Class 2 Fluid and Electrolytes Flashcards
Na+ is responsible for _____ osmotic balance
ECF (extracellular fluid)
K+ responsible for the _____ osmotic balance
ICF (intracellular fluid)
Osmolality
solutes/particles per kg of water
Osmotic pressure
pulling pressure
Oncontic pressure
osmotic pressure of plasma proteins, Albumin is the most important plasma protein.
Hyrostatic pressure
pushing pressure against cell membrane or vessel wall
Edema
excessive fluid within the intersititial spaces.
-localized vs. generlized (all over body)
Pitting edema
when touch the skin and leaves a finger mark
Third spacing
fluid trapped in an area in the body, fluid thats trapped can not be used. Patient can be dyhydrated
Causes of edema
- increase in capillary hydrostatic pressure
- decrease in plasma oncotic pressure
- increase in capillary permeability
- lymph obstruction
- increase in tissue oncotic pressure
ADH (antidiaretic hormone)
-tap water hormone
causes the kidneys to reabsorb water.
-Renal absorption of water due by ADH makes smaller volume of more concentrated urine.
Aldosterone
- saltwater hormone
- causes kidneys to reabsorb sodium and water
- renal absorption of sodium and water due to aldosterone makes a smaller volume of urine.
Hypertonic
cell shrinks, fluid/water moves from inside the cell from a lower concentration to a higher concentration.
Isotonic
equal exchange, water goes in and out of cell
Hypotonic
cell swells, solution outside the cell has a lower solute concentration and water moves to an area of high concentration in the cell,
Fluid volume excess
Excessive Sodium or water intake OR Inaqequate sodium or water elimination
Etiology of Excessive Sodium or water in take
- patient eating high sodium diet
- could be drinking alot of fluid
- enteral feedings and not balancing those feedings
Etiology Inaqequate sodium or water elimination
- Hyperaldosteronism
- cushing syndrome
- sydrome of inapprorriate antidiuretic hormone
- renal failure
- live failure
- heart failure
Clinical Manifestations of Fluid volume excess
- generalized edema
- localized edema
- dsypnea
- bounding pulse
- tachycardia
- polyuria
- rapid weight gain
- JVD
- Crackles
Etiology of Fluid volume deficit
Inadequate fluid intake or excessive fluid or sodium losses
Inadequate fluid intake
- poor oral itake caused by impaired thirst mechanism, inability to swallow
- inadequate IF fluid replacement
Major Electrolytes
Sodium Na+ Potassium K+ Calcium Ca++ Magnesium Mg++ Phosphorus PO4-
essential to heart, nerves, and muscles functioning properly
Sodium
Normal values 136-145 mEq/L
- Primary ECF electrolyte
- Regulates osmotic forces and water balance
Hyponatremia
Serum Na+ <136 mEq/L
- Related to sodium loss or water gain
- sodium deficits cause plasma hypoosmolatiy and cellular swelling
Hypernatremia
Serum Na+ >145 mEq/L
- related to sodium gain, water loss
- sodium overload causes hyperosmolatiy and cellular shrinking
Hypernatremia
Serum Na+ >145 mEq/L
- related to sodium gain, water loss
- sodium overload causes hyperosmolatiy and cellular shrinking
Potassium
Normal value is 3.5-5 mEq/L
- major intracellular electrolyte
- 98% inside the cell
- Concentration maintained by Na+/K+ pump
Hypokalemia
Serum K+ <3.5 mEq/L
Hyperkalemia
Serum K+ >5 mEq/L
_________, ____________, and ___________ influence serum postassium levels
Aldosterone, insulim, and catecholamines
Potassium adaptation
SLOW CHANGES tolerated better than acute
Calcium
Normal value 9-10.5mg/dl
-99% of calcium is located in teeth and bones
The electrolyes in circulation are regulated by ?
Vitamin D, PTH (parathyroid hormone), and calcitonin
Hypocalcemia
Serum Ca2++ <9mg/dL
Hypercalcemia
Serum Ca2++ >10.5 mg/dL
Phosphate
Normal value 2 to 4.5 mg/dL
-Calcium and phosphate concentrations are rigidly controlled if……?
- if the concentration of one is elevated, that of the other is decreased.
- located in bone
- energy source for cellular processes
_________, _________, and ______ act together to control phosphate absoprtion and excretion
Parathyroid hormone, vitamin D3, and calcitonin
Hypophosphatemia
Serum PO4 3- <3 mg/dL
Hyperphosphatemia
Serum PO4 3- > 4.5 mg/dL`
Hyperphosphatemia
Serum PO4 3- > 4.5 mg/dL`
Magnesium
Normal value 1.3-2.1 mEq/L
- largely stored in bone
- protein bound within bloodstream
- most abundant intracellular cation
Hypomagnesemia
Serum Mg < 1.3 mEq/L
Hypermagnesemia
Serum Mg > 2.1 mEq/L
A client is seen in the ER with reports of nausea, vomiting, dizziness, and weakness for 4 days. Physical Assessment reveals dry oral mucous membranes, oral temp 101.3 F, pulse 116 bpm, respirations 20 bpm, blood pressure 102/64 mm Hg. Which of the following are consistent with the presence of fluid volume deficit? SELECT ALL THAT APPLY
A. thirst B. flat jugular veins C. Decreased skin turgor D. Weight gain E. Altered level of consciousness
A. thirst
B. flat jugular veins
C. Decreased skin turgor
E. Altered level of consciousness
A client is admittedd to an acute care facility with dyspnea, weakness, weight gain of 2lbs, 1+ pitting edema in both lower extremities. Assessment findinfs include temp 99 F, pulse 96 bpm, respirations 22 bpm, 152/96 mm Hg. The client is diagnosed with heart failure and fluid volume excess. Based on this assessment what other clinical manifestations could the nurse assess?
A. bounding pulse B. Decreased skin turgor C. Oliguria D. Jugular venous distention E. crackles
A. bounding pulse
D. Jugular venous distention
E. crackles
A nurse is caring for a client with the following electrolyte results:
Na + 130 mEq/L
K+ 4 mEq/L
Ca 2+ 9.7 mg/dL
Mg 1.6 mEq/L
Which of the following is likely to cause these results
A. three tap water enemas
B. 0.9% sodium chloride 50 mL/hr
C. D5W with 20 mEq K+ 80 mL/hr
D. Administration of glucocorticoids
A. three tap water enemas
A nurse is caring for a client with potassium level of 5.5 mEq/L. What should the nurse assess for in this client?
A. constipation
B. polyuria
c. ECG changes
D. hypotension
c. ECG changes
Which of the following electrolyte imbalances should the nurse monitor a client for with a nasogastric tube?
A. hypocalcemia
B. hypokalemia
C. Hypomagnesemia
D. Hypophosphatemia
B. hypokalemia
A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which off the following fluid compartments?
A. intracellular fluid (ICF)
B. intraocular fluid
C. interstitial fluid
D. intravascular fluid
D. intravascular fluid
When planning care for elderly individuals , the nurse should remember the elderly are at a higher risk for developing dydration. What is the cause for this complication?
A. bc they have a higher total body water volume
B. bc they have decreased muscle mass
C. bc they have increased thirst
D. bc they have an increased tendency toward developing edema.
B. bc they have decreased muscle mass
Which of the following patients should the nurse assess for decreased oncotic pressure in the capillaries?
A. a patient with a high-protien diet
B. a patient with liver failure
C. a patient with low blood pressure
D. a patient with low blood glucose
B. a patient with liver failure
What causes water movement between the ICF and ECF compartments?
A. determined by osmotic forces
B. determined by plasma oncotic pressure
C. determined by antidiuretic hormone
D. determined by buffer systems
A. determined by osmotic forces
When the nurse is planning care for a dehydrated patient, the nurse should remember which principle of water balance?
A. water balance is closely related to the balance of potassium
B. water balance is closely related to the balance of chloride
C. water balance is closely related to the balance of bicarbonate
D. water balance is closely related to the balance of sodium
D. water balance is closely related to the balance of sodium
Which organ system should the nurse monitor when the patient has long-term potassium deficits?
A. central nervous system
B. lungs
C. kidneys
D. gastrointestinal tract
C. kidneys
A client has a potassium level of 6.5 mEq?L. Which assessment finding should the nurse expect to observe?
A. weak pulse
B. excessive thirst
C. constipation
D. EKG changes
D. EKG changes
A client is admitted to the emergency department with 3+ pitting edema in the bilateral lower extremitites. Based on this finding what other assessment findings could the nurse expect to find? SELECT ALL THAT APPLY
A. dsypnea B. crackles C. tachycardia D. low blood pressure E. weak, thready pulse
A. dsypnea
B. crackles
C. tachycardia
The client is diagnosed with fluid volume excess. What could cause the 3+ pitting edema? SELECT ALL THAT APPLY
A. increased capilllary hydrostatic pressure B. decreased tissue oncotic pressure C. decreased plasma oncotic pressure D. increased capillary permeability E. lymph obstruction
A. increased capilllary hydrostatic pressure
B. decreased tissue oncotic pressure
C. decreased plasma oncotic pressure
D. increased capillary permeability
Further assessment findings suggest the patient has heart failure. What etiology caused this clients 3+ pitting edmea?
A. increased capillary hydrostatic pressure
B. decreased tissue oncotic pressure
C. decreased plasma oncotic pressure
D. increased capillary permeability
A. increased capillary hydrostatic pressure
The client is given furosemide (Lasix) 40 mg twice a day (BID). After 3 days the client complains that “ it feels like there is a butterfly in my chest” What is the priorority intervention for the nurse?
A. get an order for lab work
B. place client on heart monitor
c. call the provider
D. give the client a PRn dose of lasix
B. place client on heart monitor
The heart monitor shows a prominent U wave. The nurse immediately gets a potassium level. The lab calls the nurse: K+ 2.5 mEq/L
Based on this lab work what other assessment findings are possible? SELECT ALL THAT APPLY
A. skeletal muscle weakness B. cardiac dysrhythmias C. restlessness D. tingling of fingers E. loss of smooth muscle tone
A. skeletal muscle weakness
B. cardiac dysrhythmias
E. loss of smooth muscle tone
The client is given 50 mL/hr 0.9 normal saline with 20 mEq/L K+. what should the nurse monitor while the client is on this IV solutions? SELECT ALL THAT APPLY
A. crackles B. weight gain C. restlessness D. tingling of fingers E. tall, peaked T waves
All of the above
