Fluid, Electrolyte, and Acid-Base Imbalances Flashcards
1
Q
what are the possible causes of hypotension?
A
fluid volume deficit, low Ca2+, high Mg2+
2
Q
what is the normal range for sodium?
A
135-145
3
Q
what is the normal range for potassium?
A
3.5-5.0
4
Q
what is the normal range for calcium?
A
8.6-10.2
5
Q
what is the normal range for phosphate?
A
2.5-4.5
6
Q
what is the normal range for magnesium?
A
1.5-2.5
7
Q
what is the difference between cations and anions?
A
cations: positive
anions: negative
8
Q
what is the difference between a solute and a solvent?
A
solute: substance dissolved in liquid (kool-aid)
solvent: liquid in which solute is dissolved (water)
9
Q
what is osmolality?
A
concentration of solutes in the body
10
Q
why is ATP needed in active transport?
A
because energy is needed to move molecules against the concentration
11
Q
why does active transport need ATP but osmosis doesn’t?
A
because osmosis is just moving water, whereas active transport moves ions
12
Q
difference between oncotic and hydrostatic pressure
A
oncotic: keeps fluids inside
hydrostatic: pushes fluids out of vessel
13
Q
what is osmotic pressure?
A
the power of a solution to pull water across a semi-permeable
membrane
14
Q
what does 240 ml of fluid equal in lbs
A
0.5 lbs
15
Q
what does 1 L of water weigh in kg and lbs?
A
1 kg or 2.2 lbs
15
Q
what is normal urine output/day
A
1.5 L
16
Q
how much is 1 tsp in ml
A
5ml
17
Q
what is the percentage of ICF in an adult’s body fluid
A
2/3 body fluid
17
Q
what is the percentage of ECF in an adult’s body fluid
A
1/3
17
Q
what is the difference between hypertonic and hypotonic?
A
hyper: ECF solutes are more concentrated than in cell, leads to shrinking cell
hypo: ECF solutes are less concentrated than in cell, leads to bigger cell
18
Q
what does ADH (anti-diuretic hormone) do?
A
helps kidneys manage water in body, reabsorbs water (no ADH = releases water)
19
Q
what does cortisol do?
A
anti-inflammation and releases glucose
20
Q
what does aldosterone do?
A
Causes sodium retention and potassium excretion
21
Q
what causes hypovolemia?
A
- Diabetes insipidus
- GI losses: vomiting, NG suction, diarrhea, fistula drainage
- Hemorrhage
- Inadequate fluid intake
- ↑ Insensible water loss or perspiration (high fever, heatstroke)
- Osmotic diuresis
- Overuse of diuretics
- Third-space fluid shifts: burns, pancreatitis
22
what are the manifestations of hypovolemia?
* ↓ Capillary refill
* Confusion, restlessness, drowsiness, lethargy
* Cold clammy skin
* Postural hypotension, ↑ pulse, ↓ CVP
* ↑ Respiratory rate
* Seizures, coma
* Thirst, dry mucous membranes
* ↓ Urine output, concentrated urine
* Weakness, dizziness
* changes in LOC (fall risk)
* Weight loss
23
what does hypo/hypervolemia do to your BP/HR?
hypo: BP down, HR up
hyper: BP up, HR doesn't change much but can go down
24
what causes hypervolemia?
* Corticosteroids use long-term
* Cushing syndrome
* Heart failure
* Primary polydipsia
* Renal failure
* SIADH
25
what are the manifestations of hypervolemia?
* Bounding pulse, ↑ BP, ↑ CVP
* Confusion, headache, lethargy
* Dyspnea, crackles, pulmonary edema
* Edema
* JVD (distended neck veins)
* Muscle spasms
* Polyuria (with normal renal function)
* S3 heart sound
* Seizures, coma
* Weight gain
26
what are the nursing interventions for hypovolemia?
Offer fluids every 1 to 2 hours and at select times. Remind the patient to finish all drinks.
make it easier for the patient to reach the toilet when needed.
fall risk precautions
27
what are the nursing interventions for hypervolemia?
Diuretics and fluid restriction
Sodium restriction
Protect tissues from extreme temperature, prolonged pressure, and trauma
implement fall risk
28
what are the functions of sodium?
important in generating and transmitting nerve impulses, muscle contractility, and regulating acid-base balance
29
what are the causes of hypernatremia?
Issues with synthesis/release of ADH
Decrease in responsiveness (kidney) to ADH
Excessive sodium intake + inadequate water intake
Hypertonic saline
Use of sodium-containing drugs
Excess oral intake of sodium
Ingesting seawater
Primary aldosteronism
Caused by tumor in adrenal glands
Cushing syndrome
Diabetes insipidus
Diarrhea
↑ Insensible water loss (high fever, heatstroke, prolonged hyperventilation)
Osmotic diuretic therapy
30
what are the causes of hyponatremia?
* draining wounds, diarrhea, vomiting, and primary adrenal insufficiency
*Inappropriate use of sodium-free or hypotonic IV fluids causes hyponatremia from water excess
*Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
* Cirrhosis
* Heart failure
* Primary hypoaldosteronism
31
what are the manifestations of hypernatremia (with decreased ECF volume)?
* Agitations, restlessness, lethargy, seizures, coma
* Dry swollen tongue, intense thirst, sticky mucous membranes
* Postural hypotension, ↓ CVP, weight loss, ↑ pulse
* Weakness, muscle cramps
32
what are the manifestations of hyponatremia (with decreased ECF volume)?
* Apathy, headache, confusion, muscle spasms, seizures, coma
* Nausea, vomiting, diarrhea, abdominal cramps
* Weight gain, ↑ BP, ↑ CVP
33
what are the interventions for hypernatremia?
depends on the underlying cause and the patient’s volume status
fluid replacement is given either orally or IV with isotonic solutions
diuretics -> sodium excretion
initiate seizure precautions if pt has altered consciousness or has seizures
Monitor serum sodium levels, serum osmolality, and the patient’s response to therapy
34
what are the interventions for hyponatremia?
replacing fluid using isotonic sodium-containing solutions, encouraging oral intake, and withholding all diuretics
Monitor serum sodium levels, urine output, and the patient’s response to therapy.
Vasopressor receptor antagonists that block the activity of ADH
if pt has an altered consciousness or is having seizures, initiate seizure precautions.
35
what causes SIADH?
when the body makes excess amount of ADH
36
what are the manifestations of SIADH?
dilutional hyponatremia caused by abnormal retention of water
37
will you have high or low sodium levels with SIADH?
low
38
what is the main cation for ECF?
sodium
39
what are the manifestations of hypernatremia (with increased ECF volume)?
* Agitations, restlessness, twitching, seizures, coma
* Edema, peripheral and pulmonary
* Intense thirst, flushed skin
* Weight gain, ↑ BP, ↑ CVP
40
what are the manifestations of hyponatremia (with normal/increased ECF volume)?
* Apprehension, irritability, confusion, dizziness, personality changes, tremors, seizures, coma
* Cold and clammy skin
* Dry mucous membranes
* Postural hypotension, ↓ CVP, ↓ jugular venous filling, ↑ pulse, thready pulse
41
what does potassium do in the body?
affects cardiac and neuromuscular function
regulates intracellular osmolality and promotes cellular growth
42
what are good sources of K+ in diet?
Fruits and veggies, salt substitutes, potassium medications, stored blood
43
what causes hyperkalemia?
excess k+ intake (through IV, k+ containing drugs, salt substitutes)
shift of K+ out of cells (acidosis, intense exercise, tumor lysis syndrome)
failure to eliminate potassium (adrenal insufficiency, meds (angiotensin II receptor blockers, ACE inhibitors, NSAIDs), renal disease
44
what causes hypokalemia?
potassium loss (dialysis, diaphoresis, diarrhea, renal losses (diuretics, hyperaldosteronism)
shift of potassium into cells (alkalosis, increased epinephrine, more insulin release)
lack of potassium intake (diet)
45
what are the manifestations of hyperkalemia?
* Abdominal cramping, diarrhea, vomiting
* Confusion
* Fatigue, irritability
* Irregular pulse
* Loss of muscle tone
* Muscle weakness, cramps
* Paresthesias, decreased reflexes
* Tetany
46
what are the manifestations of hypokalemia?
* Constipation, nausea, paralytic ileus
* Fatigue
* Hyperglycemia
* Irregular, weak pulse
* Muscles soft, flabby
* Muscle weakness, leg cramps
* Paresthesias, decreased reflexes
* Shallow respirations
47
what are the interventions for hyperkalemia?
stop oral and IV potassium intake
increase potassium excretion (loop diuretics)
force potassium from ECF to ICF (via IV regular insulin and β-adrenergic agonist)
stabilize cardiac membranes
48
what are the interventions for hypokalemia?
give oral or IV KCl supplements
increase dietary intake of potassium
monitor serum potassium levels, ECG, and urine output as appropriate
49
what medication would you give for hyperkalemia?
IV regular insulin with dextrose and a β-adrenergic agonist
(stimulates sodium-potassium pump)
50
how do you safely give potassium to a patient?
* Always dilute IV KCl and do not give in concentrated amounts.
* Never give KCl via IV push or as a bolus or exceed 10 mEq/hr.
* Invert IV bags containing KCl several times to ensure even distribution in the bag.
* Do not add KCl to a hanging IV bag to prevent giving a bolus dose.
* assess IV sites at least hourly for phlebitis and infiltration
51
what are the ECG changes in hyperkalemia?
* Loss of P wave
* Prolonged PR interval
* ST segment depression
* Widening QRS
* Tall, peaked T wave
* Ventricular fibrillation
* Ventricular standstill
52
what are the ECG changes in hypokalemia?
* Peaked P wave
* Prolonged QRS
* ST segment depression
* Flattened T wave
* Presence of U wave
* Ventricular dysrhythmias
* First- and second-degree heart block
53
what does calcium do in the body?
Formation of teeth and bone
Blood clotting
Transmission of nerve impulses
Myocardial contractions
Muscle contractions
(Need vitamin D to absorb)
54
what are the causes of hypocalcemia?
decreased total calcium (acute pancreatitis, chronic alcohol use, diarrhea, meds (biphosphonates, loop diuretics), primary hypoparathyroidism, etc)
decreased ionized calcium (alkalosis)
55
what are the causes of hypercalcemia?
increased total calcium (hyperparathyroidism, hematologic cancer, meds (thiazide diuretics, calcium-containing antacids, vitamin A or D), paget disease
increased ionized calcium (acidosis)
56
what are the manifestations of hypocalcemia?
Tingling around the mouth or in the extremities
Laryngeal stridor (high pitched gasping sound), Dysphagia (difficulty swallowing)
muscle tremors, severe cramps -> tetany and convulsions
cardiac dysrhythmias, low cardiac output, abnormal ECG patterns
+ Trousseau’s (put on BP cuff, someone’s arm goes up and hand looks really wonky) and Chvostek’s (tap on cheek- face will twitch)
Confusion, anxiety, psychoses
Hyperactive deep tendon reflexes
57
what are the manifestations of hypercalcemia?
Lethargy, weakness, stupor, coma
Decreased deep-tendon reflexes
Decreased memory
Confusion, personality changes, psychosis
Anorexia, nausea, vomiting
Bone pain, fractures, nephrolithiasis
Polyuria, dehydration
58
what are the interventions for hypercalcemia?
Increased movement and exercise
Increased oral fluid intake – 3000-4000 mL/day
Limit food/fluids high in Ca+
High fiber foods
Protect confused patients
Encourage intake of cranberry or prune juice
Excretion of Ca with loop diuretic (be careful with potassium levels)
Hydration with isotonic saline infusion
Synthetic calcitonin
Bisphosphonates for hypercalcemia related to malignancy
59
what are the interventions for hypocalcemia?
Treat cause
Oral and IV calcium supplements (NOT IM to avoid local reactions)
Rebreathe into paper bag
Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis
Protect confused patient
Monitor respiratory and cardiac status
Administer oral and IV Ca+ as ordered
Teach clients about the risk for osteoporosis and measures to take
60
what is the difference between Trousseau's and Chvostek's signs?
trousseau: put on BP cuff, someone’s arm goes up and hand looks really wonky
Chvostek’s: tap on cheek- face will twitch
61
what is the role of the parathyroid gland for calcium?
regulates calcium levels in blood
62
how are phosphate levels affected by calcium?
Reciprocal with calcium
63
how would you treat renal calculi (as an effect of high calcium)
more oral fluid intake (ideally water)
Increased movement and exercise
Limit food/fluids high in Ca+
High fiber foods
Encourage intake of cranberry or prune juice
Excretion of Ca with loop diuretic (be careful with potassium levels)
Hydration with isotonic saline infusion
Synthetic calcitonin
64
how does calcium affect lung sounds/respiratory efforts?
hypocalcemia: laryngeal stridor (high pitched gasping sounds)
65
what does phosphate do in the body?
Essential to function of muscle, red blood cells, and nervous system
Involved in acid-base buffering system, ATP production, cellular uptake of glucose, and metabolism of carbohydrates, proteins, and fats
66
how are serum levels for phosphate controlled?
by parathyroid hormone
67
what are the causes of hypophosphatemia?
* Chronic alcohol use
* Chronic diarrhea
* Diabetic ketoacidosis
* Malabsorption syndromes
* Malnutrition, vitamin D deficiency
* Hyperparathyroidism
* Parenteral nutrition
* Phosphate-binding antacids
* Refeeding syndrome
* Respiratory alkalosis
68
what are the causes of hyperphosphatemia?
* Excess ingestion (e.g., phosphate-containing laxatives)
* Hyperthermia
* Hypoparathyroidism
* Phosphate enemas (e.g., Fleet Enema)
* Renal failure
* Rhabdomyolysis
* Sickle cell anemia, hemolytic anemia
* Tumor lysis syndrome
* Thyrotoxicosis
69
what are the manifestations of hypophosphatemia?
Mild – asymptomatic, severe – potentially fatal
CNS depression
Confusion
Decreased LOC
Muscle weakness and pain
Dysrhythmias
Cardiomyopathy
70
what are the manifestations of hyperphosphatemia?
Neuromuscular irritability and tetany (hypocalcemia)
Calcified deposition in soft tissue such as joints, arteries, skin, kidneys, and corneas (can cause organ dysfunction)
71
what are the interventions for hypophosphatemia?
Oral supplementation
Ingestion of foods high in phosphorous
IV administration of sodium or potassium phosphate
72
what are the interventions for hyperphosphatemia?
Identify and treat underlying cause
Restrict foods and fluids containing phosphorus
Phosphate-binding agents (calcium-carbonate)
Adequate hydration and correction of hypocalcemic conditions
Hemodialysis, IV insulin and glucose
73
what does magnesium do in the body?
Coenzyme in metabolism of protein and carbohydrates,
Required for nucleic acid and protein synthesis,
Important for normal cardiac function and neuromuscular,
Can prevent preeclampsia in pregnant people,
Helps maintain calcium and potassium balance
Necessary for sodium-potassium pump
74
what causes hypomagnesemia?
CHRONIC ALCOHOLISM
pancreatitis
* Acute pancreatitis
* GI tract fluid losses (e.g., diarrhea, NG suction)
* Hyperglycemia
* Malabsorption syndromes
* Prolonged malnutrition
* Proton pump inhibitor therapy
* ↑ Urine output
75
what causes hypermagenesemia?
* Adrenal insufficiency
* Antacids, laxatives
* Hypothyroidism
* IV administration of magnesium, especially for treatment of eclampsia
* Metastatic bone disease
* Renal failure
* Tumor lysis syndrome
76
what are the manifestations of hypermagnesemia?
Lethargy
Nausea and vomiting
Decreased reflexes
Somnolence (tired)
Respiratory and cardiac arrest
77
what are the manifestations of hypomagnesemia?
Confusion
Hyperactive deep tendon reflexes
Muscle cramps
Tremors
Seizures
Cardiac dysrhythmias
Corresponding hypocalcemia and hypokalemia
78
what are the interventions for hypomagnesemia?
Treat underlying cause
Oral supplements
Increase dietary intake of Mg
Parenteral IV or IM magnesium when severe
79
what are the interventions for hypermagnesemia?
Prevention first- restrict magnesium intake in high-risk patients
Emergency treatment (IV CaCl or calcium gluconate)
Fluids and IV furosemide to promote urinary excretion
Dialysis
80
what is the emergency treatment for hypermagnesemia?
IV CaCl or calcium gluconate
81
what are food sources for magnesium?
green vegetables, nuts, bananas, oranges, peanut butter, chocolate
82
what are food sources for phosphate?
dairy products, meat/protein, beans/legumes, nuts/seeds
83
what are food sources for calcium?
dairy products, leafy greens, broccoli, tofu, sardines, nuts and seeds (almonds/sesame)
84
what are food sources for sodium?
saltine crackers, nuts, seeds, and nut butter, fermented foods, olives, canned foods (seafood/beans), cottage cheese
85
what are ECG changes in hypocalcemia?
* Elongated ST segment
* Prolonged QT interval
* Ventricular tachycardia
86
what are ECG changes in hypercalcemia?
* Short ST segment
* Short QT interval
* Ventricular dysrhythmias
* Increased digitalis effect
