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NUR 325 Patho > Fluid Balance & Electrolytes > Flashcards

Fluid Balance & Electrolytes Flashcards

1
Q

What is osmosis

A

Movement of WATER down a concentration gradient

From region of low SOLUTE concentration to one of high solute concentration across a SEMIPERMEABLE MEMBRANE

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2
Q

When does osmosis stop

A

Stops when concentration differences disappear OR when hydrostatic pressure builds and opposes further movement

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3
Q

what is diffusion

A

Movement of molecules from an area of high concentration to a lower concentration

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4
Q

when does diffusion stop

A

Movement stops when concentrations are equal in both areas

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5
Q

What 2 electrolytes are outside the cell

A

sodium and chloride

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6
Q

what 4 electrolytes are primarily inside the cell

A

potassium, magnesium, phosphate, and sulfer

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7
Q

what is osmotic pressure

A

the amt of pressure needed to prevent the movement of water across a cell membrane

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8
Q

What are the 3 Primary colloids

A

albumin, globulin, fibrinogen

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9
Q

how are colloids measured

A

Total protein level

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10
Q

What do colloids do?

A

move fluid from interstitial compartment to plasma (blood) compartment

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11
Q

what is hydostatic pressure

A

Force of fluid in compartment pushing AGAINST A CELL MEMBRANE (or vessel wall)

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12
Q

what generates hydrostatic pressure

A

Generated by blood pressure

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13
Q

what does hydrostatic pressure do at the capillary level

A

major force that pushes water OUT of the vascular system into interstitial space

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14
Q

Oncotic pressure

A

Caused by plasma colloids (large molecules) in solution

Major colloids in vascular system= albumin

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15
Q

T/F colloids are abundant in plasma and fewer in interstitial space

A

True, Plasma proteins attract water, pulling fluid from tissue space into vascular space

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16
Q

What does hydrostatic pressure do?

A

pushes fluid out of the capillary

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17
Q

what does oncotic pressure do

A

pulls fluid INTO the capillary

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18
Q

What 5 things do electrolytes influence

A 
Fluid balance
acid base balance
nerve impulses
muscle contraction
heart rhythm
other cell functions
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19
Q

what are electrolytes

A

substances that are ELECTRICALLY charged when in solution

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20
Q

what 4 things are concentrations of electrolytes dependent on

A

intake
absorption
distribution
excretion

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21
Q

What electrolytes have the highest INTRACELLULAR concentration

A

Potassium (+)
Magnesium (+)
Phosphorous (-)

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22
Q

What electrolytes have the highest EXTRACELLULAR concentration

A

Sodium (+)
Chloride (-)
Bicarbonate(-)

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23
Q

Normal range of sodium

A

136-145 meq/L

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24
Q

normal range of potassium

A

3.5-5.0meq/L

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25
Q

normal range of magnesium

A

1.7-2.2 mg/dl

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26
Q

normal range of calcium

A

9-11 mg/dl

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27
Q

normal range of phosphate

A

3.2-4.3 mg/dl

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28
Q

What does Na+ activate

A

muscle and nerve cells. ion movement important in action potentials

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29
Q

4 characteristics of Na+

A

main ECF cation
Governs osmolality
influences water distribution
aids in acid-base balance

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30
Q

5 Causes of hyponatremia

Na < 136

A 
GI loss
Renal loss
Skin loss
Fasting diets
Excess hypotonic fluid
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31
Q

S/S of hyponatremia

A

CONFUSION/ ALTERED LOC
anorexia
muscle weekness
can lead to seizures/coma

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32
Q

Dilutional hyponatremia =

A

Hypervolemic

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33
Q

depletional hyponatremia =

A

hypovolemic

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34
Q

5 characteristics of dilutional hyponatremia

A 
hypervolemia
increase BP
weight gain
bounding rapid pulse
increae urine sp gravity
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35
Q

6 characteristics of depletional hyponatremia

A 
hypovolemia
decrease BP
tachy pulse
dry skin
weight loss
decrease sp gravity
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36
Q

5 characteristics for treatments for hyponatremia

A 
sodium replacement (slowly)
PO/IV
IV - normal saline
Fluid restriction
Treat underlying problems
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37
Q

Sodium Bicarbonate MOA

A

Dissociates to provide bicarbonate ion which neutralizes ion concentration and raises blood and urinary pH

Increases concentration of sodium in plasma

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38
Q

Sodium Bicarbonate Indication

A

metabolic acidosis

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39
Q

Adverse effects of Sodium Bicarbonate

A

edema,
cerebral hemorrhage, hypernatremia,
lots of electrolyte abnormalities, metabolic alkalosis, flatulence with PO, tetany,
pulmonary edema, heart failure exacerbation

40
Q

4 nursing considerations for Sodium Bicarbonate

A

Do not give IV for hyponatremia- VESICANT at high concentrations
If IV, monitor patency thoroughly!
Lots of drug interactions if the drug mixing with is diluted with sodium solutions
PO- give 1-3 after or before meals

41
Q

3 causes of Hypernatremia

>145

A

IV fluids, tube feeds, near drowning in salt water = excess sodium intake
Not enough water intake or too much water loss = cognitively impaired, diarrhea, high fever, heatstroke
Profound diuresis

42
Q

S/S of Hypernatremia

>145

A

Alter LOC/Confusion, seizure, coma
Extreme thirst (hyperosmolality)
Dry, sticky mucous membranes
Muscle cramps

43
Q

Hypernatremia treatment

A

If H20 loss is cause_ ADD WATER

If sodium excess is cause_ REMOVE SODIUM

44
Q

T/F you should quickly correct sodium levels

A

False, GRADUALLY achieve normal sodium level over a 48 hours period to avoid edema of cerebral cells

45
Q

6 characteristics of potassium

A

Intracellular cation
Helps regulate cell excitability and electrical status
Helps control intracellular osmolality
Diet is main source
Kidneys main source of potassium loss Pee out Potassium
Normal Values: 3.5-5 mEq/L

46
Q

2 causes of Hypokalemia <3.5

A

Renal or GI losses
DIURESIS
Acid base disorders (potassium in ECF goes into ICF)

47
Q

S/S of hypokalemia

A

Cardiac rhythm disturbances can be lethal
Muscle weakness, leg cramps
Decreased bowel motility- constipation, nausea, ileus

48
Q

Potassium chloride (KCl) indications

A

Treat/prevent K+ depletions when dietary measures prove inadequate

49
Q

4 nursing implications for KCl (PO)

A 
DILUTE with water/juice to ↓ GI distress
tastes awful! powder/tablets
 may cause GI ulcers/bleeding
assess for N/V
Critical Point: IV MUST ALWAYS be diluted; NEVER IV Push!!
50
Q

4 nursing indications for KCl (IV)

A

IV: MUST BE DILUTED!!! and ADMINISTERED SLOWLY
Give only to clients with documented urine output
May cause phlebitis/pain
IV solutions should not contain more than 40 mEq/L of K+; rate should not exceed 10-20 mEq/hr

51
Q

2 Contraindications for KCl

A

Renal Failure

Dialysis

52
Q

what can undiluted potassium cause

A

ventricular fibrillation

53
Q

Should you give K+ IV push?

54
Q

3 Causes of hyperkalemia

A

Decreased potassium OUTPUT (renal failure, not peeing)
Burns, crush injuries, sepsis anything with massive cell injury
Drugs– potassium sparing diuretics, ACE, ARBs NSAIDs

55
Q

S/S of Hyperkalemia

A

CARDIAC RHYTHM DISTURBANCES
Muscle weakness, cramps
Abdominal cramping, diarrhea, vomiting

56
Q

Kayexalate/sodium polystyrene sulfonate class

A

cation exchange resins

57
Q

Kayexalate/sodium polystyrene sulfonate route

A

available as oral suspension, oral and rectal powder, oral and rectal suspension, rectal enema

58
Q

Kayexalate/sodium polystyrene sulfonate Indication

A

To treat high levels of potassium in the blood (hyperkalemia

59
Q

Kayexalate/sodium polystyrene sulfonate MOA

A

kayexalate binds to potassium in the digestive tract replacing potassium ions for sodium ions. Potential to drop K by 0.5-1.0 meq/L in 4-6H

60
Q

Adverse Reactions to kayexalate

A

Constipation, diarrhea, N/V, hypokalemia

Serious: intestinal obstruction and intestinal necrosis

61
Q

precaution of kayexalate

A

use only in patient with normal bowel function

62
Q

MOA of D50/Insulin

A

combo shifts potassium into cell temporarily (10units of regular insulin to 1 ampule of D50)

63
Q

Lytic Cocktail

A

Reduces potassium level

  1. 10% 10cc calcium gluconate - protects heart by stabilize myocardium
  2. dextrose 50 - 500cc - counteract effect of insulin
  3. insulin - iv actrapid 10 unit - drive K+ into cells
64
Q

3 charateristics of magnesium

A

Helps to stabilize cardiac muscle cells

Blocks/controls movement of K+ out of cardiac cells

Helps to stabilize smooth muscle

65
Q

causes of hypomagnesium

A

diuresis, GI or renal losses, limited intake (fasting or starvation), alcohol abuse, pancreatitis, hyperglycemia

66
Q

S/S of hypomagnesium

A

S/S: hyperactive reflexes, confusion, cramps, tremors, seizures
Nystagmus

67
Q

oral treatment of hypomagnesium

A

Mylanta

Magnesium sulfate

68
Q

IV treatment of hypomagnesium

A

IV Magnesium sulfate
Replace over several days
Can give IV push if necessary

69
Q

Hypermagnesemia causes

A

increased intake accompanied by renal failure
Chronic renal failure who take milk of mag
OB patients

70
Q

S/S of hypermagnesium

A

lethargy, floppiness, muscle weakness, decreased reflexes, flushed/warm skin, decreased pulse/BP

71
Q

Treatment of hypermagnesemia

A

Treatment: stop replacement, if chronic decrease intake = dialysis

72
Q

Mag Sulfate and Mag Oxide MOA

A

replaces magnesium

73
Q

Mag Sulfate and Mag Oxide indication

A

hypomag, prevent/treat seizures in pre-eclampsia, treat cardiac rhythm disturbances [constipation PO]

74
Q

Mag Sulfate and Mag Oxide adverse effects

A

hypermag  confusion, sluggish, slow movements, SOB, nausea, dizzy [low calcium], abnormal heart rhythm

75
Q

What is calcium

A

Hormones released by the thyroid and parathyroid glands are controllers for the amount of calcium that is released from and absorbed into the bone

76
Q

5 characteristics of calcium

A

Enzyme reactions
Effects membrane potentials and nerve excitability
Necessary for contraction of skeletal, cardiac and smooth muscle
Helps in release of hormones, neurotransmitters and chemical mediators
Influences cardiac contractility and automaticity
Necessary for blood clotting (part of the clotting cascade)

77
Q

treatment of hypocalcemia (IV)

A 
IV calcium 
Calcium Chloride (ionized form and preferred) = given through central only at UK 
Calcium Gluconate =  prefer to give through central line
78
Q

Oral treatment of hypocalcemia

A

Elemental calcium, calcium carbonate (Tums)
May also need Vit D
Active form in impaired liver &/or kidney function

79
Q

causes of hypercalcemia

A

hyperparathyroidism, cancers

80
Q

S/S of hypercalcemia

A

calcium acts like a sedative, fatigue, lethargy, confusion, weakness, leading to seizures, coma
Kidney stones

81
Q

4 treatments of hypercalcemia

A

Adequate hydration
Increased urine output
Diuretics and NaCl (sodium excretion is accompanied by calcium excretion)
Dialysis in renal failure

82
Q

T/F low calcium = high phosphate

83
Q

5 MOAs of phosphorus

A 
Role in bone formation 
Essential for ATP formation and enzymes needed for glucose, protein  and fat metabolism 
Part of DNA and RNA
Acid-base buffer 
Normal function of WBCs and platelets
84
Q

percentage of phosphorus found in bone

85
Q

percentage of phosphorus found intracellular

86
Q

causes of Hypophosphatemia

A 
Decreased absorption 
Antacids overdose
Severe diarrhea
Increased kidney elimination
Malnutrition
Alcoholism 
TPN
Recovery from malnutrition
87
Q

manifestations of hypophosphatemia

A 
mild-moderate few, severe:
Tremor
Paresthesia
Confusion to coma 
Seizure 
Muscle weakness
Joint stiffness
Bone pain 
Hemolytic anemia
Plt dysfunction
Impaired WBC function
88
Q

causes of Hyperphosphatemia

A 
Kidney failure
Laxatives/enemas with phosphorus
Shift from intra- to extracellular compartment 
Massive trauma
Heat stroke 
Hypoparathyroidism
89
Q

manifestations of Hyperphosphatemia

A 
Usually asymptomatic 
Typically only symptoms of hypocalcemia: 
Muscle spasms
Paresthesia
Tetany
90
Q

treatment for Hypophosphatemia

A 
IV or oral replacement
Given IV over a LONG period of time  
Increase oral intake
Take care with CKD or hypercalcemia 
Increased risk of calcifications
91
Q

treatment for Hyperphosphatemia

A

Treat the cause
Calcium-based phosphate binders
Hemodialysis – Renal failure

92
Q

Chvostek’s sign

A

ipsilateral twitching of the circumoral muscles in response to gentle tapping of the facial nerve just anterior to the ear

93
Q

Trousseau’s sign

A

carpal spasm upon inflation of a BP cuff to 20 mmHg above the patient’s systolic blood pressure for three minutes

94
Q

T/F Low Mag= Low calcium

95
Q

Causes of Hypocalcemia

A 
Unable to mobilize bone
increased renal loss
increased binding
decreased intake of absorption (Decreased vitamin D)
Acute pancreatitis
thyroid and parathyroid surgery
increased neuromuscular excitability
cardiac insufficiency
positive chvosteks sign
positive trousseaus sign

NUR 325 Patho (18 decks)

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