Fluid and Electrolytes Flashcards
Functions of Water in the Body
- Aides in digestion
- Maintains blood volume
- Waste removal
- Solvent
- Electrolytes in/out of cells
- Lubricates
- Regulates body temperature
Fluid Loss: Sensible
• Measurable
• Urine, diarrhea, wound/gastric drainage
*Softer the stool= greater the fluid loss
Fluid Loss: Insensible
• Unmeasurable
• Breathing, sweating
*Breaks in skin/burns= potential fluid loss
Factors Affecting Water Distribution in Body
- Body Fat
- Age
- Gender
Fluid Compartments in Body: Intracellular Fluid
- Fluid in cells
- Volume= 25 L
- 60% (2/3) bw
- Oxygen, electrolytes, glucose
Fluid Compartments in Body: Extracellular Fluid
• Fluid outside of cells • Volume= 15 L • 20% (1/3) bw *Transports water/O2/electrolytes/nutrients *Removes waste
Fluid Compartments in Body: Extracellular: Interstitial Fluid
EXCESS= EDEMA
• Fluid surrounding cells
• Volume= 12 L
• 80% of ECF
Fluid Compartments in Body: Extracellular: Intravascular Fluid
*TRANSPORTS RBCs* • Fluid in vascular system • i.e. Plasma • Volume= 3 L • 20% of ECF
Third Spacing↑↓
- Symptoms: ↓ BP, urine output; ↑ HR, thirst, fatigue
- Fluid moving into interstitial areas
- Fluid in lungs= Pulmonary Edema
- Fluid in abdomen= Ascites/Peritoneum
- Fluid in skin/mucous/viscera= Angioedema
Sodium (Na+)
- 135-145 mEq/L
* Functions: Nervous System, conducts nerve impulse, regulates fluid volume
Hyponatremia
- Cause: GI loss, diuretics
- Signs: confusion, seizures
- Treatment: water restricting, ↑ Na+ intake
Hypernatremia
- Cause: excessive sodium, water deprivation, water loss
- Signs: thirst, dry mucous membrane, lethargy
- Treat: ↑ fluids, restrict Na+ intake
Chloride (Cl-)
- 95-105 mEq/L
* Osmotic pressure with Na+, production of HCl
Potassium (K+)
- 3.5-5 mEq/L
* Cardiac muscle contraction, transmits electrical impulses
Hypokalemia
- Cause: GI loss, diuretics
- Signs: muscle weakness, dysrhythmias, paresthesia
- Treatment: K+ supplement (Potassium Chloride KCl)
Hyperkalemia
- Cause: renal failure, ↑ K+ intake, medications
- Signs: muscle weakness, dysrhythmias
- Treatments: Loop diuretics (non-potassium sparing), Sodium Polystyrene Sulfonate (Kayexalate), dialysis
Calcium (Ca+)
- 8.5-10.5 mg/dL
* Skeletal/cardiac muscle contraction, bone formation, blood clotting
Hypocalcemia
- Cause: Hypoparathyroidism, malabsorption
- Signs: tetany, paresthesia
- Treatment: Ca+ supplements (calcium carbonate, tums), ↑ Ca+ intake
Hypercalcemia
- Cause: Hyperparathyroidism, malignancy, prolonged immobility
- Signs: muscle weakness, constipation, kidney stones
- Treatment: ↑ Ca+ intake, physical activity, encourage fluids
Magnesium (Mg++)
- 1.6-2.6 mEq/L
* Skeletal muscle contraction, electrical activity in nerve/muscle membranes
Hypomagnesemia
- Cause: NG suction, malabsorption
- Signs: dysrhythmia
- Treatment: magnesium sulfate, ↑ intake
Hypermagnesemia
- Cause: renal failure
- Signs: hypoactive reflex, bradycardia
- Treatment: restrict intake, avoid magnesium based antacids/laxatives
Phosphorus (P-)
- 1.7-2.6 mEq/L
* Acid-base balance, promotes muscle/nerve action
Hypophosphatemia
- Cause: alcohol withdrawal, respiratory acidosis
- Signs: paresthesia, seizures
- Treatment: monitor P- levels with replacement
Hyperphosphatemia
- Cause: renal failure
- Signs: tetany
- Treatment: monitor for tetany, phosphorus binding medication
Bicarbonate (HCO3-)
• 22-26 mEq/L
• Acid-base balance, buffer (homeostasis, pH)
*Body naturally produces bicarbonate
Urine Specific Gravity
- 1.002-1.030
- increases with FVD
- decreases with FVE
Hemoconcentration: Fluid Volume Deficit (hypovolemia)
- Causes: poor fluid intake, GI loss, sweating, fever, meds, hemorrhage, diuretics
- Signs: changes in LOC, tachycardia, hypotension/low BP, concentrated (amber) urine, increased urine SG, increased hematocrit, increased thirst, decreased skin turgor, dry mucous membranes, weight loss, weakness
- Tests: serum electrolytes, hematocrit, urine SG, BUN/Creatinine (high with FVD)
- Treatments: increased fluids, blood products, treat cause
Hemodilution: Fluid Volume Excess (hypervolemia)
- Causes: renal failure, excessive sodium intake, meds, CHF, burn treatments, albumin infusion, blood products
- Signs: edema, tachycardia, high BP/hypertension, bounding pulse, crackles/rales lung sounds, S3 heart sounds, weight-gain, decreased urine SG, dyspnea, tachypnea, JVD, ascites, changes in LOC, confusion, seizures, anorexia, nausea
- Tests: serum electrolytes, BUN/Creatinine, urine SG, natriuretic peptides (higher if CHF), chest-xray
- Treatments: restrict fluids, loop diuretic, potassium sparing diuretic, dietary restrictions
Regulation of Fluids/Electrolyes: Neurological System
• LOC (hypo/hypernatremia, hypomagnesemia)
• Irritability (hypernatremia, hypomagnesemia)
• Reflexes (hypermagnesemia)
• Fatigue (hypo/hypernatremia, hypokalemia, hypermagnesemia)
*Cannot directly measure blood volume
*Baroreceptors sense BP and send signals to retain/excrete fluid
Regulation of Fluids/Electrolyes: Cardiovascular System
*TRANSPORTS HORMONES that control kidney to restrict or excrete fluid
*Vasodialation/vasoconstriction
• History
• Physical Exam (pulse, BP, neck, pericordium, hands, face, eyes, abdomen, legs peripheral vascular system)
• Tachycardia (potassium, magnesium, sodium, calcium)
• Dysrhythmias (potassium, magnesium)
• Increased BP (hypernatremia)
• Decreased BP (high intake of potassium)
• Pulse (thready/weak or bounding)
• Cap Refill (delayed/decreased=FVD)
• Perfusion (palor, cyanosis)
• Veins (JVD=FVE, flat=FVD)
Regulation of Fluids/Electrolyes: Respiratory System
• Evaporation (insensible loss) • FVD=thickened mucous membranes (retains fluids) • Acid-base balance (resp inc/dec due to pH disturbance) • Assess: -Lung sounds (crackles/rales= FVE) -Rate -Depth -Pattern -O2 saturation -Increased resp rate= dyspnea
Regulation of Fluids/Electrolyes: Genitourinary System
• Regulates BV/BP and blood pH • Controls electrolytes • Eliminates waster • Assess: -I/O -usual diet -diet changes -incontinence -daily weights
Regulation of Fluids/Electrolyes: Integumentary System
• Regulates body temperature • Eliminates waste • Assess: -Edema -Color -Circulation -Skin turgor -Fever (flushed, diaphoretic) -Moisture (dry/scaly= FVD) -Dry mucous membranes
Interventions for FVD
- Monitor LOC
- Increase PO intake/fluids
- Daily labs
- Treat the cause
Interventions for FVE
- Activity (reduces dependent pitting edema)
- Diuretics
- Restrict fluid/sodium intake
- I/O
- TEDS/SCD stockings
- Meds
- High fowlers
