Fluid & Electrolytes Flashcards
1
Q
Normal urine output rate
A
1 ml/kg/hour
2
Q
What is a normal hourly urine output?
A
40-80 ml/hour
3
Q
What is urine output during illness?
A
~ 0.5 ml/kg/hour
4
Q
Intercellular Fluid
A
Fluid located within cells
5
Q
Extracellular Fluid
A
Fluid outside of cells
6
Q
Intravascular fluid
A
Fluid within blood vessels and Lymphatic vessels
7
Q
Interstitial or extracellular Fluid
A
Fluid found between cells
8
Q
How is fluid balanced achieved?
A
Fluid and electrolytes flows between IVS, EXCS, ICS to maintain homeostasis
9
Q
What are some things that can effect fluid and electrolyte balance?
A
Treatments or disorders can disrupt fluid/electrolyte balance
10
Q
Electrolytes
A
Electrically charged ions that become so by being broken down/dissolved in a solution
11
Q
What are two major electrolytes?
A
Na+ and K+
12
Q
What is Na+ normal range?
A
125-135 mEq/L
13
Q
List functions of Na+
A
- Control/regulate water balance
- Maintain acid:base balance
- Muscle contraction
- Transmit nerve impulses
14
Q
List risk factors that can lead to HYPOnatremia
A
- Decreased Na+ intake
- Increased fluid intake (oral or HYPOtonic solutions)
- SIADH
- HF
- Diarrhea/vomiting
- NG sxn
- Diuretics
- Impaired kidney fnxn
15
Q
List risk factors leading to HYPERnatremia
A
- Increased Na+ intake
- Dehydration
- Sweating
- Diabetes Insipudus(dehydration occurs due to increased urine output = high sodium volume)
16
Q
What are some SxS that HYPOnatremia and HYPERnatremia share?
A
- Confusion
- Irritable
- Lethargic
- Restless
- Siezures
17
Q
What are SxS of HYPOnatremia?
A
- Muscle cramps
- weakness
- USG < 1.010
- Shared sxs = Lethargy, confusion, restless, irritable, and seizures
18
Q
What are SxS of HYPERnatremia?
A
- Dry muc. membrane
- Thirst
- Increased body temp
- USG> 1.015
- Shared SxS: Lethargy, restless, confused, irritable, seizures
19
Q
List nursing interventions for HYPOnatremia
A
- Remove cause whenever possible
- Restrict Oral/IV fluids
- Hypertonic soln. ( 3% NS)
- Increase sodium intake in diet
- Implement seizure precautions
20
Q
List nursing interventions for HYPERnatremia
A
- Eliminate cause if possible
- Decrease sodium intake
- Hypotonic solution (0.45 NS or D5W) to decrease sodium levels
- Diuretics to excrete sodium
21
Q
List functions of Chloride
A
- Maintain osmotic pressure
2. Maintain acid base balance
22
Q
What increases Cl- levels? What decreases Cl- levels?
A
Increased levels: with poor kidney function
Decreased levels: excessive vomit/diarrhea
23
Q
What is the normal range for Chloride?
A
95-105 mEq/L
24
Q
What is the normal range for K+?
A
3.5-5.0 mEq/L
25
What are functions of potassium?
1. Maintain water balance
2. Carbohydrate and protein metabolism
3. Regulate acid:base balance
4. Transmit nerve impulses to heart, skeletal muscle, intestinal muscle and lungs
26
What are risk factors that contribute to HYPOkalemia?
1. Decreased K+ intake
2. K+ wasting Diuretics
3. NG sxn
4. Diarrhea/Vomitting
5. Laxatives
27
What are some risk factors of HYPERkalemia?
1. Increases K+ intake
2. K+ sparing diuretics
3. ACE inhibitors
4. Decreased kidney function
28
What SxS do HYPERkalemia and HYPOkalemia have in common?
1. Arrhythmias
| 2. Muscle weakness
29
What are SxS of HYPOkalemia?
1. Muscle cramping
2. FLAT T wave on EKG
3. Decrease in peristalsis
4. Shared SxS: Arrhythmias and muscle weakness
30
What are SxS of HYPERkalemia?
1. Tall/peaked T wave on EKG
2. Paralysis
3. Paresthesia of face, tongue, hands, and feet
4. Shared SxS: Arrhythmias and muscle weakness
31
List nursing interventions for HYPOkalemia
1. Remove cause if possible
2. K+ supplements: oral or IV
3. Increase K+ in diet
4. Assess renal function (BUN,Cre, and GFR) before administering
5. Assess SxS digoxin toxicity
6. Teach proper laxative or diuretic use
7. Monitor cardiac rhythm
32
List nurse interventions for HYPERkalemia
1. Monitor cardiac rhythm
2. Restrict K+ intake in diet
3. Discontinue K+ supplements
4. Administer Kayexalate(treat high levels of K+)
5. Administer K+ wasting diuretics
33
What is the normal range for Calcium?
8.4-10.6 mEq/L
34
What are functions of calcium?
1. Transmit nerve impulses
2. Heart & muscle contractions/relaxation
3. Blood clotting
4. Formation of teeth and bones
35
What are dietary sources of Calcium?
- Milk and milk products
- green leafy veggies
- dried beans
- dried peas
- fish with bones
36
What are dietary sources of K+?
- fruits
- veggies
- whole grains
- milk
- meat
- dried peas/beans
37
What are dietary sources of Na+?
- sodium preservatives
- salt in processed foods
- beef broth
- tomato juice
38
What are dietary sources of Magnesium?
- leafy greens
- nuts
- seafood
- whole grains
- dry peas/beans
- cocoa
39
How is sodium gained and lost in the body?
Sodium is GAINED through diet and LOST through the GI tract, kidneys, and skin
40
How is K+ gained and lost in the body?
GAINED by dietary sources and LOST by vomit, diarrhea, and kidneys
41
How is Calcium gained and lost in body?
GAINED through dietary sources and LOST through feces/urine
42
What are risk factors for HYPOcalcemia?
- decreased calcium intake
- vitamin D deficiency
- malabsorption (A condition that prevents absorption of nutrients through the small intestine)
- loop diuretics
43
What are risk factors of HYPERcalcemia?
- increased calcium intake
- increased vitamin D intake
- bone cancer
- thiazides
- prolonged immobilization
44
What are SXS of HYPOcalcemia?
- trousseau (contraction of face muscle when tapping facial nerve anterior of ear) and Chvostek (inversion of hand when inflating BP cuff for 3 mins)
- numbness and tingling in fingers
- spasm of laryngeal muscles
- bone fractures
- seizures
- Shared SxS: Arrhythmias
45
What is a shared SxS of HYPERcalcemia and HYPOcalcemia?
Arrhythmias
46
What are SxS of HYPERcalcemia?
- constipation
- renal stones
- muscle weakness
47
What are nursing interventions for HYPOcalcemia?
1. Remove cause when possible
2. Increase Ca2+ and Vitamin D in diet
3. Administer Ca2+ supplements (oral or IV) w/ OJ to increase absorption
4. Monitor cardiac rhythm
5. Monitor airway (laryngeal spasm possible)
6. Seizure precautions
48
What are nursing interventions for HYPERcalcemia?
1. Restrict calcium intake in diet
2. Increase fluid intake (will decrease Ca2+ levels and decrease chance of constipation and kidney stones)
3. Hypotonic IV 0.45% NS to decrease Ca2+ levels
4. Loop diuretics
5. Increase physical activity to promote Ca2+ uptake into bones
49
What is the normal range of Magnesium?
1.6-2.0 mEq/L
50
What are some functions of Magnesium?
1. Metabolize carbohydrates and proteins
2. C.V function (vasodilation)
3. Electrical activity in nervous tissue and muscle membranes
51
What are risk factors for HYPOmagnesemia?
- decreased mg2+ intake
- malabsorption
- Diarrhea/vomit
- NG sxn
- Thiazides
52
What are SxS of HYPOmagnesemia?
- tachycardia
- HTN
- mood swings
- confusion
- increased deep tendon reflexes
53
What is a shared SXS of HYPOmagnesemia and HYPERmagnesemia?
Arrhythmias
54
What are nursing interventions of HYPOmagnesemia?
- Increase Mg2+ intake
| - shared NI: monitor cardiac rhythm, BP/HR, and monitor DT reflexes
55
What are some shared nursing interventions of HYPOmagnesemia and HYPOmagnesemia?
- Monitor DT reflexes
| - monitor cardiac rhythm, and BP/HR
56
What are risk factors of HYPERmagnesemia?
- increased Mg2+ intake
| - decreased kidney fnxn
57
What are some SXS of HYPERmagnesemia?
- Bradycardia
- Hypotension
- Decreased RR
- Decreased or absent DT reflexes
- facial flushing
58
What are some nursing interventions for HYPERmagnesemia?
-monitor airway (due to possible impaired breathing)
| Shared SxS: monitor cardiac rhythm, HR/BP, and DT reflexes
59
Hypervolemia
Also called “Fluid volume excess”; this happens when you consume high amounts of water and salt, causing fluid retention
60
Hypovolemia
Also called “Fluid volume excess”— occurs from decreased fluid intake, which causes loss of body fluids.
61
Sensible fluid loss and examples
Fluid that is lost that is measurable. Some examples include urine, NG suction drainage, vomit, diarrhea, wound drainage
62
Insensible fluid loss
This is fluid loss that is not able to be measured. Some examples are fluid loss by exhalation or fluid loss from skin(sweating)
63
What are dietary sources of Sodium?
Sodium preservatives
Tomato juice
Beef broth
Processed foods
64
What are dietary sources of calcium?
Milk/milk products, leafy green veggies, fish w/bones, dried peas/beans
65
What are dietary sources of Potassium?
Meat, dried peas/beans, milk, fruits, veggies, whole grains
66
What are dietary sources of magnesium?
Nuts, seafood, leafy green veggies, whole grains, dried peas/beans, cocoa
67
food sources of sodium
Sodium preservatives
Salt in processed foods
Beef broth
Tomato juice
68
Food sources of potassium
```
Fruits
Veggies
Whole grains
Milk
Dried peas/beans
```
69
Food sources of calcium
Milk or milk prods
Green leafy veggies
Dried beans/peas
Fish w/bones
70
Food sources of magnesium
```
Leafy greens
Nuts
Seafood
Whole grains
Dried peas/beans
Cocoa
```
71
Functions of phosphorus
1. Acid base balance
2. Nerve and muscle contraction
3. Required for vitamin B + carbohydrate metabolism
72
What is the relationship between phosphorus and calcium?
They are inversely related. If someone has hyperphosphatemia, then they will have low calcium levels.
73
Risk factors of hypophosatemia
1. Total parenteral nutrition
| 2. Decreased phosphorus intake
74
Risk factors of hyperphosphatemia
1. Decreased kidney function
2. Increased milk intake
3. Increased vitamin D
4. Excessive fleets enema use
75
List SxS of hypophosphetemia
Respiratory failure
| Due to poor contractility of diaphragm and Arrhythmias
76
Nursing interventions for hypophosphatemia
1. Monitor heart rhythm
2. Monitor respiratory suction
3. Administer TPN (prevent referring syndrome)— ability for body to process food is compromised when someone goes into starvation; commonly caused by decrease in electrolytes such as phosphorus
4. Administer phosphorus via IV
5. Monitor calcium (sudden spike in phosphorus = HYPOcalcemia
77
What is a shared SXS of hyperphosphatemia and hypophosphetemia?
Arrhythmias
78
SxS of hyperphosphatemia
Few clinical signs but will reflect SXS HYPOcalcemia due to inverse relationship
- Tross/chvst signs
- numbness/tingling of fingers, toes,
- spasm of laryngeal muscles
- Arrhythmias
79
Nursing interventions for hyperphosphatemia
1. Decrease phosphorus intake
2. Monitor muscle tetany
3. Monitor airway (possible laryngeal spasm)
4. Teach proper laxative use (laxatives may contain phosphorus)
80
What vitamin helps absorb calcium in body
Vitamin D helps body absorb calcium
81
Nursing interventions for cognitive impairment
Speak calm, slow, clear
Face to face
Emphasize strengths
82
Nursing interventions for unconscious patients
Notify before touching
| Talk in normal tone
83
Nurse interventions for language barriers
Interpret telephone
Family for non medical translation
In person interpreter
84
Does HYPOkalemia increase or decrease chance of dig toxicity
It increases risk of Dig toxicity bc drug needs K+ to bind to Dig receptors (not able to bind so levels in blood are toxic)
