Fluids and Electrolytes

Question 1

Fluid Balance

Answer 1

Total body water
Composed of:
Intracellular fluid: 67%
Interstitial fluid: 25%
Plasma volume: 8%
———-

60% of adult human body is water.

Question 2

Intravascular fluid

Answer 2

Fluid inside blood vessels

Question 3

Extravascular fluid

Answer 3

Fluid outside blood vessels

Lymph, cerebrospinal fluid

Question 4

Extravascular volume

Answer 4

Plasma

Interstitial fluid: fluid in space between cells, tissues, and organs

Question 5

Extracellular volume

Answer 5

Interstitial fluid

Intracellular fluid

Question 6

Plasma proteins exert constant osmotic pressure.

Answer 6

Colloid oncotic pressure

Normally 24 mm Hg

Question 7

Interstitial fluid exerts hydrostatic pressure.

Answer 7

Normally 17 mm Hg

Question 8

Edema

Dehydration and fluid loss

Answer 8

Acid–base balance

Sodium is principal extracellular electrolyte, playing a major role in maintaining water concentration

Question 9

Distribution of Total Body Water

Answer 9

TBW- 60% is water

ECF- 1/3

PV- 1/3

ISF- 2/3

ICF- 2/3

Question 10

Hypertonic

Answer 10

H20 goes outside the cell

Question 11

Isotonic

Answer 11

H20 in and out of the cell is balanced

Question 12

Hypotonic

Answer 12

H20 goes inside the cell

Question 13

Crystalloids

Answer 13

Solutions containing fluids and electrolytes that are normally found in the body

Do not contain proteins (colloids)

No risk for viral transmission, anaphylaxis, or alteration in coagulation profile

Better for treating dehydration rather than expanding plasma volume

Question 14

Crystalloids is used as maintenance fluids to:

Answer 14

Compensate for insensible fluid losses

Replace fluids

Manage specific fluid and electrolyte disturbances

Promote urinary flow

Question 15

7 Crystalloids solutions

Answer 15

Normal saline (NS): 0.9% sodium chloride is isotonic; 0.45% “half-normal” is hypotonic)

3.3% dextrose and 0.3% NS (two thirds and one third) (isotonic)

Hypertonic saline (3% sodium chloride)

Lactated Ringer’s solution (isotonic)

Dextrose 5% in water (D5W) (isotonic)

D5W and 0.45% NS (hypertonic)

Plasma-Lyte (isotonic)

Question 16

Crystalloids indications

Answer 16

Acute liver failure
Acute nephrosis
Adult respiratory distress syndrome
Burns
Cardiopulmonary bypass
Hypoproteinemia
Hemodialysis
Deep vein thrombosis (reduction of risk)
Shock

Question 17

Crystalloids Adverse effects

Answer 17

May cause edema, especially peripheral or pulmonary

May dilute plasma proteins, reducing colloid oncotic pressure

Effects may be short-lived

Prolonged infusions may worsen alkalosis or acidosis

Question 18

Colloids

Answer 18

Protein substances

Increase colloid oncotic pressure

Move fluid from interstitial compartment to plasma compartment (when plasma protein levels are low)

Question 19

3 Colloids

Answer 19

Albumin 5% and 25% (from human donors)

Dextran 40 or 70 (available in sodium chloride and 5% dextrose)

Hetastarch (synthetic)

Question 20

Colloids Adverse effects

Answer 20

Usually safe

May cause altered coagulation, resulting in bleeding

Have no clotting factors or oxygen-carrying capacity

Rarely, dextran therapy causes anaphylaxis or kidney failure.

Question 21

Colloids: Albumin

Answer 21

Natural protein that is normally produced by the liver

Responsible for generating approximately 70% of colloid oncotic pressure

Sterile solution of serum albumin that is prepared from pooled blood, plasma, serum, or placentas obtained from healthy human donors

Pasteurized to destroy any contaminants

Question 22

Blood Products

Answer 22

The only class of fluids that are able to carry oxygen

Increase tissue oxygenation

Increase plasma volume

Increase colloid osmotic pressure and plasma volume
-Pull fluid from extravascular space into intravascular space (plasma expanders)
-Red blood cell products also carry oxygen.

Question 23

Blood products facts

Answer 23

Most expensive and least available fluid because they require human donors

Derived from human donors and thus have all the benefits (and hazards) of human blood products

Question 24

Blood Products Indications

Cryoprecipitate and plasma protein factors

Answer 24

Management of acute bleeding (greater than 50% slow blood loss or 20% acutely)

Question 25

Blood Products Indications Fresh frozen plasma

Answer 25

increase clotting factor levels

Question 26

Blood Products Indications Packed red blood cells

Answer 26

To increase oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume

Question 27

Blood Products Indications Whole blood

Answer 27

Same as for packed red blood cells except that whole blood is more beneficial in cases of extreme (greater than 25%) loss of blood volume, because whole blood also contains plasma Contains plasma proteins, which help draw fluid back into blood vessels from surrounding tissues

Question 28

Blood Products Adverse Effects

Answer 28

Incompatibility with recipient’s immune system Cross-match testing Transfusion reaction Anaphylaxis Transmission of pathogens to recipient (hepatitis, human immunodeficiency virus)

Question 29

Electrolytes 1. Principal ECF electrolytes 2. Principal intracellular fluid electrolyte 3. Others

Answer 29

Principal ECF electrolytes 1.Sodium cations (Na+) 2.Chloride anions (Cl−) Principal intracellular fluid electrolyte 1.Potassium cation (K+) Others 1.Calcium 2.magnesium 3.phosphorus

Question 30

Potassium

Answer 30

Most abundant positively charged (cationic) electrolyte inside cells 95% of body’s potassium is intracellular. Potassium content outside of cells ranges from 3.5 to 5 mmol/L. Potassium levels are critical to normal body function.

Question 31

Potassium obtained from foods

Answer 31

Bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes.

Question 32

Excess dietary potassium excreted via _____ What happens if its impaired?

Answer 32

KIDNEYS Impaired kidney function leads to higher serum levels, possibly toxicity.

Question 33

Hyperkalemia

Answer 33

excessive serum potassium;serum potassium level over 5.5 mmol/L ---------- Potassium supplements Angiotensin-converting enzyme inhibitors Kidney failure Excessive loss from cells Potassium-sparing diuretics Burns Trauma Metabolic acidosis Infections

Question 34

Hypokalemia

Answer 34

deficiency of potassium; serum potassium level less than 3.5 mmol/L --------- Excessive potassium loss (rather than poor dietary intake) Alkalosis Corticosteroids Diarrhea Ketoacidosis Hyperaldosteronism Increased secretion of mineralocorticoids Burns Thiazide, thiazide-like, and loop diuretics Vomiting Malabsorption Others

Question 35

Hypokalemia, in the presence of digoxin therapy, can cause digoxin toxicity, resulting in

Answer 35

serious ventricular dysrhythmias.

Question 36

Potassium is responsible for:

Answer 36

Muscle contraction Transmission of nerve impulses Regulation of heartbeat Maintenance of acid–base balance Isotonicity Electrodynamic characteristics of the cell

Question 37

Potassium indication

Answer 37

Treatment or prevention of potassium depletion when dietary means are inadequate Other Stop irregular heartbeats Management of tachydysrhythmias that can occur after cardiac surgery

Question 38

Potassium Adverse effects

Answer 38

Oral preparations -Diarrhea, nausea, vomiting, gastrointestinal bleeding, ulceration IV administration -Pain at injection site -Phlebitis Excessive administration -Hyperkalemia -Toxic effects -Cardiac arrest

Question 39

Hyperkalemia manifestations

Answer 39

Muscle weakness, paresthesia, paralysis, cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest)

Question 40

Treatment of severe hyperkalemia

Answer 40

IV sodium bicarbonate, calcium gluconate or calcium chloride, dextrose with insulin Sodium polystyrene sulphonate (Kayexalate®) or hemodialysis to remove excess potassium

Question 41

1. Sodium 2. Foods high in Sodium

Answer 41

Most abundant positively charged electrolyte outside cells Normal concentration outside cells is 135 to 145 mmol/L Maintained through dietary intake of sodium chloride Salt, fish, meats, foods flavoured or preserved with salt

Question 42

Hyponatremia

Answer 42

sodium loss or deficiency; serum levels below 135 mmol/L

Question 43

Symptoms of hyponatremia

Answer 43

Lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures

Question 44

Causes of hyponatremia

Answer 44

Some of the same conditions that cause hypokalemia Also, excessive perspiration (during hot weather or physical work), prolonged diarrhea or vomiting, kidney disorders, and adrenocortical impairment

Question 45

Hypernatremia

Answer 45

sodium excess; serum levels over 145 mmol/L

Question 46

Symptoms of Hypernatremia

Answer 46

Water retention (edema), hypertension Red, flushed skin; dry, sticky mucous membranes; increased thirst; elevated temperature; decreased or absent urinary output

Question 47

Causes of Hypernatremia

Answer 47

Poor kidney excretion stemming from kidney malfunction; inadequate water consumption and dehydration

Question 48

Sodium is responsible for:

Answer 48

Control of water distribution Fluid and electrolyte balance Osmotic pressure of body fluids Participation in acid–base balance

Question 49

Main indication of sodium

Answer 49

Sodium depletion when dietary measures are inadequate (treatment or prevention)

Question 50

Sodium Depletion Treatment 1. Mild 2. Severe

Answer 50

Mild Treated with oral sodium chloride or fluid restriction or both Severe Treated with IV NS or lactated Ringer’s solution

Question 51

Sodium facts

Answer 51

New class of drugs for the treatment of euvolemic hyponatremia Dual arginine vasopressin V1A- and V2-receptor antagonists tolvaptan (Samsca®), often referred to as vaptans

Question 52

Sodium Adverse effects

Answer 52

Adverse effects Oral administration Nausea, vomiting, cramps IV administration Venous phlebitis

Question 53

Nursing Implications

Answer 53

Assess baseline fluid volume and electrolyte status. Assess baseline vital signs. Assess skin, mucous membranes, daily weights, and input and output. Assess for contraindications to therapy. Assess transfusion history. Establish venous access as needed. Monitor serum electrolyte levels during therapy. Monitor infusion rate, appearance of fluid or solution, and infusion site. Observe for infiltration and other complications of IV therapy. Monitor therapeutic response. Normal laboratory values -Red blood cells, white blood cells, electrolyte levels -Improved fluid volume status -Increased tolerance to activities Watch for adverse effects.

Question 54

Before giving potassium, assess?

Answer 54

electrocardiogram

Question 55

Parenteral infusions of potassium must be monitored closely.

Answer 55

Must be diluted in either water or fruit juice (100 to 250 mL) and taken with food or immediately after meals to minimize gastrointestinal distress or irritation and to prevent too rapid absorption Monitor reports of nausea, vomiting, gastrointestinal pain, and gastrointestinal bleeding.

Question 56

action of nurse for a pt receiving an infusion of rbc?

Answer 56

Flush IV line with NS before blood is added to the infusion

Question 57

contraindication of administering K IV?

Answer 57

serum potassium of 5.6 -hyperkalemia (3.5 to 5 is normal)

Question 58

Which comorbidity is a concern before an albumin infusion

Answer 58

heart failure

Question 59

What is administred if pt has deficienty in clotting factors?

Answer 59

Fresh frozen plasma

Question 60

Pt receiving cyrstalloid solution, what is a AE?

Answer 60

Fluid overload

Question 61

How to administer K IV

Answer 61

Administer K at a rate no faster than 20mmol/ hr Monitor CARDIAC RHYTHM with a heart monitor

Question 62

non protein plasma expander: dextran: which type of blood loss is this given to?

Answer 62

slow loss of 20 % to 50 %