Fluid &Electrolytes Flashcards
Osmosis
movement of water and small particles pass from an area of lower concentration to an area of higher concentration until concentrations are equalized
Interstitial
Fluid around cells- reserve fluid replacing fluid either in the blood vessels or cells depending on the need
Pt with hypovolemia experiencing inadequate tissue perfusion you can expect to see what
change in mental status.heart is not being adequately perfused so you can have heart arrhythmias. Urine output less than 30cc an hr. Falling blood pressure tachypnea / falling of bp, organ problems these are signs of failing pt.
Osmolality
concentration of particles per kilogram of water too much osmolality higher is too little fluid so inverse relationship if osmolality is lower too much fluid
Osmolarity
concentration of particles per liter of solution.(does not have to be water) sn can be serum
hypernatremia causes what
pulling of water
The higher the osmolality of a solution, the greater its?
pulling power for water (osmotic pressure) sn urinalysis will tell you water osmolarity and serum osmolarity
Serum osmolality is
the concentration of particles (major particles are sodium and protein) in the blood plasma
Normal serum osmolality is
275-295
Blood Urea Nitrogen (BUN) and glucose are
large particles that increase serum osmolality
Isotonic IV Fluids Include:
Normal saline, Ringers Solution (contains sodium, potassium, calcium in similar concentrations to plasma and Lactated Ringers ( contains sodium chloride, potassium, calcium and lactate in concentrations similar to plasma
define HYPOTONIC
low fluid volume
Patients receiving hypotonic solutions require frequent monitoring of
VS, LOC, and circulation to detect depletion of vascular volume (symptoms of inadequate organ perfusion/shock) and cerebral cellular edema (Symptoms of change in level of consciousness
receiving hypotonic require frequent monitoring bc the pulling of water out of vascular into the cells causes decrease?
you will also have signs and symptoms?
circulating blood volume
of inadequate circulation
define HYPERTONIC
what does hypertonic cause in the body
higher osmolality than normal plasma too little fluid present
lower osmolality means too much fluid
hypernatremia pulling water to try to equalize concentration to bring sodium level down.
cause water to be pulled from the cells into the vessels resulting in increased vascular volume and decreased cell water
Hypertonic IV Solution include
Saline solutions greater than 0.9% (3-5%)
intracellular
resistant to fluid shift fluid that lives within the cell
Intervascular
Fluid within blood vessels- least stable and is quickly lost or gained in response to fluid intake or losses
isotonic fluid
fluid primarily in the vascular system.
same osmolality as normal plasma therefore because no osmotic pressure difference is created, fluids remain primarily in the Extracellular fluid (Vascular System)
hypotonic
decrease circulating blood volume signs & symptoms of decreased circulating blood volume. loc neurological symptoms
sodium level too low in vascular
water move out of vascular into the cell inverse relationship
osmitrol pull fluid from
third spaces usually seen in severe ascites and pleural effusions
isotonic solutions
expand circulating blood volume
Third Spacing causes
a type of fluid volume deficit
injury or inflammation, malnutrition, liver dysfunction, high vascular hydrostatic pressure as seen in heart failure, renal failure
assessment of fluid volume deficit
urine output >30cc/hr metnal status change status, dark urine with high specific gravity normal is 1.010 to 1.030, decreased turgor test only on sternum, forehead or inner thigh
normal high specific gravity
1.010 to 1.030
serum osmolality range
275-295
fluid excess major concerns are cerebral edema congestive heart failure pulmonary edema
sign and symptom
adventitious lung sounds you usually see this before peripheral edema
causes of isotonic fluid excess
renal failure, heart failure, excessive fluid intake, high corticosteroid levels due to therapy, stress response or x
hypotonic fluid excess (water intoxication)
Repeated plain water enemas or NG tube irrigations with plain water – the free water is drawn into cells while the expelled water washed out electrolytes
Overuse of hypotonic solutions
Syndrome of Inappropriate ADH causes excessive release of ADH causing retention of water
Mechanisms of Edema
Increased hydrostatic pressure such as hypertension or vascular fluid overload forces more fluid out of the arterial end of the capillary and draws less fluid back into the venous endDecreased oncotic pressure because of decreased albumin or plasma proteins allows more fluid to be pushed out of the arterial end and draws less fluid back into the venous end
how to grade edema
1+ (minimal) to 4+ (severe)
anasarca
generalized edema seen in periorbital area most often related to heart, liver, and kidney problems.
fluid excess assessment
distended jugular neck vein when head of bed is elevated to 45 degrees, decreased 02 sat, wet lung sounds crackles, gallop s3 heart sound, tight shiny skin , delayed vein emptying >5 secs when hand raised, tachypnea, dyspnea, productive cough
fluid excess diagnostic test
low serum sodium <125
serum osmolality <275
chest x-rays may show pleural effusions
risk factors associated with fluid volume excess
elderly because of decreased heart and kidney function
infants and children 2-12 have less stable regulatory response to fluid imbalances
acute illness surgery stimulates the stress response
chronic illness-cardiac dx, cardiac output with less perfusion of kidneys
renal dx leads to abnormal retention of water
ways to fix fluid volume excess
1000-1500/day
240cc is cup of water
sodium restriction
promote excretion by using loop diuretics (furosemdie-lasix)
potassium sparing diuretics (spironolactone-aldactone), thiazide diuretics,
human b-type natriuretic peptide (hBNP)
digoxin, beta-blocking agents and ace increase cardiac output and renal perfusion
sodium level in the vasculature is too high what happens ( excess particles less water)
sodium lower than normal what occurs (less particles excess water)
fluid moves from cell to vasculature brain can be dehydrated
fluid is going to move from the vasculature into the cells which can cerebral edema which will be manifested by neurological changes
counseling a patient for a low sodium diet what would you tell them to eat
fresh meat, fish, vegetables and fruits, no-added salt snack items, sodium free spices, low sodium canned products
hyponatremic response
adh- renal sodium excretion is decreased by stimulating less fluid excretion by the kidneys
aldosterone promotes sodium retention and potassium excretion
osmotic force of water in the brain can lead to the development of cerebral edema
hyponatremia predisposing clinical conditions
renal losses through excretion, diuretic administration and renal dx.
GI losses through vomiting, diarrhea, gastric suctioning, tap water enemas, GI surgeries and bulimia.
Skin losses through perspiration, burns, tissue destruction
Wound drainage and wound suctioning
what hyponatremia assessment can you used on your patients to determine if they have low sodium serum
thirst, neuromuscular problems lethargy, weakness, and neurological changes headaches confusion, agitation, dizziness, seizures
What assessment findings do you see with decreased vascular volume
What assessment findings do you see with increased vascular volume
tachycardia, hypotension, pale dry skin and dry mucous membrane
hypertension, bounding pulse, edema and weight gain
Diagnostic test for Hyponatremia
serum sodium <135
urine specific gravity <1.010
decreased BUN and Hematocrit
hyponatremia with hypovolemic volume is treated with?
normal saline or lactated ringers
hypernatremia-assesment
tachycardia, hypertension, dry sticky mucous membrane, thirst, increased urine output, twitching, tremor, hyper-reflexia, agitation, watery diarrhea, nausea, chloride level may also be elevated
what are some important consideration for administering potassium
Iv potassium administration should not be infused more quickly than
never give potassium through which routes
you are always supposed to use IV through what?
administer potassium oral supplements with at least 4 oz of fluid
never crush or break tablets or capsules
take potassium with or after meals
10-20mEq in 100 cc NS/hr or in concentrations greater than 40mEq per liter
iv push or im
infusion pump
Potassium should be administered in ____free solutions to avoid the release of insulin which will transport the potassium into cells.
If more than _____ is administered the client should have continuous ___ and have potassium levels checked every ___ to __ hrs.
dextrose
20mEq/hr
EKG monitoring
4-6 hours
elevated potassium levels results from decreased excretion due to what?
adrenal and renal insufficiencies
what are a few reasons someone can have hyperkalemia of >5.0
excessive potassium intake, potassium sparing diuretics, decreased excretion due to adrenal and kidney insufficiencies, burns, gi bleeds, insulin deficiencies, metabolic acidosis,
what are some signs you will see in a pt that has hyperkalemia
Irregular slow heart rate
Decreased blood pressure
EKG changes: tall, peaked T waves, widened QRS, frequent abnormal beats and ventricular arrhythmias
Muscle twitching, muscle cramps
Hyperkalemia nursing Interventions
Restrict potassium intake,
Monitor labs,
Monitor for cardiac arrhythmias, metabolic acidosis, administer diuretics as ordered.
Beware that numerous blood transfusions can cause elevated potassium unless administered in the form of packed red blood cells,
calcium function as a extracellular cation found in hard bones and provide what functions in the body?
skeletal and heart muscle relaxation activation, excitation and contraction,
calming effect on nerve cells, blood clotting - innervates conversion of prothrombin to thrombin, bone and teeth health, lactation
calcium regulation is stimulated by what?
parathyroid hormone
calcium levels are dependent upon?
what does calcitrol do ?
what is calcitonin
calcium and ____ levels are inversely related?
calcitrol
they play a major role in prevention of hypocalcemia and hypomagnesemia noted by neuromuscular irritability
a calcium lowering hormone produced by the thyroid – counteracts PTH by transferring calcium from plasma to skeletal system
phosphorus
adults need to consume how much calcium daily?
pregnant, lactating, and postmeno women need to consume how much calcium daily
1000-1200mg
1200-1500mg
what are a few causes of hypocalcemia
hypoparathyroidism, hypomagnesemia, massive blood transfusions,
hypoalbuminemia, acute pancreatitis- Calcium in the intestine binds to undigested fat and excreted via GI tract,
inadequate vitamin D,
Renal dx
what are the clinical manifestations seen with hypocalcemia?
what are two crucial ways to test for hypocalcemia and what are the following test consist of?
Tetany/laryngospasm – airway obstruction, Hyperactive deep tendon reflexes, Hyperactive bowel sounds, abdominal cramps diarrhea, mental status changes, Hypotension, decreased cardiac contractility
Chvostek’s (tapping facial nerve results in facial muscle contraction and twitching) and Trousseau’s(inflation of BP cuff upper arm 20 mm above systolic for 3 minutes results in carpal spasm) signs positive
Interventions with a pt affected by hypocalcemia?
Daily oral doses or elemental calcium gluconate 1-3 gms per day
Vitamin D to absorb calcium 400-1000IU
Phosphorus binding antacids to increase calcium
Monitor lab values and for signs of tetany
Have emergency equipment at the bedside for high risk clients to manage airway obstruction (laryngospasm) 100% oxygen via rebreather mask
Basic Metabolic Profile
Glucose Sodium Potassium BUN Creatinine C02
Anion Gap
70-120 135-145 3.5-5 5-20 0.6-1.3 22-26 <22 associated with respiratory alkalosis or metabolic acidosis; >26 associated with respiratory acidosis or metabolic alkalosis
3-11(Serum sodium minus the sum of the chloride and bicarbonate levels) Anion gap is increased in metabolic acidosis associated with acid gain but remains normal in metabolic acidosis caused by bicarbonate loss
Hypercalcemia can be caused by ?
Steroids – increase calcium reabsorption from bone
Metastatic Cancer – most common cause related to increased release of calcium from bone that is destroyed; tumor cells can stimulate bone reabsorption and increased calcium excretion from bones
Renal insufficiency or failure
Hypercalcemia treatment and nursing interventions
Isotonic solutions at 300-500 ml/hr and up to 6 liters until vascular volume restored or calcium 8-9 Synthetic calcitonin to lower levels Low calcium diet Loop diuretics to promote excretion IV phosphorous Dialysis
