Exam 3- Fluids and Electrolytes Flashcards
What maintains homeostasis?
Fluids and electrolytes
Why are fluids essential for the body?
- GI absorption of nutrients
- transport of nutrients, electrolytes, and 02 to cells
- regulation of body temp
- transport cellular wastes
- lubrication of joints and membranes
- medium for food digestion
What is the primary source of fluid loss?
URINATION. urine output.
Sensible versus Insensible
Sensible-CAN SEE via sweat, losing water and electrolytes
Insensible- respirating air, CANNOT SEE the h20 loss and no electrolyte loss. From lungs and skin.
What are the 2 diff fluid compartments?
Intracellular fluid (ICF) and Extracellular fluid (ECF)
What is the most prevalent cation and anion in ICF?
K+
P04- Phosphate-
Fluid w/in cells
What is the most prevalent cation and anion in ECF?
Na+
Chloride-
interstitial
intravascular- plasma needs blood test
6 ways to control fluid and electrolyte movement
- Diffusion- 02 from lungs to body
- Facilitated Diffusion- lock and key no ATP required
- Active Transport- 3 Na+ out, 2 K+ in
- Osmosis- High to Low conc.
- Hydrostatic Pressure- BP pushes everything out of cap. beds
- Oncotic pressure
Oncotic pressure involves?
Albumins- Albumins stay in the CV system and attracts h20 & keeps fluid vol and oncotic pressure going.
What is first fluid spacing?
everything in homeostasis, normal distribution of fluid
What is second fluid spacing?
abnormal accumulation of interstitial fluid..EDEMA/SWELLING
What is third fluid spacing?
Fluid accumulation in part of body where it is not easily exchanged with ECF. TRAPPED w/in compartments (pleura, cv areas, brain, synovial sac) body c/n excrete it regularly
What is ascites?
Fluid accumulation in abdominal cavity, seen in alchys.
What are S and Sx of hypernatremia?
THIRST CNS deterioration- osmoreceptors in brain not triggering thirst but body is dehydrated but doesn't drink h20 Increased interstitial fluid TIERD/LETHARGIC AGITATION SEIZURES COMA
What are two things that may be going on with hypernatremia?
- H20 loss- increased amounts of H20 loss therefore blood vol. becomes concentrated with Na+
- Sodium gain- Dietary meds cont. Na+ and kidney disfunction t/4 Na+ builds up in blood and cells crenate becoming dehydrated because h20 goes into the hypertonic blood.
What functions is Na+ associated with?
- ECF vol. and concentration
- Generation & transmission of nerve impulses
- Acid base balance
* Na+ is associated with h20, K+, and shifts
What are S and Sx of Hyponatremia?
CONFUSION N & V SEIZURES COMA CNS DETERIOATION
What causes hyponatremia and how do we replace the Na+ levels in the blood?
Increased loss of Na+ via output or drinking excess H20.
If severe, SEIZURES can occur therefor small amount of IV hypertonic saline sol. 3% NaCl is given.
What functions is K+ associated with?
CV CHANGES AND THE HEART transmission and conduction of nerve impulses maintenance of normal cardiac rhythms skeletal muscle contraction acid base balance
What food sources are rich in K+?
FRUITS AND VEGETABLES
K-dur meds
stored blood products- blood transfusions
If K+ serum level is above 5.0 mEq/L pt is?
HYPERKALEMIA- elevated T-wave in EKG..ventricles repolarizing (T wave small to big) TIERD/LETHARGIC CV ABNORMALITIES DYSRHYTHMIA VEN FIB HB
What causes hyperkalemia?
Increased retention due to RENAL FAILURE or K+ sparing diuretics
Increased intake of K+
Mobilization from ICF- tissue destruction= all K+ leak into CV system
Nursing implementations for hyperkalemic pt?
- Eliminate oral and parental K+ intake
2. Increase elimination of K+ by loop diuretics, dialysis, etc
If K+ serum level is less than 3.5 mEq/L pt is?
HYPOKALEMIA- t wave big to small BRADYCHARDIA ECG CHANGES CNS CHANGES ANOREXIA N&V WEAK PERIPHERAL PULSES MUSCLE WEAKNESS
What cause hypokalemia?
Increased loss of K+ by loop diuretics
GI looses K+ in fluids, associated with Mg deficiency, movement into cells
What is the most common cause of hypokalemia?
LASIX- because it is a loop diuretic that is commonly used. Excretes K+ by eliminating K+ t/4 teach pt to eat K+ RICH FOODS OR SUPS (raisins, bananas, oranges, beans, carrots, APRICOTS, DRY FRUITS that cont high levels of K+)
Can you administer K+ by itself in IV and why?
NEVER administer K+ by itself in Iv, needs to be DILUTE b/c may burn/hurt and CARDIAC ARREST risk.
In oral sups- dilute in juice and give with meal to avoid gastric irritation
What pt is at risk for being hypokalemic?
Pt on DIGOXIN because of shift with K+ (Lasix)
What are S and Sx of hypercalcemia? COW AIN’T FLEXIN!
Lack of coordination Anorexia N&V Confusion, low LOC personality changes dysrhythmia, hb, ca pt looks weak& FLACID, NO MUSCLE TONE
What causes hypercalemia, >5.5?
Hyperthyroidism b/c parathyroid regulates Ca+ vol
malignancy
vit d overdose
prolonged immobilization
A pt with low Ca+ serum levels could indicate? COW IS CRACKED OUT!
HYPOCALEMIA TETANY: TROUSSEAU'S & CHVOSTEK'S CONFUSION SEIZURE IRRITABILITY
What causes hypocalemia?
Not enough Ca+ from diet. Regulated by the PTH hormone and Vit D. favilitates reaborption of Ca+ from bone and engances reabsorption from GI tract
How to indicate Trousseau’s sign in hypocalemic pt?
Inflate BP cuff on upper arm to 20mmHg above sys pressure, MUSCLE, CARPAL SPASMS within 2-5 minutes indicate TETANY.
How to indicate Chvostek’s sign in hypocalemic pt?
Tap facial nerve 2 cm ant. to the earlobe just below zygomatic arch, TWITCHING OF FACIAL MUSCLES indicates TETANY
Hypermagnesemia, >2.5 mEq/L
Potent Vasodilator
Causes: Renal failure, excessive Mg administration via antacids, cathartics
S and Sx: depresses CNS and cardiac impulse transmission
CA, facial flushing, SHALLOW RESP, muscle weakness, DEEP TENDON REFLEXES ABSENT, PARALYSIS
Hypomagnesemia, <1.5 mEq/L
Causes: Alcoholism, GI suction, diarrhea, intestinal fistulas, poorly controlled diabetes mellitus, malabsorption
S and Sx: Increased NM irritability, tremors, tetany, hyperactive deep tendon reflexes, seizures, dysrhythmia, disorientation, confusion
