Fluid, Electrolyte, and Acid-Base Balance Flashcards

1
Q

Fluid:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ECF:

A

Extracellular fluid: outside the cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ICF:

A

Intacellular fluid: inside the cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ECF Contains

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ICF Cations and Anions:

A

C: Potassium and magnesium
A: phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Osmolality of a fluid is a

A

measure of particles per kilogram of water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Normal value range for Osmolality:

A

280-300 mOsm/kg H2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Normal range for Sodium:

A

136-145 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Normal range for Potassium:

A

3.5-5.0 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Normal range for Chloride:

A

98-106 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Normal range for Bicarbonate (HCO3):

A

22-26 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Normal range for calcium:

A

8.5-10 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Normal range for magnesium:

A

1.5-2.5 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Normal range for Anion gap:

A

5-11 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Normal range for pH:

A

7.35-7.45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Normal range for PaCO2 (Arterial blood gases):

A

35-45 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Normal range for Arterial blood gases PaO2:

A

80-100 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Normal range for Arterial blood gases O2 Sat:

A

95-100%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Brain Natriuretic peptide:

A

determine presence of heart failure with fluid excess

Evaluation for patients who have congestive heart failure 0-100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Isotonic:

A

Use 5% dextrose in water

fluid with the same concentration of nonpermeant particles as normal blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hypotonic:

A

45% normal solution

more dilute than the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hypertonic:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Osmosis:
Water moves through membrane that separates fluid with different particle concentrations --> meet equilibrium osmotic pressure: inward pulling force caused by particles in the fluid
26
Filtration:
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
27
Diffusion:
passive movement of electrolytes or other particles down the concentration gradient (high areas to low)
28
Normal range for Fluid Intake:
Women: 2700 ml/day Men: 3500 ml/day
29
Normal range for Output:
Urine 1500 ml/day | Defecation 100-200 ml/day
30
Fluid output normally occurs through 4 organs:
Skin Lungs GI tract Kidneys
31
Abnormal fluid includes:
Vomiting Wound drainage Hemorrhage
32
ADH:
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
33
RAAS:
Converts Angiotensis 1 to 2, stimulates production of aldosterone = increases BP High BP = ACE inhibitor Angiotensin Converting Enzyme
34
Aldosterone:
Passive, water absorbed and blood volume expands | Maintains BP and fluid balance
35
Thyroid:
cardiac output increased glomerular excretion rate, filter faster more urine
36
Extracellular fluid volume imbalances:
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
37
Osmolality imbalances:
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
38
Clinical dehydration:
the combination of ECV deficit and hypernatrmia occur at same time
39
Where can you find Potassium?
``` Fruits Potatoes Instant coffee Molasses Brazil nuts Absorbs easily ```
40
Where can you find calcium?
``` dairy products canned fish with bones broccoli oranges requires vitamin D for best absorption undigested fat prevents absorption ```
41
Where can you find Magnesium?
dark green leafy vegetables whole grains Mg containing laxatives and antacids Undigested fat prevents absorption
42
Where can you find phosphate?
Milk processed foods Aluminum antacids prevents absorption
43
What are used to monitor a patient's acid base balance?
lab tests of blood called ABGs Arterial blood gases | -Also reveals adequacy of ventilation and oxygention
44
Acid production: 2 types
Cellular metabolism creates 1. Carbonic acid: H2CO3 2. Metabolic acids: any acids are not carbonic acid which include citric acid, lactic acid
45
Acid Excretion: 2 systems
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
Anion gap:
relfection of unmeasured anions in plasma
47
What removes carbonic acid from the body?
Compensatory hyperventilation
48
Values for Normal anion gap:
5-11 mEq/L, varies depending on lab
49
Daily weights and fluid intake and output measurement: Each kilogram of weight gained or lost overnight is equal to ___ retained or lost.
1 L of fluid
50
Assessment body weight changes from previous day:
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
Infiltration:
occurs when an IV catheter becomes dislodged or a vein ruptures and IV fluids inadvertently enter subcutaneous tissue around venipuncture site
52
Extravasation:
when the IV fluid contains additives that damage tissue
53
Phlebitis:
inflammation that results from chemical, mechanical, or bacterial causes
54
After ABG puncture, apply pressure to site for at least how many minutes and why?
5 minutes to reduce the risk of hematoma formation
55
Edema forms with changes in
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
Minimum amount of urine per day is called
Obligatory urine output | 400-600 mL
57
Insensible water loss vs sensible:
Insensible: skin, lungs Sensible: urine, defecation, wounds
58
The patient with fluid overload and edema is at risk for
skin breakdown
59
Paralytic ileus:
severe hypokalemia can cause the absence of peristalsis
60
Palmar reflex indicates
positive Trousseau's sign in hypocalcemia
61
Kussmaul respiration:
pattern of breaths that are deep and rapid and not under voluntary control
62
Causes of Hypovolemia:
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
: 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
What to look for in Hypovolemia
64
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
Tests & treatment for Hypovolemia
65
Causes of dehydration:
prolonged fever, watery diarrhea –give meds like diphenoxylate, renal failure & hyperglycemia
66
``` 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 ```
What to look for n dehydration
67
``` Tests/ Treatment Elevated hematocrit (over 42) Elevate serum osmolality above 300 Elevated serum sodium (NA) above 145 Hypotonic solution ```
Dehydration
68
``` Nursing Interventions Symptoms & vital signs I & O Monitor labs Safety due to fall risks Daily weights Skin assessment ```
Dehydration
69
Edema – pitting edema rate
1-4 Dependent areas Anasarca: edema everywhere, cannot give diuretic for to get rid of ASSOCIATED WITH HYERVOLEMIA
70
``` 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 ```
hypervolemia
71
Treatment: Restrict sodium & fluid intake Medications – diuretic furosemide (Lasix) –changes in bp, tenitis (ringing in ears)
Hyervolemia
72
``` 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 ```
hypervolemia
73
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
Hyponatremia – common with dehydration
74
Treatment: hypertonic solution= infused slowly
Hyponatremia – common with dehydration
75
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
Hypernatremia
76
Treatment: underlying disorder, oral fluids, salt-free solution, diuretics
Hypernatremia
77
Causes: prolonged intestinal suction, dietary intake, prolonged vomiting, diarrhea, laxative misuse, severe diaphoresis, medications: diuretics (furosemide & thiazide), corticosteroids and insulin
Hypokalemia
78
S&S: muscle weakness, leg cramps, decreased deep tendon reflexes, decreased bowel sounds, dilute urine, pulse weak & irregular, orthostatic hypotension, palpitations
Hypokalemia
79
Treatment: high-potassium low-sodium diet, oral supplement, IV replacement
Hypokalemia
80
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
Hyperkalemia
81
S&S: skeletal muscle weakness, decreases reflexes, smooth muscle hyperactivity, decreased heart rate, irregular pulse, hypotension, cardiac arrest
Hyperkalemia
82
Treatment: loop diuretic, potassium restricted diet, Kayexalate
Hyperkalemia
83
Causes: dietary, poor absorption GI tract, enteral feedings, excretion (loop/ thiazide diuretic), renal absorption
Hypomagnesemia
84
STARVED S&S for hypo magnesium:
``` Siezures Tetany Anorexia and arrtheymia Rapid heart rate Vomiting Emotional liability Deep tendon reflexes increases ```
85
Tests: low magnesium, low potassium & calcium, ECG changes Treatment: underlying cause, diet, oral supplement, intravenous magnesium
hypomagniusm
86
Causes: renal dysfunction, TPN, continuous intravenous infusions
Hypermagnesemia
87
S&S: sleepy, weakens respiratory muscles, weak pulse , bradycardia, vasodilatation, hypotension, flushed, hypoactive reflexes
Hypermagnesemia
88
increase fluids= increase urine output, loop diuretic
Hypermagnesemia
89
Causes: inadequate intake, malabsorption GI tract (esp. high phosphorus), acute pancreatitis (loss thru feces); medication: calcitonin, loop diuretic
Hypocalcemia
90
S&S: confusion, irritability, seizures, paresthesia: numbness, twitching, muscle cramps, fractures
Hypocalcemia
91
Treatment: intravenous calcium, vitamin D supplements, oral calcium supplements, diet
Hypocalcemia
92
Causes: hyperparathyroidism & cancer; GI tract, kidneys, fractures
Hypercalcemia
93
S&S: fatigue, confusion, memory loss, personality change, depression, muscle weakness, hyporeflexia, hypertension, GI effects
Hypercalcemia
94
Treatment: reduce dietary intake & medications; hydrate
Hypercalcemia
95
-causes: due to refeeding regular food again, alcohol withdrawal
Hypophosphatemia
96
S&s: seizures, joint stiffness, paresthesia
Hypophosphatemia
97
-iv- tpn
Hypophosphatemia
98
Causes- due to renal failure, hypothyroidism, chemo therapy, laxities that contain phosphate
Hyperphosphatemia
99
S&s: tetany, cramps
Hyperphosphatemia
100
Treatments -increase calcium, med adm binder to phosphorus (fas-low)
Hyperphosphatemia
101
Most abundant ECF | Associated with sodium (potassium & calcium)
Chloride
102
ICF & ECF; kidneys regulate | Buffer
Bicarbonate
103
compound that contains hydrogen (H+) ions
Acid
104
compound that accepts hydrogen ions
Base
105
3 complex mechanisms maintain acid-base balance
Buffers Respiratory control carbon dioxide Renal regulation of bicarbonate
106
Prevent wide swings in ph contains weak acid and base Keep strong acids and bases either by absorbing or releasing
Buffer systems
107
Lungs second line of defense Control carbonic acid Too basic: rapid deep breathing Too acid: shallow respiration
2. Respiratory mechanisms
108
Kidneys last line Regulate plasma bicarbonate Can neutralize more acid or base It is slow, 3 days
Renal mechanisms
109
Respiratory Acidosis cause:
retention of CO2
110
Metabolic Acidosis cause:
loss of bicarbonate
111
Respiratory Alkalosis cause:
blowing off CO2
112
Metabolic Alkalosis cause:
increase in bicarbonate