E3 Fluid & electrolytes Flashcards
What does body fluid do?
- Transport nutrients & waste to & from cells
- Solvent for electrolytes
- Body temp
- digestion
- elimination
- acid-base balance
- lubrication of joints & body tissue
_____% of adults body weight is water
50-60%
How much of water is intracellular and extracellular? Parts of extracellular?
Intra- 70%
Extra- 30%
1. Interstitial fluid- btwn cells
2. Intravascular fluid-plasma (nonRBCs)
Describe Osmosis
Movement of water from low solute concentration to high solute concentration across semipermeable membrane
Describe Diffusion
Movement of molecules from high concentration to low concentration
Osmotic pressure
the amount of pressure needed to prevent the movement of water across a cell membrane
Colloids
Substances that increase colloid oncotic pressure
Move fluid from interstitial space to plasma (blood)
What are the 3 primary colloids?
-Albumin
-Globulin
-Fibrinogen
Colloids can be measured with ______ and decreaes with ______
total protein level
age & overall nutrition
Describe Hydrostatic pressure
Force of fluid pushing against cell membrane (vessel wall)
Generated by BP
At capillary level, major force that pushes water out of the vascular space into interstitial space
Aids the supply of nutrients to the tissues of the body
Describe Oncotic pressure
aka colloid osmotic pressure
major colloid is albumin
Plasma has LOTs of colloids, interstitial space has little
Plasma proteins attract water, pulling fluid from tissue space into vascular space
Helps remove metabolic waste from tissues
Electrolytes influence:
-Fluid balance
-Acid-base balance
-Nerve impulses
-Muscle contraction
-Heart rhythm
Concentrations of electrolytes are dependent on
-Electrolyte intake
-Electrolyte absorption
-Electrolyte distribution
-Electrolyte excretion
Intracellular electrolytes & charges
Potassium K+
Magnesium Mg+2
Phosphorus P-3
Extracellular electrolytes & charges
Sodium Na+
Chloride Cl-
Bicarbonate HCO3-
Sodium normal lab value
136-145 meq/L
Potassium normal lab value
3.5-5.0 meq/L
Magnesium normal lab value
1.7-2.2 mg/dl
Calcium normal lab value
9-11 mg/dL
Phosphate normal lab value
3.2-4.3 mg/dL
What follows sodium?
Water
What is Hyponatremia and the causes?
Low Na+ <136
-Gi losses (N/V/fistulas/NG suction)
-Renal losses (Diuretics, adrenal insufficiency, Peeing)
-Skin losses (burns, wound damage)
-Fasting diet, polydipsia (water intoxication)
-Excess hypotonic fluid
Hyponatremia S/S
-CONFUSION/ ALTERED LOC (swelling of brain cells)
-Anorexia & Muscle weakness
-Can lead to seizures/comas
What is Dilutional Hyponatremia & symptoms?
- Hypervolemia = Too much water
- Increase BP
- Weight gain
- Bounding rapid pulse
- Increase urine specific gravity
What is Depletional Hyponatremia & symptoms?
- Hypovolemia = Absolute loss of Na+ (fluid loss)
- Decrease BP
- Tachy pulse
- Dry skin
- Weight loss
- Decreased urine specific gravity
Hyponatremia treatment
- Sodium replacement (SLOWLY)
- PO- Sodium Bicarbonate
- IV-Normal Saline (0.9%)
- Fluid restriction
- Treat underlying problem (Water intoxication or not eating)
MOA of Sodium Bicarbonate
Dissociates to provide bicarbonate ion which neutralizes concentration and raises blood and urine pH
Also, increases concentration of sodium in plasma
Indication of Sodium Bicarbonate
Metabolic Acidosis
How is Sodium Bicarbonate administered?
PO only
-Do not give IV: Vesicant at high concentrations (Only given for acid-base imbalance through central line)
Adverse effects of Sodium Bicarbonate
-Pulmonary Edema
-Cerebral hemorrhage
-Hypernatremia
-Lots of electrolyte abnormalities
-Metabolic alkalosis
-Flatulence with PO
-Tetany
-Heart failure exacerbation
Nursing considerations for Sodium Bicarbonate
-Monitor cardiac, ABGs, & electrolytes
-If IV, monitor patency
-Lots of drug interactions if drug mixing with is diluted with sodium solutions
-If PO, give 1-3 hours after or before meals for better absorption
What is Hypernatremia and causes?
High Na+ >145
1. IV fluids, TF, near salt water drowning, excess sodium intake, NOT by eating high salt diet
2. Not enough water intake or too much water loss (congnitively impaired, diarrhea, high fever, heatstroke)
3. Profound diuresis
S/S of Hypernatremia
-ALTER LOC/ CONFUSION/ seizure/ coma (Shrinking of brain cells)
-Extreme thirst (Hyperosmolality)
-Dry, sticky mucous membranes
-Muscle cramp
Treatment of Hypernatremia
If H2O is cause –> Add water
If sodium excess is cause–> remove sodium (TF, IV fluids)
GRADUALLY achieve normal Na+ levels over 48hr period to avoid edema of cerebral cells (lethal)
Sodium key points
- Main ECF cation
- Governs osmolality
- Influences water distribution
- Aids in acid-base balance
- Activates muscle & nerve cells
Potassium key points
1.Main ICF cation
2. Helps regulate cell excitability & electrical status
3. Helps control intracellular osmolality
4. Diet is main source
5. Kidneys main source of potassium loss
What is Hypokalemia & causes?
Low K+ <3.5
1. Renal or GI losses (D/V/ illiostomy/ diuresis)
2. Acid base disorders
S/S of Hypokalemia
-CARDIAC RHYTHM disturbances can be lethal (Cardiac arrest)
-Muscle weakness & leg cramps
-Decreased bowel motility- Constipation, nausea, ileus
Hypokalemia Pharmacologic Treatment & nursing considerations
Potassium chloride
-PO: Dilute w/ water/juice to decrease GI distress (taste bad)
-IV: MUST ALWAYS BE DILUTED and given SLOWLY, NEVER IV PUSH
-Give only to clients with documented urine output
-May cause phlebitis/pain
-IV fluids should not contain more the 40mEq/L of K+ rate should not exceed 10-20 mEq/hr
-Cardiac monitor
_______ can be precipitated by administration of undiluted IV KCL
Ventricular fibrillation
What is Hyperkalemia and Causes?
High K+ >5
1. Decreased K+ output (renal failure/ not peeing)
2. Burns, crush injuries, sepsis (anything w/ massive cell injury)
3. Drugs potassium sparing diuretics, ACE, ARBS, NSAID
S/S Hyperkalemia
-CARDIAC RHYTHM DISTURBANCES (peaked T waves)
-Muscle weakness & cramping
-Abdominal cramping, Diarrhea, Vomiting
Pharmacotherapy for Hyperkalemia & its class
D50/INsulin or
Sodium polystyrene sulfonate
-Cation exchange resins
MOA of Sodium polystyrene sulfonate
kayexalate binds to K+ in digestive tract replacing K+ ions for Na+ ions
Use Sodium polystyrene sulfonate only in patients with _____
Normal Bowel Movements (After binding you gotta poop it out)
Adverse reactions of Sodium polystyrene sulfonate
-Constipation
-N/V/D
-Hypokalemia
Serious: Intestinal obstruction & intestinal necrosis
What does D50/Insulin do for Hyperkalemia?
Insulin shifts K+ into cells temporarily & D50 keeps you from getting super hypglycemic
-Only in emergent situations
-If BS very low don’t give
Magnesium helps to stabilize _____ and _______
Smooth muscle & Cardiac muscle cells (Blocks/ controls movement of K+ out of cardiac cells)
What is hypomagnesemia and the causes?
Low Mg+2 <1.7
-Diuresis
-GI or renal loss
-Limited intake (fasting/starving)
-Alcohol abuse
-Pancreatitis
-Hyperglycemia
S/S of hypomagnesemia?
-Hyperactive reflexes
-Confusion
-Cramps
-Tremors
-Seizures
-Nystagmus
What is hypermagnesemia & the causes?
High Mg+2 >2.2
Increased intake accompanied by renal failure
-Chronic renal failure who take milk of mag (elderly take for constipation)
-OB pts (given to prevent seizures for preeclampsia)
S/S of hypermagnesemia?
-Lethargy
-Floppiness
-Muscle weakness
-Decreased reflexes
-Flushed/ warm skin
-Decreased pulse/BP
Pharmacological treatment for hypomagnesemia and MOA?
Magnesium Sulfate
Magnesium Oxide
MOA: replaces magnesium
Adverse effects of Magnesium Sulfate & Magnesium Oxide
-Hypermag
-Confusion
-Sluggish
-Slow movements
-Nausea
-Dizzy (low Ca+2)
-Abnormal heart rhythm
-Can burn with IV
Can Magnesium Sulfate or Magnesium Oxide be given long term for low magnesium?
Magnesium Oxide
Hormones released by the ______ and ______ are controllers for the amount of calcium that is released from and absorbed into bone
thyroid & parathyroid glands
Majority of calcium is in the _______
bones
50% ionized and available for use
40% protein bound
10% chelated (bound to other substances)
Calcium is involved in: (5)
- Enzyme reactions
- Membrane potential & nerve excitability
- Release of hormones, NTs, chemical mediators
- Cardiac contractility & automaticity
- Blood Clotting
What is Hypocalcemia and Causes?
Low Ca+2 <9
-Unable to mobilize bone (hypoparathyroidism & Hypomagnesemia)
-Increased renal loss
-Increased binding
-Decreased Vit D
-Acute pancreatitis
-Thyroid & parathyroid surgery (sudden)
S/S of Hypocalcemia
- Increased neuromuscular excitability
-Parasthesias (numbing/tingling)
-Muscle cramps
-Bone pain
-Tetany
-Laryngeal spasm
-Hyperactive reflexes - Cardiac insufficiency- prolonged QT interval (can lead to fatal arrhythmia)
What are the 2 distinctive signs of Hypocalcemia?
Positive Chvostek’s- Tap on cheek & eye will close
Positive Trousseau’s sign- Spasm of carpal muscle when BP cuff inflated to 20mmHG above the pts systolic blood pressure for 3 mins
Treatment of Hypocalcemia
IV calcium: Calcium Chloride or Calcium Gluconate
Oral Calcium: Elemental calcium or calcium carbonate (tums)
-May also need vit D
What is Hypercalcemia & the causes?
High Ca+2 >11
-Hyperparathyroidism
-Cancers
-Overdose on tums
S/S Hypercalcemia
-Calcium acts like a sedative
-Fatigue
-Lethargy
-Confusion
-Weakness
-Leading to seizures or coma
-Kidney stones
Treatment of Hypercalcemia
-Adequate hydration
-Increased urine output
-Diuretics and NaCl (sodium excretion is accompanied by calcium excertion)
-Dialysis in renal failure
low calcium = low ______
phosphorus
Important things to know about phosphorus?
-Found in bone (85%) and intracellular (14%)
-Higher levels in infants & kids
-Organic: circulating and measured
-Inorganic: intracellular and can’t be measured
-Role in bone formation
-Essential for ATP formation & enzymes needed for glucose, protein, and fat metabolism, Part of DNA/RNA
-Acid-base buffer
What is Hypophosphatemia & causes?
Low Phosphorus <3.2
-Ca+2 imbalance (commonly)
-Decreased absorption
-Antacids overdose
-Severe diarrhea
-Increased kidney elimination
-Malnutrition (Alcoholism, TPN, Recovery from malnutrition)
Clinical manifestations of Hypophosphatemia?
-Tremor
-Paresthesia
-Confusion to coma
-Seizure
-Muscle weakness
-Joint stiffness
-Bone pain
-Hemolytic anemia
-Plt dysfunction
-Impaired WBC function
What is Hyperphosphatemia and causes?
High Phosphorus >4.3
-Kidney failure
-Laxatives/enemas with phosphorus
-Shift from intra- to extracellular compartment (massive stroke or heat stroke)
-Hypoparathyroidism
Clinical Manifestations of Hyperphosphatemia
-Usually asymptomatic
-Typically only symptoms of hypocalcemia: muscle spasm, paresthesia, tetany
Hypophosphatemia treatment
-IV or oral replacement (Given IV over a long period of time)
-Increase oral intake
-Take care with CKD or hypercalcemia (increases risk of calcifications)
Hyperphosphatemia treatment
Treat the cause
-Calcium-based phosphate binders
-Hemodialysis- renal failure
