Fluids & Electrolytes Flashcards
What would you expect to find in a patient who has had nausea/vomiting for 4 days?
-Fluid Volume Deficit
-Weakness, lethargy
-Low BP, high HR
-Weak pulse (+1)
-Magnesium and potassium low
-Sodium may be elevated
-Decreased skin turgor
How many liters of fluid do we need in a day?
2-3L
Is 100 mL/hr good for replacement fluids?
No - good for maintenance, not for replacement
Normal range for potassium
3.5 - 5 milliequivalents per liter (mEq/L)
Most important electrolytes to monitor for cardiac dysrhythmias
Magnesium and potassium
Normal range for magnesium levels
1.5-2.5 milliequivalents per liter (mEq/L)
Extracellular fluid is made up of ______ and _____
Interstitial fluid (between cells) and Plasma (intravascular fluid)
Hypovolemia is caused by a loss of ____ and ___ in the same proportion in the extracellular fluid space
fluids and electrolytes
The _______ refers to the movement of fluid from the intravascular space (blood vessels) into the transcellular compartment, such as the pleural, peritoneal (ascites), or pericardial areas; joint cavities; the bowel; or an excess accumulation of fluid in the interstitial space.
The fluid has not been lost but is trapped in another body space for a period of time and is essentially unavailable for use
“third space shift”
Third space shift can cause ____volemia
hypo
What are two serious potential consequences of third space shift?
Dehydration
Hemorrhage
_____ refers to excess H20 and NaCl in ECF in near equal portion
Hypervolemia
Who is at high risk of fluid & electrolyte balances?
-Heart failure
-Critically ill
-Old/young
-Diarrhea
-Neuro r/t dehydration & malabsorption
-Trauma/burns
What conditions might cause depleted hemoglobin on a CBC?
Anemia, hemorrhage, hemolytic reaction
What conditions commonly cause elevated hematocrit?
Fluid volume deficit
Shock
What conditions commonly cause depleted hematocrit?
-Acute massive blood loss
-Fluid volume overload
-Hemolytic reaction
What conditions commonly cause elevated creatinine?
-Kidney damage or failure
-Heart failure
-Shock
-Dehydration
(All reduce blood flow to the kidneys)
What might cause elevated BUN?
Shock
Heart failure
DKA
burns
What is the normal range for urine pH?
4.6 - 8.2
What condition commonly causes low specific gravity (<1.005)?
Renal damage
What conditions commonly cause low urine pH?
Low k
Renal failure
What conditions cause high specific gravity?
Vomiting
Diarrhea
Heart failure
What conditions commonly cause high urine pH?
Low K
Renal failure
What foods are high in potassium?
Bananas
Citrus fruits
Apricots
Broccoli
Potatoes
Lima beans
What are some hypotonic solutions?
1/3 NS
1/2 NS
What tonicity do maintenance fluids have?
Hypotonic
What are common hypertonic solutions?
5% dextrose in LR
5% dextrose in NS
Lymph is a type of _____ fluid
interstitial
_____ fluids include cerebrospinal, pericardial, synovial, intraocular, and pleural fluids, as well as sweat and digestive secretions.
Transcellular
Substances that are capable of breaking into particles called ions
Electrolytes
Major electrolytes in the ECF include _____, chloride, calcium, and bicarbonate.
sodium
Major electrolytes in the ICF include _____, phosphorus, and magnesium
potassium
The concentration of particles in a solution, or its pulling power, is referred to as the _____ of a solution
osmolarity
Plasma proteins, particularly albumin, facilitate reabsorption by “pulling” the fluid back into the capillaries. This “pulling” force is known as ______ _______ _________
colloid osmotic pressure
_____ pressure refers to the pressure exerted by a fluid against the walls of its container. In the context of capillaries, it’s the pressure exerted by the blood on the walls of the capillary vessels.
Hydrostatic
Fluid volume deficit (FVD) is caused by a loss of both water and solutes in the same proportion from the ECF space. This state is commonly known as ______ or isotonic fluid loss.
hypovolemia
A ____ weight loss caused by fluid deficiency usually is life threatening.
15%
Causes of third-space shift
severe burn, a bowel obstruction, surgical procedures, pancreatitis, ascites, or sepsis
Accumulation of fluid in the interstitial space is known as _____.
edema
Although the body attempts to maintain normal balance in all fluid spaces, the _____ fluid is usually protected at the expense of interstitial fluid and ICF.
intravascular
most abundant electrolyte in the ECF
sodium
_______ is the major intracellular electrolyte
potassium
______ is the most abundant intracellular cation after potassium
Magnesium
Respiratory ______ is caused by hyperventilation
alkalosis
Any decrease in alveolar ventilation that results in retention of carbon dioxide can cause respiratory ______.
acidosis
In metabolic _____, the respirations become slow and shallow, and periods of no breathing may occur.
alkalosis
Patients at risk for fluid and electrolyte imbalances
-Acute and chronic illnesses (e.g., diabetes mellitus, congestive heart failure, renal failure)
-Abnormal losses of body fluids (e.g., prolonged or severe vomiting or diarrhea, draining wounds, fistulas).
-Burns
-Trauma
-Surgery
-Therapies that may disrupt fluid and electrolyte balance, e.g., medications such as diuretics and steroids, and treatments such as IV therapy and PN
_____ hematocrit values: found in severe fluid volume deficit and shock (when hemoconcentration rises considerably)
Increased
_______ hematocrit values: found with acute, massive blood loss, and with hemolytic reaction after transfusion of incompatible blood or with fluid overload
Decreased
_______ levels of hemoglobin: found in hemoconcentration of the blood
Increased
_____ levels of hemoglobin: found with anemia states, severe hemorrhage, and after a hemolytic reaction
Decreased
_____ creatinine: found with impaired renal function, heart failure, shock, dehydration
Increased
______ BUN: found with impaired renal function (such as associated with shock, heart failure, salt and water depletion), diabetic ketoacidosis, burns
Increased
medications or treatments that might disrupt fluid and electrolyte balance
steroids, diuretics, parenteral nutrition, dialysis
Both the urine pH and specific gravity may be obtained by _____ measurement, using a fresh voided specimen or through laboratory analysis.
dipstick
____ than normal urinary pH can occur with respiratory alkalosis, potassium depletion, and chronic renal failure.
Higher
____ ______ is a measure of the urine’s concentration.
Specific gravity
_____ than normal urinary pH can occur with metabolic acidosis, diabetic ketosis, and diarrhea.
Lower
The pH of urine usually ranges between ____ and _____
4.6 and 8.2
BUN (Blood Urea Nitrogen)
BUN is a waste product generated when the body breaks down proteins, and it is eliminated by the kidneys through urine
LR and NS (0.9%)
Isotonic solutions
5% dextrose in LR
5% dextrose in NS
are ______ solutions
Hypertonic
What kind of tonicity do you want to replace electrolytes?
Hypertonic
What kind of solution do you use to treat Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
Hypertonic (to correct hyponatremia)
laboratory tests commonly used to determine the adequacy of oxygenation and ventilation, as well as in the assessment and treatment of acid–base imbalance
ABGs (Arterial Blood Gases)
How do you use phlebitis scale?
0 - none
1 - erythema
2 - edema
3 - streak/cord
4 - cord > 1 inch, purulent
