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CPNP AC flash cards > fluid and electrolytes > Flashcards

fluid and electrolytes Flashcards

1
Q

What body fluid is made up of K, Cl, Na, Ca, Mg, proteins, and HCO3?

A

extracellular fluid

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2
Q

What body fluids are made up of Na, K, Ca, Mg, Cl, HCO3, proteins, phosphate, and organic ion?

A

intracellular fluid

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3
Q

What type of IV fluids are made up of Na 154 and Cl 154?

A

NS

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4
Q

What type of IV fluids are made up of Na 130 and Cl 109?

A

lactated ringers

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5
Q

Lactated ringers prevents a____ from h___c___ when excessive r___ is needed

A

acidosis
hyperchloremia
resucitation

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6
Q

What type of IV fluids are made up of Na 513 and Cl 513?

A

hypertonic fluids

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7
Q

What type of fluids are made up of Na 77 + Cl 77 + Glucose 50?

A

D5 1/2 NA

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8
Q

What type of blood product is made up of Na 100-160 + < 120 Cl?
a____

A

albumin

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9
Q

Mild dehydration = ___ %

A

5

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10
Q

Mild dehydration presents with f____, normal ____, and refusal of o___ i____

A

fatigue
V/s
oral intake

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11
Q

Moderate dehydration = ___ %

A

10

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12
Q

Moderate dehydration presents with mild ___ changes, th____, re____, ir____, reduced te___, and d___ m___ m____

A

v/s changes
thirst
restless
irritable
tears
dry mucous membranes

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13
Q

severe dehydration = ___ %

A

15

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14
Q

severe dehydration presents with le____, ___ alterations, c__/m____ extremities, deep br____, and minimal to no o____

A

lethargy
v/s alterations
cool/mottled extremities
deep breathing
output

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15
Q

Isonatremic dehydration = ____ serum sodium ranging from ___-____

A

normal
135-145

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16
Q

hypernatremic dehydration = serum sodium > ____

A

145

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17
Q

hyponatremic dehydration = serum sodium < ____

A

135

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18
Q

Dehydration management
* replace ______ slowly
*correct fluid losses over ___-__ hours
*monitor strict __/___
*monitor ____ closely

A

electrolytes
24-48
I/Os
electrolytes

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19
Q

Severe hyponatremia is a serum sodium < ____

A

125

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20
Q

Hyponatremia is caused by
S____, ad___ i____, hy____, hy____, excessive w ____ intake

A

SIADH
adrenal insufficiency
hypervolemia
hypovolemia
excessive water intake

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21
Q

Severe hyponatremia will result in?

A

seizures

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22
Q

Correct hyponatremia at __ mEq/L/hr

A

0.5

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23
Q

If a patient with hyponatremia is experiencing seizures, correct hyponatremia with
1) n___ b___ at __ ml/kg
or
2)h____ s____ ___-___ ml/kg given centrally

A

NS bolus at 20

hypertonic saline 3-5 ml/kg

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24
Q

If hyponatrmia is corrected to quickly the patient is a risk for ce___ po____ de_____ of wh___ ma___

A

central pontine demyelination of white matter
—called osmotic demyelination syndrome (ODS)

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25
Q

Severe hypernatremia is a serum sodium > ____

A

160

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26
Q

hypernatremia is caused by f___ l____, de____, excess s___ i____, D___

A

fluid loss
dehydration
salt intake
DI

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27
Q

Hypernatremia complications include s___ and al___ me___ s____

A

seizures and
altered mental status

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28
Q

In a patient with hypernatremia, reduce sodium at ___ mEq/L/hr
—reducing too quickly will cause s____

A

0.5 mEq/L/hr
–seizures

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29
Q

hyperkalemia causes
increased in____
decreased ex____ d/t r__ f___, b___ b___ use, ac____, t___ l___, rha____, congenital ad___ hy____, and r___ t____ a_____

A

intake
excretion
renal failure, beta blocker, acidosis, tumor lysis, rhabdomyolysis, congenital adrenal hyperplasia, renal tubular acidosis

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30
Q

hyperkalemia s/s include
___ changes such as
–p___ ___ w___, depressed s___, wide q___, absent __ w____

A

EKG
peaked T waves
depressed ST
wide QRS
absent P wave

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31
Q

When mild hyperkalemia is present, ensure your sample is not h___ before treating

A

hemolyzed

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32
Q

Mild hyperkalemia management includes removing or stopping all?

A

oral/IV potassium sources

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33
Q

Severe hyperkalemia management
*perform e___
*obtain c___, c___, a___, u___
*remove e___ p___ a____

A

EKG
CBC, CPK, ABG, UA
exogenous potassium administration

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34
Q

Severe hyperkalemia management
-Stabilize myocardium by giving-
*C__ (10 %): ___ mg/kg IV
or
*C__ g___: ___-___ mg/kg/dose (max 3 grams)

A

CaCl 10% 20 mg/kg IV

Calcium gluconate 60-100 mg/kg/dose

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35
Q

Severe hyperkalemia management
-Enhance movement of K into cells by-
*giving s__ b___: __-__ mEq/kg IV (best way)
or
*g___: __ g/kg + i____ ___-___ units/kg

A

sodium bicarb 1-2 mEq/kg IV

Glucose 0.5 g/kg + insulin 0.1-0.3 units/kg

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36
Q

Severe hyperkalemia management
-Remove K from the patient by giving-
*k____ ( __ g/kg) PO, NG, rectally
——-use this as a last resort
*can also give d___ such as f____

**In the most severe cases of hyperkalemia give d____

A

kayexalte 1g/kg

diuretics such as furosemide

dialysis

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37
Q

Hypoglycemia is defined as a blood glucose less than ___ mg/dl

A

50

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38
Q

Neonatal causes of hypoglycemia
–d___ m___, a___c____ d____, i____ e____ of m_____, and h___p______

A

diabetic mom
adrenocortical deficiency
inborn errors of metabolism
hypopituitarism

39
Q

Neonatal causes of hypoglycemia
—can be t_____
—-are associated with a la___ of g___ su_____

A

transient
lack of glucose supply

40
Q

childhood causes of hypoglycemia
—i____ e__, g___ de____, st____, h____ dysfunction, b___ b___ ingestion , inf____, and uncontrolled d____

A

inborn errors
GH deficiency
stress
hepatic dysfunction
beta blocker ingestion
infection
uncontrolled diabetes

41
Q

hypoglycemia glucose replacement is ___-___ gram/kg (10% or 25%_

A

0.5-1 gram/kg

42
Q

hypoglycemia s/s include
ir_____, ji____, se_____, vo____, he___

A

irritable
jittery
seizures
vomiting
headache

43
Q

Before treating hypoglycemia, obtain the following labs STAT
-fr___ fa___ ac____, in____, be___ h___b___, cor____, acylcarnitine, la____, py____, gr___, a____, ur___ ke_____

A

free fatty acid
insulin
beta-hydroxybutyrate
cortisol
lactate
pyruvate
growth hormone
urine ketones

44
Q

hypocalcemia causes
h__p____p___t_, di____, vi___ ___ deficiency, re____ insufficiency, massive tr_____, rh____, t___ ly____, et___/gl____ ingestion

A

hypoparathyroidism
DiGeorge
vitamin D
renal, transfusion
rhabdomyolysis
tumor lysis
ethanol/glycol

45
Q

Hypocalcemia management caused by hypoalbuminemia
–correct Ca at ___ mg/dL for each __ g/dl the patients calcium is low

A

0.8 mg/dL
1 g/dL

46
Q

Hypocalcemia management includes obtaining an e___

A

EKG

47
Q

Replace calcium with either c___ c____ or c___ g___ IV slowly or via a central line

—–during replacement monitor for s____

A

calcium chloride
calcium gluconate

seizures

48
Q

hypocalcemia s/s include
s____, tet____, m____ irritability, l__ q___, and par____

A

seizures
tetany
myocardial
long QT
paresthesias

49
Q

for a child presenting with hypocalcemia, obtain p____ levels

A

parathyroid

50
Q

in a newborn presenting with hypocalcemia, obtain f___ studies

A

FISH

51
Q

If hypocalcemia is refractory to correction, ensure m____ levels are normal

A

magnesium

52
Q

what acid-base imbalance is this?

Ph 7.5
PCO2 40
PO2 86
HCO3 36

A

metabolic alkalosis

53
Q

Children with chloride-responsive metabolic alkalosis most often have the following diagnosis
-con____
-s/p di___ use
-s/p vo___
-s/p ga___ se____su____
-s/p st___ use

A

contractions
diuretics
vomiting
gastric secretion suctioning
steroid

54
Q

Children with chloride-resistant metabolic alkalosis most often have the following diagnosis
—h___a____ state or
—severe ___ depletion

A

hyperaldosteronism
potassium

55
Q

what acid-base imbalance is this?

Ph 7.1
PCO2 30
PO2 96
HCO3 10

A

Metabolic acidosis

56
Q

Children with metabolic acidosis, try to compensate via h_____
—exhibited by low ____
—–seen in patient with d____

A

hyperventilation
—-CO2
—–DKA

57
Q

Children with metabolic acidosis will experience bi___ lo____

A

bicarbonate losses

58
Q

In children with metaboic acidosis
—monitor for ___ and ____ abnormalities

A

potassium
sodium

59
Q

Anion gap normal level
___ +/ __ mEq/L

A

12 +/2 mEq/L

60
Q

The anion gap calculation is

___ - ( ___ + ___)

A

Na - (Cl + HCO3)

61
Q

In nongap acidosis
–gap will be b___ n___

A

below normal

62
Q

in gap acidosis
–gap will be a___ n___

A

above normal

63
Q

NonGap Metabolic Acidosis medication causes
-sp____, pr____ in____, triamterene, amiloride, pe____, tri___, cyc____

A

spironolactone
prostaglandin inhibitors
pentamidine
trimethoprim
cyclosporine

64
Q

Enteral nutrition
–nutrients via E___ or f___ to g__ t___

A

EBM or formula to GI tract

65
Q

Start enteral nutrition within __-__ hours of l___ or a____

A

24-48 hours of life or admission

66
Q

enteral nutrition has been shown to decrease h___ l___ of s___, improves o____, decreased i____, and improved i____

A

hospital length of stay
outcomes
infection
immunity

67
Q

enteral nutrition contraindications
–b___ o____, recent g___ s____, U___ b___

A

bowel obstruction
recent GI surgery
UGI bleeding

68
Q

In a child on vasopressors, enteral feeds should be ____ ___

A

slow drip

69
Q

nutrition labs include
p__-a____
g___
ph____
and s___ st____

A

pre-albumin
glucose
phosphorus
stool studies

70
Q

nutrition monitoring
*track w___
*calculate daily c___ i___
*calculate f___ needs

A

weights
caloric intake
fluid

71
Q

Parenteral nutrition =

A

TPN

72
Q

Begin parenteral nutrition when meeting n___ needs with e___ f____ is c____

A

nutritional needs
enteral feeds
contraindicated

73
Q

Children on parenteral nutrition must have reliable access, ___ ___ preferred

A

Central line

74
Q

Parenteral nutrition macronutrients ==
pr___, gl___, fa___

A

protein, glucose, fat

75
Q

parenteral nutrition micronutrients ==
e___, m___, v____

A

electrolytes, minerals, vitamins

76
Q

parenteral nutrition should be adjusted ___ and based on ___

A

daily
needs

77
Q

Parenteral nutrition’s long-term effects
-th___ formation, in____, cho____, bo___ disease, li___ disease especially in infants, and ac___ impairment

A

thrombosis
infection
bone
liver
activity

78
Q

obesity if a BMI > ___% due to excess c___ i___

A

95%
caloric intake

79
Q

obesity acute care concerns
–medication d____, d____, decreased wo___ he___, decreased pu___ mechanics, decreased gl____ control

A

dosing
DVT
wound healing
pulmonary
gluco0se

80
Q

obesity labs
-c___ panel
-f___ g____
-H___ ___
-i___ level

A

cholesterol panel
fasting glucose
Hgb A1C
insulin level

81
Q

Bulimia
-c___ r____ leading to excess h___/b___ and resultant self i___ v____

*weight may be?

A

calorie restriction
hunger/binge
induced vomiting

normal

82
Q

Children with bulimia may use
l___, d___ or e____

A

laxatives
diuretics
enemas

83
Q

Bulimia will eventually lead to e____ abnormalities

A

electrolytes

84
Q

Bulimia + Anorexia management
*stabilize f___ status
—s/s include h___ and t____

*correct e____
—most often low _____

*obtain ___ evaluation

A

fluid status
–hypotension + tachycardia

electrolytes
—phosphate

psychiatric

85
Q

Bulimia complications
*c___ a___
*severe h____p___
*a__/b__ disturbances
*de___ problems

A

cardiac arrhythmias
severe hypophosphatemia
acid/base
dentition

86
Q

Anorexia nervosa = c__ r____
—body weight will be < ___%

A

calorie restriction

85%

87
Q

Anorexia nervosa s/s inclue
e____ imbalances
i___v____ v___ depletion
m___ a_____

A

electrolytes
intravascular volume
metabolic acidosis

88
Q

Anorexia complications
c___ a____, severe h__p_____,
a___/b___ disturbances, severe b_____

A

cardiac arrhythmias
hypophosphatemia
acid/base
bradycardia

89
Q

90% of FTT is inorganic d/t
*inadequate c___ i___
*inadequate a____
*excessive m__ d____

A

caloric intake
absorption
metabolic demands

90
Q

Refeeding syndrome
—hallmark lab finding =

A

hypophosphatemia

+ low mag and K

91
Q

In refeeding syndrome monitor for c___ and a____

A

CHF and arrhythmias

92
Q

What nutritional lab reflects the last 24-48 hours of nutrition?

A

Pre-albumin

93
Q

obtain a pre-albumin level during acute n___ changes

A

nutritional

94
Q

Children with glycogen storage depletion will have l___ intolerance and p___ catabolism

A

lipid
protein

CPNP AC flash cards (10 decks)

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