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NUR 520 > Fluid and Electrolyte balance > Flashcards

Fluid and Electrolyte balance Flashcards

1
Q

What is the primary requirement for proper functioning of all body systems?

A

Fluid and electrolyte balance (Homeostasis)

Homeostasis is crucial for maintaining stable internal conditions in the body.

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2
Q

What percentage of body fluid is intracellular fluid (ICF)?

A

40%

ICF is the fluid located inside cells.

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3
Q

What percentage of body fluid is extracellular fluid (ECF)?

A

20%

ECF includes fluid outside cells, comprising intravascular, interstitial, and transcellular fluids.

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4
Q

Fluid % Intravascular and Interstitial

A

Intravascular (Plasma) 5%
Interstitial (surrounds tissues/cells) 14%

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5
Q

What is the best indicator of fluid loss or gain?

A

Change in daily weight
-Weight-in at the same time each day wearing the same clothes

1 L of water is equal to 1 kg of body weight.
1 L of water weighs 2.2 lbs

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6
Q

Define electrolytes.

A

Substances whose molecules dissociate into ions when placed in water

Electrolytes are crucial for various physiological functions.

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7
Q

What is the prevalent cation/anion in intracellular fluid (ICF)?

A

K+ (Potassium)
(PO4)3-

K+ is essential for cell function and electrical activity.

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8
Q

What is the prevalent cation/anion in extracellular fluid (ECF)?

A

Na+ (Sodium)
Anion- Cl-

Na+ is vital for maintaining fluid balance and nerve function.

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9
Q

What is diffusion?

A

Movement of molecules across a permeable membrane from high to low concentration

Diffusion is a passive process that does not require energy.

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10
Q

Facilitated Diffusion

A

Uses carrier to help move molecules

Protein channels- no energy required

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11
Q

What is osmosis?

A

Movement of water ‘down’ concentration gradient
-From a region of low solute concentrarion to one of high solute concentration
-across a semipermeable membrane

Osmosis occurs across a semipermeable membrane and does not require outside energy.

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12
Q

Active Transport

A

Process in which molecules move against concentration gradient
External energy is needed for this process

AKA sodium/potassium pump

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13
Q

What does osmotic pressure measure?

A

Amount pressure/force required to stop osmotic flow of water

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14
Q

Calculate plasma osmolality using the formula: Plasma Osmolality = (2 × Na) + (BUN / 2.8) + (glucose / 18). What is the normal range?

A

Normal plasma osmolality is between 280 and 295 mOsm/kg

Values outside this range indicate- water deficit and water exess

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15
Q

What does hypotonic mean?

A

Solutes less concentrated than in cells

Hypotonic solutions can cause cell swelling.

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16
Q

What does hypertonic mean?

A

Solutes more concentrated than in cells

Hypertonic solutions can lead to cell shrinkage.

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17
Q

What is hydrostatic pressure?

A

Force of fluid in a compartment
the pressure that exists within a fluid that is not moving. It’s caused by the weight of the fluid, or the force of gravity acting on the fluid.
(static)

Hydrostatic pressure is generated by the heart’s contraction.

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18
Q

Oncotic Pressure

A

Colloid osmotic pressure
Osmotic pressure caused by plasma proteins

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19
Q

What causes edema?

A

Shifts of plasma to interstitial fluid, elevation of venous hydrostatic pressure, decrease in plasma oncotic pressure, elevation of interstitial oncotic pressure

Edema is an abnormal accumulation of fluid in interstitial spaces.

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20
Q

What is fluid spacing?

A

First spacing: Normal distribution; Second spacing: Abnormal accumulation of interstitial fluid (edema); Third spacing: Fluid is trapped where it is difficult or impossible for it to move back

Understanding fluid spacing is critical in assessing fluid imbalances.

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21
Q

What is the primary function of the kidneys in fluid balance?

A

Regulating fluid and electrolyte balance by adjusting urine volume and selectively reabsorbing water and electrolytes

The kidneys are essential for maintaining homeostasis.

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22
Q

Adrenal cortical regulation

A

Releases hormones to regulate water and electrolytes (cortisol/aldosterone)

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23
Q

Gerontologic considerations

A

-Structural changes in kidneys decrease ability to conserve water
-Hormonal changes include a decrease in renin and aldosterone and increase in ADH and ANP
-Subcutaneous tissue loss leads to increased moisture lost

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24
Q

Developmental considerations: Older adults

A

Increased risk for dehydration due to:
Less total body water
Decreased thirst mechanism
Decreased mobility difficulty obtaining fluids
Medications that increase fluid excretion

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25
Q

What is hypovolemia?

A

Fluid volume deficit (FVD)

Hypovolemia is characterized by an abnormal loss of body fluids or inadequate fluid intake.

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26
Q

What are common clinical manifestations of hypovolemia?

A

Weak heart rate, low blood pressure, decreased respiratory rate, dry mucous membranes, confusion, dark amber urine, sudden weight loss

These signs indicate significant fluid loss.

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27
Q

What is hypervolemia?

A

Fluid volume excess (FVE)

Hypervolemia results from excessive fluid intake or abnormal retention.

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28
Q

What are common clinical manifestations of hypervolemia?

A

Weight gain (most common), increased respiratory rate, dyspnea on exertion, pitting edema, headache, skeletal muscle weakness

These manifestations indicate fluid overload.
Can lead to heart failure or pulmonary edema

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29
Q

Nursing interventions: hypovolemia (ways to restore normal volume in fluid compartments)

A

-Oral fluid replacement if dehydration isn’t severe
-IV fluids if dehydration is severe or patient cannot tolerate oral liquids
-Type and amount of IV fluid depends on severity of dehydration and blood osmolality

**Assess IV site at least hourly for signs of infiltration, extravasation, and phlebitis

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30
Q

Monitor for signs of fluid overload:

A

Bounding pulse
Difficulty breathing
Neck vein distension in the upright position
Presence of dependent
edema

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31
Q

Nursing considerations for Hypovolemia

A

Interprofessional Care
-Correct the underlying cause and replace water and electrolytes
*Orally
*Blood products
*Balanced IV solutions
Goals:
Prevent further fluid losses
Prevent injury
Restore fluid volume compartments to normal volumes (oral, IV, and replace electrolytes)

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32
Q

Clinical manefestations of Hypovolemia

A

Increased HR
Weak Peripheral pulses
Decreased BP
Flat neck and hand veins
Decreased Respiratory rate
Decreased Skin Turgor
Dry, pale mucous membranes
confusion
low grade fever
Decreased Urine output
Dark amber urine
Sudden weight loss

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33
Q

Lab Values for hypovolemia

A

INCREASED:
Hemoglobin
Hematocrit
Glucose
Protein
BUN
Electrolytes

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34
Q

What is the purpose of diuretics in fluid management?

A

Remove fluid without changing electrolyte composition or osmolality of ECF

Diuretics help manage fluid overload conditions.

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35
Q

What is the role of glucocorticoids and mineralocorticoids in fluid balance?

A

Regulate water and electrolytes

These hormones are released from the adrenal cortex.

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36
Q

True or False: The elderly have a decreased risk for dehydration.

A

False

Older adults are at increased risk for dehydration due to various physiological changes.

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37
Q

What is extracellular fluid overload?

A

An overload of extracellular fluid with a significant increase in intracellular fluid volume.

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38
Q

What is the primary role of sodium in the body?

A
  • ECF volume and concentration
  • Generating and transmitting nerve impulses
  • Muscle contractility
  • Regulating acid-base balance
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39
Q

What causes hypernatremia?

A

High serum sodium may occur with inadequate water intake, excess water loss, or sodium gain.

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40
Q

What are the manifestations of hypernatremia?

A
  • Thirst
  • Changes in mental status (drowsiness, restlessness, confusion, lethargy, seizures, coma)
  • Symptoms of fluid volume deficit
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41
Q

What nursing diagnoses are associated with hypernatremia?

A
  • Electrolyte imbalance
  • Fluid imbalance
  • Risk for injury
  • Potential complication: Seizures and coma
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42
Q

What is the primary water deficit treatment for hypernatremia?

A

Replace fluid orally or IV with isotonic or hypotonic fluids.

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43
Q

What is hyponatremia?

A

Results from loss of sodium-containing fluids and/or from water excess.

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44
Q

What are the clinical manifestations of hyponatremia?

A
  • Mild: headache, irritability, difficulty concentrating
  • More severe: confusion, vomiting, seizures, coma
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45
Q

What nursing interventions are appropriate for severe hyponatremia?

A

Give a small amount of IV hypertonic saline solution (3% NaCl).

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46
Q

What are the primary sources of potassium?

A
  • Protein-rich foods
  • Fruits and vegetables
  • Salt substitutes
  • Potassium medications (PO, IV)
  • Stored blood
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47
Q

What causes hyperkalemia?

A
  • Impaired renal excretion
  • Shift from ICF to ECF
  • Massive intake of potassium
  • Some drugs
48
Q

What are the manifestations of hyperkalemia?

A
  • Dysrhythmias
  • Fatigue, confusion
  • Tetany, muscle cramps
  • Weak or paralyzed skeletal muscles
  • Abdominal cramping or diarrhea
49
Q

What management strategies are used for hyperkalemia?

A
  • Stop oral and parenteral potassium intake
  • Increase potassium excretion (diuretics, dialysis)
  • Force potassium from ECF to ICF by IV insulin with dextrose
  • Stabilize cardiac cell membrane by administering calcium gluconate IV
50
Q

What causes hypokalemia?

A
  • Increased loss of potassium via the kidneys or gastrointestinal tract
  • Increased shift of potassium from ECF to ICF
  • Dietary potassium deficiency
  • Renal losses from diuresis
51
Q

What are the manifestations of hypokalemia?

A
  • Cardiac most serious
  • Skeletal muscle weakness (legs)
  • Weakness of respiratory muscles
  • Decreased GI motility
  • Hyperglycemia
52
Q

What is the nursing implementation for potassium chloride supplementation?

A

Always dilute IV KCl, NEVER give KCl via IV push or as a bolus, and should not exceed 10 mEq/hr.

53
Q

What are the functions of calcium in the body?

A
  • Formation of teeth and bone
  • Blood clotting
  • Transmission of nerve impulses
  • Myocardial contractions
  • Muscle contractions
54
Q

What are the causes of hypercalcemia?

A
  • Hyperparathyroidism (two-thirds of cases)
  • Cancer
55
Q

What are the manifestations of hypercalcemia?

A
  • Fatigue, lethargy, weakness, confusion
  • Hallucinations, seizures, coma
  • Dysrhythmias
  • Bone pain, fractures, nephrolithiasis
  • Polyuria, dehydration
56
Q

What nursing implementation strategies are used for hypocalcemia?

A
  • Treat cause
  • Calcium and Vitamin D supplements
  • IV calcium gluconate
  • Rebreathe into paper bag
  • Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis
57
Q

What is hyperphosphatemia?

A

High serum phosphate caused by acute kidney injury, chronic kidney disease, excess intake of phosphate or vitamin D, and hypoparathyroidism.

58
Q

What are the manifestations of hyperphosphatemia?

A
  • Tetany
  • Muscle cramps
  • Paresthesias
  • Hypotension
  • Dysrhythmias
  • Seizures
59
Q

What management strategies are used for hypophosphatemia?

A
  • Oral supplementation
  • Ingestion of foods high in phosphorus
  • IV administration of sodium or potassium phosphate
  • Monitor serum calcium and phosphorus levels every 6 to 12 hours
60
Q

What is the role of magnesium in the body?

A
  • Cofactor in enzyme for metabolism of carbohydrates
  • Required for DNA and protein synthesis
  • Blood glucose control
  • BP regulation
  • Needed for ATP production
61
Q

What causes hypermagnesemia?

A

Increased intake of products containing magnesium when renal insufficiency or failure is present, or excess IV magnesium administration.

62
Q

What are the manifestations of hypermagnesemia?

A
  • Hypotension
  • Facial flushing
  • Lethargy
  • Nausea and vomiting
  • Impaired deep tendon reflexes
  • Muscle paralysis
  • Respiratory and cardiac arrest
63
Q

What is hypermagnesemia?

A

High serum Mg caused by increased intake of magnesium products during renal insufficiency or failure, and excess IV magnesium administration.

Hypermagnesemia can lead to serious health complications.

64
Q

List the manifestations of hypermagnesemia.

A
  • Hypotension
  • Facial flushing
  • Lethargy
  • Nausea and vomiting
  • Impaired deep tendon reflexes
  • Muscle paralysis
  • Respiratory and cardiac arrest

These symptoms highlight the severity of hypermagnesemia.

65
Q

What is the first step in managing hypermagnesemia?

A

Prevention first—restrict magnesium intake in high-risk patients.

Identifying at-risk patients is crucial for effective management.

66
Q

What treatments are available for symptomatic hypermagnesemia?

A
  • IV CaCl or calcium gluconate
  • Fluids and IV furosemide to promote urinary excretion
  • Dialysis

These treatments help to quickly reduce serum magnesium levels.

67
Q

What is hypomagnesemia?

A

Low serum Mg caused by prolonged fasting, chronic alcoholism, fluid loss from the GI tract, prolonged parenteral nutrition without supplementation, diuretics, proton-pump inhibitors, or hyperglycemic osmotic diuresis.

Hypomagnesemia can have various causes, often related to dietary and medical factors.

68
Q

List the manifestations of hypomagnesemia.

A
  • Resembles hypocalcemia
  • Muscle cramps, tremors
  • Hyperactive deep tendon reflexes
  • Chvostek’s and Trousseau’s signs
  • Confusion, vertigo, seizures
  • Dysrhythmias

Symptoms may overlap with other electrolyte imbalances.

69
Q

What is the management for hypomagnesemia?

A
  • Treat underlying cause
  • Oral supplements
  • Increase dietary intake
  • Parenteral IV or IM magnesium when severe

Addressing the root cause is essential in treating hypomagnesemia.

70
Q

Fill in the blank: A patient is admitted with renal failure and an arterial blood pH level of 7.29. The expected serum potassium level would be _______.

A

5.9 mEq/L

This level indicates potential complications related to renal failure.

71
Q

True or False: Muscle paralysis is a manifestation of hypermagnesemia.

A

True

Muscle paralysis can occur due to elevated magnesium levels affecting neuromuscular function.

72
Q

Which electrolyte imbalance resembles hypocalcemia?

A

Hypomagnesemia

Both conditions can present with similar neuromuscular symptoms.

73
Q

What are common causes of hypomagnesemia?

A
  • Prolonged fasting or starvation
  • Chronic alcoholism
  • Fluid loss from the GI tract
  • Prolonged parenteral nutrition without supplementation
  • Diuretics
  • Proton-pump inhibitors
  • Hyperglycemic osmotic diuresis

Understanding these causes aids in prevention and treatment.

74
Q

What is hypovolemia?

A

Fluid volume deficit

Loss of extracellular volume exceeds the intake of fluid.

75
Q

What are the causes of hypovolemia?

A
  • Abnormal fluid loss
  • At risk: Elderly, burns, surgery, hemorrhage
76
Q

What are the clinical manifestations of hypovolemia?

A
  • Weight loss
  • Decreased skin turgor
  • Oliguria
  • Concentrated urine
  • Change in blood pressure (postural hypotension)
  • Cool/clammy skin
  • Dry mucus membranes
  • Weak/rapid heart rate
  • Delayed cap refill
  • Thirst
77
Q

What is the medical management for hypovolemia?

A

Fluid replacement (PO or IV depending on severity) Isotonic solution initially.

78
Q

What nursing interventions are recommended for hypovolemia?

A
  • I & O
  • Daily weight
  • LOC
  • Breath sounds
  • Skin temp/color
  • Vitals
79
Q

What is hypervolemia?

A

Fluid volume excess

Isotonic expansion of the extracellular fluid caused by abnormal retention of water and sodium.

80
Q

What are the causes of hypervolemia?

A

Excessive fluid replacement
Kidney failure (late stage)
Heart failure
Long term steroid therapy
Syndrome of inappropriate ADH secretion (SIADH)
Psychiatric conditions with polydipsia
Water intoxication

81
Q

What are the clinical manifestations of hypervolemia?

A

increase pulse
increase blood pressure
Increased central venous pressure
increase neck and hand veins
Weight gain
Increased respiratory rate
Dyspnea on exertion
Crackles heard on auscultation
Pitting edema in dependent areas
Skin pale and cool to touch
Headache
Skeletal muscle weakness
Paresthesias
Enlarged liver

82
Q

What is the medical management for hypervolemia?

A
  • Diuretics
  • Restricting fluids and sodium
83
Q

What nursing interventions are recommended for hypervolemia?

A
  • I & O
  • Daily weight
  • Monitor edema
  • Teach about sodium and fluid restriction
  • Monitor intake
84
Q

Lab indicators for hypervolemia

A

Electrolytes usually normal
Decreased Hgb/Hct
Decreased serum protein levels

85
Q

What is the normal range for sodium levels?

A

135-145 mEq/L

86
Q

What is hyponatremia?

A

< 135 mEq/L

87
Q

What are the causes of hyponatremia?

A
  • Vomiting
  • Diarrhea
  • Fistulas
  • Prolonged/excessive sweating
  • Diuretics
  • Low salt diet
  • Water intoxication
  • SIADH
  • Psychogenic polydipsia
88
Q

What are the clinical manifestations of hyponatremia?

A
  • Poor skin turgor
  • Dry mucosa
  • Headache
  • Nausea
  • Abdominal cramping
  • Edema
  • Crackles
  • JVD
  • Altered mental status
  • Lethargy
  • Seizures
  • General weakness
89
Q

What is the medical management for hyponatremia?

A
  • Sodium replacement
  • Water restriction
90
Q

What nursing interventions are recommended for hyponatremia?

A
  • I & O
  • Daily weight
  • Neuro assessment
  • Safety
91
Q

What is hypernatremia?

A

> 145 mEq/L

92
Q

What are the causes of hypernatremia?

A
  • Fluid deprivation
  • Enteral feedings without adequate water flushes
  • Watery diarrhea (dilutional)
  • Diabetes insipidus
  • Kidney failure
  • Excessive sodium intake
  • Dehydration (dilutional)
93
Q

What are the clinical manifestations of hypernatremia?

A
  • Restlessness
  • Weakness
  • Disorientation
  • Hallucinations
  • Thirst
  • Dry mucous membranes
  • Flushed skin
  • Peripheral/pulmonary edema
  • Increased muscle tone
  • Increased deep tendon reflexes
94
Q

What is the medical management for hypernatremia?

A
  • Gradually lowering serum sodium level with infusion of hypotonic solution
  • Restrict dietary sodium
  • Diuretics that promote NA+ loss
95
Q

What nursing interventions are recommended for hypernatremia?

A
  • I & O
  • Safety
  • Offer fluids at regular intervals
96
Q

What is the normal range for potassium levels?

A

3.5-5/5.2 mEq/L

97
Q

What is hypokalemia?

A

< 3.5 mEq/L

98
Q

What are the causes of hypokalemia?

A
  • Use of diuretics
  • Diarrhea
  • Vomiting
  • Gastric suction
  • Recent ileostomy
  • Intestinal drains
  • Decreased intake (NPO, anorexia, alcoholism, fasting)
  • Metabolic alkalosis
99
Q

What are the clinical manifestations of hypokalemia?

A
  • Fatigue
  • Anorexia
  • Nausea
  • Vomiting
  • Muscle weakness
  • Leg cramps
  • Decreased bowel motility
  • Paresthesia
  • Arrhythmias
  • Decreased muscle strength
  • Decreased tendon reflexes
  • ECG changes (flat T wave, inverted T wave, elevated U wave)
100
Q

What is the medical management for hypokalemia?

A
  • Oral or IV potassium replacement
  • Typically replace anything <3.5 mEq/L especially if on diuretic or symptomatic
101
Q

What nursing interventions are recommended for hypokalemia?

A
  • Continued assessments
  • Encourage patients at risk to eat potassium-rich foods
  • Monitor kidney function
  • Administer replacement as ordered
102
Q

What is hyperkalemia?

A

> 5/5.2 mEq/L

103
Q

What are the causes of hyperkalemia?

A
  • Increased intake
  • Medications that increase (potassium-sparing diuretics, ACE inhibitors)
  • Crushing injuries
  • Burns
  • Trauma
  • Intravascular hemolysis
  • Rhabdomyolysis
  • Kidney failure
104
Q

What are the clinical manifestations of hyperkalemia?

A
  • Cardiac rhythm changes (peaked/narrow T waves, depressed ST-segment)
  • Skeletal muscle weakness
  • Paralysis
  • Nausea
  • Intermittent intestinal colic
  • Diarrhea
  • Acidosis
105
Q

What is the medical management for hyperkalemia?

A
  • Restriction of dietary potassium
  • Kayexalate (cation exchange)
  • Dangerously high levels: calcium gluconate, sodium bicarbonate, IV regular insulin, hypertonic dextrose solution
  • Loop diuretics
  • Beta-2 agonists
106
Q

What nursing interventions are recommended for hyperkalemia?

A
  • Assess neuro, cardiac, and GI
  • Avoid potassium-rich foods
107
Q

What is the purpose of interpreting arterial blood gases (ABGs)?

A

Helps identify a potential acid-base imbalance in the body.

108
Q

What are the types of acid-base imbalances that can occur in the body?

A
  • Respiratory acidosis
  • Respiratory alkalosis
  • Metabolic acidosis
  • Metabolic alkalosis
109
Q

What is the normal blood pH range?

110
Q

What does the ROME method stand for?

A
  • Respiratory
  • Opposite
  • Metabolic
  • Equal
111
Q

In the ROME method, what does ‘Respiratory Opposite’ mean?

A

CO2 and pH will be OPPOSITE of each other.

112
Q

In the ROME method, what does ‘Metabolic Equal’ mean?

A

HCO3 and pH will be EQUAL.

113
Q

What are the normal lab values for CO2?

A

35-45 mmHg

114
Q

What are the normal lab values for HCO3?

A

22-26 mEq/L

115
Q

What pH value is considered acidic?

116
Q

What pH value is considered alkalotic?

NUR 520 (10 decks)

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