Electrolytes & Fluids Flashcards
Total body water volume: (2)
40 L
60% body weight
Intracellular fluid (ICF): (3)
Fluid found in the cells.
K+ and Mg+ chief cation.
Phos chief anion
Extracellular fluid (ECF): (3)
All fluids found outside the cell.
NA and Cl-
Plasma has large protein amount
Fluid and food intake (2)
Fluid intake = 1500 ml
Food = 1000
Fluid loss through (5)
Urine 1500 ml
Sweat 100 ml
Skin 500 ml
Lungs 400 ml
Feces 200 ml
Fluid regulation by (in the brain) (1)
Hypothalamus: thirst center
The Hypothalamus’ function (3)
Osmoreceptors monitor osmolality
As osmolality increases thirst will increase
Can your client communicate or perceive thirst?
Antidiuretic hormone (ADH): (1) What it does, (1) where it is made, (1) where it is stored
Regulates amount of water kidney tubules absorb
Synthesized by hypothalamus
Stored in posterior pituitary gland
ADH and what happens when (1) you have dehydration or overly concentrated body fluid and (2) you have overly diluted body fluids
*Body fluid too concentrated → ADH increases → decreased urine output → Extreme SIADH (Soaked inside or swimming in fluid)
*Too dilute body fluids → ADH decreases → increases urine output → Extreme DI
*DI: Dry inside or diuresis increases
– Low urine osmolality and serum hypernatremia
– Fluid replacement, desmopressin or vasopressin
Fluid also regulated by (2)
Atrial natriuretic peptide (ANP) & Aldosterone
Atrial natriuretic peptide (ANP) function (3)
Released in situations of overload imbalance
Cells in right atrium release ANP when stretched
Inhibits AHD → increasing the loss of NA+ and water in the urine
Aldosterone function + increased & decreased in what condition (2)
Reabsorption of NA+ and water in fluid insufficient → increasing ECF
Influenced by renin → angiotensin → aldosterone loop
Increased in: Hemorrhage
Decreased in: Adrenal crisis
Measurement and management (fluids) (11)
Thirst
Vitals
Confusion
Mouth and mucous membranes
Body weight
Skin elasticity
Fluid balance records
Blood records
Total fluid volume fluctuates by less than 1%
Fluctuations in fluid volume by just 10% can have serious effects
20% can be fatal
Isotonic fluids (4)
- Expands intravascular compartment
- 5% dextrose is isotonic but becomes hypotonic when - glucose is metabolized
- Elderly or kidney disease = risk of fluid overload
- Lactated ringers = dont use with liver dysfunction or someone with lactic acidosis
Hypotonic fluids (7)
Moves fluid out of intravascular compartment hydrating the cells and interstitial environment
Good for DKA. Although you start with isotonic and move to hypotonic
Not good for fluid replacement in dehydration
Excessive infusion = intravascular fluid depletion
High risk in elderly
By pulling fluid into the cells the cells can rupture → cerebral edema
NO USE WITH RBCS OR SHOCK
Hypertonic fluids (6)
Moves water into the vascular space
Good for use in SIADH (because you are retaining fluid in SIADH causing diluted solutes and this causes ^^ solutes in body)
Reduce cerebral edema and PSI
Hypervolemia risk
Pulmonary edema risk
May irritate blood vessels
Isotonic solutions (3) fact, and 2 examples
same as intravascular space
Normal saline
Lactated ringers
Hypotonic solutions (3) fact and 2 examples
out of intravascular. Hydrating cells and interstitial.
5% dextrose
0.45% sodium chloride.
Hypertonic solutions (5 ish). Fact and examples
enter. Entering intravascular compartment.
3% sodium chloride
10 and –>
50% dextrose.
Colloids (on another slide)
Colloids: what it is and 3 examples
Proteins. Hypertonic. Shifts fluids into vessels.
Albumin, dextran, hetastarch
Potassium: Functions (6)
Resting membrane potential of nerve and muscle
Regulating intracellular osmolarity and promoting cellular growth
Plays role in acid base balance
Diet is major source
Kidneys are primary route for K loss
Excretion depends on serum content
Potassium range
Normal 3.5 -5 meq
Causes of hypokalemia (4)
*Gi Loss → vomiting, diarrhea, gastric suction
*Dietary → starvation, anorexia, bulimia, older adults
*Medications → corticosteroids, thiazide diuretics, loop diuretics, sodium penicillin, amphotericin B
*Disorders → Hyperaldosteronism, magnesium depletion, osmotic diuresis
S/S of hypokalemia 1/2 (4)
Fatigue and muscle weakness
Anorexia, nausea, vomiting
Polyuria
Illesu, Abdominal distention
S/S of hypokalemia 2/2 (6)
Paresthesia
Leg cramps
Decreased reflexes
Increased sensitivity to digoxin
Decreased BP and weak irregular pulse
ECG changes (flat t wave, depressed ST, U wave)
Correcting hypokalemia (6)
Replace
Oral mild to moderate
IV = if less than 2 meq
Never safe to give IV Push or IM
Magnesium replacement
Monitor ECG
Prevention of hypokalemia (3)
Elderly at risk
Those on laxatives and diuretics
Eat bananas, melons, citrus, lean meats, milk, whole grains
Causes of hyperkalemia 1/2 (6)
Serum over 5 meq
Kidney injury
Infection and increase of potassium
Medications
Injuries like crush injuries and burns
ACE inhibitors
Causes of hyperkalemia 2/2 (6)
NSAIDS
Cyclosporine
Blood transfusions
Potassium sparing diuretics combined with renal insufficiency
Disorders = addisons, hypoald.
Acidosis = increase in serum K
S/S hyperkalemia (6)
Heart palpitations
Tingling numbness
Twitching
Weakness
Flaccid paralysis
Diarrhea
ECG changes (on another slide)
ECG changes in hyperkalemia
Loss P waves, prolonged PE, wide QRS, ST depression
Treatment of hyperkalemia (8)
Lower level
Stop potassium replacements
Furosemide
Sodium polystyrene sulfonate - shit it out
Hypertonic IV solutions to pull K
Glucose and insulin to shift K into cells
Dialysis
Assess for heart complications = ECG
Sodum range
135 - 145
Sodum (3) what it does, where you get it from, where it leaves from
Maintains ECF
From food
Leaves in urine sweat and feces
Causes of hyponnatremia (6)
Water imbalances
ECF decreased below level of intracellular fluid = cell burst
Vomiting, diuretics
Excessive admin of dextrose and water IVFs
Low sodium diet
Excessive water intake
S/S hyponatremia (4)
Brain swelling → increased ICP
Mental status changes
Relative → Too much fluid.
Absolute hyponatremia → underlying cause
Excessive loss of sodium: what to do (3)
Withhold all diuretics
Replace with isotonic = 0.9% NACL
Encourage fluids
Water gain: what to do (2)
Loop diuretics
Fluid restriction
Hypernatremia: causes (7)
Cells become irritable
Hypertonic tube feedings without water supplements
Steroids
Ingestion of OTC drugs such as alka seltzer
Burns
DI → loss of fluids but no Na
Diarrhea
S/S hypernatremia (7)
Due to fluid shifting out of cells and causing cell shrinkage –> Dehydration of brain cells results
Most concerned with brain cell shrinkage → brain damage
Mental status changes
Confusion, drowsiness = No one is “just confused” on NCLEX
Irregular muscle contractions
Test reflexes = decreased or absent
Cardiac changes
Relative hypernatremia is caused by (1)
fluid volume deficit
Absolute hypernatremia has the S/S of (1)
S/S of the cause like a burn
Treatment of hypernatremia
Know the cause and treat that
Bring Na down slowly
Hemodialysis for severe hypernatremia
Med therapy
Hypovolemia → 0.9% NACL or 5% dextrose
Hypervolemia → Diuretics, furosemide, bumetanide
Calcium range: normal version + non ionized (2)
8.6 - 10.2
Non ionized 4.5 - 5.1
Calcium (6)
*Blood clotting, transmission of nerve impulses, myocardial contractions, muscle contractions
*Source of calcium is from diet
*To absorb must have Vitamin D
*Parathyroid hormone helps regulate calcium levels
*PTH increases bone resorption, increases GI absorption of calcium, and increases renal tubule reabsorption of calcium
*Calcium and phosphate have inverse relationship
S/S of hypocalcemia (7)
Paresthesia around mouth, fingers, and toes
Hyperreflexia and muscle spasms
Seizures
Intestinal cramping, diarrhea
Positive chvostek signs
Positive trousseau
ECG: increased QT interval
Treatment of Hypocalcemia
*Oral calcium replacement
*IV 10% calcium gluconate and monitor serum calcium
Hypercalcemia S/S (4)
Fatigue and weakness
Nausea
Mental status changes
Kidney changes
Hypercalcemia ECG changes
shortened QT intervals, wide and depressed T waves, bradycardia, heart blocks
TX for hypercalcemia (6)
Severe = tx
Oral phosphate
Calcitonin to decreased PTH
IV normal saline to flush calcium out
Bisphonoates
Emergency dialysis
Magnesium range
1.3 - 2.1 meq
Magnesium (3)
Responsible for ATP production
Normal neuro function
Intestines and kidneys regulate
S/S hypo magnesium (9)
Irritiabilty and behavior changes
Increased neuromuscular excitability
Convulsions
Chvostek and trousseau signs positive
Muscle cramps tetany
Hypertension
Hyper reflexes
Tachycardia
Cardiac dysrhythmias (torsades, A-fib)
TX hypomagnesemia (2)
Replace magnesium
Oral intake increase = pumpkin and chia seeds, almonds, cashews, peanuts
Hypermagnesemia (3)
Mag is a drag
Skeletal muscle depression
Nerve impulse depression
Determine cause of hypermag (3)
Stop mag intake
Examine their diet
Consider dialysis
Fluid imbalance etiology: Hypovolemia (3)
Secondary to bleeding and hemorrhage
Inadequate fluid intake
Excessive fluid output
Fluid imbalance etiology: Hypovervolemia (3)
Increased NA+ in the body
Excessive fluid that cannot be managed
Disorders: renal, hepatic, cardiac failure
Hypovolemia S/S MILD: (6)
Impaired cognitive function
reduced physical performance
HA
Fatigue
Sunken eyes
Dry, less elastic skin
Hypovolemia S/S MODERATE: (9)
Hypotension
Tachycardia
Weak thready pulse
increased body temp
Cold hands and feets
Oliguria
Cool, clammy skin
Muscle weakness
Cramps
Hypervolemia S/S (7)
Hypertension
Tachycardia
Strong, bounding pulse
Dyspnea
Adventitious breath sounds (rales, crackles)
Edema
Fatigue
Hypocalcemia causes (7)
Malnutrition (calcium and vitamin D deficiency)
Hypoparathyroidism
Blood transfusions (excess administration of citrated blood)
Wound drainage (especially GI)
Diarrhea
Malabsorption syndromes (e.g. celiac disease, crohn’s disease)
Loop diuretics
Hypercalcemia causes (7)
Bone metastasis from breast, prostate, or cervical cancer
Hyperparathyroidism (some tumors can secrete parathyroid hormone)
Blood cancers
Excessive calcium/vitamin D intake
Sarcoidosis
Acidotic states
Thiazide diuretics
Hypomagnesemia causes (6)
Malnutrition
Malabsorption syndromes
Alcoholism
Renal tubular dysfunction
Loop diuretics and proton pump inhibitors
Hyperglycemia
Hypermagnesemia causes (6)
Mag sulfate IV
Antacid overuse
Certain medications (anticholinergics, laxatives, lithium intoxication, opioids)
Kidney injury or failure
Extensive soft tissue injury or necrosis (e.g. shock, trauma, sepsis, cardiac arrest, severe burns)
Hypothyroidism
