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Health Challenges > Fluid & Electrolyte Imbalances > Flashcards

Fluid & Electrolyte Imbalances Flashcards

1
Q

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

A

Illness and therapeutic measures

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2
Q

Which electrolyte is the primary determinant of ECF osmolarity?

A

Sodium

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3
Q

Sodium is important in (2) - other than osmoarity

A

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

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4
Q

Sodium leaves the body through (3)

A

urine, sweat, feces

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5
Q

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

A

The kidneys under the influence of ADH

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6
Q

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

A

water loss or sodium gain

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7
Q

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

A

Hyperosmolarity, causing cellular dehydration

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8
Q

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

A

Alert
Water
Swallow

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9
Q

What type of patients are at risk for hypernatremia?

A

Unconscious patients and certain cognitively impaired patients

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10
Q

Clinical states that can produce water loss and hypernatremia

A

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

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11
Q

Causes of sodium gain

A

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

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12
Q

Main thing of treatment of hypernatremia

A

Treat the underlying cause

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13
Q

Treatment of Hypernatremia: Primary Water Deficit

+ Caution with rapid correction

A

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

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14
Q

Treatment of Hypernatremia: Sodium Excess

A

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.

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15
Q

Treatment of Hyponatremia: Water Excess

A

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.

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16
Q

Treatment of Hyponatremia: Sodium Loss

+ Important consideration

A

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.

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17
Q

Causes of sodium loss of hyponatremia

A

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

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18
Q

Causes of water gain of hyponatremia

A

SIADH
Heart failure
Excessive hypotonic IV fluids
Primary polydipsia

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19
Q

Causes of water deficit of hypernatremia

A

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

20
Q

Causes of sodium gain of hypernatremia

A

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

21
Q

Clinical manifestations of Hyponatremia

Decreased ECF volume - sodium loss

A

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

22
Q

Clinical manifestation of Hypernatremia

Decreased ECF volume - water loss

A

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

23
Q

Fancy term for ECF volume deficit

A

Hypovolemia, low blood volume

24
Q

Fancy term for ECF volume excess

A

Hypervolemia, high blood volume

25
Q

Causes of hypovolemia

A

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

26
Q

Fluid volume deficit vs dehydration

A

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

27
Q

Treatment of hypovolemia

A

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

28
Q

Causes of hypervolemia

A

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

29
Q

Treatment of hypervolemia

A

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

30
Q

I&O: Intake includes

A

Oral
IV
Tube Feedings

31
Q

I&O: Output includes

A

Urine
Excess perspiration
Wound/tube drainage
Vomitis
Diarrhea

32
Q

Fluid deficit vs hypovolemia

A

Fluid deficit - general state of dehydration/insufficient fluid in the body

Hypovolemia - low blood volume

33
Q

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

A

Blood pressure
Pulse force
Jugular vein visibility

34
Q

Compensatory mechanisms (consequences) for mild to moderate fluid deficit

A

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

35
Q

(cardiac) Consequences for severe fluid deficit

A

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

36
Q

Signs and symptoms of fluid excess (cardiac)

A

Increased blood pressure
Bounding pulse
Jugular vein distension

37
Q

(cardiac) Potential complications of fluid excess

A

Pulmonary edema
Congestive heart failure

38
Q

Respiratory changes in fluid excess

A

Pulmonary congestion
Pulmonary edema
Shortness of breath
Crackles on auscultation

39
Q

Respiratory changes in fluid deficit

A

Increased respiratory rate due to decreased tissue perfusion and resultant hypoxia

40
Q

Neurological consequences of hyponatremia (high water, low sodium)

A

Swelling of brain cells resulting in confusion and seizures

41
Q

Neurological consequences of hypernatremia (low water, high sodium)

A

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

42
Q

Assessment of neurological function includes evaluation of:

A

Level of consciousness x3
Pupillary response
Voluntary movement of the extremities

43
Q

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

A

Turgor (elasticity)
Mobility

44
Q

Integumentary Findings in Fluid Volume Deficit

A

Diminished skin turgor
Dry skin
Dry mucous membranes

45
Q

Integumentary Findings in Fluid Volume Excess

A

Edematous skin
Cool to the touch

Health Challenges (8 decks)

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