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ProvaENFRN > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Electrolytes

A

Is a substance that, on dissolving in solution, ionizes; that is, some of its molecules split or dissociate into electrically charged atoms and ions.
- mEq: milliequivalent (provide information about the number of anions and cations available to combine.

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2
Q

Atom

A

Composed of protons (positive), neutrons (neutral), and electrons (negative).

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3
Q

Molecule

A

2 or more atoms

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4
Q

Ion

A

Atom with electrical charge (gained or lost electrons)

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5
Q

Cation

A

Positive charge ion (lost electrons)

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6
Q

Anion

A

Negative charge ion (gained electrons)

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7
Q

Body fluid compartments

A
  • Fluids contains electrolytes.
  • To function normally: body cells must have fluids and electrolytes in the right compartments and in the right amounts. Number of cations and anions must be the same for homeostasis.
  • Intravascular: fluid inside a blood vessel.
  • Intracellular: fluid inside the cells.
  • Extracellular: fluid outside the vessel and includes intersticial fluid (third space), blood, lymph, bone, connective tissue, water.
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8
Q

Third-spacing

A

Accumulation and sequestration of trapped extracellular fluid in an actual or potencial body space as a result of disease or injury.
Pericardial, pleural, peritoneal, joint cavities, bowel, abdomen, or soft tissues.
Represents a volume loss and is unavailable for normal physiological process.

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9
Q

Edema

A

Excess accumulation of fluid in the interstitial space; it occurs as a result of alterations in oncotic pressure, hydrostatic pressure, capillary permeability, and lymphatic obstruction.
Anasarca is a generalized edema. An excessive accumulation of fluid in the intertitial space throughout the body and occurs as a result of conditions such as cardiac, renal or liver failure.

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10
Q

Body fluid (amount and distribution)

A 
Total body fluid (body weight): adult 60%, older adult 55%, and infant 80%.
Intracellular fluid 70%
Extracellular fluid 30%
- Interstitial 22%
- Intravascular 6%
- Transcellular 2%
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11
Q

Body fluid transport (diffusion, osmosis and filtration)

A

Diffusion: a solute spreads the molecule from a area of higher concentration to an area of lower concentration.
Osmosis: Movement of solvent molecules across a membrane. Usually from a solution of lower concentration to one of higher. Osmotic pressure is the force that draws the solvent from a less to a more concentrated solute.
Filtration: Movement of solutes and solvents by hydrostatic pressure. Movement occurs from an area of higher to an area of lower pressure.

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12
Q

Osmolality

A

Refers to the numeber of osmotically active particles per kilogram of water; it is the concentration of a solute.
The normal osmolality of plasma is: 275 - 295 mOsm (or mmol/kg).

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13
Q

Types of solution (Isotonic, Hypotonic, Hypertonic)

A

Isotonic: same osmolality as body fluids. Very little osmosis occurs.
Hypotonic: has less salt or more water than an isotonic. Have lower osmolality than body fluids.
Hypertonic: higher concentration of solutes and higher osmolality than body fluids.

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14
Q

Isotonic dehydration

A

Water and dissolved electrolytes are lost in equal proportions. Known as hypovolemia, and is the most common type. Results in decreased circulating blood volume.
Causes: Inadequate intake; fluid shifts between compartments; excessive losses of isotonic body fluids.

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15
Q

Hypertonic dehydration

A

Water loss exceeds electrolyte loss. Fluid moves from the intracellular compartment into the plasma and interstitial space.
Causes: Excessive perspiration; hyperventilation; ketoacidosis; prolonged fevers; diarrhea; early stage kidney disease; diabetes insipidus.

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16
Q

Hypotonic dehydration

A

Electrolyte loss exceeds water loss. Fluid moves from plasma and interstitial spaces into the cells, causing cells to swell.
Causes: Chronic illness; excessive fluid replacement (hypotonic); kidney disease; chronic malnutrition.

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17
Q

Assessment findings on fluid volume DEFICITS

A

Cardio: Thready, increased pulse rate, decreased BP and orthostatic hypotension. Flat neck and hand veins in dependent psitions, diminished peripheral pulses, decreased CVP, dysrhythmias.
Respiratory: increased rate and depth, dyspnea.
Neuromuscular: decreased SNC activity, from letargy to coma. Fever, skeletal muscle weakness.
Renal: Decreased urine output.
Integumentary: Dry skin, poor turgor, tenting, dry mouth.
GI: decreased motility and bowel sounds, constipation, thirst, decreased body weight.
Lab: Increased serum osmolality, hematocrit, blood urea nitrogen (BUN), serum sodium and urinary specific gravity.

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18
Q

Assessment findings on fluid volume EXCESS

A

Cardio: bounding increased PR, elevated BP and CVP, distended neck and hand veins, dysrhythmias.
Respiratory: Increased RR (shallow), dyspnea, moist crackles.
Neuromuscular: altered level of consciousness, headache, visual disturbances, skeletal muscle weakness, paresthesias.
Renal: increased urine output (if not cause)
Integumentary: pitting edema, pale, cool skin.
GI: Increased motility, diarrhea, increased body weight, liver enlargement, ascites.
Lab: Decreased serum osmolality, hematocrit, blood urea nitrogen (BUN), serum sodium and urinary specific gravity.

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19
Q

Isotonic Overhydration

A

Hypervolemia
Inadequaly controlled IV therapy
Kidney disease
Longterm corticosteroid therapy

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20
Q

Hypertonic Overhydration

A

Extracellular volume expands and intracellular contracts (very rare)

  • Excessive sodium ingestion
  • Rapid infusion of hypertonic saline
  • Excessive sodium bicarbonate therapy
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21
Q

Hypotonic Overhydration

A

Water intoxication. Excessive fluid moves into the intracellular space. Dillution.

  • Early kidney disease
  • Heart failure
  • Syndrome of inappropriate antidiuretic hormone secretion
  • Inadequaly controlled IV therapy
  • Replacement of isotonic fluid loss with hypertonic
  • Irrigation of wounds and body cavities with hypotonic fluid.
22
Q 
Normal level electrolytes:
Potassium
Sodium
Calcium
Magnesium
Phosphate
A

Potassium: 3.5 - 5.0 mEq/L (mmol/L)
Sodium: 135 - 145 mEq/L (mmol/L)
Calcium: 9 - 10.5 mg/dL (2.25 - 2.75 mmol/L)
Magnesium: 1.8 - 2.6 mEq/L (0.74 - 1.07 mmol/L)
Phosphate: 3.0 - 4.5 mg/dL (0.97 - 1.45 mmol/L)

23
Q

Hypokalemia (causes)

A

< 3.5 mEq/L (mmol/L)
Excessive use of diuretics or corticosteroids;
Increased secretion of aldosterone (cushing’s);
Vomiting, diarrhea;
wound drainage;
prolonged nasogastric suction;
excessive diaphoresis;
kidney disease;
inadequate potassium intake;
movement of potassium from extra to intracellular (alkalosis, hyperinsulinism)
Dilution of serum potassium (water intoxication, IV therapy with potassium deficits solutions.

24
Q

Hypokalemia (intervations)

A

Oral supplements: should not be taken on empty stomach. May cause nausea, vomiting, diarrhea and GI bleeding (may need to be discontinued). Liquid potassium has unpleasant taste (take with juice or another liquid).
IV potassium: NEVER IV push, IM or SC. Always diluted.
Other op: Foods with high potassium content, may discontinue potassium-losing diuretic.

25
Q

Hypokalemia (assessment findings)

A

Cardio: thready, weak, irregular pulse. Weak peripheral pulses, orthostatic hypotension, dysrhythmias.
Respiratory: shallow, ineffective and profound weakness of muscles. Diminished breath sounds.
Neuromuscular: anxiety, lethargy, confusion, coma. Skeletal muscle weakness, leg cramps, loss f tactile discrimination, paresthesias, deep tendon hyporeflexia.
GI: decreased motility, hypoactive to absent bowel sounds. Nausea, vomiting, constipation, distension, paralytic ileus.
ECG: ST depression; shallow, flat, or inverted T wave; and prominent U wave.

26
Q

Hyperkalemia (causes)

A

> 5.0 mEq/L (mmol/L)
Excessive potassium intake
Rapid infusion of potassium IV solutions
Potassium-sparing diuretics
Kidney disease
Adrenal insufficiency (addison’s disease)
Movement of K from the intra to extracellular fluid (tissue damage, acidosis, hyperuricemia, hypercatabolism)

27
Q

Hyperkalemia (assessment findings)

A

Cardio: slow, weak, irregular HR, decreased BP, dysrhythmias.
Respiratory: Profound weakness of the skeletal muscles leading to failure.
NM: early - muscle twitches, cramps and paresthesias. Late - profound weakness, ascending flaccid paralysis in the arms and legs.
GI: Increased motility, hyperactive bowel sounds.
ECG: tall peaked T, flat P, widened QRS and prolonged PR.

28
Q

Hyperkalemia (intervations)

A

Descontinue potassium IV and oral supplements
Initiate potassium-restricted diet
Prepare to ADM potassium-excreting diuretics
If renal function impaired, ADM sodium polystyrene sulfonate (oral or rectal) a cation-exchange resin that promotes GI sodium absorption and potassium excretion.
Prepare for dialysis if levels era critical
ADM IV calcium to avert myocardial excitability
ADM hypertonic glucose with regular insulin to move excess potassium into the cells
If transfusion needed, use fresh blood (breakdown of older cells releases potassium
Avoid food with high potassium and salt substitutes.

29
Q

Hyponatremia (causes)

A

< 135 mEq/L (mmol/L)
Sodium imbalances usually are associated with fluid volume imbalances.
- increased sodium excretion (excessive diaphoresis, diuretics, vomiting, diarrhea, wound drainage, kidney disease, decreased secretion of aldosterone)
- inadequate sodium intake (fasting or low salt diet)
- dilution of sodium (excessive ingestion of hypotonic fluids or irrigation with hypotonic fluids; kidney disease; fresh water drowning; syndrome of inappropriate antidiuretic hormone secretion; hyperglycemia; heart failure).

30
Q

Hyponatremia (assessment findings)

A

Cardio: symptoms vary with changes in vascular volume.
Respiratory: shallow, ineffective (late manifestation).
NM: skeletal weakness, diminished deep tendon reflexes.
CNS: Headache, personality changes, confusion, seizures, coma.
GI: increased motility and bowel sounds, nausea, cramping and diarrhea.
Renal: Increased urinary output.
Integumentary: dry mucous membranes.
Lab: decreased urinary specific gravity.

31
Q

Hyponatremia (intervations)

A
  • If accompanied by hypovolemia: IV sodium chloride are ADM to restore sodium content and fluid volume.
  • If accompanied by hypervolemia: osmotic diuretics may be prescribed to promote the excretion of water rather than sodium.
  • If caused by inappropriate or excessive secretion of antidiuretic hormone, medications that antagonize may be ADM.
  • Instruct to increase oral sodium (food).
  • If the client is taking lithium, monitor level, because hyponatremia can cause diminished lithium excretion, resulting in toxicity.
32
Q

Hypernatremia (causes)

A

> 145 mEq/L (mmol/L)

  • Decreased sodium excretion (corticosteroids, cushing’s syndrome, kidney disease, hyperaldosteronism)
  • Increased sodium intake (excessive oral ingestion or excessive IV fluids with sodium)
  • Decreased water intake (fasting)
  • Increased water loss (high metabolism, fever, hyperventilation, infection, excessive diaphoresis, watery diarrhea, diabetes insipidus).
33
Q

Hypernatremia (assessment findings)

A

Cardio: HR and BP respond to volume status.
Respiratory: pulmonary edema if hypervolemia.
NM: muscle twitches or irregular contractions (early). Skeletal muscle weakness, deep tendon reflexes diminished or absent (late).
CNS: Altered cerebral function. Agitation, confusion, seizures (normal or hypovolemia). Lethargy, stupor, coma (hypervolemia).
GI: extreme thirst.
Renal: decreased urinary output.
Integ: dry and flushed skin, dry and sticky tongue and mucus membranes. Presence or absence of edema.
Lab: increased urinary specific gravity.

34
Q

Hypernatremia (interventions)

A
  • if fluid loss prepare to ADM fluids.
  • if inadequate renal excretion, prepare to ADM diuretics that promote sodium loss.
  • Restrict sodium and fluid intake.
35
Q

Hypocalcemia (causes)

A

< 9 mg/dL (2.25 mmol/L)

  • Inibition of calcium absorption from the GI: inadequate oral intake, lactose intolerance, malabsorption syndromes (celic sprue or chron’s disease), inadequate intake of vit D, end stage kidney disease.
  • Increased calcium excretion: kidney disease (polyuric phase), diarrhea, steatorrhea, wound drainage (especially GI).
  • Conditions that decrease the ionized fraction of calcium: hyperproteinemia, alkalosis, medications such as calcium chelators or binders, acute pancreatitis, hyperphosphatemia, immobility, removal or destruction of the parathyroid glands.
36
Q

Hypocalcemia (assessment findings)

A

Cardio: decreased HR, hypotension, diminished peripheral pulses.
Respiratory: may happen failure or arrest due to muscle tetany or seizures.
NM: irritable skeletal muscles: twitches, cramps, tetany, seizures. Painful muscles spasms in the calf or foot, paresthesias followed by numbness. Positive Trousseau’s and Chvostek’s signs, hyperactive deep tendon reflexes, anxiety, irritability.
Renal: urinary output varies depending on the cause.
GI: Increased gastric motility and bowel sounds. Cramping and diarrhea.
ECG: Prolonged ST and QT.

37
Q

Hypocalcemia (interventions)

A
  • ADM calcium supplements orally or IV.
  • When IV: warm the solution to body temp and ADM slowly, monitor for ECG changes, infiltration and hypercalcemia.
  • ADM medications that increase absorption: aluminum hydroxide (reduces phosphorus, causing countereffect of increasing calcium). Vit D aids the absorption in the GI
  • Initiate seizure precautions.
  • Monitor for signs of pathological fractures.
  • Keep 10% calcium gluconate available.
  • Consume foods high in calcium.
38
Q

Hypercalcemia ( causes)

A

> 10.5 mg/dL (2.75 mmol/L)

  • Increased absorption: excessive oral intake of calcium or vit D.
  • Decreased excretion: kidney disease, use of thiazide diuretics.
  • Increased bone resorption: hyperparathyroidism, hyperthyroidism, malignancy (tumor), immobility, use of glucocoticoids.
  • Hemoconcentration: dehydration, use of lithium, adrenal insufficiency.
39
Q

Hypercalcemia (assessment findings)

A

Cardio: increased HR on early phase, that can lead to cardiac arrest in late phases. Increased BP, bounding, full peripheral pulses.
Respiratory: Profound skeletal muscle weakness.
NM: Muscle weakness, diminished or absent deep tendon reflexes, disorientation, lethargy, coma.
Renal: urinary output depends on the cause.
GI: decreased motility and bowel sounds. Anorexia, nausea, distension constipation.
ECG: shortened ST, widened T, heart block.

40
Q

Hypercalcemia (interventions)

A
  • Discontinue IV infusions of calcium or oral supplements and vit D.
  • Thiazide diuretics may be discontinued.
  • ADM as prescribed that inhibit calcium absorption: phosphorus, calcitonin, bisphosphonates and prostaglandin synthesis inhibitors (acetylsalicylic acid, nonsteroidal antiinflammatory).
  • if severe, prepare for dialysis.
  • monitor for signs of pathological fracture.
  • monitor for flank or abdominal pain, and strain the urine to check for stones.
  • instruct to avoid foods high in calcium.
41
Q

Hypomagnesemia (causes)

A

< 1.8 mEq/L (0.74 mmol/L)

  • Insufficient intake: malnutrition, starvation, vomiting, diarrhea, malabsorption syndrome, celiac disease, chron’s disease.
  • Increased excretion: diuretics, chronic alcoholism.
  • Intracellular movement: hyperglycemia, insulin adm, sepsis.
42
Q

Hypomagnesemia (assessment findings)

A 
Cardio: tachycardia and hypertension.
Respiratory: shallow.
NM: Twitches, paresthesias, positive Trousseau's and Chvostek's sign, hyperreflexia, tetany, seizures.
CNS: Irritability, confusion.
ECG: Tall T waves and depressed ST.
43
Q

Hypomagnesemia (interventions)

A
  • Because hypocalcemia frequently accompanies hypomagnesemia, interventions also aim to restore calcium levels.
  • Oral preparations may cause diarrhea and increase loss.
  • IV route may be prescribed in ill clients. IM causes tissue damage. Initiate seizure precautions and monitor for diminished deep tendon reflexes during adm (suggesting hyper).
44
Q

Hypermagnesemia (causes)

A

> 2.6 mEq/L (1.07 mmol/L)

  • Increased intake: magnesium-containing antacids and laxatives. Excessive adm of Mag IV.
  • Decreased renal excretion as a result of renal insufficiency.
45
Q

Hypermagnesemia (assessment findings)

A

Cardio: bradycardia, dysrhythmias, hypotension.
Respiratory: insufficiency.
NM: diminished or absent deep tendon reflexes. Skeletal muscle weakness.
CNS: drowsiness and lethargy thar progresses to coma.
ECG: Prolonged PR, widened QRS.

46
Q

Hypermagnesemia (interventions)

A

!! Calcium gluconate is the antidote for magnesium overdose !!

  • Diuretics, IV calcium chloride or gluconate may be prescribed.
  • instruct diet.
  • avoid use of laxatives and antacids containing Mg.
47
Q

Hypophosphatemia (cause)

A

< 3.0 mg/dL ( 0.97 mmol/L)
A decrease in phosphorus level is accompanied by an increase in calcium.
- Insufficient intake: malnutrition and starvation.
- Increased excretion: hyperparathyroidism, malignancy, use of magnesium-based or aluminum hydroxide-based antacids.
- Inttracelullar shift: hyperglycemia, respiratory alkalosis.

48
Q

Hypophosphatemia (assessment findings)

A

Cardio: decreased contractility and cardiac output, slow peripheral pulses.
Respiratory: shallow.
NM: weakness, decreased deep tendon reflexes, decreased bone density, rhabdomyolysis.
CNS: Irritability, confusion, seizures.
Hematological: decreased platelet aggregation and increased bleeding. Immunosupression.

49
Q

Hypophosphatemia (interventios)

A
  • Discontinue medications that contribute to hypo.
  • Adm phosphorus orally along with vit D.
  • Prepare to adm IV if level bellow 1mg/dL. Slowly!
  • Assess the renal system before adm.
  • monitor for pathological fractures.
  • increase the intake of food with P and decreasing with Ca.
50
Q

Hyperphosphatemia (cause)

A

> 4.5 mg/dL (1.45 mmol/L)
Most body tolerate elevated phosphorus levels.
It is accompanied by a decrease in calcium, which is the problem.
- decreased renal excretion because of renal insufficiency.
- tumor lysis syndrome.
- increased intake or overuse of phosphorus-containing laxatives or enemas.
- hyperparathyroidism.

51
Q

Hyperphosphatemia (assessment findings)

A

Refer to assessment of hypocalcemia.

52
Q

Hyperphosphatemia (interventions)

A
  • Management of hypocalcemia.
  • Adm phosphate-binding medications that increase fecal excretion (with meals or after).
  • instruct to avoid phosphate-containing medications (laxatives or enemas) and food.

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