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N320 -Med/Surg Drexel > Fluid/Electrolytes > Flashcards

Fluid/Electrolytes Flashcards

1
Q

Intake

A

addition of Fluid and electrolytes into the body

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2
Q

Absorption

A

movement of fluid and electrolytes into the bloodstream

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3
Q

Distribution

A

process of moving fluid between compartments

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4
Q

output

A

removal of Fluid and Electrolytes from the body via normal or abnormal routes

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5
Q

Fluid Balance

A

extracellular volume and osmolarity

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6
Q

electrolyte balance

A

extracellular fluid volume, body fluid osmolarity and plasma electrolyte concentration on a continuum

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7
Q

Osmolarity

A

concentration of molecule per weight of water

  • number of dissolved particles per unit of water*
  1. When the amount of water decreases in relation to # particles, the osmolality increases and becomes concentrated
  2. When the amount of water increases relative to solutes the osmolality decreases and becomes more diluted
  3. The primary particle responsible for regulating osmolality is sodium
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8
Q

hyper-osmolarity

A

Cells shrinking

ex: dehydration

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9
Q

Hypo-osmolarity

A

cells swelling-water gain

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10
Q

Methods of Fluid intake

A 
Oral
IV
insertion into rectum
NG tubes
infusion into body cavities
bone marrow (intraosseous)
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11
Q

Mechanism for oral intake

A

Thirst- stimulated by increased osmolarity and receptors for hypovolemia

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12
Q

Electrolyte Intake ( except IV)

A

must be absorbed by the body

CA+( calcium) absorbed in intestine (duodenum); and requires vitamin D

MG++( magnesium) absorbed by the intestinal epithelium of ileum

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13
Q

Total body water Average for adult

A

60%

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14
Q

Intracellular fluid

A
  • 40% inside the cell,
  • mostly skeletal muscle cells
  • function- keep you hydrated
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15
Q

Extracellular fluid

A

20 %

  1. -Interstitial: outside the vessel and outside the cells (EDEMA) :contains little to no protein
  2. Intravascular: inside the vessel
  3. Transcellular: Outside the cell, outside the vessel – example intra-optic fluid synovial fluid
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16
Q

Hydrostatic Pressure

A
  • Influence by blood pressure and blood Volume

- Pushes fluid out of capillary

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17
Q

Colloidal Osmotic Pressure

A

(Constant unless problems w/ protein)

  • Exerted by plasma proteins
  • Draws fluid back into capillary
  • *Direction of fluid depends on the difference of the opposing forces**
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18
Q

Protein Dificiency

A

Think ~ LIVER

  • inadequate intake
  • protein loss
  • decreased protein synthesis
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19
Q

Signs of low protein

A
  1. Decrease muscle mass (measured by weight loss)
  2. slow wound healing
  3. edema
  4. lethargy/fatigue
  5. anemia
  6. low hemoglobin
  7. shortness of breath
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20
Q

EDEMA

A
  • Pitting
  • Dependent
  • Weeping
  • Anasarca
  • Other (ascites, plural effusion)
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21
Q

What do you do for Protein deficiency???

A
  • Diet high in carbs and protein (increase carbs so they don’t use the protein for energy)
  • IV or tube feedings with amino acids.
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22
Q

Distribution of Sodium

A

High extracellular pool concentration

-reflects osmolarity

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23
Q

Distribution of Potassium

A

high intracellular pool concentration

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24
Q

Distribution of Calclium

A

Bone pool

-parathyroid-intracellular and bone pool

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25
Q

Distribution of Magnesium

A

Intracellular and bone pool

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26
Q

What factors influence Distribution

A

Hormones, diet, diseases/conditions

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27
Q

Sodium ( NA+)

A

135 - 145 mEq/L

What it does:
Water Retention, fluid volume regulation

Manifestation:
S/s hydration/dehydration

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28
Q

Chloride (Cl-)

A

97 - 107 mEq/L

What it does: for Acid/Base balance, fluid, hydrocholric acid in stomach

Manifestation:
S/s Kidney problems

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29
Q

Potassium (K+)

A

3.5 - 5.0 mEq/L

What it does: Na-K pump, cardiac**, role in muscle activity -Primarily inside the cell, high intracellular conc.

Manifestation:
lef cramps, arrhythmias

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30
Q

Calcium (Ca++)

A

8.2 - 10.2 mg/dL

important to bones Coagulation; clotting factors, muscle contractions, slows peristalsis

Manifestations:
Muscle contractions, twitching
Hyperkalemia= kidney stones, arrhythmias, *clotting factor

31
Q

Phosphorus (PO4-)

A

2.5 - 4.5 mg/dL

What it does: Acid/Base, ATP formation, *antagonist to calcium

Manifestations:
S/s Calcium Imbalance

32
Q

Magnesium (Mg++)

A

1.6 - 2.6 mg/dL

What it does: Neuromuscular excitability, reflexes, Nerve conduction to muscles (problems with muscles affect the diaphragm); THINK RESPIRATORY

Manfestation:
Change in respiratory status

33
Q

Bicarbonate (HCO3-)

A

22 - 26 mEq/L

Acid/Base; produced by kidneys

34
Q

Normal Excretory Routes

A
  1. Kidneys should produce - 30mL/HR
    ( this is an average if you know nothing about the patient)

Ideal: 1-2ml/kg/hr
(below 1 indicates kidney failure/disfunction)

  1. Skin
    o Sensible Perspiration (sweat, can see it)
    o Insensible Perspiration (almost like evaporation, skin) 200-300/day (lose more with pyrexia)
  2. Lungs ( increased respiration-more fluid loss)
  3. gastrointestinal Tract - POOOOOOOOP
35
Q

Abnormal excretory routes

A

Emesis
Hemorrhage
Drainage ( fistulas, tubes, etc.)

36
Q

Renal Excretion

A

Antidiuretic hormone (ADH) - regulates excretion for water only (posterior pituitary)

Aldosterone- retians NA+ and water and promotes renal excretion of K+ ( Adrenal Cortex)

37
Q

Calculation of Fluid Loss

A

1L = 2.2 lbs = 1kg

38
Q

Hemostasis is achieved by

A
  • Renal System
  • Hormonal System
  • Respiratory System
39
Q

Common Diagnostic Labs

A
  1. CBC ( Complete Blood Count)
  2. Electrolytes
  3. Serum Creatinine
  4. BUN
  5. Plasma Proteins
  6. Routine UA
40
Q

CBC

A 
o	Red blood cells (oxygenation)
o	White blood cells (infection)
o	Hematocrit (concentration= reflection of hydration)
o	Plasma
o	Platelets
41
Q

Serum Creaetinine

A

0.5 – 1.2 mg/dL

Kidney Function
High = Impaired /renal disease

42
Q

BUN ( Blood, urea, Nitrogen)

A

waste products – Kidney Function, but because its mixed with blood- ratio; concentration, Reflection of hydration (increase= dehydration, high=fluid overload)
o 8-21mg/dL

43
Q

Plasma Protein

A

o Total Proteins: 6.4-8.3g/dL
o Albumin: 3.5 – 5.0 g/dL

low in pts. with edema

44
Q

Routine UA

A

o Specific Gravity – 1.005-1.030
o PH
o Ketones
o Blood

45
Q

Inside the cell

A

K+, MG++, PO4-

46
Q

Outside the cell

A

NA+, HCO3, CA++

47
Q

Respiratory Acidosis

A

Causes: ( increased HCO3 and Increased CO2 )

  • Cardiac/Resp. Distress
  • overdose of sedatives
  • not coughing/deep breathing after surgery

S/S:

Mental Changes
headache
restlessness
dizziness
Coma (SEVERE)

WDYD:
improve ventilation

*DIS BREATHING HARDDDDDDD

48
Q

Respiratory Alkalosis

A 
Causes: ( Decreased CO2, Decreased HCO3)
hyperventilation
aftermath of extreme exercise
anxiety
not enough CO2 ( High flow O2)

S/S:

  • hear palpatations
  • lightheadedness
  • sweating
  • drymouth
  • N/V
  • Epigastric pain

WDYD:

  • Eliminate cause
  • control breathing
  • breath into a closed system ( paperbag)

BASIC BITCH BREATHING PROBLEM- ANXIETY AND HYPERVENTILATION**

49
Q

Metabolic Acidosis

A

Causes: ( Decreased PH, Decrease in HCO3) too much acid

  • Chronic Renal Failure
  • ketoacidosis
  • diarrhea ( loosing bicarb)
  • KyperKalemia

S/S:

  • headache
  • Increased RR ( excess of acid-lungs trying to excrete)
  • weakness

WDYD:

  • IV bicarb
  • fix underlying problem
  • observe for Hyperkalemia
50
Q

Metabolic Alkalosis

A

Causes: Increase in HCO3 and Increase in PH ( too much bicarb)

  • vomiting
  • gastric suctioning
  • antacids
  • kypokalemia

S/S:

  • dizziness
  • irritability
  • tingling digits
  • Decreased RR ( not enough acid, RR decreases to build up CO2)

WDYD:

  • Increase Cl to absorb NA resulting in HCO3 Excretion
  • Observe for hypokalemia
  • reverse underlying disorder
51
Q

Hyponatremia

A

Causes:
Loss of NA+
-Hypervolemia

S/S:

  • mental status changes
  • headaches
  • lethergy

WDYD:

  • isotonic IV
  • hypotonic IV
  • Restrict H2O intake
  • monitor for CNS changes
52
Q

Hypernatremia

A

Causes:

  • too much sodium intake
  • Dehydration
  • hypovolemia

S/S:

  • tachycardia
  • thirst
  • decreased urine output
  • hypoxia
  • decreased body weight

WDYD:

  • limit NA intake
  • isotonic or hypotonic IV
  • Monitor for mental status changes
53
Q

Hypochloremia ( Cl-)

SAME AS - NA!!!!! ( SODIUM CHOLRIDE)

A

Causes:

  • Metabolic Alkalosis
  • loss of NA

S/S:

  • mental status changes
  • headache
  • lethargy

WDYD:

  • Isotonic IV
  • Hypertonic IV
  • Monitor CNS

EAT FOODS HIGH IN CHLORIDE:

  • processed meats
  • canned veggies
  • bananas
  • tomatoes
  • foods high in salt
54
Q

Hyperchloremia ( Cl-)

A

Causes:

  • similar to hypernatremia
  • metabolic acidosis
  • fluid volume excess

S/S:

  • tachycardia
  • thirst
  • decrease urine output/weight
  • hypoxia

WDYD:
-increase bicarb

Avoid FOODS HIGH IN CHLORIDE:

  • processed meats
  • canned veggies
  • bananas
  • tomatoes
  • foods high in salt
55
Q

Hypomag ( MG++)

A

Causes:

  • alcoholism
  • malnutrition
  • diarrhea

S/S:

  • hyperactive reflexes
  • tetany
  • increased HP and BP

WDYD:

  • mag replacement ( same as IV K+ : SLOWWWWWW IV DRIP)
  • monitor cardiac sxs

Increase foods high in Magnesium:

  • Chocolate
  • soybeans
  • spinach
  • almonds
  • avocado
  • oatmeal
  • flax seed
56
Q

HyperMAG

A

Causes:

  • Renal Failure
  • Excessive MG++ intake
S/S:
- Flush skin
-sense of warmth
-N/V
-Decreased reflexes 
SEVERE: respiratory and Cardiac Depression

WDYD:

  • dialysis for kidney failure
  • calcium intake
  • monitor for cardiac sxs

Decrease foods high in Magnesium:

  • Chocolate
  • soybeans
  • spinach
  • almonds
  • avocado
  • oatmeal
  • flax seed
57
Q

Hypokalemia ( K+)

A

Causes:

  • N/V/D
  • Hyper-aldosteronism
  • too little potassium intake

S/S:

  • HEART ISSUES
  • tachycardia

WDYD:

  • give K+ ( SLOWW, IV DRIP)
  • increase intake
  • pt. education

Eat foods high in K+:

  • banana
  • avocados
  • spinach
  • green leafy veggies
  • potatoes
  • squash
  • white beans
  • citrus FRUITS
58
Q

Hyperkalemia (K+)

A

Causes:

  • excessive potassium intake (salt substitutes)
  • potassium sparing diuretics
  • renal failure
  • Metabolic Acidosis

S/S:

  • dirrhea
  • cramping
  • cardia issues ( Peak T-waves)

WDYD:

  • limit potassium intake
  • give calcium to alleviate heart issues
  • regular insulin and glucose
  • Kayexalate
59
Q

Hypophosphatemia

SEESAW WITH CALCIUM

(hypercalcemia)

A

Causes:

  • Hyperparathyroidism
  • chronic Diarrhea

S/S:

  • numbness
  • weakness ( from increase CA)
  • decreased cardiac output
  • mental status changes

WDYD:

  • replace PO4-
  • assess calcium levels
  • diet

Eat foods high in phosphate:

  • meat
  • poultry
  • fish
  • beans
  • nuts
  • dairy
60
Q

HyperPhosphatemia

hypocalcemia

A

Causes:

  • renal failure
  • hypo-PTH
  • excessive intake

S/S:

  • tingling fingers
  • muscle spasms

WDYD:

  • IV Calcium ( FLUSH BEFORE and AFTER, NO IM injections)
  • Treat underlying disorder

Avoid foods high in phosphate:

  • meat
  • poultry
  • fish
  • beans
  • nuts
  • dairy
61
Q

HypoCalcemia

Seesaw with PO4

(hyperphosphatemia)

A

Causes:

  • renal failure
  • hypoparathyroidism
  • too little Vitamin D
S/S: "CATS"
-Confusion/Convulsions
-Arrhythmias
-Tetany/Trousseau's sign/ Chvosteks sign
-Spasms/
Stridor (in the lungs)

WDYD:

  • increase vitamin D
  • IV Calcium ( FLUSH BEFORE and AFTER, NO IM injections)

Increase foods high in Calcium:
-milk, dairy, green leafy veggies, broccoli

62
Q

Hypercalcemia

BONES, STONES, GROANS

A

Causes:

  • hyperparathyroidism
  • immobility (leaching from bones)
  • over use of calcium products
  • malignancies

S/S:

  • kidney stones
  • muscle weakness
  • bradycardia ( weak heart beats slow)
  • fatigue
  • constipation ( weak muscles= decreased peristalsis)

WDYD:

  • IV phosphorus
  • IV fluids
  • GET THE PATIENT UPPPPP
  • Low calcium diet:

decrease milk, dairy, leafy veggies and broccoli

63
Q

What electrolytes are lost with vomiting

A

H+

NA+
K+
Cl-

Think: upper GI looses hydrochloric acid from stomach

64
Q

What electrolytes are lost with diarrhea

A

HCO3
NA+
K+
Cl-

Think: Lower GI looses BICARB from instestines
(bicarb out the butt)

65
Q

What CAN’T a UAP do

A

can’t take initial vitals
no teaching
no assessing
nothing invasive

66
Q

What Can’t an LPN do

A

Can’t do initial assessment
can NOT initiate teaching
can NO do things with IVs!!!

67
Q

5 Rights of delegation

A
  1. Task
  2. Circumstance.Concern
  3. Person
  4. Directions/Communication
  5. Supervision ( reporting back to RN)
68
Q

Hypotonic IV solutions

A

lower osmolarity than cells

-increases volume of cell, increases pressure

  • D5W
  • 45% NS
  • 25% NS
69
Q

Isotonic IV solutions

A

-Same osmolarity as blood and bodily fluids

.9 NS
Lactated Ringers

70
Q

hypertonic IV Solutions

A

Higher osmolarity than cells

  • any saline higher than .9
  • 25% dextrose in water

-decreases volume of cell, decreases pressure

71
Q

Renin-Angiotensin-Aldosterone system

A

Kicks in when blood pressure is low or if serum sodium.

Purpose: Regulating blood pressure

Renin releases into blood from kidneys and angiotensinogen from liver make angiotensin 1 which mixes with ACE enzymes in the lungs which makes angiotensin 2 (which is a potent vasoconstrictor)

Angiotensin 2 does 4 things

  1. hypothalamus kicks in thirst mechanism
  2. adrenal cortex releases aldosterone (increases reabsorption of sodium, decrease potassium)
  3. Blood vessels constrict
  4. ADH secretion from pituitary

all 4 things increases blood pressure

72
Q

ADH

A

Is released from the posterior pituitary in response to increased osmolarity (high blood concentration and increased sodium), decreased BP or Decreased blood volume

synthesized in hypothalamus and released by posterior pituitary

  • makes the kidnesy reabsorb water and puts this water back into the vascular system thus decreasing the concentration of the blood and increasing blood volume

( output of concentrated urine , peeing out more electrolytes than water) =HIGH specific gravity

73
Q

Aldosterone

A

increases sodium

decreases potassium

74
Q

Naturitic Peptide Hormone

A

in response to increased blood volume or increased blood pressure is released from specialized cells in the heart and DILATES the vasculature, thus decreasing blood pressure

N320 -Med/Surg Drexel (35 decks)

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