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NURS 312 > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Homeostasis

A

State of equilibrium within the body; naturally maintained by adaptive responses. Body fluids and electrolytes are maintained within narrow limits.

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2
Q

What fraction of body water is intracellular fluid

A

2/3 of body water

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3
Q

What fraction of body water is extracellular fluid

A

1/3 of body water; interstitial fluid, intravascular fluid (plasma), and cerebral spinal fluid

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4
Q

Sodium (cation) ranges

A

ECF: 135-145 mEq/L
ICF: 10-14 mEq/L

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5
Q

Chloride (anion) ranges

A

ECF: 98-106 mEq/L
ICF: 3-4 mEq/L

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6
Q

Potassium (cation) ranges

A

ECF: 3.5-5.0 mEq/L
ICF: 140-150 mEq/L

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7
Q

Bicarbonate (anion) ranges

A

ECF: 24-31 mEq/L
ICF: 7-10 mEq/L

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8
Q

Calcium (cation) ranges

A

ECF: 8.5-10.5 mg/dL
ICF: <1 mEq/L

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9
Q

Phosphate (anion) ranges

A

ECF: 2.5-4.5 mg/dL
ICF: Variable

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10
Q

Magnesium (cation) ranges

A

ECF: 1.8-3.0 mg/dL
ICF: 40 mEq/Kg

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11
Q

Diffusion

A

Movement of charges or uncharged particles along a concentration gradient. Collision of particles provides energy; passive transport

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12
Q

Osmosis

A

Movement of water across a semipermeable membrane along a concentration gradient; passive transport

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13
Q

Facilitated diffusion

A

Allows water or ion molecules (Na+) to move through channel proteins; porins. Uses specific carrier molecules to accelerate diffusion. Movement of molecules from high to low concentration; passive transport

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14
Q

Active transport

A

Molecules move against concentration gradient; sodium potassium pump. External energy required; important concept to know during acidosis; increased extracellular K+

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15
Q

Serum osmolality

A

Normal 275 to 295 mOsm/kg; fluid overload <275 mOsm/kg, dehydration >295 mOsm/kg

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16
Q

Urine specific gravity

A

Normal 1.005 to 1.030; fluid overload <1.005; dehydration >1.030

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17
Q

Urine/serum osmolality ratios

A

Normal=1:1
Difficulty concentrating urine<1:1
Overnight fluid deprivation= 3:1
Dehydration= 4:1
Fluid overload= 1:4

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18
Q

Intracellular fluid

A

Regulated by proteins and organic compounds. Water moves through permeable cell membranes, while proteins and organic compounds cannot.

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19
Q

Intracellular proteins are…

A

negatively charged; attract cations ions (K+)

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20
Q

Sodium enters the by…

A

diffusion! Pulls water into the cell; risk of cellular rupture. Na+/K+ -ATPase removes Na x3 out of cell, moves K+ x2 into the cell.

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21
Q

ECF

A

Vascular compartment (serum/blood); systematically transports electrolytes, gases, nutrients, waste.
Interstitial space: Moves substances between vascular compartment and body cells. Tissue gel sponge material composed of proteoglycan filaments; reservoir for lost vascular fluid; prevents free water accumulation; this is where peripheral edema occurs.

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22
Q

What are the four forces that control movement of water between vascular and interstitial compartments?

A
  1. Capillary filtration pressure: Pushes water out of capillary into interstitial tissue
  2. Capillary colloid osmotic pressure: Pulls water back into capillary
  3. Interstitial tissue hydrostatic pressure: Opposes water movement out of capillary
  4. Interstitial tissue colloid osmotic pressure: Pulls water out of capillary
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23
Q

Edema

A

Palpable swelling produced by expansion of interstitial fluid volume

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24
Q

Anasarca

A

Simultaneous generalized edema

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25
Q

Third spacing

A

Loss or trapping of ECF into transcellular space.
Causes: Excess fluid in pleural space; pleural effusion, excess fluid in peritoneal cavity; aseity, abdominal compartmental syndrome, pancreatitis; hypoalbuminemia (general edema) burn injuries, liver failure

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26
Q

Tonicity

A

Tension that effects osmotic pressure of solutions; when impermeable solutes exerts on cell size because of water movement

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27
Q

Hypotonic fluid

A

<280 mOsm/L; cell swelling

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28
Q

Isotonic fluid

A

280 mOsm/L; no cellular change

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29
Q

Hypertonic fluid

A

> 280 mOsm/L; cellular shrinkage

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30
Q

Hematocrit

A

Normal range: 37-50%
Increased hematocrit (concentrated): Dehydration
Decreased hematocrit (diluted): Fluid overload

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31
Q

Urine specific gravity

A

Normal range: 1.010-1.025
Increased USG (concentrated): Dehydration
Decreased USG (diluted): Fluid overload

32
Q

Characteristics of measurement for normal urine analysis

A

Adult urine output: 30 ml/hr, 600-2,500 ml/24 hrs, Average=1,200/24 hrs. Amber in color, clear to hazy, SG (1.010-1.025), pH 4.5-8.0; average 5-6

33
Q

Chemical determinations of normal urine analysis

A

Bilirubin negative, urobilinogen 0.5-4.0 mg/day, nitrate for bacteria negative, leukocyte esterase negative, glucose, ketones, blood, and protein negative

34
Q

Microscopic examination of sediment of normal urine analysis

A

Few epithelial cells, hyaline casts 0 to 1/1 pf (low power field), cast negative w/ occasional hyaline casts, RBC negative or rare, crystals negative (none), white blood cells negative or rare

35
Q

What are the two physiologic mechanisms that regulate water body levels?

A

Thirst (oral water intake) and ADH (controls output of water by kidneys).

36
Q

What is hypothalamic regulation?

A

Osmo-receptors in the hypothalamus sense fluid deficit or excess stimulates thirst and ADH release. Results in increase in free water and decreased plasma osmolality

37
Q

When does the posterior pituitary release ADH?

A

Decreased BP, dehydration, increased serum osmolality (hypernatremia)

38
Q

Sympathetic nervous system

A

Compensatory response to decreased CO. Stimulates alpha and beta1/2 adrenergic receptors. Tachycardia increases demand for oxygen. Vasoconstriction, bronchodilation (adenylate cyclase).

39
Q

Renin-angiotensin-aldosterone mechanism

A

Increase in renin by kidneys. Angiotensin I is converted to angiotensin II by the lungs. Increase in angiotensin II and aldosterone means kidneys absorb water and sodium.

40
Q

ADH

A

Angiotensin II stimulates posterior pituitary gland secretes ADH. ADH is a vasoconstrictor; retains water

41
Q

Syndrome of inappropriate ADH (SIADH)

A

Too much ADH (decreases serum osmolality and increases water retention). Transient pain and chronic neurogenic conditions, carcinomas.
Clinical manifestations: Decreased urine output, dark urine, irritability, nausea
Diagnosis: Decreased serum osmolality, increased urine osmolality, low hematocrit

42
Q

Interventions for SIADH

A

Plan is to increase urine output. Fluid constriction for mild conditions. Diuretics, and ADA (lithium and demeclocycline) inhibition for moderate conditions. 3% sodium chloride for severe conditions.

43
Q

Diabetes insipidus (DI)

A

Not enough ADH; decreased renal response to ADH; unable to concentrate urine during water restriction.
Two types, neurogenic (central), where there is a deficit in the synthesis or release of ADH, and nephrogenic, where kidneys do not respond to ADH or vasopressin.
Clinical manifestations: Increased urine output (3-20 L/day), clear urine, intensive thirst & crave ice water.
Diagnosis: Increased serum osmolality and hematocrit, decreased urine osmolality

44
Q

DI interventions

A

Plan is to decrease urine output. Desmopressin acetate (DDAVP) stimulates release of ADH. Thiazide increased sodium and water.

45
Q

Natriuretic peptides

A

Antagonists to RAAS. Decrease BP and blood volume. Aldosterone, renin, ADH involved in cardiac regulation.

46
Q

Losses in gastrointestinal regulation

A

GI tract: Small amounts of water
Diarrhea: Bicarbonate loss creates metabolic acidosis
Nasal/oral gastric tube/vomiting: Acid loss creates metabolic alkalosis

47
Q

Insensible water loss

A

Regulates body temperature. Approximately 600-900 ml/day is lost, no electrolytes are lost.

48
Q

ECF volume deficit (hypovolemia)

A

Diarrhea, hemorrhage, dehydration, edema.
Intervention: Replace water and electrolytes (oral or IV); isotonic for intravascular volume, hypotonic for ECF replacement.

49
Q

ECF volume excess (hypervolemia)

A

Excessive fluid intake, congestive heart failure, interstitial to plasma fluid shift.
Intervention: Fluid restriction, diuretics, dialysis

50
Q

What are the roles of sodium?

A

ECF volume and concentration, generation and transmission of nerve impulses, acid-base balance

51
Q

Hypernatremia

A

EXCESS fluid loss or sodium intake; DI; near drowning.
Clinical manifestations: Thirst, lethargy, agitation
Diagnosis: Med hx & assessment, serum Na+>145 mEq/L
Plan: Correct underlying cause

52
Q

Hypernatremia interventions and evaluation

A

Administer hypotonic IV fluid (0.45 NaCl/5% dextrose in water), decrease sodium intake, promote oral water intake, strict intake & output (daily weight). Evaluate serum Na+ levels 135-145 mEq/L

53
Q

Hyponatremia

A

LOSS of sodium or water excess.
Clinical manifestations: Headache, hypotension, tachycardia, adventitious breath sounds, muscle twitching
Diagnosis: Increase in intracranial pressure; cerebral edema. Serum Na+ <135 mEq/L

54
Q

Hyponatremia interventions and evaluation

A

LAST RESORT: DIURETICS
Oral administration of sodium-rich foods (beef broth or tomato juice). Hypertonic or isotonic IV fluid (3% saline, 0.9% normal saline IVF). Water restriction, strict intake & output (daily weight). Evaluate serum Na+ levels 135-145 mEq/L

55
Q

Potassium

A

Normal serum level: 3.5-5.0 mmol/L
MAJOR ICF CATION!

56
Q

What is potassium required for and what are its sources?

A

Required for: Transmission and conduction of nerve/muscle impulses, cellular growth, maintenance of cardiac rhythms, acid-base balance.
Sources: Fruits and vegetables (bananas & citrus), salt substitutes, medications that contain K+, stored blood (RBC lysis –> increased potassium)

57
Q

Hyperkalemia

A

Excessive salt intake. Shift from ICF to ECF; exchange between K+ and Na+. Comes from crush injury or renal failure.
Clinical manifestations: Lower extremity cramping/pain, muscle weakness, ventricular tachycardia, peak T-wave
Diagnosis: K+ >5.0 mmol/L, peak T-waves

58
Q

Hyperkalemia interventions

A

Emergency: Glucose 50 mL D50 or D10 NS IVF, regular insulin 10u IVP, calcium gluconate 1 gm IVP, bicarbonate IVP, albuterol nebulizer 10 to 20 mg.
Non-urgent: Kayexalate, dialysis

59
Q

Hypokalemia

A

Abnormal losses of K+; metabolic alkalosis; hypomagnesemia.
Clinical manifestation: Confusion, nausea/vomiting, muscle cramps, prolonged PR interval, ST segment depression
Diagnosis: K+ <3.5 mmol/L

60
Q

Hypokalemia interventions

A

Increase potassium intake, administer K+ per MD orders; NS with 20 mEq K+ (DO NOT PUSH K+ IV)!

61
Q

How does pH affect calcium?

A

Decreased pH (acidosis): Increases ionized and serum calcium
Increased pH (alkalosis): Decreases ionized and serum calcium

62
Q

How does vitamin D affect PTH control of calcium?

A

Increases serum calcium level

63
Q

How does calcitonin affected PTH control of calcium?

A

Decreases serum calcium level

64
Q

Chvostek sign

A

Contraction of facial muscles in response to light tap over facial nerve in front of ear

65
Q

Trousseau sign

A

Carpal spasm; induced by inflating BP cuff above systolic pressure for a few minutes

66
Q

Hypercalcemia

A

EXCESS CALCIUM intake. Hyperparathyroidism causes 2/3 of cases. Malignancies, decreased phosphate levels, and prolonged immobilization also part of etiology.
Clinical manifestations: Stupor, weakness, muscle flaccidity
Diagnosis: Total Ca++ >10.5 mg/dL, ionized Ca++ >5.4 mg/dL

67
Q

Hypercalcemia interventions and evaluation

A

Interventions: Isotonic IVF, diuretic (lasix), calcitonin, dialysis.
Evaluation: Total Ca++ 8-10.5 mg/dL, ionized C++ 4.4 to 5.4 mg/dL

68
Q

Hypocalcemia

A

Dietary deficiency, decreased PTH, increased vitamin D and phosphate levels, multiple blood transfusions (citrate). Clinical manifestations: Positive Trousseau’s and Chvostek’s sign, dysphagia (laryngeal stridor), mouth/extremity tingling.
Diagnosis: Total Ca++ <8 mg/dL, Ca++ <4.4 mg/dL

69
Q

Hypocalcemia interventions and evaluation

A

Interventions: Supplemental calcium, synthetic PTH, administer active vitamin D for clients with liver/renal failure
Evaluation: Total Ca++ 8-10.5 mg/dL, Ca++ 4.4-5.4 mg/dL

70
Q

Phosphate range and roles

A

Primary anion in ICF normal serum value: 2.5 to 4.5 mg/dL
Roles: Muscle function, RBCs, nervous system, deposited with calcium for bone growth and tooth structure, renal function, acid-base buffering system, ATP production, cellular uptake of glucose

71
Q

Hyperphosphatemia

A

Etiology: Excessive phosphate intake, renal failure, trauma, chemotherapy
Clinical manifestations: Related to calcium deficiency, dysphagia, mouth/extremity tingling, positive Trousseau’s and Chvostek’s sign.
Diagnosis: Phosphate > 4.5 mg/dL

72
Q

Hyperphosphatemia interventions and evaluation

A

Interventions: Dietary management, calcium acetate (phosphate binder), calcium gluconate, dialysis
Evaluation: Phosphate 2.5-4.5 mg/dL

73
Q

Hypophosphatemia

A

Etiology: Malnourishment, GI malabsorption, alcohol withdrawal, phosphate-binding antacids, prolong glucose infusion and hyperventilation (increased protein binding decreases ionized calcium)
Clinical manifestations: Confusion, muscle weakness and pain, dysrhythmias, cardiomyopathy
Diagnosis: Phosphate <2.5 mg/dL

74
Q

Hypophosphatemia interventions and evaluation

A

Interventions: Diet management and phosphate supplements (oral and IVPB)
Evaluation: Phosphate 2.5-4.5 mg/dL

75
Q

Magnesium range and roles

A

Normal serum value: 1.8-3.0 mg/dL
Roles: 50-60% contained in bone, coenzyme in metabolism of protein and carbohydrates, related to calcium, acts directly on myoneural junction, important for normal cardiac function. Ex: Brown rice, almonds, spinach, avocados

76
Q

Hypermagnesemia

A

Etiology: Excess magnesium intake; renal insufficiency/failure, increased magnesium suppresses calcium levels (hypocalcemia)
Clinical manifestations: Confusion, hyporeflexia, muscle weakness, hypotension, prolongation of PR interval

77
Q

Hypermagnesemia interventions and evaluation

A

Interventions: Oral supplements, increased dietary intake, IV or IM magnesium
Evaluation: Serum Mg 1.8-3.0 mg/dL

NURS 312 (5 decks)

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