FLUID AND ELECTROLYTE Flashcards
1
Q
Approx. ____ of body weight consists of fluid
A
60%
2
Q
FACTORS - body fluids
A
AGE
GENDER
BODY FAT
3
Q
Fluid Compartments:
A
Extracellular Fluid
Intracellular Fluid
4
Q
Under Extracellular Fluid
A
Intravascular
Interstitial Fluid
Transcellular Space
5
Q
ECF total body fluid
A
1/3
6
Q
ICF total body fluid
A
2/3
7
Q
Fluid that surrounds the cell
Contains 11 L to 12 L in adults
Lymph fluid
A
Interstitial Fluid
8
Q
Smallest division of ECF
Contains approx. 1 L
A
Transcellular space
9
Q
Plasma, effective circulating volume
3L of the 6L of blood volume in adults made up the plasma
Found within the blood vessel
A
Intravascular
10
Q
MAJOR CATIONS (body fluid):
A
Sodium (Na+), Potassium (K+) ✓ Calcium (Ca+), Magnesium
(Mg+) ✓ Hydrogen ions (H+)
11
Q
Loss of ECF into a space that does not contribute to the equilibrium between the ICF and ECF is referred to as
A
third-space fluid shift or third spacing.
12
Q
MAJOR ANIONS
A
✓ Chloride (CI-), Bicarbonate (HCO3-)
✓ Phosphate (PO4-), Sulfate
(SO4-)
✓ Proteinate ions
13
Q
- dominates the ECF. It is important in regulating the volume fluid of the body.
A
Sodium ions
14
Q
-dominates the ICF.
A
Potassium
15
Q
-the diffusion of water caused by a fluid concentration gradient.
A
Osmosis
16
Q
- is the ability of all solutes to cause an osmotic force that promotes water movement from one compartment to another.
A
Tonicity
17
Q
- the pressure exerted by the fluid on the walls of the blood vessel.
A
Hydrostatic pressure
18
Q
- is the amount of hydrostatic pressure needed to step the flow of water by osmosis.
A
Osmotic pressure
19
Q
- is the osmotic pressure exerted by proteins.
A
Oncotic pressure
20
Q
- is the increase in urine output caused by excretion of substances such as glucose, mannitol, or contrast agents in the urine
A
Osmotic diuresis
21
Q
- to move from an area of higher concentration to one of lower concentration
A
DIFFUSION
22
Q
-movement of water and solutes occurs from an area of high hydrostatic pressure to an area of low hydrostatic pressure
A
FILTRATION
23
Q
cell membrane, actively moves the sodium from I the cell into the ECF
A
Na-K pump (sodium potassium pump)
24
Q
- implies that energy must be expended for the movement to occur against a concentration gradient
A
Active transport
25
Systemic routes of gains and losses
KIDNEYS
SKIN
LUNGS
GI
26
KIDNEYS-daily urine output in the adult is
1L to 2L approx.
27
sensible perspiration refers to visible water and electrolyte loss through skin
sweating
28
Fluid losses from the skin and lungs are referred to as _____ because they can't be measured or seen.
insensible losses
29
Fluid losses from urination, defecation, wounds, and other means are referred to as ___ because they can be measured.
sensible losses
30
NORMAL VALUE
k
mg
na
ca
Inorganic phosphorus
phosphate
chloride
HCO3
3.5-5 mEq/L (ABG)
1.5-2 mEq/L
135-145 mEq/L
8.5-10.5 mEq/L
1-1.5 mmol/L (acid base value)
0.8-1.5 mmol/L
95-106 mmol/L
18.22 mmol/L
22-28 mEq/L
31
Osmolality measures in
Osmolarity
milliosmoles per kg of water
milliosmoles per liter
32
occurs when the loss of ECF volume exceeds the intake of fluid.
It occurs when water and electrolytes are lost in the same proportion as they exist in normal body fluids;
hypovolemia
33
results from loss of body fluids and occurs more rapidly when coupled with decreased fluid intake.
can also develop with a prolonged period of inadequate intake.
FVD (FLUID VOLUME DISTURBANCE)
34
first line choice for hypotensive patient with FVD
Isotonic solution
35
Fluid volume excess
An isotonic expansion of the ECF caused by an abnormal retention of water and sodium
HYPERVOLEMIA
36
Most abundant electrolyte in the ECF.
Primarily determinant of ECF volume and osmolality
Major role in controlling water distribution throughout the body
sodium
37
Serum sodium level that is less than 135 mEq/L (135 mmol/L)
Hyponatremia
38
- Na+ loss is greater than water loss.
HYPOVOLEMIC HYPONATREMIA
39
- total body water is moderately increased and Na+ levels are normal.
EUVOLEMIC HYPONATREMIA
40
there is greater increase in total body water than in total body Na+.
HYPERVOLEMIC HYPONATREMIA
41
no change in total body water or Na+ but instead a shifting between ICF and ECF.
REDISTRIBUTE HYPOVOLEMIA
42
Serum sodium level higher than 145 mEq/L (145 mmol/L)
It can be caused by a gain of sodium in
excess of water or by a loss of water in excess of sodium.
Occurs in patients with normal fluid volume, FVD, FVE
Most affected are very old, very young, and cognitively impaired.
HYPERNATREMIA
43
- total body water is greatly decreased relative to Na+ loss.
HYPOVOLEMIC HYPERNATREMIA
44
- TBW is decreased relative to the normal total body Na+.
EUVOLEMIC HYPERNATREMIA
45
TBW is increased but Na+ gain exceeds water gain.
HYPERVOLEMIC HYPERNATREMIA-
46
Below-normal serum potassium
<3.5 mEq/L
May occur with normal potassium levels:
when alkalosis is present a temporary shift of serum potassium into cells occurs.
POTASSIUM DEFICIT (HYPOKALEMIA)
47
98% is inside the cells. 2% is in the ECF
Important in neuromuscular function
Influences both skeletal and cardiac muscle activity.
Potassium
48
99% of the body's calcium (Ca++) is located in the skeletal system
Plays a major role in transmitting nerve impulses
Helps regulate muscle contraction and relaxation, including cardiac muscle.
Calcium
49
Serum calcium value lower than 8.6 mg/dL [2.15 mmol/L]
Hypocalcemia
50
- most characteristic manifestation of hypocalcemia and hypomagnesemia
TETANY
51
-inflate BP cuff on the upper arm, (+) carpal spasms within 2-5 minutes.
Trousseau sign
52
- consists of twitching of muscles enervated by the facial nerve.
Chvostek sign
53
Serum calcium value greater than 10.2 mg/dL [2.6 mmol/L]
CALCIUM EXCESS (HYPERCALCEMIA)
54
is abundant intracellular cation.
Magnesium
55
It acts as an activator for many intracellular enzyme systems.
Plays a role in both carbohydrate and protein metabolism
is important in neuromuscular function
Magnesium
56
Below-normal serum magnesium concentration (1.3 md/dL [0.62 mmol/L)
MAGNESIUM DEFICIT (HYPOMAGNESEMIA)
57
Frequently associated with hypokalemia and hypocalcemia.
Causes: alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood.
Hypomagnesemia
58
Serum magnesium level higher than 3.0 mg/dL [1.25 mmol/L]
Rare electrolyte abnormality, because the kidneys efficiently excrete magnesium
Hypermagnesemia
59
a primary anion in IFC
PHOSPHORUS
60
Essential to the function of muscle and red blood cells, and nervous system.
It is deposited with calcium for bone and tooth structure. I
VOLUMN
Involve in acid-base buffering system, energy production of ATP.
Cellular uptake and use of glucose.
Phosphorus
61
serum level below 2.5 mg/dl
Hypophosphatemia
62
Serum phosphorus level that exceeds 4.5 mg/dL (1.45 mmol/L).
Causes: kidney injury, excess phosphorus, excess vitamin D, hypoparathyroidism, chemotherapy
Hyperphosphatemia
63
The major anion of the ECF, is found more in interstitial and lymph fluid compartments than in blood.
Also contained in gastric and pancreatic juices, sweat, bile, and saliva
Chloride
64
A serum chloride level below 97 mEq/L (97 mmol/L).
NT
Causes: Addison disease, reduced chloride
intake, Gl loss, diabetic ketoacidosis, excessive sweating, fever, medications, metabolic alkalosis bums, medications, metabolic alkalosis
Hypochloremia
65
Serum level of chloride exceeds 107 mEq/L (107 mmol/L)
Hyperchloremia
66
These are located in the left atrium and the carotid and aortic arches.
These receptors respond to changes in the circulating blood volume and regulate the sympathetic and parasympathetic neural activity as well as endocrine activities.
Baroreceptors
67
-is an enzyme that converts angiotensinogen, a substance formed by the liver into angiotensinogen I.
RENIN
68
- converts angiotensinogen I to angiotensin II.
ANGIOTENSIN CONVERTING ENZYME (ACE)
69
- vasoconstrictor properties, INCREASE ARTERIAL PERFUSION PRESSURE and stimulates thirst
ANGIOTENSIN II
70
is number 1 indicator for fluid balance, only applicable to conscious people.
Thirst mechanism
71
- produced by the atrial myocardium with tissue distribution in the cardiac atria and ventricles
Atrial natriuretic peptide (ANP)
72
- produced by the ventricular myocardium with tissue distribution in the brain and cardiac ventricles
Brain Natriuretic Peptide (BNP)
73
is the rapid loss of more than 3% of body weight owing to the loss of either water or sodium.
Dehydration
74
intravascular contains how many L of blood volume in adults
3L of 6L
75
interstitial fluid contains
11L to 12L
76
Transcellular fluid contains
1L
77
Continues water loss by evaporation approximately
500 ml/day
78
The lungs normally eliminate water vapor at rare approximately
300
79
the usual loss through GI Track is
100 to 200ml daily
80
clinical manifestations of hypovolemia
mababa ang timbang, bp, urine output
flattened neck vein
opposite sa laboratory findings (matataas)
81
Medical management of hypovolemia if not severe
Oral replacement
82
Medical management for severe cases of hypovolemia
IV replacement
83
First line choice for hypotensive patient with fluid volume disturbance
Isotonic solution
84
Nursing management for hypovolemia
Pinakaimportante - Monitor input and output at least every 8 hours
Vital signs closely monitored
- bp drop
- rr increases
- pr increases (report, might have hypovolemic shock)
85
caause of fluid volume excess (hypervolemia)
Heart failure
kidney failure/injury
cirrhosis of liver
86
clinical manifestation of HYPERVOLEMIA
edema
distended neck veins
crackles
87
medical management for hypervolemia
Diuretics - mild to moderate THIAZIDE
Loop Diuretic - severe FUROSEMIDE
88
Due of effects of some diuretics, what medication (under hypervolemia)
K supplements
89
If patient have severe hypervolemia and diuretics is not possible what is the next option
Temporary Dialysis (HEMO/PERITONEAL DIALYSIS)
90
Nutritional therapy for hypervolemia
dietary restrictions of NA
Low sodium diet - 250 mg
91
nursing management hypervolemia
I&O Input
daily weights (1kg = 1L water retain)
92
inverse relationship between electrolyte
Na & K
Ca & Ph
Cl & Bicarbonate
Mg & Ph
93
same relationship between electrolyte
Ca & Mg
Mg & K
Na & Cl
