FLUID & ELECTROLYTES

Question 1

Positive electroyltes

Answer 1

cations- magnesium, potassium, sodium, calcium

Question 2

Negative electrolytes

Answer 2

anions- phosphate, sulfate, chloride, bicarbonate

Question 3

Hypovolemia-Isotonic FVD

Answer 3

loss of water and electrolytes

Hypovolemia can lead to hypovolemic shock.

Question 4

Dehydration-osmolar FVD

Answer 4

Loss of water with no loss of electrolytes.
Hemoconcentration- increased HCT, serum, electrolytes, and urine SG.

Compensatory Mechanisms- sympathetic nervous system responses of increased thirst,ADH release, aldosterone release

Question 5

Causes of hypovolemia

Answer 5

GI losses, diaphoresis, renal losses (diuretics, DI, renal disease, adrenal insufficiency, osmotic diuresis), third spacing (peritonitis, intestinal obstruction, ascietes, burns), hemorrhage, altered intake- NPO.

Question 6

Causes of dehydration

Answer 6

hyperventilation, DKA, enteral feeding without sufficient water intake

Question 7

hypervolemia-isotonic FVE

Answer 7

water and sodium retained in abnormally high proportions

severe hypervolemia leads to PE and HF

decreased hct, sodium normal, decreased electrolytes, bun, creatinine

Question 8

overhydration-osmolar FVE

Answer 8

more water gained than electrolytes

hemodilution occurs with overhydration- decreased HCT, serum electrolytes, and protein

decreased hct, decreased hemodilution, decreased electrolytes, bun, creat.

Compensatory mechanisms- increased release of naturetic peptides, increased loss of sodium and water by the kidneys and decreased release of aldosterone

Question 9

Causes of hypervolemia

Answer 9

chronic stimulus to the kidney to conserve sodium and water (HF, cirrhosis, increased glucocorticoids), abnormal renal fx with reduced excretion of sodium and water (renal failure), interstitial to plasma fluid shifts (hypertonic fluids, burns), age related changes in cardiovascular and renal fx, excessive sodium intake

Question 10

Causes of overhydration

Answer 10

water replacement without electrolyte placement (strenuous exercise with profuse diaphoresis)

Question 11

Sodium

Answer 11

found in ECF
maintains acid/base balance, active and passive transport mechanisms, irritability and conduction of nerve and muscle tissue
136-145 mEq/L

Question 12

Hyponatremia

Answer 12

less than 136. net gain of water or loss of sodium rich fluid. delays and slows the depolarization of membranes. water moves from ECF to ICF- causes cells to swell. can lead to coma, seizures, respiratory arrest.

Question 13

Causes of hyponatremia

Answer 13

deficient ECF volume, abnormal GI losses, renal losses, skin losses, increased or normal ECF volume (increased water intake, SIADH), edematous states, excessive hypotonic IV fluids, inadequate sodium intake (NPO status), age related RF.

Question 14

Hyponatremia symptoms

Answer 14

hypothermia, tachycardia, rapid thready pulse, hypotension, orthostatic hypotension.
Headache, confusion, lethargy, muscle weakness with possible respiratory compromise, fatigue, decreased DTR. Increased motility, hyperactive bowel sounds, abdominal cramping, nausea.

Question 15

Hyponatremia tx

Answer 15

restrict fluids, administer hypertonic oral and IV fluids as prescribed, encourage foods high in sodium, restore normal ECF volume- administer isotonic IVF

Question 16

Hypernatremia

Answer 16

> 145, causes significant neurological, endocrine, and cardiac disturbances. causes hypertonicity of the serum- causes a shift in water out of the cells making the cells dehydrated.

Question 17

Causes of hypernatremia

Answer 17

water deprivation (NPO), excessive sodium intake, excessive sodium retention- renal failure, cushings, aldosteronism, meds(glucocorticoids), fluid losses-fever, diaphoresis, burns, respiratory infection, diabetes insipidus, hyperglycemia, watery diarrhea. age related changes, compensatory mechanisms- increased thirst and increased production of adh.

Question 18

Hypernatremia symptoms

Answer 18

hyperthermia, tachycardia, orthostatic hypotension.
Restlessness, irritability, muscle twitching, muscle weakness, seizures, coma, reduced/absent DTR.
thirst, dry mucous membranes, increased motility, hyperactive bowel sounds, abdominal cramping, nausea

Question 19

Hypernatremia TX

Answer 19

administer hypotonic IV fluids (0.45% NS), administer isotonic IVF, encourage water intake, discourage sodium intake, administer loop diuretics

Question 20

Potassium

Answer 20

major cation in ICF, vital role in cell metabolism, transmission of nerve impulses, functioning of cardiac, lung and muscle tissue, and acid/base balance.
Has reciprocal action with sodium.
levels 3.5-5 mEq/L

Question 21

Hypokalemia

Answer 21

<3.5, result of increased loss of potassium from the body or movement of potassium into the cells

Hypokalemia increases risk of digoxin toxicity.

Question 22

Causes of Hypokalemia

Answer 22

abnormal GI losses- vom, suction, diarrhea, laxatives. renal losses- diuretics such as furosemide, cortecosteroids. skin losses- sweat, wounds. insufficient K, insufficient in diet is rare. prolonged administration of non-electrolyte IVF such as D5W. ICF- metabolic alkalosis after correction of acidosis, during periods of tissue repair (burns, trauma, starvation), TPN. Age related- old ppl.

Question 23

Hypokalemia symptoms

Answer 23

hyperthermia, weak irregular pulse, hypotension, respiratory distress.
weakness with resp collapse/paralysis, muscle cramping, decreased muscle tone and hypoactive reflexes, paresthesias, mental confusion.
PVCs, bradycardia, blocks, vtach, inverted T waves, ST depression.
Decreased motility, abdominal distention, constipation, ileus, n/v, anorexia
polyuria (excess dilute urine)
metabolic alkalosis

Question 24

Hypokalemia TX

Answer 24

replace potassium- encourage foods (avocados, brocolli, dairy, dried fruit, canteloupe, bananas), oral supplement, IV supplement- NEVER IV BOLUS (high risk of cardiac arrest), max recommended IV rate is 5-10 mEq/hr.

Question 25

Hyperkalemia

Answer 25

> 5.0

Increased intake of K, movement of K out of the cells, or inadequate renal excretion.

Question 26

Causes of Hyperkalemia

Answer 26

increased K form IV K or salt substitutes, ECF shift- decreased insulin, acidosis (DKA), tissue catabolism (sepsis, trauma, surgery, fever, MI). hypertonic states (uncontrolled DM). decreased excretion of potassium (renal failure, severe dehydration, K sparing diuretics, ACEIs, nsaids, adrenal insufficiency). old people.

Question 27

Hyperkalemia symptoms

Answer 27

slow irregular pulse, hypotension
restlessness, irritability, weakness with ascending flaccid paralysis, paresthesias.
vfib, peaked Twaves, widened QRS.
n/v/d, increased motility, hyperactive bowel sounds.
oliguria.
metabolic alkalosis

Question 28

Hyperkalemia TX

Answer 28

stop IV K, withhold oral K, K restricted diet, dialysis. Promote movement of K from ECF to ICF- fluids with dextrose and regular insulin, sodium bicarb to reverse acidosis. Loop diuretics- lasix if renal fx is adequate

Question 29

Calcium

Answer 29

found in bones and teeth.
9-10.5 mg/dL
calcium balance is essential for proper fx of cardiovascular, neuromuscular, endocrine, blood clotting, bone and teeth formation.

Question 30

Hypocalcemia causes

Answer 30

malabsorption syndromes- crohns, ESRD, post thyroidectomy, hypoparathyroidism, repeated transfusion.

Question 31

Hypocalcemia symptoms

Answer 31

frequent painful muscle spasms at rest, hyperactive DTR, positive chovesteks and trosseaus sign, decreased myocardial contractility (decreased HR and hypotension), hyperactive bowel sounds, diarrhea, abdominal cramping, seizures due to overstimulation of CNS, prolonged QT interval

Question 32

Hypocalcemia TX

Answer 32

oral or IV calcium, seizure precautions, foods high in Ca

Question 33

Magnesium

Answer 33

most found in bones, small amount in cells, tiny in ECF

1.3-2.1 mEq/L

Question 34

Hypomagnesemia

Answer 34

caused by malnutrition, alcohol ingestion.
s/s: increased nerve impulse transmission (hyperactive DTRs, paresthesias, muscle tetany), positive chvosteks and trosseaus. hypoactive bowel sounds, constipation, abdominal distention, paralytic ileus.
TX: dc diuretics, oral or IV mag sulfate. oral can cause diarrhea, foods high in mag- dairy, dark green veg.