Fluid and Electrolyte Disturbances Flashcards
Are chemicals that conduct electricity when dissolved in water
Electrolytes
Carry positive charges
Cations
Carry negative charges
Anions
The total body water
60% body weight
The intracellular water
40% body weight
The extracellular water
20% body weight
Major ECF electrolyte
Sodium
Major ICF electolyte
Potassium
The system that includes all fluids enclosed in the cells by their plasma membrane
Intracellular Fluid (ICF)
Sorrounds all cells in the body
Extracellular Fluid (ECF)
The fluid component of the blood
Plasma
Sorrounds all cells not in the blood
Interstitial Fluid
Normal value levels of sodium
135-145 mEq/L
Normal value levels of potassium
3.5- 5.0 mEq/L
Normal levels of chloride
98-106 mEq/L
Normal levels of calcium
8.5- 10.5 mEq/L
Normal levels of Phosphate
2.5- 4.5 mEq/L
Normal levels of Magnesium
1.8- 3.0 mEq/L
Normal levels of Magnesium
1.8- 3.0 mEq/L
Movement of water and solutes from an area of higher hydrostatic pressure to an area of lower hydrostatic pressure
Filtration
Movement of water from an area of lower concentration to an area of higher concentration
Osmosis
Describes the concentration of solutions and measured in milliosmoles per liter (mOsm/L)
Osmolarity
Measures the solute concentration per kilogram in blood and urine
Osmolality
Normal serum level
275-290 mOsm/kg water
Normal urine level
200-800 mOsm/kg water
Measures the ability of the kidneys to excrete or conserve water and compares urine with the weight of distilled water (1.000)
Urine Specific Gravity
Normal level of Urine Specific Gravity
1.010 to 1.025
Indicator of renal function
Blood Urea Nitrogen
The normal level of Blood Urea Nitrogen
10-20 mg/dl
A more reliable indicator of renal function than BUN
Serum Creatine
Normal level of Serum Creatinine
0.6 - 1.2 mg/dl
Measures the volume percentage of red blood cells (erythrocytes) in whole blood
Hematocrit
Normal Hematocrit in Men
42% to 52%
Normal Hematocrit in Women
35% to 47%
Is an efficient and effective way of supplying fluids directly into the intravascular fluid compartment, in replacing electrolyte losses, and in administering medications and blood products
IV fluid therapy
are supplemental fluids used in intravenous therapy to restore or maintain normal fluid volume and electrolyte balance when the oral route is not possible
Intravenous Fluids
Have a total osmolality close to that of the ECF; Have no effect on cells; Expand the ECF volume
Isotonic Solutions
Have a lower concentration than plasma; causes cells to swell; provides free water for excretion of body wastes
Hypotonic Solutions
Have a higher concentration than the plasma and causes cells to shrink
Hypertonic Solutions
Plain Normal Saline Solution (PNSS) or 0.9% NACI
-Contains sodium and chloride
-Solution of choice for expanding ECF
-ONLY solution of compatible with blood transfusion
-Contraindicated to renal patients, heart failure, and pulmonary edema
Lactated Ringer’s (LR or PLR)
-Contains potassium and calcium in addition to sodium and chloride
-Used to correct dehydration, sodium depletion, and replaces GI losses
-Contains bicarbonate precursors
Used for replacing water in patients who have hypovolemia with hypernatremia
0.45% NSS (Half-strength Saline)
Used to allow kidneys to retain the needed amounts of water
0.33% NSS
Characteristics of slightly hypertonic
-D5NSS
-D5LR
Characteristics of strong hypertonic
-D10W- for ketosis of starvation
-D50W- for severe hypoglycemia
Occurs when loss of ECF volume exceeds the intake of fluid
Hypovolemia
It occurs when water and electrolytes are lost in the same proportion as they exist in normal body fluids
Hypovolemia
Loss of water ONLY
Dehydration
Hypovolemia causes if abnormal fluid loss
-Vomiting
-Diarrhea
-GI suctioning
-Profuse diaphoresis
Hypovolemia causes decreased intake
-Nausea
-Lack of access to fluids
Hypovolemia causes third spacing
-Edema in burns
-Ascites in liver dysfunction
Hypovolemia Clinical Manifestations
“FEWCHART”
F-Flat neck veins
E- Eyes sunken
W- Weight loss
C- Concentrated urine (SG > 1.025, oliguria)
H- Hypotension
A- Anxiety
R- Rapid, weak pulse; Respirations increased
T- Temperature elevated
Medical Management of Hypovolemia
-Fluid replacement therapy
-Mild-moderate
If mild to moderate increase oral fluids and oral rehydration salts
-If severe
IV therapy
-If with hypotension, give isotonic fluid
- Once normotensive, give hypotonic fluids
-Antidiarrheals, if with diarrhea
-Loperamide (Diatabs)
-Antiemetics, if with nausea/ vomiting
-Metoclopramide (Plasil)
Hypovolemia Nursing Management
-Monitor I&O and daily weights, as ordered
-Monitor vital signs; Watch out for hypotension and tachycardia
-Monitor skin and tongue turgor
-Encourage small, frequent sip of oral fluids; consider likes and dislikes of patient
-Regulate IV fluid to prescribed rate
-Administer medications, as prescribed
-Refers to an isotonic expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF
-Fluid overload
Hypervolemia
Hypervolemia causes
-Heart failure
- Kidney injury
- Liver cirrhosis
- Excessive salt intake
- Excessive administration of sodium-containing fluids in patients with impaired regulatory mechanisms
Hypervolemia Clinical Manifestations
-Edema
-Distended neck veins
- Puffy eyelids
- Crackles
- Weight gain
- Hypertension
- Bounding pulse
- Tachypnea, dyspnea
- Increased urine output; dilute urine
Hypervolemia medical management
- Low sodium diet (mild restriction to as low as 250 mg/day)
-Diuretics
Thiazide Diuretics- mild to moderate hypervolemia
Loop Diuretics- severe hypovolemia
-Potassium supplementation, to prevent hypokalemia while on diuretics - Dialysis for severe renal impairment
Hypervolemia Nursing Management
- Monitor I&O as ordered
-Weigh daily, watch out for rapid weight gain (1kg= 1L of fluid)
-Monitor breath sounds, especially if with IV therapy
-Monitor for the presence of edema - Encourage bed rest
- Regulate IVF as prescribed
-Place on semi-fowlers position if with dyspnea
-Reposition at regular intervals to prevent pressure ulcers
-Emphasize need to read food labels
-Instruct to avoid food high in sodium.
Hypervolemia patient experiences dyspnea
Place the patient on a semi-fowlers position
