Fluid and Electrolyte Imbalance Flashcards
the maintanence of equillibrium
homeostasis
what can affect homeostasis
fluid and electrolytes
energy and nutrition
immune response
natural tendency of a substance to move from area of higher concentration to lower concentration
diffusion
how much fluid filtered in kidneys
180L of plasma per day
energy must be expended for movement on concentration gradient
active transport
exerted by fluid at equillibrium at any given point within the fluid, due to force of gravity
hydrostatic pressure
movement of water caused by concentration gradient
osmosis
number of dissolved particles contained in a unit of fluid
osmolality
movement of isotonic fluids
water and solute equal
no fluid shift
movement of hypotonic fluid
watery, diluted liquid
fluid rushes inside the cell
big like a hippo
movement of hypertonic fluids
solute rich, concentrated liquid
water passes through membrane escaping cell - shrinks
factors affecting water regulation
-hypothalamic-pituitary
-renal
-adrenal cortical
-cardiac
-GI
-Age
signs of edema
-accumulation of fluid in interstitial space
-hydrostatic pressure rises
-low plasma oncotic pressure
-increased interstitial oncotic pressure
hypovolemia vs dehydration
hypo - loss of ECF volume exceeds intake of fluid
dehydration - loss of water alone
leads to hypovolemia
-inadequate intake
-elderly
-V/D
-GI suctioning
-fever
-sweating
-burns
-surgery
-DI
-hemorrhage
clinical manifestations of hypovolemia
weight loss
decreased skin turgor
oliguria
high urine specific gravity
postural hypotension
weak, rapid HR
flattened neck veins
clammy skin
dry oral mucous
delayed capillary refill
thirst
management of hypovolemia
consider usual maintenance requirements
oral or IV hydration
isotonic solutions
assess I&O, weight, VS, CVP, LOC, breath sounds, skin color
hypovolemia nursing diagnosis
fluid imbalance
impaired cardiac output
acute confusion
risk for seizures
potential: hypovolemic shock/multisystem organ failure
isotonic expansion of the ECF caused by abnormal retention of water and sodium
hypervolemia
clinical manifestations of hypervolemia
edema
distended neck veins
crackles, dyspnea
tachycardia, bounding pulse
increased BP, weight, urine output,
SOB
wheezing
AMS
seizures
S3
management of hypervolemia
- directed at the cause
- DC sodium containing fluids
- diuretics and restrict fluid
- pericentisis
hypervolemia (ECF volume excess) nursing diagnosis
-fluid imbalance
-impaired gas exchange
-impaired tissue integrity
-activity intolerance
-disturbed body image
-potential; pulmonary edema, ascites
sodium normal range
135-145
main cation of ECF
sodium
purpose of sodium in the body
controlling water distribution throughout the body because it does not easily cross intracellular membrane
acid base balance
muscle contraction
transmission of nerve impulses
how is sodium regulated
ADH
thirst
RAAS
clinical manifestations of hypernatremia
restlessness, AMS
thirst
edema
hypotension
incr. body temp
incr. DTR
weakness
disorientation
delusions
hallucinations
what does a pt with hypernatremia look like
flushed skin
edema
dry and swollen tongue
sticky mucous membranes
management for hypernatremia
oral hydration
hypotonic electrolyte solution
isontonic nonsaline solution (D5W)
hypernatremia nursing diagnosis
electrolyte imbalance
fluid imbalance
risk for injury
risk for seizures
manifestations of hyponatremia
HA
irritability
loss of focus
seizures
coma
confusion
death
nursing diagnosis for hyponatremia
-electrolyte imbalance
-acute confusion
-risk for injury
-risk for seizures
main cation of the ICF
potassium
impacts of potassium
neuromuscular function
cardiac rythyms
acid base balance
cellular growth
hyperkalemia is often caused by:
iatrogenic (treatment induced)
clinical manifestations of hyperkalemia
cardiac effects!!!
muscular weakness
paralysis of resp and speech muscles
nausea
colic
diarrhea
metabolic acidosis
confusion
nursing diagnosis of hyperkalemia
electrolyte imbalance
activity intolerance
impaired cardiac output
risk for dysrhythmias
management of hyperkalemia
restrict dietary potassium
cardiac monitoring!!
insulin and dextrose - help cellular exchange
calcium gluconate
risk factors for hypokalemia
diuretics
diarrhea
vomiting
gastric suction
recent ileostomy
intestinal drains
villous adenoma
decreased intake
low mag levels which stimulate renin and aldosterone = K excretion
DKA
clinical manifestations of hypokalemia
resp arrest
impaired insulin secretion - insulin pulls K into cell
fatigue
anorexia
nausea
vomiting
muscle weakness
leg cramps
decreased bowel motility
paresthesias
arrhythmias
nursing diagnosis of hypokalemia
electrolyte imbalance
activity intolerance
impaired cardiac output
risk for dysrhythmias
management of hypokalemia
cardiac monitoring!!
assessment of underlying cause
replace K with IV KCL
IV management
ECG monitoring
normal calcium range
8.5-10.5
major roles of calcium
bones and teeth
blood clotting
transmission of nerve impulses
cardiac and muscle contractions
calcium is regulated by:
absorbed from food
excreted by feces and urine
serum controlled by PTH and calcitonin
risk factors for hypercalcemia
malignancy
hyperparathyroidism
clinical manifestations of hypercalcemia
reduced neuromuscular excitability
muscle weakness
incoordination
anorexia
constipation
hypertension
elevated QT interval
nausea
vomiting
hallucination
seizures
dysrhythmias
nursing diagnosis of hypercalcemia
electrolyte imbalance
acute confusion
impaired physical mobility
risk for dysrhythmias
management of hypercalcemia
decreasing serum calcium
treat underlying cause
thiazides
IV fluids
0.9% sodium chloride solution
bisphosphonates - reduce breakdown of bone
fall risk
seizure precautions
heart monitoring
risk factors for hypocalcemia
pancreatitis
alcoholism
malnutrition
alkalosis
blood transfusions
taking aluminum-containing antacids, aminoglycosides, anticonvulsants, corticosteroids, loop diuretics
clinical manifestations for hypocalcemia
usually asymptomatic
tetany
convulsions
tingling
spasms
pain
dysphagia
Trousseau sign or Chvostek’s sign
management of hypocalcemia
neuro exam
seizure precaution
airway status
ECG monitoring
IV calcium
normal magnesium range
1.3-2.1
magnesium’s roles in the body:
activator for many intracellular enzyme systems
carb and protein metabolism
produces sedative effect
produce vasodilation
decreased total peripheral resistance
magnesium is regulated by:
eliminated by kidneys
GI system
risk factors for hypermagnesemia
kidney failure
lithium intoxication
adrenocortical insufficiency
addisons
hypothermia
excess use of antacids or laxatives
opioids
anticholinergics
lithium intoxication
clinical manifestations of hypermagnesemia
depress CNS
hypotension
N/V
urinary retention
paralysis and coma
weakness
soft tissue calcifications
facial flushing
lethargy
difficulty speaking
drowsiness
depressed respirations
increased potassium and calcium
nursing diagnosis of hypermagnesemia
eletrolyte imbalance
impaired physical mobility
risk for dysrhythmias
management of hypermagnesemia
avoid admin in pts with kidney failure
discontinue mag salts
cardiac monitoring
monitor DTR
emergencies: ventilator and IV calcium gluconate
loop diuretics
lactated ringers
risk factors for hypomagnesemia
insufficient food intake
diabetes
pancreatitis
nasogastric suctioning
diarrhea
fistulas
IBD
alcoholism
sepsis
burns
hypothermia
clinical manifestations of hypomagnesemia
hyperexcitability
dysrhythmias
muscle cramps
tremors
tetany
tonic clonic or focal seizures
laryngeal stridor
postive chvostek and trousseau signs
marked alterations in mood
management of hypomagnesemia
diet
oral or gluconate mag
mag sulfate IV
seizure precautions
swallow eval
IV additives for replacing electrolytes
KCL
CaCL2
MgSo4
HCO3
Large molecules that increase oncotic pressure and pull fluid into the blood vessels.
colloids
colloids that restore blood volume
albumin
FFP - clotting factors
blood
access devices
peripheral venous access
midline catheter
central venous access
nursing management when preparing for administration
review lab orders
gather supplies
choose site
clean catheter hub
flush for patency
start infusion per order
monitor pump, IV site, and pt
nursing management when preparing for administration
review lab orders
gather supplies
choose site
clean catheter hub
flush for patency
start infusion per order
monitor pump, IV site, and pt
potential local complications for IV therapy
Phlebitis
Infiltration
Thrombophlebitis
Hematoma
Catheter clotting
potential systemic complications
Fluid overload
Air embolism
Infection
Reaction
isotonic fluids
0.9% NS
LR
D5 25% NS
hypertonic fluids
shrinks cell size
D5LR
D5 1/2
D10W
Hypotonic fluids
enlarge cells
0.45% NS
D5W
