Fluid & Electrolytes Flashcards
Where does water reside in the body?
Lymph fluid, cerebrospinal fluid, pleural fluid, GI and peritoneal fluid, synovial fluid, blood & plasma
Clinical manifestations of fluid deficit
increased thirst, confusion, oliguria, poor skin turgor, weight loss, poor capillary refill, increased heart rate, postural hypotension, restlessness, weakness, lethargy, increased respirations, decreased CVP
Lab results for fluid deficit
Increased BUN, specific gravity, Hct to Hgb ratio, RBCs
Dehydration can be caused by
H20 or Na loss
Nursing management of fluid loss deficit?
- Measure I’s and O’s
- Electrolytes, CBC, and urine specific gravity
- Assess for hypotension and weak pulses
- Assess respiratory system and perfusion
- Orientation, vision, hearing, reflexes, and muscle strength
- Daily weights
- Skin breakdown, good oral care
- Watch closely for any developing complications.
Nursing management for fluid volume excess
- Frequent respiratory assessments and assess LOC/confusion
- Cardiovascular assessment takes priority
- Edema, I’s and O’s, daily weights
- Restrict fluids
Neurological symptoms of fluid volume excess
Headache, confusion, LOC changes, seizures
Respiratory symptoms of fluid volume excess
Pulmonary congestion
Cardiovascular symptoms of fluid volume excess
Bounding pulse, increased blood pressure, increased jugular vein distention, S3 heart sound, tachycardia, dependent pitting edema
Gastrointestinal signs of fluid volume excess
Anorexia, nausea
Why are hematocrit levels reduced when a patient is in fluid volume overload?
From dilution of excess water
What is the adrenal cortex’s role in maintaining fluid balance?
Regulates sodium by releasing aldosterone to increase sodium reabsorption, maintaining ECF volume, and by excreting K.
What is the posterior pituitary gland’s role in maintaining fluid balance?
Releases antidiuretic hormone (ADH/vasopressin) which regulates fluid volume in the body. ADH prompts the kidney to reabsorb water, which increases urine concentration.
Isotonic
Same concentration as particles in plasma (no fluid movement)
Hypertonic
greater concentration as particles in plasma (fluid movement into veins)
Hypotonic
lesser concentration as particles in plasma (fluid movement out of veins).
What are some examples of isotonic solutions?
0.9 normal saline, D5W, and Lactated Ringer’s
What are some examples of hypotonic solutions?
).45 saline, 0.225 saline, 0.33 saline
What are some examples of hypertonic solutions?
3% saline, 5% saline, Dextrose 5 in 0.45 saline or 0.9 saline, or Lactated Ringers
Colloids
Protein substances that increase COP. Move fluid from interstitial space to plasma space when plasma protein levels are low.
What are some examples of colloids?
Albumin 5% and 25%, Dextran 40, 70, 75, and Hetastarch
What are colloids used for?
Used to treat wide variety of conditions when patient requires plasma volume expansion, i.e. shock and burns
What are some adverse effects of colloids?
Altered coagulation, bleeding risk, no oxygen carrying capacity, anaphylaxis, renal failure (dextran therapy)
Blood products
Only class of fluids that can carry oxygen, increase tissue oxygenation, increase plasma volume, most expensive and least available because they require human donors
What is fresh frozen plasma used for?
To increase clotting factor levels in patients with demonstrated deficiency
What are packed red blood cells used for?
To increase oxygen-carrying capacity in patients with anemia, in
patients with substantial hemoglobin deficits, and in patients who
have lost up to 25% of their total blood volume
When is whole blood use indicated?
Same as for PRBCs except that whole blood is more beneficial in
cases of extreme (greater than 25%) loss of blood volume
because whole blood also contains plasma.
Contains plasma proteins, which help draw fluid back into blood
vessels from surrounding tissues
Which systems control electrolytes?
Renin-angiotensin-aldosterone system
Antidiuretic hormone system
Sympathetic nervous system
What are the functions of potassium?
Plays role in active transport processes, regulates cardiac rhythms, normal glycogen deposit in muscles and liver, and nerve impulses in smooth muscle.
Normal range for potassium
3.5-5.0
What are some potassium rich foods?
Fruit and fruit juices (bananas, oranges, apricots, dates,
raisins, broccoli, green beans, potatoes, tomatoes),
meats, fish, wheat bread, and legumes
How is excess dietary potassium eliminated?
Through the GI and renal systems
Potassium is responsible for
Muscle contraction
Transmission of nerve impulses
Regulation of heartbeat
Maintenance of acid-base balance
Isotonicity
Hypokalemia combined with (BLANK) therapy can cause serious ventricular dysrhythmias
Digoxin
What are symptoms of low potassium?
Respiratory alkalosis, metabloic alkalosis via diuretic use, increased urine output, severe V/D, skeletal muscle weakness, smooth muscle weakness, respiratory muscle weakness and paralysis
Nursing management of low potassium
- IV potassium replacement
- Slow IV infusion (10-20/hour)
- Dietary sources
- Oral supplements
When should potassium be held?
If urine output is less than 0.5 mL/kg of body weight per hour
7 L’s of hypokalemia
Low BP, lethargy, limp muscles, low shallow respirations, lots of urine, lethal cardiac dysrhythmias, leg cramps
