Fluids and Electrolytes Part 2 Flashcards
What is the sodium fluid volume?
136 - 145 mmol/L
Define hypernatremia with its causes and the fluid volume?
- Water deficiency caused by plasma osmolality
- > 145 mmol/L
Define hyponatremia with its causes and the fluid volume?
- Excess water or loss of sodium containing fluids
- <136 mmol/L
For treating a patient with hyponatremia why do we not rapidly correct sodium levels?
Leads to osmotic demyelination syndrome with permanent damage to nerve cells in brain
How we do being to check each patient for any extracellular fluid volume balances?
By checking hematocrit: ratio of red blood cells to the volume of whole blood. Expressed as a percentage. The higher the percentage the more dehydrated an the lower the percentage means over hydration
What are some signs of dehydration?
- Decreased skin turgor and dry mucous membrane
- Low blood pressure
- Increased hematocrit
- Low urine
What are some signs of fluid excess?
- Swelling, pitting edema
- Crackles
- Increased jugular vein distention
- Increased body weight
What are primary forms of therapy?
For fluid volume excess, it’s diuretics and fluid restriction
Which systems are you evaluating for intake and output for nursing implementation?
- Cardiovascular changes
- Respiratory changes
- Neurological changes
- Respiratory changes
What is the volume of potassium for normal balance?
3.5 - 5.1 mmol/L
What controls the potassium in the body?
Na/K pump
What is the primary route of potassium loss?
90% of potassium is excreted by the kidneys
What would cause high potassium levels?
Kidney failure since the kidneys are responsible to excreting potassium
What relationship do sodium and potassium have?
Inverse relationship. Factors that cause sodium retention will result in potassium loss in urine
Define hyperkalemia w/clinical manifestations and its value. basically everything you know
- Potassium level of >5.1mmol/L
- MOST signs and symptoms are ELEVATED. Basically heart is tight and contracted (everything ELEVATED such as bowel sounds, diarrhea, abdominal cramping))
- usually impaired by renal excretion or massive cell destruction causing potassium to leak from cells such as a massive burn, tissue damage or crash injury.
What system does hyperkalemia affect and how?
Cardiac system. High potassium = Tall, peaked T waves. Because as Potassium increases, membranes depolarize, altering cell excitability.
How do we increase excretion of potassium?
- Eliminate oral and parenteral potassium intake
- diuretics, dialysis, ion-exchange
Define hypokalemia w/clinical manifestations and its value
- Abnormal losses of potassium level < 3.5mmol/L. shift of potassium from ECF to ICF. Caused by low magnesium, alkalosis and diabetic ketoacidosis
- Associated with impaired repolarization such as:
- flattening of T wave
- emergence of U wave
- peaked P wave
- MOST signs and symptoms are Fatigue, muscle weakness, decreaed reflexes, LOW and SLOW and DEPRESSED
How do we fix hypokalemia?
Administer potassium chloride supplements (KCl)
What must be done to KCl before administering?
Must be diluted before administering
What are the 2 levels of calcium levels?
Total: 2.10 - 2.50 mmol/L
Ionized: 1.15 - 1.35 mmol/L
What is the relationship between calcium and phosphorous?
They have an inverse relationship. As one increases the other decreases.
Define hypercalcemia w/symptoms and its value, basically everything you know
- hyper = LOW and SLOW. Reduced excitability of both muscles and nerves
- Excess calcium mostly caused by hyperparathyroidism and malignancy.
- Value of > 2.50 mmol/L
Define hypocalcaemia w/symptoms and its value, basically everything you know
FAST and EXCITABLE
- Caused by decrease in the production of PTH resulting in low calcium.
- tetany (muscle contraction)
- It’s value is < 2.10 mmol/L
Increase excitability
What are the 2 important signs from hypocalcaemia?
1) Trousseau’s sign: carpal spams induced by inflation BP cuff above the SP
2) Chvostek’s sign: contraction of facial muscles in response to a tap over the facial nerve in front of the ear
What is the normal range for phosphate?
1.0 - 1.50 mmol/L
Define hyperphosphatemia and its value. what does it cause?
- > 1.5 mmol/L usually caused by renal failure or chemotherapy or large intake of vitamin D
- Doesn’t cause too many problems with body functions but hyperphosphatemia causes hypocalcaemia so we must treat.
Define hypophosphatemia, it value and clinical manifestations
- Usually found in malnourishment and alcohol withdrawal.
- Related to deficient of ATP or an enzyme in RBC’s
- Value is < 1.0mmol/L
what do we want to avoid when administering phosphate?
Sudden hypocalcaemia is a potential complication of administering phosphorous too quickly
What is the normal range for magnesium?
0.65 - 1.05 mmol/L
How is magnesium regulated?
By GI absorption and renal excretion
Define hypermagnesemia and its value
- Increased magnesium intake accompanied by renal insufficiency or failure. > 1.05mmol/L
- Impairs nerves and muscles as well as deep tendon reflexes
- Note that treatment of eclampsia in pregnancy is administration of magnesium sulphate
What systems do magnesium affect?
Cardiac system. High magnesium comes close send after potassium for putting someone in cardiac arrest.
Define hypomagnesemia w/clinical manifestations and its value
- Limited magnesium intake (prolonged fasting, starvation, chronic alcoholism).
- same signs as hypocalcaemia1) Trousseau’s sign: carpal spams induced by inflation BP cuff above the SP2) Chvostek’s sign: contraction of facial muscles in response to a tap over the facial nerve in front of the ear
Hyperactive deep tendon reflexes - < 0.65 mmol/L
How does protein imbalances impair plasma?
Larger molecular size makes it remain in vascular spaces
Define hypoproteinemia
Low protein. Decreased food intake and starvation
Define hyperproteinemia
Excess protein which is rare. Caused by dehydration and hemoconcentration
What symptoms of protein imbalances?
- Edema (decreased oncotic pressure)
- Slow healing
- Anorexia
- Slow healing
How do we correct mild fluid and electrolyte imbalances?
Oral rehydration
Water, electrolytes, glucose which helps Na absorption in small intestine
Describe hypotonic solutions
Provides more water then electrolytes thus diluting ECF
What are some hypotonic solutions?
0.45% saline
Describe isotonic solutions
Expands only the ECF
- Ideal for fluid replacement for patients with ECF volume deficit
What is an isotonic solution?
ringer’s lactate
Describe hypertonic solutions
Initially raises the osmolality of ECF and expands it
- Required frequent monitoring
Describe plasma expanders solutions
- Stays in vascular space
- Increases the osmotic pressure
