Fluid and Electrolytes Flashcards
What is the intracellular space ?
space within the cell
- holds about 67% of the body’s water
What is the extracellular space ?
space outside the cell (includes the interstitial and intravascular)
- holds 25% of the body’s water
How much water does the intravascular space hold ?
8% of the body’s water
What is the interstitial fluid ?
fluids between cells and outside the blood vessels
- include lymph
What is the intravascular fluid ?
blood plasma found in the vascular system
What is the transcellular fluids ?
secreted by epithelial cells and include cerebrospinal, pleural, peritoneal, and synovial fluids
What does the hemoglobin test measure ?
the amount of hemoglobin in blood and is a good measure of the blood’s ability to carry oxygen throughout the body
What does the hematocrit test measure ?
amount of space (volume) red blood cells take up in the blood
- value is given as a % of RBCs in a volume of blood
- Ex.) hematocrit of 38 means that 38% of the blood’s volume is made of RBCs
What is the best indicator of fluid retention and overload ?
weight gain
- congestive heart failure and renal failure and great examples of diseases that can retain large amounts of fluid
How much of weight gain does one gain per liter ?
2.2 lbs= 1 L (1000mL)
What are some causes of hypervolemia ?
- excessive intake of fluids
- abnormal retention of fluids
- heart failure
- renal failure
- long term corticosteroid therapy
What is hypervolemia ?
where the liquid portion of the blood (plasma) is too high
- or fluid in the body is too high
What are signs and symptoms of hypervolemia ?
- increased pulse: full and bounding distended neck veins
- increased BP
- polyuria/nocturia
- edema
- SOB
- moist crackles
- headache
What is a classic sign of hypervolemia ?
full and bounding distended neck veins
What are some nursing consideration for hypervolemia ?
- maintain oxygenation (semi or full fowler’s to improve gas exchange)
- fluid restriction: I & O
- promote excretion of excess fluids
- monitor electrolytes (prevent tissue injury)
- evaluate feet for edema and discoloration when pt is OOB (out of bed)
- observe suture line on surgical pt’s (potential evisceration due to fluid retention)
What are some causes of hypovolemia ?
- abnormal fluid loss
- diarrhea
- hemorrhage
- fever (increased perspiration)
- inadequate intake
- DKA (diabetic ketoacidosis)
What are some signs and symptoms of hypovolemia ?
- increased HR (due to SNS: sympathetic NS)
- weak/thready pulses
- change in position may cause increased HR or decreased BP
- dizziness/light-headedness
- UO <500 mL/day
- altered mental status
- restlessness
- lethargy
What are some RN considerations for hypovolemia ?
- maintain pt’s safety
- Skin care: edematous tissues protected from extreme temps, pressure, and trauma
- frequent skin care and changes in position
- elevate edematous extremities to promote venous return and fluid reabsorption
What is the goal of IV therapy ?
- correct or prevent fluid and electrolyte disturbances
- provide direct access to the vascular system
What is isotonic fluid ?
fluid with the same concentration of normal blood
- most common
What is isotonic fluid used for ?
used for volume replacement (after prolonged vomiting)
- 0.9% sodium chloride (normal saline)
- LR
What is hypotonic fluid ?
fluid that is more dilute than blood
What is hypotonic fluid used for ?
used to rehydrate the cells
- 0.45% NaCl
- D5 0.45% NaCl (once infused, dextrose enters cells rapidly leaving free water)
What is hypertonic fluid ?
fluid is more concentrated than normal blood
What is hypertonic fluid used for ?
to increase vascular volume
- use with caution due to risk for fluid overload
- 3% normal saline (NS)
Why should Potassium Chloride (KCl) be given cautiously ?
it can cause hyperkalemia which can cause fatal cardiac dysrhythmias
- NEVER GIVE IV PUSH (can stop heart)
- must be given slowly
- KCl irritates the veins and pt’s will complain of pain (can be given with other fluids to reduce irritation)
What is the primary extracellular electrolyte ?
sodium
How does sodium work in the body ?
- helps maintain BP by balancing the volume of water in the body
- works with other electrolytes to promote nerves, muscles, and other body tissues to work properly
What are the causes of hypernatremia ?
- inadequate water intake
- NPO status
- excessive water loss
- gastroenteritis/vomiting/watery diarrhea
- NG suction
- severe burns
- high fever
- diuretic therapy
- excessive sweating
- disease states (kidney disease or failure, uncontrolled DM)
What are the symptoms of hypernatremia ?
- restlessness
- agitation
- confusion
- seizures
- thirst
- dry, swollen tongue
- hypotension
- flushed skin
- edema (peripheral and pulmonary)
- weight gain
What is hypernatremia ?
too much sodium in the body
- >145
What are the treatments for hypernatremia ?
- treat underlying cause
- water replacement: oral, Na-free isotonic fluids to dilute serum NA, then 0.45% NS to prevent hyponatremia
- diuretics (to promote excretion of Na)
- dietary NA may be restricted
What are some causes of hyponatremia ?
- vomiting
- diarrhea
- NG suctioning
- diuretic
- burns
- wounds
- excessive water gain
- tap water enemas
What are some symptoms of hyponatremia ?
- N, V, D
- lethargy
- confusion
- headache
- restlessness
- irritability
- tremors, seizures, coma
- weight gain
- increased BP
What are some treatments for hyponatremia ?
- treat underlying cause
- potential fluid restriction
What is the largest intracellular electrolyte ?
potassium
- contributes to intracellular osmotic pressure
How does Potassium get used in the body ?
- supports transmission of electrical impulses in the nerves and muscles (skeletal, cardiac, and smooth muscle contractions)
- regulates glucose use and storage
- small changes have a profound effect and is poorly tolerated
- kidneys eliminate approx. 90% of K
What are the causes of hyperkalemia ?
- failure to eliminate K (renal disease, K+ sparing diuretics, ACE inhibitors)
- excess K intake
- excessive or rapid parenteral administration
- shift of K out of cells (acidosis, crushing injury, tissue catabolism fever, sepsis, burns)
What are the symptoms of hyperkalemia ?
- irritability
- abdominal cramping, diarrhea
- weakness of lower extremities
- irregular pulse
- cardiac arrest if hyperkalemia sudden or severe
- EKG: Vfib, V standstill
What is hyperkalemia ?
high potassium levels
What are treatments of hyperkalemia ?
- eliminate K intake, both oral and IV
- dialysis (if due to renal failure)
- diuretics (K wasting)
- insulin (pushes K into the cell)
What is given to treat mild to moderate hyperkalemia ?
Kayexalate
- ion-exchange resin
- used if kidney function is not normal
What are some causes of hypokalemia ?
- Potassium loss
- GI losses (D, V, fistulas, NG suction, NPO status)
- renal losses: diuretics
- skin losses: diaphoresis
- dialysis
- shift of K into cells (alkalosis)
- lack of K intake (starvation, diet let in K, fail to include K in parenteral fluids if NPO, TPN)
What are symptoms of hypokalemia ?
- fatigue
- constipation
- muscle weakness, leg cramps
- N, V, paralytic ileus
- soft, flabby muscles
- dysrhythmias (PVCs)
- bradycardia
What are treatments for hypokalemia ?
- treat underlying cause
- K supplementation
- NEVER IV PUSH K
Where is Calcium found in the body ?
blood and cells
- but 99% is stored in the bones and teeth
What is calcium need for in the body ?
mineralization of bones, muscle contractions, nerve transmission, clotting, hormone secretion, and cardiac function
What are some causes of hypercalcemia ?
- increased total calcium
- cancer
- hyperparathyroidism
- prolonged immobilization
- thiazide diuretics
- renal failure
What are some symptoms of hypercalcemia ?
- GI (1st to occur): constipation, abdominal pain, N, V, anorexia
- lethargy, weakness
- depressed reflexes (DTR)
- confusion, personality changes, psychosis
- bone pain, fractures
- flank pain/renal calculi
- ventricular dysrhythmias
What are some treatments for hypercalcemia ?
- phosphate
- admin of IV fluids followed by loop diuretics (excretion of Ca is followed by excretion of Na)
- calcitonin via IV to promote renal excretion of Ca
- stool softeners given for constipation
- cardiac monitoring
- dialysis: for severe hypercalcemia
- management of renal calculi
What are cause of hypocalcemia ?
- vita. D deficiency
- hypoparathyroidism
- hormonal changes (menopause)
- chronic renal failure
- loop diuretics (furosemide)
- multiple blood transfusions
What are symptoms of hypocalcemia ?
- Chvostek’s & Trousseau’s sign
- chest pain, dysrhythmias, heart failure, syncope
- numbness and tingling in extremities around mouth, hyperreflexia, muscle cramps
- confusion lethargy, seizures, personality changes
- wheezing, laryngeal spasm, dysphagia
Where is magnesium found in the body ?
intracellular
- 50 to 60% in the bones
What is the use of Magnesium in the body ?
- regulation of nerve and muscle function
- maintain BP, glucose
- bone/teeth health
What are the causes of hypermagnesemia ?
- renal failure
- pt’s who ingest large amounts of Mg- containing antacids such as Tums, Maalox, Mylanta
What are some symptoms of hypermagnesemia ?
- nausea, dizziness, weakness, confusion
- bradycardia, hypotension
- severe hypermagnesemia: cardiac arrest
- lethargic
- coma
- deep tendon reflexes- reduced or absent
- skeletal muscle contractions because progressively weaker and finally stop
What are treatments of hypermagnesemia ?
- treat underlying cause
- IV diuretics
What are some causes of hypomagnesemia ?
- malabsorption disorders
- inflammatory bowel disease (IBD)
- diarrhea/pancreatitis
- certain abdominal surgeries
- alcoholism
- diuretics
What are some symptoms of hypomagnesemia ?
- N, V, decreased appetite
- weakness, fatigue
- confusion
- neuromuscular changes
- tremors/seizures
- hyperactive deep tendon reflexes
- painful muscle contractions
What are some treatments for hypomagnesemia ?
- treat underlying cause
- Mg supplement
