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Nursing 202 > Fluid, Electrolyte, and Acid-Base Balance > Flashcards

Fluid, Electrolyte, and Acid-Base Balance Flashcards

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1
Q

Fluid:

A

water that contains dissolved or suspended substances such as glucose, mineral salts, and proteins

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2
Q

ECF:

A

Extracellular fluid: outside the cells

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3
Q

ICF:

A

Intacellular fluid: inside the cells

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4
Q

ECF has 2 major divisions, and 1 minor division:

A

Major:
1. Intravascular fluid: liquid portion of blood
2. Interstitial fluid: between cells and outside blood vessels
Minor:
1. Transcellular fluids: secreted by epithelial cells-cerebrospinal, pleural, peritoneal, and synovial fluids

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5
Q

ECF Contains

A

Sodium, chloride, and bicarbonate
Albumin (intravas)
Gastric and intestinal secretions (trans)

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6
Q

ICF Cations and Anions:

A

C: Potassium and magnesium
A: phosphate

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7
Q

Osmolality of a fluid is a

A

measure of particles per kilogram of water

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8
Q

Normal value range for Osmolality:

A

280-300 mOsm/kg H2O

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9
Q

Normal range for Sodium:

A

136-145 mEq/L

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10
Q

Normal range for Potassium:

A

3.5-5.0 mEq/L

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11
Q

Normal range for Chloride:

A

98-106 mEq/L

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12
Q

Normal range for Bicarbonate (HCO3):

A

22-26 mEq/L

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13
Q

Normal range for calcium:

A

8.5-10 mg/dL

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14
Q

Normal range for magnesium:

A

1.5-2.5 mEq/L

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15
Q

Normal range for Anion gap:

A

5-11 mEq/L

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16
Q

Normal range for pH:

A

7.35-7.45

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17
Q

Normal range for PaCO2 (Arterial blood gases):

A

35-45 mm Hg

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18
Q

Normal range for Arterial blood gases PaO2:

A

80-100 mm Hg

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19
Q

Normal range for Arterial blood gases O2 Sat:

A

95-100%

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20
Q

Brain Natriuretic peptide:

A

determine presence of heart failure with fluid excess

Evaluation for patients who have congestive heart failure 0-100

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21
Q

Isotonic:

A

Use 5% dextrose in water

fluid with the same concentration of nonpermeant particles as normal blood

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22
Q

Hypotonic:

A

45% normal solution

more dilute than the blood

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23
Q

Hypertonic:

A

5% dextrose in normal saline, 10% dextrose in water, lactated ringers
more concentrated than normal blood

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24
Q

Active transport:

A

cells maintain their high intracellular electrolyte concentration
ATP moves electrolytes across cell membranes against the concentration gradient
Ex. Sodium potassium pump: Na out and K in

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25
Q

Osmosis:

A

Water moves through membrane that separates fluid with different particle concentrations –> meet equilibrium

osmotic pressure: inward pulling force caused by particles in the fluid

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26
Q

Filtration:

A

fluid moves into and out of capillaries

Hydrostatic pressure: the force of the fluid pressing outward against a surface
Colloids: containing albumin and other proteins
Colloid osmotic pressure or oncotic pressure: inward pulling force caused by blood proteins that help move fluid from interstitial area back into capillaries

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27
Q

Diffusion:

A

passive movement of electrolytes or other particles down the concentration gradient (high areas to low)

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28
Q

Normal range for Fluid Intake:

A

Women: 2700 ml/day
Men: 3500 ml/day

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29
Q

Normal range for Output:

A

Urine 1500 ml/day

Defecation 100-200 ml/day

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30
Q

Fluid output normally occurs through 4 organs:

A

Skin
Lungs
GI tract
Kidneys

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31
Q

Abnormal fluid includes:

A

Vomiting
Wound drainage
Hemorrhage

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32
Q

ADH:

A

Vasopressin
water retainer, increasing water retention

regulates the osmolality of the body fluids by influencing how much water is excreted in urine

Renal failure will not be able to absorb or secrete this hormone

More ADH is released if body fluids become more concentrated

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33
Q

RAAS:

A

Converts Angiotensis 1 to 2, stimulates production of aldosterone = increases BP

High BP = ACE inhibitor
Angiotensin
Converting
Enzyme

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34
Q

Aldosterone:

A

Passive, water absorbed and blood volume expands

Maintains BP and fluid balance

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35
Q

Thyroid:

A

cardiac output increased glomerular excretion rate, filter faster more urine

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36
Q

Extracellular fluid volume imbalances:

A
  1. ECV deficit: present when there is insufficient isotonic fluid in the extracellular compartment
  2. Hypovolemia: decreased vascular volume, often used when discussing ECV deficit
  3. ECV excess: there is too much isotonic fluid in the extracellular compartment, intake of sodium containing isotonic fluid has exceeded fluid output
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37
Q

Osmolality imbalances:

A

Hypernatremia: water deficit, hypertonic condition,
2 causes: loss of relatively more water than salt
gain of relatively more salt than water

Hyponatremia: water excess or water intoxication, hypotonic condition, arises from gain of relatively more water than salt or loss of relatively more salt than water

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38
Q

Clinical dehydration:

A

the combination of ECV deficit and hypernatrmia occur at same time

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39
Q

Where can you find Potassium?

A 
Fruits
Potatoes
Instant coffee
Molasses
Brazil nuts
Absorbs easily
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40
Q

Where can you find calcium?

A 
dairy products
canned fish with bones
broccoli 
oranges
requires vitamin D for best absorption 
undigested fat prevents absorption
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41
Q

Where can you find Magnesium?

A

dark green leafy vegetables
whole grains
Mg containing laxatives and antacids
Undigested fat prevents absorption

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42
Q

Where can you find phosphate?

A

Milk
processed foods
Aluminum antacids prevents absorption

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43
Q

What are used to monitor a patient’s acid base balance?

A

lab tests of blood called ABGs Arterial blood gases

-Also reveals adequacy of ventilation and oxygention

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44
Q

Acid production: 2 types

A

Cellular metabolism creates

  1. Carbonic acid: H2CO3
  2. Metabolic acids: any acids are not carbonic acid which include citric acid, lactic acid
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45
Q

Acid Excretion: 2 systems

A
  1. Lungs: Excretion of Carbonic Acid - exhale = form of CO2 and water
    people who have lung disease have difficulty with normal excretion of carbonic acid = more acidic
  2. Kidneys: Excretion of metabolic acids - too many H+ ions in the blood, renal cells move more H+ ions into renal tubules to be expelled, retaining more HCO3, too few = renal cells secrete fewer H+ ions
    Phosphate buffers keep urine from being too acidic
46
Q

Anion gap:

A

relfection of unmeasured anions in plasma

47
Q

What removes carbonic acid from the body?

A

Compensatory hyperventilation

48
Q

Values for Normal anion gap:

A

5-11 mEq/L, varies depending on lab

49
Q

Daily weights and fluid intake and output measurement: Each kilogram of weight gained or lost overnight is equal to ___ retained or lost.

A

1 L of fluid

50
Q

Assessment body weight changes from previous day:

A

loss of 2.2 ilbs in 24 hr in adults = ECV deficit

gain of 2.2 ilbs in 24 hr in adults = ECV excess

51
Q

Infiltration:

A

occurs when an IV catheter becomes dislodged or a vein ruptures and IV fluids inadvertently enter subcutaneous tissue around venipuncture site

52
Q

Extravasation:

A

when the IV fluid contains additives that damage tissue

53
Q

Phlebitis:

A

inflammation that results from chemical, mechanical, or bacterial causes

54
Q

After ABG puncture, apply pressure to site for at least how many minutes and why?

A

5 minutes to reduce the risk of hematoma formation

55
Q

Edema forms with changes in

A

hydrostatic pressure differences between the capillary blood and the interstitial fluid, such as patients with right sided heart failure
-definition: tissue swelling from excess fluid

56
Q

Minimum amount of urine per day is called

A

Obligatory urine output

400-600 mL

57
Q

Insensible water loss vs sensible:

A

Insensible: skin, lungs
Sensible: urine, defecation, wounds

58
Q

The patient with fluid overload and edema is at risk for

A

skin breakdown

59
Q

Paralytic ileus:

A

severe hypokalemia can cause the absence of peristalsis

60
Q

Palmar reflex indicates

A

positive Trousseau’s sign in hypocalcemia

61
Q

Kussmaul respiration:

A

pattern of breaths that are deep and rapid and not under voluntary control

62
Q

Causes of Hypovolemia:

A
  1. fluid loss (bleeding) or 2. third-space fluid shift
1. Fluid loss – 
Abdominal surgery Diabetes mellitus 
Diuretic therapy, excessive sweat
Fever
Hemorrhage
Nasogastric drainage Renal failure with increased urination, Vomiting & diarrhea – raises Ph level causing alkalosis 
3rd space fluid shift – Acute intestinal obstruction
Acute peritonitis, burns, Crush injuries
Heart failure
Hypoalbuminemia
Liver failure
Pleural effusion
63
Q

: Thirst, dizziness, nausea
Increased heart rate
Orthostatic hypotension
flat jugular veins
Deterioration in mental status (Restlessness, Anxiety, confusion) because of hypoxia
Initially Urine output > 30 mL/ hr then 10-30 ml/hr
weight loss
Delayed capillary refill, Cool ,pale skin, weak peripheral pulses
Normal blanching is 2-3 seconds- anything over that is delayed capillary refill

A

What to look for in Hypovolemia

64
Q

Fluid replacement- isotonic (normal saline/ lactated ringers)
Oxygen therapy
Control bleeding
Lower HOB bring blood flow to brain
IV access
Monitor mental status & VS
I & O
Lung sounds: do not want fluid to go through lungs –proper adm of fluids
Weight
Mental status
Skin temperature & pulses – vital signs ia

A

Tests & treatment for Hypovolemia

65
Q

Causes of dehydration:

A

prolonged fever, watery diarrhea –give meds like diphenoxylate, renal failure & hyperglycemia

66
Q 
Changes in mental status
Dizziness, weakness, extreme thirst
Fever
Dry skin & mucous membranes; poor skin turgor –tenting of skin 
Tachycardia, hypotension
Decrease urine output, concentrated
A

What to look for n dehydration

67
Q 
Tests/ Treatment
Elevated hematocrit (over 42)
Elevate serum osmolality above 300
Elevated serum sodium (NA) above 145
Hypotonic solution
A

Dehydration

68
Q 
Nursing Interventions
Symptoms & vital signs
I & O
Monitor labs
Safety due to fall risks 
Daily weights
Skin assessment
A

Dehydration

69
Q

Edema – pitting edema rate

A

1-4
Dependent areas
Anasarca: edema everywhere, cannot give diuretic for to get rid of

ASSOCIATED WITH HYERVOLEMIA

70
Q 
Tests
Low hematocrit (hemodilution)
Normal sodium
Low potassium
Low BUN
Decreased serum osmolality
Low oxygen level: due to too much fluid 
Chest x-ray = pulmonary congestion – dots of white
A

hypervolemia

71
Q

Treatment:
Restrict sodium & fluid intake
Medications – diuretic furosemide (Lasix) –changes in bp, tenitis (ringing in ears)

A

Hyervolemia

72
Q 
Nursing interventions:
Vital signs- look for tachypnea, elevated B/P
Jugular vein distention
I &o
Lung sounds- crackles; sputum pink frothy
Monitor labs
Elevate HOB to help with breathing 
Monitor edema
Weights –morning daily 
Skin care
See it in sacrum
A

hypervolemia

73
Q

Causes: vomiting, diarrhea, excessive sweating, burns, wound drainage, diuretics
S&S: headache, irritable, disoriented, poor skin turgor, weak, rapid pulse, low B/p, dry mucous membranes

A

Hyponatremia – common with dehydration

74
Q

Treatment: hypertonic solution= infused slowly

A

Hyponatremia – common with dehydration

75
Q

Causes: thirst, salt tablets, high-sodium foods, medication, gastric/ enteral tube feeding
S&S: restlessness, anorexia, N&V, weakness, lethargy, confusion, lower-grade fever, flushed skin, thirst, elevated b/p, bounding pulse, dyspnea

A

Hypernatremia

76
Q

Treatment: underlying disorder, oral fluids, salt-free solution, diuretics

A

Hypernatremia

77
Q

Causes: prolonged intestinal suction, dietary intake, prolonged vomiting, diarrhea, laxative misuse, severe diaphoresis, medications: diuretics (furosemide & thiazide), corticosteroids and insulin

A

Hypokalemia

78
Q

S&S: muscle weakness, leg cramps, decreased deep tendon reflexes, decreased bowel sounds, dilute urine, pulse weak & irregular, orthostatic hypotension, palpitations

A

Hypokalemia

79
Q

Treatment: high-potassium low-sodium diet, oral supplement, IV replacement

A

Hypokalemia

80
Q

Causes: increased dietary intake, excessive salt substitute, potassium supplements, medications: beta-adrenergic, potassium-sparing diuretic, chemotherapy, kidney damage, burn, severe infection, trauma, crush injury, renal failure

A

Hyperkalemia

81
Q

S&S: skeletal muscle weakness, decreases reflexes, smooth muscle hyperactivity, decreased heart rate, irregular pulse, hypotension, cardiac arrest

A

Hyperkalemia

82
Q

Treatment: loop diuretic, potassium restricted diet, Kayexalate

A

Hyperkalemia

83
Q

Causes: dietary, poor absorption GI tract, enteral feedings, excretion (loop/ thiazide diuretic), renal absorption

A

Hypomagnesemia

84
Q

STARVED S&S for hypo magnesium:

A 
Siezures
Tetany
Anorexia and arrtheymia
Rapid heart rate
Vomiting
Emotional liability
Deep tendon reflexes increases
85
Q

Tests: low magnesium, low potassium & calcium, ECG changes
Treatment: underlying cause, diet, oral supplement, intravenous magnesium

A

hypomagniusm

86
Q

Causes: renal dysfunction, TPN, continuous intravenous infusions

A

Hypermagnesemia

87
Q

S&S: sleepy, weakens respiratory muscles, weak pulse , bradycardia, vasodilatation, hypotension, flushed, hypoactive reflexes

A

Hypermagnesemia

88
Q

increase fluids= increase urine output, loop diuretic

A

Hypermagnesemia

89
Q

Causes: inadequate intake, malabsorption GI tract (esp. high phosphorus), acute pancreatitis (loss thru feces); medication: calcitonin, loop diuretic

A

Hypocalcemia

90
Q

S&S: confusion, irritability, seizures, paresthesia: numbness, twitching, muscle cramps, fractures

A

Hypocalcemia

91
Q

Treatment: intravenous calcium, vitamin D supplements, oral calcium supplements, diet

A

Hypocalcemia

92
Q

Causes: hyperparathyroidism & cancer; GI tract, kidneys, fractures

A

Hypercalcemia

93
Q

S&S: fatigue, confusion, memory loss, personality change, depression, muscle weakness, hyporeflexia, hypertension, GI effects

A

Hypercalcemia

94
Q

Treatment: reduce dietary intake & medications; hydrate

A

Hypercalcemia

95
Q

-causes: due to refeeding regular food again, alcohol withdrawal

A

Hypophosphatemia

96
Q

S&s: seizures, joint stiffness, paresthesia

A

Hypophosphatemia

97
Q

-iv- tpn

A

Hypophosphatemia

98
Q

Causes- due to renal failure, hypothyroidism, chemo therapy, laxities that contain phosphate

A

Hyperphosphatemia

99
Q

S&s: tetany, cramps

A

Hyperphosphatemia

100
Q

Treatments -increase calcium, med adm binder to phosphorus (fas-low)

A

Hyperphosphatemia

101
Q

Most abundant ECF

Associated with sodium (potassium & calcium)

A

Chloride

102
Q

ICF & ECF; kidneys regulate

Buffer

A

Bicarbonate

103
Q

compound that contains hydrogen (H+) ions

A

Acid

104
Q

compound that accepts hydrogen ions

A

Base

105
Q

3 complex mechanisms maintain acid-base balance

A

Buffers
Respiratory control carbon dioxide
Renal regulation of bicarbonate

106
Q

Prevent wide swings in ph
contains weak acid and base
Keep strong acids and bases either by absorbing or releasing

A

Buffer systems

107
Q

Lungs second line of defense
Control carbonic acid
Too basic: rapid deep breathing
Too acid: shallow respiration

A
  1. Respiratory mechanisms
108
Q

Kidneys last line
Regulate plasma bicarbonate
Can neutralize more acid or base
It is slow, 3 days

A

Renal mechanisms

109
Q

Respiratory Acidosis cause:

A

retention of CO2

110
Q

Metabolic Acidosis cause:

A

loss of bicarbonate

111
Q

Respiratory Alkalosis cause:

A

blowing off CO2

112
Q

Metabolic Alkalosis cause:

A

increase in bicarbonate

Nursing 202 (20 decks)

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