Fluid & Electrolyte Balance

Question 1

What role does water have in digestion?

Answer 1

Lubricates

makes stools easier to pass

Question 2

How does pericarditis affect heart?

Answer 2

increases in fluid –> puts more pressure on heart

Question 3

Electrolytes with positive charges (cations) –> normal values/ chief functions

Answer 3

sodium- controls regulates volume of body fluids (135-145 mEq/L)
potassium- regulates cellular enzyme activity and water content (3.5-5.0 mEq/L)
calcium- nerve impulse, blood clotting, muscle contraction, B12 absorption (8.6-10.2 mg/dL)
magnesium- metabolism of carbs and proteins, vital actions in enzymes (1.3-2.3 mEq/L)

Question 4

Anions w negative charge– chief function and normal values

Answer 4

Chloride- maintains osmotic pressure in blood, produces Hcl (97-107mEq/L)
bicarbonate- primary buffer, regulates acid-base balance (25-29 mEq/L)
phosphate- chemical reactions, cell division, hereditary traits (2.5-4.5 mEq/L)

Question 5

Milliequivalent (MeQ):

Answer 5

unit of measurement that describes the chemical activity of electrolytes. one MeQ = chemical equivalent to activity of 1mg of Hydrogen
want homeostasis— equal anions and

Question 6

pg 1475**

Answer 6

know normal values

Question 7

Osmolarity

Answer 7

“pulling power”

concentration of particles in a solution

Question 8

Tonicity

Iso, hyper, hypo

Answer 8

concentration of a substance dissolved in water

Isotonic: Same concentration of body fluids

hypertonic- greater osmolarity than plasma- cells shrink –> water moves out of cells to intravascular compartment

hypotonic- less osmolarity than plasma. solution moves from intravascular space –> intracellular fluid –> cells swell –> can possibly burst

Question 9

Diffusion

Answer 9

movement from higher concntration to lower until equilibruim is establshed.
solutes move through solvent
gasses can occur through diffusion

Question 10

Hydrostatic Pressure

Answer 10

pushing force against walls of capillaries

when hydrostatic pressure inside capillary exceeds surrounding interstitial space –> fluids and solutes forced out of capillary to interstitial space

Question 11

What role does thyroid play?

Answer 11

increases blood flow in body and increases renal circulation

-parathyroid- regulates level of calcium in ECF

Question 12

What is pH?

Answer 12

unit of measure to describe the acid-base balance
normal blood plasma 7.35-7.45
-hydrogen ion concentration
acidosis: anything below 7.35 (7.8 = dead)
alkalosis- above 7.45 (6.8=dead)

Question 13

What are the buffers of pH in body?

Answer 13

carbonic acid** most important
sodium bicarbinate
Protein

Respiratory- changes rate and depth of breathing to eliminate more CO2 to make blood more alkaline
Renal system- kidneys excrete or hold on to hydrogen ions
**both help keep body in homeostasis

Question 14

where can fluid go in 3rd space fluid shift?

Answer 14

plueral, peritoneal, pericardial areas; joint cavity space; bowels; or excess accumulation in interstitial space

can lead to ECF volume deficit

Question 15

Sodium: most abundant electrolyte in EFC
Normal: 135-145
hyponatremia <135 mEq/L
hypernatremia >145

Answer 15

hypo- vomitting, diarrhea, fistulas
*confusion, hypotension, edema, muscle cramps, weakness, dry skin, nausea,

hypernatremia- excess water loss –> excess of sodium. fluid deprivation. lack of fluid comsumption
*neurological impairment

Question 16

Potassium: major intracellular electrolyte
Normal: 3.5-5.0

Hypokalemia <3.5
Hyperkalemia >5

Answer 16

hypo: vomitting, gastric suction, alkalosis
- *muscle weakness and leg cramps, fatigue

hyper- renal failure, hypoaldosteronism, heparin, ACE inhibitors, NSAIDs
**may affect nerve conduction(more dangerous than hypo), skeletal muscle weakness, paralysis, cardiac irregularities, ardiac arrest

Question 17

Calcium: bones and teeth
Normal: 8.6-10.2
hypocalcemia <8.9 mg/dL
hypercalcemia: >10.1

Answer 17

hypo: inadequate calcium intake/uptake, calcium loss
* numbness/itngling of fingers, mouth, feet, muscle cramps, seizures

hyper: cancer and hyperparathyroidism
* nausea, vomitting, constipaition, bone pain
* **sever–> cardiac arrest

Question 18

Magnesium: 2nd most abundant in ICF
Normal: 1.3-2.3
hypomagnesiumia <1.5

hypermagnesemia >2.5

Answer 18

hypo: nasogastric suction, diarrhea, alcoholism, sepsis, burns
* muscle weakness, tremors, seizures, heart block

hyper: renal failure
* nausea, vomitting, weakness, flush, lethargy

Question 19

Respiratory Acidosis

RESPIRATORY Alkalosis

Answer 19

• in lungs
  acid- too much carbonic acid in resp. from alveolar hypoventilation

alk- not enough carbonic acid, alveolar hyperventilation

Question 20

Metabolic Acidosis:

Metabolic Alkalosis:

Answer 20

deficit of bicarbonate in ECF
*Kidneys try to fix by retaining bicarbonte, excreting H+

too much bicarb. decrease in H+
*body holds on to CO2, excretes less H2O

*

Question 21

what labs would you look at for imbalances?

Answer 21

CBC- total blood count–> # of RBCS, values for H&H
*increase hematocrit: volume deficit/shock
decrease hematocrit: blood loss, fluid overload
inc. hgB- hemoconcentration of blood
decrease HgB: anemia
serum electrolytes
BUN: impared renal fxn
Creatinine: impared renal function, heart failure, shock
urine pH: low = acidosis; higher=alkalosis
ABG: PaCO2 low=

Question 22

what is hypovolemia?

Answer 22

a fluid volume deficit
isotonic fluid loss
young children, older adults, people who are ill are at risk

Question 23

Hypervolemia

Answer 23

fluid volume excess
edema- extra fluid in ECF
can result in 5% body weight gain
kidney failure, heart failure

Question 24

trousseaus’s sign

Chovosteks sign

Answer 24

seen in low calcium–

Question 25

what are average fluid intake and output measures?

Answer 25

1,500-3,500 mL per day. average is 2,600 mL

• drink 6-8 glasses of water
• limit sugar salt and alcohol
• report side effects of medications like diarrhea
• weigh self daily and report changes

Question 26

What are grades of edema?

Answer 26

1+, 2mm w. fluid volume 30% above normal
2+ : 4mm
3+ : deep pit 6mm, remains seconds after pressing, obvious by inspection
4+ deep 8mm, remains for long time after pressing

Question 27

what solution is best for a pt with hypernatremia?

Answer 27

5% dextrose in water
.33% NaCl (1/3 strength of saline)
.45% naCl (1/2 strength of normal saline)

Question 28

what is most reliable indicator of a person fluid balance status?

Answer 28

daily weight

Question 29

what acid base imbalance would have pH 7.3,
PaCO2 36mmHg
HCO3- 14

Answer 29

metabolic acidosis-
low pH= acidotic
CO2 normal= not respiratory
Bicarb low= metabolic acidosis

Question 30

a nurse is monitoring pt w fluid imbalance r/t development of ascites, what imbalances would nurse monitor for?

Answer 30

extracellular fluid volume deficit
protein deficit
sodium deficit
plasma-interstitial fluid shift

Question 31

pt receiving IV infusion of normal saline–> apprehensive and has pounding headache, rapid pulse rate, shills, and dyspnea. (speed shock: reaction to substance injected into circulatory system too rapidly) what is priority intervention?

Answer 31

discontinue immediately
report symptoms to PCP
motior vital signs

Question 32

what would be damaged if pt couldnt control carbonic acid supply and affect acid-base balances?

Answer 32

lungs

*kidneys are bicarbonate
adrenal gland-catecholamines & steroid hormones
BV=transport system

Question 33

what would a nurse do if IV has been infiltrated? (insertion site is edematous and cool touch & fluid does not flow easily)

Answer 33

put on gloves and remove catheter
apply pressure with sterile guaze pad secure w tape
restart iv in new location

Question 34

what would a nurse do if IV has been infiltrated? (insertion site is edematous and cool touch & fluid does not flow easily)

Answer 34

put on gloves and remove catheter
apply pressure with sterile guaze pad secure w tape
restart iv in new location

Question 35

what happens if flushing port does not have a blood return?

Answer 35

have pt perform valsalva and change position.