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HLSC 220 Pharmacotherapeutics for Health Professionals 💊 > Fluids and Electrolytes - Ch. 45 > Flashcards

Fluids and Electrolytes - Ch. 45 Flashcards

1
Q

What are the 3 main components of total body water?

A

Intracellular fluid (ICF) 67%
Interstitial fluid (IF) 25%
Plasma volume (PV) 8%

IF + PV = ECF (33%)

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2
Q

What are the components of ECF?

A

Interstitial fluid
Blood (Plasma and cells)`

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3
Q

What determines the distribution of fluid in ECF?

A

Bulk flow
-Starling forces

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4
Q

What pressures need to be balanced during fluid balance?

A

Hydrostatic pressure, aka blood pressure
Colloid osmotic pressure due to plasma proteins

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5
Q

What is equal to maintain water balance?

A

Water intake = Water loss

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6
Q

What can occur when fluid is out of balance?

A

Edema
Dehydration
Fluid loss

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7
Q

Why are IV fluids administered?

A

Dehydration
Electrolyte imbalances
Blood component deficiencies
Nutrition

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8
Q

What are the types of IV fluids?

A

Crystalloids
Colloids
Blood and blood products

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9
Q

What are Crystalloids?

A

Solutions (contain water) with
-electrolytes (Na, K, Cl)
-small molecules (glucose, lactate)

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10
Q

Crystalloids DO NOT contain what?

A

Proteins/large molecules

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11
Q

Examples of crystalloids?

A

Normal saline
Hypertonic saline
Half normal saline
Lactated RInger (LR)
D5W
Normosol/Plasmalyte

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12
Q

Osmolarities of Normal saline?

A

Na 154
Cl 154
K 0

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13
Q

Osmolarities of Hypertonic saline?

A

Na 513
Cl 513
K 0

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14
Q

Osmolarities of Lactated Ringer (LR)?

A

Na 130
Cl 109
K 4

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15
Q

Osmolarities of D5W?

A

Na 0
Cl 0
K 1

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16
Q

What percentatge of sodium chloride is in each kind of saline?

A

Normal saline 0.9% NaCl
Half normal saline 0.45% NaCl
Hypertonic saline 3% NaCl

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17
Q

In what ways are crystalloids used as replacement/maintenance fluids?

A

Compensate for insensible fluid losses (eg, NS)
To replace fluids (eg NS)
To manage specific fluid and electrolyte disturbances (eg Ringer’s lactate)
Promote urinary flow (eg NS)
Expand plasma volume (eg 3% NaCl)

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18
Q

What indications require Crystalloids?

A

Acute liver failure
Acute nephrosis
Burns
Hypovolemic shock
Renal dialysis

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19
Q

Normal saline-based fluids (0.9% NaCl) are used with the administration of which products?

A

Blood cell products

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20
Q

What adverse effects are associated with Crystalloids?

A

Edema (Peripheral or pulmonary)
Dilute plasma proteins

-Short-lived effects, lots of other effects

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21
Q

How do crystalloids cause edema?

A

Fluid overload

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22
Q

How do colloids work?

A

Increase colloid osmotic pressure (COP)
-Move fluid from the interstitial compartment to the plasma compartment

Plasma volume expanders -restore BP

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23
Q

What do colloids initiate?

A

Diuresis
e.g, removal ascites in patients with portal hypertension

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24
Q

Examples of colloids?

A

Dextran 40 or 70
Hetastarch/hydroxyethyl starch (HES)
Modified gelatin
Albumin (human donors)

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25
Q

What are Dextran 40 or 70?

A

BIG glucose polymers

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26
Q

What are Hetastarch/hydroxyethyl starch (HES)?

A

Synthetic and derived from cornstarch

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27
Q

What indications require colloids?

A

Trauma
Burns
Sepsis
Hypovolaemic shock

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28
Q

What do colloids contain that crystalloids do not?

A

Proteins/large molecules

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29
Q

What fluids are more expensive, crystalloids or colloids?

A

Colloids

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30
Q

What adverse effects are associated with colloids?

A

They are usually safe
-some concerns in renal failure

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31
Q

What disadvantages are associated with colloids?

A

May cause altered coagulation -bleeding
No oxygen-carrying capacity

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32
Q

What are the most expensive and least available fluids?

A

Blood and blood products
-require human donors

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33
Q

What are some examples of blood/blood product fluids?

A

Whole blood
RBC products carry oxygen
Increase the supply of various products e.g, clotting factors from plasma
Platelets

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34
Q

What are packed RBCs and whole blood used for?

A

Increase oxygen-carrying capacity
-anemia
-substantial hemoglobin deficits
-blood loss >25% of Total blood volume

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35
Q

What is fresh frozen plasma (FFP) used for?

A

Increase clotting factor levels in clients with demonstrated deficiency = coagulation disorders
e.g, disseminated intravascular coagulation (DIC)

36
Q

What are cryoprecipitate and plasma protein factors (PPF) used for?

A

Fibrinogen, Factor VIII, prothrombin complex concentrates

37
Q

What adverse effects are associated with blood products?

A

Transfusion reaction
-Blood type, cross-match

Transmission of pathogens to the recipient
-Hepatitis B and C, HIV

38
Q

What should you do to ensure client care when administering IV fluids?

A

Administer colloids slowly
Monitor for fluid overload and possible heart failure
Monitor closely for signs of transfusion reactions

39
Q

Advantages of crystalloids?

A

Few side-effects
Low cost
Wide availability

40
Q

Disadvantages of crystalloids?

A

Short duration of action
May cause edema

41
Q

Advantages of colloids?

A

Longer duration of action
Less fluid is required to correct hypovolaemia

42
Q

Disadvantages of colloids?

A

Higher cost
May cause volume overload
May interfere with clotting
Risk of anaphylactic reactions

43
Q

What are the principal ECF electrolytes?

A

Sodium
Chloride

44
Q

What is the principle ICF electrolyte?

A

Potassium

45
Q

What is potassium responsible for?

A

Skeletal muscle contraction
Transmission of nerve impulses
Regulation of heartbeat
Maintenance of acid-base balance

46
Q

What is the most abundant positively charged electrolyte inside cells?

A

Potassium

47
Q

What percentage of the body’s potassium is intracellular?

A

95%

48
Q

What is the normal potassium concentration in ECF?

A

3.5 to 5mmol/L

49
Q

What levels are critical to normal body function?

A

Potassium

50
Q

What is a way potassium is obtained?

A

Dietary aka via Food
-Fruit, fish, vegetables, poultry, meats, dairy products

51
Q

How is excess dietary potassium excreted?

A

Via kidneys

52
Q

Impaired kidney function can lead to what in regards to potassium levels?

A

Higher serum levels and possibly toxicity

53
Q

What is the name for a deficiency of potassium?

A

Hypokalemia

54
Q

What is the potassium concentration that is considered hypokalemia?

A

<3.5 mmol/L

55
Q

What is hypokalemia?

A

Excessive potassium loss
-Not poor dietary intake

56
Q

What can cause hypokalemia?

A

**Loop and thiazide diuretics
**Vomiting
**Diarrhea
Malabsorption
Large amounts of real black licorice
Alkalosis
Glucocorticoids
Crash diets
Ketoacidosis

57
Q

What are some symptoms of hypokalemia?

A

Muscle weakness or lethargy
Cardiac dysrhythmias (irregular pulse)
Paralytic ileus (decreased bowel motility)

58
Q

Oral preparations of potassium can cause what?

A

Diarrhea, nausea, vomiting, GI bleeding, ulceration

59
Q

IV administration of potassium can cause what?

A

Pain at the injection site
Phlebitis

60
Q

Excessive potassium administration can cause what condition?

A

Hyperkalemia

61
Q

What is the concentration of potassium that is considered hyperkalemic?

A

> 5 mmol/L

62
Q

What can cause hyperkalemia?

A

**Potassium-sparing diuretics
Supplements
ACE inhibitors
Renal failure
Loss from cells
Burns
Trauma
Metabolic acidosis
Addison’s disease (Hypoaldosteronism)

63
Q

What are some symptoms of hyperkalemia?

A

Cardiac rhythm irregularities
-Possible Vfib and cardiac arrest

Muscle weakness, paralysis
Paresthesia (tingling)

64
Q

How is hyperkalemia treated?

A

IV sodium bicarbonate
calcium salts
dextrose with insulin
sodium polystyrene sulfonate (kayexalate)
Hemodialysis to remove excess

65
Q

What kind of infusions need to be monitored very closely?

A

Parenteral infusions of potassium

66
Q

What should the rate of parenteral potassium infusions be?

A

Never exceed 10 mmol/hour

67
Q

You should never give potassium as what?

A

IV bolus or undiluted

68
Q

Oral forms of potassium must be?

A

Diluted in water/juice to minimize GI irritation
-Monitor for nausea, vomiting, GI pain or bleeding

69
Q

What is the most abundant positively charged electrolyte outside cells?

A

Sodium

70
Q

What is the normal concentration of sodium outside cells?

A

135 to 145 mmol/L

71
Q

What foods provide the dietary intake of sodium chloride?

A

Salt, fish, meats, foods flavoured/preserved with salt

72
Q

What is sodium responsible for?

A

Control of water distribution
Fluid and electrolyte balance
Osmotic pressure of body fluids
Participates in acid-base balance

73
Q

What is hyponatremia?

A

Sodium loss or deficiency

74
Q

What concentration or serum level is considered hyponatremic?

A

<135 mmol/L

75
Q

What are some symptoms of hyponatremia?

A

Lethargy
Stomach cramps
Hypotension
Vomiting
diarrhea
seizures

76
Q

What causes hyponatremia?

A

Same causes as hypokalemia
Prolonged diarrhea or vomiting
renal disorders

77
Q

What is an excess of sodium called?

A

Hypernatremia

78
Q

What concentration of sodium is considered hypernatremic?

A

> 145 mmol/L

79
Q

What are some symtpoms of hypernatremia?

A

Edema, hypertension
Red, flushed skin
dry, sticky mucous membranes
Increased thirst
Elevated temperature
Decreased urine output

80
Q

What causes hypernatremia?

A

Kidney malfunction
Inadequate water consumption and dehydration

81
Q

How is mild sodium depletion treated?

A

Oral sodium chloride and/or fluid restriction

82
Q

How is severe sodium depletion treated?

A

IV normal saline or lactated Ringer’s solution

83
Q

What adverse effects are associated with the oral administration of sodium?

A

Nausea
Vomiting
Cramps

84
Q

What adverse effects are associated with IV administration of sodium?

A

Venous phlebitis

85
Q

What should you do to ensure client care when administering electrolytes?

A

Monitor serum electrolyte levels during therapy
Monitor infusion rate, appearance of fluid or solution, infusion site
Observe for infiltration, other complications of IV therapy

86
Q

How does a nurse monitor for a therapeutic response?

A

Check for normal lab values
-RBCs, WBC, Hgb and Hct, electrolyte levels

Improved fluid volume status
Increased tolerance to activities
Monitor for adverse effects

HLSC 220 Pharmacotherapeutics for Health Professionals 💊 (15 decks)

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