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A. NCLEX > Electrolytes & Fluids > Flashcards

Electrolytes & Fluids Flashcards

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1
Q

Total body water volume: (2)

A

40 L
60% body weight

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2
Q

Intracellular fluid (ICF): (3)

A

Fluid found in the cells.
K+ and Mg+ chief cation.
Phos chief anion

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3
Q

Extracellular fluid (ECF): (3)

A

All fluids found outside the cell.
NA and Cl-
Plasma has large protein amount

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4
Q

Fluid and food intake (2)

A

Fluid intake = 1500 ml
Food = 1000

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5
Q

Fluid loss through (5)

A

Urine 1500 ml
Sweat 100 ml
Skin 500 ml
Lungs 400 ml
Feces 200 ml

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6
Q

Fluid regulation by (in the brain) (1)

A

Hypothalamus: thirst center

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7
Q

The Hypothalamus’ function (3)

A

Osmoreceptors monitor osmolality
As osmolality increases thirst will increase
Can your client communicate or perceive thirst?

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8
Q

Antidiuretic hormone (ADH): (1) What it does, (1) where it is made, (1) where it is stored

A

Regulates amount of water kidney tubules absorb
Synthesized by hypothalamus
Stored in posterior pituitary gland

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9
Q

ADH and what happens when (1) you have dehydration or overly concentrated body fluid and (2) you have overly diluted body fluids

A

*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

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10
Q

Fluid also regulated by (2)

A

Atrial natriuretic peptide (ANP) & Aldosterone

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11
Q

Atrial natriuretic peptide (ANP) function (3)

A

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

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12
Q

Aldosterone function + increased & decreased in what condition (2)

A

Reabsorption of NA+ and water in fluid insufficient → increasing ECF
Influenced by renin → angiotensin → aldosterone loop
Increased in: Hemorrhage
Decreased in: Adrenal crisis

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13
Q

Measurement and management (fluids) (11)

A

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

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14
Q

Isotonic fluids (4)

A
  • 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
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15
Q

Hypotonic fluids (7)

A

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

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16
Q

Hypertonic fluids (6)

A

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

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17
Q

Isotonic solutions (3) fact, and 2 examples

A

same as intravascular space
Normal saline
Lactated ringers

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18
Q

Hypotonic solutions (3) fact and 2 examples

A

out of intravascular. Hydrating cells and interstitial.
5% dextrose
0.45% sodium chloride.

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19
Q

Hypertonic solutions (5 ish). Fact and examples

A

enter. Entering intravascular compartment.
3% sodium chloride
10 and –>
50% dextrose.
Colloids (on another slide)

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20
Q

Colloids: what it is and 3 examples

A

Proteins. Hypertonic. Shifts fluids into vessels.
Albumin, dextran, hetastarch

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21
Q

Potassium: Functions (6)

A

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

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22
Q

Potassium range

A

Normal 3.5 -5 meq

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23
Q

Causes of hypokalemia (4)

A

*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

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24
Q

S/S of hypokalemia 1/2 (4)

A

Fatigue and muscle weakness
Anorexia, nausea, vomiting
Polyuria
Illesu, Abdominal distention

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25
Q

S/S of hypokalemia 2/2 (6)

A

Paresthesia
Leg cramps
Decreased reflexes
Increased sensitivity to digoxin
Decreased BP and weak irregular pulse
ECG changes (flat t wave, depressed ST, U wave)

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26
Q

Correcting hypokalemia (6)

A

Replace
Oral mild to moderate
IV = if less than 2 meq
Never safe to give IV Push or IM
Magnesium replacement
Monitor ECG

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27
Q

Prevention of hypokalemia (3)

A

Elderly at risk
Those on laxatives and diuretics
Eat bananas, melons, citrus, lean meats, milk, whole grains

28
Q

Causes of hyperkalemia 1/2 (6)

A

Serum over 5 meq
Kidney injury
Infection and increase of potassium
Medications
Injuries like crush injuries and burns
ACE inhibitors

29
Q

Causes of hyperkalemia 2/2 (6)

A

NSAIDS
Cyclosporine
Blood transfusions
Potassium sparing diuretics combined with renal insufficiency
Disorders = addisons, hypoald.
Acidosis = increase in serum K

30
Q

S/S hyperkalemia (6)

A

Heart palpitations
Tingling numbness
Twitching
Weakness
Flaccid paralysis
Diarrhea
ECG changes (on another slide)

31
Q

ECG changes in hyperkalemia

A

Loss P waves, prolonged PE, wide QRS, ST depression

32
Q

Treatment of hyperkalemia (8)

A

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

33
Q

Sodum range

A

135 - 145

34
Q

Sodum (3) what it does, where you get it from, where it leaves from

A

Maintains ECF
From food
Leaves in urine sweat and feces

35
Q

Causes of hyponnatremia (6)

A

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

36
Q

S/S hyponatremia (4)

A

Brain swelling → increased ICP
Mental status changes
Relative → Too much fluid.
Absolute hyponatremia → underlying cause

37
Q

Excessive loss of sodium: what to do (3)

A

Withhold all diuretics
Replace with isotonic = 0.9% NACL
Encourage fluids

38
Q

Water gain: what to do (2)

A

Loop diuretics
Fluid restriction

39
Q

Hypernatremia: causes (7)

A

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

40
Q

S/S hypernatremia (7)

A

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

41
Q

Relative hypernatremia is caused by (1)

A

fluid volume deficit

42
Q

Absolute hypernatremia has the S/S of (1)

A

S/S of the cause like a burn

43
Q

Treatment of hypernatremia

A

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

44
Q

Calcium range: normal version + non ionized (2)

A

8.6 - 10.2
Non ionized 4.5 - 5.1

45
Q

Calcium (6)

A

*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

46
Q

S/S of hypocalcemia (7)

A

Paresthesia around mouth, fingers, and toes
Hyperreflexia and muscle spasms
Seizures
Intestinal cramping, diarrhea
Positive chvostek signs
Positive trousseau
ECG: increased QT interval

47
Q

Treatment of Hypocalcemia

A

*Oral calcium replacement
*IV 10% calcium gluconate and monitor serum calcium

48
Q

Hypercalcemia S/S (4)

A

Fatigue and weakness
Nausea
Mental status changes
Kidney changes

49
Q

Hypercalcemia ECG changes

A

shortened QT intervals, wide and depressed T waves, bradycardia, heart blocks

50
Q

TX for hypercalcemia (6)

A

Severe = tx
Oral phosphate
Calcitonin to decreased PTH
IV normal saline to flush calcium out
Bisphonoates
Emergency dialysis

51
Q

Magnesium range

A

1.3 - 2.1 meq

52
Q

Magnesium (3)

A

Responsible for ATP production
Normal neuro function
Intestines and kidneys regulate

53
Q

S/S hypo magnesium (9)

A

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)

54
Q

TX hypomagnesemia (2)

A

Replace magnesium
Oral intake increase = pumpkin and chia seeds, almonds, cashews, peanuts

55
Q

Hypermagnesemia (3)

A

Mag is a drag
Skeletal muscle depression
Nerve impulse depression

56
Q

Determine cause of hypermag (3)

A

Stop mag intake
Examine their diet
Consider dialysis

57
Q

Fluid imbalance etiology: Hypovolemia (3)

A

Secondary to bleeding and hemorrhage
Inadequate fluid intake
Excessive fluid output

58
Q

Fluid imbalance etiology: Hypovervolemia (3)

A

Increased NA+ in the body
Excessive fluid that cannot be managed
Disorders: renal, hepatic, cardiac failure

59
Q

Hypovolemia S/S MILD: (6)

A

Impaired cognitive function
reduced physical performance
HA
Fatigue
Sunken eyes
Dry, less elastic skin

60
Q

Hypovolemia S/S MODERATE: (9)

A

Hypotension
Tachycardia
Weak thready pulse
increased body temp
Cold hands and feets
Oliguria
Cool, clammy skin
Muscle weakness
Cramps

61
Q

Hypervolemia S/S (7)

A

Hypertension
Tachycardia
Strong, bounding pulse
Dyspnea
Adventitious breath sounds (rales, crackles)
Edema
Fatigue

62
Q

Hypocalcemia causes (7)

A

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

63
Q

Hypercalcemia causes (7)

A

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

64
Q

Hypomagnesemia causes (6)

A

Malnutrition
Malabsorption syndromes
Alcoholism
Renal tubular dysfunction
Loop diuretics and proton pump inhibitors
Hyperglycemia

65
Q

Hypermagnesemia causes (6)

A

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

66
Q
A

A. NCLEX (6 decks)

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