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Med Surg > Fluid & Electrolytes > Flashcards

Fluid & Electrolytes Flashcards

1
Q

Normal Sodium range

A

135-145 meq/L

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2
Q

Normal Potassium Range

A

3.5-5 meq/L

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3
Q

Hyponatremia- sodium level

A

<135 meq/L

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4
Q

Hypernatremia- sodium level

A

> 145 meq/L

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5
Q

Hypokalemia- K level

A

< 3.5 meq/L

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6
Q

Hyperkalemia- K level

A

> 5 meq/L

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7
Q

Normal pH range

A

7.35-7.45

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8
Q

Normal PCO2 range

A

35-45 mmHG

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9
Q

Normal HCO3 range

A

22-26 meq/L

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10
Q

Normal PaO2 range

A

80-100

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11
Q

Normal SaO2 range

A

90-93% (elderly/compromised)

>93% (everyone else)

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12
Q

Respiratory Alkalosis Values

A

H pH

L PCo2

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13
Q

Respiratory Acidosis Values

A

L pH

H PCo2

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14
Q

Metabolic Alkalosis Values

A

H pH

H HCO3

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15
Q

Metabolic Acidosis Values

A

L pH

L HCO3

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16
Q

What does Isotonic IV solutions do? Ex of who would receive it?

A

Increases vascular volume but does not cause a change in cell volume. The concentration of sodium is nearly equal to that of blood. Ex- Used to increase Blood Pressure.

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17
Q

What does Hypotonic IV solutions do? Ex of who would receive it?

A

Fluid in blood moves into cells. Hypotonic solutions lower serum osmolarity fluid shifts out of blood vessels and interstitial spaces. It hydrates the cells while depleting circulatory system. Ex- pts who need cellular hydration: diabetic ketoacidosis or pts depleted from diuretic therapy.

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18
Q

What does Hypertonic IV solutions do? Ex of who would receive it?

A

Fluid in cells moves into blood. Hypertonic solution raises serum osmolarity and pull fluid from interstitial compartments into intravascular compartments. (Pulls excess fluid out of cell) Ex- pts with brain injury swelling or to reduce postop edema

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19
Q

Examples of Isotonic IV Solutions

A

Ringers Lactate

Normal Saline 0.9%

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20
Q

Examples of Hypotonic IV Solutions

A

.45 NS
.33 NS
.20 NS
D5W

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21
Q

Examples of Hypertonic IV Solutions

A 
Anything with Dextrose
D10W
D5W/.9NS
D5W/.45NS
D5 LR
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22
Q

What is diffusion

A

Movement of molecules from an area of high concentration to one of low concentration. Must be permeable membrane. No external energy

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23
Q

What is facilitated diffusion

A

involves the use of a protein carrier in the cell membrane. It combines with a molecule and assists in moving the molecule across the membrane from area of high to low concentration. Req no energy. ex- glucose transport

24
Q

What is active transport

A

process where molecules move against the concentration gradient. External energy is required. Ex sodium-Potass pump

25
Q

What is osmosis and osmotic pressure

A

Osmosis is the movement of water down a concentration gradient, from region of low solute concentration to high, across a semipermeable membrane. Whenever dissolved substances are contained in a space with a semipermeable membrane, they can pull water into the space by osmosis. The concentration of the solution determines the strength of the osmotic pull or the osmotic pressure.

26
Q

what is hydrostatic pressure

A

force within a fluid compartment. In blood vessels its the blood pressure generated by the contraction of the heart. At the capillary level, hydrostatic pressure is the major force that pushes water out of the vascular system and into the interstitial space.

27
Q

What is oncotic pressure

A

is the osmotic pressure caused by plasma colloids in solution. Major colloid in vascular system is protein. Plasma protein molecules attract water, pulling fluid from tissue space to vascular space.

28
Q

The lab values for someone with ECFVD would be all High or all Low?

A

All High

29
Q

The lab values for someone with ECFVE would be all High or all Low?

A

All Low

30
Q

Causes of Extracellular fluid volume deficit (ECFVD)

A

Abnormal loss of body fluids, inadequate intake, Severe vomit/diarrhea, NG tube suction, fluid from plasma to interstitial, burns, fever, hemorrhage.

31
Q

Clinical Manifestations of ECFVD

A

Thirsty, tired, Decreased BP, Increased Heart Rate, poor skin turgor, wght loss, weakness, dry mucosa, constipated, orthostatic hypertension, decreased Central Venous Pressure, Flat jugular veins, slow capillary refill.GENERALLY NO Neuro changes or confusion.

32
Q

Expected Labs for ECFVD

A

All Labs High

  • Na > 145
  • BUN >25
  • hematocrit >55%
  • Osmolality > 295
  • Urine specific gravity >1.030
33
Q

Normal Serum Osmlality

A

275-295 mOsm/kg

34
Q

Causes of Extracellular fluid volume excess (ECFVE)

A

Heart failure, renal failure, SIADH, excessive isotonic or hypotonic IV fluids, fluid overload, pulmonary/peripheral overload, increased hydrostatic pressure, cecreased oncotic pressure, ascites.

35
Q

Clinical manifestations of ECFVE

A

(No Edema) Increased BP, Bounding Pulse, Crackles, distended jugular veins, headache, lethargy, wgt gain, polyuria

36
Q

Interventions for ECFVD

A
  • TREAT CAUSE
  • I/O
  • Daily Wgts
  • Ortho bp every 4 hrs
  • Fall precautions
  • Assess skin (Increased skin breakdown)
  • BUN/creatinine
  • Fluids
  • oral care frequently
37
Q

Interventions for ECFVE

A
  • TREAT CAUSE
  • I/O
  • Restrict sodium and fluids
  • Assess labs, Neuro, skin
  • Elevate legs
  • Support extremities
  • Mobilize fluids
  • Promote urinary elimination
  • Aspiration precautions
38
Q

Expected labs for ECFVE

A

ALL LABS LOW

  • Osmolality < 275
  • Na < 135
  • Hematocrit < 1.010
39
Q

Intracellular fluid volume deficit (ICFVD) cause, symptoms, interventions

A

Very rare. Cells shrink. Causes: wrong IV fluid given, or ECFVD is so bad that it pulls fluid from cells. Symp: thirst, oliguria, confusion, coma. Very critical. Intervent: restore fluids, address underlying cause.

40
Q

Intracellular fluid volume excess (ICFVE) cause, sympt, interventions

A

Water intoxication (excess), sodium deficit, intracellular shift of water toward sodium. Sympt: increased intracranial pressure, altered LOC, critical care. Intervent: Assess LOC and pupils, I/O, decrease intracranial pressure (keep calm, stool soft, treat any incr. in BP), fluid restriction, hypertonic IV, steroids + diuretics, Admin NA.

41
Q

Causes of Extracellular fluid volume shift: third spacing

A

Increased capillary permeability, poor nutritional status, decreased serum protein/ albumin levels, obstructed lymphatic drainage, tissue injury, protein malnutrition, increased capillary hydrostatic pressure. Tissue injury or protein malnutrition leading to fluid shift. Fluid in useless spacing.

42
Q

Clinical manifestations of Third spacing

A

EDEMA, Weak pulse, hypotension, pallor, decreased urine, decreased LOC

43
Q

Interventions for Third spacing

A
  • TREAT CAUSE
  • I/O
    prevent skin breakdown
    promote vascular repletion
44
Q

Albumin: what it is, what it does, normal serum albumin range?

A

Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood. Albumin helps keep fluid in blood from leaking into tissues. NORMAL RANGE: 3.4-5.4 g/dL

45
Q

Hyponatremia: pathophys?

A 
Na < 135
Too much water or losing too much Na
- decreased NM excitability
- delayed membrane potential
- fluid shift into ICF- cells swell
- Increased intracranial pressure
46
Q

Hyponatremia: sympt?

A
  • Headache, fatigue, thready pulse
  • apprehension, confusion, altered LOC
  • weakness, nausea, cramping
  • seizures
  • Hypovolemia: poor skin turgor, dry, thready pulse, wt loss
  • Hypervolemia: bounding pulse, wt gain, edema.
47
Q

Hyponatremia: mgmt?

A
  • TREAT CAUSE
  • Monitor CNS, GI, CV, resp, renal
  • Monitor I/O, wt, vitals
    FVD: 3% saline infusions
    FVE: diuretics and fluid restrictions
48
Q

Hypernatremia: pathophys?

A 
Na>145
Water loss or Na gain
- Increased NM excitability
- fluid shift to ECF- cells shrink
- Increased serum osmolality
- ICF dehydration
- Decreased myocardial contractility
- decreased total body water (TBW)
- hyperosmolar
49
Q

Hypernatremia: sympt?

A

Restlessness, agitation, muscle twitches, anorexia, wt loss, tachycardia, poor turgor, dry skin, fever, neuro issues.
Hypervolemia: HTN, bounding pulse, dyspnea
Hypovolemia: dry membranes, oliguria

50
Q

Hypernatremia: mgmt?

A
  • TREAT CAUSE
  • Monitor CNS, GI, CV, resp, renal
  • Monitor I/O, wt, vitals
  • Seizure precautions
  • Hypotonic IV to restore cell volume
  • Diuretics + D5W (turns hypotonic)
51
Q

Hypokalemia: Etiology/patho?

A

K <3.5 meq/l
Decreased K intake or increased K loss (vomit, diarrhea, NG suction, fistula, ileostomy, DKA, diuresis, diuretics(LOOP = K wasting), stress of surgery)
Patho: increased NM excitability

52
Q

Hypokalemia: Sympt?

A
  • may not show signs
  • thready pulse, weakness, lethargy
  • shallow resp
  • U wave on EKG
  • muscle cramps
  • slow GI
  • decrease in deep tendon responses
  • cardiac event will result
53
Q

Hypokalemia: Mgmt?

A
  • TREAT CAUSE
  • If Mg low, replenish Mg. K will not come up if Mg is not right
  • IV replacement always diluted and on pump. NO IV PUSH.
  • NEVER > 10 meq/hr*
  • monitor vitals
  • Put on remote tele
54
Q

Hyperkalemia: Etiology/patho?

A 
K > 5 meq/l
Retention of K (renal failure)
Excess K release from injured cells (traumatic accident)
Adrenal insufficiency
Altered NM excitability
55
Q

Hyperkalemia: sympt?

A
  • Early: muscle twitches cramps, tingling
  • Late: weakness, paralysis
  • diarrhea, hyperactive bowel sounds
  • dysrhythmia
  • PEAKED T WAVE on EKG
56
Q

Hyperkalemia: mgmt?

A
  • TREAT CAUSE
  • decrease K intake
  • Cation exchange resin (Kayexalate “code brown”) oral or enema causes K to be pulled out of body and into stool.
  • dialysis
  • Low K diet
  • Insulin will shift K back into ICF
  • Ca to reverse membrane excitability

Med Surg (20 decks)

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