fluid, electrolyte, and acid-base regulation Flashcards
what are electrolytes
- Mineral in body
- urine, blood, tissues
*Balancing the amount of
water in the body.
*Balancing the body’s pH
(acid/base) level..
*Allowing the body’s muscles,
heart, nerves, and brain to
function properly.
what are electrolytes responsible for
- Balancing the amount of water in the body.
- Balancing the body’s pH (acid/base) level.
- Moving waste out of body cells.
- Moving nutrients into body cells.
- Allowing the body’s muscles, heart, nerves, and brain to function properly.
what is dehydration
Loss of water, or lack of intake, without loss of sodium
* Hypernatremia results
* Causes: vomiting, diarrhea, sweating, fever
* Manifestations =
hypernatremia s/s
* Diagnostic labs:
* BMP or CMP
* Serum osmolality
* Urine sample to assess urine specific gravity
* Treatment focus
what populations are at the highest risks for dehydration (Exam)
older adults
infants and children
individuals with chronic illnesses
individuals who work out in the elements
what is thirst
- Thirst results from nerve centers in the brain being stimulated when the body needs water.
- To conserve water, the pituitary gland secretes vasopressin (the antidiuretic hormone).
- Vasopressin stimulates the kidneys to excrete less urine, which helps conserve water.
what can lead to electrolyte imbalances
- Dehydration
- Overhydration
- Certain medications
- History of heart, kidney, or liver disorders
- Incorrect intravenous fluids or feedings
- All can lead to an electrolyte imbalance.
normal electrolyte level for potassium
Potassium (K+) 3.5 - 5 mEq/L
normal electrolyte number for sodium
Sodium (Na+) 136 - 145 mEq/L
normal electrolyte value for calcium
Calcium (Ca2+) 9 - 10.5 mg/dL
normal electrolyte value for magnesium
Magnesium (Mg2+) 1.3 - 2.1 mg/dL
potassium (exam)
- Helps with nerve and muscle cell function
- plays an important role in the muscle cells in the heart.
low potassium (Exam)
Low potassium levels are called hypokalemia.
* Symptoms include:
* Muscle Weakness
* Hypotension
* Dysrhythmia
high potassium (exam)
- High potassium levels are known as hyperkalemia.
- Symptoms include:
- Decreased deep tendon reflexes
- Paralysis
- Dysrhythmia
sodium (low and high exam)
- Supports the function of nerves and muscles
- Maintains normal blood pressure
- regulates the body’s fluid balance.
- Low sodium levels are called hyponatremia.
- High sodium levels are called hypernatremia.
calcium
Calcium helps the body maintain strong bones and is primarily stored in teeth and bones to support their hardness.
* Calcium also helps muscles move
* Nerves to carry messages between the brain and body
* Blood vessels to move blood throughout the body.
* Low calcium levels are called hypocalcemia.
* High calcium levels are called hypercalcemia.
hypoparathyroidism
low parathyroid hormone levels, which is a common cause of low calcium levels
hypercalcemia
is most commonly caused by overactive parathyroid glands or hyperparathyroidism
magnesium
- Magnesium’s role in the body is to:
- Assist in the regulation of:
- Nerve and muscle function
- Blood pressure
- Blood sugar levels
- As well as:
- Making bone
- Protein
- DNA
what are low and high magnesium levels known as
- Low magnesium levels are known as
hypomagnesemia. - High levels are called hypermagnesemia.
when does hypovolemia occur
Hypovolemia occurs when there is a decrease in blood volume within the body due to loss of body fluids or blood.
- can be tested with a BMP, CMP, CBC, or urine sample to asses urine specific gravity
what does hypovolemia do to the body
- Excessive sweating, large burns, diuretics, inadequate fluid intake, and increased urination can lead to hypovolemia.
- At first, hypovolemia causes the nose, mouth, and other mucous membranes to dry out, the skin to lose elasticity, and urine output to
decrease. - The body then tries to compensate for volume loss by increasing the heart
rate and strength of contractions. - Blood vessels are constricted in the extremities to preserve blood flow for
the heart, brain, and kidneys.
what serious symptoms can untreated hypovolemia lead to
- Blue discoloration of lips and nail beds
- Change in alertness or level of consciousness
- Chest pain, tightness, or pressure
- Palpitations
- No urine production
- Tachycardia – increased heart rate
- Tachypnea – rapid breathing
- Decreased blood pressure
- Weak pulse
what is hypervolemia
Hypervolemia, or Circulatory Overload, is when the body has too much water.
* Commonly caused by problems with the kidneys as they are responsible for balancing the salt and fluid in the body.
* The goal of treatment is to rid the body of excess fluid.
possible assessment findings of hypervolemia (Exam)
- Tachycardia
- Crackles in the lungs
- Cough
- Pallor
- Peripheral Edema
intravenous rehydration (exam)
- Small particles that can easily pass from the bloodstream into cells and tissues are known as crystalloid solutions.
- Each crystalloid solution is categorized by its tonicity, or ability to make water move in or out of cells via osmosis.
- Hypotonic solutions move water from extracellular space into cells.
- Hypertonic solutions cause water to leave the cells.
- There is no movement between extracellular and intracellular fluids in isotonic solutions.
- Appropriate fluids should be chosen based on the patient’s condition
blood transfusions - packed red blood cells
Packed red blood cells (RBCs), also known as erythrocytes, can be used to restore blood levels without substantially increasing the client’s overall blood volume.
whole blood
Whole blood contains white cells, red cells, and platelets suspended in blood plasma. Trauma and surgery causing a significant blood loss are common uses for whole blood.
blood
- The liquid portion of blood is known as plasma which is where the platelets and red and white blood cells are suspended as they travel throughout the body.
- Platelets, or thrombocytes, stop or prevent bleeding. Platelets are commonly used during organ transplants, cancer treatments, and surgery
intake and output
- Intake simply refers to the amount taken in by a client.
- Output is the amount produced by the body of a client.
- Should be recorded at least every 8 hours or per a facility’s protocol.
- Intake includes anything the client puts in their mouth, takes in intravenously, or any feeding tubes.
- Output includes urine, bowel movements, and vomiting.
- the nurse’s responsibility includes everything liquid taken in and excreted out from the body
acid-base balance
- Is the correct balance of acidic and
basic (alkaline) compounds in the blood. - Acidosis occurs when the levels of
acid in the blood are too high. - Alkalosis occurs when the blood
becomes too alkaline.- is controlled by buffers, respiratory and renal regulation, ABGs done to assess
- normal is 7.35-7.45
common causes of metabolic acidosis (exam)
- Kidney disease
- Lactic acidosis
- Diabetic keto acidosis – ketones that are acidic build up when diabetes is uncontrolled
- Severe dehydration
- Severe diarrhea due to loss of too
much sodium bicarbonate
common causes of metabolic alkalosis (Exam)
- Diuretic overuse
- Excess vomiting
- Antacids
- Loss of potassium or sodium from the body quickly
- Ingestion of bicarbonate
- Alcohol abuse
- Laxatives
- Heart, kidney, or liver failure
what is respiratory alkalosis (exam)
- Respiratory alkalosis occurs when the carbon dioxide levels in the body drop too low and may result from breathing too fast or too deep.
- Hyperventilation, or over-breathing, is a common cause of respiratory alkalosis
- Due to the action of deep or rapid breathing ridding the body of too much carbon dioxide.
what can easily be done for someone who is hyperventilating
- A simple thing anyone can do if someone is hyperventilating is to have them
breath into a paper bag to slow their respiratory rate and increase their CO2
levels.
what is respiratory acidosis
- When the lungs cannot remove enough carbon dioxide from the body, respiratory acidosis occurs.
Common causes include:- Airway diseases such as COPD and asthma
- Diseases that affect the chest and breathing ability such as scoliosis
- Diseases of the lung tissues
- Medicines that suppress breathing such as narcotics
- Severe obesity
- Obstructive sleep apnea
hypovolemia =
fluid volume deficit
what is hypovolemia
- Loss of both fluid and electrolytes.
*Can lead to a decrease in circulating blood volume and perfusion to the tissues.
*Causes: blood loss, severe burns, excessive sweating
*Diagnostic labs:- BMP or CMP (BUN/CR)
- CBC (hematocrit)
- Urine sample to assess urine specific gravity
*Treatment focus/Prevent shock
hypervolemia =
fluid volume excess
hypervolemia is
Too much water in the body or “fluid overload”
* Commonly caused by kidney issue
* No specific diagnostic tests
* Manifestations:
* peripheral edema
* crackles in lungs
* Goal = manage cause, rid body of excess fluid
hypotonic solution with IV therapy (exam)
Hypotonic – water moves into cells
- 0.45% Sodium Chloride
- Treats hypernatremia
isotonic with IV therapy (exam)
Isotonic – water doesn’t move in or out
- 0.9% Sodium Chloride
- Treats dehydration
hypertonic with IV therapy (exam)
Hypertonic – water moves out of cells
- 3% Sodium Chloride
- Treats symptomatic hyponatremia
when are blood transfusions given
Given when fluid loss is caused from bleeding/hemorrhage
First 15 minutes - stay with client
○ Check VS before and after, and per policy
types of transfusion reactions
- Transfusion associated circulatory overload**
- Hemolytic
- Febrile (non-hemolytic)
- Allergic & anaphylaxis
steps to interpreting arterial blood gases
- Determine if pH is acidic, basic/alkaline, or normal
a. Acidosis or Alkalosis or neither? - Look at PaCo2 (respiratory component)
a. Below, above, or within normal range?
b. Is it out of range and going in opposite direction of pH?
i. If yes, then you have either respiratory acidosis or alkalosis depending on your answer for #1
ii. If no, go to step 3. - Look at HCO3 (metabolic component)
a. Below, above, or within normal range?
b. Is it out of range and going in the same direction of pH?
i. If yes, then you have either metabolic acidosis or alkalosis depending on your answer for #1
common manifestations of metabolic acidosis and alkalosis
acidosis - increased rate and depth of respirations
alkalosis - seizures, headaches, confusion
common manifestations of respiratory alkalosis and acidosis
alkalosis - anxiety, SOB, lethargy, sleepiness
acidosis - hyperventilation, dizziness, confusion, chest pain, tachycardia
BMP - basic metabolic panel
electrolyte/fluid balance
renal function
glucose levels
CMP - complete metabolic panel
protein and liver function
common electrolytes in the body
potassium
sodium
calcium
magnesium
what can transfusion associated circulatory overload cause
the body will start to retain fluids and the body can go into pulmonary edema
pH
PaCO2
HCO3
pH = acidosis or alkalosis
PaCO2 = respiratory component
HCO3 = metabolic component
normal ranges:
pH
PaCO2
HCO3
pH = 7.35-7.45
PaCO2 = 35-45 mmHg
HCO3 = 22-26 mEq/L
manifestations of respiratory acidosis versus alkalosis
acidosis - anxiety, SOB, lethargy/sleepiness
alkalosis - hyperventilation, dizziness, confusion, chest pain, tachycardia
