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Cardiac > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

When studying fluid and electrolytes what are you studying?

A

The process of regulating the extracellular fluid volume, body fluid osmolarity, and plasma concentration of electrolyte.

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2
Q

What are the three factors that affect the ability to maintain fluid and electrolyte balance?

A
  • Illness
  • Trauma, surgery
  • Medications
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3
Q

What is an isotonic imbalance?

A

Water and electrolyte loss or gain at the same time

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4
Q

What is an osmolar imbalance?

A

When you lose either water and keep electrolytes or lose electrolytes and keep water.

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5
Q

How is fluid volume deficit described?

A

Fluids and electrolyte loss

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6
Q

How is dehydration described?

A

Loss of fluid alone.

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7
Q

What is the most common way patients excessively lose fluids?

A

Excessive loss of GI fluids

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8
Q

What are the 5 ways patients have excessive loss of GI fluids?

A
  • Vomiting
  • Diarrhea
  • GI suctioning
  • Intestinal fistulas
  • Intestinal drainage
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9
Q

How is GI suctioning done and what does it promote?

A

Through an NG tube promoting gastric rest by removing GI contents.

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10
Q

What are the 4 ways a patient can experience fluid loss?

*hint: not talking about GI fluid loss

A
  • Excessive renal loss (diuretics)
  • Heavy sweating
  • Hemorrhage
  • Chronic abuse of laxatives or enemas
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11
Q

What are the 5 ways a patient can experience insufficient fluid intake?

A
  • Lack of access to fluid
  • Inability to request or swallow fluids
  • Oral trauma
  • Altered thirst mechanisms
  • Excessive exercise: especially in hot weather
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12
Q

What happens during third spacing?

A

Fluid become trapped between intracellular and extracellular spaces

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13
Q

If the fluid is trapped due to third spacing what happens to the overall fluid volume in the body?

A

The patient experiences overall volume loss

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14
Q

Why is assessing the extent of FVD difficult?

A

There tends to not be a change in body weight

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15
Q

Where does third spacing normally occur?

A

In the interstitial tissues

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16
Q

What clinical manifestation occurs during third spacing?

A

Edema

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17
Q

What is the main cause of fluid shifts within the body?

A

Failure of regulatory mechanisms

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18
Q

Burns, Loss of sodium, and serum proteins cause what in the body?

A

Loss of fluids

The fluids leak into interstitial spaces causing edema

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19
Q

Why do children have a higher risk of FVD?

A

They sweat more and lack immune system support making them more likely to experience fever, vomiting and diarrhea.

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20
Q

Why do pregnant women have a higher risk of FVD?

A

Due to vomiting (morning sickness) in the first trimester and blood loss due to miscarriage.

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21
Q

Why are older adults at a higher risk of FVD?

A

They have a stunted thirst perception, they stop drinking sooner in fear of incontinence, and they have an alteration in ration of body fluids to muscle mass.

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22
Q

Where is the best place to check on a patient for their skin turgor?

A

Their sternum

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23
Q

What is the main neurological clinical manifestation in an elderly patient with FVD?

A

Confusion

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24
Q

What diagnostic tests are used to diagnose FVD?

A

Serum Electrolyte Panel
BUN
Creatinine
Urine Specific Gravity

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25
What clinical therapies are there to treat FVD?
Oral rehydration | Iv fluids
26
In a patient with FVD: what type of blood pressure should you make sure to do?
Orthostatic
27
What do you need to assess in terms of the patients skin when doing a physical assessment?
Skin color Temperature Turgor
28
When a patient is experiencing isotonic hypervolemia what is going on?
Both water and sodium are retained in the body
29
What is going on when a patient is experiencing over hydration?
More water retained than electrolytes
30
What is Fluid volume excess caused by?
Fluid overload or impairment of mechanisms of homeostasis, renal dysfunction, or excess sodium intake.
31
What does fluid volume excess lead to?
Excess intravascular fluids | Excess interstitial fluids
32
What clinical manifestations occur in a patient with excess intravascular fluid?
Hypervolemia, pulmonary edema and heart failure
33
What clinical manifestation occurs in a patient with excess interstitial fluids?
edema
34
Why would fluid volume excess cause blocked lymphatic drainage?
The fluid is not in the vessels it is out in the tissues- causing exerted pressure on the lymph blocking it
35
When a patient is experiencing fluid volume excess what are the two thing that are increased?
Increased blood hydrostatic pressure | Increased interstitial fluid osmotic pressure
36
When a patient is experiencing fluid volume excess what is decreased in response?
Decreased blood colloid osmotic pressure
37
What type of fluid should you not use if a patient has high potassium
A high sodium fluid
38
Why would you hear moist crackles in a patient with fluid volume excess?
Due to an overload on the heart and lungs
39
Why would the patients Hct and Hgb decrease if they are experiencing fluid volume excess?
The excess of fluid dilutes the blood cell count by increasing the plasma
40
What does cerebral edema cause?
Altered mental status and anxiety
41
Which sided heart failure causes pulmonary edema?
Left sided
42
Which sided heart failure causes body edema?
Right sided.
43
What diagnostic test should you do on a patient who is experiencing fluid volume excess?
- serum electrolytes and osmolarity - serum hematocrit and hemoglobin - Renal and live function studies - Chest xray
44
What treatments do you do on a patient who is experiencing fluid volume excess?
- Diuretics - limit fluids and sodium as ordered - auscultation of lungs - Monitor heart rhythm
45
What type of fluid guidelines would be instituted on a patient who is experiencing fluid volume excess?
Fluid restriction with strict I and O
46
Why would a patient who is experiencing fluid volume excess have a persistent cough?
Due to fluid back up
47
What is ascites?
A swelling of the abdomen due to protein containing fluid
48
True or false: | Electrolyte imbalance tend to be only one electrolyte at a time?
False: It normally happens together Ex) sodium and chlorine usually go together
49
What can happen to the body as the patient experiences severe electrolyte imbalance?
Multisystem effects or even death
50
What is the normal level of sodium?
135-145 meq/L
51
Where is sodium the most abundant?
In the ECF
52
Sodium is essential for what in the body?
- Maintaining acid-base balance | - Conduction of nerve impulses for muscle tissue
53
What assists in regulating serum sodium balance?
ADH, thirst and aldosterone
54
What is sodium balance affected by?
Food intake
55
What is hyponatremia?
low serum sodium levels | Less than 135 meq/L
56
What is responsible for hyponatremia?
the gain of water or loss of sodium
57
What are the six things that can cause a patient to go into hyponatremia?
- Vomiting - Diuretics - Excessive sweating - Excessive water intake - Excess ADH - Inadequate sodium intake
58
If a patient has hyponatremia what happens to the membranes?
It delays the depolarization of membranes
59
What are the signs and symptoms of hyponatremia?
- Lethargy - Headache - Confusion - Nausea - Muscle weakness - Seizures
60
What do the signs and symptoms of hyponatremia depend on?
The actual levels in the ECF
61
How is hyponatremia managed?
- Sodium-containing fluid/food - Fluid restriction - Diuretics - Monitor I and O - Monitor weight - 3% sodium chloride IV
62
What is hypernatremia?
Elevated serum sodium levels | Above 145 meq/L
63
What causes hypernatremia?
A shift of water out of cells resulting in cellular dehydration
64
What is hypernatremia due to?
- Water deprivation - excessive sodium intake - renal failure - fluid losses (burns, diarrhea)
65
What are the signs and symptoms of hypernatremia?
- Hyperthermia - Tachycardia - Irritability - Muscle twitching - Thirst - Dry, sticky membranes - Seizures - Coma
66
How is hypernatremia managed?
- Fluid replacement - Discourage sodium intake - Monitor Vital Signs - Monitor Heart Rhythm
67
What is the normal levels of potassium?
3.5-5.3 meq/L
68
What does potassium have a reciprocal action with?
Sodium
69
What does potassium play a vital role in?
- Transmission of nerve impulses - Function of heart and muscle tissues - Cell metabolism - Acid-base balance
70
What type of cation is potassium?
Intracellular cation
71
What is hypokalemia?
Low serum potassium levels | Less than 3.5 meq/L
72
What is hypokalemia due to?
- GI losses - Excessive diuretics - Excessive laxatives - Diaphoresis - Inadequate intake
73
What are the signs and symptoms of hypokalemia?
- Dysrhythmias - Irregular pulse - Anorexia - Decreased bowel sounds - Ileus - Muscle cramping/weakness
74
What are the diagnostic tests for hypokalemia?
Labs and ECG
75
How is hypokalemia managed?
- Replacement of potassium in foods - PO meds or IV - Monitor labs - Monitor heart, lung, GI and kidney function
76
What is hyperkalemia?
High serum potassium levels | -greater than 5.3 meq/L
77
What is hyperkalemia due to?
- Increased intake of potassium - Potassium leaking from cells - Renal dysfunction - Decreased insulin
78
What are the signs and symptoms of hyperkalemia?
- Dysrhythmias - Irregular pulse - Hypotension - Nausea/vomiting - Hyperactive bowels - Weakness - Irritability
79
How is hyperkalemia managed?
- Administration of calcium gluconate - Insulin/glucose - Kayexalate - Diuretics - Monitor ECG
80
What is the normal levels for calcium?
8.2-10.2 mg/dL
81
What is calcium responsible for?
- Neuromuscular transmissions - Helps regulate muscle contraction-including the heart - Blood clotting - Bone, teeth formation - Cellular membrane function
82
What are calcium levels controlled by?
- Vitamin D - Calcitonin - Parathyroid hormone
83
What is calcium inversely related to?
Phosphorus levels
84
What is hypocalcemia?
Low calcium levels | less than 8.2 mg/dL
85
What is hypocalcemia due to?
- Low intake - Malabsorption - End-stage kidney failure - Hypoparathyroidism - Neck surgery
86
What are the signs and symptoms of hypocalcemia?
- Paresthesias - Muscle twitching and tetany - Cramps - Confusion - Chvostek and Trousseau signs - Decreased HR and BP - ECG changes - Seizures - Osteoporosis
87
How are the severe symptoms of hypocalcemia managed?
- IV replacement at a moderate rate | - Oral increase in calcium and vitamin D
88
What is hypercalcemia?
High calcium levels | Over than 10.2 mg/dL
89
What is hypercalcemia usually due to?
- Malignancies | - Hyperparathyroidism
90
What are the signs and symptoms of hypercalcemia?
- Weakness - Dysrhythmias - Nausea/vomiting - Headache - Constipation - Polyuria and polydipsia - ECG changes
91
How is hypercalcemia managed?
By treating the underlying causes: - Partial parathyroidectomy - D/C of thiazide diuretics - Vitamin and mineral supplements - Low-calcium diet
92
What is administered to a patient who is under a crisis of hypercalcemia?
Calcitonin
93
What is administered with IV fluids that can increase calcium excretion?
Furosemide
94
What type of IV mineral can be given to reduce calcium in a patient with hypercalcemia?
Phosphate
95
What is the normal range for chloride?
97-107 mEq/L
96
Chloride is the most prevalent what?
anion in extracellular fluid
97
When chloride is with sodium what does it maintain?
Electricity of body in neutral state
98
When chloride is with hydrogen what does it form?
Hydrochloric acid in the stomach to aid in digestion
99
What does chloride place a role in?
-Acid-base balance
100
What does chloride have an inverse relationship with?
Bicarbonate
101
What is hyperchloremia?
High levels of chloride | Above 107 mEq/L
102
What is hyperchloremia due to?
- Renal failure - Head injury - Hypernatremia - Diuretics - Severe diarrhea
103
What are the signs and symptoms for hyperchloremia?
- Kussmaul respirations - Weakness - Thirst - Dysrhythmias
104
How is hyperchloremia managed?
- Diuretics - IV fluids - Treatment of underlying causes: dialysis
105
What is hypochloremia?
Low levels of chloride | Below 95 mEq/L
106
What is hypochloremia due to?
- Vomiting - Diarrhea - Decreased Sodium intake
107
What are the signs and symptoms of hypochloremia?
- Paresthesia of face and extremities - Muscle spasms - Tetany - Slow, shallow respirations - Irritability
108
How is hypochloremia managed?
- Increased salt in diet - Adding chloride to IV fluids - Treating underlying causes
109
What do you need to monitor for both hyperchloremia and hypochloremia?
- Labs - I and O - Lung - Heart - Neuro

Cardiac (13 decks)

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