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Patient Care > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Average Fluid Input/Output per day

A

2500mL

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2
Q

Adult normal urine output

A

0.5-1mL/kg/hr

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3
Q

Peds normal urine output

A

1-2mL/kg/hr

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4
Q

Fluid Distribution

A

60% water: 2/3 intracellular, 1/3 extracellular

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5
Q

Extracellular Fluid Distribution

A

80% interstitial
20% intravascular

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6
Q

Law of Capillaries

A

Two vectors determine water exchange between plasma and interstitial fluid

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7
Q

Blood hydrostatic Pressure

A

Forces fluid out of capillaries into interstitial fluid

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8
Q

Interstitial Fluid Colloid Osmotic Pressure

A

Pulls fluid out from capillaries into interstitial fluid

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9
Q

Blood Colloid Osmotic Pressure

A

Pulls fluid from interstitial space into capillaries

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10
Q

Interstitial Fluid Hydrostatic Pressure

A

Forces fluid from interstitial space into capillaries

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11
Q

Osmosis

A

Dissolved particles pull water across membranes to equalize particle concentration on each side

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12
Q

Osmolarity

A

Measure of how many dissolved particles are in a L of blood

Plasma proteins, glucose, electrolytes

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13
Q

Causes of low serum osmolarity

A

Fluid overload
Low levels of plasma protein, albumin (anemia)

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14
Q

Causes of higher serum osmolarity

A

Dehydration
Hyperglycemia

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15
Q

Hypotonic Solution

A

Moves fluid from vascular space to interstitial and intracellular space

Cell swells

D5W

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16
Q

Hypertonic Solution

A

Moves fluid from intracellular to interstitial and vascular

Cell shrinks

3% NS or Mannitol

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17
Q

Isotonic Solution

A

1/3 stays in vascular space
2/3 drawn into interstitial space
0.9% NS

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18
Q

Potassium

A

Main intracellular electrolyte

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19
Q

Potassium Serum Levels

A

3.5-5

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20
Q

Sodium

A

Main extracellular electrolyte

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21
Q

Sodium Serum Levels

A

136-145

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22
Q

Cation

A

Ion which loses an electron and takes a positive charge
Na (outside) + K (inside)

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23
Q

Anion

A

Gains an electron and takes a negative charge

Chloride

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24
Q

Sodium Potassium Pump

A

Maintains concentration gradient of Na and K across cell membrane
3 Na Out
2 K in
1 ATP used

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25
Q

Moderate hypernatremia

A

146-159 mmol/L

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26
Q

Severe Hypernatremia

A

> 160mmol

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27
Q

Causes of Hypernatremia

A

Dehydration
Water loss (burns, vomiting/diarrhea, hyperglycemias, heat/sweat)
Increased Na intake (less common): salt, hypertonic solution, aldosterone excess, cushing syndrome

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28
Q

Hypernatremia + Brain

A

Leads to shrinkage secondary to water loss
Treatment for ICP

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29
Q

Mild Hyponatremia

A

130-135

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30
Q

Moderate Hyponatremia

A

120-130

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31
Q

Severe hyponatremia

A

<120

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32
Q

Hyponatremia

A

Excess of water in relation to sodium in the ECF

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33
Q

Most common electrolyte derangement in hospitalized pts

A

Hyponatremia
**especially post-op

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34
Q

Role of ADH

A

Maintains BP, blood volume and tissue water contents

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35
Q

Inappropriate ADH secretion

A

Possible development of hyponatremia

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36
Q

ADH secretion stimulation

A

Hypovolemia
Fever
Pain/Stress
Respiratory distress/failure/infection
Head trauma
CNS infections
Medications (thiazides, SSRI, PPI, ACE inhibitors, loop diuretics)

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37
Q

Increase ADH

A

Fluid retention

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38
Q

Decrease ADH

A

Fluid excretion

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39
Q

Osmotic Demyelination Syndrome

A

Neurologic manifestation associated with overly rapid correction of hyponatremia using hypertonic solutions

Rapid correction of hyponatremia >48 causes pons and CNS structures to demyelinate.

Permanent neurological impairment

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40
Q

Importance of K in the body

A

Regulates fluid and electrolyte balance in the cell
Maintain BP
Helps to transmit nerve impulses
Helps control muscle contraction, in heart especially
Maintains healthy bonesn

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41
Q

Mild Hyperkalemia

A

5.5-6

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42
Q

Moderate Hyperkalemia

A

6.1-7

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43
Q

Severe Hyperkalemia

A

> 7

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44
Q

Causes of Hyperkalemia

A

Increased K intake
Decreased K excreted by kidneys
Increased K released from cells

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45
Q

Causes of cells to release K

A

Rhabdomyolysis
Tumor lysis
Crush injury
Acidosis
Succinylcholine/burns/trauma
Old PRBCs
Digoxin toxicity

46
Q

Severe Hyperkalemia

A

Hypotension, decreased LOA, ECG changes

47
Q

MURDER Hyperkalemia

A

Muscle cramps
Urine abnormalities
Respiratory distress
Decreased cardiac contractility
EKG changes
Reflexes

48
Q

Moderate Hypokalemia

A

2.5-3

49
Q

Severe Hypokalemia

A

<2.5

50
Q

Causes of Hypokalemia

A

Inadequate K in diet or IV fluids
Inappropriate diuresis of K from osmotic diuresis or diuretic use
GI loss from diarrhea/vomiting
Transcellular shift of K from serum because of alkalosis

51
Q

K Acid-Base Disturbances

A

Metabolic Acidosis: hyperkalemia
Metabolic alkalosis: hypokalemia

52
Q

pH and K

A

pH inversely correlate with K

53
Q

Aldosterone

A

Maintains salt and water balance by increasing sodium + water reabsorption in kidneys
Promotes potassium excretion in urine

54
Q

Role of Magnesium

A

Growth + maintenance of bones
Nerve, muscle, cardiac muscle function
Co-factor in enzymatic reactions

55
Q

Magnesium range

A

0.74-1.07

56
Q

Hypomagnesemia Levels

A

<0.74

57
Q

Hypermagnesemia Level

A

> 2

58
Q

Hypomagnesemia causes

A

Diuretics
Malabsorption from GI tract or significant diarrhea depletes Mg
Acs and IDDM
Malnutrition
Alcoholism

59
Q

Hypermagnesemia Causes

A

Less common
Impaired renal function
Excessive intake

60
Q

Hypermagnesemia S/Sx

A

N/v
Loss of deep tendon reflexes
AV nodal block
Bradycardia
Hypotension
Cardiac arrest

61
Q

Treatment of hypermagnesemia

A

IV calcium gluconate or calcium chloride and hemodialysis

62
Q

Calcium regulation

A

Thyroid gland and Parathyroid hormone stimulates release from bone

Vitamin D utilized to assist in uptake of Ca in GI tract + kidneys

63
Q

Normal Calcium Ranges

A

2.1-2.6

64
Q

Causes of hypocalcemia

A

Hypoparathyroidism
In-hospital causes

65
Q

In-hospital causes of hypocalcemia

A

Blood transfusions
Mg depletion
Renal insufficiency
Sepsis
Pancreatitis
Alkalosis

66
Q

S/Sx of Hypocalcemia

A

tetany
Hyperreflexia
Paresthesias
Seizures
Hypotension
ventricular ectopy

67
Q

Hypercalcemia Causes

A

Hyperparathyroidism or malignancy

68
Q

ECG changes hypercalcemia

A

Shortening of ST segment and QT interval

69
Q

S/Sx of Hypercalcemia

A

N/v
Constipation
Polyuria
Confusion
Altered LOC

70
Q

Chloride

A

Main extracellular anion
Maintains osmotic pressure and water balance
Maintains balance between cations and anions

71
Q

Normal Chloride

A

98-106

72
Q

Anion Gap

A

Balance between cations and anions in serum

73
Q

High anion gap

A

Unmeasured anions in the serum
Ketoacidosis, lactic acidosis, renal failure, toxic ingestions

74
Q

Normal anion gap

A

Hyperchloremic metabolic acidosis, loss of bicarb

75
Q

Anion Gap equation

A

(Na + K) – (Cl + HCO3)

76
Q

Purpose of IV therapy

A

Gain access to body circulation
Drug administration
Fluid administration and fluid balance
Nutrition and nutrient replacement

77
Q

Local Complications of IV therapy

A

Pain and irritation
Infiltration and extravasation
Phlebitis
Hematoma
Venous spasm
Vessel collapse
Infection
Nerve, tendon, ligament damage

78
Q

Systemic Complications of IV therapy

A

Sepsis
Hypersensitivity reactions
Pulmonary edema
Emboli

79
Q

Causes of Infiltration

A

Dislodged catheter during venipuncture
Puncture through distal vein wall
Leaking solution from insertion site
Poorly secured IV
Poor vein site
Irritating solution or medication
Improper cannula size
Pressure or high rate of delivery

80
Q

S/Sx of Infiltration

A

Coolness of skin around IV site
Swelling at site
Sluggish/absent flow
Infusion when pressed applied above tip of cannula
No back flow

81
Q

Approved medications in minibag

A

Benadryl, Gravel, Morphine, Fentanyl, Amiodarone, Calcium gluconate

82
Q

Shock trauma IO

A

Paediatric + adult shock
Burns
Drug overdose
RSI
Post part hemorrhage

83
Q

Shock trauma IO

A

Paediatric + adult shock
Burns
Drug overdose
RSI
Post part hemorrhageC

84
Q

Cardiac IO

A

VSA
Arrhythmia
MI
CHF
Chest pain

85
Q

Neurological IO

A

Status seizure
Stroke
Coma
Head injury

86
Q

Respiratory IO

A

Respiratory arrest
Status asthmaticus

87
Q

Systemic IO

A

Hemophilic crisis
Sickle cell crisis
Dehydration
DKA
Renal disease
Dialysis

88
Q

IO Contraindications

A

Prosthesis
Trauma to bone
No anatomical landmarks
Local infections
Recent IO in same bone (<48hrs)

89
Q

IO Sites

A

Proximal Humerus
Proximal Tibia
Distal Tibia

90
Q

Complications of IO

A

Fracture of target bone
Physeal plate injury
Infection
Extravasation
Subperiosteal infusion
Embolism
Compartment syndrome
Pain on use
Dislodgement
Necrosis`

91
Q

pH range

A

7.35-7.45

92
Q

Dangerous pH levels

A

below 6.8 or above 7.8

93
Q

Physiological Buffer System

A

Chemical buffer rely on physiochemical action to minimize pH changes in kidneys
Respiratory and renal systems are physiological mechanisms which excrete H

94
Q

Chemical Buffer System

A

First 2 respond to changes
Fast
Protein buffer
Phosphate buffer
Bicarbonate-Carbonic Acid Buffer

95
Q

Bicarbonate Carbonic Acid buffer System

A

Largest chemical buffer system
CO2 + H20 <–> H2CO3 <–> H + HCO3

96
Q

Respiratory buffer system

A

Mid speed
Takes 1-3 mins
Compensates until renal kicks in

97
Q

Renal Buffer system

A

Slowest but most effective
Hours to days
Kidneys excrete or retain bicarbonate and hydrogen

98
Q

Respiratory Acidosis

A

Conditions causing hypoventilation
CNS depression
Impaired respiratory muscle function from SCI, neuromuscular disease, drugs
Pulmonary disorders
PE
Hypoventilation due to pain, injury, abdominal distension

99
Q

Respiratory Alkalosis

A

Hyperventilation
Psychological
Pain
Metabolic demand increase
Medications
CNS lesions

100
Q

Metabolic Acidosis

A

Deficit of base in blood stream or excess acids other than CO2
Renal failure
DKA
Anaerobic metabolism
Starvation
Salicylate intoxication

101
Q

Alkalosis

A

Excess base or loss of acid in the body
Loss of acids

102
Q

Oxygenation normal values

A

PaO2: 80-100mmHg
SaO2: >95%

103
Q

Acid Base Normal Values

A

pH: 7.35-7.45
PaCo2: 35-45mmHg
HCO3: 22-26mEq/L

104
Q

ETCO2 Changes

A

Ventilation: air in/out of lungs
Diffusion: exchange
Perfusion: circulation

105
Q

Phase 1 ETCO2

A

Dead space ventilation
Beginning of exhalation
No gas exchange
Air from trachea, posterior pharynx, mouth and nose

106
Q

Phase 2 ETCo2

A

Ascending Phase
CO2 from alveoli reaches upper airway and mixes with dead space air causing rapid rise in CO2

107
Q

Phase 3 End-Tidal

A

End-Tidal
End of exhalation containing the highest concentration of CO2

108
Q

Phase 3: Alveolar Plateau

A

Co2 rich gas constitutes majority of exhaled air

109
Q

Phase 4 ETCO2

A

Descending phase
Inhalation begins
Oxygen fills airway
Co2 levels drop

110
Q

Ventilation changes to waveform

A

Frequency
Duration
Height
Shape
Hyperventilation
Hypoventilation

111
Q

Physiologic Factors trending ETCO2 up

A

Increased muscular activity
Malignant hyperthermia/fever
Increased CO
Bicarbonate infusion
Tourniquet release
Drug therapy for bronchospasm
Hypoventilation

Patient Care (11 decks)

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