Fluid and Electrolyte Flashcards
How much of us is fluid?
at least 50% at any point in our life newborn 80 childhood 65 adults 55 older adult 50
What is osmolality?
particles in a given WEIGHT of fluid
what is osmolarity?
particles in a given VOLUME of fluid
a serum ______ is a method of determining if someone is over/de hydrated
a serum osmolarity is a method of determining if someone is over/de hydrated
normal serum osmolarity range
280-300 mOsm/L
too high a serum osmolarity indicates
dehydration (too many solutes)
too low a serum osmolarity indicates
fluid overload (less solutes)
where is majority of fluid?
intracellular
-2/3
Intracellular fluid contains
potassium, phosphate, sulfate
fluid volume outside of the cell
1/3 extracellular
extracellular fluid contains
sodium, chloride, bicarbonate
what is the fluid called that is inside the blood vessels?
intravascular
what is the fluid called in between the cells?
interstitial
what 3 components determine the fluid balance in extracellular compartments?
- protein (keeps fluid in vascular space)
- Bld vessel integrity (keeps fluid in vascular space)
- hydrostatic pressure (push fluid into interstitial space)
what is osmotic pressure?
pressure exerted to prevent movement of water out of the intravascular space
pressure exerted to keep h20 in blood vessels
what is colloid oncotic pressure?
proteins attract water and hold onto water
- more stuff in water = keep it in BV and not leek
- type of osmotic pressure**
what is hydrostatic pressure?
pressure of blood against the vessel wall
-causes filtration of a fluid from an area of high pressure to low pressure
what effects hydrostatic blood pressure?
arterial BP, Venous pressure, rate of blood flow
What is filtration pressure?
- process that transfers nutrients and oxygen into cells
- hydrostatic pressure minus osmotic pressure
- causes fluid to move into tissues @ arterial end
- causes fluid to move into vessel @ venous end
How does tonicity effect movement of fluid?
disrupts filtration pressure
3 kinds of tonicity
isotonic, hypotonic, hypertonic
What is an isotonic solution?
- equal osmotic pressure in extracellular and intracellular
- equal concentration of water and electrolytes
what is a hypotonic solution in relation to cells?
-concentration of electrolytes outside cell is lower
-concentration of water outside cell is higher
(more water with less stuff outside the cell)
what is hypertonic solution in relation to cells?
-concentration of electrolytes outside cell is higher
-concentration of water outside cell is lower
(less water with more stuff outside the cell)
Stop, draw a picture of isotonic, hypotonic, hypertonic
yay! you did it
Cell is 0.9% NaCl inside
A .45% NaCl is administered (so fluid outside cell is 0.45%)
What direction will the fluid go?
- water will flow into cell!
- b/c….higher concentration of a solute, the lower the concentration of water
- water flows high to low
hypotonic is _____% NaCl
0.45%
Isotonic solution is _____% NaCl
0.9%
which fluid type is used with blood product administration?
Isotonic
Examples of hypertonic solutions
3% NaCl
Dextrose 5% in 0.45% NaCl
Dextrose 5% in 0.9% NaCl
what kind of fluid do you use for hypernatremia and DKA
hypotonic 0.45%
What is a crystalloid fluid?
- aqueous solution with electrolyes
- can be hypo/hyper/iso tonic
what is a colloid fluid? what does it do to pressure?
contains large molecules (ex: albumin) that do not transport outside of the intravascular space
fxn: increase osmotic pressure
- ->pulls cellular volume into blood vessels
3 fluid types
- crystalloid
- colloid
- blood products
Nursing consideration with colloids-
too much colloid can cause?
must be administered carefully or can cause signs of fluid volume excess
What are packed red blood cells used for? when use (specific hgb volume) ?
- used for blood loss
- 1 unit increased hgb by 1g/dL
- use if hgb <7 or 8 g/dL
When are platelets used?
given when reduced level of platelets
when is fresh frozen plasma used (FFP)?
trauma, burns, shock, bleeding, clotting disorders
when is Crypoprecipitate used?
-used for clients with hereditary disorders that lead to inadequate clotting
What do you match to determine right type of blood donor for patient?
blood type
Rh factor
What is the difference b/w type/screen and crossmatch?
type/screen = what patient is crossmatch = blood match patient
Universal donor?
O negative
Universal recipient?
AB positive
What do you need before administering blood products?
CONSENT
Signs and symptoms of a transfusion reaction?
- fever,chills
- altered BP
- Resp difficulty
- allergic reaction
Definition of dehydration
loss of body water but electrolytes remain consistent
definition of fluid volume deficit
- loss of both body fluid and electrolytes
- can also include loss of circulating blood volume and perfusion to tissues
- hypovolemia
definition of fluid volume excess
too much fluid
too much or same electrolyte
What can cause edema- fluid volume excess or deficiency?
can relate to both deficit and excess of fluid
causes of dehydration
- inadequate water intake
- vomiting/diarrhea
- fever
- meds that increase thirst like SSRI, benzo
- DKA* use ketones- cells deficient in fluid, polyphagia and polyuria
labs that correlate with dehydration
- increase: serum osmolarity, creatinine, BUN, urine specific gravity
- hypernatremia
fluid volume deficit signs and sxs
- hypotension
- tachycardia
- orthostatic hypotension
- decreased urine output
- flat neck veins
- weak pulse
- third spacing
what is third spacing?
- occurs in fluid volume deficit
- too much fluid in interstitial space and not enough in intravascular space
fluid volume deficit treatments
- replacement of fluids
- safety education (fall risk)
- third spacing treatment
how do you treat third spacing? What is lacking in third spacing? (what tonicity is needed?)
- third space is lacking protein
- give Albumin IV
- hypertonic crystalloids
What causes a reduced colloid oncotic pressure?
reduced levels of albumin
what keeps fluid in intravascular space?
albumin
what happens to fluid when there is a reduced colloid oncotic pressure?
- fluid goes into intravascular space and into interstitial space
- -> edema!
causes of decreased colloid oncotic pressure?
malnutrition, liver failure, nephrosis
what causes increased hydrostatic pressure?
increase BP, fluid overload, decreased cardiac output (heart failure)
what causes increased capillary permeability?
- allergies
- septic shock –> endotoxins
- pulmonary edema
how can someone have a fluid volume deficit if they have too much fluid somewhere?
fluid in interstitial space but dehydrated @ cellular level
- sometimes treatment is just about moving fluid from one space to the other b/c patient has enough fluid
- why tonicity matters!
causes of fluid volume excess in intravascular space
- congestive heart failure
- renal failure
- cirrhosis
- excess IV fluid
- medication causing sodium and water retention (steroids/anti-diuretics)
(heart, liver, kidneys, IV fluids, meds)
signs and symptoms of fluid volume excess
- weight gain more than 0.5 kg/day
- hypertension
- bounding pulse
- distended neck veins
- dyspnea
- crackles
- orthopnea
fluid volume excess treatment? meds? restrictions?
- diuretics (furosemide, spirolactone, bumetanide, hydrochlorothiazide)
- restrictions: fluid
potassium sparing diuretic?
spironolactone
functions of electrolytes
- maintain balance of water in body
- balancing blood pH
- move nutrient in, waste out
- fxn of muscles, hearts, nerves, brain
Potassium range
3.5-5 mEq/L
sodium range
135-145 mEq/L
calcium ranges
serum: 8.9-10.5 mg/dL
ionized: 4.5-5.6 mg/dL
Magnesium ranges
- 8-2.3 mg/dL
1. 3-2.1 mEq/L
which electrolyte is a reflection of bodies water balance, support neuro fxn, and BP regulation?
sodium
what electrolyte controls neuro function and cardiac activity?
magnesium
what electrolyte functions for synaptic transmission, wound healing, teeth/bone structure?
calcium
what electrolyte fxns in cardiac, neural, muscular and is controlled by insulin and aldosterone?
potassium
causes of hypokalemia
-diuretics, metabolic acidosis, folic acid deficiency, GI losses, decreased potassium intake
hypokalemia signs/sxs
mild: cardiac arrythmias, constipation, fatigue
severe: resp. paralysis, paralytic ileus, hypotension, rhabdo
hypokalemia treatment
- priority is determining underlying cause
- supplements
- dietary changes
- IV only
- switch to potassium sparing diuretics
when do you push Potassium?
never! only infuse slowly
safe potassium concentration IV and side effects
10mEq-100 ml
-patient report burning
hyperkalemia causes
- acute renal failure
- dehydration
- diabetes
- burns
- acidosis
- blood transfusion
hyperkalemia signs and sxs
mild: nausea, vomit, muscle aches, weakness, dysrhythmias
severe: paralysis, heart failure, death
hyperkalemia treatment
- hemodialysis if renal failure is cause
- loop diuretics if no renal failure
- calcium gluconate
- sodium polystrene sulfonate
- IV insulin
how does calcium gluconate/chloride treat hyperkalemia?
-reduce effects of hyperkalemia on the heart
how does sodium polysytrene sulfonate treat hyperkalemia?
binds to potassium and excrete it in feces
How does IV insulin treat hyperkalemia?
- insulin helps to push potassium into cell
- must have glucose monitored to prevent hypoglycemia
Hyponatremia causes?
- severe V/D
- excess H2O
- excess Alc
- thiazide diuretics
- liver/heart diease
hyponatremia signs and sxs
mild: nausea, feeling unwell
severe: cerebral edema, lethargy, confusion, irritability, seizure, coma
hyponatremia treatment
- increase Na levels slowly
- if cause is too much water: fluid restriction
- if cause thiazide diuretics: give isotonic or hypertonic fluids slowly infused
- alter treatment for heart and liver failure
why give Na slowly?
prevent rapid fluid shifts in neurological cells
Hypernatremia causes
dehydration (v/d, CKD, diabetes, impaired thirst repsonse)
high Na intake
signs and symptoms of hypernatremia
neuro, vomiting
hypernatremia treatment
- hypotonic fluids
- diet education
what can cause cerebral edema with hypernatremia treatment?
if Na is lowered to quickly
–> why water is not used for hypernatremia treatment
causes of hypocalcemia
- inadequate vitamin d
- decreased estrogen
- hypoparathyroidism
- renal disease
- low albumin
- stimulant laxatives
- chronic steroid use (decrease intestinal Ca absorption)
- proton pump inhibitors (decrease intestinal Ca absorption)
signs and symptoms of hypocalcemia
- chvostek and trousseau sign
- chest pain
- dysrhythmia
- renal calculi
- numbness/tingling
- muscle cramping
- confusion
- osteopenia
- dental problems
(heart, bones, muscles, neuro)
chvostek sign- what is it and what does it indicate
to a twitch of the facial muscles that occurs when gently tapping an individual’s cheek, in front of the ear.
-hypocalcemia
trousseau sign - what is it and what does it indicate?
Trousseau’s sign is considered positive when a carpopedal spasm of the hand and wrist occurs after an individual wears a blood pressure cuff inflated over their systolic blood pressure for 2 to 3 minutes
-hypocalcemia
what is serum calcium?
-accounts for ALL calcium whether it is free ionized or bound to proteins
what is ionized calcium?
detected active or unbound form of calcium in body
which is more accurate- serum or ionized calcium?
ionized
when do serum calcium?
shows up on lab with other electrolyte values and it done upon initial assessment
when do ionized calcium?
if signs/sxs / abnormal serum suggest calcium issue
hypocalcemia treatment
calcium/vit d supplements
diet
Ca injections
hypercalcemia causes (3)
- cancer
- hyperparathyroidism
- Vit D toxicity
what over the counter medication for heartburn contains calcium carbonate?
Tums
Ca has an inverse relationship with
phosphorous
signs and sxs of hypercalcemia
mild: constipation, abd pain, n/v
severe: confusion, renal failure, arrhythmias, coma, death
hypercalcemia treatment
- administer phosphate
- loop diuretics
- IV saline bolus
- hemodialysis if severe
hypomagnesemia causes
- chron’s/celiac
- diarrhea/pancreatitis
- Type 2 diabetes
- hypocalcemia or hypokalemia
- decreased intake
- increased renal excretion
s/s hypomagnesemia
mild: decreased appetite, fatigue, nausea, weakness
severe: muscle cramping, numbness, tingling, seizure, tetany, personality change*
hypomagnesemia treatment
- oral/iv Mg
- diet education
- treat Ca/K imbalance first*
hypermagnesemia causes
kidney disease
- acidosis
- hypothyroidism
- trauma
- meds that slow digestion (opioids/anticholinergics)
- laxatives/ antacids that contain Mg
s/s hypermagnesemia
mild: dizziness, nausea, weakness, confusion
severe: confusion, blurred vision, headache, bladder paralysis, bradycardia, decrease RR, loss of deep tendon reflex, death
hypermagnesemia treatment
- calcium chloride/gluconate
- IV saline with diuretics
- hemodialysis
Foods high in electrolytes
look over the chart…too lazy to type all those in
hydrostatic pressure- push or pull?
PUSH
Colloid oncotic pressure - push or pull?
PULL
if hydrostatic > oncotic pressure =
fluid move out of capillaries
if oncotic pressure > hydrostatic pressure =
move into capillaries
if hyponatremia cause is too much water:
fluid restriction
if hyponatremia cause is thiazide diuretics:
give isotonic or hypertonic fluids slowly infused
2 electrolyte imbalances you can treat with loop diuretics?
hyperkalemia
hypercalcemia
dehydration leads to which 2 electrolyte imbalances?
hypernatremia
hyperkalemia
diabetes is the cause of which electrolyte imbalances?
hypomagnesemia
hyperkalemia
hypernatremia
calcium gluconate treats which electrolyte imbalance?
hyperkalemia
hypermagnesemia
which electrolyte imbalances result in dys/a rhythmias?
hypercalcemia
hypocalcemia
hyperkalemia
renal disease results in which electrolyte imbalances
hyperkalemia
hypermagnesemia
hypomagnesemia (increased renal excretion)
hypocalcemia
which electrolyte imbalances are characterized by muscle cramping/pain?
hypocalcemia
hypomagnesemia
hyperkalemia
which electrolyte imbalance can result in a paralytic ileus?
hypokalemia
low albumin will cause
- decrease colloid oncotic pressure (third spacing)
- hypocalcemia
vomiting and diarrhea can cause hyper or hyponatremia?
both!
hyper- dehydration
hypo-Na follows stomach acid
calcium gluconate/chloride, what is it good for?
hyperkalemia and hypermagnesemia
fluids for hyponatremia if thiazide diuretics is cause?
fluids for hypernatremia?
fluids for hypernatremia if from shock/lowbp?
hypo/thiazide –> hyper/isotonic
hypernatremia –> hypotonic
hypernatremia shock/low bp–> isotonic
