Fluid & Electrolytes Flashcards
Normal WBC
4,000 - 11,000
Normal hemoglobin (Hcb)
12-18
Normal hematocrit (Hct)
40%-54%
Normal BUN
17-20
Normal Sodium (Na)
135-145
Normal Potassium (K)
3.5-5
600-900 mL of water is lost each day via
via insensible water loss (vaporization by the lungs and skin)
1500 mL of water is lost each day via
urine
100 mL of water is lost each day via
feces
8000 mL of digestive fluids are
secreted daily but most are reabsorbed in the GI tract
In the case of heart failure where diuretics are overused, the most likely respiratory manifestation would be
increased respiratory rate
first spacing
the normal distribution of fluids in the intracellular fluid and extracellular fluid compartments
second spacing
edema
third spacing
the collection of excess fluid in the nonfunctional areas between the cells
extracellular
fluids found outside of cells, in blood vessels and lymph
intracellular
fluid in cells, out of blood vessels and lymph
the most accurate measure of fluid volume stats
measuring body weight daily
Restlessness is an early cerebral sign that
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.
BNP
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.
Edema 1+
2mm deep
Edema 2+
4mm deep
Edema 3+
6mm deep
Edema 4+
8mm deep
Poor skin turgor is characterized by skin that takes _______ seconds to return to normal after pinch
20-30
normal skin resumes shape within seconds
Albumin
a colloid solution that pulls fluid into the blood vessels, which restores blood volume. This medication is used to treat hypovolemia.
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
the most relative volume of body fluid
intracelllular fluid (28 liters)
adipose tissue does not contain body fluid (lipids)
interstitial fluid (10 liters)
Cushing syndrome is associated with
extracellular fluid volume excess
Causes of extracellular fluid volume deficit
Vomiting, hemorrhage and diabetes insidpidus
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
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
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
0.9% sodium chloride
isotonic fluid, used to rapidly replace fluid volume
0.45% sodium chloride
hypotonic fluid
sodium chloride with dextrose
hypertonic
Administering _________ to maintain fluid and electrolyte balance is beneficial to polyuria.
lactaed Ringer solution (isotonic)
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
Addison disease symptoms
hypoglycemia, weight loss and hypotension
Extremities will be elevated to decrease
edema
Patients should be repositioned frequently to avoid
skin breakdown
Patients at risk for fluid volume changes should be weighed
daily
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.
A patient with overuse of diuretics is likely to have a fluid volume
deficit
Decreased sodium (normal sodium 135-145), decreased BUN (normal BUN 7-20), and decreased hematocrit (normal hematocrit 35%-47%) indicate a fluid volume
excess
Extracellular fluid accounts for ______ of total body fluids, which consist of interstitial fluid, plasma, and transcellular fluid.
a third
The extracellular fluid may become excessive when the elimination of water is impaired, especially during
kidney failure
conditions that result in the loss of body fluid
fistula drainage, osmotic diuresis, and heatstroke
one liter of water weighs
one kg (divide mL by 1000)
1 kg equals _____ lbs
2.2
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
Sodium intake should be ________ in cases of fluid volume excess
restricted
A blood transfustion would be given if the fluid volume deficit was due to __________ and not dehydration
blood loss
Giving hypertonic sodium chloride would exacerbate a patient’s _________
dehydration
Restriction of dietary sodium would help control the fluid ____________ and maintain the fluid balance
accumulation
paracentesis
removes fluid from the abdominal cavity with a needle or catheter
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
1 kg weight gain indicates _______ mL of body water.
1000 mL
osmolality (concentration):
high and _____
low and _____
high and dry
low and wet
(usually sodium)
normal magnesium
1.3-2.1
normal calcium
9-10.5
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
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
anemia
low hemoglobin (below 12)
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
deep tendon reflexes are measured to determine
magnesium
hypermagnesemia - diminisehed DTRs (muscle paralysis)
hypomagnesemia - hyperactive DTRs (increased pulse, BP, seizures)
normal urine output
30 mL/hour
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))
_______ and _______ pressure affects distribution of EC fluid between capillary and tissue
hydrostatic (pushing/squeezing)
and
oncotic (pulling/sucking)
hydrostatic pressure is _______ at the arterial end of the capillary (going into the tissue)
40 mm HG
if you’re in septic shock, you wont’ have enough ________ pressure to get oxygen to the tissues
hydrostatic
oncotic pressure is the protein power of the vascular space, proteins ___________
draw fluid TOWARDS them (pulling/sucking out of tissue)
normal oncotic pressure at the capillary is
25 mm Hg
hydrostatic pressure at the venous end is
10 mm Hg
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)
normal interstitial hydrostatic pressure (in the tissue) is usually
1 mm Hg
if you don’t have enough protein in your blood, fluid is going to
seep out into the tissues
S3 sound indicates
fluid volume overload to the left ventricle
diuretics ____ fluid
pull fluid off, release
________ pulse could mean fluid overload
bounding
_______ pulse could mean fluid deficit
weak, thready
albumin (protein) will help draw water from the 3rd space to the
intravascular space
jvd
jugular vein distention
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
orthostatic hypotension indicates volume ________
depletion
low sodium, ______ fluid
too much fluid
high sodium, ______ fluid
loss of fluid
sodium imbalances affects
fluids, but also mental status, level of consciousness
if severe, could cause siezures and coma
a hypotonic solution _____ cells
swells/lyses
a hypertonic solution ______ cells
shrinks cells
crystalloid IV fluids can exert ______ pressure
osmotic pressure (isotonic is ideal for fluid replacement)
colloid fluids contain proteins and increase ______ pressure
oncotic pressure (plasma expanders/albumin)
osmotic pressure is for the ______, oncotic pressure is for the _______
osmotic for the cell
oncotic for the blood
IV additives can be
Bicarb, Magnesium, KCL
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
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
D10 / 10% dextrose in water is
hypertonic
for chronic hypoglycemic
0.45% saline is
hypotonic
0.9% saline is
isotonic
3.0% saline is
hypertonic
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
Ringer’s solution is
an isotonic multiple electrolyte solution
LR / Lactated Ringer’s solution is
an isotonic multiple electrolyte solution
treating hypernatremia too fast with hypotonic solution can lead to
brain cell swelling, seizures, coma, or brain herniation
treating hyponatremia too fast with hypertonic solution can lead to
ataxia, confusion, slurred speech, drooling, tremor, weakness
potassium problem manifestations
dysrhythmias
EKG changes
muscle weakness (lower bowel motility: hypokalemia = constipation
hyperkalemia = diarrhea
hypopotassium causes
GI loss, diuretics, Cushings
Addison’s is an adrenal deficiency, the opposite of
Cushings
potassium cocktail can be infused IV at less than
10 mEq / hour
does cause pain at IV site
hypercalcemia causes
endocrine disorder (hyperparathyroid)
calcium-containing antacids
prolonged immobilzation
hypocalcemia causes
endocrine disorders (parathyroid removal)
renal failure
multiple blood transfusions
hyperpotassium causes
renal failure, DKA, Addisons
hypercalcemia manifestations
decreased excitability of nerves/muscles
hypocalcemia manifestations
Chvostek orTrousseau’s signs
hypemagnesemia causes
magnesium-laxatives
renal failure
hypermagnesemia manifestations
muscle paralysis (respiratory arrest)
Deep Tendon Reflexes
hypomagnesemia causes
renal and GI losses
chronic alcohol use
hypomagnesemia manifestations
hyperactive Deep Tendon Reflexes
increased BP and pulse
siezures
laxitives generally have ______ in them
magnesium
_______ may be observed due to incorrect fluid replacement with hypotonic crystalloids in patients with DKA
cerebral edema
DI is caused by an insufficiency in
ADH
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
what could result from a decrease in serum albumin level?
reduction of colloidal oncotic pressure in the blood
ascites
the abnormal accumulation of fluid in the abdominal cavity
chronic kidney disease places a patient at a higher risk for ___________
hyperkalemia
salt substitutes contain _______
potassium
adrenal insufficiency, addisons, or an adrenalectomy can cause
hypotension
a patient with low sodium requires _________ precautions
siezure
what clinical manifestation is indicative of the fluid and electrolyte imbalance associated with a parathyroidectomy?
muscle spasms for hypocalcemia
______ 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
