Fluid and Electrolytes Flashcards
What is homeostasis?
-ability to maintain internal equilibrium by adjusting physiologic processes
-reestablishment and maintenance a goal in managing fluid, electrolyte, and acid-base imbalance
What does water do in body fluid composition?
-transport nutrients
-medium for metabolic reactions
-regulation of body temp
What do electrolytes do in body fluid composition?
-water balance regulation
-acid base balance
-enzyme reactions
-neuromuscular activity
What is Intracellular fluid?
-found WITHIN the cells
-essential for normal cell functions
What electrolytes are in the ICF?
-potassium
-magnesium
-phosphate
-glucose
-oxygen
What is Extracellular fluid?
-fluid outside the cell
-interstitial fluid
-intravascular fluid
-transcellular fluid
What electrolytes are found in the ECF?
-sodium
-chloride
-bicarbonate
What are the major fluid compartments of the body?
-total body fluid: 60% body weight
-ICF: 40% of body weight
-plasma: 5% of body weight
What are some normal intake values?
-fluids: 1200cc
-solid foods: 1000cc
-oxidation: 300cc
-total: 2500cc
What are some normal output values?
-insensible: 900cc
-feces: 100cc
-urine: 1500cc
-total: 2500cc
What are key implications for elderly in normal fluid balance?
-decreased percentage of fluid
-hormone regulators respond more slowly
-increased loss of moisture through skin
-decreased thirst mechanism
Key values for weight loss
-up to 2 lb/ week or 1 lb per day is normal
-30 to 50 cc/hr urine output
What is the Specific gravity of urine?
1.010-1.030
Who is at higher risk for dehydration and electrolyte imbalances?
Elderly
Diluted vs Concentrated Urine
-concentrated: less water; more heavy (dehydration)
-diluted: more water
You notice the following intake and output pattern on an adult patient for an 8 hour shift. What should be your interpretation?
Oral Intake- 50cc; IV Intake- 1100cc; Urinary Output- 500cc; Vomitus- 500cc
this would represent an adequate pattern (there will always be a little more going in than coming out)
What is osmosis?
movement of water molecules from less concentrated area to more concentrated area
What is diffusion?
movement of molecules from an area of higher concentration to lower concentration
What are the types of diffusion?
simple and facilitated
What is simple diffusion?
molecules move through membrane w/o help
What is facilitated diffusion?
diffusion that’s assisted by integral (channel) proteins
What is filtration?
separation of solids from fluids (liquids or gases)
What is the purpose of filtration?
balance hydrostatic, colloid osmotic pressure. push and pull that occurs in the capillary bed and glomerulus
What is active transport?
-movement of ions or molecules across a cell membrane from low to high concentration requiring energy or enzymes
-sodium potassium pump
What does the sodium potassium pump do?
moves sodium out of the cell and potassium into the cell against their concentration gradients
Where is fluid balance between intravascular and interstitial spaces?
maintained in the capillary beds by a balance of filtration at the arterial end and osmotic draw at the venous end
What do the veins do?
carries away waste using osmotic pressure
What is the active transport process fueled by?
energy from ATP
If albumin is low what does that mean?
it is a blood product
What are the Isotonic solutions?
0.9% NS
LR (favorite for SHOCK)
D5W
What are hypotonic solutions?
-0.45% NS (1/2 NS)
-1/4 NS
What are hypertonic solutions?
-D5 NS
-D5 LR
-D10W
What do isotonic solutions do to a RBC?
neither gain nor lose water, retaining their normal biconcave shape
What do hypertonic solutions do to a RBC?
cells LOSE water and shrink in size
cellular dehydration=
hypernatremia
What do hypotonic solutions do to a RBC?
cells absorb water and may burst (hemolysis)
If the nurse were to administer 1/2 NS IV solution, what would be the expected outcome?
the fluid would move from the vascular volume to the cells (solution is hypotonic)
What is thirst?
primary regulator of water intake
What do the kidneys do?
regulates volume, osmolality of body fluids
What is renin-angiotensin-aldosterone system?
helps maintain intravascular fluid balance and BP
What is Antidiuretic hormone and what does it do?
-made by the hypothalamus and stores in the posterior pituitary gland
-regulates water excretion from kidneys
What is the Atrial natriuretic peptide?
released by atrial muscle cells in response to distention from fluid overload
What does the atrial natriuretic peptide do?
inhibits aldosterone and dilates the afferent arteriole to reduce blood volume
What does aldosterone do?
causes the reabsorption of sodium in the kidney tubule
Where water goes…
sodium and potassium follow
What do increased levels of aldosterone regulate?
sodium and potassium, BP, and water balance
Why is aldosterone released?
decreased blood volume and renal perfusion sets off a chain reaction leading to the release
What stimulates the release of ADH from the posterior pituitary?
increased serum osmolality or a fall in blood volume
What does ADH INCREASE?
the permeability of distal tubules, promoting water reabsorption
What are some risks for loss of water and electrolytes?
-vomiting
-diarrhea
-excess sweating
-polyuria
-fever
-abnormal drainage or wound losses
What can insufficient intake be due to?
-anorexia
-nausea
-inability to access fluids
-impaired swallowing
-confusion
What are some weight loss clinical manifestations ?
-2% loss: MILD FVD
-5% loss: MODERATE
-8% loss: SEVERE
What are fluid volume deficit clinical manifestations?
-weight loss
-fluid intake less than output
-dry mucous membranes
-weak, rapid pulse
-hypotension (BP drops when moving from lying to sitting)
-decreased capillary refill
-decreased urine volume
What are some nursing interventions for fluid volume deficit?
-assess
-monitor vitals and weight
-assess tissue turgor
-monitor I & O
-monitor lab findings
-provide frequent mouth care
NANDAs for fluid volume deficit
-deficient fluid volumes
-ineffective tissue perfusion
-risk for injury
When fluid is low what happens to the hematocrit?
increased hematocrit due to increased formed elements
Why is a person with fever most likely to have a fluid volume problem?
they are likely to have increased perspiration and respiration (insensible loss)
What is the primary rationale for good skin care in the patient with the nursing diagnosis of fluid volume deficit from any cause?
there is likely to be decreased tissue perfusion to the skin and higher breakdown risk
Fluid Volume Excess- Risk factors
-heart failure
-renal failure
-cirrhosis of liver
Clinical Manifestations- Fluid Volume Excess
-weight gain
-intake greater than output
-full, bounding pulse
-increased BP and venous pressure
-distended neck veins
-crackles in lungs (bilaterally)
-dyspnea, SOA
-mental confusion
What are nursing interventions for fluid volume excess?
-monitor weight and vitals
-assess for edema
-assess breath sounds
-monitor I & O
-place in Fowler’s position
-administer diuretics
-restrict fluid intake and dietary sodium
-implement measures to prevent skin breakdown
What are the priorities of care for a patient with fluid volumes excess?
supporting cardiovascular, respiratory function
What are some fluid volumes excess NANDAs?
-fluid volume excess
-risk for impaired skin integrity
-impaired gas exchange
Fluid Volume Deficit vs. Fluid Volume Excess: BP
-FVD: decreased
-FVE: increased
Fluid Volume Deficit vs. Fluid Volume Excess: HR
-FVD: increased
-FVE: increased
Fluid Volume Deficit vs. Fluid Volume Excess: pulse
-FVD: decreased
-FVE: increased
Fluid Volume Deficit vs. Fluid Volume Excess: Respirations
-FVD: normal
-FVE: moist crackles, wheezing
Fluid Volume Deficit vs. Fluid Volume Excess: Edema
-FVD: rare
-FVE: dependent
Fluid Volume Deficit vs. Fluid Volume Excess: Skin Turgor
-FVD: loose, poor
-FVE: taut
Fluid Volume Deficit vs. Fluid Volume Excess: Urine Specific Gravity
-FVD: high
-FVE: low
Which of the following assessment findings in an adult patient most clearly supports the nursing diagnosis of fluid volume OVERLOAD
intake greater than output
What are electrolytes important for?
-maintaining fluid balance
-contributing to acid base
-facilitating enzyme reactions
-transmitting neuromuscular reactions
Where are most electrolytes obtained?
through the diet and excreted in urine; some are not stored and must be consumed daily
