Ch 8 Fluid and Electrolyte Management

Question 1

What are the major Cations?

Answer 1

Sodium, Potassium, Magnesium, hydrogen

Question 2

What are the major anions?

Answer 2

Chloride Bicarbonate Phosphate

Question 3

What does the transcellular portion effect?

Answer 3

GI respiratory,urinary,glandular,intraocular,cerebrospinal fluid

Question 4

Osmosis

Answer 4

the movement of water through a semipermeable membrane from a area of high water concentration to an area of lower concentration

Question 5

Diffusion

Answer 5

Moves solutes or particles from an area of higher concentration to area of lower concentration

Question 6

Fluid intake & output

Answer 6

2,500ml

Question 7

Hypotonic

Answer 7

Lower concentration, fluid movement in cells

Question 8

Hypertonic

Answer 8

Higher concentration fluid movement out cells shrink

Question 9

Oncotic pressure

Answer 9

Pulls fluid from interstitial space back into the intravascular space

Question 10

Osmotic Diuresis

Answer 10

Increase urine output

Question 11

What organ is primary for regulating fluid volume?

Answer 11

Kidneys

Question 12

Fluid and electrolyte balance is maintained by which hormone?

Answer 12

ADH

Question 13

Fluid loss occurs from the lungs through?

Answer 13

Vaporization

Question 14

Increased insensible water losses can be seen in which hypermetabolic states

Answer 14

trauma, burns,fever,thyroid crisis, impaired skin integrity

Question 15

Normal BUN

Answer 15

8-21

Question 16

Increase Bun does what to kidneys?

Answer 16

Impaired renal function

Question 17

Decrease BUN does what?

Answer 17

seen in SIADH, liver failure,malnutrition,Dilutes blood volume

Question 18

Creatine Normal levels

Answer 18

0.5-1.2

Question 19

Age related changes

Answer 19

Decrease in taste smell,thirst, comorbidities,medication,decrease in olfactory function

Question 20

Hypovelemia

Answer 20

Cause-excess loss of fluid, fluid shifts(third spacing)-fluid leaves the vasular space
Clinical manifestations- Weight loss, loss of skin turgor, oliguria,thirst,dry mucous membranes
Decrease- hemoglbin,hematocrit
Increase- urine specific gravity,serum osmality,urine osmolality

Question 21

Hypervolemia

Answer 21

Causes- Increase water and sodium retention, cirrhosi,heart failure, stress
BUN and hematocrit are low
low albumin hyonatremia
Clinical manifestations-weight gain,edema,tachycardia,increase urine output
complication pulmonary edema

Question 22

Sodium Normal level

Answer 22

135-145

Question 23

Hyponatremia

Answer 23

Causes-diuretics, diarrhea, hyperglycemia,hyothyroidism,SIADH,adrenal insufficiency
Clinial Manifestations- cerebral edema,neuro decline,lethargy,headache,gait disorder
COmplications- Postural hypotension
Severs seizure coma death

Question 24

Hypernatremia

Answer 24

Causes reduced water intake, DI, Hyperglycemia,hypercalcemia,hyperkalemia
Clinical manifestations-neuro changes,hallucinations thirst
limit sodium

Question 25

Chloride Normal range

Answer 25

97-107

Question 26

Hypochloremia

Answer 26

Causes-Severe vomiting,burns,respiratory acidosis,mtabolic alkalosis, addison disease Clinical manifestaions-irritablity,hypotension, shallow resp complication-cardiac hyponatremia, dsyrthmias related to hypokalemia

Question 27

Hyperchloremia

Answer 27

Causes-Infusion of high levels of chloride Clinical maifestations-deep rapid resp,tachypnea, high bp, medical management- hypotonic iv solutions complications- decrease cardiac output

Question 28

Potassium Normal range

Answer 28

3.5-5.0

Question 29

Hypokalemia

Answer 29

less than 3.5 Causes-loss of potassium stores Medications-laxatives,diuretics,steroids Clinical manifestations-st depression,cardiac resp arrest,constipation weakness Medical management-potaaium supplements cardiac monitoring Complications-muscle weakness decrease gi mobility,cardiac dysrthmias

Question 30

Hyperkalemia

Answer 30

more than 5 causes- acute or chronic renal failure excess intake of foods with high potassium shift of intracellular potassium to extracellularspace Clinical manifestations-muscle cramps palpations, paresthesias(tingling) ecg changes Complications-muscle weakness,cardiac dysrthmias

Question 31

Magneisum normal range

Answer 31

1.6-2.2

Question 32

Hypomagnesium

Answer 32

causes-malnutrition ,chronic alchol abuse,excessive excretion via renal system CLinical Manifestation-muscle weakness and cramping tetany,trousseau,chovestek,tachycardia,vertigo Medical management-evaluation of potassium and calcium levels\ Complications-seizures, vent fib Nursing managemnt no drinking alcohol,falls precaution, cardiac monitor

Question 33

Hypermagnesium

Answer 33

more than 2.2 Causes- over replacement of magnesium renal insuffiency, soft tissue injury Clinical manifestation-hypotension,asytole,cardiac dysrthmias muscle weakness,increase bleeding Medical maagement-hydration,loop diuretics Complications-resp failure stupor,coma hypotension, refractory to vasopressors

Question 34

Calcium normal range

Answer 34

8,2-10.2

Question 35

Hypocalcemia

Answer 35

less than 8.2 Causes vitamin d Deficiency, malnutition, chronic renal failure, chronic alcohol abuse,hypoparathyrodism Clinical manifestations-positive trosseau chvostek, prolonged qt interval,muscle spasm medical management-cardiac monitoring,oral calcium vitamin d Complication-Refractory hyptension, dsyrthmias

Question 36

Hypercalcemia

Answer 36

more than 10.2 Causes hyperparathyroidism, malignancy Clinical manifestation-bradycardia,hypertension,muscle weakness,thirst,anorexia Medical management-removal of parathyroid gland,calcitonin,dialysis,hydration 0.9nnacl complication-T wave changes confusion

Question 37

Phosphorus Normal range

Answer 37

2.5-4.5

Question 38

Hypophosphatemia

Answer 38

less than 2.5 causes resp alkalosis decrease absorption of phosphorus clinical manifestations-tremors,joint stiffness,confusion,paraesthesia Medical management- oral or iv replacement of phosphorus Complication-bleeding decrease function of white blood cells impaired hepatic function organ system dysfunction

Question 39

Hyperphosphatemia

Answer 39

more than 4.5 causes- renal failure diabetic keto acidosis, hyperthyroidism or hyperparathyroidism Clinical manifestations-delirium prolonged qt interval, positive chvostek trosseau sign medical management-loop diuretics dialysis complicatons tetany kidney disease

Question 40

Magnesium foods

Answer 40

Nuts fish oatmeal peanut butter halibut