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Foundations 3 > F&E > Flashcards

F&E Flashcards

1
Q

Osmolality

A

Osmolality are particles in a given weight of fluid

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2
Q

Osmolarity

A

are particles in a given volume of fluid

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3
Q

A serum osmolarity, Normal range, too high, too low?

A

is a method of determining if someone is overhydrated or dehydrated

  • Normal range is roughly 280 to 300
  • Too high indicates dehydration
  • Too low indicates fluid overload
  • For our purposes they will be interchangeable
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4
Q

Intracellular

A

is the fluid inside the cell
-2/3 of fluid volume

Primary electrolytes
Potassium
Phosphate
Sulfate

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5
Q

Extracellular

A

is the fluid outside the cell

1/3 of fluid volume

Primary electrolytes
Sodium
Chloride
Bicarbonate

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6
Q

What is the fluid called that is inside the blood vessels?

A

intravascular

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7
Q

What is the fluid called in-between the cells?

A

interstitial

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8
Q

What three components determine the fluid balance in these compartments?

A
  • Protein– keeps fluid invascualr space (colloid oncontic pressure)
  • Blood vessel integrity – keeps fluid in vascular space
  • Hydrostatic pressure- pushes fluid into interstitial space
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9
Q

Osmotic Pressure is impacted by what?

A

Osmolality- Pressure exerted to prevent movement of water out of the intravascular space

Colloid Oncotic pressure- Proteins attract water and hold onto water

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10
Q

Hydrostatic Pressure

A

Arterial blood pressure (higher)
Venous pressure (lower)
Rate of blood flow

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11
Q

Filtration Pressure

A

-Process that transfers nutrients and oxygen to cells
Hydrostatic minus osmotic
-At the arterial end of the capillary the fluid is pushed into tissues
-At the venous end the fluid is brought back into circulation

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12
Q

Tonicity

A

Concentration of fluid

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13
Q

Isotonic

A

Equal concentration of water and electrolytes

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14
Q

Hypertonic

A
  • Concentration of electrolytes outside cell is higher
  • Concentration of water outside cell is lower

Hypertonic solution : cause cells to shrink

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15
Q

Hypotonic

A
  • Concentration of electrolyte outside cell is lower
  • Concentration of water outside cell is higher

Hypotonic solution cause cells to swell

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16
Q

Hypotonic Solutions (<250 mOsm/ L)

A
  • 0.45% sodium chloride also known as “half normal saline”

- Used for: hypernatremia and diabetic ketoacidosis. Due to tonicity can cause hypotension

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17
Q

Isotonic (250 – 375 mOsm / L)

A
  • 0.9% sodium chloride also known as “normal saline”
  • Most common fluid used for hydration. Only solution used with blood product administration
  • Lactated Ringers
  • Used with surgery, trauma, burns. Not recommended for patients with renal problems
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18
Q

Hypertonic (> 375 mOsm/L)

A

-3% sodium chloride
Used in emergency situations for cerebral edema

Dextrose 5% in 0.45% sodium chloride or called “D5 ½ normal saline”
-used for hypovolemia with hypernatremia

D5 normal saline- used with electrolyte and fluid loss

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19
Q

Crystalloids

A

-Aqueous solution with electrolytes

Hypotonic, isotonic, and hypertonic solutions (chart from last slide)

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20
Q

Colloids

A

-Contain large molecules that do not transport outside of the intravascular space
Also called “volume expanders”

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21
Q

Blood products

A

A fluid type only administer normal saline with blood!

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22
Q

Functions of Colloids

A
  • Function to increase the osmotic pressure in the intravascular space leading to fluid being pulled into the intravascular space
  • Albumin, Dextran, Hetastarch
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23
Q

Nursing consideration of colloids

A

-Must be administered carefully or can cause signs of fluid volume excess (listed out on the fluid volume excess slide)

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24
Q

Packed RBCs

A

Used for blood loss

  • 1 unit roughly increases hemoglobin by 1 g/dL
  • Usually reserved for a hemoglobin less than 7 or 8 g/dL
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25
Q

Platelets

A

Given when there is a reduced level of platelets

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26
Q

Fresh, Frozen, Plasma

A

-Used for trauma, burns, shock, or bleeding and clotting disorders

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27
Q

Cryoprecipitate

A

Used for clients with hereditary disorders that lead to inadequate clotting

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28
Q

Nursing Considerations for Blood products

-Should consent be obtained before administering blood products

A

-Blood type and Rh factor protein are determined to match a person with the right type of donor
Type and crossmatch performed

-A consent must be obtained before administration of any blood products

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29
Q

Universal Donor

A

O neg

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30
Q

Universal Recipient

A

AB positive

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31
Q

Signs for Transfusion reaction

A
  • Fever, chills
  • Altered blood pressure
  • Respiratory difficulty
  • Signs of an allergic reaction
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32
Q

Dehydration

A

Loss of body water but electrolytes remain consistent

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33
Q

Fluid Volume Deficit

A
  • Loss of both fluid and electrolytes.
  • Can also include a loss of circulating blood volume and perfusion to tissues
  • Hypovolemia
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34
Q

Fluid volume excess

A

-Electrolytes are same or altered

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35
Q

Edema

A

-Can relate to both deficit and excess

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36
Q

Dehydration Causes

A
  • Inadequate water intake
  • Increased GI losses
  • Fever
  • SSRIs and Benzo decrease thrist mechanism
  • DKA
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37
Q

Dehydration lab tests

A
  • Elevated serum osmolality
  • Elevated creatinine
  • Elevated BUN
  • Increased urine specific gravity
  • Hypernatremia: why is this one if electrolytes remain consistent?
  • Electrolyte level is constant, but the amount of body fluid is reduced. The serum is more concentrated and electrolyte levels will be higher due to concentration
38
Q

Fluid Volume deficit s/s

A 
Hypotension
Tachycardia 
Orthostatic hypotension
Decreased urine output
Flat neck veins
Weak pulse
39
Q

What is Third spacing

A

Too much fluid in interstitial space and not enough in the intravascular space

40
Q

TX for deficit and third spacing

A

Replacement of fluids
Safety education: Advise patient to sit or stand slowly

For third spacing:

  • Give protein IV: albumin and it comes in diff %
  • Give Hypertonic solution
41
Q

What causes a reduced colloid oncotic pressure?

A

-Reduced levels of albumin

42
Q

What does Protein do

A

-keeps fluid in intravascular space

43
Q

What happens to the fluid when there is a reduced colloid oncontic pressure?

A

Fluid leaves the intravascular space and into interstitial space
-edema occurs

44
Q

Mechanism of edema: increased hydrostatic pressure causes

A
  • elevated BP
  • Fluid overload
  • decreased cardiac output
45
Q

Causes of decreased oncotic pressure

A

Malnutrition, Liver failure, Nephrosis

46
Q

Causes of blocked or removal of lymph nodes

A

Mastectomy and Lymphoma

47
Q

causes of increased capillary permeability

A

allergies, septic shock, pulm edema

48
Q

How can someone have a fluid volume deficit if they have too much fluid somewhere?

A
  • ECF and ICF need a certain level of fluid to function

- Tx can just be moving fluid from one area to another within a compartment rather than giving more fluid overall

49
Q

Causes of Excess Fluid Volume

A
  • HF, Renal Failure, Cirrhosis, Excess IV fluid, Medications that cause sodium and water retention
50
Q

S/s of Fluid volume excess

A 
Weight gain of more than 0.5 kg a day
Hypertension
Bounding pulse
Distended neck veins AKA jugular venous distention
Dyspnea
Crackles
Orthopnea
51
Q

Treatment for Fluid Volume Excess

A
  • Diuretics: Furesomide, Spirnoalctone, butanamide, hydrochlorothiazide
  • Fluid restriction on patinets door
52
Q

Funcitons of Electrolytes

A

Maintaining balance of water in the body

Balancing the blood pH

Moving nutrients into the cells

Moving wastes out of the cells

Maintaining proper function of the body’s muscles, heart, nerves, and brain

53
Q

Potassium range and fxn

A

range: 3.5-5.0
Fxn: Cardiac, neuro, and muscular fxn controlled by aldosterone and insulin

54
Q

Sodium range and fxn

A

range: 135-145
Fxn: Reflection of body’s water balance
-supports neuro and muscular fxn
- Blood Pressure regualtion

55
Q

Calcium range and fxn

A

range: 8.9-10.5 serum
ionized: 4.5-5.6
F: Synaptic transmission, wound healing, muscle contractility, teeth and bone structure.
- Controlled by PTH hormone

56
Q

Calcium as an inverse relationship with?

A

Phosphorus

57
Q

Magnesium range and Fxn

A
  1. 8-2.3 mg/ dL
  2. 3- 2.1 mEq/L
    - NM and Cardiac activity
58
Q

Hypokalemia Causes

A 
Diuretics 
Metabolic alkalosis
Folic acid deficiency
Gastrointestinal losses
Decreased intake of potassium 
Chronic kidney disease
59
Q

Hypokalemia S/s (LOW and SLOW)

A

Mild: cardiac arrthymias, constipation, fatigue

Severe: Respiratory paralysis, paralytic ileus, tetany, hypotension, rhabdomyolysis, life threatening arrythmias

60
Q

Hypokalemia Tx

A

-Potassium supplementation, potassium sparing diuretics, making dietary changes, IV potassium

61
Q

Do you push Potassum IV?

A

-NEVER! Give it slowly can cause burning in patients

62
Q

Hyperkalemia Causes

A
  • Acute renal failure
  • Dehydration
  • diabetes
  • Burns
  • Acidosis
  • Blood Transfusion
  • CPR
63
Q

Hyperkalemia S/s (Tight and Contracted)

A

Mild: N/v, muscle aches, weakness, dysarrthymias
Severe: Paralysis, HF, Death

64
Q

Hyperkalemia TX:

A
  • Hemodialysis for acute renal failure
  • Calcium Gluconate or calcium chloride for heart
  • loop diuretics if renal failure is not present
  • Sodium polysstyrene sulfonate: binds to K and excretes it
  • Intravenous insulin: Insulin helps to push K into cell but glucose needs to be monitored
65
Q

Hyponatremia Causes

A 
Severe vomiting or diarrhea
Drinking excess water
Excess alcohol intake
Thiazide diuretics
Liver or Heart disease
66
Q

Hyponatremia S/S Depressed/ Deflated

A

Mild
Nausea, feeling unwell

Severe
Cerebral edema, lethargy, confusion, irritability, seizure, coma

67
Q

Hyponatremia Tx

A
  • Raise sodium levels slowly
  • If hyponatremia was caused due to excess fluid use a fluid restriction
    -Cause is due to thiazide diuretics:
    Isotonic IV fluids
    -Hypertonic is only used in cerebral edema
    -
68
Q

Hypernatremia Cause

A 
Dehydration and things that cause a state of dehydration
Vomiting 
Chronic kidney disease
Diabetes
Impaired thirst response
Consumption of high sodium items
69
Q

Hypernatremia S/s: Big and Bloated

A

Similar to hyponatremia

70
Q

Hypernatremia Tx

A
  • Restore fluid status
  • Give isotonic fluids
  • IF BP is low or in shock give hypotonic
  • -Water is not used for treatment
  • Educate clients on dietary measures to reduce sodium
71
Q

Hypocalcemia Cause

A 
Inadequate vitamin D
Decreased estrogen production 
Hypoparathyroidism
Renal disease
Low albumin levels
Stimulant laxatives
Chronic steroid use
Proton pump inhibitors
72
Q

S/s of hypocalcemia (spastic)

A 
Chest pain
Dysrhythmias
Renal calculi
Numbness and tingling
Muscle cramping
Confusion
Osteopenia 
Dental problems
73
Q

What 2 signs can you see with hypocalcemia

A
  • Chvosteks and Trousseau sign
74
Q

Ionized Calcium

A
  • Serum calcium accounts for all calcium, whether it is in the free ionized form or if it is bound to proteins.
  • it can detect unbound and active which leads it to be the most accurate
  • Serum is used more commonly though
  • Ionized is performed if signs/symptoms or abnormal serum levels of calcium suggest a calcium issue
75
Q

Hypocalcium TX

A

Calcium and vitamin D supplementation

Increased dietary intake

Calcium injections

76
Q

Hypercalcemia Cause

A

Cancer
Hyperparathyroidism
Vitamin D toxicity
What over the counter medication for heartburn contains calcium carbonate?
Tums, too much can contribute to hypercalcemia

77
Q

Hypercalcemia s/s (slow and swollen)

A 
Mild symptoms
Constipation
Abdominal pain
Nausea
Vomiting 
Severe symptoms
Confusion
Renal failure
Arrhythmias
Coma
Death
78
Q

Hypercalcemia TX

A
  • IV Phosphate bolus
  • loop diuretic
  • hemodialysis in severe cases
79
Q

Hypomagnesium cause

A 
Crohn’s disease or celiac disease
Diarrhea or pancreatitis
Type 2 diabetes
In the presence of hypokalemia and hypocalcemia
Decreased intake 
Increased renal excretion
80
Q

S/s of hypomagnesium (Buck Wild)

A

Mild symptoms
Decreased appetite, fatigue, nausea, weakness

Severe
Muscle cramps, numbness and tingling, seizures, tetany, and personality changes

81
Q

Hypomagnesium Tx

A

Oral or intravenous magnesium

Educate clients on foods high in magnesium

82
Q

What might have to be treated first before magnesium can be given?

A

Restore calcium or potassium balance

83
Q

Hypermagnesium Cause

A

Kidney disease
Acidosis
Hypothyroidism
Trauma
Medications that increase dwell time of food in the intestines (opioids or anticholinergics)
Laxatives or antacids that contain magnesium

84
Q

Hypermagnesium S/s (Calm and quiet)

A

-Mild symptoms
Dizziness, nausea, weakness, confusion

-Severe symptoms
Confusion, blurred vision, headache, bladder paralysis, bradycardia, reduced respiratory rate, loss of deep tendon reflexes, death

85
Q

Hypermagnesium TX

A
  • Calcium chloride and gluconate for cardiac issues
  • IV saline w/ diuretics
  • Severe: Hemodialysis
86
Q

Sources of Sodium

A

-Sodium chloride, MSG, soy sauce

87
Q

Sources of potassium

A

-Fruits ( bananas), veggies (avocado), orange juice, tomato juice

88
Q

Calcium sources

A

-Dairy and green dark veggies and salmon, oysters

89
Q

Magnesium sources

A

-Nuts and peanut butter, egg yolk, milk

90
Q

Phosphorus sources

A

Dairy, meat, fish, bran and wheat cereals

Foundations 3 (5 decks)

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