Fluid & Electrolytes Flashcards
1
Q
Normal WBC
A
4,000 - 11,000
2
Q
Normal hemoglobin (Hcb)
A
12-18
3
Q
Normal hematocrit (Hct)
A
40%-54%
4
Q
Normal BUN
A
17-20
5
Q
Normal Sodium (Na)
A
135-145
6
Q
Normal Potassium (K)
A
3.5-5
7
Q
600-900 mL of water is lost each day via
A
via insensible water loss (vaporization by the lungs and skin)
8
Q
1500 mL of water is lost each day via
A
urine
9
Q
100 mL of water is lost each day via
A
feces
10
Q
8000 mL of digestive fluids are
A
secreted daily but most are reabsorbed in the GI tract
11
Q
In the case of heart failure where diuretics are overused, the most likely respiratory manifestation would be
A
increased respiratory rate
12
Q
first spacing
A
the normal distribution of fluids in the intracellular fluid and extracellular fluid compartments
13
Q
second spacing
A
edema
14
Q
third spacing
A
the collection of excess fluid in the nonfunctional areas between the cells
15
Q
extracellular
A
fluids found outside of cells, in blood vessels and lymph
16
Q
intracellular
A
fluid in cells, out of blood vessels and lymph
17
Q
the most accurate measure of fluid volume stats
A
measuring body weight daily
18
Q
Restlessness is an early cerebral sign that
A
dehydration has progressed to the point where an intracellular fluid shift is occurring. If the dehydration is left untreated, cerebral signs could progress to confusion and later coma.
19
Q
BNP
A
brain natriuretic peptide or B-type natriuretic peptide
a hormone produced when the atrial pressure increases. This blood test is used to diagnose the severity and treatment outcomes of congestive heart failure (CHF). The atrial pressure increases because of increased venous return and hypernatremia.
20
Q
Edema 1+
A
2mm deep
21
Q
Edema 2+
A
4mm deep
22
Q
Edema 3+
A
6mm deep
23
Q
Edema 4+
A
8mm deep
24
Q
Poor skin turgor is characterized by skin that takes _______ seconds to return to normal after pinch
A
20-30
normal skin resumes shape within seconds
25
Albumin
a colloid solution that pulls fluid into the blood vessels, which restores blood volume. This medication is used to treat hypovolemia.
26
Chlorhexidine-based solutions (chlorhexidine gluconate) have been shown to be more effective at
killing bacteria than providone-alcohol or isopropyl alcohol solutions. Sterile saline doesn’t have any antiseptic properties
27
the most relative volume of body fluid
intracelllular fluid (28 liters)
adipose tissue does not contain body fluid (lipids)
interstitial fluid (10 liters)
28
Cushing syndrome is associated with
extracellular fluid volume excess
29
Causes of extracellular fluid volume deficit
Vomiting, hemorrhage and diabetes insidpidus
30
Fluid volume excess results in
dyspnea (shortness of breath)
increased BP
a full, bounding pulse (not easily obliterated)
hypertension
the presence of an S3 heart sound
Pulmonary congestion
juglular venous distention (distended neck veins)
moist lung crackles
31
clinical manifestations of deficient fluid volume
flattened neck veins
low BP
weak and thready pulse that can be easily obliterated
Orthostatic hypotension
increased heart rate
32
Patients experiencing a fluid volume deficit with clinical findings of hypotension will experience low _____ and high ________.
_______ will be elevated.
low calcium and high magnesium
sodium, chloride, and potassium will be elevated
33
0.9% sodium chloride
isotonic fluid, used to rapidly replace fluid volume
34
0.45% sodium chloride
hypotonic fluid
35
sodium chloride with dextrose
hypertonic
36
Administering _________ to maintain fluid and electrolyte balance is beneficial to polyuria.
lactaed Ringer solution (isotonic)
37
Cushing syndrome symptoms
dyspnea, wight gain, hyperglycemia, and hypertension
can cause extracellular volume accumulation, which blocks interstitial air and tissue spaces and results in dyspnea, crackles, and peripheral edema
38
Addison disease symptoms
hypoglycemia, weight loss and hypotension
39
Extremities will be elevated to decrease
edema
40
Patients should be repositioned frequently to avoid
skin breakdown
41
Patients at risk for fluid volume changes should be weighed
daily
42
The cap off the central line could potentially allow entry of air into the circulation. For an air embolus from any source, the priority is to
administer oxygen
Next the nurse would clamp the CAVD catheter and position the patient on the left side with the head down. Notify HCP. Use of CAVD and rate adjustments would depend on provider orders.
43
A patient with overuse of diuretics is likely to have a fluid volume
deficit
44
Decreased sodium (normal sodium 135-145), decreased BUN (normal BUN 7-20), and decreased hematocrit (normal hematocrit 35%-47%) indicate a fluid volume
excess
45
Extracellular fluid accounts for ______ of total body fluids, which consist of interstitial fluid, plasma, and transcellular fluid.
a third
46
The extracellular fluid may become excessive when the elimination of water is impaired, especially during
kidney failure
47
conditions that result in the loss of body fluid
fistula drainage, osmotic diuresis, and heatstroke
48
one liter of water weighs
one kg (divide mL by 1000)
49
1 kg equals _____ lbs
2.2
50
To correct a fluid volume deficit due to severe diarrhea, the nurse would anticipate a prescription for
lactated Ringer’s solution, which is isotonic and replaces fluid and electrolytes
51
Sodium intake should be ________ in cases of fluid volume excess
restricted
52
A blood transfustion would be given if the fluid volume deficit was due to __________ and not dehydration
blood loss
53
Giving hypertonic sodium chloride would exacerbate a patient’s _________
dehydration
54
Restriction of dietary sodium would help control the fluid ____________ and maintain the fluid balance
accumulation
55
paracentesis
removes fluid from the abdominal cavity with a needle or catheter
56
After a paracentesis of 5 liters or more of ascites (built up) fluid, a ________ solution may be used to draw free fluid from the interstitial space into the intravascular space
25% albumin
57
1 kg weight gain indicates _______ mL of body water.
1000 mL
58
osmolality (concentration):
high and _____
low and _____
high and dry
low and wet
(usually sodium)
59
normal magnesium
1.3-2.1
60
normal calcium
9-10.5
61
oncotic pressure
a type of osmotic pressure exerted by proteins, primarily ALBUMIN, in the blood plasma.
These proteins are too large to pass freely through the capillary walls, so they attract water to maintain fluid balance between the blood and tissues.
hypoalbuminemia, hypoproteinemia
62
osmotic pressure
is the pressure that needs to be applied to a solution to prevent the flow of water into it, and it’s influenced by the concentration of solutes
tonicity
hypo, iso, hyper
63
anemia
low hemoglobin (below 12)
64
Crystalloids
solutions that contain small molecules/ions easily dissolved in water, passing freely thru cell membranes. can contain electrolytes (sodium, chloriede, potassium, glucose)
Saline solutions (0.9% sodium chloride), Ringer's lactate, dextrose solutions
commonly used to maintain hydration, restore fluid volume, and correct electrolyte imbalances. They are the most commonly used fluids in IV therapy
65
deep tendon reflexes are measured to determine
magnesium
hypermagnesemia - diminisehed DTRs (muscle paralysis)
hypomagnesemia - hyperactive DTRs (increased pulse, BP, seizures)
66
normal urine output
30 mL/hour
67
intracellular has the ______ fluid in the system
most (28 L) but we look at ECV (interstitial (11 L) and lab values from intravascular (3 L))
68
_______ and _______ pressure affects distribution of EC fluid between capillary and tissue
hydrostatic (pushing/squeezing)
and
oncotic (pulling/sucking)
69
hydrostatic pressure is _______ at the arterial end of the capillary (going into the tissue)
40 mm HG
70
if you're in septic shock, you wont' have enough ________ pressure to get oxygen to the tissues
hydrostatic
71
oncotic pressure is the protein power of the vascular space, proteins ___________
draw fluid TOWARDS them (pulling/sucking out of tissue)
72
normal oncotic pressure at the capillary is
25 mm Hg
73
hydrostatic pressure at the venous end is
10 mm Hg
74
If hydrostatic pressure is too high at the venous end of the capillaries, it can lead to
impaired fluid return to the bloodstream, which can result in edema (swelling)
75
normal interstitial hydrostatic pressure (in the tissue) is usually
1 mm Hg
76
if you don't have enough protein in your blood, fluid is going to
seep out into the tissues
77
S3 sound indicates
fluid volume overload to the left ventricle
78
diuretics ____ fluid
pull fluid off, release
79
________ pulse could mean fluid overload
bounding
80
_______ pulse could mean fluid deficit
weak, thready
81
albumin (protein) will help draw water from the 3rd space to the
intravascular space
82
jvd
jugular vein distention
83
Orthostatic hypotension (postural hypotension) symptoms (light-headedness or dizziness) and a significant drop in _________ pressure (greater than ___________) or a drop by at least _______ in _______ pressure
drop in systolic pressure greater than 20 mm Hg
or by at least 10 mm Hg in diastolic
84
orthostatic hypotension indicates volume ________
depletion
85
low sodium, ______ fluid
too much fluid
86
high sodium, ______ fluid
loss of fluid
87
sodium imbalances affects
fluids, but also mental status, level of consciousness
if severe, could cause siezures and coma
88
a hypotonic solution _____ cells
swells/lyses
89
a hypertonic solution ______ cells
shrinks cells
90
crystalloid IV fluids can exert ______ pressure
osmotic pressure (isotonic is ideal for fluid replacement)
91
colloid fluids contain proteins and increase ______ pressure
oncotic pressure (plasma expanders/albumin)
92
osmotic pressure is for the ______, oncotic pressure is for the _______
osmotic for the cell
oncotic for the blood
93
IV additives can be
Bicarb, Magnesium, KCL
94
blood is technically a _______ but it's biologic
colloid
it can expand plasma, can improve oxygenation or clotting
but it's expensive and could carry disease
95
D5W / 5% dextrose in water is
isotonic when prepared but physiologically hypotonic when administered to the body (glucose metabolized)
allows for free water, maybe for elevated sodium
can prevent ketosis when patient isn't getting any food
96
D10 / 10% dextrose in water is
hypertonic
for chronic hypoglycemic
97
0.45% saline is
hypotonic
98
0.9% saline is
isotonic
99
3.0% saline is
hypertonic
100
D5/45 = 5% dextrose in 0.45% saline is
hypertonic
provides sodium and chloride and free water due to rapid metabolism of dextrose
used as a maintenance solution
101
Ringer's solution is
an isotonic multiple electrolyte solution
102
LR / Lactated Ringer's solution is
an isotonic multiple electrolyte solution
103
treating hypernatremia too fast with hypotonic solution can lead to
brain cell swelling, seizures, coma, or brain herniation
104
treating hyponatremia too fast with hypertonic solution can lead to
ataxia, confusion, slurred speech, drooling, tremor, weakness
105
potassium problem manifestations
dysrhythmias
EKG changes
muscle weakness (lower bowel motility: hypokalemia = constipation
hyperkalemia = diarrhea
106
hypopotassium causes
GI loss, diuretics, Cushings
107
Addison's is an adrenal deficiency, the opposite of
Cushings
108
potassium cocktail can be infused IV at less than
10 mEq / hour
does cause pain at IV site
109
hypercalcemia causes
endocrine disorder (hyperparathyroid)
calcium-containing antacids
prolonged immobilzation
110
hypocalcemia causes
endocrine disorders (parathyroid removal)
renal failure
multiple blood transfusions
111
hyperpotassium causes
renal failure, DKA, Addisons
112
hypercalcemia manifestations
decreased excitability of nerves/muscles
113
hypocalcemia manifestations
Chvostek orTrousseau's signs
114
hypemagnesemia causes
magnesium-laxatives
renal failure
115
hypermagnesemia manifestations
muscle paralysis (respiratory arrest)
Deep Tendon Reflexes
116
hypomagnesemia causes
renal and GI losses
chronic alcohol use
117
hypomagnesemia manifestations
hyperactive Deep Tendon Reflexes
increased BP and pulse
siezures
118
laxitives generally have ______ in them
magnesium
119
_______ may be observed due to incorrect fluid replacement with hypotonic crystalloids in patients with DKA
cerebral edema
120
DI is caused by an insufficiency in
ADH
121
interventions in caring for a patient with DI
provide adequate fluids within easy reach
assess for and report changes in neuro status
monitor for constipation, weight loss, hypotension, and tachycardia
122
what could result from a decrease in serum albumin level?
reduction of colloidal oncotic pressure in the blood
123
ascites
the abnormal accumulation of fluid in the abdominal cavity
124
chronic kidney disease places a patient at a higher risk for ___________
hyperkalemia
125
salt substitutes contain _______
potassium
126
adrenal insufficiency, addisons, or an adrenalectomy can cause
hypotension
127
a patient with low sodium requires _________ precautions
siezure
128
what clinical manifestation is indicative of the fluid and electrolyte imbalance associated with a parathyroidectomy?
muscle spasms for hypocalcemia
129
______ is the most appropriate initial IV fluid for a patient with severe diarrhea and dehydration
0.9% sodium chloride, it's normal saline and isotonic to quickly replace volume losses and promote stabalization
