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Med Surg 1 > Fluid and electrolytes 1 > Flashcards

Fluid and electrolytes 1 Flashcards

1
Q

Hypotonic solution is to

A

Dilute ECF and rehydrate cells of hypertonic fluid imbalances.

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2
Q

Hypotonic solution

A

< 250 mEq/L

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3
Q

Solutions of hypotonic

A

D5W, 2.5% dextrose in water

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4
Q

Hypotonic solutions do what to cells

A

Cells swell

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5
Q

Do not give hypotonic solution to

A

Hypotension pt., infants, or patients with head injury

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6
Q

Isotonic solutions normal range is

A

250-375

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7
Q

Lactated Ringer’s and 0.9% NS is

A

Isotonic solutions

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8
Q

Isotonic solutions are for

A

Fluid rewsuscitation, keep vein open, dilute mess, expand volume

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9
Q

Hypertonic solutions is greater than

A

375

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10
Q

D10W, D5LR, and D51/2NS are all

A

Hypertonic solutions

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11
Q

Hypertonic solutions do what to cells

A

Shrink

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12
Q

Na is for

A

Volume replacement of hypertonic solutions

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13
Q

D51/2NS is fo

A

Severe hyponatremia and cerebral edema

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14
Q

Hypertonic solutions have to be infused

A

Slow

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15
Q

Be aware for checking patient that is given hypertonic solutions

A

BP,HR, lung sounds, urine output

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16
Q

Hyponatremia is

A

Low sodium in the cells to where water shifts for ECF to ICF

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17
Q

Euvolemic hyponatremia

A

Water increases, Na+ levels stays same

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18
Q

No edema

A

Na+ is diluted due to increase H2O levels

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19
Q

Hyponatremia causes

A

SIADH (syndrome of inappropriate antidiuretic hormone), DI ()diabetes insipidus), adrenal insufficency

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20
Q

Hyponatremia

A

Serum Na+ < 135mEq/L

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21
Q

Hyponatremia results from

A

Excess of water or loss of Na+

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22
Q

In Hyponatremia, water shifts from

A

ECF into cells

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23
Q

Hyponatremia you will have

A

No edema

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24
Q

Hypervolemia hypernatremia

A

Na+ and h20 levels increase in the body. Fluid volume overload.

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25
Q

Hypervolemia hypernatremia

A

Na+ and h2o levels are regulated differently and independently of each other in the human body

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26
Q

Causes of hypervolemia hypernatremia

A

CHF, kidney failure, excessive infusion of saline solution or liver failure.

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27
Q

Sodium-Na+ Range is

A

135-145 mEq/L

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28
Q

Is sodium a major cation or anion

A

Cation

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29
Q

Chief electrolyte of extra cellular fluid is

A

Na+

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30
Q

Cation is a positive or negative charge

A

Postive

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31
Q

Sodium regulates

A

Volume of body fluids by maintaining osmotic pressure

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32
Q

Sodium is needed for

A

Nerve impulse and muscle fiber transmission (Na/K pump)

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33
Q

Major muscle fiber that would be affected by sodium

A

Heart muscle

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34
Q

Sodium is regulated by

A

Kidneys/hormones

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35
Q

Sodium is

A

Outside of the cell in the ECF

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36
Q

Most common electrolyte disturbances is

A

Hyper and Hyponatremia

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37
Q

Hyper and Hyponatremia is

A

Most abundant in extracellular fluid and therefore more prone to fluctuation

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38
Q

Osmosis

A

Movement of water from an area of lesser to one of greater concentration through a semi-permeable membrane

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39
Q

Diffusion

A

Passive movement of electrolytes or other particles down the concentration gradient (from higher to lower concentration)

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40
Q

Filtration

A

Movement across a membrane, under pressure from a higher to lower pressure

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41
Q

Filcilatated diffusion

A

Carrier from higher to lower

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42
Q

Active transport

A

Metabolic energy is expended, movement from less concerntated solution to more concentrated one

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43
Q

Osmotic pressure

A

An inward-pulling force caused by particles in the interstitial and intracellular fluids

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44
Q

Hydrostatics pressure

A

The major force that pushes water out of the vascular system at the capillary level and into interstitial fluid

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45
Q

Extracellular fluid

A

Found outside the cells and accounts for about 1/3 of total body fluid

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46
Q

Intracellular fluid

A

Found within the cells of the body

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47
Q

Intravascular fluid

A

Plasma, accounts for approx 20% of the ECF

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48
Q

Interstitial fluid

A

Surrounds the cells, 75% of the ECF

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49
Q

Cation

A

Positively charged ion

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50
Q

Anion

A

Negatively charged ion

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51
Q

Causes of hyponatremia

A

“NO NA+”

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52
Q

“No NA+” N is

A

N-Na+ excretion increased with renal problems, NG suctioning, DI, aldosterone secretion, diuretics, sweating

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53
Q

“NO NA+” O is

A

Overload of fluids-CHF, hypotonic IVF, liver failure, will dilute sodiumm

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54
Q

“NO NA+” N is

A

Low intake of Na+, low Na+ diet, NPO, elderly

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55
Q

NO NA+” A is

A

Antidiuretic hormone over secreted

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56
Q

Signs and symptoms of Hyponatremia

A

“SALT LOSS”

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57
Q

” SALT LOSS” STANDS FOR

A

S-seizures and stupor
A-abdominal complaint, attitude change (confusion)
L-lethargic
T-tendon reflexes diminished, trouble concentration
L-loss of urine, appetite
O-orthostatic hypotension, overactive bowel sounds
S-shallow breathing late sign (shallow breathing, skeletal muscle weakness)
S-spasm of muscles

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58
Q

Nursing interventions for hyponaterima

A

Monitor cardiac, respiratory, neuro, renal and GI systems

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59
Q

Hypovolemic hyponaterima

A

Give IVF to restore balance of fluids and sodium (hypertonic solution; 3%), given too fast fluid volume overload.

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60
Q

Hypervolemia hyponatremia

A

Restrict fluids, possibly diuretics, renal failure-dialysis

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61
Q

SIADH

A

Restrict fluids, antidiuretic hormone antagonist; declomycin-not given with food especially dairy. Also conserves lithium when sodium levels are increased.

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62
Q

For sodium loss

A

Instruct patients to consume sodium rich foods. (Canned foods, bacon, table salt, processed foods)

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63
Q

What are some medical conditions that may cause a dilution all hyponatremia

A

Heart disease, renal disease, adrenal insufficiency

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64
Q

What are some conditions that might cause actual loss of sodium from the body

A

GI losses- nasogastric suctioning, vomiting, diarrhea
Certain diuretic therapies
Polydipsia

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65
Q

Permanent neurological damage can occur when serum Na levels fall below 120 mEq/L. Why?

A

Hypotonic environment swells cells, increasing ICP-brain damage

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66
Q

Hypernatremia Serum level Na+

A

> 145mEq/L

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67
Q

Hypernatremia results from

A

Na+ gained in excess of water Or Water is lost in excess of Na+

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68
Q

Hypernatremia water shifts from

A

Cells to ECF

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69
Q

S/S: hyperosmolity of ECF

A 
Cellular dehydration, 
thirst
dry mucous membranes and lips
Oliguyria
Increased temp and pulse
Flushed skin
Restlessness
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70
Q

Treatment of hypernatremia

A

IV therapy; hypotonic or isotonic solution

Diet

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71
Q

Causes of hypernatremia- HIGH SALT

A

H-hypercortisolism overproduction of cortisol (Cushings disease and hyperventilation)
I-increased salt (IV and oral)
G-GI tube feedings without adequate water supplements
H-hypertonic solutions (3% saline)

S-sodium excretion decrease (ex. Corticosteroids)
A-aldosterone problems (^ reabsorption)
L-loss of fluid (dehydration) fever, seweating
T- thirst impairment (access to clean water)

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72
Q

S/S of hyernatremia-No “FRIED” foods for you

A 
F-fever, flushed skin
R-restless, really agitated
I-increased fluid retention
E-edema, extremely confused
D-decreased urine output, dry mouth and skin
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73
Q

Nursing interventions for hypernatremia

A

Restrict Na+
Safety
MD order hypotonic or isotonic IVF (0.45% Na+)-give slowly (hydrating cells)-many cause cerebral edema
Educated patient about diet and S/S of increase sodium levels.

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74
Q

Potassium K+ serum level

A

3.5-5.0 mEq/L

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75
Q

Chief electrolyte of intracellular fluid is

A

Potassium K+

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76
Q

Potassium is the major mineral in

A

All cellular fluids

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77
Q

Potassium AIDS in

A

Muscle contraction,
nerve and electrical impulse conduction,
regulates enzyme activity,
Regulates intracellular fluid H2O content
Assists in acid-bade balance

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78
Q

Potassium is regulated by

A

Kidneys/hormones

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79
Q

Potassium is inversely proportional to

A

Na+- Sodium, too much or to little is deadly

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80
Q

Hypokalemia serum level

A

<3.5 mEq/L

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81
Q

Hypokalemia results from

A

Decreased intake, loss via GI/Renal and potassium depleting diuretics f

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82
Q

Hypokalemia is life threatening to

A

All body systems affected

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83
Q

S/S of Hypokalemia

A

Muscle weakness and leg cramps
Decreased GI motility
Cardiac Arrhythmias

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84
Q

Treatment of Hypokalemia is

A

Diet
Supplements
IV therapy-

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85
Q

Causes of hypokalemia “your body is trying to “DITCH potassium”

A

D-drugs (laxatives, diuretics, corticosteroids)
I-inadequate so sumptuous of Potassium (NPO, anorexia)
T-too much water intake (dilutes the potassium)
C-cushing’s syndrome (high secretion of aldosterone)
H-heavy fluid loss (NG suction, vomiting, diarrhea, wound drainage, sweating)
-(other causes: when the potassium moves from the extracellular to the intracellular with alkalosis or hyperinsulinism (this is where too much insulin in the blood and the patient will have symptoms of hypoglycemia).

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86
Q

7 L’s for hypokalemia

A
  • LETHARGY (confusion)
  • LOW, SHALLOW RESPIRATIONS (due to decreased ability to use accessory muscles for breathing)
  • LETHAL CARDIAC dysrhythmias
  • LOTS of urine
  • LEG cramps
  • LIMP muscles
  • LOW BP and Heart
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87
Q

Nursing interventions for hypokalemia

A

Watch heart rhythm (place on cardiac monitor…most already on telemetry), respiratory status, Nero, GI, urinary output and renal status (BUN and creatinine levels)
> watch other electrolytes like Magnesium (will also decrease…hard to get K+ to increase if Mag is low), watch glucose, sodium, and calcium all go hand-in-hand and play a role in cell transport
lad minister oral supplements for potassium with doctor’s order: usually for levels 2.5-3.5…give with food can cause GI upset
>IV potassium for levels less 2.5*****NEVER GIVE POTASSIUM VIA IV PUSH OR BY IM OR SUBQ ROUTES!!!!!!!!!!!
>Give according to the bag instruction don’t increase the rate…has to be given SLOW…patients given more than 10-20 mEq/HR should be on a cardiac monitor and monitored for EKG changes
lac use phlebitis or infiltrations
>don’t give LASIX, demanded, or thiazides (waste more Potassium) or Digoxin (cause digoxin toxicity) if potassium level low…notify MD for further orders)
>physician will switch patient to a potassium sparing diuretic Dpironolactone (Aldactone), Dyazide, Maxide, Triamterene.

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88
Q

For hypokalemia instruct patient to eat

A 
"Potassium" rich foods
P-POTATOES, PORK
O-ORANGES
T-TOMATOES
A-AVOCADOS
S-STRAWBERRIES
S-SPINACH
I-fIsh
U-mUSHROOMS
M-MUSK MELONS: CANTALOUPE
A-ALSO INCLUDED ARE: CARROTS, RAISINS, BANANAS
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89
Q

Potassium is dangerous when

A

It is too low! Serum K+ < 3.5mEq/L

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90
Q

What are some medical conditions that may cause hypokalemia

A

Renal disease,
Heart failure
Metabolic alkalosis

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91
Q

What are some conditions that might cause actual loss of potasaasium from the body

A

GI losses-nasogastric suctioning, vomiting, diarrhea

Certain diuretic therapies

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92
Q

Cardiac arrest may occur when serum K levels fall below 2.5 mEq/L. Why?

A

Increased cardiac muscle irritability leads to PACs and PVCs, then AF

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93
Q

Hyperkalemia serum level

A

> 5 mEq/L

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94
Q

Hyperkalemia results from

A 
Excessive intake, 
Trauma
Crush injuries
Burns
Renal failure
Adrenal insufficiency
Acidosis
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95
Q

S/S of hyperkalemia

A

Muscle weakness
Cardiac changes
N/V
Paresthesia of face/fingers/tongue

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96
Q

You treat hyperkalemia with

A

Diet
Med’s
IV therapy
Possible dialysis

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97
Q

Causes of hyperkalemia: the body “CARED” too much about potassium

A

C-cellular movement of potassium from intracellular to extracellular (burns, tissue damages, acidosis)
A- adrenal insufficiency with Addison’s Disease
R-renal failure
E-excessive potassium intake
D-drugs (potassium-sparing drugs like Aldactone (spiraled acetone), Triamterene, ACE inhibitors, NSAIDS (good at retaining)

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98
Q

S/S: “MURDER”

A

M-muscle weakness
U-urine production little or none (renal failure)
R-respiratory failure (due to the decreased ability to use breathing muscles or seizures develop)
D-decreased cardiac contractile the (weak pulse, low blood pressure)
E-early signs of muscle twitches/cramps…late profound weakness, flaccid
R-rhythm changes: Tall peaked T waves, flat p waves, widened QRS and prolonged PR interval

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99
Q

Hyperkalemia interventions;

A 
Monitor cardiac, respiratory, neuromuscular, renal, and GI status
> stop IV potassium if running and hold any PO potassium supplements
> initiate potassium restricted diet and remember foods that are high in potassium; "POTASSIUM"
-potatoes, pork
Oranges
Tomatoes
Avocados
Strawberries
Spinach
Fish
Mushrooms
Musk melons: cantaloupe
--Also carrots, raisins, bananas
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100
Q

For hyperkalemia instruct patient not to eat

A

Potassium rich foods, “POTASSIUM-A”

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101
Q

SIGNS of hyperkalemia

A 
Muscle twitches-> cramps-> paresthesia
Irritability and anxiety
Decreased BP
EKG changes
Dysrhythmias-irregular rhythm
Abdominal cramping
Diarrhea
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102
Q

What are some medical conditions that may cause hyperkalemia

A

Renal disease
Burns trauma
Metabolic acidosis

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103
Q

What are some conditions that might cause potassium levels to rise in the body

A

Certain diuretics

Excessive intake

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104
Q

Cardiac arrest may occur when serum K levels rise above? MEq/L. Why?

A

Decreased electrical impulse conduction leads to bradycardia and eventual a systole.

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105
Q

When administering IV potassium:

A

Monitor the IV sites for phlebitis
Place on cardiac monitor if > 10 mEq
Assure of adequate mixing of K in solution
Monitor for elevated K levels
Monitor for decreased Na levels
NEVER-administer potassium by slow IV push method

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106
Q

Calcium Ca+ total serum levels:

A

9-11 mg/deciliter, ionized calcium (in serum unbound) 4.25 to 5.25 mg/dL.

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107
Q

Calcium is most abundant

A

In the body but: 98-99% in teeth and bones

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108
Q

Calcium is needed for

A

Nerve transmission
Vitamin B12 absorption
Muscle contraction and blood clotting

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109
Q

Calcium has a inverse relationship with

A

Phosphorus

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110
Q

Calcium is needed for Vitamin D for

A

Gut

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111
Q

Calcium is needed for magnesium for

A

Bones

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112
Q

Hypocalcemia serum Ca level

A

< 9 mg/dL

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113
Q

Hypo alchemical results from

A 
Low intake,
Blood transfusions
Loop diuretics
Parathyroid disorders (decreased PTH)
Hypoalbuminemia
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114
Q

S/S: of hypocalcemia

A 
Osteomalacia
EKG changes
Numbness/tingling in fingers,
Muscle cramps/tetany
Seizures
Chovstek sign and Trousseau Sigh
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115
Q

Treatment for hypocalcemia

A

Diet/ IV therapy

116
Q

Calcium regulation;

A

Parathyroid detects Too little Ca in blood

Releases PTH,

117
Q

PTH assists in making

A

Vitamin D, reabsorption Ca in kidneys

Ca absorption in intestines and reabsorption from bones.

118
Q

chovstek

A

Twitching in cheek

119
Q

Trousaseau

A

Apply pressure hand curls up then Postive for low calcium

120
Q

What are a some medical conditions that may caused hypocalcemia

A

Hypoparathyroidism
Acute pancreatitis
Crohns diease
Hyperphosphatemia

121
Q

What are some other conditions that might cause low Ca

A

GI losses-nasogastric suctioning, bomiting, diarrhea, long term immobilization, lactose intolerance

122
Q

If hypocalcemia is prolonged

A

The body will utilize stored Ca from bones

123
Q

What complication might arise from hypocemia

A

Fractures ( late sign)

124
Q

Hypercalcemia serum level

A

> 11 mg/dL

125
Q

Hylpercalemia results from

A

Hyperarathyroidism
Bone Maligqancies
Prolonged immolation
Drug toxicity (lithium)

126
Q

S/S of hypercalcemia

A 
Muscle weakness
Renal calculus
Motility
Altered LOC
 Decreased GI motility
Cardiac c
Constipation
N/V
Polyuria
127
Q

Treatment of hypercalcemias

A

Medication/ IV therapy

128
Q

What are some medical conditions that. At cause hypercalcemia

A

Hyperparathyroidism
Paget’s disease
Some cancers-multiple myleoma
Chronic alcoholism

129
Q

What are some other conditions that might cause low Ca

A

Excessive intake of Ca or Vitamin D

Excessive intake of OTC antacids

130
Q

If hypercalcemia is unccorrected,

A

AV block and cardiac arrest may occur

131
Q

Magnesium Mg2+ serum level

A

1.5-2.5 mERq/L

132
Q

Magnesium is most located

A

Within intracellular fluid

133
Q

Magnesium is most needed for

A

Activating enzymes, electrical activity
Metabolism of carbs do/proteins
DNA synthesis

134
Q

Magnesium is reglulated by

A

Intestinal absorption and kidney

135
Q

Hypomagnesemia serum level

A

1.5 mEq/L

136
Q

Hypomagnesemia results from

A

Decreased intak,
Prolonged NPO status
Chronic alcoholism aND NASOGASTRIC SUCTIONING

137
Q

S/S: of hypomagnese

A

Muscle weakness
Cardiac changes
Mental changes
Hyperactive reflexes and other hypocalcemia S/S

138
Q

Treatment of hypomagnesemia

A

Replacement IV therapy restore normal Ca levels (Mg mimics Ca)
Seizure precations

139
Q

Hypomagnesemia is common in

A

Critically ill patients

140
Q

Hypomagnesemia is associated with

A

High mortality rates

141
Q

Hypomagnesemia

A

Increases cardiac irritability and ventricular dysthymia -especially in patients with recent MI

142
Q

Maintenance of hypomagnesemia

A

With adequate serum Mg has been shown to reduce mortality rates post MI

143
Q

Hypomagnesemia is

A

An uncommon variant of ventricular tachycardia

The rhythm is usually self-terminating but may degenerate into ventricular fibrillation

144
Q

Hypermagnesemia serum level is

A

> 2.,5 mEq/L

145
Q

Hypermagnesemia results from

A

Renal failure

Increased intake

146
Q

S/S do hypermagnesemia

A 
Flushing
Lethargy
Cardiac changes (decreased HR)
Decreased resp
Loss of deep tendon reflexes
147
Q

Treatment of hypermagnesemia

A

Restrict intake diuretic rx

148
Q

Chloride Cl- serum level

A

95-1-05 mEq/L

149
Q

The most abundant anion in extracellular fluid

A

Chloride Cl-

150
Q

Chloride maintains

A

Osmotic pressure
Acid-base balance
And AIDS in digestion (forming hydrochloride acid in then stomach

151
Q

Chloride is regulated by

A

Kidneys

152
Q

What is most always found with chloride

A

Sodium Na

153
Q

When serum level in < 95 mEq/L in chloride it is

A

Hypochloremia

154
Q

Hypochloremia results from

A

Prolonged vomiting, diarrhea and suctioning

155
Q

S/S of Hypochloremia are

A

Paresthesia of face and extreme ties
Muscle spasm
Tetany

156
Q

Treatment for Hypochloremia consist of

A

Diet

IV therapy

157
Q

Hyperchloremia starts at what serum level

A

> 105 mEq/L

158
Q

Hyperchloremia results from

A 
Diarrhea
Renal failure
Overactive parathyroid glands
Metabolic acidosis and
Respiratory alkalosis
159
Q

S/S of hyperchloremia are

A

Muscle weakness
Increased thirst
Kussmauls’s Respirations (short rapid Respirations)

160
Q

You treat hyperchloremia by

A

IV fluids
Diuretics
And treat the cause

161
Q

Interventions for fluid and electrolyte balance consist of

A 
Assess patient carefully-note changes
Monitor I &amp; O (intake &amp; output)
Monitor weight changes
Monitor urine
Monitor VS
Monitor lab results and dx test
Maintain proper IV therapy
162
Q

Sodium which is outside the cell in extracellular fluid consist of

A

90% of ECF cations

163
Q

Sodium has a

A

Positive charge

164
Q

Sodium always hangs out with its

A

Negative anion friends-chloride and bicarbonate

165
Q

Interstitial sodium surrounds

A

Cells of the body

Circulatory or inter vascular fluid for glucose

166
Q

Decreased Na is caused by

A

Dilution as a result of excess H2O or increase Na loss

167
Q

Some situations of hyponatremia

A 
Gastrointestinal suctioning 
Vomiting
Diuretics
Mannitol/fluid shift from ICF to ECF by hypertonic solutions which leads to dilution all Hyponatremia 
Inadequate salt intake
Diarrhea
168
Q

S/S of Hyponatremia

A 
Lethargy
headache
Confusion
Apprehension
Seizures
Coma
169
Q

The highest priority of life

A

Homeostasis

170
Q

Concept of homeostasis is

A

Dynamic processes involved in the maintenance of body functioning

171
Q

Homeostasis is

A

The way our internal body system responses to maintain stability or steady state

172
Q

Imbalance is

A

Not compatible with Life

173
Q

Homeostasis related to volume and composition of body fluids with which internal body organs

A

Kidneys
Heart and
Lungs

174
Q

Factors that are involved in helping to maintain the homeostasis of the volume of the vascular system are

A

Hormones such as antidiuretic hormone

The renin-angiotensin-aldosterone system and atrial natriuretic factor

175
Q

Homeostasis is

A

The state of dynamic equilibrium of the internal environment of the body that is maintained by the ever-changing process of feedback and regulation in response to external or internal changes

176
Q

Homeostasis is only stagnet at

A

Death

177
Q

Fluids in the body

A 
Blood
Serum
Saline
Albumin
Bile
Urine
Hormones
Cerebrospinal
178
Q

Electrolytes in the body are

A

Charged ions capable of conducting electricity

179
Q

Body fluid composition of water in infant is

A

70-80%

180
Q

Body fluid composition of water in older adults is

A

45-55%

181
Q

The average adult body fluid composition of water is

A

50-60%

182
Q

The Role of water is

A 
Medium for transport and &amp; exchange of nutrients
Medium for elimination of wastes
Medium for metabolic processes
Regulates body temperature
Insulation/lubrication
183
Q

Total body weight is determined

A

0.6 x body weight

184
Q

ECF fluid volume is

A

1/3 of total body weight

185
Q

ECF is further broken down to

A

Interstitial fluid with 3/4 of ECF
Plasma 1/4 fo ECF
Transcellular fluid

186
Q

Fluid compartments of ECF

A

Vascular-3 L
Interstitial- 1 L
Transcellular
And intracellular ICF- 28 L

187
Q

Fluid compartment output through

A 
Kidneys
Lungs
Feces
Sweat
Skin
188
Q

Ions is

A

A substance that when dissolved in water dissociates and becomes ions (charged)

189
Q

Cations:

A

Positively charged

190
Q

Anions:

A

Negatively charged

191
Q

Electrolytes

A

Work with fluids to keep the body healthy and in balance

192
Q

Electrolytes are

A

So lutes that are found in various concentrations and measured in terms of milliquivalent (mEq) units

193
Q

Electrolytes are typically

A

Gained and lost in equivalent amounts

194
Q

For homeostasis body needs:

A

Total body ANIONS = total body CATIONS

195
Q

Electrolytes in cations-positive charge

A

Sodium Na+- mental status
Potassium K+ - heart
Calcium Ca++- bones
Magnesium Mg++

196
Q

Most important electrolytes of cations are

A

Sodium
Potasaasium
Calcium

197
Q

Electrolytes in anions-negative charge

A

Chloride Cl-
Phosphate PO4-
Bicarbonate HCO3-

198
Q

Electrolyte imbalances are caused by

A

Abnormal losses; nasogastric suctioning
Hemorrhage
Vomiting and /or diarrhea

199
Q

Electrolyte imbalances are also caused by

A

Abnormal gains;
Polydipsia- overload fluid
Increased salt intake
Heart/kidney dysfunction

200
Q

Mechanisms of fluid and electrolyte movement

A

Diffusion
Osmosis
Filtration
And active transport

201
Q

Diffusion is

A

Passive movement of electrolytes or other particles down the concentration gradient (from higher to lower concentration

202
Q

Facilitated diffusion

A

Requires a carrier molecule

And accelerates rate of diffusion

203
Q

Filtration

A

Movement across a membrane under pressure from a higher to lower pressure

204
Q

Osmosis

A

Movement of water from an area of lesser to one of greater concentration through a semi-permeable membrane

205
Q

Active transport

A

Movement of ions against the osmotic pressure to an area of higher pressure: requires energy

206
Q

Two major factors regulate the movement of water and electrolytes from one fluid compartment to another they are

A

Hydrostatic pressure

And osmotic pressure

207
Q

Hydrostatic pressure

A

Arterial side pushing out to a lesser; vascular and capillary

208
Q

Osmotic pressure

A

Venous side sucking from lesser to higher; interstitial to vascular

209
Q

Cation in ICF

A

Potassium

Magnessium

210
Q

Cation in ECF

A

Sodium

Calicum

211
Q

Anion in ECF

A

Chloride

Bicarbonate

212
Q

Anion in ICF

A

Phosphorus

213
Q

Electrolytes in ECF are

A

Sodium chloride bicarbonate

Calicum

214
Q

Electrolytes in ICF are

A

Potassium
Magnessium
Phosphate

215
Q

Na and Cl form a

A

Perfect valance NaCl

216
Q

PO4- and Ca form a

A

Perfect valance

217
Q

Potassium K+

A

3.5-5

218
Q

Magnessium Mg+

A

1.5-2.5

219
Q

Sodium Na

A

135-145

220
Q

Calcium Ca

A

9-11

221
Q

Chloride Cl-

A

95-105

222
Q

Phosphate PO4-

A

2.5-4.5

223
Q

Bicarbonate HCO3-;buffer

A

22-26

224
Q

Serum osmolality

A

280-300 mOsm/kg

225
Q

Urine osmolality

A

200-800 mOsm/kg

226
Q

Urine specific gravity

A

1.005-1.030

227
Q

CBC

A

40-50 cells to plasma

228
Q

Molarity is

A

Fluid outside

229
Q

Maloality is

A

Fluid inside

230
Q

Osmotic pressure

A

An inward- pulling force caused by particles in the interstitial and intracellular fluids

231
Q

Any condition that changes osmotic pressure in either ICF or ECF compartments will cause a

A

Redistribution of water

232
Q

_________ is required to stop the osmotic flow of water

A

Pressure

233
Q

The major colloid in the vascular system contributing to the total osmotic pressure is

A

Protein (Albumin) = colloid osmotic pressure

234
Q

Hydrostatic pressure is the ________ force

A

Pushing

235
Q

Colloid Osmotic pressure is the _____ force

A

Pulling

236
Q

What represents the “push” and “pull” required to maintain homeostasis between the interstitial and intravascular spaces

A

Hydrostatic pressure and colloid osmotic pressure

237
Q

You have to be careful with patients with

A

CHF and Renal disease

238
Q

Osmosis molecules

A

Go through a semipermeable membrane; just water

239
Q

Molecules move around

A

To creat equilibrium

240
Q

Diffusion molecules

A

Spread out over a large area; everything but water

241
Q

First spacing

A

Normal distribution of fluid in ICFG and ECF

242
Q

Second spacing

A

Abnormal accumulation of interstitial fluid (edema)

243
Q

Third spacing

A

Most problematic; fluid accumulation in part of body where it is not easily exchanges with ECF

244
Q

Fluid shifts-plasma-to-interstitial fluid shift results in edema; causes

A

Elevation of hydrostatic pressure
Decrease in plasma colloid osmotic pressure
Elevation of interstitial colloid osmotic pressure

245
Q

Edema

A

Fluid build up under the skin

246
Q

Subcutaneous pitting edema

A

You can push on skin where fluid is accumulated and it keeps an indention.

247
Q

Fluid shifts- interstitial fluid to plasma

A 
Fluid drawn into plasma space with increase in plasma osmotic or colloid osmotic pressure
And 
Diuretics (pulls fluid into vascular) and compression stockings (pushes back into plasma) decrease peripheral edema
248
Q

Third-space fluid shift/third “spacing”

A

Loss of ECF into a space that does not contribute to equilibrium between ICF and ECF

249
Q

Examples of third spacing can be seen in

A 
As cites
Burns
Peritonitis
Bowel obstruction
Massive bleeding
Liver failure
250
Q

Belly and gut are

A

Very permeable

251
Q

Ascites

A

Abdominal swelling caused by accumulation of fluid, most often related to liver disease

252
Q

Fluid intake is regulated by

A

Thirst mechanism in the brain

253
Q

Fluid output is regulated by

A

Kidneys-skin-lungs-GI tract; urine, sweat, metabolism,

254
Q

Hormones are regulated by

A

ADH-Aldosterone

255
Q

Intake equals

A

Output

256
Q

Oral fluid intake daily

A

1200 mL

257
Q

Solid food intake daily

A

1000 mL

258
Q

Oxidative metabolism intake

A

300 mL

259
Q

Total intake per day

A

2500 mL

260
Q

Output of kidney/urine

A

1500 ML

261
Q

GI/feces

A

100 mL

262
Q

Insensible loss (SKIN/LUNGS)

A

900 ML

263
Q

Total output per dasy

A

250 mL

264
Q

Osmolality

A

Refers to the solute concerntration in fluid by weight. The number of millions old (mOsm/kg) in a kilogram of solution. Fluid inside the body.

265
Q

Osmolarity

A

Refers to the solute in concentration in fluid by volume. The number of milolosmols (mOsm/L) by liter. Pertains to fluids outside of the body.

266
Q

Changes in water content causes cells to

A

Either swell or shrink

267
Q

Normal serums (plasma) osmolality is

A

290mOsm/kg

268
Q

Toxicity of a solutions can be IV

A

Hypotonic, isotonic and hypertonic

269
Q

Hypotonic

A

< 250

270
Q

Isotonic

A

290 same as the normal plasma serum

271
Q

Hypertonic

A

> 375

272
Q

Lactate ringer LR

A

For fluid resecetation

273
Q

D5W

A

Is isotonic until it reaches the body then turns hypotonic

No babies or head injury patients

274
Q

0.9% NS NaCl

A

Expand volume, dilute medication and keep vein open

275
Q

Intravenous fluids can change the fluid compartments in one of the following ways:

A

Expand the intravascular compartment,
Expand the intravascular compartment and deplete then intracellular and interstitial compartments,
Expand the intracellular compartment and deplete the intravascular compartment

276
Q

Intravenous solutions of hypotonic and RBCs

A

Because inside is higher concentration it will swell

277
Q

RBSc in a isotonic solution will

A

Stay the same because of same concentration inside and outside

278
Q

RBSc in a hypertonic solution will

A

Shrink because inside concentration is less than outside of the cells

279
Q

Hypotonic solution has

A

Low osmolality in relation to plasma (<250)
Provides more weather than electrolytes
Dilutes the ECF and produces movement of water from the ECF to the ICF (moves water into the cells)

280
Q

Hypotonic solution is administered to expand the

A

Intracellular space. Commonly infused top dilute extracellular fluid and rehydrate the cells of patients who have hypertonic fluid imbalances and to treat gastric fluid loss and dehydration from excessive diuretics.

281
Q

Hypotonic solution

A

5% dextrose in water (this is technically isotonic, but once the dextrose is absorbed then it acts on the body as if it were hypotonic)
-0.45% NS
Do NOT GIVE TO HYPOTENSIVE PATIENTS

282
Q

Isotonic solutions

A

Have same osmolality in relation to plasma (290)
No fluid shifts
Expands the body’s fluid (extracellular fluid) flume without causing a fluid shift, replaces fluid loss, expands intravascular (plasma) volume

283
Q

Isotonic solution

A

0.9% NaCl

Lactate do Ringers solution

284
Q

Hypertonic solutions are

A

High osmolality in relation to plasma (>375)
Fluid shifts from ICF top ECF compartments
Draws water from the cells (ICF) into the vascular and interstitial spaces (ECF)
Used to treat patients who have severe Hyponatremia

285
Q

Hypertonic solutions

A 
D5NS- 5% dextrose in 0.9% sodium chloride
D5LR- 5% dextrose in lactate do ringers
D10W- 10%  dextrose
5% dextrose in 0.45%
Monitor patients closely.
286
Q

7 regulations of water balance in maintaining homeostasis

A 
Hypothalamic regulation
Pituitary regulation
Adrenal cortical regulation
Renal regulation
Cardiac regulation
Gastrointestinal regulation 
Insensible water loss

Med Surg 1 (2 decks)

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