Exam 2 - fluids & electrolytes Flashcards
Active Transport
- Physiologic pump that moves fluid from an area of lower concentration to one of higher concentration
- Movement against the concentration gradient
- Sodium-potassium pump maintains the higher concentration of extracellular sodium and intracellular potassium
- Requires adenosine (ATP) for energy
Filtration
•Movement of water and solutes from an area of higher hydrostatic pressure to an area of lower hydrostatic pressure
Fluid & Electrolyte Balance.. What is it? goals?
- Necessary for life and homeostasis
* Nursing role is to help prevent and treat fluid and electrolyte disturbances
Fluid…
- Approximately 60% of the typical adult is fluid
* Varies with age, body size, and gender
What is “Third Spacing” ?
loss of ECF into a space that does not contribute to equilibrium
Movement of fluid through the capillary wall depends on?
–Hydrostatic pressure =Pressure exerted on the walls of blood vessels
–Osmotic pressure= Pressure exerted by the protein in the plasma
The direction of fluid movement depends on….
the differences of hydrostatic and osmotic pressure
What are electrolytes?
•Active chemicals that carry positive (cations) and negative (anions) electrical charges
What are the major cations?
Sodium, Calcium, Magnesium, and Hydrogen Ions
What are the major anions?
– Chloride
– Bicarbonate
– Phosphate
– Sulfate
Extracellular fluid has high concentrations of what?
- Na+
- Clˉ
- HCO3-
Intracellular fluid has high concentrations of what
- K+
- PO4—
- Mg++
What is Osmosis?
•Movement of fluid from and area of lower solute concentration to an area of higher solute concentration
What is diffusion?
Movement of molecules and ions from an area of higher concentration to an area of lower concentration
Route of gain for fluid &electrolytes?
–Dietary intake of fluid and food or enteral feeding
–Parenteral fluids
Routes of fluid and electrolyte loss?
–Kidneys via Urine output
–Skin loss: sensible and insensible losses
What maintiains homeostasis in the body?
–Kidneys –Hormones –ADH –Renin-angiotensin-aldosterone system –Atrial natriuretic system
What are the main electrolytes that need to be maintained???
- Sodium
- Potassium
- Calcium
- Magnesium
- Chloride
- Phosphate
- Bicarbonate
Ph measures, what do high and low PH mean?
- Low pH = acidic
* High pH = alkalinic
How do body fluids maintain their PH??
•Body fluids maintained between pH of 7.35 and 7.45 by
–Buffers
–Respiratory regulation
–Renal regulation
What do buffers do?
•Prevent excessive changes in pH
What do buffers do?
•Prevent excessive changes in pH
What is the major buffer in EFC?
HCO3- and H2CO3
What are some examples of other buffers?
–Plasma proteins
–Hemoglobin
–Phosphates
What do the Lungs do in regards to fluids & electrolytes???
•Regulate acid-base balance by eliminating or retaining carbon dioxide
How do the Lungs regulate acid - base balance?
by altering rate/depth of respirations
When the lungs breathe at a Faster Rate and have More Depth (tachypnea), what happens?
get rid of more CO2 and pH rises
What happens when the lungs breathe at a Slower Rate, with Less Depth? (Bradypnea)
retain CO2 and pH lowers
What function do the kidneys have in regards to fluids and electrolytes???
•Regulate fluids & electrolytes by selectively excreting or conserving bicarbonate and hydrogen ions
*They are also Slower to respond to change
What are the clinical manifestations of Respiratory Acidosis???
Increased Pulse and repiratory rate, Warm flushing of the skin, Confusion and a decreased level of consciousness, Heaches, Dizziness, Convulsions.
What are the Clinical Manifestations of Respiratory Alkalosis????
Complaints of Shotness if Breath, Chest Tightness, Lightheadedness with circumoral paresthesias, Numbness and Tingling of the Extremities, Difficulty Concentrating, Tremulousness, Blurred Vision.
What causes Respiratory Acidosis??
Acute Lung Conditions that impair the Alveolar gas exchange. for example, Pnemonia, Acute Pulmonary Edema,
Aspiration of a Foreign Body, Near- drowning.
Can also be caused by Chronic Lung diseases like Asthma, Cystic Fibrosis, and Emphysema.
An Overdose of narcotics that cause a decrease in Respiratory Rate & depth can also cause respiratory acidosis.
Airway Obstruction.
What are the Lab findings for Respiratory Acidosis??
Arterial Blood PH of less than 7.35 (acidic), PaCO2 above 45mmHg, HCO3- normal or slightly elevated in acute respiratory acidosis, or above 26 mEq/L in Chronic respiratory acidosis.
What are the lab findings for Respiratory Alkalosis??
Arterial Blood PH above 7.45, PaCO2 less than 35 mmHg
What causes Respiratory Alkalosis??
hyperventilation (a lot of breathing) due to Anxiety, Elevated Body Temperature, Overventilation with a mechanical ventilator, Hypoxia, Salicylate Overdose, Brainstem Injury, Fever, Increased Metabolic Rate
What are the Nursing Interventions for Respiratory Acidosis??? (Caused by too little breathing)
Frequently assess respiratory status and lung sounds,
Monitor airway and ventilation,
insert an artificial airway and prepare for mechanical ventilation as necessary.
Administer pulmonary therapy measures such as inhalation therapy, percussion and postural drainage, bronchodilators, and antibiotics as ordered.
Monitor vitals and ABGs, maintain adequate hydration.
What are the Nursing Interventions for a patient experiencing Respiratory Alkalosis???
Monitor Vital signs, Monitor ABGs, Assist the patient to breathe more slowly, and help the patient breathe in a paper bag or apply a rebreather mask (in order for the patient to inhale CO2 because they are getting rid of CO2 too fast. )
What are the symptoms of Metabolic Alkalosis??
Decreased respiratory rate and depth, dizziness, Circumoral paresthesias, numbness and tingling of the extremities, Hypertonic muscles, tetany
What are the lab values for metabolic alkalosis?
Arterial blood PH above 7.45, Serum Bicarbonate greaterthan 26 mEqL/ PaCO2 higher than 45 mmHg with respiratory compensation.
What causes Metabolic Alkalosis?
Excessive acid losses due to Vomiting, Gastric Suction, Excessive Use of Potassium-losing diuretics, Cushings Syndrome, Hyperaldosteronism, Excessive bicarbonate intake due to Antacids or Parenteral NaHCO3.
What are the Nursing interventions for Metabolic Alkalosis???
Monitor intake and output closely, Monitor Vitals, especially respirations and levels of consciousness.Administer ordered IV fluids carefully, treat the underlying problem.
What causes Metabolic Acidosis?
Conditions that increase nonvolatile acids in the blood,
For example, Renal Impairment, Starvation, Diabetes Mellitus. Also conditions that decrase bicarbonate, like prolonged diarrhea.
Excessive infusion of chloride-containing IV fluids (e.g NaCl);
Excessive ingestion of acids like salicylates.
Cardiac Arrest.
What are the symptoms of Metabolic Acidosis???
Kussmaul’s respirations (deep, rapid breathing) ; Lethargy, Confusion, Headache, Weakness, Nausea and Vomiting
What are the lab findings for Metabolic Acidosis???
Arterial Blood PH below 7.35 ; Serum Bicarbonate less than 22 mEq/L ; PaCO2 less than 32 mmHg with respiratory compression.
Nursing inteventions for A patient with Metabolic Acidosis???
Monitor ABG values, Monitor Intake & Output, Administer IV Sodium Bicarbonate carefully if ordered, Treat the underlying problem.
What factors affect body fluids, Electrolyte, and Acid-Base Balance?
- Age
- Gender
- Body size
- Environmental temperature
- Lifestyle
Gerontologic things to consider with fluids and electrolytes:
- Reduced homeostatic mechanisms: cardiac, renal, and respiratory function
- Decreased body fluid percentage
- Medication use
- Presence of concomitant conditions
Fluid Volume Deficit -Hypovolemia
Isotonic loss of water and electrolytes
•Third Space Syndrome!
Fluid Volume Excess - Hypervolemia
Isotonic gain of water and electrolytes
•Edema!
What causes a fluid volume deficit???
dehydration, GI losses, renal losses, third spacing, fluid loss from vomiting, diarrhea, GI suctioning, sweating, decreased intake, and inability to gain access to fluid
Who is at a high risk for Fluid Volume Deficit?
Very young people ;very Old people; very ill people ; stroke patients; patients with Dysphagia.
What are other risk factors for Fluid Volume Deficit???
diabetes insipidus, adrenal insufficiency, osmotic diuresis, hemorrhage, coma, and third space shifts
What happens with a Fluid Volume Deficit?
•Loss of extracellular fluid exceeds intake ratio of water, and electrolytes are lost in the same proportion as they exist in normal body fluids
What does dehydration associated with fluid volume deficit mean??
Loss of water alone with increased serum sodium level
What are the Clinical Manifestions/ Symptoms of a Fluid Volume Deficit???
Rapid weight loss, decreased skin turgor, oliguria, concentrated urine, postural hypotension, rapid and weak pulse, increased temperature, cool and clammy skin due to vasoconstriction, lassitude, thirst, nausea, muscle weakness, and cramps
What lab data would be seen with a patient with a fluid volume deficit?
Elevated BUN in relation to serum creatinine; increased hematocrit; possible serum electrolyte changes
How would you manage a fluid volume deficit??
Provide IV and oral fluids to meet the body’s needs
Substances that are used to replace fluids in patients with a fluid volume deficit
•Crystalloids
–Fluid challenge is given with isotonic solutions like 0.9% NSS
–If intracellularly dehydrated, can give hypotonic solutions like 0.45 NSS cautiously
–Fluid maintenance is around 2-3 L/day
•Colloids
–Usually albumin but can include hetastarch and dextran
–High molecular weights; can pull fluid into vascular space
What causes Fluid Volume Excess (Hypervolemia)
Heart, renal or liver failure, and medications like steroids.
What are the interventions that are used for treating fluid volume excess aimed at doing??
Finding/ treating the underlying cause of it.
How is Fluid Volume Excess treated??
•Water and sodium restriction •Diuretics Examples of Diuretics: –Loop (furosemide [Lasix]) –Thiazide (hydrochlorothiazide [HCTZ]) –Potassium-sparing (spironolactone [Aldactone]) –Carbonic anhydrase inhibitors (acetazolamide [Diamox]) –Osmotic (mannitol [Osmotrol])
What kind of assessments would a nurse do for patients with suspected fluid balance problems?
- Nursing history
- Physical assessment
- Clinical measurement
- Review of laboratory test results
When assessing a patient’s history, what would the Nurse Assess for?
- Chronic diseases
- Acute conditions
- Medications
- Treatments
- Age: Very old or very young
- Inability to access food and fluids
What would a physical assessment consist of assessing?
- Skin
- Mucus membranes
- Eyes
- Fontanels (infants)
- Cardiovascular system
- Respiratory system
- Neurologic
What clinical measurments would a Nurse take for an assessment of Fluid Balance??
•Daily weights –At the same time each day –Wearing the same or similar clothing –On the same scale •Vital signs •Fluid intake/output
What counts as intake that should be recorded?
- Oral fluids
- Ice chips
- Foods that are or become liquid at room temperature
- Tube feedings
- Parenteral feedings
- IV medications
- Catheter or tube irrigation
What would be considered output and would have to be recorded??
- Urinary output
- Vomitus and liquid feces
- Tube drainage
- Wound and fistula drainage
What is the definition of dehydration as a fluid imbalance?
Hyperosmolar loss of only water leaving the client with excess sodium
Overhydration as a fluid imbalance
–Hypo-osmolar gain of only water leaving low osmolality and low serum sodium levels
Names of Electrolyte Imbalances
- Hyponatremia
- Hypernatremia
- Hypokalemia
- Hyperkalemia
- Hypocalcemia
- Hypercalcemia
- Hypomagnesemia
- Hypermagnesemia
- Hypochloremia
- Hyperchloremia
- Hypophosphatemia
- Hyperphosphatemia
What kind of lab data is taken when assessing for fluid and electrolyte imbalances???
- Complete Blood Count
- Hematocrit
- Osmolarity
- Urine Specific Gravity
- Urine pH
- Arterial blood gases (ABGs)
What are the phases of diagnostic testing called??
- Pretest
- Intratest
- Post test
What would the Nurse do for the patient during the Pretest Phase of Diagnostic testing?
- Instruct the client and family about the procedure
- Explain the purpose of the test
- Instruct the client and family about activity restrictions
- Instruct the client and family on the reaction the diagnostic test may produce
- Provide client with detailed information about the diagnostic testing equipment
- Inform the client and family of the time frame for when the results will be available
- Instruct the client and family to ask questions
What does the Intratest Phase of diagnostic testing involve???
- Collecting the specimen
- Performing or assisting
- Providing emotional and physical support
- Monitoring the client as needed
- Correct labeling, storage, and transportation of specimen
What does thr Post Test Phase of Diagnostic Testing Involve?
- Nursing care of client
- Performing follow-up activities and observations
- Comparing the previous and current test results
- Modifying nursing interventions as needed
- Reporting the results to appropriate health team members
What are common blood tests to do be done during diagnostic testing?
- Complete blood count
- Serum electrolytes
- Serum osmolality
- Drug monitoring (peak and tough levels)
- Arterial blood gases
- Blood chemistry
- Metabolic screening
- Capillary blood glucose
What does a complete Blood Count measure?
- Hemoglobin
- Hematocrit
- RBC count
- RBC indices
- WBC count
- WBC differential
What do Sedimentation Rate & Coagulation Panels measure?
- Sedimentation Rate (Sed rate); Erythrocyte Sedimentation Rate (ESR)
- PT/INR
- PTT
What are the Serum Electrolytes?
–Sodium
–Potassium
–Chloride
–Bicarbonate ions
What does BUN& Creatinine evaluate?
Renal Function
What produces Creatinine?
The Muscles
Why would you monitor a therapeutic drug?
Because the Client is taking a medication with a narrow therapeutic range
Peak Level
Highest cocentration of a drug
Trough Level
Lowest concentration of a drug
Arterial Blood Gases
- Usually taken by specialty nurses, medical technicians, and respiratory therapists
- Take specimens of blood from radial, brachial, femoral arteries
Why is Blood chemistry evaluated???
•Determine for certain enzymes present –Lactic dehydrogenase (LDH) –Creatine Kinase (CK) –Aspartate aminotransferase (AST) –Alanine aminotransferase (ALT) •Serum glucose •Hormones
Nursing responsibilities for fluid collection
- Provide client comfort, privacy, and safety
- Explain the purpose of the specimen collection and the procedure
- Use the correct procedure or ensure that client or staff follows the correct procedure
- Note relevant information on the laboratory requisition slip
