitis Thrombophlebitis Infection Systematic complications -fluid overload, embolus, sepsis
Infiltration
-leakage of fluid into interstitial space because catheter not in vein

Extravasation
-leakage to surrounding tissue by vesicant causing necrosis
Phlebitis -inflammation of vein (Cord) -typically occurs 48 to 72 hours post IV removal  Thrombophlebitis -clot causing inflammation in vein  Infection
Systematic complications
-fluid overload, embolus, sepsis
If Phlebitis ( Cord ) develops what actions do you take as a nurse
If phlebitis occurs
- discontinue IV
- start new IV
- apply cold compress
What is the most common complication for IV therapy
when dealing with IV and dressing what must you maintain
Most common IV complication = infection
When dealing with IV and dressing = sterile
What must you always ensure before giving a blood product
 
What is required before starting an IV
Ensure typing and cross matching
most importantly Rh factor!!!
Before starting an IV you MUST have doctors orders
When initiating transfusions
- what do you want to get
-what do you want to ensure (size)
-how should the tubing be
-what should be taken before starting the blood transfusion
-how many nurses must check the blood
-how do you want to start the transfusion (for how long)
-how long do you stay with the patient

initiating Transfusions:
-get informed consent
• witness and put in chart
- ensure large vein with a needle at 18 to 20 gauge
- tubing should be primed with NS
- get baseline before starting blood pressure for comparison
- two nurses must check the blood
- Start a transfusion slow (for 15 minutes) stay with a patient for 15 minutes

What is the maximum infusion time
Max infusion time: 4 hours and throw the rest away
Reactions
When will the most severe blood reactions happen
Give signs and symptoms of a blood reaction
What do you do if suspected blood reaction
Most of your blood reactions will happen within the first 15 minutes
Signs and symptoms of a blood reaction:
- itching/hives
- fever chills
- lower back pain
- dyspnea
If suspected blood reaction: #1STOP Blood -remove old tubing -put new tubing with NS -check vitals -tell doc 
 When is the only time you can slow blood
Give signs and symptoms of fluid overload
You can only slow blood if fluid overload
S&s
- dyspnea
- Dry cough 
 What can you use to evaluate and Readjust your plan interventions
What are ways to evaluate if your pt has improved related to fluid and electrolyte balance
Use nursing care plan to evaluate and readjust your plan and interventions
Ways to evaluate if your patient has improved related to fluid and electrolyte balance:
-is your patient’s urine output equal to their intake
- are there abnormal sources of food loss
- Are the signs and symptoms of the initial condition absent or improved
- is a patient now able to practice self-care behaviors maintain fluid and electrolyte as well as acid base balance

Describe what is happening during the acid base reaction
Metabolic alkalosis
metabolic acidosis
respiratory alkalosis
respiratory acidosis
Metabolic alkalosis  ➡️ kidneys keep hydrogen excrete bicarb
metabolic acidosis ➡️Kidneys excrete hydrogen keep bicarb
respiratory alkalosis ➡️Retain CO2 slow breathing
respiratory acidosis➡️ Release CO2 fast breathing
