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Anatomy and Physiology > FLUIDS AND ELECTROLYTES > Flashcards

FLUIDS AND ELECTROLYTES Flashcards

1
Q

Major element in blood plasma that is used to transport nutrients, oxygen, and electrolytes throughout the body.

A

Fluid

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2
Q

Total Body Water (TBW%)
Intracellular Fluid (ICF)
Extracellular Fluid (ECF)

INFANTS

A

TBW - 75
ICF - 45
ECF - 30

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3
Q

Total Body Water (TBW%)
Intracellular Fluid (ICF)
Extracellular Fluid (ECF)

ADULT MALE

A

TBW - 60
ICF - 40
ECF - 20

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4
Q

Intracellular FluidTotal Body Water (TBW%)
Intermediate Care Facility (ICF)
Extracellular Fluid (ECF)

ADULT FEMALE

A

TBW - 50
ICF - 35
ECF - 15

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5
Q

FLUID
COMPARTMENTS

A

Intracellular fluids
extracellular fluids

extracellular - interstitial fluid and plasma (intravascular fluid)

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6
Q

Fluid not lost in the body but
unavailable for use by either
ICF/ECF

occurs when too much fluid moves from the intravascular space (blood ve

A

3RD SPACE SHIFTING

Third-spacing

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7
Q

Manifested by decrease in
urine output despite fluid
intake, edema, JVD

A

3RD SPACE SHIFTING

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8
Q

ELECTROLYTES

MAJOR IONS

A

Sodium (Na+)
Potassium (K+)
Calsium (Ca2+)
Magnesium (Mg2+)
Chloride (Cl-)
Phosphate (HPO4-)

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8
Q

ELECTROLYTES

Location (ICF and ECF)
-mEq/L

Sodium (Na+)
Potassium (K+)
Calsium (Ca2+)
Magnesium (Mg2+)
Chloride (Cl-)
Phosphate (HPO4-)

A
  1. 12; 145
  2. 150; 4
  3. 5; <1
  4. 40; 2
  5. 103; 4
  6. 4; 75
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9
Q

Type of diffusion specifically for water molecules moving across a semi-permeable membrane

ADDITIONAL INFO

A

Osmosis

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9
Q

Movement of molecules from an area of high concentration to an area of lower concentration

ADDITIONAL INFO

A

Diffusion

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10
Q

TONICITY

A

Isotonic - water in and out of blood cell; has similar concentration of fluid (blood shape maintained)
Hypotonic - water out; has a lower concentration of fluid (blood shape balloon)
Hypertonic - water in; has a higher concentration of fluid (blood shape flat/shrinked)

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11
Q

OSMOTIC FORCES

A

OSMOTIC PRESSURE
ONCOTIC PRESSURE
OSMOTIC DIURESIS

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12
Q

amount of hydrostatic pressure needed to stop the flow of water by
osmosis (concentration of solutes)

A

OSMOTIC PRESSURE

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13
Q

osmotic pressure exerted by proteins (albumin)

A

ONCOTIC PRESSURE

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13
Q

increase in urine output caused by excretion of substances (glucose,
mannitol, contrast agents)

A

OSMOTIC DIURESIS

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14
Q

TRANSPORT MECHANISMS

Filtration

A

K+ in (cytoplasm) Na+ out ECF

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15
Q

AVERAGE INTAKE

(mL)

A

oral liquids - 1300
water in food - 1k
water produced by metab- 300
total gain = 2600

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15
Q

AVERAGE OUTPUT

(mL)

A

urine - 1500
stool - 200
insensible lungs - 300
insensible skin - 600
total loss = 2600

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16
Q

State of equilibrium in the
body with respect to
functions and composition
of fluids and tissues

A

HOMEOSTASIS

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17
Q

HOMEOSTASIS

involves

A

Kidneys
Lungs
Heart
Adrenal Glands
Parathyroid glands
Pituitary glands

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18
Q

regulates ECF volume and osmolality by retention and excretion of fluids

FLUID CYCLE

A

Kidneys

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19
Q

Regulation of electrolyte levels

FLUID CYCLE

A

Kidneys

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20
Q

Regulation of pH of the ECF by retention of hydrogen ions

FLUID CYCLE

A

Kidneys

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21
Q

Excretion of metabolic wastes

FLUID CYCLE

A

Kidneys

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22
Q

Pumps blood with sufficient pressure to allow urine formation

FLUID CYCLE

A

Heart

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23
Q

Hypothalamus makes ADH > stored and released by pituitary gland
(posterior) to conserve water

FLUID CYCLE

A

Pituitary Gland

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23
Q

Maintains acid-base balance and exhalation of moisture

FLUID CYCLE

A

Lungs

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24
Q

Secretes aldosterone (zona glomerulosa) in the cortex to retain sodium
and lose potassium

FLUID CYCLE

A

Adrenal Gland

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25
Q

Regulates calcium and phosphate

FLUID CYCLE

A

Parathyroid Gland

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26
Q

SNS (constricts arterioles) and PNS
(dilates arterioles) neural activities

FLUID CYCLE (others)

A

Baroreceptors

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27
Q

Thirst center in the hypothalamus from intracellular dehydration

FLUID CYCLE (others)

A

Thirst

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28
Q

FLUID CYCLE (others)

A

RAAS and ANP

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29
Q

secreted by the Juxtaglomerular Apparatus [JGA]
when:
1. JGA detects a drop in afferent arteriole pressure [reduced stretch]
2. Macula Densa – detects low Na+ concentration in the filtrate

RAAS MECHANISM

A

Renin

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30
Q

protein the blood produced by the liver

RAAS MECHANISM

A

Angiotensinogen

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31
Q

proteolytic enzyme in
capillary beds

RAAS MECHANISM

A

Angiotensin-converting Enzyme

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32
Q

Hormone that causes VASOCONSTRICTION

RAAS MECHANISM

A

Angiotensin II

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33
Q

Increases the rate of ALDOSTERONE,
sensation of THIRST, SALT APPETITE and ADH
secretion

RAAS MECHANISM

A

Angiotensin II

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34
Q

Released by adrenal gland and goes to the
DCT and Collecting Ducts

RAAS MECHANISM

A

ALDOSTERONE

35
Q

Increase carrier proteins for Na+

RAAS MECHANISM

A

ALDOSTERONE

36
Q

Also known as vasopressin

RAAS MECHANISM

A

Anti-Diuretic Hormone [ADH]

37
Q

Released from posterior pituitary

RAAS MECHANISM

A

Anti-Diuretic Hormone [ADH]

38
Q

When blood osmolality increases or
when blood pressure declines, ADH is
secreted to reabsorb water

RAAS MECHANISM

A

Anti-Diuretic Hormone [ADH]

39
Q

promotes aquaporin molecule
insertion

RAAS MECHANISM

A

Anti-Diuretic Hormone [ADH]

40
Q

Secreted from cardiac muscles

CHECKS AND BALANCE

A

ATRIAL NATRIURETIC HORMONE
[ANH]

41
Q

Inhibits Na+ reabsorption and ADH
secretion

CHECKS AND BALANCE

A

ATRIAL NATRIURETIC HORMONE
[ANH]

42
Q

Resulting to increased volume of
urine and lowers blood volume and
BP

CHECKS AND BALANCE

A

ATRIAL NATRIURETIC HORMONE
[ANH]

43
Q

Also called fluid volume deficit

FLUID VOLUME
ALTERATIONS

A

HYPOVOLEMIA

44
Q

Not simply dehydration = loss of
water with increased serum sodium
levels

FLUID VOLUME

A

HYPOVOLEMIA

45
Q

Occurs when loss of ECF volume
exceeds the intake of fluid, serum
electrolytes essentially are
unchanged

FLUID VOLUME

A

HYPOVOLEMIA

46
Q

HYPOVOLEMIA CAUSES

FLUID VOLUME

A

Vomiting Diarrhea GI
Suctioning
Decreased
Fluid intake
Third
Space fluid shift
Diseases

47
Q

HYPOVOLEMIA MANIFESTATIONS

FLUID VOLUME

A

Weight Loss, acute
Decreased skin turgor
Oliguria
Weak, rapid HR
Flattened neck veins
Increased temp
Thirst
Delayed CRT
Cool, clammy pale skin
Lassitude
Muscle weakness
Cramps
BUN:Crea Ratio = greater than 20:1
Elevated Hematocrit

48
Q

Nursing Management to HYPOVOLEMIA

FLUID VOLUME

A
  1. Measure I&O q8hrs/ q1
  2. Daily body weight checking (1L = 1kg)
  3. V/S
  4. Tissue turgor (pinch the skin over sternum, inner aspects of thigh or forehead)
  5. Tongue turgor (not affected by age)
  6. Monitor labs esp, urine concentration and electrolyte values (should be greater than 1.020 good renal conservation of fluid)
  7. Mental function monitoring
  8. Frequent mouth care
49
Q

Medical Management to HYPOVOLEMIA

FLUID VOLUME

A

GOAL: CORRECT FLUID LOSS
1. If deficit is not severe, oral route is preferred
2. If severe, IV route is preferred
3. Rate of fluid administration is based on severity of loss
and hemodynamic responses

50
Q

Also called Fluid Volume Excess

FLUID VOLUME

A

HYPERVOLEMIA

51
Q

Isotonic expansion of the ECF by abnormal retention of water
and sodium

FLUID VOLUME

A

HYPERVOLEMIA

52
Q

CAUSES
Heart failure Renal failure Liver cirrhosis Excessive
IVFs

FLUID VOLUME

A

HYPERVOLEMIA

53
Q

HYPERVOLEMIA MANIFESTATIONS

FLUID VOLUME

A

Edema
Distended neck veins
Crackles
Tachycardia
Increased BP, CVP and Pulse Pressure
Increased weight
Increased U/O
SOB/ Wheezing

54
Q

NURSING MANAGEMENT to HYPERVOLEMIA

FLUID VOLUME

A

Monitor I&O
Weight daily
Monitor breath sounds
Monitor degree of edema
Diet: Sodium restriction as prescribed
Avoid OTC medications
Maintain regular rest periods
Regular position change/turning

55
Q

PITTING EDEMA - HYPERVOLEMIA

FLUID VOLUME

A

0+ no pitting edema; 0 mm
1+ Mild; 2 mm depression disapears rapidly
2+ moderate; 4 mm depression disapears 10-15 sec.
3+ moderatley severe; 6 mm depression last more than 1 minute
4+ severe; 8 mm depression last more than 2 minute

56
Q

MEDICAL MANAGEMENT to HYPERVOLEMIA

FLUID VOLUME

A
  1. Discontinue excessive sodium-containing fluids
  2. Administer diuretics as prescribed
  3. Restrict sodium and fluids as prescribed
  4. Dialysis if with severe renal impairment
57
Q

Block sodium retention in the distal tubule
* HydroDIURIL, Cotrazid, Hydrax, Hydrochlorothiazide (HCTZ)

SIDEBAR: DIURETICS

58
Q

Block sodium reabsorption in the ascending
* Furosemide (Lasix), Bumetanide, Torsemide

SIDEBAR: DIURETICS

59
Q

LABORATORY VALUES

ELECTROLYTE - NORMAL VALUE

under ELECTROLYTE IMBALANCE

A

Calcium (total) = 8.6-10.2 mg/dL
Chloride = 96-106 mEq/L
Magnesium = 1.5-2.5 mEq/L
Phosphorus = 2.4-4.4 mg/dL
Potassium = 3.5-5.0 mEq/L
Sodium = 135-145 mEq/L

60
Q

Blocks retention at the last distal tubule
* Spironolactone (Aldactone)

SIDEBAR: DIURETICS

61
Q

ELECTROLYTES

MAJOR CATION

A

Sodium
Potassium
Calcium
Magnesium

62
Q

ELECTROLYTES

MAJOR ANION

A

Chloride Cl
Bicarbonate HCO3
Phosphate HPO4
Protein

63
Q

LOCATIONS (ELECTROLYTES)

INTRACELLULAR

A

POTASSIUM
MAGNESIUM
PHOSPHATE

64
Q

LOCATIONS (ELECTROLYTES)

OUT [EXTRACELLULAR]

A

SODIUM
CALCIUM
CHLORIDE

65
Q

Contributing
Factors: Loss of sodium, use of diuretics, loss
of GI fluids, renal disease, SIADH,
medications, psychogenic
polydipsia

SODIUM

A

HYPONATREMIA

66
Q

Manifestations: N&V, headache, lethargy, dizziness,
muscle cramps, muscular twitching,
seizures

SODIUM

A

HYPONATREMIA

67
Q

Labs: Decreased serum and urine sodium,
decreased urine spec. gravity

SODIUM

A

HYPONATREMIA

68
Q

Contributing
Factors: Water deprivation, hypertonic tube
feedings, DI, heatstroke,
hyperventilation, diarrhea, burns,
diaphoresis, salt-water drowning

SODIUM

A

HYPERNATREMIA

69
Q

Manifestations: Thirst, elevated body temp, swollen,
dry tongue, lethargy, seizures,
hyperreflexia

SODIUM

A

HYPERNATREMIA

70
Q

Labs: Increase serum, decreased urine
sodium, increased urine spec gravity,
decreased CVP

SODIUM

A

HYPERNATREMIA

71
Q

HYPONATREMIA MGT

SODIUM

A
  1. Administration of sodium by mouth, NGT or parentera
  2. PLR or PNSS may be prescribed (Overcorrected ( more than 140
    mEq/L) may cause symmetric myelin destruction causing
    paraparesis, dysarthria, dysphagia or coma )
  3. Highly hypertonic sodium (2-3%) should be administered only in
    the ICU
  4. Water restriction (800mL in 24 hours)
  5. IV conivaptan HcL (Vaprisol) – stimulates free water excretion
72
Q

Most commonly caused by fluid deprivation in unconscious
patients

SODIUM

A

Hypernatremia

73
Q
  1. Infusion of hypotonic solutions (0.3%) or isotonic solutions
  2. Rapid decrease in sodium may lead to cerebral edema
  3. Desmopressin, antidiuretic hormone, can be given is with
    Diabetes insipidus

SODIUM

A

Hypernatremia

74
Q

NURSING MGT

Hypernatremia

SODIUM

A
  1. Monitor electrolyte values and progression of symptoms
  2. Monitor I&O carefully
  3. Monitor for behavior changes
  4. Obtain medical and pharmacological history
  5. Weight daily
75
Q

Contributing
Factors: Diarrhea, vomiting, gastric suction,
steroid administration, bulimia,
alkalosis, starvation, diuretics,
digoxin toxicity

POTASSIUM

A

HYPOKALEMIA

76
Q

Manifestations: Fatigue, anorexia, N&V, muscle
weakness, polyuria, decrease bowel
motility, ventricular asystole/
fibrillation, ileus,

POTASSIUM

A

HYPOKALEMIA

77
Q

Labs: ECG: flattened T waves, prominent
U waves, ST depression, prolonged
PR Interval

POTASSIUM

A

HYPOKALEMIA

78
Q

Contributing
Factors: Oliguric renal failure, use of K-
conserving diuretics, metabolic
acidosis, burns, crush injury, stored
bank blood transfusions, rapid IV adm
of K, medications

POTASSIUM

A

HYPERKALEMIA

79
Q

Manifestations: Muscle weakness, tachycardia >
bradycardia, dysrhythmias, flaccid
paralysis, irritability, paresthesia

POTASSIUM

A

HYPERKALEMIA

80
Q

Labs: ECG: tall tented T waves, prolonged
PR interval and QRS duration, absent P
waves, ST depression

POTASSIUM

A

HYPERKALEMIA

81
Q

98% of the this is inside the cells

82
Q

Affects neuromuscular, skeletal and cardiac muscle
activity

83
Q

80% of the potassium is excreted by way of

84
Q

patients with persistent insulin hypersecretion may
experience?

A

hypokalemia (TPN)

85
Q

can produce small bowel lesions

A

oral potassium

86
Q

MGT (HYPOKALEMIA)

A

Replace potassium in the body and resolve underlying cause
IV potassium supplements given only after the patient voids
POTASSIUM IS NEVER GIVEN VIA IV PUSH

87
Q

MGT (HYPERKALEMIA)

A

Dietary limits of potassium
Discontinue potassium losing diuretics
Kayexalate [exchange resin]
Administer glucose and insulin
Severe levels, adm IV calcium gluconate, sodium bicarbonate

88
Q

CALCIUM

Anatomy and Physiology (4 decks)

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