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Pharm 2 > Exam #1 Fluid and Electrolytes > Flashcards

Exam #1 Fluid and Electrolytes Flashcards

1
Q

% of Total Body Water ( TBW )

A

55-60% in younger adults
50-55% in older adults

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2
Q

Body fluid is divided into what two groups?

A

Intracellular Fluid
Extracellular Fluid

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3
Q

Intracellular Fluid ( Hypotonic )

A

Intracellular Fluid ( Hypotonic )

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4
Q

Extracellular Fluid ( Isotonic )

A

1/3 ( 15 L ) ; composed of intravascular component, interstitial component and transcellular componenet

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5
Q

Intravascular Component

A

Composed of constitutes of whole blood; Potassium, Magnesium, Phosphate and Protein

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6
Q

Interstitial Fluid Component

A

Composed of the fluid in the tissues and surrounding the cells.

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7
Q

Transcellular Component

A

Smallest, composed of fluid in defined spaces.
Lymph fluid
Cerebral spinal fluid

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8
Q
  1. Filtration
A

Is the movement of fluid through a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of membrane.
Ex: Blood Pressure
Higher —> lower

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9
Q
  1. Diffusion
A

Movement of solution from an area of high concentration to low concentration.
- Smaller substances diffuse more easily!
Molecules intermerge

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10
Q

Facilitated Diffusion / Active transport

A

The transport of substances across a biological membrane from an area of higher to lower concentration WITH the help of a transport molecule.
- Regulates what goes in/out of cell.
Ex: Sodium / P pump

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11
Q
  1. Osmosis
A

Movement of water across the cellular membrane from an area of lower concentration to higher.
- Helps regulate fluid balance.

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12
Q

Three hormones help control F&E Balance…

A
  1. Aldosterone
  2. ADH
  3. NP’s
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13
Q

Aldosterone

A

Primary function is to regulate your blood pressure.
- Signals kidney and colon to increase the amount of sodium they send INTO the bloodstream and the amount of Potasium OUT of urine.
- Retained water in blood= increasing blood volume

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14
Q

ADH

A

Conserves fluid volume in the body by reducing the amount of water passed through the urine.
- Released from pituitary gland

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15
Q
  • Released from pituitary gland –> when ( ADH )
A
  1. Decrease in blood volume / pressure
  2. Concentration of salts in blood increase ( sweating )
  3. Thirst, N/V to keep fluid balance up
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16
Q

High levels of ADH causes kidneys to …

A

Retain water in body

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17
Q

Low level of ADH causes kidneys to …

A

Excrete too much water

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18
Q

NP’s

A

Peptide hormones that are synthesized by the heart, brain and other organs.
- Secreted in response to increased blood pressure usually in response to heart failure

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19
Q

Main action of NP?

A

Reduce arterial pressure by decreasing blood volume and systemic vascular resistance.

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20
Q

RAAS Pathway

A

Regulates fluid and sodium in body!

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21
Q

RAAs Steps

A

Angiotensin ( + Renin ) –> Angiotensin 1 ( + ACE ) –> Angiotensin 2
OR
Kidney –> Renin –> Liver –> Angiotensin –> Angio 1 –> ACE –> Angio 2

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22
Q

Diuretics

A

Increase sodium excretion ; for fluid retention

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23
Q

ACE Inhibitors

A

Less vasoconstriction and reduced peripheral resistance, greater excretion of sodium and water.

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24
Q

ARBS

A

Block receptors that bind with angiotensin II lowering BP

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25
Q

Direct Renin Inhibitors

A

Affect early in the pathway changing angiotensinogen to angiotensin!

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26
Q

Fluid Intake

A

2.3 L Daily

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27
Q

Min Urine output daily

A

400-600 mL ( 30 cc/hr )

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28
Q

What happens when body fluids are disrupted?

A

The amount of fluids affects the workload of the heart!
- Excess fluid increases BP, decreased fluid decreases BP
- Fluid changes result in changes of vital signs
- Edema
- Affects oxygenation
- Influence electrical signals

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29
Q

What test evaluates the presence of electrolytes?

A

BMP/CMP

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30
Q

Metabolic Acidosis

A

Increased H+ concentration or decreased HCO3
- Hyperventilation

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31
Q

Respiratory Acidosis

A

Increased CO2, hyperventilation

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32
Q

Metabolic Alkalosis

A

Decreased H+ or increased HCO3
- Hyperventilation

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33
Q

Respiratory Alkalosis

A
  • Decrease CO2
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34
Q

Dehydration

A

Cardio: Increased heart rate, low BP
Respiratory: Increased rate
Skin: Poor skin turgor
Neuro: Cognition changes
Kidney: Concentrated urine, strong odor, < 500 mL = Concerning!
Labs: Multiple labs + S/S

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35
Q

S/S of Dehydration in Infants / Children

A

-Dry mouth
-Lack of tears
-No wet diapers for 3 hrs *
-Sunken eyes

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36
Q

S/S Dehydration in Older Adults

A
  • Increased heart rate
    -Weak pulses
    -Ortho Hypotension
    -Poor skin turgor
    -Increased respiratory rate
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37
Q

Dehydration Nursing Priorities

A
  • Prevent further fluid loss
    -Increase fluids
    -Prevent Injury
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38
Q

Fix Dehydration?

A

-Oral Fluids if awake
-Pedialyte
- IV Fluids: 0.9% NS
- Monitor I&O
-DAILY WEIGHTS!!!!
- Meds: antiemetics, antipyretics, desmopressin ( diabetes insipidus )

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39
Q

Fluid intake of?

A

1500 mL a day

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40
Q

Fluid Overload ( Hypervolemia )

A

Fluid intake is greater than the body’s need!
-Excess extracellular fluid.

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41
Q

Causes of Hypervolemia

A

-Excessive fluid replacement
-Kidney Failure
-Heart Failure
- Prolonged use of corticosteroids

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42
Q

Fluid Overload S/S

A

Cardio: Increased pulse, high bp, distended neck veins
Resp: Increased rate, crackles
Skin: Edema
Neuro: HA, weakness
GI: Increased motility, enlarged liver

43
Q

Fixing Fluid Overload?

A

-Drug therapy: Removing Excess fluid; * Diuretics such as furosemide ( loop )
-Nutrition: Fluid restriction possible for chronic cases.
-Monitoring: I&O and daily weights!

44
Q

Causes of Dehydration?

A
  • Not drinking, sweating, vomiting, high sodium
45
Q

Sodium Potassium Pump

A
  • Active Transport
    -Requires ATP
    -Moves molecules too large to diffuse
  • Against a electrochemical gradient
    -3 NA+ out, 2 K+ IN
46
Q

Hyponatremia

A

Is when the serum sodium level is below 136 mEq/L
Sodium most abundant in electro in ECF

47
Q

Causes of Hyponatremia

A

“No Na+”
NA+ excretion increased with renal problems: Loss of sodium and water!
- NG suction, vomitting, over use of diuretics, sweating, diarrhea
Overload of fluid with CHF
- Water follows sodium
- Sodium decreasing because of dilution: renal failure, hypotonic fluid infusions

48
Q

Hyponatremia manifestations

A

***Neuro: HA, Increased intracranial pressure, seizures, coma can occur
Musc: Muscle Weakness, DTR diminish
Intestinal: Increased motility causing N/V, diarrhea, hyperactive BS
Cardio: Rapid, weak, thready pulse, decreased BP

49
Q

BUT.. when hyponatremia occurs with hypervolemia

A

Cardiac changes include full/bounding pulse with normal/ high BP

50
Q

Hyponatremia S/S

A

SALT LOSS
* S eizeres and stupor
A bdominal Cramping, confusion
* L ethargic
T endon Reflexes
L oss of urine
O rthostatic Hypotension
S hallow respiration
Spasms of muscles

51
Q

Hyponatremia Interventions

A

Always bring up Na+ SLOWLY! Never exceed 12 meQ in 24 hr time period
- Drug Therapy: Reduce diuretics bc of sodium loss, IV Saline, promote excretion of water rather than sodium when caused by fluid excess.
- Increase oral sodium

52
Q

Hypernatremia

A

Hypernatremia

53
Q

Hypernatremia Manifestations

A

Neuro: AMS, short attention span, agitated, confused
- *** hypernatremia and fluid overload can cause lethargy, stupor, coma
Skeletal Muscle: Muscle twitching, weak, deep tendon reflexes are absent, occurs bilaterally, no pattern
Cardio: Increased pulse rate, hypotension = hypernatremia and hypovolemia
Decreased pulse rate, distended neck veins, increased BP = hypernatremia and hypovolemia

54
Q

Hypernatremia Interventions

A

Drug: Need diuretics that promote sodium loss
( furosemide, bumetanide )
Nutriton: Ensure adequate fluid intake
- Dietary sodium restriction
ALWAYS CONTINUE TO ASSESS THE PATIENT FOR INDICATIONS OF EXCESSIVE LOSSES OF FLUID, SODIUM, POTASSIUM

55
Q

Potassium

A

Normal Range: 3.5-5.0
- Commonly altered by changes in K+ intake
- Essential in NA/K pump
-Foods high: Meat, fish, fruits, veggies
-Foods low in: Eggs,bread, grains
- Facilitates glycogen storage in lover and skeletal muscle cells
- Main ion in ICF 98%

56
Q

What is potassium removed by?

A

80% removed by kidney ( so that if anything is wrong with pts kidneys or if medications act directly on the kidneys think ab potassium imbalance )

57
Q

Hypokalemia

A

Serum potassium level below 3.5
- Low K+ levels reduce exitability of cells, causing excitable tissues to respond to less stimuli

58
Q

Most K+ is?
( Inside or Outside Cells )

A

Inside cells and minor changes in extracellular potassium levels causes major changes in cell membrane excitability.
- This imbalance can be LIFE THREATENING because every body system is affected.

59
Q

Low levels of ? accompanied with hypokalemia

A

Magnesium!
- Check both Mg and K+ and GIVE Mg before K+ to help K+ bind

60
Q

Examples of how Hypokalemia can occur!

A

Excessive Fluid Loss: Vomiting, Diarrhea, NG suction
Diuretic Drugs
Kidney Disease
Cushings
Wound Drainage
Diuresis
Heart Failure
Rapid infusion of insulin… because drug increases the activity of Sodiumm- Potassium pump forcing more blood potassium levels are linked to magnesium
Stress reaction

61
Q

How to assess those with Hypokalemia?

A
  1. What meds? If patient is taking diuretics, cortico, beta agonist it can increase kidney potassium loss.
    - Ask if patient takes a potassium suplement
  2. Disease can lead to potassium loss
    -Ask ab chronic disorders
62
Q

S/S of Hypokalemia

A

Muscle: skeletal muscle weakness, DTR reflexes reduced = flaccid paralysis
*** Cardio: Thready, weak pulse. Orthostatic Hypotension.
- Perform an ECG. Can include ST- segment depression, flat T wave, increased U waves. Dysrhymias can lead to death.
Neuro: AMS, irrability, anxiety
Ints: N/V, constipation, abdominal distension

63
Q

How to fix Hypokalemia?

A
  1. Preventing K+ loss
    - Potassium Sparing Diuretic
    - Sprinlactone
  2. Increasing K+ Levels
    - Potassium Supplements: Potassium chloride, glucanate, citrate given oral or IV.
  3. Resp Monitoring: Nail bed pallor or cyanosis.
64
Q

Potassium Supplements ( KCI )

A

PO Potassium Chloride ( KCI ) is an erosive substance that can cause pill induced esophagitis.

65
Q

How to prevent esophageal erosion?

A
  1. Client should be sitting upright for < 30 mins after ingestion.
  2. Take w plenty of water at least 4 oz
66
Q

Potassium Chloride is NEVER

A

Administered IV Push!!!
- Potassium chloride given IV is a high alert drug.

67
Q

Potassium Chloride Dosages

A

A concentration of ***10 meQ KCL/100 mL can be administered through a peripheral vein; You can run 20 mEq/100 mL though a central venous catheter or PICC.

68
Q

For a patient complaining of burning at the PIV site…

A
  1. Check the patency of the PIV ***
  2. Flush the the PIV with 7-10 mL of 0.9% NaCL to check for patency.
  3. Nurse should slow infusion rate if client cont to feel a burning.
    KCL irriatates the vein and irratation and discomfort at the site is EXPECTED.
69
Q

Hyperkalemia

A

Level higher than 5.0 mEq / L
- Increase exitability of cells, causing excitable tissues to respond to less intense stimuli.
- Can lead to V-Fib
- Sudden potassium rises cause severe problems at serum levels betweem 6-7. When serum potassium rises slowly, problems may not occur until K+ levels reach 8+.

70
Q

Examples of Hyperkalemia can occur..

A
  • Over ingestion of potassium containing foods / meds.
  • Rapid infusions
  • Burns, MI ***
  • Kidney failure
    -Potassium sparing diuretics
  • ACE’S 1 **
    -Acidosis **
  • Diabetes ( uncontrolled )
71
Q

Hyperkalemia Manifestations

A

***CV: Brady, hypotension, ECG changes of tail peaked T waves, aystole and V Fib
Neuro: Twitching, tingling, burning, numbness, muscle weakness and flaccid paralysis
Intest: Increased motility with diarrhea

72
Q

Hyperkalemia Temp Fixes

A
  • All of these solutions will only last a few hours and then excessive potassium inside the cell will leak back to the extracellular environment via potassium channels.
73
Q

Hyperkalemia 3 Solutions

A

Hyperkalemia 3 SolutionsHyperkalemia 3 SolutionsHyperkalemia 3 Solutions

74
Q

Hyperkalemia 3 Solutions

A
  1. First Intervention: Insulin ( IVP 10-15 Units of regular insulin along with 50 mL of 50% dextrose to prevent hypoglycemia ) will lead to shift of potassium ions into the cell secondary to increased activity of the sodium - potassium pumps. Can be repeated.
  2. Biocarbonate ( e.g. 1 ampule ( 50 meQ ) infused over 5 mins ) is effective in shifting potassium into the cell. The biocarbonate ion will stimulate an exchange of cellular H+ ( moves it out cell ) for Na+ leading to stimulation of pumps.
  3. Albuterol ( beta 2 agonist; inhaled as neb ) : This drug lowers blood levels of K+ by promoting its movement into cells.
75
Q

If client has ECG changes ( tall, peaked T waves )….

A

Calcium gluconate should be given before insulin / dextrose
- Stabilize cardiac muscle

76
Q

Hyperkalemia Perm Fixes

A
  1. Loop Diuretics ( Furosemide ) - gets the client to urinate and potassium leaves the body completely again need a patient who makes urine.
  2. Sodium Polystyrene Sulfonate - Given PO or as enema. Potassium is exchanged for sodium in intestines and excreted in stool. Causes frequent stooling; dont give to someone with impaired bowel function —> intestinal necrosis
    - Monitor s/s of fluid overload: crackles, edema, HTN, JVD distention, assess abdomen, monitor K+ lab
  3. Dialysis usually hemodyalysis: If this is AKI patient might just have a few runs of hemo –> until kidney function improves.
77
Q

Permanent Actions…

A

Lower K+ actually get the K+ out of the body instead of just shifting it inside cells where it will eventually leak back outside through potassium channels in the cell membranes.

78
Q

Calcium

A

9.0-10.5
- Must be kept in narrow range ECF
-Absorbed through intestinal tract.
-Requires active form of VIT D

79
Q

Calcium is essential for

A

Bone strength
Coagulations
Allows skeletal muscle and cardiac muscle contraction
Cellular electrophysiology and membrane potential
Controlling nerve transmission

80
Q

Hypocalcemia how it can occur…

A
  • Common in renal failure
    • Hypothyroidism
      -Hypomagnsemia
  • Vit D deficiency
    -Pancreatis
    -Alkalosis
    • Malabsorption syndrome
      -Diarrhea
      -Would drainage
81
Q

Hypocalcemia Manifestations

A

NeuroM: Parathesia occurs first, with sensations of tingling and numbness. Frequent painful muscle spasms- thigh, foot, calf during sleep.
- Charli Horse
- Trousseau’s
- Chvstek’s
CV: HR could be slower or faster, weak, thready pulse. Severe hypotesnion.
Intest: Hyperactive BS
Skelt: osteoporosis, curv of spine

82
Q

Trosseaus Sign

A

Spasm or palmar flexion after BP cuff inflation

83
Q

Chvosteks

A

Facial twitching after tapping the ipsilateral cheek

84
Q

Hypocalcemia How to fix it?

A

Drug Therapy: Oral or IV calcium & Vit D to enhance absorption. Treating hypothy with Vit D
- *Phosphate: binding agents may be required to reduce serum phosphurus in patients w chronic renal failure.
- Take w meals ^
Nutrtion: Increase calcium rich foods

85
Q

Hypercalcemia

A

Serum level above 10.5 mg/dl or 2.62 mmol/l
- Causes exitable tissues to be less sensitive to normal stimuli thus requiring stonger stimulus to function.
- Most affects heart, skeletal muscles, nerves, intestinal smooth muscles.

86
Q

Causes of Hypercalcemia

A
  • Excessive intake of calcium
    -Excessive oral intake of vit D
  • Kidney Failure
  • Thiazide diuretics ***
    -Hyperthyroidism
  • Gluccocorticosteroids
87
Q

In context of hyperparathyroidism, excessive amounts of parathyroid hormone are produced causing…

A
  1. Increased calcium release from bones
  2. Enhanced kidney reabsoprtion of calcium
88
Q

Hypercalcemia S/S

A

Cardio: Most serious:
- 1. Causes increased heart rate and BP.
2. Severe depresses electrical conduction slowing heart rate.
- Short QT interval
- Monitor for blood clots
NeuroM: Muscle weakness, decreased deep tendon reflexes with paraesthesia. Confused, lethargic.
Intestinal: Constipation, abdominal pain

89
Q

Hypercalcemia Treatment

A
  1. Fluid Volume Replacement: 0.9% NACL
  2. Drug Therapy:
    - ** Thiazide diuretics are discontinued and replaced with diuretics that enhance discretion of calcium, such as furosemide. Calcium chelators help lower calcium levels.
    -Drugs to prevent hypercalcemia include agents that inhibit calcium resorption ( movement out ) from bone such as ****phosphurs    , calcitonin, bisphosphonates, and prostaglandin synthesis inhibitors ( NSAIDS, aspirin )
  3. Dialysis if severe
90
Q

Calcium has an inverse relationship with phosphurus

A

This means that as levels of phosphuorus in the blood rise, levels of calcium in the blood fall because phosphorus binds to calcium reducing the available free calcium in the blood.

91
Q

Magnesium

A

1.8-2.6 mg/dL

92
Q

Magnesium is essential for

A

Skeletal Muscle Contraction
Carbo Metabolism
Generation of energy stores
Vit Activation
Blood Coag
Cell growth

93
Q

Hypomagnesemia

A

Below serum level of 1.8 meQ
Caused by decreased absorption of dietary magnesium or increased kidney magnesium secretion

94
Q

Causes of hypomagnesemia

A

*Malnutrition
Diarrhea
Celiac Disease
Crohns Disease
Drugs ( diuretics )
*Ethanol Ingestion ( alcohol abuse )

95
Q

Hypomagnesemia Manifestations

A

Cardio: Can increase risk of hypertension, athersclerosis, hypertrophic left ventricle, dysrhymias
Neuro: Caused by increase nerve impulse transmission
- Hyperactive deep tendon reflexes, numbness, tingling, painful muscle contractions
- Positive Chvostek, Trosseau signs
Intestinal: Decreased peristalis, constipation, N/V, paralytic illeus

96
Q

Low Mag levels =

A

Low Potassium levels

97
Q

Low Mag levels =

A

Greater cardiac muscle cell damage after MI

98
Q

Hypomagnesemia How to fix it?

A

Hypomagnesemia and Hypocalcemia go hand in hand!
- Disc drugs that promote Mag loss…
- Loop diuretics, osmotic diuretics, aminoglycoside antibiotics, phosphurus
Mag is replaced with magnesium sulfate *
- IV replacement

99
Q

Hypermagnesemia

A

Serum level above 2.6 meQ
- Increased intake of antiacids, too much IV, decreased kidney excretion = kidney disease

100
Q

Hypermagnesemia Manifestions

A

**Cardio: Brady, cardiac arrest, peripheral vasodilation, hypotension, ECG changes
- Grave danger for cardiac arrest
CNS: Depressed nerve impulse, drowsiness, coma
NeuroM: Absent tendon relfexes, muscle contractions
Resp: Weak, shallow respirations

101
Q

How do we fix Hypermagnesemia?

A

Discontinue drugs that increase Mag levels:
- All oral/ parenteral mag
- Administer mag free IV
- Loop diuretics can further reduce serum levels
- ***When cardiac problems are severe giving calcium may reverse the cardiac effects of hypermagensemia

102
Q

Potassium Supplement: Pot Chloride, Gluconate, Phosphate, Bicarb

A

MOA: Essential in production of DNA and erthyropoiseis
Therapuetic Uses: Hypokalemia
Complications: GI distress, ulceraiton, hyperkalemia
Contradictions: Severe kidney disease
Interactions: Concurrent use of potassium sparing diuretics or ACE increase risk of hyperkalemima
Nursing Admin: Powder mix and effervesecent with 90-240 ml cold water or juice drink slowly 5-10 mins
Take oral, 8 0z water
NO IV PUSH or rapid infusion
10m eq no faster!!!!!
Large bore needle

103
Q

Magnesium Sulfate, Hydroxide, Oxide, Citrate

A

MOA: Activates intracellular enzymes, binds messenger to RNA to ribosomes, skeletal muscle contractillity and blood coag
Therapeutic Uses: Hypomagnesemia, preterm labor
Comp: Muscle weakness, flaccid paraylsis, supressed AV conduction, resp depression, diarrhea
Contradictions: Preg Risk A, AV block, rectal bleed, N/V, abd pain
Nursing Admin:
- Monitor BP, HR, RR
-DTR
-***Calcium gluconate to counteract if mag level is too high: for heart / cardiac problems

Pharm 2 (10 decks)

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