Fluid/Electrolytes Flashcards
1
Q
Types of fluids
A
Blood Serum Saline Albumin Bile Urine Hormones Cerebrospinal ECF (Extracellular Fluid Volume) ICF (Intracellular Fluid Volume)
2
Q
Types of hormones
A
Antidiuretic Hormone
Renin-Angiotensin Aldosterone System
Atrial Natriuretic Factor
3
Q
Internal Body Organs
A
Kidneys
Heart
Lungs
4
Q
Electrolytes
A
Charged ions capable of conducting electricity
5
Q
Function of Water
A
Medium for metabolic reactions Lubricant Transport for nutrients, waste products Insulator Shock absorber Regulate and maintain body temp
6
Q
___ % of body is water
A
60%
7
Q
Main electrolytes in body fluid
A
Na+ K+ Cl- Mg 2+ Ca 2+
8
Q
General Function of Electrolytes
A
Maintain fluid volume and concentration Distribute water between compartments Regulate acid/base balance Muscle contraction Nerve impulse transmission Blood clotting Regulate enzyme reactions (ATP)
9
Q
Cations
A
Positively charged
10
Q
Anions
A
Negatively charged
11
Q
Normal loss of fluid and electrolytes occurs:
A
Urine
Stool
Sweat
Evaporation of fluid from lungs and skin (no loss of electrolytes)
12
Q
Water and electrolytes can move through:
A
Diffusion Osmosis Facilitated diffusion Filtration Active Transport
13
Q
Fluid Compartments: Extracellular
A
Vascular
Interstitial
Transcellular
Lymph
14
Q
Diffusion
A
Passive movement of electrolytes or other particles down the concentration gradient (from higher to lower concentration)
**Everything but water
15
Q
Facilitated Diffusion
A
Requires a carrier molecule
Accelerates rate of diffusion
16
Q
Osmosis
A
Movement of water from an area of lesser to one of greater concentration through a semi-permeable membrane
**Just water
17
Q
Filtration
A
Movement across a membrane under pressure from a higher to lower pressure
18
Q
Active Transport
A
Movement of ions against the osmotic pressure to an area of higher pressure: requires energy
19
Q
Hydrostatic Pressure
A
Major force that PUSHES WATER OUT of the vascular system at the capillary level and into interstitial fluid
20
Q
Osmotic Pressure
A
INWARD PULLING force caused by particles in the interstitial and intracellular fluids
21
Q
Any condition that changes osmotic pressure in either ICF or ECF compartments will cause…
A
Redistribution of water across semipermeable membrane
22
Q
The major colloid in the vascular system contributing to the total osmotic pressure is…
A
protein (albumin)
23
Q
Hydrostatic pressure and colloid osmotic pressure represent ____ and ____ required to _________ _________ between the _______ and _________ spaces
A
“push” (hydrostatic) and “pull” (Colloid Osmotic Pressure)
maintain homeostasis
interstitial and intravascular spaces
24
Q
First Spacing
A
Normal distribution of fluid in ICF and ECF
25
Second Spacing
Abnormal accumulation of interstitial fluid (edema)
26
Third Spacing
Fluid accumulation in a part of the body where it is not easily exchanged with ECF
27
Plasma to interstitial fluid shift results in _____
- _______ of hydrostatic pressure
- _______ in plasma colloid osmotic pressure
- _______ of interstitial colloid osmotic pressure
Edema
Elevation
Decrease
Elevation
28
Interstitial fluid to plasma
Fluid drawn into plasma space with increase in plasma osmotic or colloid osmotic pressure
29
What can be used to decrease peripheral edema?
Diuretics and Compression stockings
30
What is Third space fluid shift?
| Examples?
```
Loss of ECF into a space that does not contribute to equilibrium between ICF and ECF
Severe burns
Bowel obstruction
Massive bleeding
Ascites
Peritonitis
```
31
Ascites
fluid collected within abdominal cavity is secreted by capillaries of the abdominal peritoneum
32
Regulation of Body Fluids
```
Fluid intake (Thirst mechanism)
Fluid Output (Kidneys, lungs, skin, GI tract)
Hormones (Aldosterone)
```
33
Tonicity of Solutions
Hypotonic 350
34
Fluids shift in the body to....
Expand the intravascular compartment
Expand the intravascular compartment and deplete the intracellular and interstitial compartments
Expand the intracellular compartment and deplete the intravascular compartment
35
Main purpose of IVFs
Replenish fluid compartments/restore balance between the ECF and ICF
Replace renal and insensible losses
Correct electrolytes
Provide glucose calories if solution contains glucose
Correct/maintain acid-base balance
36
IV Therapy: Isotonic Solutions
Same osmolality in relation to plasma (290)
-Matches the bodys concentration of solutes in the plasma
No fluid shifts
37
IV Therapy: Isotonic solutions
Action?
Examples?
Expands the bodys fluid (extracellular) volume without causing a fluid shift, replaces fluid loss, expands intravascular (plasma) volume
Examples:
NS
LR
D5W
38
When are isotonic solutions indicated for your patient?
When your patient has low intravascular volume from fluid loss or to dilute high concentrations of electrolytes in the serum
39
Isotonic solutions are best when?
You don't want to shift fluids in or out of the cell
40
Isotonic solutions are given for fluid volume deficit but must be used with caution with what type of patients and why?
Heart and renal failure patients
| These patients cannot handle a rapid increase in blood volume
41
IV Therapy: Hypotonic Solutions
Low osmolality in relation to plasma
| Provides more water than electrolytes
42
IV Therapy: Hypotonic Solutions
Action ?
Examples ?
Dilutes the ECF and produces movement of water from the ECF to the ICF
Given to expand the intracellular space. Commonly infused to dilute extracellular fluid and rehydrate the cells of patients who have hypertonic fluid imbalances
Treat gastric fluid loss and dehydration from excessive diuresis
Examples:
2.5% Dextrose in Water
0.45% NS
5% Dextrose in 0.45%
43
Hypotonic solution is given to what type of patients?
| Whats the goal?
Hypertonic dehydration
Water replacement
Diabetic ketoacidosis with corrected sodium level
Goal:
Pull fluid from the ECF and pull into the cell
44
What type of patients shouldn't receive hypotonic solutions?
Patient with low blood pressure since it would pull the fluid dilute out the electrolytes and cause fluid to shift from the serum to the cell
(Less volume in the bloodstream = low blood pressure)
45
IV Therapy: Hypertonic Solution
```
High osmolality (concentration) in relation to plasma (>375)
Fluid shifts from ICF to ECF compartments
```
46
IV Therapy: Hypertonic Solutions
Action?
Examples?
Draws water from the cells (ICF) into the vascular and interstitial spaces (ECF)
Used to treat patients who have severe hyponatremia
```
Examples:
D5NS
D5LR
D10W
3% Na+ (2 nurse sign off)
Colloids (Albumin 25%, dextran)
```
47
When do you give hypertonic solutions?
- When your patient has dangerously low concentrations of electrolytes or glucose
- When you want to draw fluid in from the interstitial space into the plasma
48
Hypertonic solutions are very ______ to veins
Irritating
49
How should hypertonic solutions be infused?
| To prevent what?
Should be infused slowly to prevent circulatory volume overload
50
Summary: IVF: Isotonic
No fluid shifting
| Just expands the vascular volume
51
Summary: IVF: Hypotonic
Shifts fluid from within the vascular space into the cells
| Cells swell
52
Summary: IVF: Hypertonic
Shift fluid from within the cell to the vascular space
| Cells shrink
53
REGULATION of water balance maintaining homeostasis
```
Hypothalamic
Pituitary
Adrenal cortical
Renal
Cardiac
GI
Insensible water loss
```
54
Nursing assessment for fluid and electrolyte status
| What to ask the patient?
- Make sure to obtain a health history
- Think to ask and look for any chronic cardiac, renal, or endocrine diseases
- Medications
- Client's food and fluid intake, fluid output, daily weights
Physical assessment/VS
55
What to look for in a physical assessment for Fluid deficit?
Manifestations of dehydration
```
Hypotension
Tachycardia
Weak pulse
Tachypnea
Reduced urine output
Dry mucous membranes
Weight loss
Poor skin turgor
N/V
```
56
What to MONITOR for fluid volume deficit?
```
Daily weight
I&O
Lab Values
LOC
Mucous membranes
Skin turgor
Urinary output (less than 30mL/hr reported to doctor)
Vital signs
```
57
CMP Lab
Complete Metabolic Panel
| Measures electrolyte levels in the body and renal labs like BUN and Creatinine are measures of kidney function
58
CBC Lab
Hematocrit measures volume of whole blood that is RBCs
Affected by changes in plasma volume
Normal between 40-50%
59
What to monitor when giving hypotonic solutions?
Blood pressure
| Risk of lowering
60
Serum Osmolality
| Normal Range?
Measures the solute concentration of the blood
Evaluates fluid balance
Normal: 280-300 mOsm/kg
61
Urine Osmolality
| Normal Range?
Measures the solute concentration of the urine
Consists of nitrogenous wastes (BUN, Creatinine Uric acid)
Normal 200-800 mOsm/kg
62
Urine specific gravity
| Normal range?
Indicator of urine concentration
| Normal 1.005-1.030
63
Causes of fluid volume deficit: Dehydration
```
Excessive fluid loss
Insufficient intake
Failure of regulatory mechanisms
Pediatric differences
Older adults
```
64
Causes of fluid volume deficit: Dehydration: Excessive Fluid Loss examples?
```
Hemorrhage
GI Suction
Intestinal fistulas
Vomiting
Diarrhea
```
65
Causes of fluid volume deficit: Dehydration: Insufficient intake examples?
Lack of fluid access
Oral trauma
Swallowing difficulty
Altered thirst mechanism
66
Causes of fluid volume deficit: Dehydration: Failure of Regulatory Mechanisms
Burns: 1st barrier: evaporation
67
Causes of fluid volume deficit: Dehydration: Pediatric Differences
Imbalances due to exercise
Heat stress
Increased respiratory rate
Fevere
68
Causes of fluid volume deficit: Dehydration: Older adults
Fewer intracellular reserves leads to rapid dehydration
69
Nursing Interventions for fluid volume deficit
```
Encourage PO fluid intake
Administer IVF per order
Initiate fall precautions
Reposition q 2 hrs
Teach prevention of orthostatic hypotension, prevention of fluid deficit, maintaining fluid intake
```
70
Fluid Volume Deficit: Nursing Diagnosis
Deficient fluid volume
Ineffective peripheral tissue
Confusion
Activity intolerance
71
Fluid Volume Overload: Interstitial Fluid
- Increased blood hydrostatic pressure
- Decreased blood osmotic pressure
- Increased interstitial fluid osmotic pressure
- Blocked lymphatic drainage
72
Fluid Volume Overload: Interstitial Fluid: Causes of Increased blood hydrostatic pressure
Inflammation
Local infection
Right sided heart failure
Venous thrombosis
73
Fluid Volume Overload: Interstitial Fluid: Causes of Decreased blood osmotic pressure
Albumin-Nephrotic syndrome
Kwashiorkor
Liver disease
74
Fluid Volume Overload: Interstitial Fluid: Causes of increased interstitial fluid osmotic pressure
Increased capillary permeability caused by inflammation
Toxins
Burns
Hypersensitivity reactions
75
Fluid Volume Overload: Interstitial Fluid: Blocked lymphatic drainage
Tumors
Goiters
Parasites
Surgery
76
Clinical manifestations of fluid volume overload
```
Weight gain >5% over a short period of time
Edema (anasarca)/Ascites
Increased blood pressure
Full/bounding pulse
Distended neck/peripheral veins
Cough/Dyspnea/Orthopnea
Moist crackles and rhonchi in lungs **
Polyuria
Possible cerebral edema
Decreased hematocrit and BUN (diluted)
```
77
All diagnostic tests (labs) for Fluid Volume Overload will be what?
```
Decreased
CBC: Hematocrit
Serum osmolality
Specific gravity
Renal labs (BUN and Creatinine)
```
78
Nursing interventions for Fluid Volume Overload
Weigh daily
Monitor labs
Position in Fowler position
Elevate HOB
Monitor I&O, SaO2, Cardiorespiratory
Educate and encourage Na+ restriction diet
Administer meds: i.e. diuretics
Teach med safety
Oral hygiene q 2 hrs
Reposition q 2 hrs--- elevate area with edema
79
Electrolytes function is to?
- Facilitate enzyme reactions
- Transmits neuromuscular reactions
- Maintain fluid balance
- Contributing to acid-base regulation
80
Na+
Normal range?
Chief electrolyte of ___ ?
Sodium
135-145 mEq/L
ECF
81
What should you think when thinking about Na+
Neuro: confusion: cerebral edema
82
What regulates Na+ ?
Kidneys and hormones
| Aldosterone is the primary mineralocorticoid in regulating Na+
83
Where Na+ goes ____ and _____ follows
Cl- and H2O
84
Na+ is required for _____ _____ and ______ _______ transmission through the ____ / ____ pump
Nerve impulse
Muscle fiber transmission
Na+ / K+
85
Regulates volume of body fluids through which pressure
Osmotic pressure
86
Hyponatremia:
Below what range?
Critical?
87
What does hyponatremia result from?
Excess of water intake or loss of Na+
88
Water shifts from ____ to ____
ECF to ICF
89
Hyponatremia S/S
```
Abdominal cramps
Muscle cramps
Weakness
Fatigue
Confusion
N/V
Edema
Convulsions (if critically low) (cerebral edema)
```
90
Hyponatremia Tx
Diet
IV Therapy
Fluid Restrictions
91
Hypernatremia
Above what range?
Critical?
>145 mEq/L
>160 mEq/L (Critical)
92
Hypernatremia results from?
Excess of water loss or increase Na+ intake
93
Water shifts from ____ to ____
ICF to ECF
94
Hypernatremia: Clinical Manifestations
- ECF hyperosmolality
- Cellular dehydration
- Thirst
- Dry mucous membranes
- Oliguria
- Increased temp and pulse
- Flushed skin
- Restlessness
95
Hypernatremia: Tx
Diet (Low Na+)
| IVF (D5W or 0.45% NS)
96
K+
Normal Range?
Chief electrolyte of ____ ?
5.5 - 5 mEq/L
ICF
Major mineral in all cellular fluids
97
What does K+ aid in?
- Muscle contraction: i.e. cardiac and skeletal muscles
- Nerve & electrical impulse conduction
- Regulates enzyme activity
- Regulates ICF H2O content
- Assists in acid-base balance
98
K+ is regulated by ____ and _____
Kidneys and hormones
99
Hypokalemia
Below what range?
Critical?
100
Hypokalemia results from?
Affects what body systems?
Decreased intake of K+
Increased excretion via GI/Renal
K+ depleting diuretics
All body systems and life threatening
101
Hypokalemia: S/S
Muscle weakness
Leg cramps
Decreased GI motility
Cardiac arrhythmias
102
What should the nurse monitor when administering IV K+ ?
```
Place on cardiac monitor >10 mEq/L K+
Monitor IV site for phlebitis
Assure of adequate mixing of K+ in solution
Monitor elevated K+ levels
Monitor decreased Na+ levels
NEVER administer K+ by IV push
```
103
How much K+ can be administered through peripheral IV?
| Central IV?
10 mEq/hr
| 20 mEq/hr
104
Hyperkalemia
Above what range?
Critical?
>5 mEq/L
>7 mEq/L (Critical)
105
Hyperkalemia: S/S
Muscle weakness
Cardiac changes
N/V
Paresthesia of face/fingers/tongue
106
Hyperkalemia results from?
```
Excessive intake of K+
Trauma
Crush injuries
Burns
Renal failure
Adrenal insufficiency
Acidosis
```
107
Hyperkalemia: Tx
Diet
Meds: Kayaxelate (GI tract absorbs K+, explosive diarrhea), insulin, D50, Ca++ gluconate (protect heart)
IV Therapy- dilute
Possible dialysis
108
Ca++
Normal range ?
Ionized Ca++ ?
9 - 11 mg/dL
4.25 - 5.25 mg/dL
109
Ca++ is found where?
| And needed for?
```
98-99% in teeth and bones
Needed for:
nerve transmission
Vitamin B12
Muscle contraction
Blood clotting
Absorption of Vitamin D in gut
Absorption of Mg- bones
```
110
Hypocalcemia
Below range?
Results from?
111
Hypocalcemia: Manifestations
```
Osteomalacia
EKG changes
Numbness/tingling in fingers
Muscle cramps/tetany
Siezures
Chovstek sign
Trousseau sign
```
112
Hypercalcemia
Above range?
Results from?
> 11 mg/dL
Hyperparathyroidism
Bone malignancies
Prolonged immobilization
Drug toxicity (Lithium, thiazides, Vitamins A and D)
113
Hypercalcemia: S/S
```
Muscle weakness
Renal calculi
Fatigue
Altered LOC
Decreased GI motility
N/V
Cardiac change
Constipation
Polyuria
```
114
Hypercalcemia: Tx
PO4-
| IVF
115
Mg++
Normal range?
Located?
1.5-2.5 mEq/L
Located within ICF
116
Mg++ is needed for ?
```
Activating enzymes
Electrical activity
Metabolism of carbs/proteins
DNA synthesis
Production and use of ATP
```
117
Mg++ regulated by?
Intestinal absorption and kidneys
118
Hypomagnesemia
Below range?
Results from?
119
Hypomagnesemia: S/S
```
Muscles weakness
Cardiac changes
Mental changes
Hyperactive reflexes
Other hypocalcemia S/S
```
120
Hypomagnesemia: Tx
Replacement IV Therapy
Restore normal Ca levels (Mg mimics Ca)
Seizure precautions
121
Hypomagnesemia is common in what type of patients and does what with the heart?
Common in critically ill patients
Increases cardiac irritability and ventricular dysrhythmias: especially with patient with recent MI
Torsade de Pointe **
122
Hypermagnesemia
Normal range?
Results from ?
> 2.5 mEq/L
Renal failure
Increased Mg intake
123
Hypermagnesemia: S/S
```
Flushing
Lethargy
Cardiac changes (decreased HR)
Decreased resp
Loss of deep tendon reflexes
```
124
Hypermagnesemia: Tx
Restrict intake
| Diuretic Rx
125
Cl-
Normal range?
Most abundant anion in the ____
95-105 mEq/L
ECF
126
Cl- maintains what?
Osmotic pressure
Acid-base balance
Aids in digestion (forming hydrochloric acid in the stomach)
127
Hypochloremia
Below range?
Results from?
128
Hypochloremia: S/S
Paresthesia of face and extremities
Muscle spasm
Tetany
129
Hypochloremia: Tx
Diet
| IV Therapy
130
Hyperchloremia
Above range?
Results from?
>105 mEq/L
Renal failure
Overactive parathyroid glands
Metabolic acidosis
Respiratory alkalosis
131
Hyperchloremia: S/S
Muscle weakness
Increased thirst
Kussmauls's resp. (rapid, short resp)
132
Hyperchloremia: Tx
IVF
Diuretics
Treat underlying cause
