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Health And Illness 2 > Fluid and Electrolyte > Flashcards

Fluid and Electrolyte Flashcards

1
Q

Intracellular Fluid ( Hypotonic )

A

2/3 of body fluid

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2
Q

Extracellular

A

1/3 of body fluid
Interstital
Intravascular
Transcellular

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3
Q

Fluid Intake

A

2,5000 mL a day

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4
Q

Fluid Output

A

1,4000-1,5000 mL

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5
Q
  1. Filtration
A

Is the movement of fluid through a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of membrane.
Ex: Blood Pressure
Higher —> lower

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6
Q
  1. Diffusion
A

Movement of solution from an area of high concentration to low concentration.
- Smaller substances diffuse more easily!
Molecules intermerge

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7
Q

Facilitated Diffusion / Active transport

A

The transport of substances across a biological membrane from an area of higher to lower concentration WITH the help of a transport molecule.
- Regulates what goes in/out of cell.
Ex: Sodium / P pump

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8
Q
  1. Osmosis
A

Movement of water across the cellular membrane from an area of lower concentration to higher.
- Helps regulate fluid balance.

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9
Q

Hypovolemia

A

Isotonic Loss
Risk Factors: GI loss, skin loss, burns, high intake of salt, hyperventilation, low water intake.
Cardio: Increased heart rate, low BP
Respiratory: Increased rate
Skin: Poor skin turgor
Neuro: Cognition changes
Kidney: Concentrated urine, strong odor, < 500 mL = Concerning!
Labs: Multiple labs + S/S

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10
Q

Third Spacing

A

From vascular space to other areas
Trapped fluid= volume loss
Causes: Burns, trauma, surgery, sepsis

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11
Q

Diagnostics Fluid Deficit

A

HcT increased
BUN increased
Elevated Urine Specific Gravity
Na+ elevated
Increased blood osmolarity

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12
Q

Interventions for Dehydration

A

-Oral Fluids if awake
-Pedialyte
- IV Fluids: 0.9% NS
- Monitor I&O
-DAILY WEIGHTS!!!!
- Meds: antiemetics, antipyretics, desmopressin ( diabetes insipidus )

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13
Q

Hypovolemic Shock

A

Cells no longer carry oxygen to the blood
- Administer Oxygen
- Monitor VS
- Fluid Replacements
- Vasoconstrictors

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14
Q

Hypervolemia

A

Causes: Heart failure, kidney failure, overdose of fluids, corticocosterioids
Cardio: Increased pulse, high bp, distended neck veins
Resp: Increased rate, crackles
Skin: Edema
Neuro: HA, weakness
GI: Increased motility, enlarged liver
*** increased CVP

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15
Q

Hypervolemia Diagnostics

A

Decreased HCT
Decreased blood osmolarity
Decreased urine specific gravity
Decreased BUN

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16
Q

Fixing Fluid Overload?

A

-Drug therapy: Removing Excess fluid; * Diuretics such as furosemide ( loop )
-Nutrition: Fluid restriction possible for chronic cases.
-Monitoring: I&O and daily weights!

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17
Q

What response does the nurse expect as a result of infusing 500 mL of a 3% NS solution over a 1 hr time period?

A

Plasma volume osmolarity increases; blood pressure increases
- Solutes going into blood = High BP

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18
Q

Which clinical indicators are most relevant for the nurse to monitor during IV fluid replacement for a client with dehydration?

A

BP
Pulse Rate
Urine output

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19
Q

Cations

A

NA-
K+
Mg+
CA+

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20
Q

Anions

A

Phosphate
Cl-

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21
Q

Sodium

A

Most abundant in ECF

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22
Q

Hyponatremia

A

Is when the serum sodium level is below 136 mEq/L
Sodium most abundant in electro in ECF
No Na+”
NA+ excretion increased with renal problems: Loss of sodium and water!
- NG suction, vomitting, over use of diuretics, sweating, diarrhea
Overload of fluid with CHF
- Water follows sodium
- Sodium decreasing because of dilution: renal failure, hypotonic fluid infusions

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23
Q

Hyponatremia manifestations

A

***Neuro: HA, Increased intracranial pressure, seizures, coma can occur
Musc: Muscle Weakness, DTR diminish
Intestinal: Increased motility causing N/V, diarrhea, hyperactive BS
Cardio: Rapid, weak, thready pulse, decreased BP

24
Q

Hyponatremia Interventions

A

Always bring up Na+ SLOWLY! Never exceed 12 meQ in 24 hr time period
- Drug Therapy: Reduce diuretics bc of sodium loss, IV Saline, promote excretion of water rather than sodium when caused by fluid excess.
- Increase oral sodium

25
Q

Hypernatremia Risk factors

A

Kidney failure, cushings, cortico, excessive oral sodium intake, fevers, sweating
-Above 145

26
Q

Hypernatremia Manifestations`

A

Neuro: AMS, short attention span, agitated, confused
- *** hypernatremia and fluid overload can cause lethargy, stupor, coma
Skeletal Muscle: Muscle twitching, weak, deep tendon reflexes are absent, occurs bilaterally, no pattern
Cardio: Increased pulse rate, hypotension = hypernatremia and hypovolemia
Decreased pulse rate, distended neck veins, increased BP = hypernatremia and hypovolemia

27
Q

Hypernatremia Interventions

A

Drug: Need diuretics that promote sodium loss
( furosemide, bumetanide )
Nutriton: Ensure adequate fluid intake
- Dietary sodium restriction
ALWAYS CONTINUE TO ASSESS THE PATIENT FOR INDICATIONS OF EXCESSIVE LOSSES OF FLUID, SODIUM, POTASSIUM

28
Q

Potassium

A

Normal Range: 3.5-5.0
- Commonly altered by changes in K+ intake
- Essential in NA/K pump
-Foods high: Meat, fish, fruits, veggies
-Foods low in: Eggs,bread, grains
- Facilitates glycogen storage in lover and skeletal muscle cells
- Main ion in ICF 98%

29
Q

Hypokalemia

A

Serum potassium level below 3.5
- Low K+ levels reduce exitability of cells, causing excitable tissues to respond to less stimuli
Excessive Fluid Loss: Vomiting, Diarrhea, NG suction
Diuretic Drugs
Kidney Disease
Cushings
Wound Drainage
Diuresis
Heart Failure
Rapid infusion of insulin… because drug increases the activity of Sodiumm- Potassium pump forcing more blood potassium levels are linked to magnesium
Stress reaction

30
Q

S/S of Hypokalemia

A

Muscle: skeletal muscle weakness, DTR reflexes reduced = flaccid paralysis
*** Cardio: Thready, weak pulse. Orthostatic Hypotension.
- Perform an ECG. Can include ST- segment depression, flat T wave, increased U waves. Dysrhymias can lead to death.
Neuro: AMS, irrability, anxiety
Ints: N/V, constipation, abdominal distension
- Shallow respirations

31
Q

How to fix Hypokalemia?

A
  1. Preventing K+ loss
    - Potassium Sparing Diuretic
    - Sprinlactone
  2. Increasing K+ Levels
    - Potassium Supplements: Potassium chloride, glucanate, citrate given oral or IV.
  3. Resp Monitoring: Nail bed pallor or cyanosis.
32
Q

Potassium Chloride Dosages

A

A concentration of ***10 meQ KCL/100 mL can be administered through a peripheral vein; You can run 20 mEq/100 mL though a central venous catheter or PICC.

33
Q

Hyperkalemia

A

Level higher than 5.0 mEq / L
- Increase exitability of cells, causing excitable tissues to respond to less intense stimuli.
- Can lead to V-Fib
- Sudden potassium rises cause severe problems at serum levels betweem 6-7. When serum potassium rises slowly, problems may not occur until K+ levels reach 8+.

34
Q

Examples of Hyperkalemia can occur..

A
  • Over ingestion of potassium containing foods / meds.
  • Rapid infusions
  • Burns, MI ***
  • Kidney failure
    -Potassium sparing diuretics
  • ACE’S 1 **
    -Acidosis **
  • Diabetes ( uncontrolled )
35
Q

Hyperkalemia Manifestations

A

***CV: Brady, hypotension, ECG changes of tail peaked T waves, aystole and V Fib
Neuro: Twitching, tingling, burning, numbness, muscle weakness and flaccid paralysis
Intest: Increased motility with diarrhea

36
Q

Hyperkalemia 3 Solutions

A
  1. First Intervention: Insulin ( IVP 10-15 Units of regular insulin along with 50 mL of 50% dextrose to prevent hypoglycemia ) will lead to shift of potassium ions into the cell secondary to increased activity of the sodium - potassium pumps. Can be repeated.
  2. Biocarbonate ( e.g. 1 ampule ( 50 meQ ) infused over 5 mins ) is effective in shifting potassium into the cell. The biocarbonate ion will stimulate an exchange of cellular H+ ( moves it out cell ) for Na+ leading to stimulation of pumps.
  3. Albuterol ( beta 2 agonist; inhaled as neb ) : This drug lowers blood levels of K+ by promoting its movement into cells.
37
Q

If client has ECG changes ( tall, peaked T waves )….

A

Calcium gluconate should be given before insulin / dextrose
- Stabilize cardiac muscle

38
Q

Hyperkalemia Perm Fixes

A
  1. Loop Diuretics ( Furosemide ) - gets the client to urinate and potassium leaves the body completely again need a patient who makes urine.
  2. Sodium Polystyrene Sulfonate - Given PO or as enema. Potassium is exchanged for sodium in intestines and excreted in stool. Causes frequent stooling; dont give to someone with impaired bowel function —> intestinal necrosis
    - Monitor s/s of fluid overload: crackles, edema, HTN, JVD distention, assess abdomen, monitor K+ lab
  3. Dialysis usually hemodyalysis: If this is AKI patient might just have a few runs of hemo –> until kidney function improves.
39
Q

Calcium

A

9.0-10.5
- Must be kept in narrow range ECF
-Absorbed through intestinal tract.
-Requires active form of VIT D

40
Q

Hypocalcemia how it can occur…

A
  • Common in renal failure
    • Hypothyroidism
      -Hypomagnsemia
  • Vit D deficiency
    -Pancreatis
    -Alkalosis
    • Malabsorption syndrome
      -Diarrhea
      -Would drainage
41
Q

Hypocalcemia Manifestations

A

NeuroM: Parathesia occurs first, with sensations of tingling and numbness. Frequent painful muscle spasms- thigh, foot, calf during sleep.
- Charli Horse
- Trousseau’s
- Chvstek’s
CV: HR could be slower or faster, weak, thready pulse. Severe hypotesnion. Prologned QT
Intest: Hyperactive BS
Skelt: osteoporosis, curv of spine

42
Q

Hypocalcemia How to fix it?

A

Drug Therapy: Oral or IV calcium & Vit D to enhance absorption. Treating hypothy with Vit D
- *Phosphate: binding agents may be required to reduce serum phosphurus in patients w chronic renal failure.
- Take w meals ^
Nutrtion: Increase calcium rich foods

43
Q

Hypercalcemia

A

Serum level above 10.5 mg/dl or 2.62 mmol/l
- Causes exitable tissues to be less sensitive to normal stimuli thus requiring stonger stimulus to function.
- Most affects heart, skeletal muscles, nerves, intestinal smooth muscles.

44
Q

Causes of Hypercalcemia

A
  • Excessive intake of calcium
    -Excessive oral intake of vit D
  • Kidney Failure
  • Thiazide diuretics ***
    -Hyperthyroidism
  • Gluccocorticosteroids
45
Q

Hypercalcemia S/S

A

Cardio: Most serious:
- 1. Causes increased heart rate and BP.
2. Severe depresses electrical conduction slowing heart rate.
- Short QT interval
- Monitor for blood clots
NeuroM: Muscle weakness, decreased deep tendon reflexes with paraesthesia. Confused, lethargic.
Intestinal: Constipation, abdominal pain

46
Q

Hypercalcemia Treatment

A
  1. Fluid Volume Replacement: 0.9% NACL
  2. Drug Therapy:
    - ** Thiazide diuretics are discontinued and replaced with diuretics that enhance discretion of calcium, such as furosemide. Calcium chelators help lower calcium levels.
    -Drugs to prevent hypercalcemia include agents that inhibit calcium resorption ( movement out ) from bone such as ****phosphurs    , calcitonin, bisphosphonates, and prostaglandin synthesis inhibitors ( NSAIDS, aspirin )
  3. Dialysis if severe
47
Q

Magnesium is essential for

A

Skeletal Muscle Contraction
Carbo Metabolism
Generation of energy stores
Vit Activation
Blood Coag
Cell growth

48
Q

Hypomagnesemia Risk Factors

A

*Malnutrition
Diarrhea
Celiac Disease
Crohns Disease
Drugs ( diuretics )
*Ethanol Ingestion ( alcohol abuse )

49
Q

Hypomagnesemia Manifestations

A

Cardio: Can increase risk of hypertension, athersclerosis, hypertrophic left ventricle, dysrhymias
Neuro: Caused by increase nerve impulse transmission
- Hyperactive deep tendon reflexes, numbness, tingling, painful muscle contractions
- Positive Chvostek, Trosseau signs
Intestinal: Decreased peristalis, constipation, N/V, paralytic illeus

50
Q

Hypomagnesemia How to fix it?

A

Hypomagnesemia and Hypocalcemia go hand in hand!
- Disc drugs that promote Mag loss…
- Loop diuretics, osmotic diuretics, aminoglycoside antibiotics, phosphurus
Mag is replaced with magnesium sulfate *
- IV replacement

51
Q

Hypermagnesemia

A

Serum level above 2.6 meQ
- Increased intake of antiacids, too much IV, decreased kidney excretion = kidney disease

52
Q

Hypermagnesemia Manifestions

A

**Cardio: Brady, cardiac arrest, peripheral vasodilation, hypotension, ECG changes
- Grave danger for cardiac arrest
CNS: Depressed nerve impulse, drowsiness, coma
NeuroM: Absent tendon relfexes, muscle contractions
Resp: Weak, shallow respirations

53
Q

How do we fix Hypermagnesemia?

A

Discontinue drugs that increase Mag levels:
- All oral/ parenteral mag
- Administer mag free IV
- Loop diuretics can further reduce serum levels
- ***When cardiac problems are severe giving calcium may reverse the cardiac effects of hypermagensemia

54
Q

With which client does the nurse remain alert for and. assess most frequently for s/s of hypokalemia?

A

22 yr old receiving an IV infusion of reg insulin to manage ep of ketoacidosis

55
Q

Potassium level went from 4.6-6.1 which assessment first?

A

Pulse rate and rhythm

56
Q

Which condition in the client with a serum sodium level at 149 indicates to the nurse that this electrolyte imbalance is caused by dehydration/

A

Hematocrit is 52%; HC is higher is definite sign

57
Q

Which electrolytes are most affected by low mag levels

A

Calcium, Potassium

Health And Illness 2 (4 decks)

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