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Patient Centered Care I > Fluid and Electrolytes > Flashcards

Fluid and Electrolytes Flashcards

1
Q

What is Fluid

A

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.

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2
Q

What are Electrolytes?

A

Active ions that carry charges.
Cations are Na+, Ca+, K+, Mg+
Anions are Cl-, HC03-, P04-
Concentrations vary depending on the compartment

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3
Q

Magnesium Lab Value

A

1.8 -2.6

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4
Q

Sodium Lab Value

A

135-145

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5
Q

Potassium Lab Value

A

3.5-5

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6
Q

Calcium Lab Value

A

8.8-10.4

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7
Q

Phosphate Lab Value

A

2.5-4.5

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8
Q

Chloride Lab Value

A

98-106

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9
Q

Regulation of Fluid

A

Movement of fluid through capillary walls depends on differences of hydrostatic & osmotic pressure.

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10
Q

Osmotic Pressure

A

Movement of fluid from a greater concentration to a lower concentration

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11
Q

Hydrostatic Pressure

A

pressure exerted on the walls of the blood vessel

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12
Q

What is the difference between hypotonic and hypertonic?

A

Hypotonic- hydrates the cell

Hypertonic - Fluid moves out of the cell

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13
Q

Lifespan Consideration for Infants and Children (Less than 2 yr.)

A

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

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14
Q

Lifespan Consideration for Older Adults

A

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.

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15
Q

What is a consideration with gender?

A

Males have a decreased amount of fat in comparison to females. Fat= water content

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16
Q

What is a consideration for African Americans?

A

They have increased sensitivity to salt.

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17
Q

What are causes of Fluid Volume Deficit?

A

Vomiting
Diarrhea
Decreased fluid intake
Third space fluid shifts- which fluid becomes inaccessible to the body ex- Burns

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18
Q

Clinical Manifestations of Fluid Deficit

A

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

19
Q

Treatments for Fluid Volume Deficit

A 
Encourage Fluid Intake 
Antiemetic via IV 
Oral hygiene and lubricating lips 
Education on prevention of fluid loss 
Monitor labs to assess kidney function
20
Q

What is Fluid Volume Excess?

A

abnormal retention of water and sodium

21
Q

What causes Fluid Volume Excess?

A 
Heart failure 
Kidney Injury 
Cirrhosis of the liver 
TOO much SALT 
Excess administration of sodium containing fluids
22
Q

Clinical Manifestation of Fluid Volume Excess

A 
BIG AND BLOATED 
Dependent Edema 
Bounding pulses 
Distended Neck Veins 
Elevated blood pressure 
Weight Gain
**** REQUIRED: Na+ restriction
23
Q

Treatment for Fluid Volume Excess

A

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

24
Q

Hyperkalemia

A 
TIGHT & CONTRACTED 
Decreased LOC 
Hypotension & bradycardia 
Diarrhea & hyperactive bowels  
Paralysis in extremities 
Decreased DTR
25
Q

Hyperkalemia Treatment & Causes & Diets

A 
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
26
Q

Hypokalemia

A 
LOW & SLOW 
Cardiac dysthymias 
Shallow respirations 
Irritability 
Confused & Lethargic 
Flaccid limbs - skeletal muscle weakness
Hypoactive Bowel - paralytic ileus
27
Q

Hypernatremia

A 
BIG & BLOATED 
Flush, red and rosy
Edema & low-grade fever
Polydipsia- Thirsty 
Severe Symptoms- swollen furrowed tongue, N/V, decreased muscle tone
28
Q

Hyponatremia

A 
DEPRESSED & DEFLATED 
Seizures and Coma 
Tachycardia & weak thready pulses
Hypotension
Respiratory arrest
***REQUIRES FLUID RESTRICTION
29
Q

What is the relationship between Sodium & Chloride?

A

They are BESTIES! If sodium is LOW chloride is LOW

30
Q

Hyperchloremia

A

N/V
Swollen dry tongue
Confusion

31
Q

Hypochloremia

A

Diarrhea
Vomiting
Sweating
Fever

32
Q

Magnesium

A

Magnesium acts like LAW & ORDER in the muscle and keeps the peace. Required for calcium and vitamin D absorption. Magnesium and Calcium are BESTIES!

33
Q

Hypermagnesemia

A 
Calm & Quiet 
Bradycardia & Hypotension 
Decreased DTR 
Deep shallow respirations 
GI is Calm & Quiet
34
Q

Hypomagnesemia

A 
BUCK WILD 
Tachycardia & Dysrhythmia's 
Increased DTR - Hyperreflexia 
EYE- nystagmus (dancing eyes) 
GI- diarrhea
***AT RISK:  Chronic alcoholics
35
Q

What is the relationship between calcium & Phosphate?

A

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!!!!

36
Q

Hypercalcemia

A 
SWOLLEN & SLOW 
MOANS- constipation 
GROANS- Bone pain
STONES- kidney stones
Decreased DTR & muscle weakness
37
Q

Hypocalcemia

A

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

38
Q

Hyperphosphatemia

A

Trousseau Sign - arm twerk with blood pressure cuff
Chvostek’s Sign - smile stroking the cheek
Diarrhea
Weak 3 B’s

39
Q

Hypophosphatemia

A 
Constipation 
Decreased DTR 
Severe muscle weakness 
Decreased HR & RR 
Increased BP
40
Q

Independent Nursing Interventions Fluid & Electrolyte Imbalances

A

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

41
Q

Furosemide

A

Loop Diuretic

Hypokalemia, volume depletion, hypotension, CNS effects, GI upset, hyperglycemia

42
Q

Bumetanide

A

Loop Diuretic

Hypokalemia, volume depletion, hypotension, CNS effects, GI upset, hyperglycemia

43
Q

Torsemide (Demadex)

A

Loop Diuretic

Hypokalemia, volume depletion, hypotension, CNS effects, GI upset, hyperglycemia

44
Q

Hydrochlorothiazide (HCTZ)

A

Thiazide

GI upset, CNS complications, hypovolemia

Patient Centered Care I (2 decks)

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