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Med Surge 4th exam > fluid and electrolytes > Flashcards

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

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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

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3
Q

What are the three major compartments of the ECF:

A

interstitial, intravascular (plasma), transcellular fluid

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4
Q

What is the fluid found within the vascular system:

A

intravascular or plasma

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5
Q

What is the fluid that surrounds the cells:

A

interstitial fluid

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6
Q

What is the fluid that makes up the cerebrospinal, biliary, synovial, pleural, and peritoneal cavities:

A

transcellular fluid

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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

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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

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9
Q

What are some examples of cations:

A

Na, K, Ca, Mg

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10
Q

What are some examples of anions:

A

Cl, bicarbonate HCO3, phosphate, and sulfate

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11
Q

What are the principle electrolytes of the ECF:

A

Na, Cl, bicarbonate

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12
Q

What are the primary electrolytes of ICF:

A

K, Mg, phosphate, and sulfate

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13
Q

A major concern in the loss of fluids and electrolytes can occur by what causes:

A

vomiting, diarrhea, gastric suction

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14
Q

Cell membranes are permeable to what:

A

H2O and selectively permeable to solutes

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15
Q

Substances that dissolve in a liquid is defined as:

A

solutes

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16
Q

Large protein molecules that do not readily dissolve into solutions are defined as:

A

colloids (albumin)

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17
Q

The component of a solution that can dissolve a solute is defined as:

A

solvent

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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)

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19
Q

What is the primary determinant of osmolality (mOsm/kg) of plasma:

A

Na

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20
Q

What is the determinant of osmolality of ICF:

A

K, glucose, urea

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21
Q

What is the normal plasma osmolality:

A

280-295 mOsm/kg

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22
Q

A plasma osmolality that’s >295 means that the concentration is…

A

too great/water content too small

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23
Q

A plasma osmolality that’s <280 means that the concentration is…

A

too small/water content is too high

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24
Q

Isotonic, hypertonic, and hypotonic that’s used to refer to the osmolality in a solution is defined as:

A

tonicity

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25
Q

A solution that has the same osmolality as the ECF is defined as and what is an example:

A

isotonic; 0.9%NS/LR/D5W

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26
Q

A solution that has a higher osmolality than the ECF is defined as and an example is:

A

hypertonic; 3% NS/D5 1/2 NS/D5NS/D5LR

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27
Q

A solution that is less osmolality than the ECF is defined as and an example is:

A

hypotonic; 0.45% NS/0.33% NS/2.5 D5W

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28
Q

The power of a solution to pull water across a semipermeable membrane is defined as:

A

osmotic pressure

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29
Q

If I were to infuse a hypertonic solution (3% NS), what will happen to the RBCs:

A

Plasma will have higher concentration than the cells and will pull water from the cells–>cells will shrink

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30
Q

If I were to infuse a hypotonic solution (0.49 NS) into the plasma, what will happen to the RBCs:

A

Plasma will have less concentration causing the RBCs to pull in water from the plasma=RBCs will swell

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31
Q

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:

A

Oncotic/colloid osmotic pressure

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32
Q

Movement of solutes across a membrane from higher concentration to lower concentration is defined as:

A

diffusion (no energy required)

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33
Q

Movement of WATER across a semi-permeable membrane from a lower concentration to a higher concentration is defined as:

A

osmosis

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34
Q

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:

A

Concentration in plasma is high; osmosis will cause water from the interstitial and intracellular to flow into the vascular compartment (plasma) to maintain homeostasis

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35
Q

The process in which both fluids and solutes move together across a membrane from high PRESSURE to low PRESSURE is defined as:

A

filtration (capillary fluid/nutrients seep from the arterioles to the interstitial fluid)

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36
Q

The (pushing) pressure exerted by a stationary fluid (fluid w/in a closed system) is defined as:

A

hydrostatic pressure (the force of blood exerted against the vessel walls)

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37
Q

The movement of solutes across a cell membrane from less concentration to greater concentration which utilizes ATP is defined as:

A

Active transport

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38
Q

What is an example of active transport:

A

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

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39
Q

What is the primary regulator of fluid intake:

A

thirst mechanism located in the hypothalamus

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40
Q

What are some triggers of the thirst mechanism which causes the sensation of thirst:

A

osmotic pressure of body fluids, vascular volume, and angiotensin (released in response to decreased blood flow to the kidneys)

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41
Q

What organ is the primary regulator of body fluids and electrolyte VOLUME AND OSMOLALITY VIA excretion:

A

Kidneys

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42
Q

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:

A

ADH (antidiuretic hormone)

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43
Q

When serum osmolality rises, what will ADH do:

A

ADH causes the collecting ducts to reabsorb water so that water will be absorbed into the plasma

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44
Q

What happens to ADH when the serum osmolality is low:

A

ADH is suppressed and water is excreted

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45
Q

What causes renin to be released and what occurs:

A

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.

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46
Q

This hormone is released from the atrium of the heart in response to excess blood volume and stretching of the arterial walls.

A

Atrial Natriuretic factor (ANF)

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47
Q

WHy is the aterial natriuretic factor released:

A

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)

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48
Q

This body system promotes return of water and protein from the interstitial spaces and into the…

A

lymphatic system; intravascular spaces

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49
Q

What is the amount of water excreted daily by a healthy person:

A

1000-1500 mL/day

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50
Q

This electrolyte is the most abundant cation of the ECF; major contributor to serum osmolality; maintains blood volume; transmits nerve impulses; contracts muscles:

A

Na (135-145 mEq/L)

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51
Q

This electrolyte is the major cation of the ICF; maintains ICF osmolality; regulates skeletal, cardiac, sm muscle activity:

A

K (3.5-5.1 mEq/L)

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52
Q

This electrolyte maintains the natural cardiac pacemaker; forms bones and teeth:

A

Ca (8.5-10.3 mEq/L)

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53
Q

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:

A

Mg (1.7-2.3 mEq/L)

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54
Q

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

A

Cl

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55
Q

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:

A

PO4 (2.5-4.5)

56
Q

This electrolyte’s major function is a buffer involved w/acid-base regulation; regulated by the kidneys (excretes and reabsorbs)

A

Bicarbonate (HCO3)

57
Q

Why are infants at high risk for F/E imbalances:

A

Immature kidneys cannot concentrate urine; rapid RR/larger body surface=greater insensible looses through skin and RR; cannot express thirst

58
Q

What is a nsg intervention for young children w/vomiting and diarrhea:

A

Oral rehydration therapy (ORT) such as pedialyte to resore F/E balance

59
Q

Why are older adults at risk for F/E imbalances:

A

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
Q

What is one of the first S/S of F/E imbalance in the elderly:

A

change in mental status

61
Q

What has higher water content. Fat or lean tissue:

A

Lean tissue (men have more water weight than women d/t leaner tissue)

62
Q

How do lifestyles affect F/E:

A

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
Q

When the body loses both F/E in the same amounts, it becomes known as:

A

(isotonic) fluid volume deficit

64
Q

Decreased volume of circulating blood can lead to intracellular fluid deficit is defined as:

A

hypovolemia

65
Q

How does FVD occur:

A

abnormal losses through the skin/GI/kidney; decreased intake of fluid; Decreased ADH d/t lithium; bleeding; third space syndrome

66
Q

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:

A

Third space syndrome

67
Q

Increased fluid in the intravascular/interstitial compartments=retention of fluids is defined as:

A

Fluid volume excess/hypervolemia (increased blood volume)/fluid overload/over hydration (HYPO-OSMOLAR fluid imbalance)

68
Q

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:

A

FVD

69
Q

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:

A

FVE

70
Q

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:

A

FVE

71
Q

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:

A

FVD

72
Q

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:

A

FVE

73
Q

What are some nsg interventions for a pt that has FVD:

A

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
Q

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:

A

FVD

75
Q

What are some NSG interventions for the pt that has FVE:

A

Assess for S/S of FVE; monitor weight/I&O/VS; diuretics; Na/fluid restriction; skin care; fowler’s postion

76
Q

Prolong fever, receiving enteral feedings w/insufficient H2O intake; hyperventilation; diabetic ketoacidosis will cause what type of F/E imbalance:

A

dehydration (hyperosmolar fluid imbalance)

77
Q

What are the S/S of dehydration:

A

fatigue, weakness, dry/flushed skin and thirst

78
Q

What type of lab would you expect to see in a dehydrated pt:

A

Increased Na and increased serum osmolality levels which means only water is lost and Na is being retained

79
Q

What is the nsg intervention for the dehydrated pt:

A

fluid replacement

80
Q

Excess interstitial fluid is defined as:

A

edema

81
Q

How does capillary hydrostatic pressure cause edema:

A

Increase cap hydrostatic pressure causes edema by pushing fluid into the interstitial spaces (feet, ankles, sacrum-dependent tissues)

82
Q

How does plasma oncotic pressure cause edema:

A

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
Q

How does capillary permeability cause edema:

A

Tissue trauma or allergic reactions causes the cap wall to be more permeable allowing fluid to escape into the interstitial spaces

84
Q

How does Na cause edema:

A

Increase in Na retention will cause edema d/t water following wherever Na goes

85
Q

How does lymph drainage cause edema:

A

When the lymphatic drainage has become obstructed or decreased, fluid stays in the interstitial spaces resulting in edema

86
Q

What are two methods that can be used to determine fluid status:

A

Hand-vein distention (hands down=veins dilate; hands up=veins constrict); weight 2.2 lb=1 L of fluid

87
Q

Increase in free water, diet low in solutes, hypotonic solutions, decrease in renal function, increase in ADH, head injury are causes of:

A

overhydration (water intoxication)

88
Q

What are the early S/S of overhydration:

A

HA, N/V

89
Q

What are the late S/S of overhydration:

A

cerebral symptoms (confusion, agitation) can lead to SZ

90
Q

What type of labs would you expect on overhydrated pt:

A

Low Na levels

91
Q

What is a nsg intervention for overhydration:

A

reduce water and promote elimination

92
Q

A Na imbalance of less than 135 mEq/L is defined as:

A

hyponatremia; levels lower than 110 mEq/L can lead to permanent neurological damage as a result of cerebral edema

93
Q

A Na imbalance greater than 145 mEq/L causing the fluids to leave the cells is defined as:

A

hypernatremia;

94
Q

Na loss d/t GI/diuretics/hypoaldosterone; increase of H2O; decrease Na intake; drinking plain water w/severe diaphoresis can all cause:

A

Hyponatremia less than 135

95
Q

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:

A

hypernatremia greater than 145

96
Q

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:

A

hyponatremia less than 135

97
Q

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:

A

Hypernatremia greater than 145

98
Q

What type of lab findings would you expect fro hyponatremia:

A

decreased Na and osmolality; decreased HCT if fluid is increased

99
Q

What type of lab would you expect for hypernatremia:

A

Increased Na and increased serum osmolality

100
Q

What is a nsg intervention with a pt thats hyponatremia and hypovolemia:

A

bullion and isotonic NS

101
Q

What is a nsg intervention for hyponatremia with hypervolemia:

A

fluids restricted; oral supplement are given; if Na is 110, hypertonic NS is given SLOWLY with diuretics so as to not become hypertonic

102
Q

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:

A

hypokalemia less than 3.5

103
Q

Renal failure; acidoses; cell injury (k moving to vascular space); too much intake of salt substitutes; BBs and K sparing diuretics can cause:

A

hyperkalemia greater than 5.1

104
Q

Cramps, muscle weakness, EKG changes; irregular pulse; N/V; constipation are all S/S of:

A

hypokalemia less than 3.5

105
Q

Parathesia, decrease muscle strength; EKG changes; bradycardia; GI hyperactivity; leads to CARDIAC ARREST are all S/S of:

A

hyperkalemia greater than 5.1

106
Q

What type of labs would you expect for hypokalemia:

A

K less than 3.5; Low Mg; increased pH and HO3 (alkalosis)

107
Q

What type of labs would you expect for hyperkalemia:

A

K greater than 5.1; decreased pH and HO3 (acidosis)

108
Q

What type of IV replacements would I give to a hypokalemic pt:

A

DILUTED; IV PUMP ONLY; rapid fusion must be on cardiac monitor; IV site can cause pain and irritation

109
Q

Foods high in K:

A

bananas; nuts; watermelon; mushrooms; potatoes

110
Q

What are my nsg interventions in a hyperkalemic pt:

A

Diuretics/glucose/insulin (pushes K into cells out of ECF); increase fluid intake; dialysis; kayexalate;

111
Q

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:

A

hypocalcemia less than 8.5

112
Q

Hyperarathyroidism; bone destruction (CA) cause increase in Ca levels; Meds (lithium, thiazide); renal failure; immobility are all causes of:

A

hypercalcemia greater than 10.3

113
Q

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:

A

hypocalcemia

114
Q

fatigue/coma; decreased GI function; Decreased cardiac function; decreased HR; renal failure; renal stones; fractures are all S/S of:

A

Hypercalcemia greater than 10.3 (the greater the Ca levels the greater are the severity of S/S)

115
Q

What labs would you expect to see in hypocalcemia:

A

Ca less than 8.5 and decreased PTH and possible decreased in Mg

116
Q

What labs would you expect in hypercalcemia:

A

Ca levels greater than 10.3 and increased PTH

117
Q

What are my nsg for hypocalcemic pts:

A

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
Q

What are my nsg for hypercalcemic pts:

A

hydration to promote excretion; diuretics; decrease dietary intake of Ca; increased weight bearing exercises; PO phosphate; cranberry juice to discourage stone formation

119
Q

This mineral is used for ATP and DPG (RBC way of releasing O2):

A

Phosphate PO4

120
Q

Increased renal loss of PO4 r/t hyperarathyroidism; diuretics; GI malabsorption; EtOH; malnutrition are causes in:

A

hypophosphatemia less than 2.5

121
Q

Renal failure that causes decreased excretion of PO4; decreased PTH; cellular destruction; laxative abuse are all causes of:

A

hyperphosphatemia greater than 4.5

122
Q

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:

A

hypophosphatemia less than 2.5

123
Q

Numbness/tingling/muscle spasms; hypocalcemia; tissue calcification leading to organ dysfunction (heart/eyes/kidneys) are S/S of:

A

hyperphosphatemia greather than 4.5

124
Q

What labs would you expect to see for hypophosphatemia less than 2.5:

A

decreased PO4, increased Ca, increased PTH

125
Q

What labs would you expect to see for hyperphosphatemia greater than 4.5:

A

Increased PO4, decreased Ca, decreased PTH

126
Q

Chronic EtOH decreases absorption of Mg, common in ICU pts, develops gradually are causes of:

A

hypoMg less than 1.7

127
Q

Usually caused by medications such as MOM; renal impairment are causes for:

A

HyperMg greater than 2.3

128
Q

Altered LOC; muscular weakness; positive Trousseau’s and Chvostek signs; cardiac irregularities; N/V; anorexia are S/S of:

A

hypoMg less than 1.7

129
Q

Sedative effect d/t general weakness and decreased muscle/nerve activity are S/S of:

A

HyperMg greater than 2.3

130
Q

What labs would you expect for HypoMg less than 1.7:

A

Decreased Mg (If K Tx is ineffective, Mg is low b/c Mg is needed for K reabsorption), decreased Ca levels

131
Q

What labs would you expect for hyperMg greater than 2.3:

A

increased Mg

132
Q

What is given for hyperMg greater than 2.3

A

Diuretics, IV Ca (decreases Mg levels)

133
Q

What is the normal range of urine specific gravity:

A

1.005-1.030 is the normal range

134
Q

If the urine SG is less than 1.005 then your fluid is:

A

FVE=kidney failure; diabetes insipidous

135
Q

If the urine SG is greater than 1.030..

A

FVD=SIADH=HR/dehydration/diarrhea

Med Surge 4th exam (8 decks)

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