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fluid and electrolytes Flashcards

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1
Q

describe intracellular

A

-in the cell
-ICF is critical for maintaining cell size
-70% of total body fluid
-about 40% of adult body weight is from ICF

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2
Q

describe extracellular

A

-outside cell
-30% of total body fluid and ~20% of body weight

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3
Q

describe intravascular fluid

A

plasma of the blood -> blood volume, impacts HR and BP

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4
Q

describe interstitial fluid

A

surrounds cells (like tissue)

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5
Q

describe trans cellular fluid

A

cerebrospinal, pleural, peritoneal, synovial, digestive secretions, sweat

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6
Q

what is osmolarity

A

concentration of particles in a solution (or its pullin power)

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7
Q

describe isotonic

A

-when osmolarity is equivalent to plasma
-isotonic fluid remains in the intravascular space
-no shift in cell size

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8
Q

describe hypertonic

A

-when osmolarity is greater than plasma
-hypertonic fluids pull water from the cells and into the intravascular spaces
-cells shrink

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9
Q

describe hypotonic

A

-when the osmolarity is less than plasma
-hypotonic fluids move from the intravascular spce to the ICF
-cells swell

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10
Q

give two examples of isotonic IV solutions

A

normal saline, lactated ringers

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11
Q

what does normal saline do

A

expand extracellular compartment, treat hypovolemia, hyponatremia, hyercalcemia, metabolic alkalosis

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12
Q

what does LR do

A

contains multiple electroltes in the same concentration as in plasma, treats hypovolemia, burns, and GI losses

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13
Q

give and example of hypertonic IV solution

A

5% dextrose in lactated ringers (D5LR)

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14
Q

what does D5LR do?

A

replaces electrolytes, provides calories, shifts fluid from cells to vascular space expanding vascular volume

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15
Q

give an example of hypotonic IV solution

A

half strength normal saline (0.45%)

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16
Q

what does hald strength normal saline do

A

often used as maintenance fluid, provides Na, Cl, and free water

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17
Q

describe fluid balance

A

-generally balance is achieved with oral intake of fluid matching the output of the kidney
-perfect balance is not always met every day, but over 2-3 days
-output can be sensible or insensible

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18
Q

what is sensible output

A

-things you can measure
-UOP, emesis, wound drainage, suction

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19
Q

what is insensible output

A

-harder to account for and not measurable
-sweat, respiratory vapors

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20
Q

describe volume overload

A

positive I&O balance

findings:
-crackles
-JVD
-edema
-dyspnea/SOB

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21
Q

describe volume deficit

A

negative I&O balance

findings:
-hypotension
-increased HR
-fatigue
-pale and cool
-dry mucus membranes
-dizziness

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22
Q

what are seom causes of abnormal fluid status

A

-CHF
-small bowel obstruction
-kidney disease
-liver dysfunction

kidneys, liver, heart, and GI

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23
Q

what are some tests to evaluate fluid balance

A

-CMP
-urinalysis
-daily weight
-telemetry

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24
Q

what organs and systems manage sluid and electrolyte balance

A

-kidneys
-heart and vascular
-lungs
-nervous system
-GI

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25
Q

organs and systems manage sluid and electrolyte balance

kidneys

A

-filter 180L of plasma/day while excreting ~1.5L/day
-manage ECF volume and osmolarity
-regulates electrolyte levels by retaining or eliminating

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26
Q

organs and systems manage sluid and electrolyte balance

heart and vascular

A

-circulate fluid, adequate perfusion pressure in kidneys for filtration
-stretch receptors respond to changes in olume and stimulate fluid retention when hypovolemia is present

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27
Q

organs and systems manage sluid and electrolyte balance

lungs

A

water vapor excreted/lost per day ~300ml/day

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28
Q

organs and systems manage sluid and electrolyte balance

nervous system

A

-osmoreceptors sense changes in ECF concentration and stimulate the pituitary gland to release or inhibit release of ADH
-thirst center in the hypothalamus is activated by cellular dehydration

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29
Q

organs and systems manage sluid and electrolyte balance

GI track

A

absorbs water and nutrients

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30
Q

hormonal control of fluid and electrolyte balance

adrenal glands

A

-aldosterone secretion causes sodium (and water) retention and potassium loss
-excess cortisol secretion can cause the same effect of aldosterone

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31
Q

hormonal control of fluid and electrolyte balance

pituitary gland

A

manages ADH

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32
Q

hormonal control of fluid and electrolyte balance

what does ADH do

A

-allows the body to retain water
-released when osmotic pressure of ECF is greater than that of cells, when blood volume is decreased
-suppressed when osmotic pressure of the ECF is less than that of the cells, or when blood volume is increased

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33
Q

hormonal control of fluid and electrolyte balance

thyroid gland

A

thyroxine secretion released to increased blood flow including to the kidneys, whey increases flitration rate and UOP

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34
Q

hormonal control of fluid and electrolyte balance

parathyroid gland

A

regulates calciuma dn phosphate balance through parathyroid hormone (PTH)

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35
Q

hormonal control of fluid and electrolyte balance

what does PTH do

A

-influences bone reabsorption, calcium absorption from the intestines and calcium reabsorption from the kidneys
-increased PTH causes increased blood calcium and decreased phosphate
-decreased PTH causes decreased calcium and increased phosphate

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36
Q

name some different fluid volume problems

A

-fluid volume deficit/hypovolemia
-dehydration
-fluid volume excess

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37
Q

describe fluid volume deficit/hypovolemia

A

-low circulating volume
-loss of fluid and solutes from ECF

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38
Q

describe dehydration

A

loss of total body water, results in increased serum sodium

39
Q

describe fluid volume excess

A

-retaining sodium and water in ECF
-intravascular excess = hypervolemia
-interstitial excess = edema

40
Q

name and descrie a fluid distribution problem

A

third spacing
-fluid moves into transcellular compartments (pleural, peritoneal, pericardial, joints, or bowels) or interstitial spaces
-causes hypovolemia (fluid is unavailable for use)
-no drastic change in weight

41
Q

what are electrolytes

A

the basis for chemical interactions in the body necessary for metabolism and other functions

42
Q

name some cations

A

sodium, potassium, calcium, hydrogen, magnesium

43
Q

name some anions

A

chloride, bicarbonate, phosphate

44
Q

-natremia

A

sodium

45
Q

-kalemia

A

potassium

46
Q

-calcemia

A

calcium

47
Q

-magnesia

A

magnesium

48
Q

-phosphatemia

A

phosphorus

49
Q

-chloremia

A

chloride

50
Q

hyponatremia

causes

A

diuretics, GI losses, excessive water intake

51
Q

hyponatremia

symptoms

A

confusion, lethargy, twitching, seizures, coma

52
Q

hyponatremia

treatment

A

-encourage sodium rich food
-seizure precautions

53
Q

hypernatremia

causes

A

-poor oral intake
-increased fluid losses
-increased salt intake
-enteral feeding without water

54
Q

hypernatremia

symptoms

A

-hallucinations
-lethargy
-seizures
-coma

55
Q

hypernatremia

treatment

A

-gradual rehydration
-sodium restricted diet

56
Q

hypokalemia

causes

A

-vomiting
-diarrhea
-GI losses
-diuretics
-poor intake
-polyuria

57
Q

hypokalemia

symptoms

A

-cardiac arrhythmias (increased excitability of cardiac tissue)
-paresthesia
-postural hypotension
-EKG changes

58
Q

hypokalemia

treatment

A

-critical values can be life threatening
-PO (needs to be diluted)
-IVPB
-never IV push
-monitor cardiac function/EKG/BP

59
Q

hyperkalemia

causes

A

-end stage renal disease
-acidosis
-burns
-tissue trauma
-diuretics

60
Q

hyperkalemia

symptoms

A

-vage muscle weakness
-cardiac arrhythmias (decreased cardiac excitibility)
-cardiac arrest
-peak T wave

61
Q

hyperkalemia

treatment

A

-kayexalate (binds K in GI tract and causes excretion via BM) this is used if pt is alert
-severes tx with CA (cardioprotective), insulin, and glucose
-can treat with diuretics and dialysis

62
Q

if Mg is low, what else usually is too?

A

K

63
Q

hypomagnesia

causes

A

-chronic alcoholism
-diarrhea
-NG suction
-drugs

64
Q

hypomagnesia

symptoms

A

tachyarrhythmias

65
Q

hypomagnesia

treatment

A

monitor condition of airway bc laryngeal sridor can occur

66
Q

hypermagnesia

causes

A

rare, ESRD or IV magnesium

67
Q

hypermagnesia

symptoms

A

-hypotension
-flushing
-drowsiness

68
Q

hypermagnesia

treatment

A

-admin of calcium gluconate
-diuretics or dialysis

69
Q

hypocalcemia

causes

A

-surgical
-excessive administration of citrated blood

70
Q

hypocalcemia

symptoms

A

-cardiac arrhythmias
-spasm of laryngeal muscles

71
Q

hypocalcemia

treatment

A

-seizure precautions
-monitor airway
-replace calcium

72
Q

hypercalcemia

causes

A

-hyperparathyroidism
-cancers

73
Q

hypercalcemia

symptoms

A

cardiac arrest

74
Q

hypercalcemia

treatment

A

monitor EKG changes

75
Q

what are the clinical manifestations of hypocalcemia

A

increased excitability of muscles and nerves

76
Q

what two test are used to determine hypocalcemia

A

-chvosteks sign
-trousseau sign

77
Q

describe chvosteks sign

A

tapping on facial nerve just anterior to the ear produces tetany (involuntary twitching) on the ipsilateral side of the patients face/upper lip

78
Q

describe trousseau sign

A

inflate BP cuff above NSBP range. positive response in a pt with hypocalcemia is a wrist metacarpal and phalangeal/thumb flexiion

79
Q

hypophosphatemia

causes

A

-refeeding after starvation
-alcohol withdrawal

80
Q

hypophosphatemia

symptoms

A

respiratory failure

81
Q

hypophosphatemia

treatment

A

replace carefully and slowly. can cause hypocalcemia

82
Q

hyperphosphatemia

causes

A

ERSD, chemotherapy

83
Q

hyperphosphatemia

symptoms

A

-tetany
-long term can lead to calcification of soft tissues

84
Q

hyperphosphatemia

treatment

A

phosphate binders given with meals

85
Q

describe history assessment of fluid and eectrolyte balance

A

risk factors:
-illnesses (DM, HF, renal failure)
-abnormal fluid losses (vomiting, diarrhea, draining wounds), burns, trauma, surgery
-medications (laxatives, diuretics)
-weight changes
-lab studies (CBC electrolytes, BUN, creatinine, specific gravity)

86
Q

describe physical exam forthe assessment of fluid and electrolyte balance

A

-skin (turgor, mucous membranes)
-cardiac (edema, HR, rhythm, BP, JVD)
-respiratory (lung sounds)
-neuromuscular (mental status, reflexes, muscle tone)

87
Q

what are some nursing diagnoses for fluid and electrolyte imbalance

A

-excess fluid volume
-deficient fluid volume
-impaired oral mucous membrane integrity r/t fluid volume deficit

88
Q

what are some preventions of fluid and electrolyte imbalance

A

-education
-monitor I&O, daily weights, labs

89
Q

what are some treatments of fluid and electrolyte imbalance

A

-fluid management
-encourage or restrict oral fluid intake
-IV fluid administration as prescribed

90
Q

describe encouraging oral fluid intake

A

offer preferred fluids, set goals, always have some fluids available for the pt

91
Q

describe restricing oral fluid intake

A

set goals, use smaller cups, provide ice chips instead, avoid salty foods, keep drinks out of sight, good oral hygiene, communicate with other caregivers

92
Q

describe electrolyte management

A

-administer replacement electrolytes as ordered
-be aware of admin instructions. many IV preparations must be diluted and given very slowly (over hours!)

93
Q

escribe med management for fluid and electrolyte imbalance

A

diuretics may be ordered to assist with fluid or ekectrolyte imbalance

nursing 20030 (31 decks)

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