Fluid & Electrolyte Imbalances

Question 1

What are the two main things that can cause fluid and electrolyte imbalances?

Answer 1

Illness and therapeutic measures

Question 2

Which electrolyte is the primary determinant of ECF osmolarity?

Answer 2

Sodium

Question 3

Sodium is important in (2) - other than osmoarity

Answer 3

generation + transmisison of nerve impulses
regulation of acid-base balance

Question 4

Sodium leaves the body through (3)

Answer 4

urine, sweat, feces

Question 5

Which organ is the primary regulator of sodium balance, under the influence of what hormone?

Answer 5

The kidneys under the influence of ADH

Question 6

Serum sodium levels become elevated as a result of __ __ or __ __

Answer 6

water loss or sodium gain

Question 7

Since sodium is the major determinant of ECF osmolarity, hypernatremia causes ___, shifting water out of the cells, causing cellular ___

Answer 7

Hyperosmolarity, causing cellular dehydration

Question 8

Hypernatremia is not a problem in a person who is __ and has access to __ and is able to __

Answer 8

Alert
Water
Swallow

Question 9

What type of patients are at risk for hypernatremia?

Answer 9

Unconscious patients and certain cognitively impaired patients

Question 10

Clinical states that can produce water loss and hypernatremia

Answer 10

Dysfunctional ADH
Osmotic diuretics
Hyperglycemia from uncontrolled diabetes
Excessive sweating & increased sensible losses from high fever

Question 11

Causes of sodium gain

Answer 11

IV administration of hypertonic saline
Use of sodium-containing drugs
Excessive oral intake of sodium (ingestion of seawater)
Primary aldosteronism

Question 12

Main thing of treatment of hypernatremia

Answer 12

Treat the underlying cause

Question 13

Treatment of Hypernatremia: Primary Water Deficit

+ Caution with rapid correction

Answer 13

Replace fluid orally or through IV infusion with isotonic fluids

Correct hypernatremia slowly prevents a rapid shift of water into cells, which can cause cerebral edema

Patients with long-standing hypernatremia (over several days or longer) are at higher risk of complications from overly rapid correction

Question 14

Treatment of Hypernatremia: Sodium Excess

Answer 14

Dilute the sodium concentration using salt-free IV fluids, such as 5% dextrose in water (D5W).
Promote sodium excretion by administering diuretics.
Restrict dietary sodium intake as needed.

Question 15

Treatment of Hyponatremia: Water Excess

Answer 15

Restrict fluids are often all that is needed.

If severe symptoms (seizures) develop, small amounts of IV hypertonic saline solution are administered to restore the serum sodium level while the body is returning to normal water balance.

Question 16

Treatment of Hyponatremia: Sodium Loss

+ Important consideration

Answer 16

The nurse must monitor serum sodium levels and the patient’s response to treatment to avoid rapid correction or overcorrection.

Rapidly increasing levels of sodium can cause osmotic demyelination syndrome with permanent damage to nerve cells in the brain.

Question 17

Causes of sodium loss of hyponatremia

Answer 17

GI losses
- diarrhea
- vomiting
- NG suction
Renal losses
- diuretics
- adrenal insufficiency
Skin losses
- burns
- wound drainage

Question 18

Causes of water gain of hyponatremia

Answer 18

SIADH
Heart failure
Excessive hypotonic IV fluids
Primary polydipsia

Question 19

Causes of water deficit of hypernatremia

Answer 19

Increased insensible water loss or perspiration (high fever, heatstroke)
Diabetes insiders
Osmotic diuretics

Question 20

Causes of sodium gain of hypernatremia

Answer 20

IV hypertonic NaCl
IV sodium bicarbonate
IV excessive isotonic NaCl
Primary hyperaldosteranism
Saltwater near-drowning

Question 21

Clinical manifestations of Hyponatremia

Decreased ECF volume - sodium loss

Answer 21

Irritability, apprehension, confusion
Postural hypotension
Tachycardia
Rapid, thready pulse
Decreased CVP
Decreased jugular venous filling
N+V
Dry mucous membrane
Weight loss
Tremors and seizures

Question 22

Clinical manifestation of Hypernatremia

Decreased ECF volume - water loss

Answer 22

Intense thirst; dry, swollen tongue
Restlessness, agitation, twitching
Seizures and coma
Weakness
Postural hypotension
Decreased CVP
Weight loss

Question 23

Fancy term for ECF volume deficit

Answer 23

Hypovolemia, low blood volume

Question 24

Fancy term for ECF volume excess

Answer 24

Hypervolemia, high blood volume

Question 25

Causes of hypovolemia

Answer 25

Abnormal loss of body fluids - diarrhea - hemorrhage - polyuria Decreased intake of fluids Plasma-to-Interstitial Fluid Shift: Movement of fluid from the vascular space to the interstitial space. Third spacing

Question 26

Fluid volume deficit vs dehydration

Answer 26

Fluid volume deficit - loss of water with electrolytes Dehydration - loss of pure water

Question 27

Treatment of hypovolemia

Answer 27

Correct underlying cause Replace both water and electrolytes using: Balanced IV solutions: Lactated Ringer’s solution. Isotonic NaCl (0.9%): For rapid volume replacement. Blood transfusions: When volume loss is caused by blood loss

Question 28

Causes of hypervolemia

Answer 28

Excessive intake of fluids. Abnormal retention of fluids: Conditions like heart failure or renal failure.

Question 29

Treatment of hypervolemia

Answer 29

Treat underlying cause Remove sodium and water: diuretics and fluid restriction

Question 30

I&O: Intake includes

Answer 30

Oral IV Tube Feedings

Question 31

I&O: Output includes

Answer 31

Urine Excess perspiration Wound/tube drainage Vomitis Diarrhea

Question 32

Fluid deficit vs hypovolemia

Answer 32

Fluid deficit - general state of dehydration/insufficient fluid in the body Hypovolemia - low blood volume

Question 33

Signs and symptoms of fluid excess and deficit are reflected in changes in (3)

Answer 33

Blood pressure Pulse force Jugular vein visibility

Question 34

Compensatory mechanisms (consequences) for mild to moderate fluid deficit

Answer 34

stimulation of the sympathetic nervous system causes - Increased heart rate to maintain cardiac output. - Peripheral vasoconstriction to maintain blood pressure.

Question 35

(cardiac) Consequences for severe fluid deficit

Answer 35

Recumbent hypotension (low bp even when lying down) Wak and thread pulse This can lead to shock

Question 36

Signs and symptoms of fluid excess (cardiac)

Answer 36

Increased blood pressure Bounding pulse Jugular vein distension

Question 37

(cardiac) Potential complications of fluid excess

Answer 37

Pulmonary edema Congestive heart failure

Question 38

Respiratory changes in fluid excess

Answer 38

Pulmonary congestion Pulmonary edema Shortness of breath Crackles on auscultation

Question 39

Respiratory changes in fluid deficit

Answer 39

Increased respiratory rate due to decreased tissue perfusion and resultant hypoxia

Question 40

Neurological consequences of hyponatremia (high water, low sodium)

Answer 40

Swelling of brain cells resulting in confusion and seizures

Question 41

Neurological consequences of hypernatremia (low water, high sodium)

Answer 41

Shrinkage of brain cells resulting in irritability, restlessness, and even lethargy and coma

Question 42

Assessment of neurological function includes evaluation of:

Answer 42

Level of consciousness x3 Pupillary response Voluntary movement of the extremities

Question 43

For fluid status, the skin is inspected for __ and __

Answer 43

Turgor (elasticity) Mobility

Question 44

Integumentary Findings in Fluid Volume Deficit

Answer 44

Diminished skin turgor Dry skin Dry mucous membranes

Question 45

Integumentary Findings in Fluid Volume Excess

Answer 45

Edematous skin Cool to the touch