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N323 > Fluid + Electrolytes > Flashcards

Fluid + Electrolytes Flashcards

1
Q

When cortisol levels go up, Na and water will be…

A

retained

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2
Q

Natriuretic peptides function to suppress _______/_________, (increasing/decreasing?) blood volume/BP

A

-renin/aldosterone
-decreasing

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3
Q

Why are older adults at risk for F&E imbalance?

A

-loss of water-holding SC fat, skin thins–thermoregulation
-decreased kidney function
-aldosterone decreases, ADH increases
-decreased interest in food/water

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4
Q

Why are babies at risk for F&E imbalance?

A

-poor thermoregulation abilities
-higher fluid exchange ratios (insensible loss)
-can’t communicate thirst
-kidneys not fully functioning yet

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5
Q

What are signs of FVO? How would you treat it?

A

-Cardiac signs: edema, bounding pulse, S3, high BP, JVD
-Respiratory signs: crackles, shortness of breath, orthopnea (HF)
TREAT: restrict water, salt, diuretics, daily weights

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6
Q

What are signs of FVD? How would you treat it?

A

-Turgor–tenting, dry mucous membranes, weak/thready pulse, low BP, tachy, dizzy/headache/confusion, small amounts of concentrated/foul urine
-TREAT: IV/oral rehydration, vasopression (synthetic ADH)

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7
Q

How does the GI system regulate F&E balance?

A

The large intestine absorbs water

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8
Q

What is the difference between active transport and facilitated diffusion?

A

-Active transport: movement up the concentration gradient, requires ATP
-Facilitated diffusion: movement of larger molecule across a PM with a helper protein

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9
Q

Describe the differences between 1st, 2nd, and 3rd fluid spacing

A

1st: normal–water in cells
2nd: fluid around cells (in interstitial space)–edema. Treat w/ diuretics
3rd: fluid TRAPPED interstitially. Treat by draining

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10
Q

Name some possible causes of hypernatremia. What are some signs/symptoms? What are some nursing interventions?

A

-decreased water intake
-excessive intake of Na IV solutions
-excessive water loss–heat stroke, fever, diarrhea
-diabetes (polyuria)

S/S: intense thirst, sticky/dry mucous membranes/skin/tongue, disorientation/hallucinations

Interventions:
-monitor Na labs, assess for thirst/behavioral changes, ensure water is given w/ tube feedings
-give water
-IV infusions like D5/10, LR… (W/O Na!)

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11
Q

Why is sodium so important for maintaining ECF?

A

B/c sodium follows water–sufficient concentration of Na outside of cells = sufficient concentration of H2O outside of cells

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12
Q

The max recommended daily dose of Na is ______mg, or ___ tsp

A

2300mg–1 tsp

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13
Q

The ________ system is the primary regulator of Na.

A

renal

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14
Q

Hyponatremia, or __________ _________can lead to what symptoms? What are some possible causes? How would you treat?

A

-water intoxication
-S/S: cold/clammy, dry mucous membranes, orthostatic hypotension, tachy/thready pulse, feeling of doom, N/V, abdominal cramps
-Causes: overexercise, overhydrating, under-electrolyte-ing–and burns/severe wounds, adrenal insufficiency
-Treat w/ water restriction–maybe small amounts of 3% NaCl

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15
Q

Overcorrection of hypernatremia can lead to…

A

cellular swelling in the brain

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16
Q

How do fluids contribute to homeostasis?

A

-carry nutrients to, waste products from cells

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17
Q

Most of the water in the body is ________ fluid

A

intracellular

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18
Q

1L of fluid is equal to how many pounds?

A

2.2 lbs

19
Q

The Na/K pump is an example of _______ ________.

A

active transport

20
Q

What happens if a cell is surrounded by isotonic fluid? Hypotonic? Hypertonic?

A

-nothing
-cells swell
-cells shrink–lyse

21
Q

________ are responsible for pushing waste out of cells.

A

capillaries

22
Q

Albumin functions to…

A

pull fluid into capillaries (low? –> edema)

23
Q

Describe how high BP and HF can lead to edema.

A

High pressure in the capillaries –> can’t reabsorb fluid from tissue –> edema

24
Q

Functions of Mg in the body

A

-DNA/protein synthesis
-Na/K pump functino
-muscle contraction/relaxation
-neuro function

25
Q

Mg is regulated by which systems? Where is it stored?

A

-renal, GI
-muscles, bones

26
Q

Hypermagnesmia–causes, S/S, treatment

A

Causes
-renal disease + increased intake (i.e., taking milk of mag w/ kidney failure–can’t excrete enough!)
-excess IV administration
S/S
-impaired reflexes, flushing, lethargy, N/V, hypotension –> res/cardiac arrest
Treatment:
-remove source, fluids/diurectics (if kidneys ok), Ca gluconate in emergencies

27
Q

When and why would we induce hypermagnesmia? Nursing considerations for this?

A

-in pre-eclamptic pregnant people
-“calms”: lowers BP, calms reflexes (seizures)
-warn of symptoms, prep cool cloths/bedpan, fall precautions.

28
Q

What causes hypOmagnesmia? S/S? Treatments?

A

-excessive GI fluid loss, long term fasting/starvation, alcoholism, PPIs and some diuretics, severe hyperglycemia
-S/S: muscle cramps, hyperactive reflexives, mood changes, seizures, tetany, positive Chvostek’s and Trousseau’s signs
-Treatment: oral supplementation, IV Mg sulfate if severe

29
Q

Signs of hypomagnesmia are identical to signs of ________.

A

hypocalcemia

30
Q

A patient who takes high protein supplements presents w/ a Mg level of 3. What is your response?

A

Protein supplements can contain Mg–discontinue use. Normal Mg levels are 3.1-2.1

31
Q

And older adult pt presents w/ low serum protein. What assessment finding would you expect? Why?

A

-edema
-serum protein (albumin) is essential for fluid reabsorption from tissues into capillaries

32
Q

K+ is vital to what systems?

A

-neuro
-cardiac muscle
-sm muscles

33
Q

________ are the primary route of K+ loss, so K+ imbalance is a major concern for patients w/ ________ ________

A

Kidneys, kidney disease

34
Q

K+ ___________ is a major concern for patients w/ kidney disease

A

overload

35
Q

Hyperkalemia: causes, signs/symptoms, nursing interventions/treatment (2 meds)

A

Causes
-excessive intake
-K+ shift out of cells from trauma
-problems w/ elimination
-medications: potassium sparing diuretics, ‘prils’ (ACE inhibitors), spironolactone

S/S
-GI: abdominal cramping, diarrhea, hyperactive bowel sounds
-Irregular, slow heart rate
-irritability, anxiety
-muscle twitching –> paralysis
-weakness in the lower extremities

Nursing interventions
-fall risk precautions
-monitor for ECG changes
-question diuretics

Treatment
-discontinue any K+ treatments
-fluids/diuretics
-med: Kayexelate–ion exchange resin that absorbs K, releases Na in intestines–takes a bit of time
-med: IV insulin–forces K+ back into cells (stimulates Na/K pump)
-Dialysis

36
Q

What medications might put a pt at risk for hyperkalemia?

A

-potassium sparing diuretics
-ACE inhibitors (‘prils’), spironolactone
-potassium supplements

37
Q

Name the considerations and MOA for giving IV insulin for hyperkalemia

A

-stimulates Na/K pump, forces K+ into cells
-insulin lowers BG–give w/ glucose

38
Q

Hypokalemia causes, signs/symptoms, nursing/interventions treatments,

A

Causes:
-diarrhea, vomiting, excess NG suctioning
-malnutrition
-K+ wasting diuretics (hydrachlorathiazide)

S/S
-paresthesia (pins and needles)
-weak, thready pulse
-fatigue
-GI: constipation, bloating, N/V
-ECG changes
-muscle weakness, leg cramps

NI/T
-monitor for ECG changes
-are they on digitalis (Hypo-K can cause digitalis toxicity)
-educate about diuretic overuse/laxative abuse
-potassium supplements (careful–NO BOLUS, dilute, can burn)

39
Q

When would you give IV vs oral K+ supplementation?

A

K+ >3 –> oral
K+ <3 –> IV

40
Q

________ is the most abundant electrolyte in the body, stored in ______ and ______.

A

calcium, bones, teeth

41
Q

Hypercalcemia: causes, signs/symptoms, nursing intervention/treatment (2 meds)

A

Causes (basically, bones breaking down):
-hyperparathyroidism (thyroid controls Ca, PO, and VitD levels)
-malignancies (bone breakdown and parathyroid mimicking)
-prolonged immobility (bone breakdown)

S/S
-Sever hyperCa –> Cardiac arrest
-decreased muscle tone/reflex
-FINISH

NI/T
-increase mobilization if immobility is a factor
-increase fluid to help w/ Ca excretion/reduce kidney stone risk
-are they on digitalis (Hypo-K can cause digitalis toxicity)
-med: give loop diuretics (Lasix)
-med: synthetic calcitonin–stops bone breakdown, Ca absorption in GI/kidneys

42
Q

What happens with the thyroid when serum Ca is low? What happens if they have hyperthyroidism?

A

-low? thyroid senses, signals to take Ca from bones and absorb more Ca in kidneys
-hyperthy: overactive, breaking down way too much Ca from that bones

43
Q

HypOcalcemia: causes, signs/symptoms, nursing intervention/treatment

A

Causes
-kidney failure
-Vit D deficiency
-parathyroid injury/removal
-malnutrition/malabsorption

S/S (same as hypoMg)
-tetany, seizure
-muscle cramps, hyperactive reflexes
-Postive Chvostek (cheek tap + twitch) and Trousseau’s signs (spasm w/ BP cuff)
-mood changes (depression, anxiety)

NI/T
-education about dietary intake, Ca and Vit D supplements
-severe: IV Ca gluconate, seizure precautions

N323 (9 decks)

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