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Adult Nursing Final > Fluid and Electrolyte balances > Flashcards

Fluid and Electrolyte balances Flashcards

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1
Q

What is the goal of fluid & electrolyte balance?

A

To maintain homeostasis

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2
Q

What is the nursing role when dealing with fluid & electrolyte imbalances?

A

anticipate potential for alterations

recognizing the S&S of imbalances with appropriate action

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3
Q

Composition of fluids in the body

A 
intracellular fluid (2/3)
Extracellular fluid (1/3)
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4
Q

Sodium

A

135-145 mEq/L

  • essential for muscle contractions, transmission of nerve impulses and acid-base balance
  • kidneys regulate and it is influenced by ADH & aldosterone
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5
Q

Potassium

A
  1. 5-5.0 mEq/L

- essential for skeletal, cardiac, muscle contraction; maintains acid-base balance

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6
Q

Chloride

A

98-106 mEq/L

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7
Q

Bicarbonate

A

24-31 mEq/L

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8
Q

Calcium

A
  1. 5-10.5 mg/dL
    - Role in transmitting nerve impulses, regulates muscle contraction & relaxation that includes cardiac
    - Activates enzyme, role in coagulation
    - Vitamin D needed for absorption from the GI track
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9
Q

Phosphate

A
  1. 5-4.5 mg/dL
    - essential to the function of muscle, RBCs, & the nervous system
    - Deposited with calcium for bone & tooth structure
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10
Q

Magnesium

A
  1. 8-3.0 mg/dL
    - Role in carbohydrate & protein metabolism
    - Regulated by GI absorption & renal excretion
    - Important for normal cardiac function
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11
Q

Hydrostatic pressure

A

pressure exerted by the fluid on the walls of the blood vessels by the heart
pressure within the arterial end of the capillary pushes water into the interstitial space

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12
Q

Oncotic pressure

A

exerted primarily by albumin

osmotic force of plasma proteins draws fluid back into the capillary at the venous end

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13
Q

Osmosis

A

fluid shifts through membranes from low solute concentration to high solute concentration

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14
Q

Diffusion

A

solutes moves from area of higher concentration to a lower concentration

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15
Q

Filtration

A

passage through a filter that prevents passage of certain molecules

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16
Q

Active transport

A

sodium moves out of the cell & potassium moves into the cell to maintain concentration

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17
Q

Kidneys

A

regulate by adjusting urine volume

  • filter plasma
  • Excrete urine
  • Regulates: ECF volume, electrolyte levels in ECF, pH of ECF, excretion of metabolic wastes & toxic substances
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18
Q

Skin (sensible perspiration) & Lungs (insensible loss)

A
  • invisible vaporization from lungs & skin assists in regulating body temperature
  • Excessive sweating (sensible perspiration) from fever or high environmental temperatures
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19
Q

GI

A
  • water intake, food metabolism, solid foods
  • GI tract secretes & reabsorbs
  • In healthy people, daily average intake & output of water are approximately equal
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20
Q

Renin-Angiotensin-Aldosterone System

A

-Renin released in response to decreased blood flow (decrease CO) or decreased renal pressure (sensed by receptors in the nephrons)

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21
Q

Antidiuretic Hormone (vasopressin)

A

a fluid deficit or increase in plasma osmolality is sensed by osmoreceptors in the hypothalamus which in turn stimulate thirst & ADH release

22
Q

Heart

A

rate, conduction, contractility & blood vessel resistance affects blood circulation to the kidney affecting renal perfusion

23
Q

what is released in response to increased fluid volume (HF) & high serum sodium levels?

A

ANP- a hormone secreted by cells in the lining of the atria

BNP- a hormone secreted by cells in the lining of the ventricles

24
Q

Lungs

A

approximately 400 mL water removed daily through exhalation

25
Q

Parathyroid

A
  • regulates calcium & phosphate
  • PTH regulates movement of calcium out of bone to the blood, calcium absorption from intestines, and calcium reabsorption from the renal tubules
26
Q

Osmolality

A

measures the solute concentration per kilogram in blood & urine

27
Q

Osmolarity

A

also describes the concentration of solutions measured in milliosmoles per liter

28
Q

Urine Specific Gravity

A

(1.010-1.025)
SG varies inversely with urine volume
-increase SG= concentrated urine (FVD)
-decrease SG= dilute urine (FVE)

29
Q

BUN

A

10-20 mg/dL
-end product of the metabolism of protein from muscle & diet by the liver
“PROTEIN ON A BUN”

30
Q

Creatinine

A
  1. 7-1.4 mg/dL

- end product of muscle metabolism

31
Q

Isotonic Fluid

A

solutions with the same osmolality as the cell interior; about equal to serum; stays in the intravascular space after administration
USE: replace ECF losses, expand the intravascular volume
Example: NS (0.9%), LR, 5% dextrose in water (DSW)

32
Q

Hypotonic Fluid

A

solutions in which the solutes are less concentrated than the cells
USE: expands the intracellular space, rehydrates the cells, treats gastric fluid loss & dehydration
Example: 0.33% NaCl, 0.45% NaCl

33
Q

Hypertonic Fluid

A

solutions more concentrated than cells
USE: draws fluid out of cells to restore circulating volume, decreases cellular swelling, treats severe hyponatremia
Example: 3% NaCl, 5% NaCl, D10%W

34
Q

Gerontologic Considerations

A

structural changes in the kidney: decrease in GFR & creatinine clearance, inability to concentrate urine, & inability to conserve water & electrolytes

  • hormone changes
  • loss of SC tissue & dermis
  • Decreased thirst mechanism
  • Musculoskeletal barriers
  • Mental status changes
  • medications
35
Q

FVD

A

(Hypovolemia) water & electrolyte are lost in equal proportion
-loss of body fluids or inadequate fluid intake

36
Q

Who are susceptible to having FVD?

A

elderly and very young children because of the inability to care for themselves properly

37
Q

Dehydration

A

loss of pure water alone without corresponding loss of sodium

38
Q

Management of FVD

A
  • encourage oral fluids
  • isotonic or Hypotonic IV fluids
  • Blood replacement if needed
  • Complication: hypovolemic shock
39
Q

Nursing role with FVD

A

monitor S&S of cerebral edema & pulmonary edema, IV site, VS, lab, daily weight

40
Q

FVE

A

(Hypervolemia) is an excess of isotonic fluid (water & sodium) in the extracellular (interstitial or intravascular compartment.

41
Q

Management of FVE

A
  • identify primary cause & treat
  • Hypertonic solutions followed by diuretics
  • Fluid & sodium restrictions
  • Hemodialysis
42
Q

Nursing role with FVE

A

fluid and dietary restrictions, O2 therapy, assess S&S of hypovolemia, monitor O2 sat, ABGs, VS, monitor potassium level, heart & lung sounds, daily weight

43
Q

Vital signs FVD vs FVE

A

FVD- hyperthermia, tachycardia, hypotension, orthostatic hypotension and an increase H&H

FVE- bounding pulse, increased BP, SOA, increased respiratory rate and a decreased H&H

44
Q

Neuromuscular FVD vs FVE

A

FVD- dizziness, syncope, confusion, weak, fatigue, muscle cramps and increased BUN & creatinine

FVE- confusion, headache, seizures, coma and decreased serum osmolarity and sodium

45
Q

Respiratory FVE

A

cough, dyspnea, crackles, pulmonary edema, distended jugular veins and decreased urine sodium & specific gravity

46
Q

GI FVD`

A

thirst, dry furrowed tongue, weight loss and increased urine specific gravity & osmolarity

47
Q

Renal FVD

A

oliguria, concentrated urine and increased serum sodium, osmolality, & specific gravity

48
Q

Water intoxication

A

occurs when excess fluid moves from the extracellular space to the intracellular space

49
Q

What can cause water intoxication?

A
  • SIADH
  • Rapid infusion of a hypotonic solution
  • Excessive use of tap water as an NGT irrigant or enema
  • Pyschogenic polydipsia
50
Q

What are symptoms of water intoxication?

A
  • increased ICP
  • change in LOC
  • Muscle cramps & weakness
  • Headache
51
Q

What are the major electrolytes in ECF?

A

sodium and chloride

52
Q

what are the most plentiful intracellular electrolytes?

A

potassium, phosphate, and magnesium

Adult Nursing Final (13 decks)

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