Fluids and Electrolytes - Ch. 45 Flashcards
What are the 3 main components of total body water?
Intracellular fluid (ICF) 67%
Interstitial fluid (IF) 25%
Plasma volume (PV) 8%
IF + PV = ECF (33%)
What are the components of ECF?
Interstitial fluid
Blood (Plasma and cells)`
What determines the distribution of fluid in ECF?
Bulk flow
-Starling forces
What pressures need to be balanced during fluid balance?
Hydrostatic pressure, aka blood pressure
Colloid osmotic pressure due to plasma proteins
What is equal to maintain water balance?
Water intake = Water loss
What can occur when fluid is out of balance?
Edema
Dehydration
Fluid loss
Why are IV fluids administered?
Dehydration
Electrolyte imbalances
Blood component deficiencies
Nutrition
What are the types of IV fluids?
Crystalloids
Colloids
Blood and blood products
What are Crystalloids?
Solutions (contain water) with
-electrolytes (Na, K, Cl)
-small molecules (glucose, lactate)
Crystalloids DO NOT contain what?
Proteins/large molecules
Examples of crystalloids?
Normal saline
Hypertonic saline
Half normal saline
Lactated RInger (LR)
D5W
Normosol/Plasmalyte
Osmolarities of Normal saline?
Na 154
Cl 154
K 0
Osmolarities of Hypertonic saline?
Na 513
Cl 513
K 0
Osmolarities of Lactated Ringer (LR)?
Na 130
Cl 109
K 4
Osmolarities of D5W?
Na 0
Cl 0
K 1
What percentatge of sodium chloride is in each kind of saline?
Normal saline 0.9% NaCl
Half normal saline 0.45% NaCl
Hypertonic saline 3% NaCl
In what ways are crystalloids used as replacement/maintenance fluids?
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)
What indications require Crystalloids?
Acute liver failure
Acute nephrosis
Burns
Hypovolemic shock
Renal dialysis
Normal saline-based fluids (0.9% NaCl) are used with the administration of which products?
Blood cell products
What adverse effects are associated with Crystalloids?
Edema (Peripheral or pulmonary)
Dilute plasma proteins
-Short-lived effects, lots of other effects
How do crystalloids cause edema?
Fluid overload
How do colloids work?
Increase colloid osmotic pressure (COP)
-Move fluid from the interstitial compartment to the plasma compartment
Plasma volume expanders -restore BP
What do colloids initiate?
Diuresis
e.g, removal ascites in patients with portal hypertension
Examples of colloids?
Dextran 40 or 70
Hetastarch/hydroxyethyl starch (HES)
Modified gelatin
Albumin (human donors)
What are Dextran 40 or 70?
BIG glucose polymers
What are Hetastarch/hydroxyethyl starch (HES)?
Synthetic and derived from cornstarch
What indications require colloids?
Trauma
Burns
Sepsis
Hypovolaemic shock
What do colloids contain that crystalloids do not?
Proteins/large molecules
What fluids are more expensive, crystalloids or colloids?
Colloids
What adverse effects are associated with colloids?
They are usually safe
-some concerns in renal failure
What disadvantages are associated with colloids?
May cause altered coagulation -bleeding
No oxygen-carrying capacity
What are the most expensive and least available fluids?
Blood and blood products
-require human donors
What are some examples of blood/blood product fluids?
Whole blood
RBC products carry oxygen
Increase the supply of various products e.g, clotting factors from plasma
Platelets
What are packed RBCs and whole blood used for?
Increase oxygen-carrying capacity
-anemia
-substantial hemoglobin deficits
-blood loss >25% of Total blood volume
What is fresh frozen plasma (FFP) used for?
Increase clotting factor levels in clients with demonstrated deficiency = coagulation disorders
e.g, disseminated intravascular coagulation (DIC)
What are cryoprecipitate and plasma protein factors (PPF) used for?
Fibrinogen, Factor VIII, prothrombin complex concentrates
What adverse effects are associated with blood products?
Transfusion reaction
-Blood type, cross-match
Transmission of pathogens to the recipient
-Hepatitis B and C, HIV
What should you do to ensure client care when administering IV fluids?
Administer colloids slowly
Monitor for fluid overload and possible heart failure
Monitor closely for signs of transfusion reactions
Advantages of crystalloids?
Few side-effects
Low cost
Wide availability
Disadvantages of crystalloids?
Short duration of action
May cause edema
Advantages of colloids?
Longer duration of action
Less fluid is required to correct hypovolaemia
Disadvantages of colloids?
Higher cost
May cause volume overload
May interfere with clotting
Risk of anaphylactic reactions
What are the principal ECF electrolytes?
Sodium
Chloride
What is the principle ICF electrolyte?
Potassium
What is potassium responsible for?
Skeletal muscle contraction
Transmission of nerve impulses
Regulation of heartbeat
Maintenance of acid-base balance
What is the most abundant positively charged electrolyte inside cells?
Potassium
What percentage of the body’s potassium is intracellular?
95%
What is the normal potassium concentration in ECF?
3.5 to 5mmol/L
What electrolyte levels are critical to normal body function?
Potassium
What is a way potassium is obtained?
Dietary aka via Food
-Fruit, fish, vegetables, poultry, meats, dairy products
How is excess dietary potassium excreted?
Via kidneys
Impaired kidney function can lead to what in regards to potassium levels?
Higher serum levels and possibly toxicity
What is the name for a deficiency of potassium?
Hypokalemia
What is the potassium concentration that is considered hypokalemia?
<3.5 mmol/L
What is hypokalemia?
Excessive potassium loss
-Not poor dietary intake
What can cause hypokalemia?
**Loop and thiazide diuretics
**Vomiting
**Diarrhea
Malabsorption
Large amounts of real black licorice
Alkalosis
Glucocorticoids
Crash diets
Ketoacidosis
What are some symptoms of hypokalemia?
Muscle weakness or lethargy
Cardiac dysrhythmias (irregular pulse)
Paralytic ileus (decreased bowel motility)
Oral preparations of potassium can cause what adverse effects?
Diarrhea, nausea, vomiting, GI bleeding, ulceration
IV administration of potassium can cause what adverse effects?
Pain at the injection site
Phlebitis
Excessive potassium administration can cause what condition?
Hyperkalemia
What is the concentration of potassium that is considered hyperkalemic?
> 5 mmol/L
What can cause hyperkalemia?
**Potassium-sparing diuretics
Supplements
ACE inhibitors
Renal failure
Loss from cells
Burns
Trauma
Metabolic acidosis
Addison’s disease (Hypoaldosteronism)
What are some symptoms of hyperkalemia?
Cardiac rhythm irregularities
-Possible Vfib and cardiac arrest
Muscle weakness, paralysis
Paresthesia (tingling)
How is hyperkalemia treated?
IV sodium bicarbonate
calcium salts
dextrose with insulin
sodium polystyrene sulfonate (kayexalate)
Hemodialysis to remove excess
What kind of infusions need to be monitored very closely?
Parenteral infusions of potassium
What should the rate of parenteral potassium infusions be?
Never exceed 10 mmol/hour
You should never give potassium as what?
IV bolus or undiluted
Oral forms of potassium must be?
Diluted in water/juice to minimize GI irritation
-Monitor for nausea, vomiting, GI pain or bleeding
What is the most abundant positively charged electrolyte outside cells?
Sodium
What is the normal concentration of sodium outside cells?
135 to 145 mmol/L
What foods provide the dietary intake of sodium chloride?
Salt, fish, meats, foods flavoured/preserved with salt
What is sodium responsible for?
Control of water distribution
Fluid and electrolyte balance
Osmotic pressure of body fluids
Participates in acid-base balance
What is hyponatremia?
Sodium loss or deficiency
What concentration or serum level is considered hyponatremic?
<135 mmol/L
What are some symptoms of hyponatremia?
Lethargy
Stomach cramps
Hypotension
Vomiting
diarrhea
seizures
What causes hyponatremia?
Same causes as hypokalemia
Prolonged diarrhea or vomiting
renal disorders
What is an excess of sodium called?
Hypernatremia
What concentration of sodium is considered hypernatremic?
> 145 mmol/L
What are some symtpoms of hypernatremia?
Edema, hypertension
Red, flushed skin
dry, sticky mucous membranes
Increased thirst
Elevated temperature
Decreased urine output
What causes hypernatremia?
Kidney malfunction
Inadequate water consumption and dehydration
How is mild sodium depletion treated?
Oral sodium chloride and/or fluid restriction
How is severe sodium depletion treated?
IV normal saline or lactated Ringer’s solution
What adverse effects are associated with the oral administration of sodium?
Nausea
Vomiting
Cramps
What adverse effects are associated with IV administration of sodium?
Venous phlebitis
What should you do to ensure client care when administering electrolytes?
Monitor serum electrolyte levels during therapy
Monitor infusion rate, appearance of fluid or solution, infusion site
Observe for infiltration, other complications of IV therapy
How does a nurse monitor for a therapeutic response?
Check for normal lab values
-RBCs, WBC, Hgb and Hct, electrolyte levels
Improved fluid volume status
Increased tolerance to activities
Monitor for adverse effects
