Fluids and Electrolytes Flashcards
1
Q
Normal Sodium (Na) Level
A
135-145 mmol/L
2
Q
Normal Chloride (Cl) Level
A
98-106
3
Q
Normal Calcium (Ca) Level
A
9.0-10.5 mg/dL
4
Q
Normal Bicarbonate (HCl3) Level
A
22-29 mEq/L
5
Q
Normal Potassium (K) Level
A
3.5-5.0 mmol/L
6
Q
Normal Phosphorus/Phosphate (P) Level
A
3.0-4.5 mg/dL
7
Q
Normal Magnesium (Mg) Level
A
1.3-2.1 mEq/L
8
Q
What is maintained by the fluids and electrolytes?
A
blood volume and normal body temperature
9
Q
What does fluids and electrolytes transports?
A
gases, nutrients, and other substances
10
Q
What does fluids and electrolytes promote?
A
cellular chemical function
11
Q
What does fluids and electrolytes eliminates?
A
waste products from the cell
12
Q
Type of loss that can’t be measured or seen?
A
insensible loss
13
Q
Type of loss that can be measured?
A
sensible loss
14
Q
Daily output
A
2600
15
Q
Output from the skin
A
600
16
Q
Output from the lungs
A
400
17
Q
Output from the kidneys
A
1500
18
Q
Output from the intestines
A
100
19
Q
Daily intake
A
2600
20
Q
Intake from liquids
A
1500
21
Q
Intake from solid foods
A
800
22
Q
Intake from water from oxidation
A
300
23
Q
Fluid compartments
A
ICF and ECF
24
Q
Compartment where all fluids are inside the cell
A
Intracellular Fluid (ICF)
25
Compartment where fluids are outside the cell
Extracellular Fluid (ECF)
26
Fluids between cell (third space) blood, lymph node, bone, connective tissue, water
interstitial fluid
27
Accumulation and sequestration of trapped extracellular fluid in actual or potential body space as a result of disease or injury
third space
28
Refers to fluid inside blood vessel
intravascular
29
Body of fluid that is not inside the cell but is separated from plasma and interstitial fluid by cellular barriers.
transcellular
30
Excess accumulation of fluid in the interstitial space; occurs as a result of alterations in oncotic pressure, hydrostatic pressure, capillary permeability, and lymphatic obstruction.
edema
31
Generalized edema, excessive accumulation of fluid in ther interstitial space throughout the body occurs as a result of conditions such as cardiac, renal, or liver failure.
anasarca
32
Factors that affect water distribution
age, sex, fluid type, fluid movements, balancing fluids
33
Fluid type that has the same osmolarity to body fluid.
isotonic solution
34
Fluid type that has the same salt concentration as cells and blood
isotonic solution
35
Fluid type that has lower concentration of salt or solute than another, more concentrated solution
hypotonic solution
36
A solution that contains fewer dissolved particles (salt and other electrolytes) than is found in normal cells and blood
hypotonic solution
37
This solution is commonly used to give fluids intravenously to hospitalized patients in order to treat and avoid dehydration.
hypotonic solution
38
Fluid type that has higher concentration of solutes than other, less concentrated solution, higher osmolarity than fluid
hypertonic solution
39
A solution that contains more dissolved particles (such as salt and other electrolytes) than is found in normal cells and blood.
hypertonic solution
40
Solute (substance dissolved) may spread through a solution/solvent (solution where solute is dissolved)
diffusion
41
Movement where solute spreads higher to lower concentration
diffusion
42
It is the process of moving molecules across a cellular membrane through the use of cellular energy
active transport
43
It is the pressure in the force that draws solvent in less concentrated solute through a high concentrated.
osmosis
44
It is where fluid generally moves out of the capillary and into the interstitial fluid
capillary filtration
45
Ways to balance fluids
thirst, kidneys, ADH, RAAS, Anti-natriuretic peptide
46
What works with fluids to maintain health and well being?
electrolytes
47
What is crucial for nearly all reactions and functions of the cell?
electrolytes
48
It is an electrically charged atom or group of atoms formed by the loss or gain of one or more electrons
ion
49
Generates a negative charge
anion
50
Generates a positive charge
cation
51
Positive and negative ions balance each other out, achieving neutral electrical charge
electroneutrality
52
Functions of electrolytes:
Regulate ______
Govern _____
Transmit _____
Contributes _____
Regulate water distribution
Govern acid-base balance
Transmit nerve impulses
Contributes on energy generation and blood clotting
53
Major EC Electrolytes
Sodium, Chloride, Calcium, Bicarbonate
54
This helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates the body’s fluid balance.
sodium
55
What are the food sources of sodium?
Bacon, frankfurters, lunch meat, butter, cheese, canned food, ketchup, mustard, milk, processed food, snack food, soy sauce, table salt
56
Causes of HYPONATREMIA
Increased Na excretion
Inadequate Na intake
Dilution of serum Na
57
Factors that affects increased Na excretion
Excessive diaphoresis, Diuretics, Vomiting, Diarrhea, wound drainage especially GI, Kidney disease, decreased secretion of aldosterone
58
Factors that affect inadequate Na intake
NPO-fasting, L Na diet
59
Factors that affect dilution of serum Na
Excessive ingestion of hypotonic fluid or irrigation with hypotonic fluid, kidney disease, freshwater drowning, SIADH secretion, Hyperglycemia, Heart failure
60
What is needed to monitor in HYPONATREMIA?
Cardiovascular, RR, Neuromuscular, cerebral, renal, GI
61
HYPONATREMIA is accompanied by _____
fluid volume deficit (hypovolemia)
62
What is administered to restore Na content of fluid?
IV Na Cl
63
What is prescribed to promote the excretion of water rather than Na?
osmotic diuretics
64
What is administered if HYPONATREMIA is caused by inappropriate or excessive secretion of antidiuretic hormone?
medications that antagonize antidiuretic hormone
65
What happens if client is taking lithium and has HYPONATREMIA?
Client may have diminished lithium excretion resulting to toxicity
66
Causes of HYPERNATREMIA?
decreased Na excretion
Increase Na intake, Na containing IVF
Decreased H2O intake, fasting, NPO
Increase H2O loss
67
Factors that affects decreased Na excretion?
Corticosteroids, Cushing’s syndrome, kidney disease, Hyperaldosteronism
68
Factors that affects increased H2O loss
Increased rate of metabolism, fever, hyperventilation, infection, excessive diaphoresis, watery diarrhea, diabetes insipidus
69
What is needed to monitor in HYPERNATREMIA?
Cardiovascular, RR, neuromuscular, cerebral, renal, and Integumentary status.
70
What to do if there's fluid loss in HYPERNATREMIA?
prepare to administer IV infusions
71
What to do if there's inadequate renal excretion of Na in HYPERNATREMIA?
prepare to administer diuretics that promote sodium loss.
72
This electrolyte helps keep the amount of fluid inside and outside of the cells in balance. It also helps maintain proper blood volume, blood pressure, and pH of your body fluids.
chloride
73
This electrolyte is needed in the body to build and maintain strong bones.
calcium
74
Some studies suggest that this electrolyte, along with vitamin D, may have benefits beyond bone health: perhaps protecting against cancer, diabetes and high blood pressure. What electrolyte is this?
calcium
75
Food sources of calcium?
Cheese, Collard greens, kale, milk and soy milk, rhubarb, sardines, tofu, yogurt
76
Causes of HYPOCALCEMIA
Inhibition of Ca absorption from GIT
Increased Ca excretion
Conditions that decreases the ionized fraction of Ca
77
Factors that affects inhibition of Ca absorption from GIT
Adequate intake of Ca
Lactose Intolerance
Malabsorption syndromes such as celiac sprue or Crohn’s disease
78
Factors that affect increased Ca excretion
Kidney disease, polyuric phase
Diarrhea, steatorrhea, wound drainage in GI
79
What are the conditions that decreases the ionized fraction of Ca?
Hyperproteinemia, Alkalosis, medications such as Ca chelators or binders, acute pancreatitis, hyperphosphatemia, immobility, removal or destruction of the parathyroid glands.
80
What is needed to monitor in HYPOCALCEMIA?
CV, RR, NM, and GI status
81
If the patient has HYPOCALCEMIA, HYPERCALCEMIA, HYPOKALEMIA, HYPOPHOSPHATEMIA, and HYPOMAGNESEMIA the patient should be placed in _____ to monitor its _____
cardiac monitor - cardiac activity
82
How should Ca supplements be administered?
orally or IV
83
Nursing interventions if Ca supplements are given IV in HYPOCALCEMIA
warm injection solution to body temp before administer and administer slowly
monitor for ECG changes
observe for infiltration
monitor for hypercalcemia
84
What is Aluminum hydroxide?
medication that reduces phosphorus level but causes countereffect of increasing Ca level
85
This aids in absorption of Ca from GIT
vitamin D
86
What treatment should be kept available for acute Ca deficit or in acute HYPOCALCEMIA?
10% Ca Gluconate
87
What precaution to be initiated in HYPOCALCEMIA?
Initiate seizure precaution
88
What should be monitored if client has HYPOCALCEMIA and HYPERCALCEMIA and he/she is to be moved?
Monitor for signs of pathologic fracture
89
Causes of HYPERCALCEMIA?
Increased Ca absorption
Decreased Ca excretion
Increased bone reabsorption of Ca
Hemoconcentration
90
Factors that affects increased Ca absorprtion?
Excessive oral intake of Ca
Excessive oral intake of vit. D
91
Factors that affects decreased Ca excretion?
Kidney diseases, use of thiazide diuretics
92
Factors that affects the increase of bone reabsorption of Ca
Hyperparathyroidism, Hyperthyroidism, Malignancy (bone destruction from metastatic tumor), immobility, use of glucocorticoids (corticosteroid)
93
Factors that affects hemoconcentration
Dehydration, use of lithium, adrenal insufficiency
94
What is needed to monitor in HYPERCALCEMIA?
CV, RR, NM, Renal, and GI status
95
If the patient that has HYPERCALCEMIA has an IV infusion that contains Ca or Vit. D, what should be done?
Discontinue
96
In HYPERCALCEMIA, what medication in discontinued and replaced?
Thiazide diuretics may discontinued & replaced with diuretics that enhance excretion of Ca
97
Medications used in HYPERCALCEMIA that inhibit Ca reabsorption from the bone
phosphorus, calcitonin, bisphosphonates, and prostaglandin synthesis inhibitors (acetylsalicylic acid, NSAID)
98
What should be done if patient has severe HYPERCALCEMIA and if medications are failed to reduce serum Ca level?
dialysis
99
What should the nurse check for presence of urinary stones?
Flank or abdominal pain and strain in the urine
100
This electrolyte is an essential component of the physiological pH buffering system of the human body.
Bicarbonate
101
This is an alkali, so it helps to keep the acid-base balance of the body stable.
bicarbonate
102
Process of bicarbonate
3/4 of carbon dioxide > carbonic acid > bicarbonate
103
Major IC Electrolytes
potassium, phosphorus, magnesium
104
This is a mineral that the body needs to work properly. It helps the nerves to function and muscles to contract. It helps the heartbeat stay regular. Also helps move nutrients into cells and waste products out of cells.
potassium
105
Food sources of potassium
Avocado, bananas, cantaloupe, oranges, strawberries, tomatoes, carrots, mushrooms, spinach, fish, pork, beef, potatoes, raisins
106
Functions of potassium
Regulates cell excitability
Nerve impulse conduction
Resting membrane potential
107
Causes of HYPOKALEMIA
Excessive use of diuretics or corticosteroids
Increased secretion of aldosterone (Cushing's Syndrome)
Vomiting, Diarrhea
Wound drainage; particularly gastrointestinal
Prolonged Nasogastric suction
Excessive diaphoresis
Kidney disease impairing reabsorption of K
NPO, Alkalosis, Hyperinsilunism
108
What is needed to be monitored in HYPOKALEMIA?
Cardiovascular, RR, Neuromuscular, Gastrointestinal, and renal status, Electrolyte values
109
How should be K supplements administered orally?
Oral K supplements should not be taken on an empty stomach: if pt. complaints of abdl pain, distention, nausea, vomiting, diarrhea, or GI bleeding - need to be discontinued.
110
Nursing interventions in Liquid K Chloride
Liquid K chloride has an unpleasant taste and should be taken with juice or another liquid.
111
IV K supplements should NEVER be administered by ____
IV push, IM, or SQ
112
Nursing intervention in IV K supplements
IV is always diluted and administered using an infusion device.
113
What kind of diuretics is discontinued and prescribed in HYPOKALEMIA?
K losing diuretic may be discontinued, K retaining should be prescribed.
114
What does patient that has HYPOKALEMIA experiences that needs safety measures?
muscle weakness
115
This occurs due to methods of blood specimen collection and cell lysis.
pseudo hyperkalemia
116
Causes of HYPERKALEMIA
Excessive K intake of food high in K or medications, K chloride or salt substitute
Decreased K excretion
Movement of K from ICF - ECF
117
Factors that decreases K excretion
K retaining diuretics
Kidney Disease
Adrenal Insufficiency, such as Addison’s disease
118
Factors that affects movement of K from ICF - ECF
Tissue damage, Acidosis, Hyperurecimia, Hypercatabolism
119
Why should K imbalances should be monitored carefully?
K imbalance may cause cardiac dysrhythmias that can be life threatening
120
Precautions in administering IV K
✓ Dilution of no or more than 1mEq/10ml. 1mmol/10ml of solution is recommended.
✓ Rotate and invert the bag to ensure that K is distributed evenly throughout the IV solution.
✓ Ensure IV bag containing K is properly labeled
121
Maximum recommended infusion of IV K in HYPERKALEMIA
5- 10 meq/hour (5-10mmol/hour) never to exceed 20mmol/hour under any circumstances.
122
Nursing interventions for patients who has HYPERKALEMIA and receiving more than 10 mEq/hr of IV K
Client receiving more than 10meq/hr should be placed on a cardiac monitor and infused via infusion device.
123
What complication can K infusion cause?
Phlebitis
124
What should a nurse assess because K infusion can cause phlebitis?
nurse should assess the IV site frequently for signs of phlebitis, or infiltration, if occurs infusion should be stopped immediately.
125
What should be monitored during administration of K and assess before administering K
Nurse should assess renal function before administering K, and monitor intake & output during administration.
126
This electrolyte controls energy metabolism
Phosphorus / Phosphate
127
It is needed by the body to build and repair bones and teeth, help nerves function, and make muscles contract.
phosphorus / phosphate
128
Food sources of phosphorus
Dairy Products, fish, Nuts, Pork, beef, chicken, organ meats, pumpkin, squash, whole grain breads and cereals
129
Relationship of phosphorus and calcium
RECIPROCAL RELATIONSHIP. Decrease in serum phosphorus is accompanied by an increased Ca level. Increase in serum phosphorus is accompanied by a decreased Ca level
130
Causes of HYPOPHOSPHATEMIA
Insufficient P intake
Increased P secretion
IC shift
131
Factors that affects insufficient Phos intake
malnutrition and starvation
132
Factors that affects increased P secretion
Hyperparathyroidism, Malignancy, Use of Mg based or aluminum hydroxide based antacids
133
Factors that affects IC shift
hyperglycemia, RR alkalosis
134
What should be monitored in HYPOPHOSPHATEMIA?
CV, RR. NM, CNS and hematological status
135
When to prepare to administer phosphate IV?
Serum phos level fall below 1mg/dl and patient shows s/sx.
136
What should be assessed first before administering P in HYPOPHOSPHATEMIA?
Renal system
137
What to instruct in HYPOPHOSPHATEMIA regarding foods?
Instruct high P containing food while decreasing intake of any Ca containing food
138
Causes of HYPERPHOSPHATEMIA
Decreased Renal excretion resulting from renal insufficiency
Tumor lysis syndrome
Increased intake of phos
Hypoparathyroidism
139
Specific in intaking phosphate
dietary intake or overuse of phos containing laxatives or enemas
140
What does phophate-binding meds do?
Increased fecal excretion of phos by binding phos from food in GIT.
141
What are phosphate-containing meds examples?
Laxatives and enema
142
Food consideration in HYPERPHOSPHATEMIA
Take phosphate with meals or immediately after meals
143
This helps to maintain normal nerve and muscle function, supports a healthy immune system, keeps the heartbeat steady, and helps bones remain strong. It also helps adjust blood glucose levels. It aids in the production of energy and protein.
magnesium
144
Food sources of magnesium
Avocado, canned white tuna, cauliflower, green leafy veg. such as spinach and broccoli, milk, oatmeal, wheat bran, peanut butter, almonds, peas, pork, beef, chicken, soybeans, potatoes, raisins, yogurt
145
Functions of magnesium
• Influence enzyme reaction
• Neuromuscular contraction
• Normal functioning of nervous and cardiovascular system
• Influences on electrolyte balance
146
Causes of HYPOMAGNESEMIA
Insufficient Mg intake
Increased mg excretion
IC movement of Mg
147
Factors that affects insufficient Mg intake
Malnutrition & starvation, vomiting or diarrhea, malabsorption syndrome, Celiac disease, Crohn’s disease
148
Factors that affects increased mg excretion
meds such as diuretics, chronic alcoholism
149
Factors that affect IC movement of Mg
Hyperglycemia, Insulin administration, sepsis
150
What should be monitored in HYPOMAGNESEMIA?
CV, RR, GI, NM, CNS
151
Relationship of calcium and magnesium
Hypocalcemia frequently accompanies hypomagnesemia, aim to restore normal Ca level.
152
Oral preparation of mg in HYPOMAGNESEMIA may cause?
Diarrhea and increased Mg loss
153
Nursing interventions during administration of Mg (IM can cause pain and tissue damage)
initiate seizure prec, monitor serum Mg level frequently, and monitor for diminished deep tendon reflexes, suggesting Hypermagnesemia
154
Causes of HYPERMAGNESEMIA
Increased Mg intake
Decreased renal excretion of Mg as a result of renal insufficiency.
155
Factors that affects increased Mg intake
Mg containing antacids & laxatives, excessive administration of Mg IV
156
What should be monitored in HYPERMAGNESEMIA?
CV, RR, NM, CNS
157
What is prescribed in HYPERMAGNESEMIA to increase renal excretion of Mg?
Diuretics
158
Medication that may be prescribed to reverse the effect of Mg on cardiac muscle
IV Ca Cl or Ca Gluconate
159
Antidote of magnesium overdose
Calcium gluconate
160
Influences one electrolyte balance
• Normal cell function
• Fluid intake and output
• Acid-base balance
• Hormone secretion
161
Organs that maintains electrolyte balances
1. Kidneys:
2. Lungs and Liver:
3. Heart:
4. Sweat Glands:
5. GI Tract:
6. Parathyroid glands:
7. Thyroid gland
