Fluid and Electrolyte Lecture 1 Flashcards
0
Q
Tachycardia
This occurs in what fluid and electrolyte imbalance?
A
A: Dehydration
Study Tip: Tachycardia occurs because there is low blood volume and it is not enough to fill the large blood vessel. (Aka hypotension) The blood must flow faster to do the same amount of perfusion as a large amount of blood volume. Causes heart to beat more rapidly.
Ex. Occurs during a hemorrhage of blood.
1
Q
S3 develops
This occurs in what fluid and electrolyte imbalance?
A
A: Hypervolemia
Study Tip: This occurs as an adaptation to increased blood volume because the heart cannot fully empty the ventricles with only two heart beats. There are situations where even an S4 is needed.
3
Q
Dry skin
Dry mucous membranes
Poor skin turgor
This occurs in what fluid and electrolyte imbalance?
A
A: Dehydration
4
Q
Amount of Intake in 24 hours
Fluids?
Solids?
Oxidation?
A
A:
Fluids: 1,500 ml
Solids: 800 ml
Cellular Oxidation: 300 ml
5
Q
Elevated hematocrit
What does this lab mean in relation to fluid and electrolyte balance?
A
A: Dehydration
Study Tip: This occurs because there is a decreased amount of water with an increased amount of red blood cells.
6
Q
As a nurse you must make sure that __________ is not caused by a nursing action.
A
Hypervolemia
7
Q
Systemic Edema is caused by ________.
A
Right Sided Heart Failure
8
Q
Fluid Distribution between the Compartments accounts Extracellular Fluid (ECF) is ____ of body water.
A
A: 1/3
9
Q
Decreased urine output
This occurs in what fluid and electrolyte imbalance?
A
A: Dehydration
Study Tip: Urine Output is decreased because the kidneys are retaining water and salt to maintain the current fluid volume.
10
Q
__________occurs because the valves can’t handle the volume of blood that they are being forced to pump.
A
Heart Failure
11
Q
Fluid Distribution between the Compartments accounts Interstitial fluid _____ of extracellular fluid
A
A: 80%
12
Q
Excessive diaphoresis
What fluid and electrolyte imbalance does this cause?
A
A: Dehydration
Study Tip: sweating results in fluid loss
13
Q
What is a common disease that can cause sodium retention?
A
Hyperaldosteronism
Study Tip: This can turn into Hypervolemia because aldosterone is secreted to retain sodium and water.
14
Q
What controls intravascular hydrostatic pressure and tonicity?
A
Sodium, Albumin, Glucose
15
Q
Severe = IV fluid replacement
What fluid imbalance is this treatment used to treat?
A
A: Treatment: Dehydration
16
Q
What labs should the nurse monitor for when the patient is having vomiting and diarrhea?
A
Serum Potassium
17
Q
Low Concentration of Solutes in the vasculature causes fluid to go inside the blood cell due to oncotic pressure pulls fluid inside which causes the cell to swell because inside the cell is where there is a higher concentration of Solutes.
What solution has this effect on Blood Cells?
A
A: Hypotonic
18
Q
Why are Kussmaul Respirations slow and shallow?
A
To increase HCO3 in the serum to buffer the acidosis.
Study Tip: Kussmaul Resporations are ALWAYS seen in Metabolic Acidosis!!!
19
Q
Mental status changes
This occurs in what fluid and electrolyte imbalance?
A
A: Dehydration
Study Tip: This occurs because hypertonic blood pulls blood from the cells and interstitial and pulls them into the intravascular. This blood is pulled from the brain cells. The brain cells begin to shrink which causes your patient to have clinical manifestations as restlessness and anxiety.
20
Q
What 5 Body Systems Regulate Fluid Balance?
A
A: GI Hypothalamus Pituitary Renal Cardiac
21
Q
This is the body’s simplest mechanism for maintaining fluid balance and occurs even with small losses of fluid?
A
A: Thirst
22
Q
If replacing fluids give _______ solution first because _______ solution will pull out of cells into intravascular. Blood pressure will not be _________ by isotonic solution.
A
Isotonic
Hypertonic
increased
23
Q
GI: diarrhea, prolonged emesis, NG drainage
What fluid and electrolyte imbalance does this cause?
A
A: Dehydration
Study Tip:
diarrhea results in fluid loss of both sodium and potassium
Vomiting results in fluid loss of both sodium and potassium
Ng drainage has an output what results in fluid loss
24
Q
What is another word for Antidiuretic Hormone (ADH)?
A
A: Vasopressin
25
________ regulates fluid balance through a series of steps.
A: Anti-Diuretic Hormone
Study Tip: The hypothalamus sense low blood volume and increased serum osmolality and signals the pituitary gland to secrete ADH which is released and this causes the kidneys to retain water and sodium by preventing the body from urinating thus increasing fluid volume.
26
The ___________ senses low blood volume and increased serum osmolality
__________ signaled.
The pituitary gland secretes __________ into blood stream
This causes _________ to retain water
__________ increases.
__________ decreases.
Balance is maintained.
```
A:
Hypothalamus
Pituitary gland
AntiDiuretic Hormone
kidneys
Blood volume
Serum osmolality
```
27
During a fever water is ________ in the body to keep the body cool.
retained
28
Giving a patient a ________ solution pulls blood into intravascular which can kill cells if done too rapidly which will remove the water from the cell.
hypertonic
29
This compensatory mechanism is less effective in the elderly.
A: Thirst
30
Angiotensin II Causes _________
A. Vasoconstriction and stimulates the release of aldosterone to retain fluids and increase blood pressure.
Study Tip: Constriction of the blood vessels increases intravascular pressure, which increases blood pressure, and stimulates the release of aldosterone with makes the kidneys retain sodium and water.
31
When Blood flow to glomerulus _______
Juxtaglomerular cells secrete Renin into the _________. Renin travels to _______ and converts Angiotensinogen to Angiotensin 1. Angiotensin I travels to the ______ and converts to angiotensin II via angiotensin converting enzyme or ACE.
Angiotensin II works by constricting the blood vessels which increases vascular resistance. Angiotensin II travels to the ________ to stimulate aldosterone. Aldosterone Increases resorption of _________ within the nephrons
_______ of water leads to increased fluid volume which increases blood pressure. When blood pressure normalizes this feedback cycle ends.
```
A:
Decreases
blood stream
liver
lungs
adrenal glands
sodium and water
Retention
```
32
Increased fluid volume causes _________.
A. Increased blood pressure
33
Brain Natriuretic Peptide (BNP)
| Is also called?
A: B-type natriuretic peptide
34
Diabetes Insipidus
| What fluid and electrolyte imbalance does this cause?
A: Dehydration
Study Tip: excretes mass amounts of unconcentrated urine forcing the body to retain sodium.
35
What is secreted by ventricles of the heart in response to stretching?
A: Brain Natriuretic Peptide (BNP)
36
________ is a cardiac hormone.
A: Brain Natriuretic Peptide (BNP)
37
What is the Brain Natriuretic Peptide (BNP) Normal lab range?
A:
38
Avoid administering hypertonic solutions
| What fluid imbalance is this treatment used to treat?
A: Treatment: Dehydration
39
This is a cardiac hormone involved in fluid volume balance. Stored in atrial cells, it is released when pressure increases.
This counteracts the effects of renin-angiotensin-aldosterone system by reducing intravascular blood volume and dropping blood pressure.
A: Atrial Natriuretic Peptide (ANP)
Rationale: FYI
40
What is a common lab used to assess heart failure?
A: Brain Natriuretic Peptide (BNP)
Rationale: Also elevated in people with left ventricular failure
42
Without treatment BP decreases and cardiac output decreases
| This occurs in what fluid and electrolyte imbalance?
A: Hypervolemia
49
This occurs when fluid loss exceeds fluid gained?
A: Dehydration
49
What is the effect of the loss of body fluids on blood tonicity?
A: increase blood solute concentration (Increased tonicity)
50
Fistulas
| What fluid and electrolyte imbalance does this cause?
A: Dehydration
Study Tip: fistula have a large amount of drainage since it is a joke between the bowel and bladder and the outside world.
51
Suppresses serum renin levels
Decreases aldosterone release by the adrenals
Increases glomerular filtration rate increasing excretion of sodium and water
Decreases ADH release
Causes vasodilation thereby reducing vascular resistance
A: Atrial Natriuretic Peptide (ANP)
Rationale: FYI
52
What is the effect of the loss of body fluids on a cellular level?
A:
Fluid shifts from inside cells to inside blood
Cells shrink
Cellular function impaired
53
Cells need water to do what three things?
A:
Obtain nutrients
Expel waste
Maintain shape
54
What increases blood pressure, and stimulates the release of aldosterone?
Angiotensin II
55
Elevated serum osmolality
| What does this lab mean in relation to fluid and electrolyte balance?
A: Dehydration
Study Tip: Increased osmolality is a signal that there is an increase in the concentration of solutes in the fluid. If decreased osmolality that signals that there is more fluid than particles in the blood.
56
Infant patients
| What fluid and electrolyte imbalance can this be a risk factor for?
A: Dehydration
Study Tip: Infants are reliant on the nurse and mother for fluid replacement.
56
Elevated sodium
| What does this lab mean in relation to fluid and electrolyte balance?
A: Dehydration
57
Decreased serum osmolality
| What does this lab mean in relation to fluid and electrolyte balance?
A: Hypervolemia
Study Tip: decreased osmolality in the blood means that their is a low concentration of Solutes in the blood aka the blood is dilute. It would only be dilute if there was a large amount of fluid in the intravascular.
58
Anything that accelerates fluid loss in the body
| What fluid and electrolyte imbalance does this cause?
A: Dehydration
59
Hypotonic solutions preferred
Replace slowly to avoid cell swelling
What fluid imbalance is this treatment used to treat?
A: Treatment: Dehydration
60
Low hematocrit, Low K+, and Low BUN
| What does this lab mean in relation to fluid and electrolyte balance?
A: Hypervolemia
61
If replacing fluids give solution second because it moves blood out of the intravascular into the cells. This can only be done after the blood pressure is balanced previously by the ________ solution.
hypotonic
isotonic
Study Tip:
Use Isotonic Solution 1st
Use Hypotonic Solution 2nd
62
Do not confuse pituitary gland with_______?
A:
PARATHYROID GLAND SECRETES CALCIUM
PITUITARY GLAND SECRETES ADH
62
______ occurs when there is an excess of isotonic fluid.
A: Hypervolemia
Study Tip: This can be caused by IV therapy or a blood/plasma transfusion.
63
Medication: Diuretics
| What fluid and electrolyte imbalance does this cause?
A: Dehydration
Study Tip: diuretics cause dehydration by increasing fluid volume loss
63
Rapid, bounding pulse
| This occurs in what fluid and electrolyte imbalance?
A: Hypervolemia
Study Tip: why?
64
When Blood flow to ______ drops
_________ cells secrete _______ into the blood stream which travels to liver and converts _________ to __________.
This travels to the lungs converts to angiotensin II via ________
Angiotensin II travels to the adrenal glands to stimulate __________.
This increases resorption of sodium and water within the _________. Retention of water leads to increased fluid volume. Increased fluid volume = _____________. When blood pressure normalizes this feedback cycle ends.
```
A:
Glomerulus
Juxtaglomerular
Renin
Angiotensinogen to Angiotensin 1
angiotensin converting enzyme or ACE
aldosterone
nephrons
increased blood pressure
```
64
Medication: Laxatives
| What fluid and electrolyte imbalance does this cause?
A: Dehydration
Study Tip: laxatives cause dehydration because the patient will have diarrhea and that causes fluid volume loss.
65
Hypotension
| This occurs in what fluid and electrolyte imbalance?
A: Dehydration
Study Tip: This occurs because of the low intravascular volume which is the same as low blood pressure.
66
Kidneys that can’t concentrate urine
| What fluid and electrolyte imbalance can this be a risk factor for?
A: Dehydration
Study Tip: the patient is dehydrated because the kidneys can't concentrate urine meaning that the Solutes that should have been excreted in the urine is still in the blood stream because the kidney is not filtering properly.
66
Fever
| This occurs in what fluid and electrolyte imbalance?
A: Dehydration
Study Tip: fever causes the body to increase fluid volume loss through sweating.
67
Salty foods dry oral mucosa stimulating the thirst center in the ________.
A: Hypothalamus
68
Weight loss
| This occurs in what fluid and electrolyte imbalance?
A: Dehydration
Study Tip: Weight loss and Weight gain shows fluid gained and fluid lost. Fluid volume is balanced by excretion and retention of fluids.
69
Same Concentration of Solutes as Blood. Cell remains the same because concentration is balanced.
What solution has this effect on Blood Cells?
A: Isotonic
70
Distended veins
| This occurs in what fluid and electrolyte imbalance?
A: Hypervolemia
Study Tip: veins are distended because of the excess blood volume is filling up the blood vessels
72
Increased blood pressure
| This occurs in what fluid and electrolyte imbalance?
A: Hypervolemia
Study Tip: blood pressure increases because blood volume is too high. The vessels are full of fluid which is increasing the pressure. Could be full of Solutes which is drawing in more fluid.
75
Increased urine specific gravity
| What does this lab mean in relation to fluid and electrolyte balance?
A: Dehydration
Study Tip: increased specific gravity is like an increased weight. The more weight the more higher the concentration of Solutes. If there is a large amount of Solutes that means that the urine is not dilute. The patient would be considered dehydrated. Urine would be dark and foul smelling.
76
Highly concentrated tube feedings without additional water
| What fluid and electrolyte imbalance can this be a risk factor for?
A: Dehydration
Study Tip: tube feeds have a concentrated amount of sodium, albumin, and glucose which are all hypertonic which will draw fluid out of the cells into the blood stream.
78
What is the Hematocrit testing for?
Total amount of concentrated blood.
| Too little fluid circulating in the blood.
79
Seizures
| This occurs in what fluid and electrolyte imbalance?
A: Dehydration
Study Tip: ask why? Seizures occur do to Hyponatremia because the brain cells swell due to cells losing gaining water from fluids leaving the intravascular.
80
Comatose or Bedridden patient
| What fluid and electrolyte imbalance can this be a risk factor for?
A: Dehydration
Study Tip: unable to get a drink on their own. Don't like the drink, don't like ice water, and doesn't get passed fresh ice water each shift.
81
_________ occurs when compensatory mechanisms fail. May result in heart failure and pulmonary edema.
A: Hypervolemia
Study Tip: this is caused by sodium and water retention.
82
```
Amount of Output in 24 hours
Kidneys?
Lungs?
Skin?
Intestines?
```
```
A:
Kidneys: 1,500 ml
Lungs: 400 ml
Skin: 600 ml
Intestines: 100 ml
```
83
Describe the levels of Tonicity
Hypertonic?
Isotonic?
Hypotonic?
1. High Concentration of Solutes per volume (High Tonicity)
2. Same Concentration of Solutes as Blood (Balanced Tonicity)
3. Low Concentration of Solutes per volume (Low Tonicity)
83
The hypothalamus senses _________ and _________.
This signals the pituitary gland to secrete ______ into blood stream which causes kidneys to ________
Blood volume _______.
serum osmolality _______.
Balance is maintained.
```
A:
low blood volume
increased serum osmolality
AntiDiuretic Hormone
retain water
increases
decreases
```
84
2/3 of fluid loss is _________.
Insensible
85
Edema in the Tissues and the Lungs
| This occurs in what fluid and electrolyte imbalance?
A: Hypervolemia
Study Tip: fluid overload will result in ronchi and crackles in the lungs.
86
Pulmonary congestion on X-ray
| What does this lab mean in relation to fluid and electrolyte balance?
A: Hypervolemia
Study Tip: fluid overload results in ronchi and crackles in the lungs
87
__________ retains H2O and NaCl- to maintain fluid balance.
Aldosterone
88
What are two common diseases that can cause fluid retention?
Heart Failure
Hepatic Cirrhosis
Study Tip: HF results in Hypervolemia because the body cannot pump the large amount of fluid in the body.
Cirrhosis results in hypervolemia because why?
89
Angiotensin I converts to Angiotensin II with the help of what enzyme?
Angiotensin Converting Enzyme
90
Pulmonary Edema is caused by __________.
Left Sided Heart Failure
91
Elderly
| What fluid and electrolyte imbalance can this be a risk factor for?
A: Dehydration
Rationale: Due to low body water content, decreased renal/kidney function, and decreased thirst
Study Tip: Encourage elderly to drink even if not thirsty.
91
Prolonged fever
| What fluid and electrolyte imbalance does this cause?
A: Dehydration
Rationale: Loss of water while sweating
92
Medications to prevent heart failure and pulmonary edema
| What fluid imbalance is this treatment used to treat?
A: Hypervolemia
Study Tip: ask teacher why?
93
Hyperglycemia
| What fluid and electrolyte imbalance does this cause?
A: Dehydration
Study Tip: increased blood glucose draws fluid from the interstitial and cells into the intravascular which results in dehydration.
94
Dizziness, weakness, extreme thirst
| This occurs in what fluid and electrolyte imbalance?
A: Dehydration
Study Tip: Dizziness and Weakness is an effect of the brain cells shrinking due to lack of fluid which usually results in hypernatremia. Extreme thirst is a normal bodily reaction to dehydration.
95
What constricts the blood vessels, increases intravascular pressure?
Angiotensin II
96
Fluid and sodium restriction
| What fluid imbalance is this treatment used to treat?
A: Hypervolemia
Study Tip: this is used to treat hypervolemia because sodium retains water added to more fluid volume increase.
97
Confused patient
| What fluid and electrolyte imbalance can this be a risk factor for?
A: Dehydration
Rationale: don't know how to drink, unable to recognize thirst and may not be able to get a drink on their own.
98
Treat cause of _________ and any complications.
A: Hypervolemia
99
Decrease Blood Pressure
and
Decreased Fluid Volume
have what effect on fluid and electrolyte imbalance?
Decreased Blood Flow to Kidneys and Glomerulus causing Blood Flow to Decrease which stimulates the Renin-Angiotensinogen-AngiotensinI-ACE-AngiotensinII-Aldosterone-Kidney-Fluid Retention System
100
________ is required for the body to function.
Fluid balance
101
2/3 of fluid loss is ________.
insensible
102
On hot days when you drink a lot of water your urine production decreases because the ________ tells your body to release ________ to retain water and sodium to prevent dehydration and increase _________.
pituitary gland
aldosterone
Blood pressure
103
Increased water in the blood means that ______ in the blood are decreased.
Solutes
104
Dehydration means their is a decrease in _______ in the body.
Water
105
Renin turns __________ into Angiotensin I.
angiotensinogen
106
If your patient is restless and they do not have a fluid and electrolyte imbalance what would be the nurses next priority assessment?
Oxygenation
107
If a patient that is elderly SUDDENLY becomes confused what would be the nurses priority assessment?
Fluid and electrolyte imbalance.
Study Tip: Second would be UTI
108
________ can cause dehydration but it can also be a symptom of dehydration.
Fever
109
How does a nurse rehydrate a patient?
Naturally is the 1st priority.
Study Tip: Give supplements orally because the body can take it better.
110
If client has fluid volume excess what intervention should the nurse implement?
Restrict sodium in their diet.
111
When doing a TPN feeding what should the nurse implement?
Place the solution on an IV pump at the prescribed rate.
Monitor Blood glucose every 6 hours
Monitor Intake and Output every shift
Change the IV tubing with every bag.
Monitor weight daily first thing in the morning
Study Tip: You would monitor glucose daily because TPN nutrition is made up of 56% dextrose which is a sugar.
112
Sodium in the blood moves fluid where?
In the blood stream
113
Fluid Distribution between the Compartments accounts Intracellular Fluid (ICF) as ____ of body water.
A: 2/3
114
Fluid Distribution between the Compartments accounts Plasma as ____ of extracellular fluid
A: 20%
114
Transcellular fluid a.k.a. ________ normally ignored in calculations. These fluids are contained inside organs, such as gastrointestinal, cerebrospinal, peritoneal, and ocular fluids.
A: third spacing
114
High Concentration of Solutes in the vasculature causes fluid to leave the inside of the cell due to oncotic pressure which causes the cell to shrink.
What solution has this effect on Blood Cells?
A: Hypertonic
114
Renal failure
| What fluid and electrolyte imbalance does this cause?
A: Dehydration
Rationale: inability to concentrate urine check ppt
114
Replace missing fluids.
Oral replacement preferred
What fluid imbalance is this treatment used to treat?
A: Treatment: Dehydration
Study Tip: oral replacement preferred because it is more natural its best to let the body fix itself that to force it and risk causing cellular damage
115
What electrolyte imbalance is always respiratory acidosis?
Hyperkalemia
Study Tip: These are life threatening events.
