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NURS120 > Fluids & Electrolytes > Flashcards

Fluids & Electrolytes Flashcards

1
Q

what are electrolytes

A

minerals that conduct electricity

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2
Q

what test is done to examine the electrolytes

A

basic or complete metabolic panel (BMP/CMP)

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3
Q

BMP vs. CMP

A

CMP is BMP (Na, K, Cl, BUN, creatinint, glucose, acid-base) & liver panel

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4
Q

Blood urea nitrogen (BUN) indication

A

kidney function

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5
Q

carbon dioxide indication

A

blood bicarbonate level

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6
Q

creatinine (CR) indication

A

kidney function

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7
Q

calcium (Ca) indication

A

liver function

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8
Q

ALP, ALT, AST indication

A

liver function

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9
Q

ALP, ALT, AST stands for what

A

ALP: alkaline phosphate
ALT: alanine transaminase
AST: aspartate aminotransferase

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10
Q

bilirubin indication

A

liver function

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11
Q

protein vs. albumin

A

protein: total blood protein
albumin: liver function

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12
Q

5 functions of electrolytes

A
  1. maintain water balance
  2. move wastes out of cells
  3. move nutrients into cells
  4. balance blood pH /acid-base level
  5. function of body’s muscles, heart, nerves, and brain
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13
Q

average person’s water %

A

1/2 - 2/3 water
men: 60%
women: 54%
kids: 70%

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14
Q

dehydration vs. hypovolemia

A

dehydration: excess water loss without the loss of Na
hypovolemia: loss of blood volume

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15
Q

osmolality definition

A

measure solutes within a solution

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16
Q

reference range of serum osmolality (blood)

A

275-295 mOsm/kg
most commonly used for body fluid status

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17
Q

referance range of urine osmolality

A

50-1,200 mOsm/kg

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18
Q

list 3 main fluid compartments in and out of cells

A

intracellular space: in the cells - 67%
extracellular space: interstitial + intravascular space - 25%

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19
Q

where is the thirst response center in the brain

A

lamina terminalis (edge of hypothalamus) monitors osmolality & 1% change would send signal

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20
Q

explain the kidneys response to the hypothalamus

A

posterior pituitary releases ADH (vasopressin) and acts on the nephrons to increase reabsorption of water

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21
Q

list 3 ways the body tries to maintain water homeostasis

A

Thirst response
ADH to the nephrons
osmosis

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22
Q

K expected range

A

3.5 - 5 mEq/L

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23
Q

Na expected range

A

135 - 145 mEq/L

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24
Q

Ca expected range

A

9 - 10.5 mg/dL

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25
Q

Mg expected range

A

1.3 - 2.1 mEq/L

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26
Q

osmosis vs. diffusion

A

osmosis: solvent moving from high to low concerntration
diffusion: movement of solvents and solutes from high to low concentration

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27
Q

active transport

A

using energy to move solutes

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28
Q

function of K

A

electrolyte responsible for nerve and muscle function; especially the heart

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29
Q

where is K mostly excreted

A

kidneys

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30
Q

causes of hypokalemia

A

meds - diuretics
less intake
heart problems
metabolic alkalosis
excessive alcohol drinking
chronic kidney disease
diabetic ketoacidosis
excessive sweating
folic acid deficiency
V&D

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31
Q

signs of life-threatening hypokalemia

A

respiratory paralysis/failure
paralytic ileus
hypotension
tetany
rhabdomyolysis (muscle tissue breakdown)
intense cardiac arrhythmias -> see ECG

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32
Q

repeated episodes of hypokalemia can affect what

A

renal function

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33
Q

what are the specifications for giving K IV

A
  • needs to be diluted -> never from the vial
  • dose doesn’t exceed 40 mEq/L
  • rate of administration 10 - 20 mEq/L
  • continuous ECG and checking levels
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34
Q

foods that are high in potassium

A

baked potato, sweet potato
prune, carrot juice
white beans
plain, nonfat yogurt
salmon
banana
spinach, avocado

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35
Q

causes of hyperkalemia

A

renal failure (#1 cause)
dehydration
diabetes mellitus
meds - Ksparing diuretics, ACE inhibitors, NSAIDs
trauma, burns, sepsis
RBC blood transfusions
excessive intake

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36
Q

common symptoms of mild hyperkalemia

A

N&V
muscle aches and weakness
decreased deep tendon reflexes
paralysis
dysrhythmias/palpitations

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37
Q

meds to take while with hyperkalemia

A

calcium gluconate (for heart)
diuretics - loop, thiazide
calcium chloride (for heart)
resin
insulin (monitor for hypoglycemia)

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38
Q

what does resin medication do

A

bind to K and excreted via stool
ex: sodium polystyrene sulfonate

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39
Q

expected range of blood glucose

A

74-106 mg/dL

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40
Q

why monitor people trying to lower Na with salt substitutes

A

those contain a lot of K and could lead to hyperkalemia

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41
Q

largest electrolyte

A

K

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42
Q

Na function

A

blood pressure
blood volume
pH balance

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43
Q

critical value for Na

A

less than 120 mEq/L

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44
Q

where is Na mostly excreted from

A

urine and sweat

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45
Q

causes for developing hyponatremia

A

meds - thiazide diuretics
N&V
drinking lots of water
excessive alcohol intake
heart, kidney, liver issues - heart failure, cirrhosis
severe burns

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46
Q

mild hyponatremia symptoms

A

nausea and general unwellness
could lead to cerebral edema

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47
Q

moderate hyponatremia symptoms

A

lethargy, confusion, headache, irritiability, restlessness

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48
Q

severe hyponatremia symptoms

A

muscle twitching, decreased LOC, seizures, coma

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49
Q

what population is more prone to getting hyponatremia & hypernatremia

A

older adults

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50
Q

critical value of hypernatremia

A

greater than 160 mEq/L

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51
Q

cause of hypernatremia

A

loss of body water (#1 cause)
meds
gastroenteritis
impaired thirst response
diabetes
chronic kidney disease
vomiting, prolonged suction
burns
excessive sweating

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52
Q

manifestations of hypernatremia

A

same as hyponatremia

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53
Q

foods high in Na

A

roasted ham
shrimp
frozen pizza
canned soup
vegetable juice
cottage cheese
vanilla pudding

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54
Q

functions of Ca

A

Bone
Blood clotting
Beats (heart)
nerve conduction

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55
Q

what vitamin is required for the absorption of calcium

A

vitamin D

56
Q

why is ionized calcium lvl a better measurement than serum calcium lvl

A

ionized Ca show the calsium that’s active and not yet bound to protein

57
Q

what is the range of ionized calcium

A

4.5 - 5.6 mg/dL

58
Q

critical low value for serum Ca and ionized Ca

A

serum Ca: 6 mg/dL
ionized Ca: 2.2 mg/dL

59
Q

causes for hypocalcemia

A

meds: stimulant laxatives, glucocorticoids, loop diuretics, decrease body’s gastric acid

not enough vit D
hormonal changes (menopause)
hypoparathyroidism (body produces less PTH)
renal disease
multiple blood transfusions
sepsis
low albumin
electrolyte imbalance of Mg, or P

60
Q

long term hypocalcemia can lead to what

A

osteopenia: low bone mass; increased risk of fractures and osteoporosis
body will take Ca from the bones

61
Q

what body systems does hypocalcemia effect

A

respiratory, cardiac, neurologic, sensory, neuromuscular, integumentary

62
Q

what population is at risk for geting hypocalcemia

A

neonates and infants with moms that have diabetes, pre-eclampsia (high BP and protein during pregnancy), or hyperparathyroidsm

63
Q

2 physical examinations that could indicate hypocalcemia (not diagnose though)

A

Chvostek sign: tap face nerve and muscle twitch
Trousseau sign: BP cuff inflated for more than 3 mins will cause irritability to nerve and carpopedal spasm will occur ( bigger indication than Chvostek sign)

64
Q

limit Ca supplement to how much to increase absorption

A

less than 600mg per dose

65
Q

foods high in Ca

A

milk, almond milk, soymilk
yogurt
cheese

66
Q

critical high value for Ca

A

serum Ca: 13 mg/dL
ionized Ca: 7 mg/dL

67
Q

reasons for hyperclacemia

A

cancer, hyperparathyroidism (top reasons)
vit D toxicity
meds - thiazide diuretics
renal failure

68
Q

hypercalcemia “mnemonic”

A

abdominal moans: constipation, N&V
painful bones
kidney stones
groans
neurologic overtones: delirium, psychosis, coma

69
Q

treatment for hyper and hypocalcemia

A

hypocalcemia: phosphate PO
hypercalcemia: saline bolus IV, loop diuretic
hemodialysis for extreme cases

70
Q

magnesium function

A

nerve and muscle function
BP
blood glucose
making DNA, protein, bone

71
Q

where is Mg stored

A

in bones

72
Q

what route is Mg excreted

A

pee and poo

73
Q

critical values for hypo and hypermagnesia

A

hypomagnesemia: 0.5 mEq/L
hypermagnesemia: 3 mEq/L

74
Q

cause of hypomagnesemia

A

meds - loop, thiazide diuretic
decreased intake
decreased absorption due to crohn’s or celiac disease
increased excretion
excessive alcohol use
diabetes type 2
burns
hypokalemia, hypocalcemia (electrolyte imbalances)

75
Q

signs of hypomagnesemia from mild to moderate to worse

A
  1. N&V, change in appetite, fatigue
  2. neuromuscular changes: seizures, tetany, tingling, etc.
  3. cardiac dysrhythmias
76
Q

foods with Mg

A

spinach
pumpking seeds
black beans, soybeans
cashews
dark chocolate
avocados
salmon
banana
tofu

77
Q

what to monitor when you give Mg IV

A

double check with another nurse for concentration;
can cause flushing, sweating, respiratory depression if administered too quickly;
decreased LOC if pt also on CNS depressant;
monitor urine output for those with impaired renal function

78
Q

causes for hypermagnesemia

A

kidney disease (#1 cause)
excessive intake
meds
trauma
hypothyroidsm
chronic alcohol use
acidotic states

79
Q

what happens when Mg levels increase to above 7 or 12

A

7: neurologic manifestations
12: muscle issues, decreased RR, hypotension, bradycardia, dysrhythmias

80
Q

what reflex to check with hypermagnesemia

A

paterlla reflex

81
Q

treatment of hypermagnesemia

A

calcium gluconate or calcium chloride
IV diuretics
hemodialysis

note: has long 1/2 life so decreasing serum lvls will take more than 24 hours

82
Q

causes for dehydration

A

lack of intake
GI losses replaced with hypertonic fluids
fever
meds - benzodiazepines, SSRI decrease thirst sensation
diabetic ketoacidosis

83
Q

what does urine specific gravity measure and its reference range

A

measures the solutes in urine
1.005 - 1.030

84
Q

fluid of choice for IV rehydration

A

dextrose 5% in water
contains no Na and glucose will be quickly metabolized

85
Q

dehydration vs. hypovolemia

A

dehydration: loss of water
hypovolemia: loss of fluid and electrolytes

86
Q

what is third spacing and causes

A

fluids move from intravascular space to interstitial space
typically from cirrhosis and pancreatitis

87
Q

what is considered hypovolemic shock

A

loss of 20% or 1/5th of blood or fluid supply

88
Q

what happens if hypovolemic shock isn’t reversed

A

multiple organ failure where tissue death happens

89
Q

what ratio of BUN/CR means there’s a lack of blood flow to the kidneys

A

20 (BUN) : 1 ( CR)

90
Q

how does hematocrit change based on reasons for hypovolemia

A

increase due to volume loss
decrease along with hemoglobin to show bleeding

91
Q

treatment for hypovolemia

A

0.9% normal saline or Ringer’s lactate IV
blood transfusion for blood loss

92
Q

causes of hypervolemia

A

heart failure, kidney failure
cirrhosis
pregnancy
excess IV fluid
meds: Ca channel blockers, vasodilators

93
Q

treatments and monitoring of hypervolemia

A

diuretics, limit fluid and Na intake, DW
check for jugular vein distension, adventitious lung sounds, I&O, dyspnea, hypertension, bounding pulse
dialysis for kidney failure
paracentesis for cirrhosis (needle in abdomin to take out fluid)

94
Q

most common cause of fluid loss in infants and young children

A

V&D

95
Q

why are older clients more at risk for fluid/electrolyte imbalances

A

renal, cardiovascular system less work
decrease in thirst sensation
decrease in RAAS system
polypharmacy

96
Q

why are infants and children more at risk for luid/electrolyte imbalances

A

maybe can’t communicate it
requires high fluid volume
high metabolism
high ratio of surface are to volume -> loose fluids faster

97
Q

where should the tourniquet be placed to dilate the veins for IV; what’s the immediate assessment

A

5-10cm above selected site
assess distal pulse to make sure not too tight

98
Q

contraindications for the use of a tourniquet

A

high risk for bleeing
compromised circulation
fragile skin

99
Q

how else to establish IV access without tourniquet

A

BP cuff set to 30mm Hg
warm compress
open and close the fist
position arm in dependent position

100
Q

avoid starting IV in which cases

A

axillary node dissection (lymph node taken out)
arteriovenous fistula
radiation therapy
stroke

101
Q

crystalloid solutions

A

IV fluids that have solutes - electrolytes or dextrose, can easily diffuse through cell membranes

102
Q

how are crystalloid solutions classified

A

hypotonic, isotonic, or hypertonic
tonicity: ability to osmosis (move water in n out)

103
Q

colloidal solutions

A

IV fluids that have large molecules that can’t pass through capillary membranes; also known as plasma or volume expanders

104
Q

purpose of using colloidal solutions

A

increase in osmotic pressure with plasma so fluids are drawn into the intravascular space

105
Q

synthetic vs. natural colloidal solutions

A

synthetic: dextrans, starches
natural: albumin

106
Q

adverse effects with colloidal solutions IV

A

allergic reaction
renal failure
blood clotting disorder

107
Q

what gauge needle for colloidal solutions IV

A

18 g central or peripheral line

108
Q

how often should IV tubing be changed for continuous and intermittent infusions

A

continuous: 96 hrs (every 4 days)
intermittent: every 24 hrs

109
Q

how often should IV tubing be changed for lipid or blood administeration

A

lipid: q12 hrs
blood: q4 hrs

110
Q

what are central venous access devices (CVADs) used for

A

inserted into a central vein (subclavian or jugular vein) to administer fluids, blood, meds;
used long-term i.e. chemotherapy

111
Q

where are peripherally inserted central catheters (PICCs) inserted

A

anterior arm
median cubital, cephalic, basilic, brachial vein

112
Q

what are PICC lines at risk for

A

infection, make sure to use aseptic technique

113
Q

nontunneled vs. tunneled CVADs

A

nontunneled: short term use, emergency, higher chance of infection
tunneled: long-term use, require healing period, lower chance of infection

114
Q

how to prevent clot formation in a CVAD

A

flush with saline or low-concentrations of heparin

115
Q

what is phlebitis

A

inflammation of the inner lining of the vein

116
Q

causes of phlebitis

A

vein too small for cannula
cannula movement
inadequate dressing
speed of infusion
type of medication infused
length of therapy
failure for aseptic technique
administration of contaminated solution

117
Q

symptoms of phlebitis

A

pain, swelling, erythema, fever, palpable cord along vein

118
Q

what are vesicants

A

fluids considered irritating to the veins -> use larger vein or CVAD

119
Q

what are infusates

A

fluid to be infused

120
Q

things to consider when minimize likelihood of phlebitis

A
  • follow aseptic technique
  • vesicants use large vein or CVAD
  • use CVAD or midline catheter if therapy longer than 5 days
  • use smallest cannula for the client and infusate
  • don’t place in areas of flexion, if must -> use stabilization board
  • maintain prescribed infusion rates
  • monitor site q4hrs & q1-2hrs if irritating, decreased LOC, location of flexion
  • monitor q1hr for babies and kids
121
Q

how often should IV catheter sites be monitored?

A
  • monitor site q4hrs & q1-2hrs if irritating, decreased LOC, location of flexion
  • monitor q1hr for babies and kids
122
Q

what to do immediately in case of phlebitis & comfort measures

A

discontinue IV and notify provider;
comfort measures: warm compress, elevation, administer analgesics

123
Q

documenting IV catheter site

A
  • description of site
  • objective & subjective findings
  • phlebitis rating score
  • notification of provider
  • interventions
  • location of new IV site if started
124
Q

cause of circulatory overload

A
  • excessive amounts of crystalloid fluid
  • blood products
  • infusion too fast
125
Q

signs of circulatory overload

A
  • tachycardia, tachypnea
  • increased BP, weight
  • decreased O2 satu, crackles in lungs
  • jugular venous distension, edema
  • pallor, cyanosis
126
Q

infiltration is what

A

IV administration of fluids into surrounding tissue due to displacement of the catheter tip

127
Q

extravasation is what

A

administration of vesicant fluid into tissues around IV cannula;
could lead to tissue damage or necrosis

128
Q

medications that are considered vesicants

A

antineoplastic (chemotherapy meds)
high osmolarity meds: dextrose 50%
vasoconstriction meds: dopamine
highly alkaline or acidic meds: phenytoin

129
Q

signs of infiltration or extravasation

A
  • coolness of skin surrounding
  • leaking of fluids
  • localized edema
  • pallor or delayed capillary refill
  • report of pain, burning, or discomfort
  • change in infusion rate
130
Q

do’s and don’ts after infiltration or extravasation

A
  • aspirate fluid from cannula, DON’t flush site
  • discontinue IV and notify PCP
  • skin mark area
  • DON’t apply pressure, DO elevate
    *reassess q1hr
131
Q

air embolism IV

A

obstruction of a vessel by air

132
Q

signs of air embolism in IV

A
  • difficulty breathing, cough, wheeze
  • low BP
  • tachycardia
  • chest, shoulder pain
  • shock, neurologic injury, MI, death
133
Q

things to do to prevent air embolism in IV

A
  • prime everything
  • check set junctions are secure before repositioning client
  • monitor bubbles, leaks in tubing
  • change IV bags before the previous one is dry
  • clamp CVAD before changing
134
Q

what to do if pt has air embolism in IV

A
  • stop infusion & clamp line
  • position pt with head down on left side
  • notify rapid response team
135
Q

if a nurse is unsure if something is within their scope of practice, where should they check

A

state’s nurse practice act

NURS120 (38 decks)

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