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NURS 305 > Chapter 42: Fluid and Electrolytes > Flashcards

Chapter 42: Fluid and Electrolytes Flashcards

1
Q

Body fluids contain

A

electrolytes such as Na+ and K+, and also have a certain degree of acidity

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2
Q

Fluid, electrolyte and acid-base balances within the body maintain

A

the health and function of all body sytems

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3
Q

The characteristics of body fluids have

A

regulatory mechanisms that keep them in balance

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4
Q

Characteristics of body fluids include

A
  1. fluid amount (volume)
  2. concentration (osmolarity)
  3. composition (electrolyte concentration)
  4. acidity (pH)
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5
Q

Body fluid

A

water that contains dissolved or suspended substances such as glucose, mineral salts and proteins

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6
Q

Approximately ____ of an adult male’s body weight is water…. decreasing to ____ in older men

A

60%

50%

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7
Q

Women have _____ water than men

A

less (less muscle mass, more adipose)

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8
Q

Why do obese people have less water than lean people?

A

fat contains less water than muscle

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9
Q

Extracellular Fluid

A

outside the cells.

in adults, this accounts for 1/3 of total body water.

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10
Q

ESF has 2 major divisions and 1 minor division, what are they?

A
  1. intravascular fluid
  2. interstitial fluid
  3. transcellular fluid (minor)
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11
Q

Intravascular fluid

A

liquid portion of the blood (plasma)

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12
Q

Interstitial fluid

A

located in-between the cells and outside the blood vessels

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13
Q

Transcellular fluid

A

cerebrospinal, pleural, peritoneal, and synovial fluids (secreted by epithelial cells)

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14
Q

Intracellular Fluid

A

inside the cells.

in adults, this accounts for 2/3 of the total body water.

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15
Q

electrolytes

A

a compound that seperates into ions (charged particles) when dissolved in water

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16
Q

2 types of electrolytes

A

cations and anions

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17
Q

cations

A

+ charge (Na+, K+, Mg++)

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18
Q

anions

A
  • charge (Cl-, HCO3-)
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19
Q

Types of Solutions

A
  1. isotonic
  2. hypertonic
  3. hypotonic
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20
Q

isotonic

A

the molecular concentration of dissolved solutes is the same on both sides of the cell membrane (NS=0.9% sodium)

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21
Q

hypertonic

A

contains more dissolved particles (Na+ and other electrolytes) than is found in normal cells.
water is pulled out of cells (3-5% NaCl)

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22
Q

hypotonic

A

contains less solute (salt and other electrolytes) than is found in normal cells
water is pulled into the cell (.45NS)

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23
Q

What are the ways in which water and electrolytes move in and out of a cell?

A
  1. active transport
  2. diffusion
  3. osmosis
  4. filtration
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24
Q

Active Transport

A

Requires energy in the form of ATP to move electrolytes across cell membranes against the concentration gradient going from low to high concentration (giving it what the cell needs) .
Example: Sodium-Potassium pump

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25
Q

What electrolytes have a higher concentration in the ICF?

A

K+, mg++, and PO43−

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26
Q

What electrolytes have a higher concentration in the ECF?

A

Na+, Cl−, HCO3

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27
Q

Diffusion

A

Passive movement of SOLUTES from areas of higher to lower concentrations

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28
Q

Osmosis

A

WATER that moves through a membrane that separates fluids with different particle concentrations.

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29
Q

Osmotic Pressure

A

(ICF or Interstitial) inward pulling force from the particles in a fluid

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30
Q

Filtration

A

Fluid and solutes moving into and out of capillaries between vascular and interstitial compartments due to hydrostatic pressure.

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31
Q

Edema

A

accumulation of excess fluid in the interstitial space

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32
Q

Heart failure

A

causes venous congestion from a weakened heart which increases capillary hydrostatic pressure causing EDEMA (transudate) by moving excess fluid into the interstitial space.

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33
Q

Conditions that can cause edema

A

heart failure and inflammation

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34
Q

inflammation

A

(exudate) increases capillary blood flow and allows capillaries to leak colloids (proteins) into the interstitial space = increased capillary hydrostatic pressure and increased interstitial colloid osmotic pressure = localized edema in the inflamed tissue

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35
Q

Fluid Intake and Absorption

A

occurs orally, IV or irrigation where fluid is absorbed.

normally daily intake around 2300 ml/day

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36
Q

Fluid Distribution

A

Movement of fluid among its various compartments (ECF vs. ICF, Interstitial (between cells, outside blood vessels) vs. Vascular)

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37
Q

Fluid can be removed from the body through

A
  1. skin
  2. lungs
  3. GI tract
  4. kidneys
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38
Q

How is fluid removed through the skin?

A

sensible/insensible loss (perspiration)

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39
Q

How is fluid removed through the lungs?

A

insensible loss (breathing)

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40
Q

How is fluid removed through the GI tract?

A

stool (normally only 100 ml/day) and digestion

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41
Q

How is fluid removed through the kidneys?

A

urine secretion

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42
Q

Abnormal fluid output includes

A

diarrhea, vomiting, wound drainage, or hemorrhage

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43
Q

Antidiuretic Hormone

A

influences how much water is excreted in the urine

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44
Q

Renin-Angiotensin-Aldosterone System

A

Regulates ECF volume by influencing how much Na+ and water are excreted in urine.
Also contributes to regulation of BP.

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45
Q

Aldosterone also contributes to

A

electrolyte and acid-base balance by increasing urinary excretion of K+, and hydrogen ions

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46
Q

Fluid Imbalances include

A
  1. volume imbalances

2. osmolarity imbalances

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47
Q

Volume Imbalances

A

disturbances in the amount of fluid in the EC compartment

hypovolemia & hyervolemia

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48
Q

hypovolemia

A

decreased vascular volume

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49
Q

hypervolemia

A

increased vascular volume

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50
Q

Osmolarity Imbalances

A

disturbances of the concentration of body fluids

hypernatremia & hyponatremia

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51
Q

hypernatremia

A

water deficit.

when interstitial fluid becomes hypertonic (increased Na+) water leaves the cells by osmosis.

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52
Q

S&S of hypernatremia includes

A

cerebral dysfunction=confusion.

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53
Q

hyponatremia

A

water excess or water intoxication.

causes water to enter cells by osmosis.

54
Q

S&S of hyponatremia

A

cerebral dysfunctions (brain swelling)

55
Q

Clinical Dehydration

A

when hypernatremia (increased sodium) occurs in combination with a ECF deficit

56
Q

Clinical Dehydration is common with

A

gastroenteritis or other causes (side effects of medications such as chemotherapy) of severe vomiting and diarrhea especially when people are unable to replace their fluid output with enough intake of dilute Na+ containing fluids.

57
Q

Clinical Dehydration causes

A

skin turgor

dry mucous membranes

58
Q

Electrolyte values measured in laboratory reports are in

A

blood serum and do not measure intracellular levels

59
Q

Potassium Imbalances

A

hypokalemia and hyperkalemia

60
Q

hypokalemia

A

abnormally low K+ in the blood

<3.5 mEq/L

61
Q

Causes of hypokalemia include

A

diarrhea, repeated vomiting, use of K+ wasting diuretics (Lasix)

62
Q

S&S of hypokalemia

A

muscle weakness
may become life-threatening if it affects cardiac (dysrhythmias) and respiratory muscles (cardiac and respiratory cells can not repolarize)

63
Q

hyperkalemia

A

abnormally high K+ in the blood

> 5 mEQ/L

64
Q

Causes of hyperkalemia include

A

: increased K= intake and absorption, shift of K+ from cells to the ECF, and decreased K+ output

65
Q

S&S of hyperkalemia

A

people with oliguria (low urine output less than <30cc/hr for 2 hours) at high risk.
muscle weakness becoming life-threatening if causes cardiac dysrhythmias (severe Bradycardia)=cardiac arrest.

66
Q

hypocalcemia

A

low Ca++.

67
Q

S&S of hypocalcemia

A

increased neuromuscular excitability

68
Q

hypercalcemia

A

high Ca++

69
Q

hypercalcemia can be found in

A

Patients with disorders to the parathyroid or osteoporosis.

70
Q

hypocalcemia can be found in

A

Acute pancreatitis (Ca++ binds to undigested fat and is excreted.

71
Q

S&S of hypercalcemia

A

decreased neuromuscular excitability-lethargy

72
Q

hypomagnesemia

A

low magnesium levels

73
Q

S&S of hypomagnesemia

A

increased neuromuscular excitability, hyperactive deep tendon reflexes (seizures) (similar to Hypocalcemia)

74
Q

hypermagnesemia

A

increased magnesium levels

75
Q

hypermagnesemia can be found in

A

end stage renal disease

76
Q

S&S of hypermagnesemia

A

caused by decreased neuromuscular excitability-lethargy and decreased deep tendon reflexes most common

77
Q

Normal arterial pH

A

7.35-7.45

78
Q

Acid-base balance is regulated by

A

the kidneys and lungs through H+ ions and CO2 respectively

79
Q

acidosis

A

blood too acidic

80
Q

alkalosis

A

blood too basic

81
Q

Respiratory Acidosis

A

Alveolar hypoventilation-lungs do not excrete enough CO2

Kidneys compensate by increasing excretion of metabolic acids in the urine (ie: lactic or citric acid

82
Q

Respiratory Alkalosis

A

Alveolar hyperventilation. Usually short-lived.

83
Q

Metabolic Acidosis

A

occurs from an increase of metabolic acid or decrease of base (HCO3) as in diarrhea
Compensation occurs through the respiratory system through hyperventilation

84
Q

Metabolic Alkalosis

A

Common causes include vomiting and gastric suctioning.

Hypoventilation is the compensatory mechanism. S&S may be absent

85
Q

S&S of Respiratory Alkalosis

A

excitement, confusion, and paresthesias (numbness and tingling in extremities)

86
Q

Assess your patient’s home management of fluid imbalances to

A

teach how to prevent he imbalances from occurring in the future

87
Q

Risk Factors for fluid and electrolyte imbalances include

A
  1. age
  2. environment
  3. dietary intake
  4. lifestyle
  5. medications
88
Q

Risk Factors: Age

A

very young and very old at risk.

elderly at additional risk of delayed recovery

89
Q

Risk Factors: Dietary Intake

A

Starvation diets or those with high fat and no carbs (Atkins-Ketosis) may lead to metabolic acidosis.
Assess ability to chew/swallow

90
Q

Risk Factors: Lifestyle

A

Alcohol consumption causes Hypomagnesemia.

Elderly: medications, withholding fluids to prevent incontinence/nocturia

91
Q

Risk Factors: Medications

A

K+ wasting diuretics, using baking soda as an antacid, use of laxatives

92
Q

When assessing medical history, assess for

A
  • acute illness or trauma
  • chronic illness
  • physical assessment
93
Q

Acute Illness or Trauma to assess for include

A

GI alterations: diarrhea, vomiting
Respiratory Disorders: bacterial pneumonia
Acute Oliguric Renal Disease: due to meds or disease
Burns: high risk for ECV deficit, infection
Trauma: hemorrhage = ECV deficit

94
Q

Crush injuries cause

A

massive release of intracellular K+ into the blood

95
Q

Chronic Illnesses to assess for include

A

cancer
heart failure
oliguric renal disease

96
Q

How does cancer affect fluid and electrolyte imbalances?

A

cancer cells may secrete chemicals that circulate into bones and cause Ca++.
Side effects from chemotherapy including anorexia and diarrhea

97
Q

How does heart failure affect fluid and electrolyte imbalances?

A

reduces kidney perfusion due to decreased cardiac output, increased risk for low K+ due to ECV excess (aldosterone causes increase in absorption of Na++ and water).
Na++ restriction important

98
Q

How does Oliguric Renal Disease affect fluid and electrolyte imbalances?

A

chronic kidney disease leads to chronic oliguria resulting in ECV excess, increased K+, increased Mg++, and metabolic acidosis

99
Q

Daily Weights

A

most reliable indicator of fluid volume status

100
Q

Diligent Intake and Output

A

All intake including meds

All output including drains, emesis, gastric secretions

101
Q

Physical Assessment of Fluid and Electrolyte Imbalances include

A
  • daily weights
  • diligent intake and output
  • edema
  • lung sounds
  • monitor laboratory values
102
Q

Nursing Diagnosis for Fluid and Electrolyte Imbalances

A 
Decreased cardiac Output
Acute Confusion
Risk for Electrolyte Imbalance
Deficient Fluid Volume
Excess Fluid Volume
Impaired Gas Exchange
Deficient Knowledge regarding Disease Management
103
Q

DO NOT delegate administration of

A

IV fluid and hemodynamic assessment to the NAP

104
Q

People of all ages need to replace body fluid losses with

A

sodium-containing fluid and water

105
Q

Teach patients to recognize

A

risk factors for developing imbalances and implement appropriate preventative measures

106
Q

Fluid Replacement Therapy includes

A
  • enteral replacement
  • parenteral replacement
  • IV therapy
107
Q

enteral replacement

A

Oral replacement or via a tube placed directly in the stomach, jejunum or duodenum

108
Q

The nurse should watch for what in a patient undergoing enteral replacement?

A

watch for patients at high risk for aspiration

oral trauma or mechanical obstruction of the GI tract

109
Q

Parenteral Replacement

A

Via IV catheter

parenteral nutrition

110
Q

Parenteral Nutrition

A

via central line

111
Q

TPN

A

highly concentrated solution containing nutrients and electrolytes

112
Q

Many IV solutions require the use of an

A

EID Electronic Infusion Device

113
Q

IV Therapy

A

fluid and/or electrolyte replacement via catheter into a peripheral vein
hypertonic, isotonic or hypotonic solutions

114
Q

Additives to solutions (na++, K+) can cause

A

serious harm.

Administer with caution and strict monitoring.

115
Q

Remember that anything liquid at room temperature is

A

considered a fluid

ice chips, jell-O, ice cream

116
Q

Vascular Access Devices include

A 
peripheral catheters (short term)
central catheters and implanted ports (long term)
117
Q

Central Catheters and Implanted Ports include

A 
PICC lines
Vas Cath (dialysis
118
Q

It is critical to take measures for

A

the prevention of catheter-related bloodstream infections

119
Q

Assess the IV site to

A

prevent the accidental disruption of an IV system

120
Q

When assessing the IV site, assess for S&S of

A

infiltration
extravasation
phlebitis

121
Q

infiltration

A

when the IV catheter becomes dislodged or a vein ruptures and IV fluids inadvertently enter SQ tissue around the IV site

122
Q

extravasation

A

When IV fluid that contains additives that damage tissue infiltrate.
S&S: coolness, paleness, swelling of the area

123
Q

Phlebitis

A

inflammation of a vein; chemical, mechanical, or bacterial causes

124
Q

Risk factors for phlebitis include

A 
acidic or hypertonic IV solutions rapid IV rate 
IV drugs such as KCL and vancomycin
VAD inserted in area of flexion
poorly secured catheter
poor hand hygiene
lack of aseptic technique.
125
Q

S&S of phlebitis

A

redness, warmth, tenderness, possibly a red streak up the arm/extremity

126
Q

Objectives for administering blood and/or blood products include:

A
  1. To replace or increase circulating blood volume after surgery or trauma, or hemorrhage (watch for S&S of fluid overload p. 913)
  2. To increase the number of RBCs and maintaining hemoglobin levels in patients with severe anemia
  3. Provide selected cellular components for replacement such as platelets, albumin, or clotting factors
127
Q

Blood Transfusion Reaction

A

an immune response to the transfused blood components

128
Q

Autologous (Auto) Transfusion

A

the collection and reinfusion of the patient’s own blood either pre-planned (patients donating their own blood pre-op) or from collection devices (chest tube drainage).

129
Q

Before doing a blood transfusion

A

Together two RN’s check the blood label against the unit of blood itself, medical record number, and patient’s blood bank ID and name band
DO NOT administer even for a minor discrepancy

130
Q

Transfusion reactions may be

A

be life threatening; know your hospitals policy and procedure for handling a transfusion reaction.

NURS 305 (30 decks)

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