fluid and electrolytes Flashcards
1
Q
What is the name of the fluid found within the cells that constitutes 2/3 of total body fluid:
A
intracellular fluid
2
Q
What is the fluid found outside of the cells that contains about 1/3 of the body’s total body fluid:
A
extracellular fluid
3
Q
What are the three major compartments of the ECF:
A
interstitial, intravascular (plasma), transcellular fluid
4
Q
What is the fluid found within the vascular system:
A
intravascular or plasma
5
Q
What is the fluid that surrounds the cells:
A
interstitial fluid
6
Q
What is the fluid that makes up the cerebrospinal, biliary, synovial, pleural, and peritoneal cavities:
A
transcellular fluid
7
Q
Which of the fluids is vital for cell functioning and contains solutes: oxygen, electrolytes, and glucose which provide a medium for metabolic processes of the cell:
A
intracellular
8
Q
Which of the fluids is the transport system that carries O2 and nutrients to and waste products from the cells:
A
extracellular fluid
9
Q
What are some examples of cations:
A
Na, K, Ca, Mg
10
Q
What are some examples of anions:
A
Cl, bicarbonate HCO3, phosphate, and sulfate
11
Q
What are the principle electrolytes of the ECF:
A
Na, Cl, bicarbonate
12
Q
What are the primary electrolytes of ICF:
A
K, Mg, phosphate, and sulfate
13
Q
A major concern in the loss of fluids and electrolytes can occur by what causes:
A
vomiting, diarrhea, gastric suction
14
Q
Cell membranes are permeable to what:
A
H2O and selectively permeable to solutes
15
Q
Substances that dissolve in a liquid is defined as:
A
solutes
16
Q
Large protein molecules that do not readily dissolve into solutions are defined as:
A
colloids (albumin)
17
Q
The component of a solution that can dissolve a solute is defined as:
A
solvent
18
Q
The CONCENTRATION of solutes in body fluids determined by the number of dissolved solutes per kg of water is defined as:
A
osmolality (mOsm/kg)
19
Q
What is the primary determinant of osmolality (mOsm/kg) of plasma:
A
Na
20
Q
What is the determinant of osmolality of ICF:
A
K, glucose, urea
21
Q
What is the normal plasma osmolality:
A
280-295 mOsm/kg
22
Q
A plasma osmolality that’s >295 means that the concentration is…
A
too great/water content too small
23
Q
A plasma osmolality that’s <280 means that the concentration is…
A
too small/water content is too high
24
Q
Isotonic, hypertonic, and hypotonic that’s used to refer to the osmolality in a solution is defined as:
A
tonicity
25
A solution that has the same osmolality as the ECF is defined as and what is an example:
isotonic; 0.9%NS/LR/D5W
26
A solution that has a higher osmolality than the ECF is defined as and an example is:
hypertonic; 3% NS/D5 1/2 NS/D5NS/D5LR
27
A solution that is less osmolality than the ECF is defined as and an example is:
hypotonic; 0.45% NS/0.33% NS/2.5 D5W
28
The power of a solution to pull water across a semipermeable membrane is defined as:
osmotic pressure
29
If I were to infuse a hypertonic solution (3% NS), what will happen to the RBCs:
Plasma will have higher concentration than the cells and will pull water from the cells-->cells will shrink
30
If I were to infuse a hypotonic solution (0.49 NS) into the plasma, what will happen to the RBCs:
Plasma will have less concentration causing the RBCs to pull in water from the plasma=RBCs will swell
31
The pulling pressure of a colloid (E.G. albumin) to pull water from the interstitial space into the vascular compartment which keeps fluid in the blood vessels is defined as:
Oncotic/colloid osmotic pressure
32
Movement of solutes across a membrane from higher concentration to lower concentration is defined as:
diffusion (no energy required)
33
Movement of WATER across a semi-permeable membrane from a lower concentration to a higher concentration is defined as:
osmosis
34
What happens to the concentration of plasma in a marathon runner that loses a great amount of water via sweat and how will osmosis equalize fluid balance:
Concentration in plasma is high; osmosis will cause water from the interstitial and intracellular to flow into the vascular compartment (plasma) to maintain homeostasis
35
The process in which both fluids and solutes move together across a membrane from high PRESSURE to low PRESSURE is defined as:
filtration (capillary fluid/nutrients seep from the arterioles to the interstitial fluid)
36
The (pushing) pressure exerted by a stationary fluid (fluid w/in a closed system) is defined as:
hydrostatic pressure (the force of blood exerted against the vessel walls)
37
The movement of solutes across a cell membrane from less concentration to greater concentration which utilizes ATP is defined as:
Active transport
38
What is an example of active transport:
Sodium potassium pump. K from the ECF will move into the ICF via ATP and Na from the ICF will move into the ECF via ATP
39
What is the primary regulator of fluid intake:
thirst mechanism located in the hypothalamus
40
What are some triggers of the thirst mechanism which causes the sensation of thirst:
osmotic pressure of body fluids, vascular volume, and angiotensin (released in response to decreased blood flow to the kidneys)
41
What organ is the primary regulator of body fluids and electrolyte VOLUME AND OSMOLALITY VIA excretion:
Kidneys
42
This hormone is synthesized by the hypothalamus, stored in the posterior pituitary gland, and secreted when the osmolality is high or if there's a ECF deficit:
ADH (antidiuretic hormone)
43
When serum osmolality rises, what will ADH do:
ADH causes the collecting ducts to reabsorb water so that water will be absorbed into the plasma
44
What happens to ADH when the serum osmolality is low:
ADH is suppressed and water is excreted
45
What causes renin to be released and what occurs:
Decreased renal blood flow/pressure causes kidneys to release renin. Renin converts A-1 to A-2. Angio-2 causes kidneys to retain Na and H2O, and Angio-2 causes aldosterone to be sec rested from the adrenal cortex which promets Na retention. Blood volume is increased.
46
This hormone is released from the atrium of the heart in response to excess blood volume and stretching of the arterial walls.
Atrial Natriuretic factor (ANF)
47
WHy is the aterial natriuretic factor released:
Increased blood volume and stretching of the arterial walls. Acts on the kidneys as a diuretic to decrease blood volume and inhibit thirst (BP and BV is decreased)
48
This body system promotes return of water and protein from the interstitial spaces and into the...
lymphatic system; intravascular spaces
49
What is the amount of water excreted daily by a healthy person:
1000-1500 mL/day
50
This electrolyte is the most abundant cation of the ECF; major contributor to serum osmolality; maintains blood volume; transmits nerve impulses; contracts muscles:
Na (135-145 mEq/L)
51
This electrolyte is the major cation of the ICF; maintains ICF osmolality; regulates skeletal, cardiac, sm muscle activity:
K (3.5-5.1 mEq/L)
52
This electrolyte maintains the natural cardiac pacemaker; forms bones and teeth:
Ca (8.5-10.3 mEq/L)
53
This electrolyte is the second most abundant ICF cation; important for intracellular metabolism; necessary for protein/DNA synthesis w/in the ell; relaxes muscle contractions; operates Na+K pump; regulates cardiac function:
Mg (1.7-2.3 mEq/L)
54
This electrolyte is a major anion of the ECF; produces HCl (gastric contents); regulates ECF balance/volume; regulates acid-base balance; buffer in O2-CO2 exchange in RBCs
Cl
55
This electrolyte is a major anion of the ICF; forms bones and teeth; metabolizes carbs/fats/protein; muscle/nerve/RBC functions; regulates acid-base balance; regulates Ca levels:
PO4 (2.5-4.5)
56
This electrolyte's major function is a buffer involved w/acid-base regulation; regulated by the kidneys (excretes and reabsorbs)
Bicarbonate (HCO3)
57
Why are infants at high risk for F/E imbalances:
Immature kidneys cannot concentrate urine; rapid RR/larger body surface=greater insensible looses through skin and RR; cannot express thirst
58
What is a nsg intervention for young children w/vomiting and diarrhea:
Oral rehydration therapy (ORT) such as pedialyte to resore F/E balance
59
Why are older adults at risk for F/E imbalances:
Decreases in: intake of food and water/THIRST/kidney function/ICF and total body water/responses to hormones that help regulate F/E; or use of diuretics; NPO status; laxatives; diabetic ketoacidosis
60
What is one of the first S/S of F/E imbalance in the elderly:
change in mental status
61
What has higher water content. Fat or lean tissue:
Lean tissue (men have more water weight than women d/t leaner tissue)
62
How do lifestyles affect F/E:
diet (anorexia), exercise (weight-bearing promotes Ca balance), stress (increases ADS and renine cascade which decreases urine production and increases bld volume), EtOH ( decreased Ca/Mg/PO4 and acidosis)
63
When the body loses both F/E in the same amounts, it becomes known as:
(isotonic) fluid volume deficit
64
Decreased volume of circulating blood can lead to intracellular fluid deficit is defined as:
hypovolemia
65
How does FVD occur:
abnormal losses through the skin/GI/kidney; decreased intake of fluid; Decreased ADH d/t lithium; bleeding; third space syndrome
66
Fluids that shift from the vascular space into an area where it's not readably accessible as ECF fluid (fluid moving to bowel/peritoneal (ascites)/injured site (burns/blisters)/interstitial space (edema) is defined as:
Third space syndrome
67
Increased fluid in the intravascular/interstitial compartments=retention of fluids is defined as:
Fluid volume excess/hypervolemia (increased blood volume)/fluid overload/over hydration (HYPO-OSMOLAR fluid imbalance)
68
Fluid loss from Gi/skin/kidney/wounds/hemorrhage; reduced F/E intake; medicated related; decreased ADH r/t lithium; third spacing (ascites-fluid in the abd) are causes of what type of F/E imbalance:
FVD
69
Increased pressure in vessels will occur in the peripheral and pulmonary with: rapid weight gain, increased BP, bounding pulse; dyspnea; early cough; edema; increased JVD are all S/S of what type of F/E imbalance:
FVE
70
Fluid/Na retention from organ dysfunction; excessive Na/fluid intake (IV-NS); excessive ingestion of Na in diet or medication are all causes of what type of F/E imbalance:
FVE
71
Decreased skin turgor/BP/UO; increased HR; weight loss; thirst; dry mucous membranes; I&O negative balance; change in LOC are all S/S of what F/E imbalance:
FVD
72
You are checking the labs of a pt with a F/E imbalance. You notice that there's decreased: HCT/serum osm/urine SG/urine osmo. These findings validate that the pt has what type of imbalance:
FVE
73
What are some nsg interventions for a pt that has FVD:
Assess S/S of FVD; monitor wt/I&O/VS; fluid replacement therapy; avoid fluid overload; skin/oral care; safety provisions d/t orthostatic hypotension
74
You are checking the labs of a pt with a F/E imbalance. The labs present INCREASE of: HCT/Serum osm/Urine specific gravity/urine osmolality. These findings validate that the pt has what type of F/E imbalance:
FVD
75
What are some NSG interventions for the pt that has FVE:
Assess for S/S of FVE; monitor weight/I&O/VS; diuretics; Na/fluid restriction; skin care; fowler's postion
76
Prolong fever, receiving enteral feedings w/insufficient H2O intake; hyperventilation; diabetic ketoacidosis will cause what type of F/E imbalance:
dehydration (hyperosmolar fluid imbalance)
77
What are the S/S of dehydration:
fatigue, weakness, dry/flushed skin and thirst
78
What type of lab would you expect to see in a dehydrated pt:
Increased Na and increased serum osmolality levels which means only water is lost and Na is being retained
79
What is the nsg intervention for the dehydrated pt:
fluid replacement
80
Excess interstitial fluid is defined as:
edema
81
How does capillary hydrostatic pressure cause edema:
Increase cap hydrostatic pressure causes edema by pushing fluid into the interstitial spaces (feet, ankles, sacrum-dependent tissues)
82
How does plasma oncotic pressure cause edema:
Low levels of plasma proteins (albumin) from malnutrition/AKI reduce oncotic pressure so that the fluid will leak into the interstitial spaces from the capillaries
83
How does capillary permeability cause edema:
Tissue trauma or allergic reactions causes the cap wall to be more permeable allowing fluid to escape into the interstitial spaces
84
How does Na cause edema:
Increase in Na retention will cause edema d/t water following wherever Na goes
85
How does lymph drainage cause edema:
When the lymphatic drainage has become obstructed or decreased, fluid stays in the interstitial spaces resulting in edema
86
What are two methods that can be used to determine fluid status:
Hand-vein distention (hands down=veins dilate; hands up=veins constrict); weight 2.2 lb=1 L of fluid
87
Increase in free water, diet low in solutes, hypotonic solutions, decrease in renal function, increase in ADH, head injury are causes of:
overhydration (water intoxication)
88
What are the early S/S of overhydration:
HA, N/V
89
What are the late S/S of overhydration:
cerebral symptoms (confusion, agitation) can lead to SZ
90
What type of labs would you expect on overhydrated pt:
Low Na levels
91
What is a nsg intervention for overhydration:
reduce water and promote elimination
92
A Na imbalance of less than 135 mEq/L is defined as:
hyponatremia; levels lower than 110 mEq/L can lead to permanent neurological damage as a result of cerebral edema
93
A Na imbalance greater than 145 mEq/L causing the fluids to leave the cells is defined as:
hypernatremia;
94
Na loss d/t GI/diuretics/hypoaldosterone; increase of H2O; decrease Na intake; drinking plain water w/severe diaphoresis can all cause:
Hyponatremia less than 135
95
N for neuro d/t fluid shifts effect on the brain=cellular dehydration; SALT (skin flushed, Agitation, Low grade fever, Thrist) edema, weight gain, INCREASED BP, DECREASED UO are all S/S of:
hypernatremia greater than 145
96
N for neuro d/t water gain leading to cerebral edema; N/V/D; DECREASED BP; DECREASED UO; muscle weakness, cramps are all S/S of:
hyponatremia less than 135
97
Na gain (from hypertonic saline, adrenal tumors); increased aldosterone; water lost d/t burns, fever, inadequate H2O intake; tube feeding with NO water given are all causes of:
Hypernatremia greater than 145
98
What type of lab findings would you expect fro hyponatremia:
decreased Na and osmolality; decreased HCT if fluid is increased
99
What type of lab would you expect for hypernatremia:
Increased Na and increased serum osmolality
100
What is a nsg intervention with a pt thats hyponatremia and hypovolemia:
bullion and isotonic NS
101
What is a nsg intervention for hyponatremia with hypervolemia:
fluids restricted; oral supplement are given; if Na is 110, hypertonic NS is given SLOWLY with diuretics so as to not become hypertonic
102
K loss d/t Gi, diuretics, adrenal disorders; decreased intake (dietary is rare); fluid shifts d/t alkalosis, tissue injury (cause K to be excreted from kidneys). tissu repair (K shifting to cells); or caused by HYPOMg are all causes of:
hypokalemia less than 3.5
103
Renal failure; acidoses; cell injury (k moving to vascular space); too much intake of salt substitutes; BBs and K sparing diuretics can cause:
hyperkalemia greater than 5.1
104
Cramps, muscle weakness, EKG changes; irregular pulse; N/V; constipation are all S/S of:
hypokalemia less than 3.5
105
Parathesia, decrease muscle strength; EKG changes; bradycardia; GI hyperactivity; leads to CARDIAC ARREST are all S/S of:
hyperkalemia greater than 5.1
106
What type of labs would you expect for hypokalemia:
K less than 3.5; Low Mg; increased pH and HO3 (alkalosis)
107
What type of labs would you expect for hyperkalemia:
K greater than 5.1; decreased pH and HO3 (acidosis)
108
What type of IV replacements would I give to a hypokalemic pt:
DILUTED; IV PUMP ONLY; rapid fusion must be on cardiac monitor; IV site can cause pain and irritation
109
Foods high in K:
bananas; nuts; watermelon; mushrooms; potatoes
110
What are my nsg interventions in a hyperkalemic pt:
Diuretics/glucose/insulin (pushes K into cells out of ECF); increase fluid intake; dialysis; kayexalate;
111
EtOH decreases Ca absorption; absorption d/t GI/low D/medications (dilantin decreased estrogen); hypoarathyroidism; phosphate meds/steroids/ASA; renal failure; pancreatitis are all causes of:
hypocalcemia less than 8.5
112
Hyperarathyroidism; bone destruction (CA) cause increase in Ca levels; Meds (lithium, thiazide); renal failure; immobility are all causes of:
hypercalcemia greater than 10.3
113
Numbness around the mouth, tingling/numbness/confusion/irritatbility/twitching (Trousseau's thumb and Chovostek's cheek); laryngeal spasms; EKG changes; bleeding/bruising; IV Ca are all S/S of:
hypocalcemia
114
fatigue/coma; decreased GI function; Decreased cardiac function; decreased HR; renal failure; renal stones; fractures are all S/S of:
Hypercalcemia greater than 10.3 (the greater the Ca levels the greater are the severity of S/S)
115
What labs would you expect to see in hypocalcemia:
Ca less than 8.5 and decreased PTH and possible decreased in Mg
116
What labs would you expect in hypercalcemia:
Ca levels greater than 10.3 and increased PTH
117
What are my nsg for hypocalcemic pts:
IV (Ca must be mixed only in 5% D); Amphogel (phospate binders); D supplement; Ca at bedside if post-op for para/thyroid surgery
118
What are my nsg for hypercalcemic pts:
hydration to promote excretion; diuretics; decrease dietary intake of Ca; increased weight bearing exercises; PO phosphate; cranberry juice to discourage stone formation
119
This mineral is used for ATP and DPG (RBC way of releasing O2):
Phosphate PO4
120
Increased renal loss of PO4 r/t hyperarathyroidism; diuretics; GI malabsorption; EtOH; malnutrition are causes in:
hypophosphatemia less than 2.5
121
Renal failure that causes decreased excretion of PO4; decreased PTH; cellular destruction; laxative abuse are all causes of:
hyperphosphatemia greater than 4.5
122
Decreased energy, weakness r/t decreased ATP can cause SZ/coma as well as decreased DPG (for RBCs to release O2) are S/S of:
hypophosphatemia less than 2.5
123
Numbness/tingling/muscle spasms; hypocalcemia; tissue calcification leading to organ dysfunction (heart/eyes/kidneys) are S/S of:
hyperphosphatemia greather than 4.5
124
What labs would you expect to see for hypophosphatemia less than 2.5:
decreased PO4, increased Ca, increased PTH
125
What labs would you expect to see for hyperphosphatemia greater than 4.5:
Increased PO4, decreased Ca, decreased PTH
126
Chronic EtOH decreases absorption of Mg, common in ICU pts, develops gradually are causes of:
hypoMg less than 1.7
127
Usually caused by medications such as MOM; renal impairment are causes for:
HyperMg greater than 2.3
128
Altered LOC; muscular weakness; positive Trousseau's and Chvostek signs; cardiac irregularities; N/V; anorexia are S/S of:
hypoMg less than 1.7
129
Sedative effect d/t general weakness and decreased muscle/nerve activity are S/S of:
HyperMg greater than 2.3
130
What labs would you expect for HypoMg less than 1.7:
Decreased Mg (If K Tx is ineffective, Mg is low b/c Mg is needed for K reabsorption), decreased Ca levels
131
What labs would you expect for hyperMg greater than 2.3:
increased Mg
132
What is given for hyperMg greater than 2.3
Diuretics, IV Ca (decreases Mg levels)
133
What is the normal range of urine specific gravity:
1.005-1.030 is the normal range
134
If the urine SG is less than 1.005 then your fluid is:
FVE=kidney failure; diabetes insipidous
135
If the urine SG is greater than 1.030..
FVD=SIADH=HR/dehydration/diarrhea
