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NURS 313R > Exam 1: Concepts Of Fluid & Electrolytes Applied To IV Solutions > Flashcards

Exam 1: Concepts Of Fluid & Electrolytes Applied To IV Solutions Flashcards

1
Q

Interstitial

A

Fluid between the cells.

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2
Q

Transcellular Fluid

A

CSF, synovial fluid, intraocular fluid

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3
Q

Cation

A

Positively charged ion

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4
Q

Anion

A

Negatively charged ion

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5
Q

Osmosis

A

Movement of water from an area of low concentration to an area of high concentration

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6
Q

Diffusion

A

Movement of solutes across a membrane from an area of high concentration to an area of low concentration

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7
Q

Filtration

A

..

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8
Q

Colloid osmotic pressure (oncotic pressure)

A

Osmotic pressure caused by plasma colloids in solution; the ability for protein to attract fluid in its direction

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9
Q

Hydrostatic Pressure

A

Force of fluid in a compartment pushing against a cell membrane or vessel wall.

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10
Q

Antidiuretic hormone

A

Released by your anterior pituitary gland to the kidneys (target organ), specifically the Loop of Henie > retains water

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11
Q

What stimulates the release of Aldosterone?

A

Stimulated by high potassium. Aldosterone is then released from the adrenal glands to the kidneys (target organ), specifically to the Loop of Henle.

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12
Q

What are the actions of aldosterone?

A

Na+ and H20 reabsorption and removal of potassium through the urine.

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13
Q

Denim

A

Converts Angiotensin I (vasoconstrictor) to Angiotensin II (stimulates aldosterone)

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14
Q

Fluid Output Regulation

A

Through urine (normal 1.5 L of urine/day)
Loss of fluid through feces.
Fluid loss through sweat, breathing (600-800mL)

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15
Q

“-emia”

A

Blood

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16
Q

Normal Sodium Values

A

135-145 mEq/L

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17
Q

Pathophysiology of Sodium Electrolytes

A

Primary extracellular electrolyte; attracts fluid

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18
Q

Hyponatremia: What causes it?

A
  1. Diarrhea, Vomiting
  2. NG tube auctioning
  3. Diuretics
  4. Wound drainage
  5. Fasting
  6. Excessive hypotonic IV fluid (water, 0.45 NaCl)
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19
Q

Hyponatremia: Symptoms

A

Headache, apathy and confusion

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20
Q

Hyponatremia: Nursing Care

A
  1. Fluid Restriction
  2. Slow amount of hypertonic solution (3% NaCl)
  3. Vasopressant (decreased antidiuretic hormone secretion)
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21
Q

Hypernatremia: What causes it?

A
  1. Excess sodium intake.
  2. Inadequate fluid intake.
  3. Excess water loss.
  4. Increase in insensible water loss (asthma, talking)
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22
Q

Hypernatremia: Symptoms

A
  1. Restlessness
  2. Agitation
  3. Twitching
  4. Seizure
  5. Constant thirst
  6. Weight gain (d/t water retention)
  7. Edema (d/t water retention)
  8. Increased BP
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23
Q

Hypernatremia: Nursing Care

A

Water replacement: hypotonic solution (D5W, 0.45 NaCl)

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24
Q

Potassium Normal Lab Values

A

3.5 - 4.5 mEq/L

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25
Q

Potassium Electrolyte

A

Can be very harmful to the tissue (has necrotic and ischemic effect.

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26
Q

Pathophysiology of Potassium Electrolyte

A

Primarily found intracellularly

Effects neuromuscular and cardiac function; contractility of muscle

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27
Q

Hypokalmeia: What causes it?

A
  1. Potassium loss (diuretics, vomiting, diarrhea, adrenal tumor, hyperaldosteronism)
  2. Cancer (aldosterone increase)
  3. Dialysis
  4. Increase in insulin (allows cell to …)
  5. Low potassium in diet
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28
Q

Hypokalemia: Symptoms

A
  • Skeletal muscle weakness and paralysis: respiratory muscles (shallow respiration’s and respiratory arrest); decreased airway responsiveness; decreased GI motility; impaired regulation of arterial BF -> smooth muscle cell breakdown.
  • Impairs insulin secretion -> hyperglycemia
29
Q

Hypokalemia: Nursing Care

A
  1. Administer potassium supplement - need to know that the patient is urinating to ensure the patient is not retaining; could lead to hyperkalemia! (Ensure that the IV is not infiltrated d/t harmful effects of potassium on tissue.
30
Q

Sources of Potassium in food include

A

Bananas, Green leafy vegetables, ..

31
Q

Hyperkalemia: What causes it?

A

(IM-PAID)

  1. Impaired renal secretion
  2. Massive intake
  3. Potassium Penicillin
  4. Adrenal insufficiency: low aldosterone = retention of K+
  5. ICF->ECF (cell lysis): Acidosis (K moves out of cell so H+ moves into cell); Massive cell destruction; Receiving old blood; decubitus ulcer
  6. Drugs: Digoxin & Beta adrenergic blockers (impairs entry of K into cells = increases K ECF concentration); K Sparing Diuretics and ACE inhibitors (decreases kidney ability to excrete K+)
32
Q

Hyperkalemia: Symptoms

A
  • increased cellular excitability
  • cramping leg pain and weakness followed by weakness/paralysis of other skeletal muscles including respiratory.
  • hyperactivity of smooth muscles = abdominal cramping & diarrhea.
  • Cardiac disturbances: too much K+ causes the heart to quiver and beat fast
33
Q

Hyperkalemia: Nursing Care

A
  • Eliminate PO/IV meds
  • Eliminate K: diuretics; dialysis; ion exchange resins (kayexalate -binds to K in exchange for Na and is released in feces)
  • Reverse membrane potential effects: IV calcium gluconate (Ca ions reverse the membrane excitability); Withhold K from diet and IV, loop/thiazides
  • IV of regular Insulin to correct acidosis
  • Beta-adrenergic agonists
34
Q

Fluid Volume Deficit: What causes it?

A

Diarrhea, vomiting, drainage

35
Q

Fluid Volume Deficit: Symptoms

A
  1. Increased thirst
  2. Lethargy
  3. Confusion
  4. Postural Hypotension
  5. Decreases capillary refill
  6. Decreases urine output
36
Q

Fluid Volume Deficit: Treatment

A
  1. Isotonic solution (0.09% NaCl, D5/Lactated Ringer, Blood Transfusion)
37
Q

Fluid Volume Excess

A

Water and solutes are retained at the same time.

38
Q

Fluid Volume Excess: What can cause it?

A

CHF, renal failure, burns

39
Q

Fluid Volume Excess: Symptoms

A
  1. Headache
  2. Polyuria, polydipsia
  3. Weight gain, edema
  4. Confusion, lethargy, seizure
  5. Crackles
40
Q

Fluid Volume Excess: Treatment

A
  1. Diuretics
  2. Fluid Restriction
  3. Sodium Restriction
41
Q

Hyperosmolar

A

Too much concentration of certain elements (ex. Hypernatremia, hyperkalemia)

42
Q

Hyposmolar

A

Too little concentration of certain elements (ex. Hypokalemia, hyponatremia)

43
Q

What factors can affect fluid and electrolyte imbalance?

A 
I. Age
II. Illness (IBS, Chron’s, Surgery, Cancer)
III. Environmental Factors
IV. Diet
V. Lifestyle
VI. Medications
44
Q

Normal CBC values

A

…

45
Q

Common Laboratory Studies R/T fluid and electrolytes

A
  1. CBC
  2. ABG
  3. Serum Electrolytes level
46
Q

Why are hematocrit levels important in relation to fluid and electrolyte balance?

A

High hematocrit levels could indicate the need for more fluid.

47
Q

Nursing Therapeutics/Plan of Care for Patients with Fluid and Electrolyte Problems

A
  1. Daily Weight Taking
  2. Enteral Replacement of Fluid and Electrolyte Loss
  3. Fluid Restriction vs. Increase Fluid Intake
  4. Parenteral Replacement of Fluid and Electrolytes
  5. Medication
  6. I&O monitoring
48
Q

What are the isotonic solutions that we use?

A
  1. Normal Saline
  2. Ringers
  3. Lactated Ringer’s
  4. Dextrose 5% in Water (D5W)
  5. 5% albumin
  6. Hetastarch
  7. Normosol
49
Q

Though Dextrose 5% in Water is an isotonic solution

A

Its physiologic effect is hypotonic because when it is taken, glucose is taken up by the body for energy leaving behind only fluid.

50
Q

What is a sign for right sided congestion?

A

Jugular venous distension

51
Q

How should you assess for jugular venous distention?

A

The patient should be position in a 30-45 degree angle with head tilted to one side. HOWEVER, the best way to verify congestion is with the patient standing up.

52
Q

Isotonic Solutions should be cautioned in what kind of patients?

A
  1. In patients with HTN and heart failure.
  2. LR should not be given to patients with a pH greater than 7.5
  3. D5W should be avoided in patients with increased ICP
53
Q

Why should LR not be given to patient with a pH greater than 7.5?

A

LR is converted to bicarbonate in the body therefore making the blood more basic.

54
Q

Why should D5W be avoided in patients with increased ICP?

A

Because D5W becomes physiologically hypotonic.

55
Q

What are the hypotonic solutions that we use?

A
  1. Half Saline (.45% NaCl)
  2. 0.33% NaCl
  3. Dextrose 2.5% in Water (D2.5W)
56
Q

Nursing Implications for Hypotonic Solutions

A
  1. Can cause vascular collapse.
  2. Increases ICP
  3. Do not give to patients at risk for ICP (CVA, neurosurgery, or patients with third spacing (blisters, burns, ascites))
57
Q

What are the hypertonic solutions that we use?

A
  1. Dextrose 5% in Normal Saline
  2. Dextrose in Lactated Ringers
  3. 3% NaCl
  4. 25% Albumin
  5. 7.5% NaCl
58
Q

What are the nursing implications for hypertonic solutions?

A

Do not give these to patient’s who have potential for cellular dehydration (e.t diabetics)

59
Q

Isotonic solutions

A

Expands the intra-vascular compartments

60
Q

Hypotonic Solutions

A

Will cause fluid shift from vessels to cell

61
Q

Hypertonic Solutionss

A

Greatly expands the intra-vascular compartment, pull fluid from intracellular compartment to intravascular.

62
Q

What kind of relationship does Na and K have?

A

Inverse relationship. When Na is retained, K is eliminated.

63
Q

Normal plasma osmolality

A

275-295 mOsm/kg.

64
Q

A plasma osmolarity of > 295 mOsm/kg indicates what?

A

that the concentration of particles is too great or that the water content is too = water deficit

65
Q

A plasma osmolarity of < 275 mOsm/kg indicates what?

A

too little solute for the amount of water or too much water for the amount of solute = water excess

66
Q

Antagonists to RAAS

A

Natriuretic peptides

67
Q

How does the hypothalamus regulate water balance?

A

Decreased body fluid and increased plasma osmolarity is sensed by osmoreceptors in the. Hypothalamus -> stimulates thirst and ADH release (acts in kidneys = water reabsorption)

68
Q

Factors that stimulates ADH release

A 
THIRST
stress 
Nausea
Nicotine
Morphine

NURS 313R (18 decks)

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