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Med Surg 1 > Fluid & Electrolytes > Flashcards

Fluid & Electrolytes Flashcards

1
Q

What’s ROME (ABG)

A

Respiratory
Opposite
PH (up) PCO2 (down)
PH (down) PCO2 (up)
Metabolism
Equal
PH (up) HCO3 (up)
PH (down) HCO3 (down)

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2
Q

ABG Values

A

PH = 7.35 to 7.45
PaCO2 = 35 to 45
HCO3 = 22 to 28

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3
Q

PH <7.35

A

Acidosis

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4
Q

PH >7.45

A

Alkalosis

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5
Q

Hypoventilation, resp failure

A

Resp acidosis

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6
Q

Hypoxemia, hyperventilation

A

Resp alkalosis

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7
Q

Lactic acid accumulation, kidney disease, severe diarrhea

A

Metabolic acidosis

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8
Q

Prolonged vomiting or gastric suctioning, gain of bicarb

A

Metabolic alkalosis

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9
Q

In which situation is sodium bicarbonate used

A

during severe acidosis, body can use this as a buffer to offset the increasing acid production, attempting to maintain homeostasis

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10
Q

What’s the renal buffering system

A

Kidneys affect PH through 2 mechanisms
- retention/reabsorption of HCO3
- Elimination of acids
This is the most effective means of controlling body pH, but response can takes 12 to 24 hours

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11
Q

What’s the respiratory control of PH

A

The respiratory center of the brain responds to increased levels of CO2 and decreased PH with increase rate of depth of ventilation
- This blows off CO2 and restores PH
The lungs can only regulate volatile acids must be regulated by other means
Responds in mins and reaches max effect in hours
(if blood becomes acidic RR increases)

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12
Q

Hydrostatic pressure

A

force of fluid in a compartment pushing against a cell membrane or vessel wall. This pressure pushes water out of the vascular space into the interstitial spaces

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13
Q

Oncotic pressure

A

pressure caused by plasma colloids in solution. This pressure pulls water from the tissue space into the vascular space

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14
Q

What’s isotonic, and fluids

A

equal pressure
NS, LR

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15
Q

What’s hypotonic, and fluids

A

cell swelling
1/2 NS,

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16
Q

What’s hypertonic, and fluids

A

cell shrinking
D5NS, 3%NS, D10W

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17
Q

Whats hypovolemic shock and S/S

A

Loss of intravascular fluid volume and is inadequate to fill the intravascular space
Rapid Pulse, Tachy, Decreased BP, Decreased Urine, Pale, Cold, Clammy, Confusion

18
Q

What’s hypervolemia and S/S

A

too much fluid
Pulmonary congestion, AMS, Edema, Bounding Pulse,Tachy, JVD

19
Q

Value phosphate

A

3.0 to 4.5

20
Q

Value calcium

A

9.0 to 10.5

21
Q

Value Magnesium

A

1.3 to 2.1

22
Q

Value Potassium

A

3.5 to 5

23
Q

Value Sodium

A

136 to 145

24
Q

What does calcium do in the body

A

helps with muscle contractions, myocardial contractions, nerve impulses, blood clotting, cell division and building bones and teeth

25
Q

what does potassium do in the body

A

necessary for resting membrane potential of nerve and muscle cells, cellular growth, maintenance of cardiac rhythms, acid-base balance

26
Q

what does magnesium do in the body

A

carbohydrate metabolism, muscle contraction/relaxation, normal neurological functioning, GI absorption, assists ATP to do its job, required for DNA synthesis

27
Q

What does sodium do in the body

A

Helps maintain fluid balance, regulates acid-base balance, helps with muscle contractions and helps with nerve impulses

28
Q

What does phosphate do in the body

A

Function of muscle, red blood cells and nervous system, involved in acid-base buffering, cellular uptake of glucose and metabolism of carbs, formation of bone & teeth, calcium regulation

29
Q

Hypernatremia risks, clinical manifestations, nursing management

A

Risks: inadequate water intake, excess water loss or rarely sodium gain. High NA causes high osmolality which causes water to move out of the cells to restore equilibrium leading to cellular dehydration.

Clinical manifestations: Dehydration of brain cells, results in changes in mental status, confusion, seizures, thirst.

Nursing Management: Correct underlying cause, seizure precautions, neuro assessment, oral or IV replacement with isotonic solutions, correct NA values slowly to avoid cerebral edema, possible NA restricted diet

30
Q

Hyponatremia risks, clinical manifestations, nursing management

A

risks: may result from a loss of sodium containing fluids, water excess in relation to the amount of sodium (dilutional hyponatremia), or a combo of both. Usually associated. with low osmolality from excess water. Body fluid drainage, diarrhea, vomiting

clinical manifestations: due to cellular swelling and first appear in the CNS → headache, difficulty concentrating to confusion, vomiting, seizures

nursing management: Replace fluid using isotonic solutions, encouraging oral intake, withholding diuretics. Hyponatremia w/water excess we may fluid restrict. With more serious hyponatremia we may use hypertonic solutions. Monitor Na levels, patients response to treatment and neuro status.

Increase slowly: increasing Na too quickly can lead to permanent damage to nerve cells in the brain

31
Q

Hyperkalemia risks, clinical manifestations, nursing management

A

cardiac monitoring
risks: impaired renal excretion, shift of K from intra to extracellular, massive intake of K or a combo. Renal failure is the most common cause. Acidosis, crush injury, and intense exercise case K to move from ICF to ECF.

clinical manifestations: changes in cardiac conduction, tall peaked T waves, heart block, fatigue, confusion, muscle cramps, paresthesias. Hyperactivity of GI smooth muscles.

nursing management: Eliminate additional K intake such as foods and medications, increase K excretion
- Kayexalat, loop diuretics, dialysis
force K from ECF to ICF
-IV regular insulin w/ dextrose and albuterol stimulate the na-K pump shifting K into the cells
-IV bicarb if pt is acidotic
stabilize cardiac membranes
-IV calcium helps to reverse the toxic effects of the cardiac cell membrane

32
Q

Hypokalemia risks, clinical manifestations, nursing management

A

risks: Increased loss of K, inadequate dietary intake of K, increased shift of K from ECF to ICF. Diarrhea, laxative misuse, vomiting, ileostomy drainage, excessive diuresis, low Mag levels, alkalosis

clinical manifestations: Impaired muscle contraction, cardiac changes, flattened T waves, skeletal muscle weakness, shallow resp, decreased GI motility, impairs insulin secretion leading to glucose intolerance and high BGL

nursing management: Oral or IV K replacement, Increase in dietary K rich foods, monitor tele, monitor labs, teach s/s of electrolyte imbalance, awareness of mediations that add to decreased K

33
Q

Hypercalcemia risks, clinical manifestations, nursing management

A

risks: hyperparathyroidism, some cancers, prolonged immobilization, increased calcium intake

clinical manifestations: fatigue, confusion, hallucinations, heart block

nursing management: low calcium diet, stop Ca containing meds, weight bearing exercises, adequate hydration, 3-4L/day to help prevent stone formation, isotonic saline, monitor for fluid overload in renal PT, may need dialysis if severe, Biphosphonate and calcitonin

34
Q

Hypocalcemia risks, clinical manifestations, nursing management

A

risks: hypoparathyroidism, multiple blood products due to the citrate which binds with Ca

clinical manifestations: nerve excitability and sustained muscle traction (TETANY), +chvosteks sign and +Trousseau’s sign. Other ones being stridor, dysphagia, paresthesia and numbness/tingling around the mouth of in extremities.

nursing management: Monitor for Chvostek’s and Trousseau’s signs, monitor tele, diet high in Ca, Ca and Vit supplements, IV Calcium gluconate, assess head and neck surgical pt, monitor for hyperventilation as this can precipitate hypocalcemia, monitor for other signs of TETANY

35
Q

what’s special about calcium and phosphate what are the values

A

they are inversely related
Ca 9.0 to 11
Phos 3.0 o 4.5

36
Q

Hyperphosphatemia risks, clinical manifestations, nursing management

A

risks: AKI, CKD, use of phosphate containing laxatives

clinical manifestations: TETANY, muscle cramps, hypotension, seizures, dysrhythmias, calcium deposits in joints, arteries, kidneys

nursing management: Identify and treat underlying cause, restrict foods high in phos, Oral phosphate binders to limit intestinal phosphate absorption and increase phosphate secretion in the intestin. severe cases may require dialysis

37
Q

Hypophosphatemia risks, clinical manifestations, nursing management

A

risks: Decreased intestinal absorption, increased urinary excretion, resp alkalosis, malnutrition

clinical manifestations: CNS depression, muscle weakness, heart failure, seizures, dysrhythmias

nursing management: Increased oral intake and/or phos supplements, IV sodium phos or K phos, monitor labs, monitor tele

38
Q

Hypermagnesemia risks, clinical manifestations, nursing management

A

risks: renal insufficiency, increased mag intake, treatment for eclampsia

clinical manifestations: hypotension, lethargy, urinary retention, nausea, loss of deep tendon reflexes, flushed warm skin

nursing management: avoid mag containing drugs and limit dietary intake of Mg, increase fluids to promote flushing out of Mag, IV calcium gluconate, monitor muscle function, monitor deep tendon reflexes

39
Q

Hypomagnesemia risks, clinical manifestations, nursing management

A

risks: Limited mag intake, increased GI losses, insufficient food intake, acute pancreatitis, diuretics

clinical manifestations: resembles hypocalcemia, muscle cramps, dysrhythmias, tremors, hyperactive deep tendon reflexes

nursing management: Assess for muscle cramping and tremors, chvostek’s sign, trousseau’s sign, neuro assessment, cardiac monitoring tele, replacement of mag

40
Q
A

Med Surg 1 (6 decks)

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