Fluids And Electrolytes Flashcards
How much body fluids do adults have
women= 55%
men=65%
Located inside the cell and outside the cell
What are the two main solutes in urine
sodium ions and chloride ions
What are the 3 major hormones that control renal NA and CI
Angiotensin II
Aldosterone
ANP
What is the main factor determining body fluid volume
The amount of urinary salt loss
What is the major hormone that regulates water loss
antidiuretic hormone
What is Angiotensin II
stimulates secretion of aldosterone, reduces water loss in urine
What is Aldosterone
Key hormone in regulating sodium= reabsorbing water
What is ANP
Atrial natriuretic peptide
Released from the heart when the blood volume increases, causing urination and salt loss increase
What is NA+
Sodium
136-142 plasma level range
Creates osmotic pressure of ECF, most abundant cation
Essential for electrical activity in neurons and muscle cells
What is K+
Potassium
3.8-5.0 plasma level range
Creates osmotiic pressure in ICF, most abundant cation in ICF
Essential for electrical activity in neurons and muscle cells
What is hypernatremia
Excessive Sodium in ECF
Loss of water through diarrhea, insensible water loss and water deprivation
Gain of sodium through diabetes or heat stroke
Deficiency and Excess of Potassium
D=Hypokalemia
E=Hyperkalemia
How would you manage hypernatremia
24 hours of I&O
Make sure urine gravity is above 5.025
Check for thready pulse and flat neck veins
Check for tachycardia and tachypnea
Check for changes in sensorium
Check and compare daily weights
Check skin and mucus membrane
What is Hyponatremia & its symptoms
Occurs when serum sodium levels are less then 135
Decreased sodium is caused by dilution ( excess H2o or increased sodium loss)
Signs = Lethargy, headache, confusion, apprehension, seizures, coma
What does Hyponatremia cause
diarrhea, inadequate salt intake, gastrointestinal suctioning, diuretics, vomiting
What is Hyperkalemia & symptoms
Too much potassium in your blood.
Caused by renal failure, acidosis, and massive tissue damage
Causes muscle cramps that can lead to weakness and paralysis, drowsiness, Low BP, Dysrythmias, Abdominal cramping, diarrhea and oliguria
Nursing interventions for hyperkalemia
SAY NO TO POTASSIUM
Give diuretics, monitor renal function and respiratory function, Increase fluid intake provide a potassium restricted diet!
What is severe hyperkalemia
Causes changes in cardiac conduction, can be life threatening
Will give Insulin to pull potassium out of the blood
What is hypokalemia
Potassium deficit, known as Alkalosis
Presents shallow respirations, irritability, confusion, weakness, arrhythmia, thready pulse, lethargy, low intestinal mobility
Nursing interventions for hypokalemia
Provide IV potassium replacement at a rate of 10-20 meq/hr(KCL) or oral potassium replacments(KCI)
Eat foods high in potassium, bananas, prunes, squash, potatoes
What is Hypovolemia
Isotonic dehydration
Results in decreases perfusion and activation of RAAS
Happens when water and salts are lost in equal amounts ( vomiting and diarrhea)
Commonly caused by hemmorhage, vomiting, diarrhea, burns, diuretic therapy, fever
What are the types of fluid volume deficits
Isotonic fluid loss, hypertonic dehydration and third spacing
What is Isotonic Fluid Loss
When fluids and solutes are lost equally
Intracellular water is not disturbed
Fluid loss is extracellular fluid
Can quickly lead to shock, requires extracellular fluid replacement and the emphasis is on increasing vascular volume
Caused by impaired intake, excessive losses of body fluids from vomitting, diarrhea or hemmorage, osmotic diuresis, excessive sweating
What is Hypertonic dehydration
proportionally lose more water then sodium.
results from end stage renal disease, diabetes, insulipids, IV fluid or tube feedings with high electrolyte levels, keto acidosis, hyperventilation, prolonged fever, diarrhea
What is Isotonic Fluid Excess
Caused by increased sodium intake, decrease in sodium and water elimination by the kidney and heart failure
What is Fluid Intake Excess aka Hypervolemia
Too much fluid going in with failure to eliminate it
Causes changes in LOC, confusion, headache, seizures, pulmonary congestion, bounding pulses, increased BP and JVD, Tachycardia, Anorexia and nausea
What are signs of Hypovolemia
Poor skin turgor, dry mucus membrane, dry axila, flat neck veins, tachycardia, hypotension, weightless and sunken eyes
What are signs of Hypervolemia
Shortness of breath at rest and exertion, Ascites, Pitting edema, Weight gain
What role does stress play in fluid
Can increase the production of ADH, which will promote fluid retention and decrease urine output
Overall assessment of fluid and electrolytes, what do you look for the observation process
Edema of lower extremities or hands and feet ( swelling of feet)
Flushed face, neck or arms
Dry and cracked lips ( dehydration)
dry mucous membrane
Sunken eyes ( general sign of illness)
tenting on skin
General assessment of F+E, nursing history
Current and past medical history
Medications
Age
Lifestyle
Food and fluid intake, and fluid output
Diagnostic tests in F+E
Serum electrolytes
Complete blood count
Osmolality
Urine specific gravity
What are some lifespan considerations to take into thought for older adults
Normal aging process will affect fluid balance and increase the risk of dehydration due to:
diminished thirst, reduced fluid reserve, decline in kidney function, increased levels of ANF, increased sensitivity to salt
What are some nursing management for FVE
Do frequent respiratory assessments and check LOC and cardiovascular checks
Watch for edema
Restrict fluids and weigh daily
What are FVE risk factors
Heart disease, kidney dysfunctions, Hypertension, diabetes
What are some collaborative interventions to FVE
calculate alllll fluid ( at meals, when meds are administered, any fluid content in food )
Provide loop diuretics, potassium sparing diuretics
Dietary management: sodium-restricted diet
Run tests: serum electrolyte
How can you prevent Fluid loss
Drink at least 1500 mL of fluid
Achieve fluid and electrolyte balance
Replace fluids when needed
What is FVD
Fluid volume deficit
Dehydration
Loss of electrolytes along with fluid
Hypotonic dehydration
porpotionaly more sodium loss then water loss results from severe prolonged vommiting and diarrhea, burns or renal disease
Signs and symptoms of FVD
weight loss over short period of time
Thirst
narrowed pulse pressure
weak, rapid pulse
low BP and turgor
dry mucous membrane
oliguria
postural hypotension
generalized weakness
How would you manage FVD
measure all fluids that enter and leave the body
Check electrolytes, CBC and urine gravity
Assess for hypotension and weak pulses
Assess respiratory system and tissue perfusion
Check oritntation, vision, hearing, reflexes and muscle strengths
Check for weight changes
Check for skin breakdown and good oral care
