Fluids and Electrolytes Flashcards
Approximately __% of an adult is fluids (water and electrolyes)
60%
Intracellular fluid makes up how much of the bodys fluids?
2/3
Extracellular fluid makes up how much of the body’s fluids?
1/3
3 Types of ECF
Intravascular
Interstitial
Transcellular
Where is intravascular ECF found?
with blood vessels - aka plasma, erythrocytes, leukocytes, thrombocytes
Where is interstitial ECF found?
surrounding cells
Examples of transcellular fluid
CSF, pericardial fluid, and synovial fluid
Examples of interstitial ECF
lymph fluid
What are the major cations of the body?
Na+, K+, Ca++, Mg+, H+
What are the major anions of the body?
Cl-, Bicarb, Phosphate, Sulfate, and negatively charged protein ions
Gerontologic Considerations of Fluid and Electrolyte Imbalances
Subtle s/s
May cause delirium
Decreased cardiac reserve
Reduced renal function
Dehydration is common
Thin skin
Loss of strength and elasticity
FVE is AKA
hypervolemia
FVD is AKA
hypovolemia
Loss of water alone with increased serum sodium levels is?
Dehydration
Occurs when loss of ECF exceeds the intake ratio of water
hypovolemia (FVD)
Causes of hypovolemia (FVD)
Abnormal fluid losses (V/D/suction)
Decreased intake (N/lack of access)
3rd space fluid shifts (burns, ascites)
Diabetes insipidus
Adrenal insufficiency
Hemorrhage
Manifestations of FVD
Wt loss
Decreased skin turgor
Prolonged cap refill
Abnormal labs
Decreased BP
Tachycardia
What abnormal labs are seen in FVD?
Increased hemoglobin and hematocrit
Increased serum and urine osmolality and SG
Decreased urine sodium
Increased BUN/Cr
Medical management of FVD
Oral route preferred
IV for acute or severe losses
Nursing management of FVD
I&O at least every 8 hrs
Daily weights
VS
Assess Skin and tongue turgor
Assess Mental status
Admin of oral or IV fluids
Manifestations of FVE
Weight gain
Edema or ascites
Distended jugular veins
SOB and crackles
Increased BP
Cough
Increased RR
Increased output
What is the only solution that may be given with blood products?
0.9% NaCl
Solution that used to expand ECF
Isotonic
What type of solution is used to treat hypovolemia, resuscitative efforts, and shock?
Isotonic or hypertonic
Examples of isotonic solutions
0.9% NaCl
Lactated Ringers
5% dextrose in water
Example of hypotonic solution
0.45% NaCl
Examples of hypertonic solution
3% NaCl
5% NaCl
IV Mannitol
A solution with same osmolality as blood
isotonic
A solution with a higher osmolality than bood
Hypertonic
A solution with a lower osmolality than blood
Hypotonic
A solution that contains particles that are nonsoluble and evenly distributed throughout the solution
Colloid
What is FVE secondary to?
to an increase in the total body sodium content
Expansion of ECF caused by abnormal retention of water and sodium in approx the same proportions in which they normally exist in the ECF
FVE or hypervolemia
Causes of FVE
Heart failure
Kidney injury or failure
Cirrhosis of liver
Excessive salt intake
Do isotonic solutions move water?
No
How do hypotonic solutions effect water?
move water from ECF to ICF
How do hypertonic solutions effect water?
move water from ICF to ECF
What abnormal labs are seen in FVE?
Decreased hgb and hct
Decreased serum and urine osmolality
Decreased urine sodium and SG
Medical management of FVE
Pharm - diuretics
Dialysis
Nutrition - sodium restriction
Nursing management of FVE
I&Os
Daily weight
Assess lung sounds
Assess edema
Monitor response to diuretics and fluids
Monitor sodium intake
Normal sodium range
135-145
Causes of hyponatremia
Loss of water by vomiting, diarrhea, sweating, diuretics, adrenal insufficiency, SIADH
Manifestations of hyponatremia
poor skin turgor
dry mucosa
headache
decreased BP
nausea
abdominal cramping
neuro changes - confusion, seizures
Management of hypnonatremia
Treat underlying condition
Na+ replacement/dietary
I & O
Daily weights
Monitor CNS changes
Seizure precautions
Causes of hypernatremia
Fluid deprivation
Excess sodium
Diabetes insipidus
Heat stroke
Hypertonic IV solutions
Manifestations of hypernatremia
Increased thirst
Hyperreflexia
Elevated temp
Seizures
Swollen tongue
Lethargy
Irritability
Management of hypernatremia
Gradual lowering of sodium with diuretics
Monitor CNS changes
Assess sodium source or source of water loss
Normal range of potassium
3.5-5.0
Causes of hypokalemia
GI losses
Medications
Suctioning
Hyperaldosteronism
Poor dietary intake
Manifestations of hypokalemia
ECG changes
dysrhythemias
dilute urine
excessive thirst
fatigue
muscle weakness
paresthesia
decreased bowels
What ECG changes are seen in hypokalemia?
flattened T waves, prominent U waves, ST depression, prolonged PR interval
Management of hypokalemia
Potassium replacement
Monitor ECG changes
Monitor aBGs
Monitor patients taking digoxin for toxicity
When do you not administer potassium if your patient has hypokalemia?
If oliguria is present
Causes of hyperkalemia
impaired renal function
rapid admin of K+
Hypoaldosteronism
Medications
Tissue trauma
Acidosis
Manifestations of hyperkalemia
ECG changes
Arrhythmias
Muscles weakness
Muscle cramps
What ECG changes are seen with hyperkalemia?
tall tented T waves, prolonged PR interval and QRS duration, absent P waves, ST depression
Management of hyperkalemia
Monitor ECG, heart rate, BP
I & O
Obtain apical pulse
Limit K+ intake, educate pt
What is the emergent care for hyperkalemia?
IV calcium gluconate
IV sodium bicarbonate
IV regular insulin and hypertonic dextrose
Dialysis
Administer slowly w an infusion pump
Normal range of calcium
8.6-10.4
The serum calcium levels of the body are controlled by?
PTH and calcitonin
Causes of hypocalcemia
Hypoparathyroidism
Malabsorption
Osteoporosis
Pancreatitis
Meds
Kidney injury
Manifestations of hypocalcemia
Tetany
Numbness
Paresthesias
Trousseau sign
Chvostek sign
Seizures
Respiratory issues
Management of hypocalcemia
IV calcium gluconate
Seizure precautions
Vit D supplements
Exercise
Educate pt r/t diet and medications
Causes of hypercalcemia
Malignancy and hyperparathyroidism
Bone loss r/t immobility
Diuretics
Manifestations of hypercalcemia
Polyuria
Thirst
Muscle weakness
Nausea
Abdominal cramps
Constipation
Diarrhea
ECG changes
Dysrhythmias
Management of hypercalcemia
Treat underlying cause (cancer)
Admin IV fluids
Meds - ferosemide, phosphate, calcitonin, bisphosphonates
Increase mobility
Normal range of magnesium
1.8-2.6
Causes of hypomagesemia
alcoholism
GI losses
Enteral or parenteral feeding deficient in mag
meds
rapid admin of citrated blood
Manifestations of hypomagnesemia
apathy
psychosis
neuromuscular irritability
ataxia
insomnia
confusion
tremors
ECG changes
Management of hypomagnesemia
Magnesium sulfate IV
Monitor VS and urine output
Monitor dysphagia
Seizure precautions
Diet - green, leafy veggies; beans, lentils, almonds, PB)
Causes of hypermagnesemia
kidney injury
diabetic ketoacidosis
excess magnesium
extensive soft tissue injuries
Manifestations of hypermagnesemia
Hypoactive reflexes
drowsiness
muscle weakness
depressed respirations
ECG changes
dysrhythmias
Cardiac arrest
Management of hypermagnesemia
IV calcium gluconate
Ventilatory support for resp depression
Hemodialysis
Loop diurectics
Limit mag intake
Monitor for LOC changes
Normal range of phosphates
2.7-4.5
Causes of hypophosphatemia
Alcoholism
Refeeding syndrome
pain
heat stroke
respiratory alkalosis
hyperventilation
low mag
low potassium
meds
Manifestations of hypophosphatemia
Confusion
Muscle weakness
Tissue hypoxia
Muscle and bone pain
What labs should be run with hypophosphatemia?
24-hr urine collection
PTH (elevated)
Vit D
Calcium
Management of hypophosphatemia
Prevention is goal
Phosphorus replacement
Monitor IV site
Monitor phosphorus, calcium, vit D
Encourage foods high phosphorus
What foods are high in phosphorus?
milk
organ meats
beans
nuts
fish
poultry
Causes of hyerphosphatemia
kidney injury
excess phosphorus
excess vit D
acidosis
hypoparathyroidism
chemotherapy
Manifestations of hyperphosphatemia
soft tissue calcifications
Management of hyperphosphatemia
treat underlying disorder
monitor labs
avoid high-phosphorus foods
patient education
Vit D and calcium-binding antacids
Loop diuretics
Dialysis
Normal chloride range
97-107
Causes of hypochloremia
Addison disease
Reduce chloride intake
GI losses
Excess sweating
Fever
Manifestations of hypochloremia
agitation
irritability
weakness
hyperexcitability of muscles
dysrhythmias
seizures
coma
Management of hypochloremia
Replace chloride with 0.45% NS
I&O
ABG values
Electrolyte values
Asses for changes in LOC
Educate about diet
Foods high in chloride
Tomato juice
bananas
eggs
cheese
milk
Causes of hyperchloremia
iatrogenically-induced
Manifestations of hyperchloremia
Tachypnea
Lethargy
weakness
rapid, deep respirations
HTN
cognitive changes
Management of hyperchloremia
Treat underlying cause
Hypertonic IV solutions
I & O
Assess resp, neuro, cardiac
