Chapter 29-Fluids & Electrolytes Flashcards
Body water is composed of these three fluids?
Intracellular fluid (ICF), interstitial fluid (ISF), plasma volume (PV)
Where is intra-vascular fluid found?
Inside the blood vessels
Where is extravascular fluid found?
Outside the blood vessels
- Lymph
- Cerebrospinal fluid
Where is interstitial fluid located?
In the space between cells, tissues, and organs
What does extravascular volume consist of?
Plasma and interstitial fluid
What does extracellular volume consist of?
Interstitial fluid and intracellular fluid
The adult body is _____% water
60%
What fraction of total body water is extracellular fluid?
ECF=1/3
What fraction of total body water is intracellular fluid?
ICF=2/3
Of the total extracellular fluid contained in total body water, what fraction is plasma volume?
PV=1/3
Of the total extracellular fluid contained in total body water, what fraction is interstitial fluid?
ISF=2/3
Plasma proteins exert constant osmotic pressure called colloid oncotic pressure (COP). Normal COP is _____ mm Hg
24 mm Hg
Interstitial fluid exerts hydrostatic pressure (HP). Normal hydrostatic pressure is _____ mm Hg
17 mm Hg
These are solutions containing fluids and electrolytes that are normally found in the body. They do not contain proteins and there is no risk for viral transmission, anaphylaxis, or alteration in coagulation profile
Crystalloids
These are used as maintenance fluids to compensate for insensible fluid losses, to replace fluids, to manage specific fluid and electrolyte disturbances, and promote urinary flow
Crystalloids
Normal saline (0.9% sodium chloride), Half normal saline (0.45% sodium chloride), Hypertonic saline (3% sodium chloride), Lactated ringer's, D5W
What kind of fluid are these classified as?
Crystalloids
What indications call for the use of Crystalloids?
Acute liver failure, acute nephrosis, adult respiratory distress syndrome, burns, cardiopulmonary bypass, hypoproteinemia, renal dialysis, reduction of the risk for DVT
What are the adverse affects of crystalloids?
May cause edema, especially peripheral are pulmonary; they dilute plasma proteins, reducing COP; effects may be short-lived; for prolonged infusions may worsen alkalosis or acidosis
These fluids contain protein substances, increase colloid osmotic pressure, move fluid from interstitial compartment to plasma compartment (when plasma protein levels are low)
Colloids
What are the adverse affects of colloids?
May cause altered coagulation, resulting in bleeding.
They have no clotting factors or oxygen carrying capacity. Rarely, dextran therapy causes anaphylaxis or renal failure
What is the only class of fluids that are able to carry oxygen?
Blood products
This class of fluids carries oxygen, increases tissue oxygenation, increases plasma volume, pull fluid from extravascular space into intravascular space (plasma expanders), and is the most expensive and least available because they require human donors.
Blood products
What blood products are used in the management of acute bleeding?
Cryoprecipitate and plasma protein factors (PPF)
What blood product is used to increase clotting factor levels in patients with demonstrated deficiency?
Fresh frozen plasma (FFP)
What blood product is used to increase oxygen-carrying capacity in patients with anemia, substantial hemoglobin deficits, and those who have lost up to 25% of their total blood volume
Packed red blood cells (PRBCs)
Which blood product is most beneficial in cases of extreme blood loss (greater than 25%)?
Whole blood
Whole blood contains plasma proteins which help draw fluid back into blood vessels from the surrounding tissue
The patient was taken to the trauma unit after a motorcycle accident. It is estimated that he has lost 30% of his blood volume is in hypovolemic shock. The nurse anticipates a transfusion with which product?
Whole blood
What are the adverse affects of blood product infusion?
Incompatibility with recipients immune system, crossmatch testing, transfusion reaction, anaphylaxis, transmission of pathogens to recipient (hepatitis, HIV)
What are the principal extracellular fluid electrolytes?
Sodium (Na+) & chloride (Cl-)
What is the principal intracellular fluid electrolyte?
Potassium (K+)
What are the other significant electrolytes?
Calcium, magnesium, phosphorus
What is the normal range for potassium outside of cells
3.5 - 5 mEq/L
What foods contain potassium?
Bananas, oranges, apricots, date, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, lagumes
Excess dietary potassium is excreted via the _____?
Kidneys
Hyperkalemia is evident with lab values greater than _____ mEQ/L
5.5
What are some causes for hyperkalemia?
Potassium supplements, ACE inhibitors, renal failure, excessive loss from cells, potassium sparing diuretics, burns, trauma, metabolic acidosis, infections
Hypokalemia where presents for deficiency with lab values less than _____ mEq/L
3.5
What are indications for excessive potassium loss?
Alkalosis, corticosteroids, diarrhea, ketoacidosis, laxative misuse, hyperaldosteronism, increased secretion of mineralocorticoids, Burns, Thiazide/thiazide-like diuretics, vomiting, malabsorption
A deficit of _____, in the presence of Digoxin therapy, can cause toxicity, resulting in serious ventricular dysrhythmias
Potassium
_____ is responsible for muscle contraction, transmission of nerve impulses, regulation of heartbeat, maintenance of acid-base balance, isotonicity
Potassium
What condition does a nurse identify as a late manifestation of hypokalemia?
Palpitations
What are some primary conditions a nurse identifies as early manifestations of hypokalemia?
Muscle weakness, hypotension, lethargy
Which conditions require the administration of potassium?
Potassium deficiency, irregular heartbeats, management of tackydysrhythmias that can occur after cardiac surgery
What are the adverse affects of oral potassium?
Diarrhea, nausea, vomiting, G.I. bleeding, ulceration
What are the adverse affects of IV administration of potassium?
Pain at injection site, phlebitis
What are the facts of excessive administration of potassium?
Hyperkalemia, toxic effects
What are the manifestations of hyperkalemia?
Muscle weakness, Paris, paralysis, cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest)
What is the treatment for severe hyperkalemia?
Are you sodium bicarbonate, calcium gluconate or calcium chloride, dextrose with insulin;
Sodium polystyrene sulfonate (Kayexalate) or hemodialysis to remove excess potassium
A patient is hypokalemic and will be receiving intravenous potassium. The patient is not on a heart monitor. How should the nurse administer the potassium replacement?
No more than 10 mEq/hr
If patient is on cardiac monitor a rate of 20 mEq/hr may be used
What is the most abundant positively charged electrolyte outside cells?
Sodium
What is the normal concentration of sodium outside of the cells?
135-145 mEq/L
Which foods are sodium rich?
Salt, fish, meats, foods flavored or preserved with salt.
What are the symptoms of hyponatremia?
Lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures
What are the causes of hyponatremia?
Excessive perspiration, prolonged diarrhea or vomiting, renal disorders, alkalosis, increased secretions of medical record records, burns, corticosteroid use, crash diets, malabsorption
What are the symptoms of hyper natremia?
Water retention; hypertension; red, flushed skin; dry sticky mucous membranes; increased thirst; elevated temperature; decreased urine output
What are the causes of hypernatremia?
Poor renal excretion stemming from kidney malfunction; inadequate water consumption; dehydration
What functions does sodium control?
Water distribution, what an electrolyte balance, of moderate pressure of body fluids, participation in acid-base balance
What are the functions are controlled by Potassium?
Muscle contraction, transmission of nerve impulses, regulation of heartbeat, maintenance of acid-base balance, isotonicity
How is mild hyponatremia treated?
Oral sodium chloride and/or fluid restriction
How is severe hyponatremia treated?
Intervenous normal saline or lactated ringers
Adverse affects of oral administration of sodium?
Nausea, vomiting, cramps
What are the adverse affects of IV administration of sodium?
Venous phlebitis
What assessment should be done before giving potassium?
ECG
Potassium should never be given via ______
IV bolus
How are oral forms of potassium given?
Diluted in water or fruit juice to minimize G.I. distress or irritation.
Monitor for complaints of nausea, vomiting, G.I. Pain, or G.I. bleeding
Polystyrene sulfonate (Kayexalate) should never be given with _____, _____, or _____
Sorbitol, laxatives, antacids
Which solution should the nurse administered with packed red blood cells?
Normal saline, 0.9% sodium chloride
Albumin and dextran fall within which fluid category?
Colloids
This fluid category is commonly known as maintenance fluids
Crystalloids
Total protein levels in the body should range between ___ to ___ g/dL.
5.4-7.4 g/dL
If the level falls below 5.3, fluid shifts out of blood vessels and into tissues
