Fluid and Electrolytes Flashcards
What is an Isotonic imbalance
Electrolytes and water lost in equal proportion
What is an osmolar imbalance
Loss or gain of water only- Electrolyte levels can increase accordingly
Where is 2/3 of bodily fluid stored?
Muscle mass
Where is the remaining 1/3 of bodily fluids?
ECF
Define Fluid Volume Deficit
Loss of water and electrolytes in equal proportion.
Is Fluid Volume deficit loss fast or slow?
Both, Fast loss= Vomiting, Diarrhea
Slow=Sweating
Dehydration is fluid loss ALONE
What are some common causes of fluid volume deficit?
Vomiting, Diarrhea, GI suctioning, Intestinal Fistulas, Intestinal Drainage.
What are other less common causes of Fluid Volume Deficit?
Hemorrhage, Chronic Abuse of laxatives (common in anorexics)/ Enemas, Heavy sweating, Heavy Renal losses (Diuretics)
What are causes of inadequate fluid intake that can lead to Fluid volume deficit?
Inability to swallow, lack of access to fluids, Altered thirst mechanisms, excessive exercise especially in hot weather, Inability to request fluids
What are other causes of Fluid Volume Deficit?
Third spacing (Ascites, Edema), Burns (skin prevents fluid loss through evaporation. If too much skin is damaged, fluid can be lost through evaporation).
Why are children especially at risk for fluid volume deficit?
Higher Surface area and metabolic rate (fluid is lost quickly through evaporation and sweat),
Increased RR
Immune system isn’t developed, so increased risk of vomiting and diarrhea through infections
Overuse of laxatives in bulimics and adolescents.
Why are pregnant women at risk for fluid volume deficit?
Morning sickness causes vomiting in the first trimester, Blood loss due to miscarriage
Why are older adults at risk for fluid volume deficit?
Forget to drink enough
Changes in mobility limit access to liquids
Fear of Incontinence
Adverse effects of Meds
What are clinical manifestations of fluid volume deficit?
Thirst Lethargy Dry mucous membranes hypotension, orthostatic hypotension Weight loss Tachycardia Tachypnea Decreased Skin Turgor- CHECK CHEST Cool Clammy Skin Increased Temp
What are clinical manifestations of fluid volume deficit in the elderly?
Changes in cognition Dry Mucous membranes Tongue furrows Itchy Skin Brittle Hair Loss of thirst reflex
What are diagnostic tools used to identify FVD?
Serum electrolyte panel
BUN and Creatinine (Function of Kidneys)
Urine Specific gravity
What are clinical therapies for FVD?
Oral Rehydration-Safest
-Pedialyte, etc.
IV Fluids- Patient can’t ingest fluids, deficit is severe
What causes Fluid Volume Excess?
Hypervolemia (both water and NA retained), and Overhydration (more water retained than electrolytes).
What can Fluid Volume Excess lead to?
Pulmonary Edema, Hypervolemia, and Heart Failure
Lymphatic vessels can be blocked, why?
Lymphatic vessels run alongside blood vessels and can be blocked by interstitial fluid
What is the etiology of Fluid Volume Excess?
Conditions that cause retention of sodium and water. Heart Failure Cirrhosis of the Liver Renal Failure Adrenal Gland Disorders Excessive sodium intake
What are clinical manifestations of Fluid Volume Excess?
Weight gain>5% of body weight Bounding Pulse Hypertension Anascara (Big edemas full of fluid) Dyspnea Cerebral Edema Decreased Hematocrit Decreased BUN Pulmonary Edema
What are diagnostic tests of Fluid Volume Excess?
Serum Electrolytes
Serum Hematocrit/Hemoglobin
Renal/Liver function studies
Why is regular of monitoring for fluid imbalance necessary?
Electrolyte imbalances can be sudden and potassium imbalances can be fatal. (Might have to correct 2 electrolytes at the same time like Na and Cl)
What does Sodium mainly effect?
The brain as well as the heart
Essential in maintaining acid-base balance
What are the clinical manifestations of hyponatremia?
Mainly changes in mentation
Lethargy
Headache
What are clinical manifestations of hypernatremia?
Tachycardia Irritability Thirst Dry Mucous Membranes (Give fluid to dilute Na)
What does Potassium mainly effect?
Nerve impulses of the heart
reciprocal action of sodium
Clinical manifestations of hypokalemia?
dysrhythmias
irregular pulse
decreased bowel sounds
Mostly all cardiac symptoms
What are foods high in potassium?
Bananas, Dates, Avocados, Potatoes Orange Juice (not good for kidneys)
Clinical manifestations of hyperkalemia?
Mostly all cardiac symptoms
What does calcium mainly effect?
Muscle contraction
Cell membrane function
Usually controlled by Vit D levels (supplements need vitamin D)
When phosphorus goes up-calcium goes down
What are clinical manifestations of hypocalcemia?
muscle twitching
chvostek and trousseau signs
Severe symptoms can be treated with IV
Clinical manifestations of hypercalcemia?
weakness dysrhythmias headache constipation stop Thiazide diuretics Furosemide increases calcium secretion
What does Cl mainly effect?
Electricity of body in neutral state (with Na)
Acid-base balance
With Hydrochloride (makes hydrochloric acid)
Clinical manifestations of hypochloremia?
Kussmaul Respirations
Weakness
Thirst
Managed with diuretics, IV fluids, dialysis
Clinical manifestations of hyperchloremia?
Parasthesia of face and extremities muscle spasm tetany shallow respirations Treated with: salt in diet, adding chloride to IV
