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PATHO > Fluid And Electrolytes > Flashcards

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
Q

Phosphate normal lab value

A

3.2-4.3 mg/dl

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26
Q

Causes of hyponatremia

A

GI loss, vomiting, diarrhea, pee lots, skin loss—wound and burn, fasting, drinking excess water (polydipsia)

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27
Q

S/s of hyponatremia

A

Altered LOC, confusion, anorexia, muscle weakness, if severe, seizure and coma

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28
Q

Dilutional hyponatremia

A

Excess water that dilutes Na; sx are hypervolemia, inc BP, weight gain, bounding rapid pulse, inc urine specific gravity

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29
Q

Depletional hyponatremia and sx

A

Lack both Na and fluid; hypovolemia, Dec BP, tachycardia, dry skin, weight loss, Dec urine specific gravity

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30
Q

Tx for hyponatremia

A

Give Na SLOWLY to avoid large, rapid shifts; PO or IV usually IV with NS; restrict fluids for dilutional hyponatremia, treat the underlying problem

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31
Q

Sodium bicarbonate indication and MOA

A

Tx for hyponatremia; PO, long-term Na deficit; MOA: dissociates to give bicarbonate ion which neutralizes ion concentration and raises blood and urinary pH

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32
Q

Sodium bicarbonate SE

A

edema, cerebral hemorrhage, hypernatremia, electrolyte imbalance, flatulence, tetany, pulmonary edema, heart failure exacerbation

33
Q

Vesicant

A

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
Q

NC for sodium bicarb

A

Monitor cardiac, ABGs, electrolytes, monitor IV and patency if given; many drug intx; give 1-3 hours before/after meals for better absorption

35
Q

Hypernatremia causes

A

Caused by IVF, tube feed, near drowning in salt water, NOT Food, low water or excess water loss, cognitive impairment, fever, heatstroke

36
Q

S/s of hypernatremia

A

Altered LOC, confusion, seizure, coma, thirst, dry stick membranes, cramps

37
Q

Hypernatremia tx

A

Slowly add water or remove sodium, slowly remove tube feeds, focus on improved Na levels within 48 hours

38
Q

Potassium functions and source

A

Cardiac muscle cell contraction, cell excitability; diet is main source; kidneys are main source of K loss—pee it out

39
Q

Hypokalemia cause

A

Renal or GI loss from diuresis especially lasix; diarrhea, acid-base problem

40
Q

Hypokalemia s/s

A

Cardiac rhythm problem—can be lethal, muscle weakness, leg cramp, Dec bowel mobility, constipation, nausea, ileus

41
Q

Potassium Chloride

A

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
Q

Which patients can you give IV potassium to?

A

Only for pt with documented urine output and tele; dialysis and end stage renal may NOT get it; may cause phlebitis and pain

43
Q

How to give IV potassium

A

Never give fast and NEVER PUSH; <40 mEq, rate below 10-20 mEq

44
Q

Hyperkalemia causes

A

Dec K output (renal failure, not peeing), burns, crush injuries, sepsis—massive cell injury, K-sparing diuretics, ACEs, ARBs

45
Q

S/s hyperkalemia

A

Cardiac rhythm disturbance, muscle cramps, muscle weakness, peaked T waves

46
Q

Kayexalate/sodium polystyrene sulfonate

A

Cation exchange resin that binds to K in digestive tract replacing K with Na; given in oral suspension, oral/rectal powder, rectal enema

47
Q

SE and NC for Kayexalate

A

Poop out the K so only for people with normal bowel function; N/V/D, constipation, hypokalemia, intestinal obstruction, intestinal necrosis

48
Q

D50/Insulin for Hyperkalemia

A

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
Q

Magnesium functions

A

Stabilizes cardiac muscle and blocks/control Mvt of K+ out of cells, stabilizes smooth muscle

50
Q

Causes of hypomagnesemia

A

Diuresis, GI/renal loss, pancreatitis, alcohol abuse, limited intake, hyperglycemia

51
Q

Hypomagnesemia s/s

A

Hyperactive reflux, confusion, cramp, seizure, tremor, NYSTAGMUS—eyes drift

52
Q

hypomagnesemia tx

A

Give PO or IV (Mylanta or Magnesium sulfate) or IV (magnesium sulfate/oxide) given over several days often (can IVP if needed)

53
Q

Causes of hypermagnesemia

A

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
Q

Hypermagnesemia s/s

A

Lethargy, floppy, muscles weak, Dec reflex, flushed/warm skin, Dec pulse and BP

55
Q

Hypermagnesemia tx

A

Stop replacement; if chronic replacement—dialysis

56
Q

Mag sulfate and oxide s/s

A

Hypermagnesemia, slow Mvt, SOB, nausea, dizziness, abnormal heart rhythm

57
Q

Mag oxide

A

Antacid—can be given for long term low mag

58
Q

Calcium

A

Controlled by thyroid and parathyroid glands and released from and absorbed into bone

59
Q

Where is most calcium located

A

In bones—99%; mostly protein bound, ionized and ready for use

60
Q

Calcium functions

A

Stability and strength, enzyme reactions, membrane potential, muscle contractions, NT release, cardiac contrast, blood clotting

61
Q

Causes of hypocalcemia

A

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
Q

Sx of hypocalcemia

A

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
Q

Positive Chvostek’s sign

A

Twitching in cheek muscle and eye close when facial nerve anterior to ear is tapped

64
Q

Positive Trousseau’s sign

A

Spasm in carpal muscle when BP cuff is inflated

65
Q

Tx of hypocalcemia

A

IV calcium—CaCl or calcium gluconate—both thru central line (vesicant); oral calcium—elemental calcium, calcium carbonate (tums), give vit D

66
Q

Hypercalcemia causes

A

Caused by hyperparathyroidism, cancers (breast and lung), tums overdose

67
Q

Hypercalcemia s/s

A

Sedative, fatigue, lethargy, confusion, seizure, coma; kidney stones if chronic

68
Q

Hypercalcemia tx

A

Hydrate, diuretic with NaCl, dialysis

69
Q

Phosphorous function

A

Works with calcium inversely (high Calcium, low phosphorous and vice versa); found mostly in bone and some Intracellular

70
Q

Organic phosphate

A

Intracellular, we don’t measure

71
Q

Inorganic phosphate

A

Circulates in bloodstream; we measure

72
Q

Phosphate functions

A

Bone formation, ATP formation, enzymes needed for glucose, protein, fat metabolism, DNA and RNA; acid-base buffer, normal function of WBCs and platelets

73
Q

Hypophosphemia causes

A

Rare; caused by Dec abs, antacids overdose, severe diarrhea, inc kidney elim, malnutrition (alc, TPN, recovery from manutrition)

74
Q

Hypophosphatemia s/s

A

Tremor, parathesia, confusion to coma, seizure, muscle weakness, joint stiffness, bone pain, hemolytic anemia, pit dysfunction, impaired WBC function, kidney problems

75
Q

Hyperphosphatemia causes

A

Kidney failure, lax/enema with phosphorus, intro-extra shift, stroke, heat, trauma, hypoparathyroid

76
Q

Hyperphosphoremia s/s

A

Asymptomatic often; muscle spasm, paresthesia, tetany

77
Q

Hypophosphatemia tx and NC

A

IV or oral replacement; given IV over a long time; inc oral intake, take care with CKD or Hypercalcemia (inc risk of calcifications)

78
Q

Hyperphosphatemia tx

A

Treat the cause—calcium-based phosphate binders, hemodialysis—renal failure

79
Q

Osmotic pressure

A

The amt of pressure needed to prevent the Mvt of water across a cell membrane

PATHO (32 decks)

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