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Elimination > fluid and electrolytes 2 > Flashcards

fluid and electrolytes 2 Flashcards

1
Q

what happens when fluids shift?

A

with decreased circulating volume, baroreceptors in the aorta are activated

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2
Q

fluids shift also causes

A

sympathetic nervous system to releases epinephrine and norepinephrine, causing vasoconstriction and an increased heart rate

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3
Q

fluid shift makes the kidneys

A

launch the renin-angiotensin-aldostrone system in response to a lower glomerular filtration rate. RAAS

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4
Q

all this happens with the goal

A

of increasing circulating volume, blood pressure and cardiac output

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5
Q

hypothalamic regulation starts

A

the osmoreceptors in hypothalamus sense fluid deficit or increase
stimulates thirst and antidiuretic hormone (ADH) release and results in increased free water and decreased plasma osmolality

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6
Q

stimuli affecting the thirst mechanism

A 
increased plasma osmolality
decreased plasma volume
angiotensin II
angiotensin III
dry pharyngeal mucous membranes
psychological factors
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7
Q

the primary regulator of fluid intake is

A

the thirst mechanism

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8
Q

In renal regulation

A

kidneys are the primary organs for regulating fluid and electrolyte balance
adjusting urine volume
selective reabsorption of water and electrolytes
renal tubules are sites of action of ADH and aldosterone

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9
Q

The antidiuretic hormone regulation

A

regulates water excretion and reabsorption from kidneys
osmolality influences the production of the hormone
other factors that affect the production and release of ADH include:
blood volume
temperature
pain
stress
drugs (opiates, barbiturates, nicotine, NSAIDS)

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10
Q

a decrease in urine output

A

fluid will dilute body fluids

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11
Q

renin-angiotensin-aldosterone system

A

responds to changes in renal perfusion
renin causes conversion of angiotensinogen to angiotensin I, which is converted to angiotensin II causing vasoconstriction and stimulates adrenal glands on top of the kidneys to produce aldosterone.

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12
Q

RAAS works to keep the body’s

A

sodium and water levels at homeostatic levels

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13
Q

sympathetic stimulation hypotension decreased sodium delivery to

A

kidney->renin and angiotensinogen-> A I (by ACE)->A II which goes to adrenal sorted to relate aldosterone to go to renal sodium and fluid retention, same time A II->pituitary-> ADH leading to renal sodium and fluid retention as well as a direct of A II to the renal sodium and fluid retention also-> increased blood volume. A II-.thirst ->increased blood volume, and A II directly to systemic vasoconstriction and cardiac and vascular hypertrophy

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14
Q

in cardiac regulation the

A

atrial natriuretic factor are antagonists to the RAAS
produced by cardiomyocytes in the atrium in response to increased atrial pressure
suppress section of aldosterone, renin, and ADH to decrease blood volume and pressure by acting as a potent diuretic
ANF ia a vasodilator

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15
Q

in gastrointestinal regulation

A

oral intake accounts for most water
small amounts of water are eliminated by gastrointestinal tract in feces
diarrhea and vomiting can lead to significant fluid and electrolyte loss
or NG tube

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16
Q

nursing assessment for fluid and electrolyte status is

A

make sure to obtain a health history
think to ask and look for any chronic cardiac, renal or endocrine diseases
medications
client’s food and fluid intake, fluid output
and a physical assessment

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17
Q

during the physical assessment for for fluid and electrolyte status you should

A

focus on the skin, oral cavity, mucous membranes, the eyes, the cardiovascular, respiratory, and neurological systems and mother function assessment

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18
Q

clinical measurements for fluid and electrolyte are

A

daily weight-first thing in morning with same everything at the same time
VS- for a normal day accurate account
and fluid intake and output

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19
Q

diagnostic tests consist of

A

renal labs: BUN and Creatinine are measures of kidney function
CBC- for hematocrit measures volume of whole blood that is RBC’s
hematocrit is the volume of cells in relation to plasma. affected by changes in plasma volume. normal is between 40%-50%.

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20
Q

serum osmolality

A

measures the solute concentration of the blood. evaluates fluid balance. Normal 280-800 most/kg

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21
Q

urine osmolality

A

measures the solute concentration of the urine, consists of nitrogenous wastes (BUN, creatinine, uric acid). Normal 200-800 most/kg

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22
Q

urine specific gravity

A

indicator of urine concentration. normal 1.005-1.030

23
Q

classification of fluid and electrolyte imbalances are

A

FVD, FVE, and electrolyte imbalances

24
Q

isotonic imbalances

A

(water and electrolytes gained or lost in equal proportions) Fluid Volume Excess or Fluid Volume Deficit

25
Q

osmolar imbalances

A

(loss and gain of water only) dehydration or overhydration.

26
Q

FVD/dehydration-GI fluid loss

A

excessive fluid loss-hemorrhage, GI suction, intestinal fistulas, vomiting, diarrhea

27
Q

insufficient intake for FVD is

A

lack of fluid access, oral trauma, swallowing difficulty, altered thirst mechanism

28
Q

FVD-failure of regulatory mechanisms

A

burns, and kidney failure

29
Q

FVD- pediatric differences

A

imbalances due to exercise, heat stress, increased respiratory rate, fever

30
Q

FVD-older adults

A

fewer intracellular reserves leads to rapid dehydration

31
Q

FVD-pregnantcy

A

can also lead to FVD

32
Q

clinical manifestations of FVD

A 
initial symptom may be thirst
-hypotension, tachycardia, weak pulse, tachypnea
-reduced urine output (oliguria)
-dry, cracked skin and dry mucous membranes
poor skin turgor
weight loss
sunken eyeballs
may complain of nausea or vomiting
33
Q

diagnostic testing for FVD consist of

A

CBC: hematocrit may be increased/not much fluid on board
Urine specific gravity may be elevated, indicating high solute load in the urine
serum osmolality: may be increased
renal labs such as BUN and creatinine may be elevated indicating renal involvement
Seem electrolytes: electrolytes may be normal if the kidneys compensate and regulate electrolyte levels.
with profuse diarrhea or vomiting the potassium levels are low, causing muscle weakness and heart rhythm disturbances.

34
Q

FVD/dehydration collaboration

A

monitor vital signs, I *& O, daily weights, skin turgor mucous membrane, urinary output
Urine output less than 30 mL/hr needs to be reported to provider
monitor lob values

35
Q

FVD/dehydration clinical therapies

A
  1. oral rehydration- safest and gradual and 30-50% of deficit in first 24 hours
  2. intravenous fluids
36
Q

FVD/dehydration nursing diagnoses

A

deficient fluid volume
ineffective peripheral tissue perfusion related to hypovolemia
confusion
activity intolerance

37
Q

FVD/dehydration implementation

A 
accurate intake and output
weigh daily
vital signs
administer fluids as ordered
monitor laboratory values
monitor level of consciousness
reposition every 2 hours
institute fall precautions
teach prevention of orthostatic hypotension, maintaining fluid intake and prevention of fluid deficit
38
Q

FVE/interstitial fluid volume excess (edema)

A

increased blood hydrostatic pressure (inflammation, local infection, right sided heart failure, venous thrombosis)

39
Q

FVE-decreaded blood osmotic pressure

A

(albumin-nephrotic syndrome, kwashiorkor, liver disease)

40
Q

FVE-increaded interstitial fluid osmotic pressure

A

(increased capillary permeability caused by inflammation, toxins, burns, hypersensitivity reactions)

41
Q

FVE-blocked lymphatic drainage

A

(tumors, goiters, parasites, surgery)

42
Q

over-hydration leads to

A 
neurologic
cardiovascular
respiratory and 
gastrointestinal problems
edema-dependent pitting edema
43
Q

FVE is

A

too much fluid going in with failure to eliminate

44
Q

you can treat FVE by

A

sodium concentrations being decreased, as well as the osmolality because there is more water than sodium and the hematocrit will be reduced from the dilution of excess water

45
Q

clinical manifestations of FVE

A 
weight gain > 5% over short period of time
edema (anasarca)
full, bounding pulse
increase blood pressure
distended neck, peripheral veins
cough, dyspnea, orthopnea
moist crackles and rales i lungs
polyuria
ascites
possible cerebral edema (altered mental status and anxiety)
decreased hematocrit and BUN
46
Q

diagnostic testing for FVE

A

CBC: hematocrit may be decreased.
serum osmolality may be decreased.
specific gravity may be decreased.
renal labs, such as BUN and creatinine may be decreased

47
Q

nursing management of fluid volume excess

A

do frequent respiratory assessments and check his LOC.
watch for edema, skill care but cardiovascular checks take priority
daily weight
fluid restriction
measure I & O
carefully observation and assessment are need buy the morse because fluid excess can be life threatening
always look and assess to be safe

48
Q

FVE-collaboration

A

diagnostic tests
pharmacological therapy (diuretics)
fluid management and restriction
low sodium diet

49
Q

fluid restriction guidelines

A

subtract requisite fluids from total daily allowance
divide remaining fluid allowance
-day shift: 50% of total
-evening shift: 25-33% of total
-night shift:remainder
explain the fluid restriction the client and family members
identify preferred fluids and intake pattern of client
place allowed amounts of fluid in small glasses (gives perception of a full glass)
offer ice chips (when melted, ice chips are approximately half the frozen volume)
provide frequent mouth care
provide sugarless chewing gum (if allowed) to reduce thirst sensation

50
Q

clinical manifestations etiologies of FVE

A

congestive heart failure
liver cirrhosis
adrenal tumor
over administration of intravenous fluids

51
Q

clinical therapies of FVE

A
  1. administration of diuretics-loop diuretics which act on the ascending loop of Henle, thiazide-type diuretics which act of the distal convoluted tubule and potassium-sparing diuretics which affect the distal nephron
  2. elevate head of bed
  3. monitor cardiorespiratory and oxygen saturation
  4. administer oxygen
  5. daily weights
  6. accurate intake/output
  7. fluid restriction
52
Q

nursing diagnoses for FVE

A 
excess fluid volume
risk of impaired skin integrity
rick for impaired gas exchange
activity intolerance
ineffective health maintenance
53
Q

implementation of FVE

A 
weigh daily
maintain intake/output records
fluid restrictions
oral hygiene every 2 hours
teach sodium restriction diet
administer medications
teach client medication safety
reposition every 2 hours-elevate area with edema
position in Fowler position
monitor labs

Elimination (4 decks)

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