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Study cards 2 > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Fluid Balance

A

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

60% of adult human body is water.

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2
Q

Intravascular fluid

A

Fluid inside blood vessels

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3
Q

Extravascular fluid

A

Fluid outside blood vessels

Lymph, cerebrospinal fluid

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4
Q

Extravascular volume

A

Plasma

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

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5
Q

Extracellular volume

A

Interstitial fluid

Intracellular fluid

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6
Q

Plasma proteins exert constant osmotic pressure.

A

Colloid oncotic pressure

Normally 24 mm Hg

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7
Q

Interstitial fluid exerts hydrostatic pressure.

A

Normally 17 mm Hg

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8
Q

Edema

Dehydration and fluid loss

A

Acid–base balance

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

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9
Q

Distribution of Total Body Water

A

TBW- 60% is water

ECF- 1/3

PV- 1/3

ISF- 2/3

ICF- 2/3

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10
Q

Hypertonic

A

H20 goes outside the cell

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11
Q

Isotonic

A

H20 in and out of the cell is balanced

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12
Q

Hypotonic

A

H20 goes inside the cell

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13
Q

Crystalloids

A

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

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14
Q

Crystalloids is used as maintenance fluids to:

A

Compensate for insensible fluid losses

Replace fluids

Manage specific fluid and electrolyte disturbances

Promote urinary flow

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15
Q

7 Crystalloids solutions

A

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)

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16
Q

Crystalloids indications

A

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

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17
Q

Crystalloids Adverse effects

A

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

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18
Q

Colloids

A

Protein substances

Increase colloid oncotic pressure

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

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19
Q

3 Colloids

A

Albumin 5% and 25% (from human donors)

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

Hetastarch (synthetic)

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20
Q

Colloids Adverse effects

A

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.

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21
Q

Colloids: Albumin

A

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

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22
Q

Blood Products

A

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.

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23
Q

Blood products facts

A

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

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24
Q

Blood Products Indications

Cryoprecipitate and plasma protein factors

A

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

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25
Q

Blood Products Indications

Fresh frozen plasma

A

increase clotting factor levels

26
Q

Blood Products Indications

Packed red blood cells

A

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

27
Q

Blood Products Indications

Whole blood

A

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

28
Q

Blood Products Adverse Effects

A

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

29
Q

Electrolytes

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

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

30
Q

Potassium

A

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.

31
Q

Potassium obtained from foods

A

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

32
Q

Excess dietary potassium excreted via _____

What happens if its impaired?

A

KIDNEYS

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

33
Q

Hyperkalemia

A

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

34
Q

Hypokalemia

A

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

35
Q

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

A

serious ventricular dysrhythmias.

36
Q

Potassium is responsible for:

A

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

37
Q

Potassium indication

A

Treatment or prevention of potassium depletion when dietary means are inadequate

Other

Stop irregular heartbeats

Management of tachydysrhythmias that can occur after cardiac surgery

38
Q

Potassium Adverse effects

A

Oral preparations
-Diarrhea, nausea, vomiting, gastrointestinal bleeding, ulceration

IV administration
-Pain at injection site
-Phlebitis

Excessive administration
-Hyperkalemia
-Toxic effects
-Cardiac arrest

39
Q

Hyperkalemia manifestations

A

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

40
Q

Treatment of severe hyperkalemia

A

IV sodium bicarbonate, calcium gluconate or calcium chloride, dextrose with insulin

Sodium polystyrene sulphonate (Kayexalate®) or hemodialysis to remove excess potassium

41
Q
  1. Sodium
  2. Foods high in Sodium
A

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

42
Q

Hyponatremia

A

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

43
Q

Symptoms of hyponatremia

A

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

44
Q

Causes of hyponatremia

A

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

45
Q

Hypernatremia

A

sodium excess; serum levels over 145 mmol/L

46
Q

Symptoms of Hypernatremia

A

Water retention (edema), hypertension

Red, flushed skin; dry, sticky mucous membranes; increased thirst; elevated temperature; decreased or absent urinary output

47
Q

Causes of Hypernatremia

A

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

48
Q

Sodium is responsible for:

A

Control of water distribution

Fluid and electrolyte balance

Osmotic pressure of body fluids

Participation in acid–base balance

49
Q

Main indication of sodium

A

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

50
Q

Sodium Depletion Treatment

  1. Mild
  2. Severe
A

Mild
Treated with oral sodium chloride or fluid restriction or both

Severe
Treated with IV NS or lactated Ringer’s solution

51
Q

Sodium facts

A

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

52
Q

Sodium Adverse effects

A

Adverse effects
Oral administration
Nausea, vomiting, cramps

IV administration
Venous phlebitis

53
Q

Nursing Implications

A

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.

54
Q

Before giving potassium, assess?

A

electrocardiogram

55
Q

Parenteral infusions of potassium must be monitored closely.

A

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.

56
Q

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

A

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

57
Q

contraindication of administering K IV?

A

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

58
Q

Which comorbidity is a concern before an albumin infusion

A

heart failure

59
Q

What is administred if pt has deficienty in clotting factors?

A

Fresh frozen plasma

60
Q

Pt receiving cyrstalloid solution, what is a AE?

A

Fluid overload

61
Q

How to administer K IV

A

Administer K at a rate no faster than 20mmol/ hr

Monitor CARDIAC RHYTHM with a heart monitor

62
Q

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

A

slow loss of 20 % to 50 %

Study cards 2 (24 decks)

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