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Semester 3-Unit 1 > Fluid and Electrolytes > Flashcards

Fluid and Electrolytes Flashcards

1
Q

Two main fluid components of body

A

Extracellular— subgroups are plasma and interstitial fluids (fluid that bathes cells)
And Intracellular

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2
Q

How much does one liter of water weigh?

A

1 kg

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3
Q

is there more intracellular or extracellular fluid?

A

ICF 66%

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4
Q

What is main cation and anion of ECF?

A

Sodium + and chloride-

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5
Q

What are main cation and anion of ICF?

A

Potassium + and phosphate -

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6
Q

Define diffusion.

A

Movement of molecules from high to low until balanced.

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7
Q

Define active transport.

A

Movement of molecules from area of low to high…being pushed uphill…takes energy. Example is sodium potassium pump. Atp is the fuel

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8
Q

Define osmosis.

A

Movement of water from area of low solute to high solute. Water tries to “water down” substance. Water follows salt. Water attempts to balance

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9
Q

What is normal plasma osmolality value and what is its significance?

A

280-295 mOsm/kg milliosmoles/kg
This is an important indicator of water balance in body. Too high and it means water deficit…too low and it means water excess. This is because this is measurement of molecules to water.

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10
Q

What happens to a cell if bathed in a hypotonic solution? (ECF)

A

Water moves into cell…water is following the saltier of the two spaces

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11
Q

What happens to cell if bathed in ECF that is hypertonic?

A

Water leaves cell..shrinks…water is following the saltier of the two spaces.

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12
Q

What is hydrostatic pressure?

A

The pressure water exerts on membrane. Think pressure water exerts on inside of a water hose wall.

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13
Q

What is oncotic pressure, also called colloidal osmotic pressure?

A

Pressure the plasma colloids (proteins) exert in a solution. This draws water into vessels to water down the proteins.

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14
Q

What is fluid spacing?

A

The distribution of body water

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15
Q

What is first spacing?

A

Normal balance between ICF and ECF

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16
Q

What is second spacing?

A

Abnormal accumulation of interstitial fluid (fluid that bathes the cells) seen as edema

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17
Q

What is third spacing?

A

Excessive fluid collecting in areas that it becomes trapped…ascites, edema from burns, trauma or sepsis

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18
Q

What role does the hypothalamus and pituitary play in water balance?

A

Osmorecetors in the hypothalamus are activated by an increase in plasma osmolarity or water deficit. This is the chain that follows:
Increase salt or decrease body water….
Hypothalamus alarms….
Thirst kicks in…
Pituitary sends out ADH (vasopressin) to kidneys….
Kidneys hang onto water

This combo of increased thirst and conservation of water restores balance

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19
Q

What does the RAAS do?

A

Manages drops in BP by activating Angiotensin 2 and aldosterone to increase BP

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20
Q

How does Angiotensin 2 increase BP?

A

Vasoconstriction and increases blood volume

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21
Q

How does Aldosterone increase BP?

A

Retains Na and excretes potassium

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22
Q

What are the natural antagonists hormones to the RAAS system?

A

Natriuretic peptides made by the heart…
Atrial natriuretic hormone ANH
and B type natriuretic peptide BNP. These work to lower BP

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23
Q

What is normal range for serum sodium?

A

135-145 mEq/L

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24
Q

What is the major body system affected by sodium imbalances?

A

Neurological.
Looks like changes in mental status
Agitation, restlessness, lethargy, confusion, tremors, seizures

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25
What is relationship of sodium and potassium?
Inverse. They balance each other. Any factor that increases sodium decreases potassium and vice versa
26
When rebalancing sodium in body what is the caution?
Must do it slowly with careful monitoring or could cause dangerous fluid shifts into cells.
27
What are some common causes of hypernatremia?
Impaired thirst cues, water loss without salt loss, too much salt ingestion or hypertonic IV solution (3% NS), Cushings syndrome (affects cortisol in body by increasing cortisol and remember too much steriod=too much sodium),
28
Hypernatremia s/sx.
Think big and bloated. Late signs: SWOLLEN DRY TONGUE N/V INCREASED MUSCLE TONE Confusion Red skin Edema Low grade fever Diarrhea Remember: Sodium affects the neuro system profoundly
29
What is SIADH?
Syndrome of inappropriate ADH In this syndrome ADH is elevated---meaning water is retained and dilutes sodium. This leads to a certain type of hyponatremia called Euvolemic hyponatremia. Too much water-too little sodium.
30
Signs and Symptoms of hyponatremia.
Think neurological s/sx. Depressed and deflated----- Lethargy, confusion, agitation, restlessness, SEIZURES AND COMA, TACHYCARDIA, WEAK THREADY PULSE, RESPIRATORY ARREST, diminished reflexes, muscle spasms, abdominal cramping
31
Interventions for SIADH.
Fluid restrictions, Declomycin-remember no dairy or antacids with.
32
What are normal potassium serum levels?
3.5----5.0 mEq/L Anything over 7 is extremely dangerous
33
What are two main body systems affected by potassium imbalances?
Neurological and muscular
34
Causes of hyperkalemia.
Burns or any major tissue damage (destroys cells and they release K+) Acidosis Adrenal insufficiency (Addisons disease) RENAL FAILURE---most common Potassium sparing diuretics (aldactone, triamterene) NSAIDS, ACE inhibitors
35
Signs and symptoms of hyperkalemia.
Think neuro/muscle..overstimulated. Everything tight and contracted! GI muscle will be jumpy--think cramping, diarrhea, vomiting Confusion, irritability, fatigue, muscle weakness, increased DTRs, decreased muscle tone. Dsyrhythmias---Tall peaked T wave, widened QRS, Loss of p wave, Bradycardia, hypotension
36
Nursing interventions for hyperkalemia.
Monitor cardiac, respiratory, and neurological. Restrict potassium intake Dialysis Kayexalate (slow acting) Lasix (potassium wasting diuretic) Thiazides (potassium wasting diuretics) Hypertonic solution of insulin and glucose (moves K+ back into cell.) Dextrose 20% and insulin (fast acting)
37
Causes of hypokalemia.
Think abnormal loss from kidneys/GI tract. Diuretics that waste potassium. (Lasix) Corticosteroids Cushings syndrome. (too much aldosterone) Fluid loss (diarrhea, NG suction, vomiting) Alkalosis
38
Signs and symptoms of hypokalemia.
Think low and slow in muscle and neuro. Constipation, PARLYTIC ILIUS, weak pulse, hypotension, muscle weakness, muscle cramps, decreased DTRs, shallow respirations, EKG changes (depressed ST, PROMINENT U WAVE, flat T wave.
39
Interventions for hypokalemia.
Cardiac monitoring. Watch glucose levels and Na levels as these are all needed to reverse hypokalemia. Watch magnesium levels (will also decrease in hypokalemia and if mag stays low difficult to bring K+ up) Watch respiratory and GI systems. Oral potassium or Potassium infusion---never give as IV push, IM or SQ. Highly irritating to veins/muscles. Give slowly in a drip. Watch for phlebitis or infiltration. Hold potassium wasting diuretics. Don't give with digoxin.
40
What hormones regulate calcium levels?
Parathyroid hormone and calcitonin keep serum calcium levels in balance.
41
What are the two main causes of hypercalcemia?
Hyperparathyroidism Cancer
42
What are signs and symptoms of hypercalcemia?
Swollen and slow and Sedating effect---reduces excitability of muscles and nerves. Kidney stones Increased BP Constipation Decreased DTRs
43
What are signs and symptoms of hypocalcemia?
Decreased BP numbness, tingling in extremities and around mouth Chvostek sign Trousseau sign Diarrhea Prolonged QT intervals Muscle spasms Tetany Confusion, irritability Same as hypomagnasemia and hyperphosphatemia laryngeal stridor dysphagia
44
What is Chvostek sign?
Twitching of facial muscles when tap on cheek in front of ear. Sign of hypocalcemia
45
What is Trousseau sign?
Hand drawing up (carpal spasm) when BP cuff inflated
46
What is main cause of hypocalcemia?
Anything that would create PTH deficiency (usually surgery of parathyroid glands) or malabsorption issues that would prevent absorption of calcium.
47
What is normal calcium serum level?
9.0---10.5 mg/dL
48
What is the relationship of Calcium and phosphate?
They are inverse. Calcium up-phosphorus down and vice versa.
49
What does Calcium do in the body?
Bones, teeth, blood clotting, muscle and nerve function
50
What is a normal phosphate serum level?
3.0---4.5 mg/dL
51
What is the role of phosphate in body?
Building bones/teeth, muscle and nerve function. Kidneys are the regulator.
52
What organs regulate phosphate?
kidneys and parathyroid. Vit D is needed for phosphate absorption
53
Causes of low phosphate.
Antacids--cause malabsorption Low Vit D Hyperparathyroidism Respiratory alkalosis Kidneys wasting phosphate (diuretics, diabetes)
54
Main reason why high phosphate level.
Kidney failure
55
Hyperphosphatemia s/sx same as hypocalcemia s/sx. What are they?
Chvostek Trousseau Numbness/tingling in extremities and mouth hyperreflexes Muscle spasms Tetany Low BP Confusion and irritability Laryngeal spasms Dysphagia
56
What is role of magnesium in body?
Muscle contraction/relaxation Neurotransmitter release Cardiac function Neuro function
57
What two organs control mag levels in body?
Kidneys and GI system
58
What is normal range for mag in body?
1.3---2.1 mEq/L
59
Most common cause of hypermagnesemia.
Renal insufficiency
60
S/sx of hypermagnesemia.
Think too much control-over zealous sheriff in town. Everything too calm and quiet. Bradycardia, hypotension, heart block, prolonged PR intervals Urinary retention, Decreased DTRs, muscle paralysis, hypoactive bowel sounds, respiratory depression
61
Causes of hypomagnesemia.
Malabsorption, Alcoholism, fluid loss
62
S/Sx of hypomagnesemia.
Everything is buck wild with no sheriff in town. Increased DTR Cardiac: V fib, tachycardia Eyes: Nystagmus GI: Diarrhea Same as hypercalcemia
63
What are some foods high in potassium?
Beans, avocados, bananas, dried fruit, oranges, potatoes, tomatoes, nuts and seeds
64
What lab tests do you run for Na and K levels?
CMP, HTN panel, electrolyte panel, general health panel
65
What lab tests do you run for Ca levels?
BMP, CMP and renal panel
66
Do loop diuretics spare any electrolytes?
No they spare nothing. Lasix (furosemide) Bumex (bumetanide) Edecrin (ethacrynic acid) Demadex (torsemide)
67
What are some potassium sparing diuretics?
Aldactone or Carospir (spironolactone) Inspra (eplerenone) Dyrenium (triamterene) Midamor (amiloride)
68
What are normal phosphate levels?
3.0----4.5 mg/dL
69
How does the adrenal gland affect fluid balance?
The adrenal cortex releases glucocorticoids (cortisol) and mineralocorticoids (aldosterone) Remember---aldosterone and cortisol makes kidneys hang onto water and excrete potassium.
70
What is max KCl IV dose per hour?
Not to exceed 10 mEq/hr —the exception is a critical situation but must have constant EKG monitor and must be put in central line—(remember it’s highly irritating to vein)
71
What is normal urine specific gravity range?
1.002——1.025 High means concentrated or dehydration Low means diluted or over hydrated
72
What are some foods high in phosphate?
Dairy Meat Canned fish
73
What is the relationship and role of bicarbonate and chloride?
Inverse. The balance each other to keep acid base balance.
74
What is classic distinguishing sign of hyperchloridemia?
Fever
75
What effect does fluid loss have on Hct and BUN?
Raises. Hct becomes more concentrated BUN becomes more concentrated
76
What is average amount of insensible water loss every day?
600----900 mL
77
What is ratio of hemoglobin to hematocrit roughly?
1:3 Hemoglobin 1 to Hematocrit 3
78
What are some hypertonic IV solutions?
D5W/0.45%NS 3% NS D10W
79
Common uses for hypertonic IV solutions
Raises osmolality of ECF Draws water out of cells Some (D10W and D5/0.45NS) provide calories Septic shock
80
What are cautions when using hypertonic IV solutions?
Can raise serum sodium too high Can raise BP too high
81
What are the isotonic IV solutions?
LR NS 0.9% D5W
82
What is effect of isotonic IV solutions on body water?
Expands only ECF Doesn't do anything in ICF No fluid shifts
83
What type of solution is D5W and what are uses?
Isotonic No electrolytes-only water replacement 170 cal/L Used for hypernatremia, water replacement
84
What are common uses of NS 0.9%?
Isotonic Compatible with most meds Used to prime blood tubing Used when need to get BP up fast
85
What are common uses of LR?
Isotonic Burns GI losses Most like plasma --Contraindicated in hyperkalemia and lactic acidosis--
86
What are uses and examples of hypotonic IV solutions?
D5W 0.45% NS Moves water from ECF into ICF Use in DKA and severe dehydration Use in maintenance fluids
87
What is difference between hypovolemia and dehydration?
Dehydration=water loss only hypovolemia=water and electrolyte loss
88
What are clinical signs of hypovolemia?
Mental deterioration Thirst Tachycardia Delayed cap refill Orthostatic hypotension Urine output of <30 mL/h Cool, pale extremities Increased RR Dry mucous membranes
89
What are some nursing managements for hypovolemia and dehydration?
I's/O's Labs:CMP, CBC, Urine Specific Gravity Cardio:Watch BP and weak pulses Resp: Watch for increased RR Daily weight Assess reflexes, muscle strength, mentation
90
What are some causes of hypervolemia?
Renal failure CHF Excessive Na ingestion Long term steroid use
91
What are some nursing managements of hypervolemia?
Fluid restrictions Daily weights Assess for lung sounds Assess mentation changes Assess for skin breakdown Diuretics
92
What are some clinical signs of hypervolemia?
Cardio: Bounding pulse, Increased BP Edema Wet lungs Weight gain Changes in mentation Headache, Seizures
93
What are normal serum chloride levels?
96----106 mEq/L

Semester 3-Unit 1 (5 decks)

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