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Fluid And Electrolytes Flashcards

1
Q

What do body fluids do

A

Transports nutrients and wastes to and from cells, acts as a solvent for electrolytes and non-electrolytes; plays role in maintaining body temp, digestion and elim, acid-base balance, lubrication of joints and body tissues

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2
Q

What is body fluid?

A

Water containing dissolved/suspended substances like glucose, electrolytes, and proteins

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3
Q

70% of body fluid is this

A

Intracellular

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4
Q

30% of body fluids is this

A

Extracellular—interstitial (between cells) and intravascular (blood plasma)

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5
Q

Osmosis

A

Mvt of water down the concentration gradient from low solute conc to high solute conc across a semipermeable membrane

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6
Q

Diffusion

A

Movement of molecules from high conc of molecules to low conc of molecules

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7
Q

When does osmosis stop

A

When conc difference is gone or when hydrostatic pressure builds and opposes further movement

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8
Q

What does water follow?

A

Electrolytes; driven by osmotic pressure

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9
Q

Colloids

A

Substances that inc colloid oncotic pressure by moving fluid from interstitial compartment to blood plasma compartment

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10
Q

3 primary colloids and how they are measured

A

Albumin, globulin, fibrinogen; total protein level

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11
Q

Factors that decrease colloid oncotic pressure

A

Age and overall malnutrition

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12
Q

How are colloids increased?

A

Colloid replacement fluid

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13
Q

What do fluids and colloids maintain in the body?

A

Pressure

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14
Q

Hydrostatic pressure

A

Force of fluid in a compartment pushing against a cell membrane or vessel wall; generated by BP; at a capillary level, pushes fluid out of vascular space into interstitial space

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15
Q

Oncotic pressure aka colloid oncotic pressure

A

Caused by plasma colloids like albumin that attract water, pulling fluid from tissue space into vascular space (capillaries)

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16
Q

Electrolytes

A

Electrically charged in solution; affect fluid balance, nerves, heart rhythm, acid-base balance

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17
Q

Electrolytes work together

A

Change in one affects change in another; give fluid of opposite charge to fix imbalance

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18
Q

Conc of electrolytes in the body are dependent on…

A

Intake, absorption (anatomy), distribution, excretion (can kidneys excrete)

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19
Q

Extracellular electrolytes

A

Na, Cl, HCO3

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20
Q

Intracellular electrolytes

A

Potassium, magnesium, phosphorous

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21
Q

Normal lab value of sodium

A

136-145 meq/L

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22
Q

Normal lab value of potassium

A

3.5-5 meq/L

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23
Q

Magnesium normal lab value

A

1.7-2.2 mg/dL

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24
Q

Calcium normal lab value

A

9-11 mg/dl

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25
Phosphate normal lab value
3.2-4.3 mg/dl
26
Causes of hyponatremia
GI loss, vomiting, diarrhea, pee lots, skin loss—wound and burn, fasting, drinking excess water (polydipsia)
27
S/s of hyponatremia
Altered LOC, confusion, anorexia, muscle weakness, if severe, seizure and coma
28
Dilutional hyponatremia
Excess water that dilutes Na; sx are hypervolemia, inc BP, weight gain, bounding rapid pulse, inc urine specific gravity
29
Depletional hyponatremia and sx
Lack both Na and fluid; hypovolemia, Dec BP, tachycardia, dry skin, weight loss, Dec urine specific gravity
30
Tx for hyponatremia
Give Na SLOWLY to avoid large, rapid shifts; PO or IV usually IV with NS; restrict fluids for dilutional hyponatremia, treat the underlying problem
31
Sodium bicarbonate indication and MOA
Tx for hyponatremia; PO, long-term Na deficit; MOA: dissociates to give bicarbonate ion which neutralizes ion concentration and raises blood and urinary pH
32
Sodium bicarbonate SE
edema, cerebral hemorrhage, hypernatremia, electrolyte imbalance, flatulence, tetany, pulmonary edema, heart failure exacerbation
33
Vesicant
Kills surrounding cells; IV sodium bicarb is one (only given IV for metabolic acidosis, acid-base prob, or low Na chronically), IV calcium, maybe potassium…
34
NC for sodium bicarb
Monitor cardiac, ABGs, electrolytes, monitor IV and patency if given; many drug intx; give 1-3 hours before/after meals for better absorption
35
Hypernatremia causes
Caused by IVF, tube feed, near drowning in salt water, NOT Food, low water or excess water loss, cognitive impairment, fever, heatstroke
36
S/s of hypernatremia
Altered LOC, confusion, seizure, coma, thirst, dry stick membranes, cramps
37
Hypernatremia tx
Slowly add water or remove sodium, slowly remove tube feeds, focus on improved Na levels within 48 hours
38
Potassium functions and source
Cardiac muscle cell contraction, cell excitability; diet is main source; kidneys are main source of K loss—pee it out
39
Hypokalemia cause
Renal or GI loss from diuresis especially lasix; diarrhea, acid-base problem
40
Hypokalemia s/s
Cardiac rhythm problem—can be lethal, muscle weakness, leg cramp, Dec bowel mobility, constipation, nausea, ileus
41
Potassium Chloride
Tx/prevention for hypokalemia; give oral/liquid and DILUTE with water or juice bc tastes awful and can cause GI bleeds, N/V/D, give slowly through IV and ALWAYS dilute
42
Which patients can you give IV potassium to?
Only for pt with documented urine output and tele; dialysis and end stage renal may NOT get it; may cause phlebitis and pain
43
How to give IV potassium
Never give fast and NEVER PUSH; <40 mEq, rate below 10-20 mEq
44
Hyperkalemia causes
Dec K output (renal failure, not peeing), burns, crush injuries, sepsis—massive cell injury, K-sparing diuretics, ACEs, ARBs
45
S/s hyperkalemia
Cardiac rhythm disturbance, muscle cramps, muscle weakness, peaked T waves
46
Kayexalate/sodium polystyrene sulfonate
Cation exchange resin that binds to K in digestive tract replacing K with Na; given in oral suspension, oral/rectal powder, rectal enema
47
SE and NC for Kayexalate
Poop out the K so only for people with normal bowel function; N/V/D, constipation, hypokalemia, intestinal obstruction, intestinal necrosis
48
D50/Insulin for Hyperkalemia
Usually for emergencies where cardiac rhythm disturbance is seen; combo shifts potassium into cell temporarily; give 10 units of insulin and 1 ampule of D50 (D50 prevents blood sugar from getting super low); check blood sugar and may give again
49
Magnesium functions
Stabilizes cardiac muscle and blocks/control Mvt of K+ out of cells, stabilizes smooth muscle
50
Causes of hypomagnesemia
Diuresis, GI/renal loss, pancreatitis, alcohol abuse, limited intake, hyperglycemia
51
Hypomagnesemia s/s
Hyperactive reflux, confusion, cramp, seizure, tremor, NYSTAGMUS—eyes drift
52
hypomagnesemia tx
Give PO or IV (Mylanta or Magnesium sulfate) or IV (magnesium sulfate/oxide) given over several days often (can IVP if needed)
53
Causes of hypermagnesemia
Inc intake accompanied by renal failure; chronic renal failure who take milk of magnesium (for constipation), OB patients (given mag sulfate to prevent preeclampsia sx)
54
Hypermagnesemia s/s
Lethargy, floppy, muscles weak, Dec reflex, flushed/warm skin, Dec pulse and BP
55
Hypermagnesemia tx
Stop replacement; if chronic replacement—dialysis
56
Mag sulfate and oxide s/s
Hypermagnesemia, slow Mvt, SOB, nausea, dizziness, abnormal heart rhythm
57
Mag oxide
Antacid—can be given for long term low mag
58
Calcium
Controlled by thyroid and parathyroid glands and released from and absorbed into bone
59
Where is most calcium located
In bones—99%; mostly protein bound, ionized and ready for use
60
Calcium functions
Stability and strength, enzyme reactions, membrane potential, muscle contractions, NT release, cardiac contrast, blood clotting
61
Causes of hypocalcemia
Calcium can’t mobilize from bones bc hypoparathyroidism, Hypomagnesemia, inc renal loss, renal failure, inc binding issues, Dec abs of vit D, acute pancreatitis, THYROID and PARATHYROID surgery (removal)
62
Sx of hypocalcemia
Inc neuromuscular activity—Parasthesias (numb/tingle), muscle cramps, bone pain, tetanus, laryngeal spasm, hyperactive reflexes, cardiac insufficiency (fatal arrhythmia), positive Chvostek’s sign, positive Trosseau’s sign
63
Positive Chvostek’s sign
Twitching in cheek muscle and eye close when facial nerve anterior to ear is tapped
64
Positive Trousseau’s sign
Spasm in carpal muscle when BP cuff is inflated
65
Tx of hypocalcemia
IV calcium—CaCl or calcium gluconate—both thru central line (vesicant); oral calcium—elemental calcium, calcium carbonate (tums), give vit D
66
Hypercalcemia causes
Caused by hyperparathyroidism, cancers (breast and lung), tums overdose
67
Hypercalcemia s/s
Sedative, fatigue, lethargy, confusion, seizure, coma; kidney stones if chronic
68
Hypercalcemia tx
Hydrate, diuretic with NaCl, dialysis
69
Phosphorous function
Works with calcium inversely (high Calcium, low phosphorous and vice versa); found mostly in bone and some Intracellular
70
Organic phosphate
Intracellular, we don’t measure
71
Inorganic phosphate
Circulates in bloodstream; we measure
72
Phosphate functions
Bone formation, ATP formation, enzymes needed for glucose, protein, fat metabolism, DNA and RNA; acid-base buffer, normal function of WBCs and platelets
73
Hypophosphemia causes
Rare; caused by Dec abs, antacids overdose, severe diarrhea, inc kidney elim, malnutrition (alc, TPN, recovery from manutrition)
74
Hypophosphatemia s/s
Tremor, parathesia, confusion to coma, seizure, muscle weakness, joint stiffness, bone pain, hemolytic anemia, pit dysfunction, impaired WBC function, kidney problems
75
Hyperphosphatemia causes
Kidney failure, lax/enema with phosphorus, intro-extra shift, stroke, heat, trauma, hypoparathyroid
76
Hyperphosphoremia s/s
Asymptomatic often; muscle spasm, paresthesia, tetany
77
Hypophosphatemia tx and NC
IV or oral replacement; given IV over a long time; inc oral intake, take care with CKD or Hypercalcemia (inc risk of calcifications)
78
Hyperphosphatemia tx
Treat the cause—calcium-based phosphate binders, hemodialysis—renal failure
79
Osmotic pressure
The amt of pressure needed to prevent the Mvt of water across a cell membrane

PATHO (32 decks)

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