Fluid and electrolyte balance Flashcards
Electrolytes
substance that ionize once dissolved in solution
Components of electrolytes
- atom
- proton
- neutron
- electron
- molecule
- ion
- cation
- anion
Metabolic panels
- basic (BMP)
- blood test that provides info about metabolism, fluid balance, and kidney function - Comprehensive (CMP)
- includes BMP and additional labs to evaluate liver function (BUN, Cr)
Electrolyte functions
- regulate fluid balance
- hormone production and balance
- strengthen skeletal structure
metabolism
nerve response and muscle contraction
Localized edema
specific part: traumatic accident, surgical site, burns
General edema
in interstitial space throughout body: cardiac, renal, liver failure
Osmolality
- concentration of solution
- found on metabolic panel
- plasma range: 275-295 mOsm/kg
Fluid tonicity definition
modify volume of cells by altering water content
Hypertonic
draws water out of cells to shrink
ex. 3% sodium chloride
Isotonic
doesn’t alter cells
ex.0.9% sodium chloride
Hypotonic
draws water into cell to plump
ex.0.45% sodium chloride
Third-spacing (“silent killer”)
- accumulation and storage of trapped ECF in body space from disease or injury
- fluid leaves to address trauma
Areas of fluid trapping
- pericardial
- pleural
- peritoneal
- joint
Signs and symptoms of third spacing
- weight gain
- decreased urine output
- hypovolemia
- increase HR
- decrease BP
Risk factors of third spacing
- trauma
- burns
- sepsis
- inflammatory conditions
- kidney disease
- heart failure
- lymphatic obstruction
Extracellular
- fluid outside of the cell
- makes 1/3 of total body water
- has 2 major divisions and 1 minor division
Intravascular fluid
liquid part of blood (plasma)
Interstitial fluid
located between cells and outside of vessels (edema)
Transcellular fluid
- cerebrospinal, pleural, peritoneal, synovial
- secreted by epithelial cells
Intracellular
fluid inside the cells
Function of body fluid
- transports nutrients to cells
- carries waste products out of cells
Total body fluid in humans: intra and extra
60% in young adults
55% in older adults
80% in infants
Body fluid if made up of
water + electrolytes +insoluble
insoluble: glucose, urea, creatinine
Hypovolemia (isotonic dehydration)
lacks water and electrolytes causing a decrease in circulating volume
Body response to hypovolemia by
releasing aldosterone and antidiuretic hormone (ADH)
Hypovolemia leads to
seizures and hypovolemic shock
risk factors of hypovolemia
- decreased body mass
- decreased ability to detect thirst
risk factors by body systems
GI: vomiting, diarrhea (increased HR, o2, and tachypnea, decreased BP)
Skin: diaphoresis w/o water and na replacement (decreased skin turgor, flat neck veins)
Renal: diuretic therapy, kidney/renal disease
third spacing burns
hemorrhage or plasma loss
Interventions of hypovolemia
- assess vitals
- monitor I/O
- weight
- labs
- injury prevention (orthostatic hypotension)
*notify provider if output is <30mL/hr
Hypervolemia
- retaining too much water and Na in ECF
- renal system attempts to respond and excrete out more fluid
Complications of hypervolemia
- pulmonary edema
- heart failure
Risk factors of hypervolemia include
- heart failure
- liver cirrhosis
- kidney failure
Expected findings of hypervolemia
- increased BP
- bounding pulse
- confusion/ altered LOC
- increased weight
- ascites
-distended neck veins - crackles in lungs
Interventions of hypervolemia
- assess vitals
- monitor I/O
- weight
- labs
- decrease IV flow (need an order)
- fluid IV restriction (need an order)
- administer diuretic (need an order)
Sodium is essential for
- acid base balance
- fluid balance
- active and passive transport mechanism
- conduction of nerve and muscle tissue
Hyponatremia causes
- excessive free water intake (diluted)
- decreased intake of sodium foods
- increased amounts of urine output w/o sodium replacement
effects of hyponatremia on the nervous system
- delays/slows down depolarization of nerve communication
- water shifts from ECF to ICF and causes cells within brain to swell
Effects of hyponatremia on muscoskeletal
- muscle weakness
Effects of hyponatremia on neuro
- coma
- seizure
- decreased LOC, DTR
- restlessness
Effects of hyponatremia on GI
- n/v
- cramping
- diarrhea
Interventions of hyponatremia
- I/O
- weight
- vitals
LOC monitoring - seizure precautions
Treatment for hyponatremia
- PO salt tablets
- increase Na foods
- administer IV hypertonic saline
- free water restrictions
Hypernatremia causes
- decreased water intake
- increase salt
- osmotic diaresis (hyperglycemia)
Effects of hypernatremia
- hypertonicity of blood leading to water shifting out of cells
- cells become small and dehydrated
Potential disturbances of hypernatremia
- neuro
- endocrine
- cardiac
Effects of hypernatremia on muscoskeletal
- muscle weakness
- twitching
Effects of hypernatremia on neuro
- coma
- seizure
- decreased LOC
- increased DTR
- restlessness
Effects of hypernatremia on GI
- swollen, red tongue
- hyperactive bowel sounds
- dry and sticky mucous membranes
Intervention of hypernatremia
- I/O
- weight
- vitals
- LOC monitoring
- seizure precautions
Treatment for hypernatremia
- PO free water intake
- IV fluid replacement
- decrease NA
- administer diuretics (thiazides)
Potassium is essential for
- cellular metabolism
- transmission of nerve impulses
- normal function of heart, lungs, and muscle tissue
- acid-base balance
causes of hypokalemia
- increase loss of k (vomit, diarrhea, sweat)
- decreased intake of k
- decreased absorption of k
- decreased movement of k into cells
Effects of hypokalemia on neuro/musco
- periodic paralysis
- respiratory collapse
- decreased reflexes
Effects of hypokalemia on cardiac/EKG
- dysrhythmias
- irregular pulse
- orthostatic hypotension
- cardiac arrest
- ventricular fibrillation
Effects of hypokalemia on GI
- decreased motility, bowel sounds
- constipation
- ileus
Interventions of hypokalemia
- monitor K levels
- monitor breathing, oxygen, cardiac rhythms
- replace k IV/PO
Treatment for hypokalemia
- k needs to be diluted
Administration (IV) for hypokalemia
- always go slow (5-10 mEq/hr)
- never bolus
- NEVER PUSH
Hyperkalemia causes
- increased k
- movement of k out of cells (sepsis, burns, trauma)
- renal disease
Effects of hyperkalemia on neuro/musco
- confusion
Effects of hyperkalemia on cardiac/ EKG
- dysrhythmias
- peak T waves
- widened PR and QRS
- cardiac arrest ASYSTOLE
Effects of hyperkalemia on GI
- abdominal cramps
- diarrhea
Interventions of hyperkalemia
- EKG monitoring
- decrease k intake
- monitor serum levels
Treatment for hyperkalemia
- dialysis
- reverse via meds (Kayexalate, k wasting diuretic, IV Ca, insulin, glucose)
Calcium is essential for
- cardiovascular
- neuro/musco
- endocrine
- clotting ability
-teeth/ bone formation
Causes of hypocalcemia
- increase Ca output
- decreased intake, absorption
- Ca shifts from ECF to bone or to inactive form
Effects of hypocalcemia on neuro/musco
- numbness/tingling
- increase DTR
- positive chvostek/trousseau
- seizures
Effects of hypocalcemia on cardiac/ EKG
- weak pulse
- increase or decrease HR
- dysrhythmias
Effects of hypocalcemia on GI
- increase bowel sounds
- diarrhea
- abdominal cramping
Interventions of hypocalcemia
- seizure and fall precautions
- emergency equipment
- EKG monitoring
Treatment for hypocalcemia
- increase Ca and vit D supplements
- increase Ca, dairy, dark green veggies
Causes of hypercalcemia
- increase intake of vit D and Ca
- thiazide diuretics
- long term glucocorticoids
- paget disease
- increase thyroidism
- bone cancer
Effects of hypercalcemia on neuro/musco
- decreased reflexes
- bone pain
- confusion
- decreased LOC
- weak
Effects of hypercalcemia on cardiac/ EKG
- dysrhythmias
- increase blood clots
Effects of hypercalcemia on GI
- kidney stone
Interventions for hypercalcemia
- monitor neuro/ cardiac status
- decrease dietary Ca
Treatment for hypercalcemia
- promote ca to be excreted by kidneys
- administer diuretics and fluids
Chvostek
tapping face and triggering twitching
Trousseau
hand/finger spasm w/ BP cuff
