Fluids And Electrolytes Flashcards
What is the ability of all the salutes to cause an osmotic driving force that promotes water movement from one compartment to another?
Tonicity
What is the movement of water caused by concentration gradient?
Osmosis
The natural tendency of a substance to move from an area of higher concentration to one of lower concentration
Diffusion
Hydrostatic pressure is used to filter fluid out of the intravascular compartment (high hydrostatic p) into the interstitial fluid (low hp)
Renal filtration
Moves sodium from the cell into the ECF and potassium into the cell
Sodium-potassium pump
What are the purpose of kidneys?
Filter plasma, excrete urine, regulate ECF :
volume, osmolaity, electrolytes, ph, and waste through SELECTIVE RETENSION AND EXCRETION
Fx of lungs?
Breathing removes fluids for acid base balance
What glands and their hormones, affect fluid electrolytes?
Pituitary- aldosterone
Adrenal- angiotensin
Parathyroid- renin
What is FVD? And what populations are at risk for it?
When the loss of ECF volume exceeds fluid intake. Renal dysfunction Heart failure Older adults-- thirst, fat,kidney weakness Small children Dementia pt Burns pt N/d/v
What is the best indicator for FVD?
Think assessment—> weight
Same t,clothes, and scale
What are symptoms of FVD? Think cardiac, integumentary.
Weight loss
Poor turgor
Tachycardia
Decreased bp
How often donee provide oral care for pt that are NPO?
Every 2 hrs
What are some other symptoms for FVD? Think renal, neuro, psychosocial, cardio?
Decreased urine out put with high specific gravity, confusion and decreased in CNS activity, restless or anxious but fatigues easily
What would the pt have wrong if they had a high specific gravity, and altered creatiene and BUN?
FVD
What are some interventions for FVD?
Oral fluid replacement
Safety education
Drug therapy to treat CAUSE of fluid deficiency
What are some causes of FVD?
Diarrhea, diuretic, meds, inadequate fluid intake in comparison to output
What are some isotonic IV fluids?
Lacerated ringers and NS or normal saline
What are some hypertonic solutions
D10W
3% 5% sodium chloride
Give an example of a hypo fluid?
1/2 NS
D5W
Isotonic FVD is treated with (blank) fluid
Isotonic- NS
Hypertonic FVD is treated with (blank) fluid
Hypotonic- d5w in body, and 1/2ns or .45% sodium chloride
Hypotonic solutions are treated with (blank) solutions
Hypertonic- 3% 5% NS and D5W
What does it mean if there is edema around a IV site?
Not in vein… Remove immediately
What solutions burn going in?
K+ causes tissue damage
Heart failure and renal failure are notorious for what type of fluid volume (deficit or excess)?
Excess
An isotonic expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportion in which they normally exist in the ECF
Hyperbole is/ fve
What are significant manifestations of hypervolemia? Think cardio, integumentary, respiratory, neuromuscular, gi?
Bounding pulse Increased bp and hr w/distended neck veins Weight gain*** Shallow/ slow respri, dyspraxia on excursion w/ crackles Pitting edema Pale cool skin All brain issues Increased motility gi
What would labs look like for hypervolemia?
Lower hmG, low concentration of cells bc of extra fluid
Elevating feet, fluid/ sodium restrictions, and assessing for increased fluid overload are interventions for what fluid disorder?
Fve hypervolemia
What diuretic is nondiscriminatory?
Lasix or furosemide
What do you monitor a pt that is hypervolemia for?
Bp, hr, o2, electrolyte imbalance
Skeletal and cardiac muscle contraction
Nerve impulse transmission maintaining ECF osmolarity and volume
Sodium fx
Name foods high in sodium
Cheese, bp, repackaged foods
What’s the normal level for sodium?
135-145 mEq/L
Hypo or hyper natremia change in cell excitability result in slower membrane depolarization?
Hypo
Causes of hypo at
Sweating, diuretics, wound drainage, renal disease, low salt intake, SIADH
Hypo at causes cellular swelling or shrinking?
Swelling
What are top assessments for hypo nat?
Confusion**
Bilateral muscle weakness
Diminished muscle tone and deep tendon reflexes
Increased gi motility and cramps
List first line therapies for hypo natremia
Increase oral sodium intake
Restrict fluids so we don’t dilute an we have
IV isotonic fluid with hypertonic saline (2,3,5% NS with lactated ringers)
Osmotic diuretics!! Only takes h2o
Cells swell or shrink with hyper natremia?
Dehydrate— shrink and are unable to respond to stimuli
Increase oral intake of sodium, saline solution with sodium, NPO, increase H2o loss with n d v swat or fever, and renal diseases.
Hyper natremia
Who is at risk for hyper natremia?
Elderly
Kidney disease
Diabetes insipidus*****
Symptoms and assessment for hyper natremia?
Neuro, nervous sys, skeletal, cardio
Increase CNS and agitation
Prone to seizures and confusion
Spontaneous muscle spasms severe weakness and deep tendon reflexes
Decreased contractility and output
Interventions for hyper natremia
Admin hypotonic fluids (1/2 NS and d5w) Loop diuretics ( lasix )
What are some potassium rich foods?
Bananas, cantaloupe, potato, broccoli, avocado, salmon, veil, raisin, oranges
What are the normal rates of K+?
3.5-5.0
What organ and hormone excrete the majority of K+?
Kidney and aldosterone
What electrolyte is in charge of marinating action potentials in excitable membranes, and regulation of protein synthesis and regulating glucose use and storage?
K+
What are the two causes of hypokalemia?
Actual
Relative
What does it mean when a cause is actual for hypokalemia?
Occurs with excessive k+ loss or inadequate k+ intake ( ie. diuretic, diarrhea, corticosteroids
What does it mean when hypokalemia is caused by relative?
K+ moves from ECF to ICF which causes an abnormal distribution of K+ ( alkalosis, hyperinsulinism
What’s the most common cause of hypokalemia?
Gi suction
For hypokalemia, is nerve and muscle stimuli fast or slow?
Low
First line assessment for hypokalemia is?
Respiratory—» ABCs airway, breath, and circulation
Shallow respri
Assessment for hypokalemia would include what? ( respi, musculoskeletal, cardio**, neuro, gi)
Shallow respri Hyporeflexia---> flaxis Slow hr, diff to palpate St depression or inversion Ortho htn Irritable and anxious Slowed gi, measure further bc paralytic ileus
What fluid volume can cause paralytic ileus?
Hypokalemia
List top interventions for hypokalemia
Oral k replacement
If severe then IV–hard on veins so monitor!
When does a pt need to be moved to a tele unit?
When k fluids are greater than 10 mEq/ hr
Does hyperkalemia increase or decrease cell excitability?
Increases
What organ is susceptible to tissue damage when dealing with k+ levels?
Heart
Causes of hyperkalemia include…
K deficits such as excess k intake or decreased k excretion
RENAL FAILURE** main cause
- others= blood transfusion, k sparing diuretic, Addison’s disease
What would an EKG look like for hyperkalemia pts?
Tall tented t wave *****
A systole or cardiac death (too much stimuli can’t respond bc weak and flaccid paralysis)
Flat p-wave
Spastic colon, diarrhea, and hyper excitable bowls are dt what electrolyte imbalance?
Hyperkalemia
Labs for hyperkalemia would look like what?
Elevated hematocrite and hmG
Elevated k if dehydrated
If renal then BUN and creatiene
How would a nurse treat a pt w/ hyperkalemia permanently?
Increase k excretion with loop diuretics like lasix or kayexalate
What are temporary agents used to treat hyperkalemia?
Insulin
Albuterol
IV calcium glauconite
Maintenance of bone strength and density, activation of enzymes or reactions, skeletal and cardiac muscle contractions, nerve impulse transmission, cofactor in blood clotting all fall under what electrolyte?
Calcium, think musculoskeletal
Foods high in calcium?
Rhubarb ( vit d is needed to absorb the ca)
Absorption of ca occurs where?
Gi tract
Causes of hypocalcemia include what?
EVERYTHING GI as well as removal of parathyroid glands
Inadequate intake
Hyperphosphatemia
What are some key assessements for hypocalcemia?
Trousseau’s and chvostek’s signed
Decreased hr
Muscle twitch and hyperactive dtr’s
Increased motility, depolarizers quickly
Calcium glauconite and alumni numb hydroxide as well as vitamin d are all interventions to treat what electrolyte disorder?
Hypocalcemia
Excitable become more or less sensitive to normal stimuli with hypercalcemia?
Less
Too much calcium leads to heat issue for fluids and flow?
Excessive clotting
Name some causes of hypercalcemia.
Thiazides diuretics, hyperparathyroidism and hyperthyroidism
What is the most important thing to assess with hypercalcemia?
Cardiac bc starts as increase bp and hr but ends with clotting and cardiac arrest
Monitor for DVT
Others include Hypo active gi
Renal stones!!
