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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
Q

What clinical therapies are there to treat FVD?

A

Oral rehydration

Iv fluids

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26
Q

In a patient with FVD: what type of blood pressure should you make sure to do?

A

Orthostatic

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27
Q

What do you need to assess in terms of the patients skin when doing a physical assessment?

A

Skin color
Temperature
Turgor

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28
Q

When a patient is experiencing isotonic hypervolemia what is going on?

A

Both water and sodium are retained in the body

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29
Q

What is going on when a patient is experiencing over hydration?

A

More water retained than electrolytes

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30
Q

What is Fluid volume excess caused by?

A

Fluid overload or impairment of mechanisms of homeostasis, renal dysfunction, or excess sodium intake.

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31
Q

What does fluid volume excess lead to?

A

Excess intravascular fluids

Excess interstitial fluids

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32
Q

What clinical manifestations occur in a patient with excess intravascular fluid?

A

Hypervolemia, pulmonary edema and heart failure

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33
Q

What clinical manifestation occurs in a patient with excess interstitial fluids?

A

edema

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34
Q

Why would fluid volume excess cause blocked lymphatic drainage?

A

The fluid is not in the vessels it is out in the tissues- causing exerted pressure on the lymph blocking it

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35
Q

When a patient is experiencing fluid volume excess what are the two thing that are increased?

A

Increased blood hydrostatic pressure

Increased interstitial fluid osmotic pressure

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36
Q

When a patient is experiencing fluid volume excess what is decreased in response?

A

Decreased blood colloid osmotic pressure

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37
Q

What type of fluid should you not use if a patient has high potassium

A

A high sodium fluid

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38
Q

Why would you hear moist crackles in a patient with fluid volume excess?

A

Due to an overload on the heart and lungs

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39
Q

Why would the patients Hct and Hgb decrease if they are experiencing fluid volume excess?

A

The excess of fluid dilutes the blood cell count by increasing the plasma

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40
Q

What does cerebral edema cause?

A

Altered mental status and anxiety

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41
Q

Which sided heart failure causes pulmonary edema?

A

Left sided

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42
Q

Which sided heart failure causes body edema?

A

Right sided.

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43
Q

What diagnostic test should you do on a patient who is experiencing fluid volume excess?

A
  • serum electrolytes and osmolarity
  • serum hematocrit and hemoglobin
  • Renal and live function studies
  • Chest xray
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44
Q

What treatments do you do on a patient who is experiencing fluid volume excess?

A
  • Diuretics
  • limit fluids and sodium as ordered
  • auscultation of lungs
  • Monitor heart rhythm
45
Q

What type of fluid guidelines would be instituted on a patient who is experiencing fluid volume excess?

A

Fluid restriction with strict I and O

46
Q

Why would a patient who is experiencing fluid volume excess have a persistent cough?

A

Due to fluid back up

47
Q

What is ascites?

A

A swelling of the abdomen due to protein containing fluid

48
Q

True or false:

Electrolyte imbalance tend to be only one electrolyte at a time?

A

False:
It normally happens together
Ex) sodium and chlorine usually go together

49
Q

What can happen to the body as the patient experiences severe electrolyte imbalance?

A

Multisystem effects or even death

50
Q

What is the normal level of sodium?

A

135-145 meq/L

51
Q

Where is sodium the most abundant?

A

In the ECF

52
Q

Sodium is essential for what in the body?

A
  • Maintaining acid-base balance

- Conduction of nerve impulses for muscle tissue

53
Q

What assists in regulating serum sodium balance?

A

ADH, thirst and aldosterone

54
Q

What is sodium balance affected by?

A

Food intake

55
Q

What is hyponatremia?

A

low serum sodium levels

Less than 135 meq/L

56
Q

What is responsible for hyponatremia?

A

the gain of water or loss of sodium

57
Q

What are the six things that can cause a patient to go into hyponatremia?

A
  • Vomiting
  • Diuretics
  • Excessive sweating
  • Excessive water intake
  • Excess ADH
  • Inadequate sodium intake
58
Q

If a patient has hyponatremia what happens to the membranes?

A

It delays the depolarization of membranes

59
Q

What are the signs and symptoms of hyponatremia?

A
  • Lethargy
  • Headache
  • Confusion
  • Nausea
  • Muscle weakness
  • Seizures
60
Q

What do the signs and symptoms of hyponatremia depend on?

A

The actual levels in the ECF

61
Q

How is hyponatremia managed?

A
  • Sodium-containing fluid/food
  • Fluid restriction
  • Diuretics
  • Monitor I and O
  • Monitor weight
  • 3% sodium chloride IV
62
Q

What is hypernatremia?

A

Elevated serum sodium levels

Above 145 meq/L

63
Q

What causes hypernatremia?

A

A shift of water out of cells resulting in cellular dehydration

64
Q

What is hypernatremia due to?

A
  • Water deprivation
  • excessive sodium intake
  • renal failure
  • fluid losses (burns, diarrhea)
65
Q

What are the signs and symptoms of hypernatremia?

A
  • Hyperthermia
  • Tachycardia
  • Irritability
  • Muscle twitching
  • Thirst
  • Dry, sticky membranes
  • Seizures
  • Coma
66
Q

How is hypernatremia managed?

A
  • Fluid replacement
  • Discourage sodium intake
  • Monitor Vital Signs
  • Monitor Heart Rhythm
67
Q

What is the normal levels of potassium?

A

3.5-5.3 meq/L

68
Q

What does potassium have a reciprocal action with?

A

Sodium

69
Q

What does potassium play a vital role in?

A
  • Transmission of nerve impulses
  • Function of heart and muscle tissues
  • Cell metabolism
  • Acid-base balance
70
Q

What type of cation is potassium?

A

Intracellular cation

71
Q

What is hypokalemia?

A

Low serum potassium levels

Less than 3.5 meq/L

72
Q

What is hypokalemia due to?

A
  • GI losses
  • Excessive diuretics
  • Excessive laxatives
  • Diaphoresis
  • Inadequate intake
73
Q

What are the signs and symptoms of hypokalemia?

A
  • Dysrhythmias
  • Irregular pulse
  • Anorexia
  • Decreased bowel sounds
  • Ileus
  • Muscle cramping/weakness
74
Q

What are the diagnostic tests for hypokalemia?

A

Labs and ECG

75
Q

How is hypokalemia managed?

A
  • Replacement of potassium in foods
  • PO meds or IV
  • Monitor labs
  • Monitor heart, lung, GI and kidney function
76
Q

What is hyperkalemia?

A

High serum potassium levels

-greater than 5.3 meq/L

77
Q

What is hyperkalemia due to?

A
  • Increased intake of potassium
  • Potassium leaking from cells
  • Renal dysfunction
  • Decreased insulin
78
Q

What are the signs and symptoms of hyperkalemia?

A
  • Dysrhythmias
  • Irregular pulse
  • Hypotension
  • Nausea/vomiting
  • Hyperactive bowels
  • Weakness
  • Irritability
79
Q

How is hyperkalemia managed?

A
  • Administration of calcium gluconate
  • Insulin/glucose
  • Kayexalate
  • Diuretics
  • Monitor ECG
80
Q

What is the normal levels for calcium?

A

8.2-10.2 mg/dL

81
Q

What is calcium responsible for?

A
  • Neuromuscular transmissions
  • Helps regulate muscle contraction-including the heart
  • Blood clotting
  • Bone, teeth formation
  • Cellular membrane function
82
Q

What are calcium levels controlled by?

A
  • Vitamin D
  • Calcitonin
  • Parathyroid hormone
83
Q

What is calcium inversely related to?

A

Phosphorus levels

84
Q

What is hypocalcemia?

A

Low calcium levels

less than 8.2 mg/dL

85
Q

What is hypocalcemia due to?

A
  • Low intake
  • Malabsorption
  • End-stage kidney failure
  • Hypoparathyroidism
  • Neck surgery
86
Q

What are the signs and symptoms of hypocalcemia?

A
  • Paresthesias
  • Muscle twitching and tetany
  • Cramps
  • Confusion
  • Chvostek and Trousseau signs
  • Decreased HR and BP
  • ECG changes
  • Seizures
  • Osteoporosis
87
Q

How are the severe symptoms of hypocalcemia managed?

A
  • IV replacement at a moderate rate

- Oral increase in calcium and vitamin D

88
Q

What is hypercalcemia?

A

High calcium levels

Over than 10.2 mg/dL

89
Q

What is hypercalcemia usually due to?

A
  • Malignancies

- Hyperparathyroidism

90
Q

What are the signs and symptoms of hypercalcemia?

A
  • Weakness
  • Dysrhythmias
  • Nausea/vomiting
  • Headache
  • Constipation
  • Polyuria and polydipsia
  • ECG changes
91
Q

How is hypercalcemia managed?

A

By treating the underlying causes:

  • Partial parathyroidectomy
  • D/C of thiazide diuretics
  • Vitamin and mineral supplements
  • Low-calcium diet
92
Q

What is administered to a patient who is under a crisis of hypercalcemia?

A

Calcitonin

93
Q

What is administered with IV fluids that can increase calcium excretion?

A

Furosemide

94
Q

What type of IV mineral can be given to reduce calcium in a patient with hypercalcemia?

A

Phosphate

95
Q

What is the normal range for chloride?

A

97-107 mEq/L

96
Q

Chloride is the most prevalent what?

A

anion in extracellular fluid

97
Q

When chloride is with sodium what does it maintain?

A

Electricity of body in neutral state

98
Q

When chloride is with hydrogen what does it form?

A

Hydrochloric acid in the stomach to aid in digestion

99
Q

What does chloride place a role in?

A

-Acid-base balance

100
Q

What does chloride have an inverse relationship with?

A

Bicarbonate

101
Q

What is hyperchloremia?

A

High levels of chloride

Above 107 mEq/L

102
Q

What is hyperchloremia due to?

A
  • Renal failure
  • Head injury
  • Hypernatremia
  • Diuretics
  • Severe diarrhea
103
Q

What are the signs and symptoms for hyperchloremia?

A
  • Kussmaul respirations
  • Weakness
  • Thirst
  • Dysrhythmias
104
Q

How is hyperchloremia managed?

A
  • Diuretics
  • IV fluids
  • Treatment of underlying causes: dialysis
105
Q

What is hypochloremia?

A

Low levels of chloride

Below 95 mEq/L

106
Q

What is hypochloremia due to?

A
  • Vomiting
  • Diarrhea
  • Decreased Sodium intake
107
Q

What are the signs and symptoms of hypochloremia?

A
  • Paresthesia of face and extremities
  • Muscle spasms
  • Tetany
  • Slow, shallow respirations
  • Irritability
108
Q

How is hypochloremia managed?

A
  • Increased salt in diet
  • Adding chloride to IV fluids
  • Treating underlying causes
109
Q

What do you need to monitor for both hyperchloremia and hypochloremia?

A
  • Labs
  • I and O
  • Lung
  • Heart
  • Neuro

Cardiac (13 decks)

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