Fluid & Electrolytes Flashcards
why is it important to MANAGE FLUID & ELECTROLYTES?
- provides PROPER TRANSPORTATION of NUTRIENTS TO CELLS and REMOVAL OF WASTE PRODUCTS AWAY FROM CELLS
- affects many DISEASE PROCESSES, TISSUE INJURIES, and SURGICAL PROCEDURES
- affects a VERY BROAD SCOPE
what is our TOTAL BODY WATER CONTENT composed of? (4)
- INTRACELLULAR FLUID (ICF)
- EXTRACELLULAR FLUID (ECF)
- INTERSTITIAL FLUID (ISF)
- INTRAVASCULAR FLUID (IVF)
intracellular fluid
fluid INSIDE the cell
- contains SOLUTES (ex. electrolytes, glucose)
extracellular fluid
fluid that is OUTSIDE of the cell
- helps to transport nutrients & waste products
interstitial fluid
surrounds the CELLS & TISSUES
- broken down into TRANSCELLULAR FLUID (seen in synovial, cerebrospinal, pleural cavities)
intravascular fluid
the BLOOD PLASMA
- fluid inside the BLOOD VESSELS
how much of the adult human body weight is composed of water?
60%
what are the MOVEMENT PROCESSES of fluids & electrolytes? (4)
- DIFFUSION
- FILTRATION
- ACTIVE TRANSPORT
- OSMOSIS
electrolytes
an ELEMENT or COMPOUND that - once DISSOLVED IN FLUID; will break up into ION (either + or - )
which electrolytes are mainly found in the INTRACELLULAR vs. EXTRACELLULAR fluid?
INTRACELLULAR FLUID;
- potassium *main electrolyte
- magnesium
- phosphate
EXTRACELLULAR FLUID;
- sodium
what is OSMOTIC PRESSURE?
the pressure that allows to PULL FLUID from one compartment to another
- allows to ATTRACT SOLUTES/ELECTROLYTES
describe the ELECTROLYTES in the ICF
have to monitor SODIUM (Na) & POTASSIUM (K+) LEVELS
- POTASSIUM **main electrolyte within ICF
- SODIUM **main electrolyte in the ECF, low conc. in ICF
both have an important relationship for FLUID BALANCE
**where sodium goes, often water follows
Na > cell > water pulled INTO CELL (osmotic pressure > cell SWELLS (vice versa)
homeostasis
the body’s state of STABILITY and internal balance within the body
dehydration
defined as the DISTURBANCE within the BALANCE between amt. of fluids between ICF & ECF
- decrease in TOTAL BODY WATER (TBW)
- decrease/imbalance of ELECTROLYTES *Na, K, Cl due to DECREASE IN TBW
what can CAUSE dehydration? (5)
- decreased intake
- increased output (ex. diarrhea, vomiting, bleeding)
- FLUID SHIFT (ex. accumulation of fluid change within diff. compartments–ascites, burns, sepsis)
- DECREASE in TBW
- HYPOVOLEMIC SHOCK
what are some CUES that the patient is DEHYDRATED?
- TACHYCARDIA
- HYPOTENSION
- fever
- vomiting/diarrhea
- OILGURIA
- reduced secretions
- DRY SKIN/MM
what are the TYPES OF DEHYDRATION?
- HYPERTONIC
- HYPOTONIC
- ISOTONIC
hypertonic dehydration
- have H2O LOSS > Na LOSS
- fluid goes OUT to the ECF; cell dehydration
- SHRINKING of the cell
cause;
- ELEVATED TEMP in perspiration
hypotonic dehydration
- Na LOSS > H2O LOSS
- solute is HIGHER inside the cell; fluid is PULLED IN
- SWELLING of the cell
cause;
- RENAL INSUFFICIENCY
- INADEQUATE ALDOSTERONE secretion
isotonic dehydration
- have LOSS OF BOTH Na & H20
- DECREASES ECF FLUID
cause;
- diarrhea & vomiting
how can DEHYDRATION be treated?
can give the patient either CRYSTALLOID or COLLOID SOLUTIONS or BLOOD PRODUCTS
crystalloids
fluids that are given by IV
- often consist of more SMALLER MOLECULES
(much more RAPID in fluid shift)
- helps to INCREASE the INTRAVASCULAR VOLUME (usage of NS / LR solution)
- allows to give IMMEDIATE FLUID RESUSCITATION
ADVERSE EFFECT;
can increase EDEMA
colloids
- given by IV
- have much more LARGER MOLECULES and help to MAINTAIN CIRCULATING FLUID VOLUME often after trauma or surgery
- due to having LARGER MOLECULES»_space; stay within the intravascular spaces much longer
ex. ALBUMIN, DEXTRAN, or HETASTARCH
what should we MONITOR when administering crystalloid or colloid solutions?
- always assessing for FLUID OVERLOAD or HEART FAILURE
- administering COLLOIDS SLOWLY
- assessing for any signs of TRANSFUSION REACTIONS
blood products
- often used when a patient has LOST OVER 25% or MORE blood volume
- allows to carry OXYGEN
- want to ASSESS FOR INCOMPATIBILITY or TRANSFUSION REACTIONS
nursing implications for BLOOD PRODUCTS
- assessing NORMAL LAB VALUES
- assessing for ADVERSE EFFECTS
- has the patient’s fluid volume status improved?
what happens if the patient has a FLUID OVERLOAD?
often known as HYPERVOLEMIA
- causes more ECF VOLUME
- increases SODIUM within the BODY
- increases OSMOLAITY; triggers compensatory mechanisms to have WATER RETENTION
- can have DEVELOPING EDEMA
what are some CUES that the patient has FLUID OVERLOAD?
- pitting edema
- ascites
- increased weight
- dyspnea/crackes
- heart failure
how can we TREAT FLUID OVERLOAD?
usage of;
1. DIALYSIS
2. PARACENTESIS
3. FLUID RESTRICTION
4. SODIUM RESTRICTION
what are our POSITIVELY and NEGATIVELY CHARGED IONS?
+ ions
Na, K, Cal, Mag
negative ions
Cl, Phos, Bicarb
principal ECF electrolyte
sodium and chloride
principal ICF electrolyte
potassium
what are the SYSTEMS within the body that control ELECTROLYTES?
- RENIN-ANGIOTENSION-ALDOSTERONE SYSTEM
- ANTIDIURETIC HORMONE SYSTEM
- SYMPATHETIC NERVOUS SYSTEM
describe POTASSIUM
- the most ICF electrolyte
- NORMAL RANGE; 3.5 - 5 mEq/L
what is POTASSIUM responsible for?
- contraction of MUSCLES
- transmission of NERVE IMPULSES
- regulates the HEART BEAT
- helps to maintain ACID-BASE BALANCE
- regulates ISOTONICITY
where can we get POTASSIUM?
- fruits (BANANAS, ORANGES, dates, meat, fish, potatoes etc)
- excretion from the KIDNEYS
**have to assess patients KIDNEY FUNCTION - if impaired can cause possible TOXICITY
hypokalemia
having a DEFICIENCY OF POTASSIUM; lower than 3.5
can cause;
- SKELETAL & CARDIAC MUSC CONTRACTION
- muscle weakness
- RESP distress; weakened resp muscles
- HEARTBEAT ABNORMALITIES
hyperkalemia
having an EXCESSIVE SERUM LVL of POTASSIUM; over 5
can cause;
- MUSCLE WEAKNESS
- CRAMPING and DIARRHEA
- CARDIAC ARRHYTHMIAS
- MALAISE; feeling tired or lazy
what can CAUSE HYPERKALEMIA?
- potassium supp.
- potassium sparing diuretic
- ACE inhibitors
- renal failure
- burns/trauma/infections
what are the DRUGS USED to treat HYPERKALEMIA?
- sodium polystyrene sulfonate (potassium exchange resin)
- patiromer (veltassa)
- sodium zirconium cyclosilicate
sodium polystyrene sulfonate/potassium exchange resin
- type of CATION EXCHANGE RESIN
- works through the INTESTINE
- works by drawing out EXCESS POTASSIUM and removal by BOWEL FUNCTION
patiromer / veltassa
- a type of NON-ABSORBED CATION EXCHANGE POLYMER
- helps to INCREASE FECAL POTASSIUM EXCRETION
- can cause many adv effects; causing HYPOMAG/KAL and N/V
- can have DELAYED ONSET OF ACTION - not used for emergencies
can we ever give an UNDILUTED POTASSIUM BOLUS/SOLUTION?
no, it must always be diluted or mixed with NS
- same goes for ORAL FORMS of potassium; must dilute with water or juice
describe SODIUM
- the MOST ABUNDANT POSITIVELY CHARGED ECF ELECTROLYTE
- normal range; 135 - 145 mEq/L
- often maintained through diet
what is SODIUM RESPONSIBLE FOR?
- WATER DISTRIBUTION
- FLUID & ELECTROLYTE BALANCE
- OSMOTIC PRESSURE OF BODY FLUIDS
- ACID-BASE BALANCE
hypernatremia; CUES and CAUSES
- known as EXCESS SODIUM; above 145 mEq/L
cues;
- EDEMA
- HYPERTENSION
- RED, or FLUSHING SKIN
- INCREASED THIRST and FEVER
causes;
- due to INADEQUATE WATER CONSUMPTION
- DEHYDRATION
- poor renal excretion / poor renal function
how can we treat HYPERNATERMIA
- must replace FLUIDS!!
- oral fluids/IV replacement
hyponatremia; CUES and CAUSES
- known as a SODIUM DEFICIENCY; serum levels are BELOW 135 mEq/L
cues;
- LETHARGIC
- HYPOTENSION
- CRAMPS
- DIARRHEA/VOMITING
causes;
- lots of sweating
- PROLONGED DIARRHEA or VOMITING
how can we treat HYPONATREMIA?
- oral SODIUM CHLORIDE/restrict fluids
- IV NS/LR
