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TEST 1 > Fluid and Electrolytes > Flashcards

Fluid and Electrolytes Flashcards

1
Q

Water content varies with

A

age
gender
and Fat content

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2
Q

What are the TWO main BODY Fluid compartments?

A

Intracellulat Fluid (ICF)
and
Extracellular Fluid (ECF)

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3
Q

How much of INTRACELLULAR Fluid COMPARTMENT (space) is located in the CELL?

A

2/3 of space is located WITHIN the cell.

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4
Q

Extracellular Fluid (ECF) is made up of 3 types.

Name them.

A
  1. interstitial spaces: b/T cells
  2. Intravascular: Plasma portion of blood
  3. Transcellular: (CSF, synovial, intra-ocular, etc) It is found in the lumen of structures lined by epithelium.
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5
Q

How many Liters of PLASMA are in the human body?

A

3 L

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6
Q

How many Liters of INTERSTITIAL FLUID (IF) is in the human body?

A

10 L

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7
Q

How many Liters of INTRACELLULAR FLUID is in the human body?

A

28 L

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8
Q

Name the FLUID parts:

A

a. Intracaellular fluid (IF)
b. Interstitial Fluid
c.Plasma
d. Lymph
e. Transcellular fluid
f. Extracellular fluid
g. Body Cell MEMBRANE

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9
Q

Fluid Shifts:

Plasma-to-interstitial fluid shift results in Edema.

What 3 things contribute to this?

A
  1. Salt intake
  2. Infection
  3. Lymph system obstruction
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10
Q

Fluid Shifts:

Interstitial fluid to plasma decreases edema.

What two things contribute tho this?

A
  1. Albumin Administration (protein in body)
  2. Compression stockings
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11
Q

What is TED HOSE?

A

ThromboEmbolism-Detterrent hose

Stockings that prevent embolisms

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12
Q

How many FLUID SPACINGs are there?

A

THREE

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13
Q

First Fluid spacing is:

A
  • fluid being where it is supposed to be.
  • Fluid inside cells and fluid inside blood vessels (normal)

A NORMAL DISTRIBUTION.

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14
Q

Second Fluid spacing consists of

A
  • ABNORMAL fluid accumulation in the INTERSTITIAL SPACE.
  • this is considered EDEMA
  • 2nd spacing is still “in contact” with the areas its SUPPOSED to be in…. so that the fluid can easily move back into the 1st spacing areas IF body conditions change.
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15
Q

Some factors that EFFECT 2nd spacing are:

A
  1. hydrostatic pressure
  2. diffusion
  3. osmosis.
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16
Q

Third fluid spacing consists of

A
  • Fluid accumulation in part of body where it is NOT easily exchanged with ECF.
  • This is TRAPPED fluid.
  • Fluid is in a place in body where it is difficult or impossible for it to move BACK INTO THE CELLS or blood vessels WITHOUT medical intervention.
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17
Q

What is Ascites?

A

Ascites is a type of edema in which fluid accumulates in the peritoneal cavity (abdomen area)

The patient commonly reports shortness of breath and a sense of pressure because of pressure on the diaphragm.

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18
Q

How does the body regulate Water Balance

2 types of losses.

A
  1. “insensible” water losses (unable to be measured)
  2. “sensible” water losses (can be measured)
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19
Q

What is considered INSENSIBLE water losses?

A
  1. invisible vaporization from lungs and skin
  2. loss of approximately 600-900 mL/day
  3. No electrolyte loss.
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20
Q

What is considered SENSIBLE water losses?

A
  1. Caused by exercise, urination and defecation
  • May lead to large losses of water and electrolytes.
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21
Q

What causes FLUID & ELECTROLYTE IMBALANCES?

A
  1. Illness or disease (burns or heart failure)
  2. Result of therapeutic measures (IV fluid replacement or diuretics.
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22
Q

ECF volume deficit is called

A

hypovolemia

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23
Q

What causes EXTRACELLULAR fluid volume imbalances?

A
  • Abnormal LOSS of normal body fluids
  • Inadequate intake
  • Plasma-to-interstitial fluid shift (plasma leaving blood vessels and entes space in tissues- called INTERSTITIAL fluid.
  • Clinical manifestations related to loss of vascular volume as well as CNS effects.
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24
Q

What tx is used for ECF volume deficits?

A

Replace water and electrolytes with balanced IV solutions.

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25
Q

Fluid Volume Deficit (FVD) Manifestations (signs):

A
  • Restlessness, drowsiness, lethargy, confusion
  • Thirst, dry mouth
  • LOW skin turgor (remains elevated)
  • LOW capillary refill
  • LOW urine output, concentrated urine (dark)
  • Hypotension (Low BP)
  • HIGH PR
  • HIGH Respiratory Rate
  • Weakness, dizziness
  • Acute Weight loss
  • Seizures, coma
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26
Q

Fluid Volume Deficit (FVD) LABS include

A
  • Elevated Hct./Hgb.
  • Elevated BUN
  • Urine osmolality & specific gravity increase
  • Serum osmolality: increased
    –> Measures the concentration of particles in a solution. It refers to the fact that the same amt. of solute is present, but the amount of solvent (fluid) is decreased. Therefore, the blood can be considered “more concentrated”.

FVD= High labs

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27
Q

PRIORITY HEALTH PREVENTION for Fluid Volume Deficit is

A

PREVENT SHOCK!!!

s/s include:
* low BP
* Increase HR
* Increase RR

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28
Q

To PREVENT SHOCK the goal is to

A

INCREASE VASCULAR VOLUME

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29
Q

WHAT CAN THE NURSE DO TO INCREASE Vascular Volume?

A
  • Start IVF (intravenous fluids)
  • Keep Warm (vasoDILATES-Helps incr. blood flow; improves circulation)
  • Elevate legs (doesnt let fluids accumulated peripherally)
  • O2 if indicated (assists RBCs)
  • Monitor V/S & I/Os
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30
Q

Nursing Management for Fluid Volume Deficit (FVD)

goals for patient

A
  • Explain the reason for the required intake and the amount needed
  • Establish 24-hour plan for ingesting fluids
  • Set short-term goals
  • Identify fluids the client likes and use those
  • Help clients select foods that become liquid at ROOM temperature
  • Supply cups, glasses, straws
  • Serve fluids at proper temperature
  • Encourage participation in recording intake
  • Be alert to cultural implications
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31
Q

FVD SKIN ASSESSMENT & CARE:

In fluid volume deficit:
skin turgor diminished, may be

A

dry/wrinkled

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32
Q

FVD SKIN ASSESSMENT & CARE:

In fluid volume deficit:

Oral mucous membranes will show

KNOW

A

dry tongue; may be furrowed

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33
Q

FVD SKIN ASSESSMENT & CARE:

In fluid volume deficit:

Client often complains of

A

THIRST

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34
Q

FVD SKIN ASSESSMENT & CARE:

In fluid volume deficit:

Oral care is

A

CRITICAL!

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35
Q

Fluid volume EXCESS is called

A

HYPERvolemia

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36
Q

What causes FLUID VOLUME EXCESS?

A
  • Excessive intake of fluids
  • abnormal retention of fluids
  • Interstitial-to-plasma fluid shift
  • Clinical manifestations related to excess volume
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37
Q

Tx for Fluid Volume Excess (hypervolemia)

A

Remove fluid WITHOUT changing electrolyte composition or osmolality of ECF

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38
Q

Fluid Volume EXCESS (FVE) manifestations (signs) include

A
  • HA, confusion, lethargy
  • Peripheral edema
  • Distended neck veins
  • Bounding pulse, High BP
  • Polyuria (w/normal renal function)
  • Dyspnea, crackles (rales), pulmonary edema
  • Muscle spasm
  • Weight gain
  • Seizures, coma
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39
Q

Labs for Fluid Volume Excess (FVE)

A
  • HCT: low (FVE lowers % of RBCs)
  • Hgb: normal - low
  • BUN: low
  • Urine specific gravity <1.010

FVE= LOW labs

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40
Q

Nursing Management For Restricting Fluid Intake

A
  • Explain reason and amount of restriction
  • Help client establish ingestion schedule
  • Identify preferences and obtain
  • Set short term goals; place fluids in small containers
  • Offer ice chips and mouth care
  • Teach avoidance of ingesting chewy, salty, sweet foods or fluids
  • Encourage participation in recording intake
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41
Q

FVE SKIN ASSESSMENT & CARE:

In Fluid Volume Excess (FVE):
Edematous skin (edema) may feel

A
  • cool
  • can stretch the skin- causing it to feel taut and hard
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42
Q

FVE SKIN ASSESSMENT & CARE:

In fluid volume excess:
Assess soft tissues overlying a bone, areas such as

A
  • tibia, fibula, and sacrum
  • patient is turned at regular intervals- edematous tissue is MORE PRONE to skin break down than normal tissue.
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43
Q

FVE SKIN ASSESSMENT & CARE:

In fluid volume excess:
Edema is assessed by pressing with

A

thumb or forefinger over the edematous area

–> 1+ slight edema= 2mm indention to 4+ pitting edema= 8mm indention

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44
Q

Neurological Effects with FVD (HYPOVOLEMIA) include

A
  • Lethargy
  • Coma
  • Fever
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45
Q

Neurological Effects with FVE (HYPERVOLEMIA) include

A
  • Altered LOC
  • HA
  • Visual disturbances
  • Muscle weakness (?)
  • Paresthesias (tingling, numbess or pins/needles)
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46
Q

Cardiovascular effects with FVD (HYPOVOLEMIA) include

A
  • Hypotension
  • Tachycardia (high HR)
  • Weak, thready Pulse (+1)
  • Postural hypotension (orthostatic hypotension)
  • Flat neck & hand veins
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47
Q

Cardiovascular effects with FVE (HYPERVOLEMIA)

A
  • Hypertension with decrease pulse pressure
  • Tachycardia (high HR)
  • Full, bounding pulse (+3)
  • Distended neck & hand veins
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48
Q

Respiratory Effects with FVD (hypovolemia)

A
  • Rapid, deep respirations
  • Will see this in shock, also a sign of impending shock
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49
Q

Respiratory Effects with FVE (hypervolemia)

A
  • Rapid shallow respirations
  • Dyspneic on exertion
  • Orthopnea: shortness of breath when lying down)
  • Moist crackles
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50
Q

Gastrointestinal Effects with FVD (hypovolemia)

A
  • Decreased GI motility
  • Diminished bowel sounds
  • Constipation
  • Thirst
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51
Q

Gastrointestinal Effects with FVE (hypervolemia)

A
  • Increased GI motility
  • Ascites
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52
Q

Integumentary Effects with FVD (hypovolemia)

A
  • Dry, scaly skin
  • Inelastic turgor with tenting (skin stays up)
  • Mouth & tongue dry
  • Dry mucous membranes
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53
Q

Integumentary Effects with FVE (hypervolemia)

A
  • Skin pale & cool
  • Dependent pitting edema
  • Diffuse profound edema, late sign, possible in shock at this point
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54
Q

Lab Values for FVD will show:

A
  • Elevated Hct.
  • Elevated Hgb.
  • Elevated BUN
  • Urine specific gravity > 1.030 (dehydration=concentrated)
  • They have hemoconcentration (incr. rbc resulting from loss of plasma or water from bloodstream)
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55
Q

Lab values for FVE will show :

A
  • HTC: Low
  • Hgb: Normal to Low
  • BUN
  • Urine specific gravity <1.010
  • Values usually decrease due hemodilution
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56
Q

Nursing diagnosis for HYPOVOLEMIA
(Signs Nurse will find)

A
  • Deficient fluid volume
  • Decreased cardiac output
  • Risk for deficient fluid volume
  • Potential complication: Hypovolemic shock
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57
Q

Nursing diagnosis for HYPERVOLEMIA

(Things you will see)

A
  • Excess fluid volume
  • Impaired gas exchange
  • Risk for impaired skin integrity (due to edema)
  • Activity intolerance
  • Disturbed body image
  • Potential complications: Pulmonary edema, ascites.
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58
Q

Nursing Management for Fluid Imbalances

(Things nurse should do)

A
  • I & O (detailed, to the mL)
  • Monitor cardiovascular changes
  • Assess respiratory changes
  • Neurologic changes
  • Daily weights (1L of water = 1 kg or 2.2 lbs)
  • Skin assessment
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59
Q

What are the TWO MAIN GOALS for TREATING FVD (HYPOVOLEMIA)

A
  1. Correct underlying cause
  2. Replace both water and any needed electrolytes
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60
Q

What are the Nursing Implementations for FVD?

A
  • Balanced IV solutions( like Lactated Ringers (LR)- usually given)
  • Isotonic (0.9%) NACL used when rapid volume replacement is indicated
  • Blood is administered when volume loss is due to blood loss
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61
Q

What is the MAIN Goal Treatment for FVE (HYPERVOLEMIA).

A

removal of fluid w/o producing abnormal changes in the electrolyte composition or osmolality of ECF

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62
Q

What are the Nursing Implementations for FVE?
(Implementation= Nurse care plan in ACTION)

A
  • Identify and treat the primary cause
  • Diuretics and fluid restriction are PRIMARY forms of therapy
  • May restrict Na+ (sodium)
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63
Q

What is the PURPOSE of IV Fluids?

A
  1. Maintenance
    - When oral intake is not adequate
  2. Replacement
    - When losses have occurred
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64
Q

______: the ability of an EXTRACELLULAR SOLUTION to make water move INTO or OUT of a cell by OSMOSIS.

A

TONICITY

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65
Q

Tonicity commonly pertains to _____ solutions.

A

intravenous (IV)

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66
Q

Tonicity most commonly refers to the ______ content of the SOLUTION.

A

NaCl (also known as table salt)

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67
Q

The tonicity of a solution is determined by how it compares to physiologic fluid which is _________.

A

0.9% NaCl

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68
Q

MOVEMENT 0f water is EITHER from

A

ICF –> ECF
or
ECF–> ICF

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69
Q

The tonicity of a solution can be used to drive water movement between compartments to change the state of ___ and ___.

A

cellular hydration AND cell size.

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70
Q

What are the THREE TYPES OF FLUIDS (categorized by tonicity)

A
  1. Hypertonic
  2. Isotonic
  3. Hypotonic
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71
Q

EFFECTS OF WATER STATUS ON RBC:

NAME THIS TYPE OF SOLUTION (water enters cell)

A

HYPOTONIC SOLUTION
-remember Hippo= hypo (fat and round)

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72
Q

EFFECTS OF WATER STATUS ON RBC:

NAME THIS TYPE OF SOLUTION (IMAGE)

A

ISOTONIC SOLUTION

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73
Q

EFFECTS OF WATER STATUS ON RBC:

NAME THIS TYPE OF SOLUTION (H2O leaves the cell)

A

HYPERTONIC SOLUTION

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74
Q

Type of FLUID (SOLUTION) that contain LESS SOLUTE (sodium chloride concentration) BUT MORE WATER than the bloodstream.

A

HYPOTONIC SOLUTION

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75
Q

IV HYPOTONIC SOLUTIONS can be used to move WATER from the ______ INTO the ________.

A

ECF INTO the ICF by osmosis.

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76
Q

IV HYPOTONIC solutions can be used to ________ a patient as they contain hIGH WATER CONCENTRATIONS.

A

HYDRATE.
(Treats cellular dehydration)

Usually, maintenance fluids

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77
Q

IV Hypotonic Fluids contain mORE WATER than ____.

A

electrolytes (solutes).

Note: Pure water lyses RBC

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78
Q

What should the NURSE monitored when using IV Hypotonic Fluids?

A

Monitor for changes in mentation (mental).

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79
Q

TYPE of FLUID (SOLUTION) that has SAME sodium and chloride concentration and SAME WATER concentration as the bloodstream

A

ISOTONIC SOLUTIONS.

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80
Q

IV ISOTONIC SOLUTIONS have NO NET LOSS OR GAIN FROM ________ compartment.

A

ICF

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81
Q

IV ISOTONIC solutions are used to EXPAND the _______

A

ECF Volume

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82
Q

Isotonic fluids are ideal to REPLACE

A

ECF VOLUME deficit.

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83
Q

What should the nurse monitor when administering ISOTONIC IV Fluids?

A

Watch for S/S of fluid overload
(Since it increases ECF VOLUME)

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84
Q

Type of FLUID (SOLUTION) composed of GREATER concentration of NaCl (solute) and LESS WATER compared to blood.

A

HYPERTONIC SOLUTION.

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85
Q

IV HYPERTONIC SOLUTION can be infused into the bloodstream to PULL WATER from the ___ iNTO___.

A

ICF into the ECF.

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86
Q

IV HYPERTONIC SOLUTION:

The movement of water from ICF to ECF will cause________ of the cells.

A

dehydration (shrinking)

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87
Q

IV HYPERTONIC SOLUTION:

The dehydration of cells is useful in disorders of severe________; particularly ________ , which requires IMMEDIATE treatment.

A

edema

cerebral edema

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88
Q

IV HYPERTONIC SOLUTION:

Name THREE examples of solutes capable of affecting water movement from ICF to ECF (from cell to outside of cell).

A
  1. Sodium
  2. Glucose
  3. Mannitol-diuretic
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89
Q

IV HYPERTONIC SOLUTION:

Out of the THREE solutes capable of affecting water movement from ICF to ECF… Which solute can be used to move water RAPIDLY?

A

MANNITOL

(nonresorbable sugar alcohol)

90
Q

IV HYPERTONIC fluids initially ______ the osmolality of ECF.

A

expands/raises

91
Q

IV Hypertonic fluids Draws (pulls) fluid into the ______ space, expanding plasma volume.

A

INTRAVASCULAR

92
Q

IV HYPERTONIC fluids require frequent monitoring of

A
  1. Blood pressure
  2. Lung sounds
  3. Serum sodium levels
93
Q

D5W stands for

A

5% dextrose in water (D5W)

94
Q

D5W is what kind of Fluid Solution?

A

ISOTONIC SOLUTION

95
Q

What is FREE WATER?

A

distilled water that is FREE of any solutes.

96
Q

D5W provides _____ cal/L and FREE WATER to aid in ________ exertion of solutes!

A

170

Renal.

97
Q

D5W Free water moves into the ____ space.

98
Q

D5W Prevents _____ associated with starvation.

A

ketosis

(Metabolic state where body Burns fat instead of glucose (carbs))

99
Q

D5W is used to replace ______ .

A

water losses
(Remember- goes into ICF space, into cell)

100
Q

D5W is also used to TREAT _____

A

hypernatremia.
(High sodium)

101
Q

Does D5W provide any electrolytes?

102
Q

Normal Saline (NS) is also known as

A

0.9% Sodium Chloride.

103
Q

What kind of solution is NS (0.9% Sodium Chloride)

104
Q

NS has mORE ____ than ECF.

105
Q

NS Expands IV ____

106
Q

NS is the Preferred fluid for

A

IMMEDIATE response

107
Q

Bc NS expands IV volume, patient has higher risk for

A

Fluid overload.

108
Q

What should the nurse monitor for when giving NS?

A

hyperchloremic acidosis
And fluid overload

109
Q

What DOESNT NS include?

A

no Free water
no calories
no additional electrolytes

110
Q

Is NS compatible with BLOOD products?

A

yes.

ONLY solution that can be given with BLOOD PRODUCTS.

111
Q

Is NS compatible with MOST medications?

112
Q

NS ( 0.9% NaCl ) has SIMILAR TONICITY to

113
Q

FLUID SOLUTION that has SIMILAR composition to plasma but lacks Mg++

A

LACTATED RINGER’S SOLUTION

114
Q

LACTATED RINGERS SOLUTION PROVIDES ____ cal/L

115
Q

What ELECTROLYTES does Lactated Ringers solution include?

A

*K
*Ca
*Cl
*lactate (metabolized to bicarbonate- HCO3)

** does not contain Mg++**

116
Q

What does Lactated Ringer’s solution do to ECF?

A

Expands EFC

117
Q

Lactated Ringers Solution is contraindicated with

A

HYPERKALEMIA
and
Lactic Acidosis

118
Q

Lactated Ringers Solution should nOT be used with kidney injury because

A

it contains potassium and can cause HYPERkalemia

119
Q

Lactated Ringers Solution Tonicity is similar to

120
Q

Lactated Ringers Solution is used for

A

*hypovolemia
*burns
*fluid lost as bile or diarrhea

121
Q

What DOESN’T Lactated Ringer’s Solution have?

A

No free water
no calories

122
Q

D5 (1/2) NS stands for

A

0.45% NaCl
(HALF-STRENGHT SALINE)

123
Q

D5 (1/2) NS is what kind of fluid (solution?

A

Hypertonic

124
Q

D5 (1/2) NS is a common ______ fluid.

A

maintenance

125
Q

What is D5 (1/2) NS is used to treat

A

dehydration- Replaces fluid loss.

126
Q

D5 1/2 NS:

_____ added for maintenance or replacement.

127
Q

D10W stands for

A

Dextrose 10% in water.

128
Q

D10W is what kind of fluid (solution)

A

Hypertonic.

129
Q

D10W provides _____ kcal/L

A

340

Double of D5W

130
Q

D10W provides _____ but NO _____

A

FREE WATER

NO ELECTROLYTES

131
Q

D10W:

Limit of dextrose concentration may be infused_____

A

peripherally

132
Q

What am I?

  • solutions (agents) used for temporary maintenance of blood volume in emergency situations.
  • have relatively HIGH molecular weight and BOOST the plasma volume by INCREASING osmotic pressure.
A

PLASMA VOLUME EXPANDERS.

133
Q

Where do you find PLASMA EXPANDERS?

A

Stay in vascular space and increases osmotic pressure

134
Q

Main type of Plasma volume expanders are called:

A

Colloids (larger insoluble molecules)

135
Q

Example that fall under the Colloids Plasma Expanders are:

A

*Plasma
*albumin
*comercial plasmas
*dextran
*hetastarch
*Blood

136
Q

Name the THREE fluids that fall under ISOTONIC SOLUTIONS?

A

*NS
*Lactated Ringers Solution
*D5W

137
Q

WHAT TWO fluids fall under HYPERTONIC solution

A

*D5(1/2) NS
*D10W

138
Q

Name the Cations in PLASMA

A

NA+
K+
CA2+
MG2+

139
Q

ELECTROLYTE that Plays a major role in water balance and neuromuscular activity.

A

Sodium (Na)

140
Q

Sodium effects water distribution between the ___ and ____.

A

ECF and ICF.

141
Q

_____ cells are very sensitive to changes in serum sodium levels.

142
Q

think ____ with Sodium (Na)

143
Q

Elevated serum sodium occurring with water loss or sodium gain

WHAT AM I?

A

HYPERNATREMIA

(high levels of sodium (Na))

144
Q

Hypernatremia:

Causes_______, leading to cellular dehydration

A

hyperosmolality

145
Q

Primary protection for Hypernatremia is______ from the hypothalamus

146
Q

What are some manifestations for HYPERNATREMIA

A
  • Thirst (hypothalmus)
  • lethargy
  • agitation
  • seizures
  • coma
  • Impaired LOC
  • Symptoms of fluid volume deficit

think BRAIN

147
Q

Remember

FRIED SALT for Hypernatremia S/S

148
Q

Nursing Management for HYPERNATREMIA

  • Treat underlying cause
    If Excess sodium, dilute with ______ and promote______.
A

sodium-free IV fluids and promote excretion with diuretics.

149
Q

Nursing Management for HYPERNATREMIA:

Primary water deficit- replace fluid orally or IV with ___- or______ fluids.

A

isotonic or hypotonic fluids

150
Q

Nursing Management for HYPERNATREMIA:

Reduce serum_______ levels gradually

151
Q

Nursing Management for HYPERNATREMIA:

Restrict dietary ______ intake

152
Q

Results from loss of ‘sodium-containing fluids’ and/or from water excess.

What am I?

A

HYPONATREMIA

(low sodium levels)

153
Q

Manifestations of Hyponatremia

A

*Confusion
*irritability
*headache
*seizures
*coma

154
Q

Hyponatremia Nursing Management:

If caused by water excess what is needed?

A

fluid restriction

155
Q

Hyponatremia Nursing Management:

Severe symptoms include

A

seizures!
(low sodium)

156
Q

If patient suffers from Hyponatremia, what type of Fluid (solution) should be given?

A

Give SMALL amount of IV hypertonic saline solution (3% NaCl)

157
Q

HYPONATRemIA Nursing implementations:

If patient suffers from ABNORMAL fluid loss, give Fluid replacement with _________ sollution

A

sodium-containing solution.

158
Q

HYPONATRemIA Nursing implementations:

Drugs that BLOCK vasopressin (antidiuretic hormone-ADH) include

A

*Conivaptan (Vaprisol)
*Tolvaptan (Samsca)

159
Q

HYPONATREMIA:

REMEMBER “SALT LOSS”

A

s- stupor/coma
a-anorexia, N&V
L- lethargy
T- tendon reflexes decreased

L-limp muscles (weakness)
O-orthostatic hypotension
S- seizures /headache
S-stomach cramping

160
Q

*Major ICF cation (+)
*Necessary for:
- Transmission and conduction of nerve and muscle impulses
- Cellular growth
- Maintenance of cardiac rhythms. (Think Heart)
- Acid-base balance

A

Potassium (K+)

161
Q

Where can you get Potassium?

A

*Fruits and vegetables (bananas and oranges)
*Salt substitutes
*Potassium medications (PO, IV)
*Stored in the blood

162
Q

Potassium is Regulated by the _____.

A
  • kidneys
  • 80% of potassium is excreted daily through the kidneys.
163
Q

HYPERKALEMIA: (high potassium)

High serum potassium caused by

(3 causes)

A
  • Impaired renal excretion
  • Shift from ICF to ECF
  • Massive POTASSIUM intake
164
Q

Hyperkalemia is most common in

A

renal failure.

165
Q

Hyperkalemia can be common in massive ______.

A

cell destruction

(burns, crush injury, tumor lysis)

166
Q

HYPERKALEMIA manifestations include

A

*Cramping leg pain
*Weak or paralyzed skeletal muscles

167
Q

Hyperkalemia Nursing Implementations:

Eliminate ORAL and PARENTERAL _____ intake.

168
Q

Hyperkalemia Nursing Implementation:

Increase elimination of
_____.

A

K+
ex: diuretics, dialysis, sodium polystyrene sulfonate-Kayexalate

169
Q

Hyperkalemia Nursing Implementation:

Force K from ECF to ICF by giving

A

IV insulin or sodium bicarbonate

170
Q

Hyperkalemia Nursing Implementation:

Reverse membrane effects of elevated ECF potassium by administering

A

calcium gluconate IV

171
Q

For HYPERkalemia (high potassium) remember MURDER

A

M- muscle cramps
U-Urine
R- Respiratory distress
D- Decreased cardiac contractility
E- Ekg changes
R-reflexes

172
Q

What causes LOW serum POTASSIUM (HYPOKALEMIA)

A
  1. Increased loss of K+ via the kidneys or gastrointestinal tract
  2. Increased shift of K+ from ECF to ICF
  3. Dietary K+ deficiency (rare)
  4. Magnesium deficiency
  5. Metabolic alkalosis
  6. Certain medications (digoxin, IV insulin, diuretics)
173
Q

Hypokalemia Nursing Implementation:

Provide ______ supplements orally or IV

174
Q

What are Hypokalemia Manifestations?

A
  1. Cardiac- most serious
  2. Skeletal muscle weakness (legs)
  3. Weakness of respiratory muscles
  4. Decreased gastrointestinal motility
  5. Impaired regulation of arteriolar blood flow
  6. Hyperglycemia
175
Q

HYPOkalemia Nursing Implementation:

IV KCl should always be

176
Q

Hypokalemia Nursing Implementation:

NEVER give KCl via IV ____ OR as a _____.

A

IV PUSH

BOLUS (RAPID administration of a concentrated dose)

177
Q

Hypokalemia Nursing Implementation:

KCl supplement SHOULD NOT exceed ________ mEq/hr to prevent ________ and _______.

A
  • 10 mEq/hr
  • hyperkalemia and cardiac arrest
178
Q

REMEMBER THE 6 L’s for HYPOKALEMIA

A
  • LETHARGY
  • LEG CRAMPS
  • LIMP MUSCLES
    *LOW, SHALLOW RESPIRATIONS
  • LETHAL CARDIAC DYSRYTHMIAS
  • LOTS OF URINE.
179
Q

What are the Functions of CALCIUM

A
  1. Formation of teeth and bone
  2. Blood clotting
  3. Transmission of nerve impulses
  4. Myocardial contractions
  5. Muscle contractions
180
Q

How is Calcium obtained?

A

Obtained from ingested foods

181
Q

What Vitamin is needed for Vitamin C to be ABSORBED.

182
Q

Present in 3 forms: Ionized calcium is biologically active

???

183
Q

What changes in _____ and ______ affect CALCIUM levels.

A

PH and serum albumin

184
Q

CALCIUM balance is controlled by

A

1.Parathyroid hormone
2. Calcitonin

185
Q

What causes HYPERCALCEMIA?

A
  1. Hyperparathyroidism (two thirds of cases)
  2. Malignancy
  3. Prolonged immobilization
  4. Vit D overdose
186
Q

HYPERCALCEMIA MANIFESTATIONS (upcoming symptoms)

A
  1. Lethargy, weakness, stupor, coma
  2. Depressed reflexes
  3. Decreased memory
  4. Confusion, personality changes, psychosis
  5. Anorexia, nausea, vomiting
  6. Bone pain, fractures, nephrolithiasis
  7. Polyuria, dehydration
187
Q

Hypercalcemia Nursing Implementation include

A
  1. Excretion of Ca with loop diuretic
  2. Hydration with isotonic saline infusion
  3. Low calcium diet
  4. Mobilization
  5. Synthetic calcitonin
  6. Bisphosphonates
188
Q

HYPOCALCEMIA is caused by

A
  1. Decreased production of PTH
  2. Acute pancreatitis
  3. Multiple blood transfusions
  4. Alkalosis
  5. Increased calcium loss
  6. Hyperphosphatemia (renal failure
  7. Prolonged NG suctioning
189
Q

What are 2 testS done TO TEST for HYPOCALCEMIA?

A
  1. Chvostek’s Sign
    - Contraction of facial muscles in response to a light tap over the facial nerve in front of the ear
  2. Trousseau’s Sign
    - Palmar flexion (carpal spasm) after BP cuff is pumped up > the client’s systolic pressure AND left pumped for 1-4 minutes
190
Q
A

Chvostek’s sign

191
Q
A

Trousseau’s Sign

192
Q

Hypocalcemia Manifestations (upcoming symptoms)

A
  1. Positive Trousseau’s or Chvostek’s sign
  2. Laryngeal stridor
  3. Dysphagia
  4. Tingling around the mouth or in the extremities
  5. Cardiac dysrhythmias
193
Q

REMEMBER CATS FOR HYPOCALCEMIA

A

C-CONVULSIONS
A-ARRHYTHMIAS
T-TETANY
S-SPASMS AND STRIDOR.

194
Q

Hypocalcemia Nursing Implementation:

A
  1. Treat cause
  2. Oral or IV calcium supplements
    Not IM to avoid local reactions
  3. Rebreathe into paper bag
  4. Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis
195
Q

Essential to function of muscle, red blood cells, and nervous system

WHO AM I?

196
Q

Phosphate is Involved in

A
  1. acid-base buffering system
  2. ATP production
    cellular uptake of glucose
    metabolism of
  3. carbohydrates, proteins, and fats
197
Q

PHOSPHATE is the Primary anion in

198
Q

Phosphate Serum levels controlled by ______ hormone

A

parathyroid hormone.

199
Q

Phosphate:

Maintenance requires adequate

A

renal functioning

200
Q

Phosphate:

Reciprocal relationship with

201
Q

HYPERphosphatemia

is HIGH SERUM PO4(3-) caused by

A
  1. Acute kidney injury or chronic kidney disease (Seen frequently at TMC, 4th Floor – Renal)
  2. Chemotherapy
  3. Excessive ingestion of phosphate or vitamin D
202
Q

HYPERphosphatemia Manifestations (upcoming symptoms)

A

1.Neuromuscular irritability and tetany (hypocalcemia)

  1. Calcified deposition in soft tissue such as joints, arteries, skin, kidneys, and corneas (can cause organ dysfunction)
203
Q

How to MANAGE HYPERphosphatemia

A
  1. Identify and treat underlying cause
  2. Restrict foods and fluids containing phosphorus
  3. Phosphate-binding agents
  4. Adequate hydration and correction of hypocalcemic conditions
  5. Hemodialysis, IV insulin and glucose
204
Q

HYPOphosphatemia:

Low Serum of PO43- is caused by

A

1.Malnourishment/malabsorption
2. Alcohol withdrawal
3. Use of phosphate-binding antacids
4. During parenteral nutrition with inadequate replacement

205
Q

HYPOphophatemia Manifestations include

A
  1. CNS depression
  2. Confusion
  3. Muscle weakness and pain
  4. Dysrhythmias
  5. Cardiomyopathy
206
Q

HYPOPHOSPHATEMIA:

When PO4 is down, the patient experiences the

A

skeletal and cardiac muscle-relaxing effect of increased MgSO4.

207
Q

HYPOPHOSPHATEMIA:

What causes the problem:
the high magnesium or the low phosphate?

A

HIGH MAGNESIUM causes the problem.

208
Q

HYPOPHOSPHATEMIA MANAGEMENT INCLUDES

A
  1. Oral supplementation
  2. Ingestion of foods high in phosphorus
  3. IV administration of sodium or potassium phosphate
209
Q

Coenzyme in metabolism of protein and carbohydrates

Required for nucleic acid and protein synthesis

Acts directly on myoneural junction

WHO AM I?

210
Q

MAGNESIUM helps maintain balance of

A

calcium and potassium

211
Q

MAGNESIUM is necessary for

A

sodium-potassium pump

212
Q

Magnesium is important for nORMAL _____function

213
Q

How much of Magnesium is contained in the bone?

214
Q

Magnesium is ABSORBED IN the

215
Q

magnesium is Excreted by the

216
Q

HYPERmagnesemia:

High serum Mg is caused by

A
  1. Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present
  2. Excess intravenous magnesium administration
217
Q

MANIFESTATIONS FOR HYPERMAGNESEMIA

A
  1. Lethargy
  2. Nausea and vomiting
  3. Impaired reflexes
  4. Somnolence(sleepy)
  5. Respiratory and cardiac arrest
218
Q

Nurse management for HYPERmagnesemia.

A
  1. Prevention first—restrict magnesium intake in high-risk patients
  2. Emergency treatment
    - IV CaCl or calcium gluconate
  3. Fluids and IV furosemide to promote urinary excretion
  4. Dialysis
219
Q

HYPOMAGNESEMIA:

LOW SERUM Mg is Caused by

A
  1. Prolonged fasting or starvation
  2. Chronic alcoholism
  3. Fluid loss from gastrointestinal tract
  4. Prolonged parenteral nutrition without supplementation
  5. Diuretics
  6. Hyperglycemic osmotic diuresis
220
Q

HYPOmagnesemia manifestations include

A
  1. Confusion
  2. Hyperactive deep tendon reflexes
  3. Muscle cramps
  4. Tremors
  5. Seizures
  6. Cardiac dysrhythmias
  7. Corresponding hypocalcemia and hypokalemia
221
Q

HYPOmagnesemia management

A
  1. Treat underlying cause
  2. Oral supplements
  3. Increase dietary intake
  4. Parenteral IV or IM magnesium when severe
222
Q

What causes Ascites?

A

it results from:
*heart failure
*nephrotic syndrome
*cirrhosis
*Some malignant tumors.

TEST 1 (4 decks)

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