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Acute Health Challenges > Fluids & Electrolytes > Flashcards

Fluids & Electrolytes Flashcards

1
Q

fluid changes with age

A
  • lose % of body wight as we age
  • both sides of spectrum at risk for dehydration
  • thirst drive decreases with age
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2
Q

osmosis

A

water moves from high water concentration to low water concentration

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3
Q

diffusion

A

particles move from high particle concentration to low particle concentration across semi-permeable membrane

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4
Q

active transport

A

ATP requires

Na-K pump

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5
Q

regulation of fluid balance

A
  • thirst (main)
  • hypothalamus
  • thirst centre
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6
Q

antidiuretic hormone (ADH)

A
  • opposite of diuretics; holds onto fluid
  • made in hypothalamus in response to concentrated fluids —> released from pituitary and acts on renal tubules—> water reabsorbed to increase fluid volume
  • opposite occurs if fluid in vascular space is dilute
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7
Q

nervous system regulation of fluids

A

baroreceptors sense change in pressure and decrease in CO —> SNS increases HR resulting in peripheral vasoconstriction —> vasoconstriction in renal arteries results in decreased glomerular filtration, decreased urine output and increased BV

increase HR for vasoconstriction to decrease urine output and increase BV

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8
Q

renin-angiotensin-aldosterone

A
  • decreased BV = decreased renal perfusion = kidneys secrete renin
  • renin acts on angiotensin to cause vasoconstriction = increased BP and renal perfusion
  • kidneys retain Na and water increasing BV
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9
Q

H2O follows…

A

Na

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10
Q

cortisol

A
  • released in stress response
  • increases BG
  • causes increased Na and fluid retention
  • cause of fluid retention post op
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11
Q

kidneys

A
  • primary organ in F&E
  • adjusts urine volume to maintain balance
  • urine specific gravity = hydration status
  • 1.5L of urine in 24hrs
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12
Q

tonicity

A
  • concentration of solutes/particles (in bag)

- determines where fluid will go

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13
Q

tonicity categories

A
  • isotonic
  • hypertonic
  • hypotonic
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14
Q

isotonic IV solutions

A
  • N/S, R/L, 2/3 & 1/3
  • tonicity similar to plasma
  • remains in vasculature
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15
Q

normal saline

A

0.9% NaCl

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16
Q

ringers lactate

A

closest to plasma

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17
Q

2/3 & 1/3

A

2/3 dextrose 1/3 saline

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18
Q

hypertonic IV solutions

A
  • D5S, D5 1/2 N/S
  • osmolality > plasma
  • pulls fluid from cells into vasculature
  • decreases post op edema and increase urinary output
  • risk for fluid overload
  • will increase BP
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19
Q

D5S

A

5% dextrose in N/S

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20
Q

D5 1/2 N/S

A

5% in 0.45% N/S

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21
Q

total parenteral nutrition

A
  • TPN

- very hypertonic solution

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22
Q

hypotonic IV solutions

A
  • 1/2 N/S, D5W
  • osmolality < plasma
  • pulls fluid from vasculature into cells/interstitial spaces
  • hydrates cell while decreasing fluid in circulatory system
  • risk of cardiovascular collapse as decrease volume in vessles
  • risk of cells swelling and bursting (ICP)
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23
Q

forces within capillaries

A
  • hydrostatic pressure

- osmotic/colloid pressure

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24
Q

hydrostatic pressure

A
  • blood pumping forcing fluid/nutrients into interstitial space
  • higher at arterial end
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25
Q

osmotic/colloid pressure

A
  • created by plasma (albumin)
  • pulls fluid from interstitial space into venous end of capillaries
  • proteins pull fluid back to vessel at venous end
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26
Q

most common abnormal fluid shift

A

intravascular to interstitial space

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27
Q

abnormal fluid shifts

A
  • intravascular to interstitial space
  • trauma, burns, massive infection
  • compression stockings
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28
Q

intravascular to interstitial space fluid shift

A
  • edema when hydrostatic P increases in vessles
  • decrease in plasma oncotic P - pull created by albumin not enough to draw fluids back into capillaries
  • high BP and low albumin —> fluid shifts without enough albumin to pull fluid back in
29
Q

causes of low albumin (plasma proteins)

A
  • excessive protein loss
  • poor nutrition (low intake)
  • deficit protein synthesis by liver
30
Q

causes of intravascular to interstitial space fluid shift

A
  • fluid overload
  • CHF
  • surgery
  • liver failure
  • obstruction of venous return to heart
31
Q

1st spacing

A

normal distribution of fluid in ICF and ECF

32
Q

2nd spacing

A

abnormal accumulation of interstitial fluid (edema)

33
Q

3rd spacing

A
  • fluid accumulation in part of body where it is not easily exchanged with ECF
  • fluid shifts into abnormal areas and body retains it
  • eventually start to diuresis and lose fluid
34
Q

trauma, burns, and massive infection fluid shift

A
  • damage to capillary walls
  • albumin collects in interstitial space
  • albumin pulls fluid from vessels to interstitial spaces
  • fluid lost to effective circulating volume = relative hypovolemia - fluid still in body but not effective
35
Q

compression stocking fluid shift

A
  • increases tissue hydrostatic P
  • forces fluid from interstitial space to vessels
  • decreases peripheral edema
  • increases fluid available to circulation
36
Q

dealing with fluid shifts

A
  • IV colloids

- Mannitol

37
Q

IV colloids

A
  • albumin, volumen, pentaspan, dextran
  • synthesis volume expanders
  • increase BP and renal perfusion
  • used if not responding to fluid bolus or cant tolerate it
38
Q

mannitol

A
  • med given to decrease ICP

- pulls fluid out of brain cells

39
Q

hyperglycaemia and fluid shifts

A
  • pulls H2O from cells

- dehydrates cells

40
Q

BP fluid balance assessment

A
  • fluid deficit = decrease in systolic and pulse pressure
  • fluid excess = increase in systolic and pulse pressure
  • change in BP late sign in children
41
Q

HR fluid balance assessment

A
  • fluid deficit = increased rate, weak, thready

- fluid excess = increased rate, strong, full, bonding

42
Q

respiration fluid balance assessment

A
  • fluid deficit = normal (12-20)

fluid excess = tachypnea, moist lung sounds, crackles

43
Q

intake/output fluid balance assessment

A
  • fluid deficit= decreased urine output, concentrated during, amber colour
  • fluid excess = intake > output
44
Q

24 hr fluid balance assessment

A
  • fluid deficit = intake < output; - fluid balance

- fluid excess = intake > output; + fluid balance

45
Q

edema fluid balance assessment

A
  • fluid deficit = rare

- fluid excess = dependent, extremities, face, sacral area, cites, anascara

46
Q

weight fluid balance assessment

A

1kg = 1L

  • fluid deficit = loss
  • fluid excess = gain
47
Q

skin turgor fluid balance assessment

A
  • fluid deficit = poor

- fluid excess = taut

48
Q

jugular vein (JVP) fluid balance assessment

A
  • fluid deficit = flat

- fluid excess = distended

49
Q

urine specific gravity fluid balance assessment

A
  • fluid deficit = increase/high, concentrated urine, high osmolality
  • fluid excess = decrease/low, dilute urine, low osmolality
50
Q

calculating fluid requirements

A
  • 100ml for first 10kg
  • 50 ml for next 10 kg
  • 20ml for remaining kg
51
Q

fluid balance assessment (8)

A
  • ins/outs
  • 24hr fluid balance (+/-)
  • 30ml/hr urine output = renal perfusion
  • chest/respiratory
  • edema
  • vitals
  • wound drainage/GI losses
  • electrolytes, Hbg, hematocrit
52
Q

sodium

A

Na+

  • primary extracellular cation
  • serum Na reflect H2O/Na ratio
  • imbalance r/t Na & H2O increase/decrease
53
Q

functions of Na

A
  • neuromuscular - transmits/conducts nerve impulses
  • body fluid - controls extracellular osmolality
  • cellular - Na pump (Na into cells K out of cells)
  • large amount in saliva, pancreatic, GI, intestinal secretions, bile, & sweat
54
Q

hyponatremia (8)

A
  • low Na
  • N&V
  • headache
  • confusion
  • decreased energy, drowsy, fatigue
  • restless/irritable
  • muscle weakness, spasm, cramps
  • seizures
  • coma
55
Q

hypernatremia (7)

A
  • high Na
  • muscle weakness
  • restless/irritable
  • extreme thirst
  • confusion
  • lethargy
  • seizures
  • unconsciouness
56
Q

potassium

A

K+

  • primary intracellular cation
  • conducts nerve impulses
  • skeletal & smooth muscle
  • small margin
  • contraction of myocardium
  • increase/decrease can cause arrhythmia
  • increased in renal failure
57
Q

hypokalemia causes (6)

A
  • low K+
  • stress of surgery
  • K wasting diuretics
  • hyperglycaemia = osmotic diuresis = K+ loss
  • acidosis = H+ enters cells K+ lives cells
  • GI losses
  • poor nutrition
58
Q

stress of surgery and hypokalemia

A
  • adrenal cortex releases aldosterone
  • conserves Na and excretes K+
  • post op usually IV with K+
59
Q

potassium replacements

A
  • food (bananas, citrus fruits, dried fruits, meats, veggies, nuts, potato skin)
  • Meds micro K, slow K, IV K
  • never give IV K direct push as can = cardiac arrest; give over 1hr
60
Q

clinical concerns with hypokalemia

A
  • cardiac arrhythmia/arrest
  • too high = cardiac irritability
  • too low = weakened contraction
  • in renal failure; acidosis
  • med kayexalate binds with K to excrete
61
Q

calcium

A

Ca++

  • 99% in bones/teeth; 1% in serum/tissue
  • vitamin D needed to absorb from GI tract
  • contraction of cardiac, smooth, and skeletal muscle
  • important for coagulation
  • regulated by parathyroid gland hormone and calcitonin
62
Q

hypocalcemia (5)

A
  • low Ca
  • renal failure; low albumin
  • thyroid & parathyroid surgery
  • tingling lips/extremities
  • Chvosteks & Trousseaus signs
  • give CaCl or carbonate
63
Q

hypercalcemia

A
  • high Ca
  • metastatic CA
  • causes bones to release Ca
  • treatment = hydration & meds
  • renal calculi (kidney stones)
  • foods
64
Q

magnesium

A

Mg++

  • important in CHO & protein metabolism
  • influences neruomuscular activity
  • if K & Ca low then Mg low too
  • PPIs decrease Mg
65
Q

magnesium effects of muscle activity

A
  • low = increased neuromuscular activity = tremors, seizures, cramps
  • high = decreased tendon reflexes, sedative effect on neuromuscular system
66
Q

phosphate

A

PO4 3-

  • primary anion in intracellular fluid
  • essential to function of muscles, RBC, NS
  • need adequate renal function to maintain levels
  • when Ca high PO4 low
  • increased in renal failure
  • decreased in malnutrition and alcohol withdrawal
67
Q

potassium values

A

normal range 3.5-5.0 mol/L

68
Q

hemoglobin values

A

normal range 115-155g/L

Acute Health Challenges (7 decks)

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