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NURS 306 > Chapter 5: Fluids and Electrolytes, Acids and Bases > Flashcards

Chapter 5: Fluids and Electrolytes, Acids and Bases Flashcards

1
Q

Total Body of Water (TBW)

A
  • total of the water in all fluid compartments.
  • 60% of body weight is water
  • varies w/ age, gender, body mass
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2
Q

TBW in older adults

A

-older adults have 50% less body weight by water because of increased body fat due to aging.

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3
Q

TBW in women

A

less body weight (water) than men because they have a greater proportion of body fat than men of the same weight.

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4
Q

TBW in newborns

A

have about 70-80% water by weight

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5
Q

Fluid Compartments

A
  1. Intracellular (ICF)

2. Extracellular (ECF)

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6
Q

Intracellular (ICF)

A

insider cells (ICF)

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7
Q

Extracellular (ECF)

A
  • outside and in between cells.

- includes interstitial (surrounding cells, lymph) and intravascular fluid.

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8
Q

Majority of body water (2/3) is located w/in

A

cells and is termed intracellular fluid (ICF) except in infants.

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9
Q

Infants have more water located in

A

the extracellular compartment

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10
Q

Fluid in extracellular space is about

A

1/3 of body water.

termed extracellular fluid (ECF)

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11
Q

Intravascular

A

w/in vascular space, inside blood vessels.

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12
Q

Transcellular fluid

A

part of the ISF

ex) CSF, synovial membrane

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13
Q

Intracellular Movement of Water

A

-intracellular water does not move readily out of the cell

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14
Q

Intravascular Movement of Water

A
  • in capillary beds, there is constant movement of fluids between extracellular fluid (interstitial & intravascular).
  • maintains equilibrium
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15
Q

fluid and electrolytes

A

move between ICF & ECF.

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16
Q

Process involved in movement is

A
  • diffusion
  • facilitated diffusion (rapid diffusion due to a combined specific molecule)
  • active transport
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17
Q

Water moves between ICF & ECF due to

A

opposing forces: capillary hydrostatic pressure and capillary osmotic pressure.

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18
Q

Capillary hydrostatic pressure

A

force w/in a fluid compartment (ex. blood vessel)

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19
Q

Capillary osmotic pressure

A

pressure required to stop osmotic flow of water.

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20
Q

Active Transport

A

Na and K

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21
Q

Osmosis

A
  • movement of water between compartments separated by membranes permeable to water only. Not permeable to solutes.
  • water then moves from the more dilute compartment (has more water) to a more concentrated side.
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22
Q

Tonicity of fluids/solutions

A
  1. isotonic
  2. hypotonic
  3. hypertonic
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23
Q

ICF and ECF are

A

isotonic to one another = no water movement occurs

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24
Q

Osmolarity

A

measures osmotic force of solute per unit of weight of solvent.
“concentration of particles dissolved in a fluid”

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25
Q

Cells are affected by the

A

osmolarity of the fluid that surrounds them.

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26
Q

Electrolytes

A
  • substances essential to life
  • mostly minerals
  • components of ICF & ECF
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27
Q

Electrolyte concentrations can be expressed in

A
  • mg/dL= milligrams per deciliter
  • mmol/L= millimoles per liter
  • mEq/L= milliequivalents per liter
28
Q

mg/dL, mmol/L

A

describes how much lipid is present in a specific amount of blood

29
Q

Electrolyte Intake

A

through diet, medications, and blood transfusions.

30
Q

Electrolyte absorption

A

GI tract: depends on concentration gradients, binding proteins, intestinal fluid pH

31
Q

Electrolyte distribution

A
  • medications
  • hormones: epinephrine (K), insulin (K), parathyroid hormone (calcium)
  • cells and bones
32
Q

Electrolyte excretion

A
  • urine
  • feces (diarrhea)
  • sweat
33
Q

Effect of undigested fat on electrolyte excretion

A

undigested fat in intestines binds to calcium and magnesium ions that are secreted into the GI tract and prevents them from being reabsorbed (seen in cystic fibrosis)

34
Q

Electrolyte Loss

A
  • vomiting
  • NG (nasogastric) suction
  • paracentecis
  • hemodialysis
  • wound drainage
35
Q

Fluid and Electrolyte Imbalances

A
  • common in chronic illnesses
  • for therapeutic measures
  • F&E imbalances: deficits or excesses.
36
Q

Examples of therapeutic measures for fluid and electrolyte imbalances

A

IVF replacements and meds such as diuretics

37
Q

Examples of chronic illnesses that can affect fluid and electrolyte balance

A

CHF, burns CRF

38
Q

Hyponatremia

A
  • less salt in ECF (water excess in ECF)

- water moves into cells causing cell swelling

39
Q

Pathogenesis of Hyponatremia: Causes

A
  • IVF after major surgery
  • excess water intake
  • IVF administration in renal failure
  • small cell lung cancer
  • diuretics
  • excessive beer or water ingestion
  • ADH administration
40
Q

Signs and Symptoms of Hyponatremia

A

cellular swelling -> swelling of neurons: malaise, anorexia, N/V, h.a., confusion, lethargy, twitching, increased reflex, convulsions, seizures - coma!

41
Q

Treatments for Hyponatremia

A
  • IV w/ small amount of hypertonic saline solution (3% NaCl) or 5% dextrose in water.
  • In GE replacement of F&E w/ oral drinks such as gatorade.
  • Drugs: arginine vasopressin (ADH) receptor antagonists, conivaptan (vaprisol)
42
Q

Hypernatremia

A
  • more salt in ECF (less water in ECF)

- water moves out of cells leading to cellular dehydration, cell shrinkage

43
Q

Neurological Symptoms of Hypernatremia

A

causes neurons to shrink

-irritability, confusion, tremors, seizures, coma.

44
Q

Cardiovascular Symptoms of Hypernatremia

A

Increased HR and hypotension

45
Q

GI Symptoms of Hypernatremia

A

N/V

46
Q

Skin Symptoms of Hypernatremia

A

dry mucous membranes, dry skin, flushed skin, edema (d/t water retention)

47
Q

Hypernatremia =

A

hyperchloremia

48
Q

Pathogenesis of Hypernatremia: Causes

A
  • concentrated tube feedings w/o enough water (esp in older adults)
  • IV infusion of hypertonic solution D5NS
  • near drowning in salt water
  • reduced fluid intake
  • difficulty swallowing fluids such as stroke pts.
  • diabetes insipidus
  • prolonged diarrhea
49
Q

Treatment for Hypernatremia

A
  • D5W (dextrose in 5% water) to dilute serum Na.

- Diuretics to promote excretion of Na

50
Q

Edema

A

excess fluid between cells (interstitial compartment)

51
Q

Pathogenesis of Edema

A

…

52
Q

Signs and Symptoms of Edema

A

…

53
Q

Treatment for Edema

A

…

54
Q

Hypokalemia

A

-low potassium in ECF

55
Q

Pathogenesis of Hypokalemia

A
  • GI tract losses
  • diuretics (lasix)
  • low serum magnesium
  • metabolic alkalosis
  • DKA
  • NPO
  • excess insulin
  • renal problems
56
Q

Signs and Symptoms of Hypokalemia

A
  • arrhythmias
  • cardiac standstill
  • muscle weakness
  • flaccid paralysis
  • may cause polyuria (d/t interfering action of ADH at renal tubules)
57
Q

Metabolic alkalosis

A

shifts K into cells in exchange for hydrogen, thus lowering K in the ECF

58
Q

Treatments for Hypokalemia

A

K chloride, K in IVF

NEVER administer K via IVP

59
Q

Hyperkalemia

A

high potassium in ECF (greater than 5.0 mEq/L)

60
Q

Pathogenesis for Hyperkalemia: Cause

A
  • by increased potassium
  • renal failure (most common cause)
  • massive cell destruction (burns, crush injury, tumor lysis, ACE inhibitors, potassium sparing diuretics)
61
Q

Signs and Symptoms of Hyperkalemia

A
  • Vfib
  • cardiac standstill!
  • causes muscle dysfunction
62
Q

Hyperkalemia and muscle dysfunction

A

hyperkalemia causes the smooth muscle and skeletal muscle to become hypopolarized causing intestinal cramping diarrhea, weakness, flaccid paralysis

63
Q

Worse hyperkalemia can cause

A

skeletal muscle to become hypopolarized so that their resting potentials lie above their threshold potential, once they have discharged, they are unable to contract again.

64
Q

Treatments for Hyperkalemia

A
  • IV insulin along with glucose (prevent hypoglycemia)
  • calcium gluconate
  • kayexalate (binds K in exchange for Na and renin is excreted in feces)
  • hemodialysis in RF
65
Q

Table 5-7 lists additional

A

electrolyte abnormalities

66
Q

Nursing Process and patient centered care teaching

A

pp 473-479

NURS 306 (26 decks)

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