Fluid and Electrolytes 2 Flashcards
A client has been taught the need to restrict sodium. Which food selections indicates appropriate choices
A. 1 cup of cottage cheese and sliced tomatoes
B. grilled American cheese on 2 pieces of white bread
C. ham and cheddar cheese sandwich on 2 whole wheat bread
D. chicken leg, 1 slice of whole wheat bread with butter and 1/2 cup of steamed carrots
D. chicken leg, 1 slice of whole wheat bread with butter and 1/2 cup of steamed carrots
a nurse is caring for an elderly with renal disease what is NPO. Yesterday the clients serum sodium level was 127 mEq/L. When the nurse assess vital signs , the client states that they are feeling much weaker then earlier in the day . what is the nurses first action
A. call the healthcare provider
B. Assess respiratory effort and circulation
C. raise the head of the bed
D. request dietary consult
B. Assess respiratory effort and circulation
BC hyponatermia causes muscle weakness that could affect the respiratory muscles
Active transport
occurs when molecules move across cell membranes against a concentration gradient from an area of low concentration to an area of high concentration— requires energy
calcium normal lab value range
8.5-10.5
can you give more the 20 mEq/hr for potassium replacement
NO
Can you give potassium replacement IM or SC or IV push
no it can irritate skin at insertion site, and can cause necrosis
NEVER IV PUSH
Capillary Filtration
movement of fluid through a permeable membrane from an area of higher pressure to one of lower pressure
causes of hyperkalemia
MACHINE
medications acidosis cellular destruction hypoaldosteronism intake -excess nephrons- renal failure excretion - impaired
chronic fluid overload nutritional therapy means
fluid and sodium restrictions
Colloids are…..
larger molecules that do not dissolve readily
Common causes of hypokalemia
medications - furoseide
vomiting
diarrhea
renal failure
Diffusion
passive process by which molecules of a solute move through a cell membrane from an area of higher concentration to an area of lower concentration until equilibrium
each pound of weight = ____ ml of retained water
500ml
Excess fluid within the interstitial space is called _____
Edema
Extracellular Fluid (ECF) is found _____
outside the cells.
Filtration
The movement of both water and smaller particles from an area of high pressure to one of low pressure
Fluid and electrolyte balance is the process of regulating…..
extracellular fluid volume,
body fluid osmolality,
plasma concentration of electrolytes.
fluid is regulated primarily by
the thirst mechanism
Fluid volume depends on ____, _____, and _____
age
body fat
gender
functions of calcium
- bone strength and density
- activates enzymes
- skeletal muscle and cardiac muscle to contract
- nerve transmission
- blood clotting
Hemoconcentration
is a decrease in plasma volume, which causes a simultaneous increase in the concentration of red blood cells
Hydrostatic pressure
The force created by fluid within a closed system and is responsible for normal circulation of blood.
hypercalcemia interventions
drug therapy to reduce calcium monitor EKG ROM to muscles evaluate mental status seizure precaution injury prevention
hypercalcemia symptoms
severe muscle weakness LOC changes increased BP decreased peristalsis bone pain
hyperkalemia symptoms
bradycardia hypotension EKG changes decreased breath sounds muscle weakness increased bowel sounds
hypernatemia symptoms
changes in LOC short attention span agitation confusion thirst twitching muscles diarrhea tachycardia
Hypernatermia interventions
monitor I and O
assess muscle activity
push PO water
salt restriction
hypertonic solution contains…
a higher concentration of solutes than does blood
hypervolemia
fluid excess
Hypocalcemia symptoms
Trousseaus sign chvosteks sign parathesia weak pulse increase peristalsis bone pain or fractures
hypokalemia interventions
check EKG
potassium replacement by IV, PO, or NG
spirolactone
Hypokalemia symptoms
A SIC WALT
Alkalosis shallow respirations irritability confusion weakness, fatigue arrhythmia lethargy thready pulse
Hypotonic solution is of _____ osmolarity then blood
of lower osmolality than blood
Hypovolemia
fluid deficit
if there is an decreased in blood osmolarity how will ADH (Antidiuretic Hormone) react
inhibits release
which causes concentration of blood
If there is an increased blood osmolarity how will ADH (Antidiuretic Hormone) do
stimulates release and causes dilution of blood
Interstitial fluid lies _____
in the spaces between the body cells
Interventions for Hypocalcemia
oral or IV replacement of calcium
seizure precaution
decrease environment stimuli
injury prevention
Interventions for hyponatermia
assess neuro every 1 hour
monitor sodium level
reduce water intake
seizure precautions
interventions of hyperkalemia
monitor EKG changes
assess muscle strength
potassium restriction
Intracellular Fluid (ICF) is where
is contained within the cells
Intravascular fluid is the _____ within the ____
the plasma within the blood
low calcium =
high phosphorus
low calicum levels increase sodium movement across membranes which increases _____
Excitability
mild fluid overload nutritional therapy means
no salt added
normal intake for food
800-1000
normal intake for oral fluids
around 2,000
normal output
2,200-2,700
Osmosis
involves movement of water across a membrane from an area of a less concentrated solution to an area of high concentrated solution.
Potassium normal lab value range
3.5-5
Purpose of fluids
- transport nutrient to and wastes from cells
- transport hormones, enzymes, blood cells, and platelets
- facilitate cellular metabolism and proper cellular chemical functioning
- Act as a solvent
- Maintain body temperatures
- Facilitate digestion, promote elimination
- Act as tissue lubricant
serum osmolarity range
270-300
severe fluid overload nutritional therapy means
restricted: 2g/day to 4g/day of sodium
signs of hypervolemia
Hypertension Tachycardia Raised JVP on lying Edema Plural effusions Pulmonary edema Ascites Organ failure
Signs of hypovolemia
Postural/supine hypotension Tachycardia Absence of JVP@45o Decreased turgor Dry mucosa Oliguria Organ failure
sodium normal lab value range
135-145
Solute
substances that are dissolved in a solution
Solvents
liquids that hold substances in solution – water is primary solvent
The following are functions of what Maintains bone strength and density Activates enzymes, Allows skeletal muscle and cardiac muscle to contract Controls nerve impulse transmission Facilitates blood clotting.
Calcium
The particle concentration ……
the number of particles dissolved in the solvent
Transcellular fluid includes _______
specialized fluids that are contained in body spaces (ex.plureal space)
What are Crystalloids
are solutes that readily dissolve
What are electrolytes
substances (e.g., sodium, potassium) that develop an electrical charge when dissolved in water
what are some foods high in potassium
leafy vegtables
dried fruits
nuts
what are some functions of potassium
- Helps control intracellular volume
- Chief regulator of cellular enzyme activity
- Vital role in transmission of nerve impulses
- Protein and carbohydrate metabolism,
- cellular building
- Assists in acid-base regulation
what are some Hyponatermia symptoms
lethargy headache confusion apprehension seizures coma muscle weakness
what are some objective assessments for fluid deficit
weight loss fever urine concentration tachycardia tachypnea neck vein collapse weak pulse increased labs
what are some objective assessments for fluid overload
dependent edema, facial swelling, changes in VS – Increase heart rate, bounding pulses, BP, inrease weight gain, change in loc
What are some risk factors to consider when assessing imbalances
Presence of other illness (acute or chronic) – renal, respiratory, cardiac, mental status change, burns, trauma,
Nausea and vomiting and/or diarrhea
Inability to communicate fluid needs
Age
Medications (including IV fluids) – adverse effects, under or over treatment
what are some situations you will see hyponatermia
- stomach suctioning
- vomiting
- diarrhea
- inadequate salt intake
- hypertonic solutions (leads to dilution)
- diuretics
what are some subjective assessments for fluid deficit/overload
nutritional assessment
report of acute/chronic conditions
medications
illness recent and past
what does ADH (Antidiuretic Hormone)
cause kidney to retain fluid
what does aldosterone do
retains sodium (and thus water), excrete potassium
What does ANP do
increases sodium and water loss – which decreases volume and osmolarity
what does tachycardia occur in hypervolemia
cardiac output has increased and heart rate must increased to handle excess volume.
what hormone regulates calcium balance
parathyroid hormone
what is Insensible fluid loss
is loss that we do not perceive and is not easily measured
What is a colloid
fluids with large molecules that do not pass through semi-permeable membranes
- volume expander
What is a crystalloid
easily mixed solutions with molecules small enough to cross semipermeable membranes
what is actual dehydration
decrease in total body water from too little intake or too great a loss
what is fluid
water plus the substances dissolved and suspended in it.
what is ionized calicum
calcium in the blood that is not attached to protein (free)
What is non electrolytes
are substances that do not conduct electricity
What is obligatory urine output
minimum output of urine necessary to remove wastes
what is relative dehydration
non-total loss but water shifts from plasma to interstitial fluid
what is Sensible fluid loss
is measurable and/or perceived. (urine)
What is solubility
the ability to be dissolved
what is the cause of hyponatermia internally
excess H2O or loss of sodium
what is the ionized lab value range
4.5-5.1
what is the most abundant mineral in the body
calcium
what is the normal albumin level
3.5-5.0
what is third spacing
conditions cause fluid to move into an area that makes it physiologically unavailable, such as into the peritoneal space (in ascites), the pericardial space (with pericardial effusion), or into the vesicles (blisters) with a burn wound.
what populations are at risk for fluid imbalances
the very young
the very old
those with serious injury
those with significant health conditions
When a hypertonic solution is infused, water moves by osmosis from where to where
from the cells into the ECF.
When a hypotonic solution is infused, water moves by osmosis from the ______ into the ____
vascular system
into the cell
when serum osmolarity is elevated (above 300) that means
volume deficit bc it is more concentrated
when serum osmolarity is reduced (below 270) that means
volume overload
When taking the blood pressure of a very ill client , the nurse observes that the clients hand undergoes flexion contractions. What is the nurses primary intervention?
A. placing the client in high fowlers and administering IV fluid
B. Deflating the BP cuff and administer O2
C. Document the finding as the only action
D. Notify the health care provider
B. Deflating the BP cuff and administer O2
where does second fluid spacing occur
interstitial edema
why does tachycardia occur in hypovolemia
heart is trying to compensate for lower volume to circulate enough O2 to tissues
