Fluid, Electrolyte, & Acid-Base Regulation (Page 1 🥲) Flashcards
Minerals in the body that are able to conduct electrical charges =
Electrolytes
Are electrolytes essential to sustain life?
Yes
Electrolytes are found in-
The blood, urine, tissues, and other body fluids
Common electrolytes include-
Potassium, Sodium, Calcium, & Magnesium
How can electrolyte levels be evaluated?
By performing metabolic panels like the BMP or CMP
A blood test that gives info like electrolyte + fluid balance. Also gives info about renal function + glucose levels =
Basic Metabolism Panel (BMP)
A blood test that gives info like electrolyte + fluid balance. Also gives info about the body’s metabolism + protein & liver function =
Complete Metabolic Panel (CMP)
What tests does a BMP provide?
Blood Urea Nitrogen (BUN), Carbon Dioxide (C02), Creatinine (CR), Glucose, Chloride (Cl- ), Potassium (K+), and Calcium (Ca+) tests
What tests does a CMP provide?
All of the tests a BMP provides, also provides Liver Enzyme , Alkaline Phosphate (ALP), Alanine Transaminase (ALT), Aspartate Aminotransferase (AST), Bilirubin (total), Protein (total), and Albumin tests
The indication that the Blood Urea Nitrogen test looks into is-
Kidney Function
The indication that the Carbon Dioxide (C02) test looks into is-
Blood Bicarbonate Level
The indication that the Creatinine (CR) test looks into is-
Kidney Function
The indication that the Glucose test looks into is-
Blood Sugar Level
The indication that the Chloride (Cl-) test looks into is-
Blood Chloride Level
The indication that the Potassium (K+) test looks into is-
Blood Potassium Level
The indication that the Sodium (Na+) test looks into is-
Blood Sodium Level
The indication that the Calcium (Ca+) test looks into is-
Liver Function
The indication that the Liver Enzymes test looks into is-
Liver Function
The indication that the Alkaline Phosphate (ALP) test looks into is-
Liver Function
The indication that the Alanine Transaminase (ALT) test looks into is-
Liver Function
The indication that the Aspartate Aminotransferase (AST) test looks into is-
Liver Function
The indication that the Bilirubin (total) test looks into is-
Liver Function
The indication that the Protein (total) test looks into is-
Total Blood Protein
The indication that the Albumin test looks into is-
Liver Function
Electrolytes are responsible for maintaining-
The balance of water in the body
Electrolytes are responsible for balancing-
The blood pH (acid-base) level
Electrolytes are responsible for moving nutrients-
Into the cells
Electrolytes are responsible for moving wastes-
Out of the cells
Electrolytes are responsible for maintaining proper function of the body’s-
Muscles, heart, nerves, and brain
The average person’s weight consists of how much water?
One-half to two-thirds water
For males, water makes up what percentage of weight?
~60% of weight
For females, water makes up what percentage of weight?
~54 %
For babies/ children, water makes up what percentage of weight?
~70 %
A poor balance of water can lead to-
Hypovolemia, Dehydration, Tachycardia, Tachypnea, Confusion, Headache, Kidney Stones, etc.
Heart rate above expected range =
Tachycardia
Respiratory rate above expected range =
Tachypnea
Organs that filter blood + excrete waste as urine =
Kidneys
Excess water loss without a loss of sodium =
Dehydration
Decrease in blood volume due to body fluid / blood loss =
Hypovolemia
Homeostasis =
Body’s natural balance
Measurements of the solutes within a solution =
Osmolality
How does the body work to maintain homeostasis?
By keeping water + electrolytes at a constant level in the blood
How can the level of water + electrolytes in the blood be monitored?
Determining the Serum Osmolality of the blood
The most frequently used laboratory indicator of the body’s fluid status =
Serum Osmolality
Expected range of Serum Osmolality =
285 - 295 m0sm / kg
As body water decreases, what increases?
The concentration of solutes
Whenever body water decreases and the concentration of solutes increases, this leads to an increase in-
Serum Osmolality and indicates decreases in hydration
Osmolality can’t be determined using urine.
True or false?
False
Urine can be used to measure Osmolality and what else?
Renal Function + Hydration Status
The expected range for urine Osmolality is -
50 - 1,200 m0sm/kg for a random specimen
Is the body’s water located within cells or outside cells?
Both
The body has how many main fluid compartments?
3
What’s the body’s largest fluid compartment?
The Intracellular Space
The Intracellular Space holds what percentage of the body’s water?
67 %
Aside from the Intracellular Space, there is also the other two compartments, which collectively come together to create the-
Extracellular Space
The two compartments that make up the extracellular space are called the-
Interstitial Space + Intravascular Space
The Intravascular Space holds what percentage of the body’s water?
8%
The Interstitial Space holds what percentage of the body’s water?
25 %
How does the water pass through the various fluid compartments in the body?
The process of Osmosis
The movement of water from an area of higher concentration to an area of lower concentration. An example is fluid moving into or out of a cell to maintain homeostasis =
Osmosis
What can Osmoreceptors detect?
Increased Osmotic Pressure
What can Baroreceptors (aortic arch, carotid sinus) detect?
Decreased Blood Pressure
Whenever osmoreceptors detect increased osmotic pressure or baroreceptors detect decreased BP, what happens next?
The Hypothalamic Neuron sends some ADH to the kidneys + blood vessels
Where is the hypothalamic neuron located?
In the Posterior Pituitary
What does the ADH do to the kidneys?
Causes an increase in the reabsorption of water
What does the ADH do to the blood vessels?
Causes Vasoconstriction
An increased reabsorption of water + vasoconstriction =
Increased Blood Volume + Increased Blood Pressure
The narrowing (constriction) of blood vessels by small muscles in their walls =
Vasoconstriction
The most obvious homeostatic mechanism to increase / retain water is the-
Thirst Response
How does the body monitor its own water balance?
The Lamina Terminalis
The Lamina Terminalis is located where?
The edge of the Hypothalamus
How does the lamina terminalis monitor the body’s water balance?
It monitors the osmolality in the ventricles of the brain
How much of a percentage increase in serum osmolality does it take to alert the brain’s sensors to a decrease in the body’s fluid volume?
A 1% increase in serum osmolality
Whenever the neurons of the laminate terminalis need to increase the body’s supply of water, they send out signals that signify -
Thirst
Whenever the brain senses excess body water, the thirst sensation-
Stops
As serum osmolality rises, what stimulates the posterior pituitary to release ADH?
The Hypothalamus
What does ADH stand for?
Antidiuretic Hormone
ADH can also be called-
Vasopressin
What does ADH act on?
The Nephrons of the Kidneys
The collecting ducts of nephrons respond to ADH by -
Increasing water absorption + decreasing urine excretion + increasing the body’s fluid volume
How does urination help the body retain water?
Urination filters the blood, which lets the blood return to circulation (the blood holds water and electrolytes so it essentially reintroduces or “recycles” water/ electrolytes)
Certain meds, dehydration, hypovolemia, overhydration can all lead to -
Fluid + Electrolyte Imbalances
The wrong IV fluids or feedings can lead to -
Fluid + Electrolyte Imbalances
Sweating, diarrhea, and vomiting can all lead to-
Fluid + Electrolyte Imbalances
What disorders can lead to Fluid + Electrolyte Imbalances?
Heart, Kidney, or Liver Disorders
What’s the expected electrolyte value range for Potassium (K+)?
3.5 to 5 mEq/L
What’s the expected electrolyte value range for Sodium (Na+)?
136 to 145 mEq/L
What’s the expected electrolyte value range for Calcium (Ca 2+)?
9 to 10.5 mg/dL
What’s the expected electrolyte value range for Magnesium (Mg 2+)?
1.3 to 2.1 mEq/L
Nurses must be able to recognize abnormalities in laboratory findings, and report these findings to the-
Provider
Can electrolytes and other substances that make up the solutes within a solution such as blood move across semi-permeable membranes like water can using osmosis?
No
How do electrolytes and other substances that make up the solutes within a solution move across semi-permeable membranes?
Diffusion + Active Transport
The movement of solutes (like electrolytes) from an area of high concentration (Like within a cell) to an area of low concentration (Like the intravascular area) =
Diffusion
When does diffusion stop?
When the number of solutes inside and outside of a cell are equal
A Passive Process =
No use of energy
Diffusion is a -
Passive Process
Does Active Transport need energy, or is it a passive process?
It needs energy
Give an example of electrolyte movement via active transport =
The movement of sodium and potassium into / out of cells through the sodium–potassium pump
Does Active Transportation move solutes from an area of higher concentration to one of lower concentration like diffusion does?
No, Active Transportation carries solutes from an area of lower concentration to one of higher concentration
Active Transportation moves electrolytes / molecules with the use of energy in the form of-
Enzymes
The body’s largest Intracellular electrolyte =
Potassium
Supports the transmission of electrical impulses of the body’s nerves + muscles =
Potassium
Potassium plays a major role in the conduction of -
Nerve cells in the heart
Does the body maintain potassium levels in a narrow range or a wide range?
Narrow Range
Potassium intake occurs through-
Food + Drinks + Supplements
Electrolyte for nerve + muscle function, especially for the heart =
Potassium
The recommended daily allowance (RDA) for daily intake of potassium is how many mg for adult males?
3,400 mg
The recommended daily allowance (RDA) for daily intake of potassium is how many mg for adult females?
2,600 mg
Responsible for the primary excretion of potassium =
Kidneys
What percentage of potassium is excreted by the kidneys?
90%
What percentage of potassium is excreted via sweat / the digestive tract =
10%
Potassium has an expected reference range in the blood of how many mEq/L?
3.5 - 5 mEq/L
Hypokalemia occurs when levels of potassium fall below -
3.5 mEq/L
Critical values occur for adults at less than how much potassium?
3 mEq/L
Critical values occur for newborns at less than how much potassium?
2.5 mEq/L
Are PN’s allowed to view laboratory values?
Yes
If the lab results are out of range, a PN must tell the-
RN or the Provider
Causes of Hypokalemia?
Excessive sweating
Meds
Certain cardiac conditions
GI losses
Metabolic alkalosis
Decreased oral intake of potassium
Excessive alcohol use
Chronic kidney disease
Diabetic ketoacidosis
Folic acid deficiency
If a client is exhibiting signs of hyperkalemia, hospitalization may be required to remove excess potassium from the -
Blood
If an elevated potassium level is due to renal failure, what may be required?
Hemodialysis
Hemodialysis =
Filtering waste from blood using a machine
In terms of alternatives to hemodialysis, what are some meds that can be used to treat hyperkalemia?
Calcium Gluconate + Diuretics + Resin Medications
Calcium Gluconate or Calcium Chloride can be used to-
Lower the effect of excess potassium levels on the heart
Loop and thiazide diuretics cause the body to excrete excess potassium through-
Urination
Sodium polystyrene sulfonate is a-
Resin Medication
Resin Medications (like sodium polystyrene sulfonate) can help decrease potassium levels via-
Bowel Movements
How do resin meds decrease potassium levels via bowel movements?
Resins bind to the potassium in the body, then are excreted via stool
Can the administration of insulin help lower potassium levels?
Yes
How does the administration of insulin help lower potassium levels?
Insulin causes the potassium to enter cells, thus lowering the serum potassium level
Clients receiving insulin to treat hyperkalemia should have what kind of monitoring?
Blood Glucose Monitoring
Why should clients receiving insulin to treat hyperkalemia have their blood glucose monitored?
Because of increased risk of hypoglycemia
Blood glucose level expected range =
74 - 106 mg/dL
A blood glucose level lower than the expected range (74 - 106 mg/dL)
Hypoglycemia
The provider may instruct the client with hyperkalemia to lower potassium levels by decreasing -
Dietary Consumption
Some salt substitutes can contain-
Potassium
Salt substitutes are commonly used by clients who have to limit their-
Sodium Intake
Does potassium chloride (contained in certain salt substitutes) raise potassium levels?
Yes
The body’s most common extracellular electrolyte =
Sodium
Supports functioning of muscles + nerves, maintaining a normal BP, regulates fluid balance in the body =
Sodium
Sodium is ingested into the body through-
Food + drink
Sodium is excreted primarily through -
Urine + Sweat
The RDA for sodium is less than how many mg per day?
Less than 2,300 mg (~1 Teaspoon)
Do most Americans get more sodium than they actually need?
Yeah
The expected reference range of sodium is -
136 - 145 mEq/L
Sodium level below expected reference range (136 - 145 mEq/L) =
Hyponatremia
The most common cause of hypokalemia is loss of potassium from the -
Kidneys or GI Tract
A category of medications that cause increased urination =
Diuretics
Name off 3 potassium-wasting diuretics =
Loop Diuretics, Osmotic Diuretics, Thiazide Diuretics
Meds that most commonly result in hypokalemia through urinary loss =
Diuretics
Amphotericin B, high doses of penicillin, and theophylline all can lead to-
Hypokalemia
Decreased potassium from GI losses may result from -
Diarrhea or vomiting, Chronic laxative use, bowel diversion, or gastric suctioning
A potassium level of 3 to 3.5 mEq/L is classified as-
Mild Hypokalemia
Common manifestations that can be seen with hypokalemia of less than 3 mEq/L include -
Muscle Weakness, Cardiac Arrhythmias, Constipation, Fatigue
Defined as a potassium level less than 2.5 mEq/L =
Life-threatening Hypokalemia
What can cause respiratory paralysis and failure to occur?
Severe life-threatening hypokalemia
Paralytic Ileus, Hypotension, Tetany, Rhabdomyolysis, and Life-Threatening Cardiac Arrhythmias can all be caused by-
Severe Life-Threatening Hypokalemia
Repeated episodes of hypokalemia can affect -
Renal Function
The provider may order an electrocardiogram (ECG) to determine -
If the level of potassium is affecting the rhythm of the heart
Arrhythmias =
Abnormal Heart Rhythm
Paralysis =
Loss of muscle functioning
Cessation of intestinal motility =
Paralytic Ileus
Hypotension =
BP below expected range
Rhabdomyolysis =
Muscle Breakdown
What does muscle breakdown result in?
The release of the protein myoglobin into the bloodstream
Whenever muscle breakdown causes the release of myoglobin into the bloodstream, what does this cause damage to?
The Kidneys
Rhabdomyolysis is characterized by-
Red-colored urine, low urine output, weakness, and muscle pain
A test to check heart activity including heart rate and rhythm =
Electrocardiogram (ECG)
Treatment of hypokalemia starts with
Identifying the underlying cause
The provider may prescribe what to restore potassium levels to the expected reference range?
Potassium Supplementation
Potassium supplements can be in the form of-
PO Meds or IV Infusion
Why should PO supplements be administered with or following a meal?
They can cause GI distress
Potassium is considered to be a high-alert medication whenever given by-
IV
If something is a high-alert medicine, then that means that-
If given incorrectly, the client can suffer great harm
When potassium is administered via IV, how many mL of a compatible solution must it be diluted?
Potassium should be diluted in 100 to 1,000 mL of a compatible solution
When administering potassium via IV, should Potassium ever be administered directly from the vial?
No
The dose of potassium (given via IV) shouldn’t go over-
40 mEq/L
When is the only time that a dose of potassium (given via IV) can go over 40 mEq/L?
Whenever severe hypokalemia is being treated
The rate of potassium administration is commonly set to how many mEq/hour to prevent adverse outcomes?
10 - 20 mEq/L
When receiving IV potassium, the client should be on continuous-
ECG Monitoring
When administering Potassium intravenously, the client’s potassium level should be checked periodically to ensure that they -
Don’t receive too much potassium
If hypokalemia is the result of diuretic use, the provider may prescribe -
Routine PO potassium supplements as an adjunct treatment
If hypokalemia is the result of diuretic use, the provider may prescribe routine oral potassium supplements as an adjunct treatment or -
Switch the PT to a Potassium-Sparing Diuretic
If hypokalemia is the result of diuretic use, the provider may instruct the client to raise the potassium level by -
Increasing Dietary Consumption of Potassium
Are nurses allowed to instruct clients in increasing potassium intake by teaching about foods that have a high potassium content?
Yes
Most potassium-rich vegetable?
Baked Potato
Most potassium-rich fruit juice?
Prune Juice
Most potassium-rich dairy product?
Plain, Non-Fat Yogurt
Most potassium-rich fish?
Salmon
Most potassium-rich fruit?
Bananas
Amount of potassium per serving of baked potato =
Amount of potassium per serving of prune juice =
Amount of potassium per serving of carrot juice =
Amount of potassium per serving of white beans =
Amount of potassium per serving of plain, nonfat yogurt?
Amount of potassium per serving of sweet potato?
Amount of potassium per serving of salmon?
Amount of potassium per serving of banana?
Amount of potassium per serving of spinach?
Amount of potassium per serving of avocado?
Following intervention, a repeat BMP or CMP should be evaluated to determine if the client’s potassium levels are -
Within the expected reference range
When a PT experiences potassium levels above the expected reference range =
Hyperkalemia
Hyperkalemia is defined as a potassium value greater than-
5 mEq/L
Critical values of hyperkalemia occur at levels greater than -
6.1 mEq/L
The body maintains the potassium level within a narrow range, and deviations can lead to significant -
Neurologic, Respiratory, or Cardiac Consequences
Causes of Hyperkalemia include =
Renal Failure + Dehydration + Diabetes Mellitus + Meds + Trauma + Excess Potassium Intake + Burns + Transfusions of Packed Red Blood Cells + Acidosis + Sepsis
The most common cause of hyperkalemia is-
Renal Failure
The meds that most commonly result in hyperkalemia are-
Potassium-Sparing Diuretics + Non-Steroidal Anti-Inflammatory Meds (NSAIDs) + Angiotensin-Converting Enzyme (ACE) Inhibitors
Does mild hyperkalemia present any manifestations?
It may or may not
Common manifestations that can be seen with hyperkalemia greater than 5 mEq/L include -
Nausea, vomiting, muscle aches + weakness, decreased deep tendon reflexes, paralysis, dysrhythmias or palpitations
Severe life-threatening hyperkalemia is defined as a potassium level greater than-
7 mEq/L
Severe hyperkalemia can cause -
Paralysis + Heart Failure
Routine blood tests such as the BMP or CMP are used to measure -
Potassium Levels
What may a provider prescribe to determine if the level of potassium is affecting the rhythm of the heart?
An ECG
As with hypokalemia, treatment of hyperkalemia begins with -
Identifying and treating the cause
What is your goal whenever treating hyperkalemia?
Removing excess potassium and stabilizing the heart
Factors that can place a client at risk for developing hyponatremia =
Meds + Chronic / Severe Vomiting or Diarrhea + Drinking Excess Amounts of Water + Excess Alcohol Intake + Heart, Kidney, Liver Problems, Severe Burns
