Fluid and Electrolytes Flashcards
What is Fluid
Fluid is necessary for life and homeostasis. 60% of the human body is fluid. It exists in two compartments Extracellular (outside the cell) & Intracellular (inside the cell). 2/3 of the fluid is in the intracellular space.
What are Electrolytes?
Active ions that carry charges.
Cations are Na+, Ca+, K+, Mg+
Anions are Cl-, HC03-, P04-
Concentrations vary depending on the compartment
Magnesium Lab Value
1.8 -2.6
Sodium Lab Value
135-145
Potassium Lab Value
3.5-5
Calcium Lab Value
8.8-10.4
Phosphate Lab Value
2.5-4.5
Chloride Lab Value
98-106
Regulation of Fluid
Movement of fluid through capillary walls depends on differences of hydrostatic & osmotic pressure.
Osmotic Pressure
Movement of fluid from a greater concentration to a lower concentration
Hydrostatic Pressure
pressure exerted on the walls of the blood vessel
What is the difference between hypotonic and hypertonic?
Hypotonic- hydrates the cell
Hypertonic - Fluid moves out of the cell
Lifespan Consideration for Infants and Children (Less than 2 yr.)
Infants have an increased risk of fluid and electrolyte imbalance because they have a higher respiratory rate & metabolic rate and immature kidneys. When infants are FVD their mucous membranes are dry, sunken soft spot and become lethargic.
***AT MOST RISK is preterm infants because of immature kidneys effect their ability to concentrate urine
Lifespan Consideration for Older Adults
The thirst sensation in the elderly is blunted resulting in decreased fluid intake. Decrease body mass which decreases the amount of water in the body. Decreased renal reserve due to decrease in the number of nephrons.
What is a consideration with gender?
Males have a decreased amount of fat in comparison to females. Fat= water content
What is a consideration for African Americans?
They have increased sensitivity to salt.
What are causes of Fluid Volume Deficit?
Vomiting
Diarrhea
Decreased fluid intake
Third space fluid shifts- which fluid becomes inaccessible to the body ex- Burns
Clinical Manifestations of Fluid Deficit
Thirst
Dizziness & Decreased LOC (water shift outside brain cells)
Weight Loss - of 1kg or more withing 24 hr.
Low blood pressure
Flat neck veins
Rapid thready pulse
Decreased skin turgor
Treatments for Fluid Volume Deficit
Encourage Fluid Intake Antiemetic via IV Oral hygiene and lubricating lips Education on prevention of fluid loss Monitor labs to assess kidney function
What is Fluid Volume Excess?
abnormal retention of water and sodium
What causes Fluid Volume Excess?
Heart failure Kidney Injury Cirrhosis of the liver TOO much SALT Excess administration of sodium containing fluids
Clinical Manifestation of Fluid Volume Excess
BIG AND BLOATED Dependent Edema Bounding pulses Distended Neck Veins Elevated blood pressure Weight Gain **** REQUIRED: Na+ restriction
Treatment for Fluid Volume Excess
Assess I &O, daily weight, auscultate lung sound (crackles), edema
Monitor response to diuretics and parenteral fluids
Teach pt. adherence to fluid restrictions and decreased sodium intake
Monitor and avoid sources of excessive sodium intake including medications (Corticosteroids)
Promotes rest
Hyperkalemia
TIGHT & CONTRACTED Decreased LOC Hypotension & bradycardia Diarrhea & hyperactive bowels Paralysis in extremities Decreased DTR
Hyperkalemia Treatment & Causes & Diets
Treatment- A-Assess EKG/ABG I-IV potassium chloride ***NEVER IV PUSH*** D-Diet Causes G-GI loss (vomiting) O-Osmotic diuresis T-Thiazides & loop diuretics S-Severe acid imbalance H-Hyperaldosteronism O-Other medications (corticosteroids) T-Transcellular shift Diet Oranges Dried fruits Tomatoes Avocados Dried peas Meats Broccoli Bananas Dairy products Whole grans
Hypokalemia
LOW & SLOW Cardiac dysthymias Shallow respirations Irritability Confused & Lethargic Flaccid limbs - skeletal muscle weakness Hypoactive Bowel - paralytic ileus
Hypernatremia
BIG & BLOATED Flush, red and rosy Edema & low-grade fever Polydipsia- Thirsty Severe Symptoms- swollen furrowed tongue, N/V, decreased muscle tone
Hyponatremia
DEPRESSED & DEFLATED Seizures and Coma Tachycardia & weak thready pulses Hypotension Respiratory arrest ***REQUIRES FLUID RESTRICTION
What is the relationship between Sodium & Chloride?
They are BESTIES! If sodium is LOW chloride is LOW
Hyperchloremia
N/V
Swollen dry tongue
Confusion
Hypochloremia
Diarrhea
Vomiting
Sweating
Fever
Magnesium
Magnesium acts like LAW & ORDER in the muscle and keeps the peace. Required for calcium and vitamin D absorption. Magnesium and Calcium are BESTIES!
Hypermagnesemia
Calm & Quiet Bradycardia & Hypotension Decreased DTR Deep shallow respirations GI is Calm & Quiet
Hypomagnesemia
BUCK WILD Tachycardia & Dysrhythmia's Increased DTR - Hyperreflexia EYE- nystagmus (dancing eyes) GI- diarrhea ***AT RISK: Chronic alcoholics
What is the relationship between calcium & Phosphate?
Calcium and Phosphate are ENEMIES
They operate inversely if Ca is HIGH —- P04 is LOW
P04 is HIGH —— Ca is LOW
Calcium keeps BONES, BLOOD & BEATS strong!!!!
Hypercalcemia
SWOLLEN & SLOW MOANS- constipation GROANS- Bone pain STONES- kidney stones Decreased DTR & muscle weakness
Hypocalcemia
Trousseau Sign - arm twerk with blood pressure cuff
Chvostek’s Sign - smile stroking the cheek
Diarrhea
Tingling around the mouth
AT RISK FOR BONES, BEAT AND BLOOD
Hyperphosphatemia
Trousseau Sign - arm twerk with blood pressure cuff
Chvostek’s Sign - smile stroking the cheek
Diarrhea
Weak 3 B’s
Hypophosphatemia
Constipation Decreased DTR Severe muscle weakness Decreased HR & RR Increased BP
Independent Nursing Interventions Fluid & Electrolyte Imbalances
Provide safety & comfort (PT with altered LOC)
Fluid Restrictions- Swish and Spit
Oral hygiene- moisturize lips
Keeping fluids out of sight
Na+ restriction - altered taste buds, encourage herbs and spices
Encourage appropriate fluids at the pt. preferred temperature
Prevention - encourages pt. to monitor their I&O and to appropriately replace what is lost
Furosemide
Loop Diuretic
Hypokalemia, volume depletion, hypotension, CNS effects, GI upset, hyperglycemia
Bumetanide
Loop Diuretic
Hypokalemia, volume depletion, hypotension, CNS effects, GI upset, hyperglycemia
Torsemide (Demadex)
Loop Diuretic
Hypokalemia, volume depletion, hypotension, CNS effects, GI upset, hyperglycemia
Hydrochlorothiazide (HCTZ)
Thiazide
GI upset, CNS complications, hypovolemia
