Exam 3 - Fluid Balance, Electrolyte Imbalances and Replacement

Question 1

what does body fluid do

Answer 1

• transports nutrients and waste to and from cells
• solvent for electrolytes and non-electrolytes
• helps maintain body temperature, digestion, and elimination, acid-base balance, and lubrication of joints and body tissues

Question 2

body fluid

Answer 2

• water that contains dissolved or suspended substances such as glucose, electrolytes, and proteins

Question 3

intracellular fluid

Answer 3

• inside the cells
• 70%

Question 4

extracellular fluid

Answer 4

• outside the cells
• 30%

Question 5

interstitial fluid

Answer 5

• between the cells

Question 6

intravascular fluid

Answer 6

• plasma
• liquid part of the blood

Question 7

diffusion

Answer 7

• movement of molecules from an area of high concentration to a lower concentration
• movement stops when concentrations are equal in both areas

Question 8

osmosis

Answer 8

• movement of water down a concentration gradient
• moves from low solute to high solute concentration
• movement stops when concentration differences disappear
• water follows electrolytes

Question 9

colloids

Answer 9

• substances that increase osmotic pressure
• move fluid from interstitial compartment to plasma compartment
• three primary: albumin, globulin, fibrinogen
• can be measured with total protein level
• decreased with age and overall nutrition

Question 10

hydrostatic pressure

Answer 10

• pushes fluid out of capillary
• force of fluid in compartment pushing against a cell membrane
• generated by BP
• happens at capillary level, pushes water out of vascular system into interstitial
• aids supply of nutrients to body tissues

Question 11

oncotic pressure

Answer 11

• aka osmotic pressure
• pulls fluid into capillary
• cause by plasma colloids in solution; major colloid - albumin
• protein has lots of colloids, interstitial space has little
• plasma attracts water, pulling fluid from tissue space into vascular space

Question 12

electrolyte

Answer 12

• influence: fluid balance, acid base balance, nerve impulses, muscle contraction, heart rhythm, etc
• substances that are electrically charged when in solution
• function with one another collaboratively, one balance affects the other

Question 13

intracellular concentration

Answer 13

• potassium +
• magnesium +
• phosphorous -

Question 14

extracellular concentration

Answer 14

• sodium +
• chloride -
• bicarbonate -
• calcium +

Question 15

hyponatremia

Answer 15

• causes: GI losses, renal losses, skin losses, fasting diets, polydipsia, excess hypotonic fluid
• s/s: confusion/altered LOC, anorexia, muscle weakness, seizures/coma
• treatment: slow sodium replacement, PO/IV, fluid restriction, treat underlying problem
• sodium bicarbonate

Question 16

dilutional hyponatremia

Answer 16

• hypervolemic
• result of taking in too much water
• s/s: increased BP, weight gain, bounding rapid pulse, increased urine specific gravity

Question 17

depletion hyponatremia

Answer 17

• hypovolemic
• too much fluid and sodium loss
• s/s: decreased BP, tachycardia, dry skin, weight loss, decreased urine specific gravity

Question 18

sodium bicarbonate for hyponatremia

Answer 18

• indication: metabolic acidosis
• MOA: dissociates to provide bicarbonate ion which neutralizes ion concentration and raises blood and urinary pH; increases concentration of sodium in plasma
• do not give IV for hyponatremia it is vesicant at high concentrations
• SE: edema, cerebral hemorrhage, hypernatremia, etc
• NC: monitor cardiac, ABGs, and electrolytes

Question 19

hypernatremia

Answer 19

• cause: IV fluids, tube feeds - excessive sodium intake; not enough water intake or too much water loss - cognitively impaired, diarrhea, high fever, heat stroke; profound diuresis
• s/s: alter LOC/confusion, seizure, coma, extreme thirst, dry sticky mucous membranes, muscle cramps
• treatment: excess sodium - remove sodium; water loss - add water; do this over a 48 hour period to avoid edema of cerebral cells

Question 20

potassium

Answer 20

• intracellular cation
• helps regulate excitability and electrical status
• controls intracellular osmolality
• diet is the main source
• kidneys are the main source of potassium loss

Question 21

sodium

Answer 21

• main ECF cation
• governs osmolality
• influences water distribution
• acid-base balance
• activates muscle and nerve cells

Question 22

hypokalemia

Answer 22

• causes: renal or GI losses; diuresis; acid base disorders
• s/s: cardiac rhythm disturbances and can be lethal
• treatment: potassium chloride (KCl)

Question 23

potassium chloride (KCl) for hypokalemia

Answer 23

indications: treat/prevent K+ depletions when dietary measures prove inadequate
- NC: oral/liquids - dilute with water or juice to lessen GI distress, large pills, may cause GI bleeds/ulcers
- NEVER GIVE IV PUSH
- only give to pts with documents urine output
- contraindicated: renal failure and dialysis
- serious ADR with undiluted potassium; ventricular fibrillation

Question 24

hyperkalemia

Answer 24

• causes: decreased potassium output; massive cell injury; drugs (potassium sparing diuretics, ACE, ARBs, NSAIDs)
• s/s: cardiac rhythm disturbances
• treatment: diuretics; sodium polystyrene sulfonate; D50/insulin

Question 25

sodium polystyrene sulfonate for hyperkalemia

Answer 25

- class: cation exchange resins - route: oral and rectal suspension, oral and rectal powder, rectal enema - indication: to treat high levels of potassium in the blood - MOA: binds to potassium in the digestive tract replacing potassium ions for sodium ions - precaution: only in patients with normal bowel function - SE: intestinal obstruction and intestinal necrosis

Question 26

D50/Insulin for hyperkalemia

Answer 26

- combo shifts potassium into the cell temporarily - usually give 10 units of regular insulin and 1 ampule of D50

Question 27

magnesium

Answer 27

- helps to stabilize cardiac muscle cells - blocks/controls movement of K+ out of cardiac cells - helps to stabilize smooth muscle

Question 28

hypomagnesemia

Answer 28

- cause: diuresis, GI or renal losses, limited intake, alcohol abuse, pancreatitis, hyperglycemia - s/s: hyperactive reflexes, confusion, cramps, tremors, seizures - SE: nystagmus - treatment: treat cause; oral and IV; replace over several days and can give IV push if necessary

Question 29

magnesium sulfate and magnesium oxide for hypomagnesia

Answer 29

- MOA: replaces magnesium - IV or PO - indication: prevent/treat seizures in pre-eclampsia, treat cardiac rhythm disturbances - SE: hypermagnesium - confusion, sluggish, slow movements, abnormal heart rhythm; can burn when given IV - magnesium oxide = antacid, given for long-term low magnesium

Question 30

hypermagnesia

Answer 30

- causes: increased intake accompanied by renal failure; OB patients - s/s: lethargy, floppiness, muscle weakness, decreased reflexes, flushed/warm skin, decreased pulse/BP - treatment: stop replacement; if chronic disease intake - dialysis

Question 31

calcium

Answer 31

- hormones released by the thyroid and parathyroid glands are controllers of the amount of calcium that is released from and absorbed into the bone - majority of calcium is in the bone

Question 32

hypocalcemia

Answer 32

- causes: unable to mobilize from bone, hypoparathyroidism, hypomagnesemia, renal failure, increased binding, decreased vitD, acute pancreatitis, thyroid and parathyroid surgery - s/s: increased neuromuscular excitability, paresthesias, bone pain, tetany - cardiac insufficiency: prolonged QT leads to fatal arrhythmia - Chvostek and Trousseau - treatment: IV and oral calcium

Question 33

positive Chvostek's sign

Answer 33

- ipsilateral twitching of the circumoral muscles in response to gentle tapping of the facial nerve just anterior to the ear

Question 34

positive Trousseau's sign

Answer 34

- carpal spasm upon inflation of a BP cuff to 20mmHg above the patients systolic blood pressure for three minutes

Question 35

treatment of hypocalcemia

Answer 35

- IV calcium: calcium chloride; calcium gluconate - oral calcium: elemental calcium, calcium carbonate; may also need vitamin D

Question 36

hypercalcemia

Answer 36

- cause: hyperparathyroidism, cancers - s/s: calcium acts like a sedative, fatigue, lethargy, confusion, weakness, seizures, coma, kidney stones - treatment: adequate hydration, increased urine output, diuretics and NaCl, dialysis in renal failure

Question 37

phosphorous

Answer 37

- calcium and phosphorous work together inversely - found in bone and intracellular - organic and inorganic forms - role in bone and ATP formation - part of DNA and RNA - acid-base buffer - normal function of WBCs and platelets

Question 38

hypophosphatemia

Answer 38

- causes: decreased absorption, antacid overdose, severe diarrhea, increased kidney elimination, malnutrition - s/s: mild-moderate few; severe - tremor, paresthesia, impaired WBC function, platelet dysfunction - treatment: IV or oral replacement; given IV over a long period of time; increased oral intake; take care wit CKD or hypercalcemia - increased risk of calcifications

Question 39

hyperphosphatemia

Answer 39

- causes: kidney failure, laxatives/enemas with phosphorous, shift from intra to extracellular, massive trauma or heat stroke, hypoparathyroidism - s/s: usually asymptomatic, symptoms of hypocalcemia - treatment: treat the cause; calcium - based phosphate binders; hemodialysis - renal failure