Fluid And Elec Exam 3 Flashcards
What are the primary functions of electrolytes in the body?
- Maintaining the balance of water in the body
- Balancing the blood pH (acid–base) level
- Moving nutrients into the cells
- Moving wastes out of the cells
- Maintaining proper function of the body’s muscles, heart, nerves, and brain
Electrolytes are essential for physiological processes.
What are the two types of solutes found in body fluids?
- Electrolytes
- Nonelectrolytes
Electrolytes conduct electricity when dissolved in water, while nonelectrolytes do not.
What is the main function of intracellular fluid (ICF)?
ICF is essential for cell function and metabolism.
ICF accounts for approximately 40% of body weight.
What is extracellular fluid (ECF) and its main function?
ECF carries water, electrolytes, nutrients, and oxygen to the cells and removes waste products of cellular metabolism.
ECF accounts for 20% of body weight.
What are the three main locations where extracellular fluid is found?
- Interstitial fluid
- Intravascular fluid
- Transcellular fluid
These locations include spaces between cells, blood plasma, and specialized body spaces.
What is third spacing in relation to fluid movement?
Fluid movement into an area that makes it physiologically unavailable, such as peritoneal space or blisters.
This condition can occur in various medical situations.
Define the term ‘electrolytes’.
Substances (e.g., sodium, potassium) that develop an electrical charge when dissolved in water.
Electrolytes are crucial for various bodily functions.
What is serum osmolality and its significance?
A laboratory test that measures the concentration of solutes to water, indicating the body’s fluid status.
It helps monitor hydration levels.
What is an isotonic solution?
A solution of the same osmolality as blood, where no osmosis occurs.
Isotonic fluids are often used for IV infusion to maintain blood volume.
What happens when a hypotonic solution is infused?
Water moves by osmosis from the vascular system into the cells.
This can cause cells to swell.
What is active transport?
The movement of molecules across cell membranes against a concentration gradient, requiring energy.
ATP is used for this process.
What is the average total fluid intake for adults over age 19 years?
- 2,700 mL/day for females
- 3,700 mL/day for males
Fluid intake should primarily come from drinking fluids.
What is the major regulator of fluid intake?
Thirst.
It is influenced by plasma osmolality changes.
What constitutes sensible fluid loss?
Measurable and perceived losses such as urine, diarrhea, ostomy, and gastric drainage.
Urine accounts for the greatest amount of fluid loss.
What is hypovolemia?
Negative fluid balance due to insufficient fluid intake or excessive fluid loss.
Can lead to dehydration and hypovolemic shock.
What are early symptoms of dehydration?
- Thirst
- Dry skin and mucous membranes
- Decreased urine output
- Flat neck veins
These symptoms indicate a fluid deficit.
What is the normal urine output per hour?
At least 30 to 50 mL/hour.
This indicates proper kidney function and hydration status.
What is the role of aldosterone in fluid regulation?
Stimulates the kidneys to reabsorb sodium and excrete potassium, increasing plasma volume.
Part of the renin-angiotensin system.
What is hypervolemia?
Excess fluid volume resulting from excessive salt intake or kidney/liver dysfunction.
Signs include elevated BP and edema.
What is the significance of the BUN-to-creatinine ratio?
Indicates fluid status; a ratio of 10:1 to 20:1 is considered normal.
Elevated levels may indicate dehydration.
True or False: Insensible fluid loss occurs through sweat and breathing.
True.
Insensible loss is not easily measured.
What is hypovolemic shock?
A condition resulting from significant fluid loss leading to decreased blood volume and inadequate tissue perfusion.
Treatment includes fluids, medications to raise pressure, and addressing the source of fluid loss.
What is hypervolemia?
Excess fluid volume in the body, often due to excessive salt intake, kidney or liver disease, or poor heart function.
Signs include elevated BP, bounding pulse, and edema.
What are the signs of fluid overload?
Elevated BP, bounding pulse, increased shallow respirations, cool pale skin, distended neck veins, edema, and rapid weight gain.
Severe cases may show moist crackles in lungs and dyspnea.
What is a diuretic?
Medications that help reduce fluid buildup in the body by promoting the excretion of salt and water through urine.
Common examples include furosemide and spironolactone.
Name two potassium-sparing diuretics.
- Amiloride
- Spironolactone
What is the recommended daily allowance (RDA) for sodium?
Less than 2,300 mg per day, or approximately 1 teaspoon.
Most Americans consume more sodium than needed.
What is hyponatremia?
A condition characterized by low sodium levels in the blood, often due to fluid loss or excessive intake of hypotonic solutions.
Symptoms include confusion, muscle cramps, and seizures.
What are the signs of hypernatremia?
Thirst, low-grade fever, flushed skin, dry mouth, tachycardia, and severe cases may lead to hallucinations and seizures.
What is the normal range for potassium (K+) levels?
3.5-5 mEq/L.
What can cause hypokalemia?
Diuretics, gastrointestinal fluid loss, steroid administration, and anorexia.
Symptoms include fatigue, muscle weakness, and dysrhythmias.
What is hyperkalemia?
A condition characterized by high potassium levels in the blood, often due to renal failure or potassium-sparing diuretics.
Symptoms include muscle weakness and risk of cardiac arrest.
What is the primary function of calcium in the body?
Supports mineralization of bone, muscle contraction, nerve transmission, and blood clotting.
What is hypocalcemia?
Low calcium levels in the blood, often due to hypoparathyroidism or vitamin D deficiency.
Symptoms may include muscle cramps and tetany.
What causes hypercalcemia?
Hyperparathyroidism, malignant bone disease, and excessive calcium supplementation.
Symptoms may include constipation and confusion.
What is the normal range for magnesium (Mg2+) levels?
1.3-2.1 mEq/L.
What are the symptoms of hypomagnesemia?
Disorientation, mood changes, increased DTR, and dysrhythmias.
Common causes include chronic alcoholism and gastrointestinal losses.
What is hypermagnesemia?
A condition characterized by high magnesium levels, often due to renal failure or excessive replacement.
Symptoms include hypotension and lethargy.
What is phosphorus important for?
Bone health, energy production (ATP), and maintaining normal pH in the body.
What is hypophosphatemia?
Low phosphate levels, often due to refeeding after starvation or diabetic ketoacidosis.
Symptoms may include joint stiffness and seizures.
What is hyperphosphatemia?
High phosphate levels, often due to renal failure or hyperthyroidism.
Symptoms may include tetany and calcification in soft tissue.
What does a Complete Blood Count (CBC) measure?
RBCs, WBCs, platelets, and hematocrit levels.
What does serum osmolality indicate?
The solute concentration of blood, often reflecting sodium levels.
In fluid volume deficit, serum osmolality rises.
What does urine osmolality measure?
The solute concentration of urine, which varies with fluid volume status.
What is the normal range for urine specific gravity?
1.002 to 1.030.
What is the purpose of IV therapy?
To administer fluids, electrolytes, medications, or nutrients via the venous route.
What should be monitored during IV therapy?
Fluid balance, electrolyte levels, and patient response to treatment.
What is the role of the parathyroid glands?
To secrete parathyroid hormone (PTH) for calcium regulation in the body.
What is intraosseous (IO) access?
Emergency access into bone matrix
Contraindications for IO use include obesity, fracture, recent surgery, infection, or evidence of poor circulation at the proposed insertion site.
What are the requirements for oral medication administration?
Must be able to swallow, have no nausea/vomiting
Oral administration is often considered the hardest to count.
What is IV therapy?
Administration of fluids, electrolytes, medications, or nutrients by the venous route.
What are the purposes of IV fluids?
- Expand intravascular volume
- Correct an underlying imbalance in fluids or electrolytes
- Compensate for ongoing problems affecting fluid or electrolytes until oral intake is tolerated
What is the typical procedure for venipuncture for IV insertion?
A modified sterile procedure; choose the most distal and nondominant hand if possible.
How often should continuous IV infusions be changed?
Every 96 hours if not detached or per policy.
How often should intermittent IV infusions be changed?
Every 24 hours due to increased likelihood of contamination.
What should be done with parenteral nutrition administration sets?
Change the administration set with each new solution, but at least every 24 hours.
When should blood administration sets be replaced?
After completion of each unit, but at least every 4 hours.
How often should CVAD dressings be changed?
Weekly or as needed.
What is the purpose of flushing saline/heparin locks?
To maintain venous access for emergencies and prevent clotting.
What factors affect IV flow rate?
- Height of the solution container
- Patient position
- Blood pressure
- Internal diameter of the IV catheter
- Condition of the IV catheter and tubing
What are the signs of IV complications?
- Infection with fever
- Phlebitis with a red streak
- Infiltration with swelling
- Extravasation with burning pain
- Hematoma with ecchymosis
- Air embolism can be fatal
What is a microdrip IV infusion set?
Delivers 60 drops (gtt) in the drip chamber to deliver 1 ml.
What is an isotonic IV solution?
Remains inside the vessel due to similar osmolality.
What are examples of isotonic IV solutions?
- 0.9% Sodium chloride (NS)
- Lactated Ringer (LR)
- D5W (isotonic in bag and hypotonic inside the body)
What is a hypotonic IV solution?
Pulls body water from the intravascular compartment into the interstitial fluid compartment.
What are examples of hypotonic IV solutions?
- 5% dextrose in water (D5W)
- 0.45% NS (½ normal saline)
- 0.33% NS
What is a hypertonic IV solution?
Pulls fluids and electrolytes from the intracellular and interstitial compartments into the intravascular compartment.
What are examples of hypertonic IV solutions?
- D5 0.9% NaCl (D5NS)
- D5 0.45% NaCl (D5 ½ NS)
- D5 lactated Ringer
- 3% NaCl and 5% NaCl (highly hypertonic)
What is the universal donor blood type?
O negative
What is the universal recipient blood type?
AB positive
What are the five types of transfusion reactions?
- Allergic
- Bacterial
- Febrile
- Hemolytic
- Circulatory overload
What should be done if a transfusion reaction occurs?
Stop the infusion, administer normal saline from new bag and tubing, assess vital signs.
What is the significance of crossmatching in blood transfusions?
Identifies possible minor antigens affecting compatibility of donor blood in recipient.
What is the liquid portion of the blood called?
Plasma
What are platelets used for?
To help the clotting process in clients with a shortage of platelets or abnormal function.
What does the nursing assessment for fluid and electrolytes include?
- Vital signs
- EKG for cardiac rhythms
- CBC
- Electrolytes
- Urinalysis
- Serum and urine osmolality
- Daily weights
What are common nursing diagnoses related to fluid and electrolyte imbalances?
- Dehydration
- Fluid overload
- Deficient fluid volume
- Imbalanced fluid volume
- Electrolyte imbalance
Sodium 136-145
Chloride 95-105
Potassium
3.5-5
Calcium
9-10.5
Magnesium
1.3-2.1
Phosphate
2.5-4.5
Body fluid is essential for proper functioning of the body organs. It is made up primarily of water and contains gases (e.g., carbon dioxide and oxygen) and solid substances, called solutes
Electrolytes are responsible for
Maintaining the balance of water in the body
Balancing the blood pH (acid–base) level
Moving nutrients into the cells
Moving wastes out of the cells
Maintaining proper function of the body’s muscles, heart, nerves, and brain)
Intercellular fluid is made up of
It accounts for approximately 40% of body weight and is essential for cell function and metabolism.
Extracellular fluid is made up of
It accounts for 20% of body weight and exists in three main locations in the body.
Extracellular fluid
Interstitial fluid lies in the spaces between the body cells. Excess fluid within the interstitial space is called edema.
Intravascular fluid is the plasma within the blood. Its main function is to transport blood cells.
Transcellular fluid includes specialized fluids that are contained in body spaces (e.g., cerebrospinal, pleural, peritoneal, and synovial fluid) and digestive juices.
what is third spacing?
Ascities- not within the intertitual cells. cirrhosis of the liver common sympt
Solutes
electroytes (charged) and non elect (non charged)
ICF
Potassium +
Magnesium +
Phosphate -
ECF
Sodium +
Chloride -
Bicarbonate-
Albumin (a protein) is here also in intravascular fluid. used as a blood volume expander.
Transcellular fluids like Gastric and intestinal fluids also contain some electrolytes
Less volume= more solutes in solution
Isotonic solution
no movement in cell
An isotonic solution is of the same osmolality as blood;
hypotonic solution
more water into cell
A hypotonic solution is of lower osmolality than blood. When a hypotonic solution is infused, water moves by osmosis from the vascular system into the cells.
Hypertonic solution
cell shrink
A hypertonic solution contains a higher concentration of solutes
Passive transport requires no energy.
Osmosis- the movement of water across a membrane from a less-concentrated solution to a more-concentrated solution.
diffusion- the movement of molecules of a solute through a cell membrane from an area of higher concentration to an area of lower concentration
filtration-e movement of water and smaller particles from an area of high pressure to an area of low pressure
Urine output varies according to intake and activity but should remain at least 30 mL/hour. The volume of urine increases as fluid intake increases, and it decreases
active transport requires energy
In the presence of ATP, the sodium-potassium pump actively moves sodium from the cell into the ECF and potassium from the ECF into the cell.
adh is released when we want to hold more water in the body
ADH: Antidiuretic Hormone Pressure sensors in the vascular system stimulate or inhibit the release of antidiuretic hormone (ADH) from the pituitary gland.
ADH causes the kidneys to retain fluid.
Low Fluid Volume = more ADH is released.
Increase in volume/pressure = less ADH is released, and the kidneys eliminate more fluid.
ADH is also produced in response to a rise in serum osmolality, fever, pain, stress, and some opioids.
Renin-Angiotensin System When Intravascular fluid volume is decreased, receptors in the glomeruli respond to the decreased perfusion of the kidneys by releasing renin.
Renin is an enzyme responsible for the chain of reactions that converts angiotensinogen to angiotensin II.
Angiotensin II acts on the nephrons to retain sodium and water and directs the adrenal cortex to release aldosterone.
Aldosterone When aldosterone is released via the renin-angiotensin system, it stimulates the distal tubules of the kidneys to reabsorb sodium and excrete potassium. Sodium reabsorption results in passive reabsorption of water, thereby increasing plasma volume and improving kidney perfusion. When fluid excess is present, renin is not released, and this process stops.
Thyroid hormone affects
cardiac outpit
BNP
heart failure
renin-angiotensin system.
What is the action of angiotensin ii? aldrostone released
What medication class comes to mind? ACE inhibitor
How does this medication work?
angiotension stops
What are some medication names? meds end in PHRIL
What is a common side effect? cough
Hypovolemia
- dehydration
resulting in dry skin and mucous membranes, decreased skin and tongue turgor, decreased urine output, and flat neck veins. Patients complain of muscle weakness, fatigue, and feeling warm
Temperature increases
Hypovolemia assessment
-s/s dehydration
-orthostatic hypotension
-daily weight check
-Blood urea nitrogen (BUN)–to-creatinine ratio hematocrit are elevated
-urine specfic gravity
-older adults reduced thirst
Hypovolomia nursing interventions
Monitor RR, effort and O2 sat – administer O2 if needed
Check u/a, CBc, and electrolytes
Daily wt – same time and scale
Assess bp, especially orthostatic
Heart rhythm
Monitor i&o; encourage fluid; alert provider is output is less that 30ml/hr
Implement fall precautions
Hypervolemia
Excess fluid volume can result from excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart.
s/s of hypervolemia
Signs of fluid overload—Elevated BP, bounding pulse, increased shallow respirations, cool pale skin, and distended neck veins. When excess ECF accumulates in the tissues, especially in dependent areas, edema and rapid weight gain occur.
hypervolemia nurse interventions
Preventing fluid overload
Monitor I&O
use electronic pumps to carefully regulate IV infusions to minimize the risk of fluid overload
Daily weights
Diuretics
What is a diuretic?
Diuretics are medicines that help reduce fluid buildup in the body.
furosemide
Thiazides
Sodium
neurologic and neuromuscular function, regulates the body’s fluid balance, and helps maintain blood pressure.
Hyponatermia
Fluid loss from diuretics, confusion and orthostatic hypotension, weak therady pulse
Hypernatremia
Excessive na+ intake,
Thirst, low-grade fever, flushed, edema, dry mouth and membranes, severe: , red dry tongue
hypochloremia
Same as hyponatremia except may see fever
hyperchlormia
Same as hypernatremia
Potassium
electrical impulses of the body’s nerves and muscles. and the HEART
kidneys secrete
hypokalemia
cause- diuretics
decreased DTR, decreased gi motility, constipation, dysrhythmias – ST depression/prominent U wave
never a bolus
hyperkalemia
Renal failure, potassium sparing diuretics, high potassium intake coupled with renal insufficiency, acidosis, trauma
Muscle weakness, increased DTR, dysrhythmias, diarrhea, hyperactive bowels, low BP & HR, severe: cardiac arrest, v fib
calcium mineral
BONE, muscle contraction, blood and beats
- parathyroid
hypocalcemia
hypoparathyroidism
Diarrhea, numbness and tingling of mouth and extremities, muscle cramps, tetany, convulsions, cardiac irritability, + trousseau and Chvostek signs, weak bones, weak pulse, risk for bleeding, V tach if severe
hypercalcemia
Hyperparathyroidism, Malignant bone disease, Prolonged immobilization, Excess calcium supplementation, Thiazide diuretics, pagets disease
Constipation, bone pain, kidney stones, muscle weakness, confusion, risk for clotting, n/v
Monitor i&o, restrict ca, increase fluids, monitor for fractures, encourage fiber
Magnesium
nerve and muscle fuction
hypomag
Chronic alcoholism, gi losses, diuretics, malabsorption
Disorientation, mood changes, increased DTR, dysrhythmia – torsades de pointes, nystagmus, neuromuscular irritability
Monitor i&O and digoxin, encourage greens, grains, and nuts
hypermag
Renal failure, Adrenal insufficiency, Excess replacement
Hypotension, Drowsiness, lethargy, *Hypoactive reflexes, *Depressed respirations, Bradycardia, cardiac arrest
Monitor vs, airway, loc, and reflexes, ca gluconate for severe cardiac changes, avoid magnesium-based laxatives and antacids
Phosphorous
bones, teeth, nevrve, muscles
Hypophosphatemia
Refeeding after starvation, Alcohol withdrawal, Diabetic ketoacidosis, Respiratory acidosis
Joint stiffness, decreased DTR, Seizures, Cardiomyopathy, Impaired tissue oxygenation, weakness
Monitor phosphate and calcium levels
hyperphosphatemia
Renal failure, Hyperthyroidism, Chemotherapy, Excess use of phosphate-based laxative
Short term: tetany symptoms—tingling of extremities and cramping; Long term: Calcification in soft tissue
Monitor phosphate, calcium, and for tetany
CBC
hematocit
serum electrolytes
serum osmolatity
In fluid volume deficit, serum osmolality rises.
In fluid volume excess, serum osmolality decreases.
potassium affects what muscle?
heart
Sodium watch for?
altered mental status
urine labs
Urine osmolality measures the solute concentration of urine
This test may require a 24-hour urine specimen
Urinalysis The routine screening urinalysis includes a measure of urine pH and specific gravity.
Specific gravity rises and falls in opposition to fluid status.
A normal range is 1.002 to 1.030.
A low specific gravity occurs when fluid is plentiful.
A high specific gravity occurs when fluid levels decrease and urine becomes more concentrated.
When this is high lab are
low
when this is low labs are
high
replacement
IV
subq
oral
Intraosseous – emergency
IV
pump at level of the heart
Drip factor med math
iv solutions
upload slide 59
Blood infusions
Patients must receive only blood that is compatible with their own blood group to prevent a hemolytic reaction
