Fluids + Electrolytes + Acid-Base Balance Flashcards
describe FLUIDS; where are they found?
- they are INTERNAL and surround our cells and are INSIDE our cells
- contain ELECTROLYTES
- water that contains DISSOLVED or SUSPENDED SUBSTANCES
(ex. glucose, mineral salts, or proteins)
what do ELECTROLYTES have?
they have a SPECIFIC DEGREE OF ACIDITY
what must be keep in balance within the body?
- our FLUID, ELECTROLYTE and ACID-BASE BALANCES
- helped to maintain proper FUNCTION in our body systems
what are the FOUR CHARACTERISTICS of body fluids that must be considered?
- FLUID AMOUNT (VOLUME)
- CONCENTRATION (OSMOLALITY)
- COMPOSITION (ELECTROLYTE CONCENTRATION)
- DEGREE OF ACIDITY (pH)
**each of these characteristics are what is needed for BALANCE of normal cellular function
describe WATER
- takes a SIGNIFICANT AMOUNT of body weight (around 60% – lowers to 50% as we age)
- WOMEN have lower water content
- OBESE patients have lower water content
**fat contains less water vs. muscle
describe the TWO DISTINCT COMPARTMENTS of fluid
- EXTRACELLULAR FLUID
the fluid that is OUTSIDE the cells
- takes up around 1/3 of total body water - INTRACELLULAR FLUID
the fluid that is INSIDE the cells
- takes up around 2/3 of total body water
describe the MAJOR DIVISIONS of EXTRACELLULAR FLUID
- INTRAVASCULAR FLUID
- the liquid part of the blood; blood plasma - INTERSTITIAL FLUID
- the fluid located between cells & is outside the blood vessels - TRANSCELLULAR FLUIDS
- csf fluids, synovial fluids, pleural, cerebrospinal fluids
definition of ELECTROLYTES
compound that begins to separate into IONS (specific CHARGED PARTICLES) when dissolved in water
- can be either be POSITIVE (CATION) or NEGATIVE (ANION)
what are our typical POSITIVELY CHARGED CATIONS?
- sodium (Na+)
- potassium (K+)
- calcium (Ca2+)
- magnesium (Mg2+)
what are our typical NEGATIVELY CHARGED ANIONS?
- chloride (Cl-)
- bicarbonate (HCO3-)
what happens if we COMBINE CATIONS and ANIONS?
they create SALTS!
ex. NaCl - when dissolved in water–separate into Na and Cl
definition of OSMOLALITY
the number of CONCENTRATION of SOLUTES in water; very important for IV fluids
- can define how particles PASS through CELL MEMBRANES; either with ease or difficulty–this is known as the fluid’s TONICITY
**aka EFFECTIVE CONCENTRATION/the ability to gain or lose water
what type of TONICITY TYPES can we have?
- ISOTONIC
around 0.9% ; has the same tonicity as blood; no changes to cell - HYPERTONIC
has HIGHER TONICITY as BLOOD **causes cell to SHRINK - HYPOTONIC
has LOWER TONICITY as blood **causes cell to GAIN VOLUME
describe pH scale
scale goes from 0 -14
normal blood pH;
7.35 - 7.45
less than 7.35;
considered ACIDIC
more than 7.45;
considered BASIC/ALKALINE
how do we LOSE FLUID?
can either have SENsible or NONsensible fluid loss
SENSIBLE FLUID LOSS;
can see visible fluid loss (ex. urine)
NONSENSIBLE FLUID LOSS;
cannot see visible fluid loss (ex. respirations or sweating)
what are the MOVEMENT PROCESSES of water & electrolytes?
- ACTIVE TRANSPORT
- DIFFUSION
- OSMOSIS
- FILTRATION
each process is important for maintaining EQUAL OSMOLALITY in all compartments
describe ACTIVE TRANSPORT
- helps to maintain INTRACELLULAR ELECTROLYTE CONCENTRATION
- requires ATP (energy) to move ELECTROLYTES against the CONCENTRATION GRADIENT (lower conc –> higher conc.)
ex. sodium-potassium pump
describe DIFFUSION
- the PASSIVE MOVEMENT of electrolytes - or other particles DOWN a CONCENTRATION GRADIENT
- **opposite direction than ACTIVE TRANSPORT
- requires PROTEINS to work as an ION CHANNEL (very strict regulation + important for muscle & nerve fxn.)
describe OSMOSIS
specific to MOVEMENT OF WATER; moving through cell membrane that separates fluids with DIFFERENT particle concentrations
(lower conc. to higher conc.)
describe FILTRATION
describes fluid movement going in and out; use of HYDROSTATIC PRESSURE
how do we get our FLUID INTAKE?
- from regular DRINKING or EATING
- IV fluids
- RECTAL (enema)
- around ~2300 mL per day
how is FLUID DISTRIBUTED?
- OSMOSIS; distributes between the ECF & ICF
- FILTRATION; distributes between the intravascular and interstitial fluids
how is FLUID OUTPUT considered?
- fluid moving out of our SKIN, LUNGS, GI TRACT, and KIDNEYS
- vomiting, diarrhea, wound drainage, hemorrhage
-urine or stool
ex. documenting I & O, documenting using percentage
baseline measurements;
1 oz = 30 mL
1 cup = 8 oz = 240 mL
1 tbsp = 15 mL
1 tsp = 5 mL
4 oz = 120 mL
describe EXTRACELLULAR VOLUME IMBALANCES
describes the AMOUNT OF FLUID in our ECF
we can either have a DEFICIT or EXCESS;
HYPOVOLEMIA:
fluid OUTSIDE of the cells is LOW; we have FLUID LOSS
HYPERVOLEMIA:
fluid OUTSIDE of the cells is EXCESSIVE; we have FLUID EXCESS
describe OSMOLALITY IMBALANCES
considers SODIUM and WATER in this case;
we will only have an IMBALANCE if we LOSE WATER or we GAIN SALT
HYPERNATREMIA;
having HIGHER LEVELS OF SODIUM + a WATER DEFICIT (this is a HYPERTONIC OSMOLALITY)
HYPONATREMIA;
having LOWER LEVELS OF SODIUM + a WATER EXCESS (this is a HYPOTONIC OSMOLALITY)
what is the NORMAL RANGE of sodium for a patient?
has to be between range of 135 - 145 mEq/L
what does it mean when a PATIENT is CLINICALLY DEHYDRATED?
this means they are HYPOVELEMIC due to the FLUID DEFICIT in the ECF & this is then combined with HYPERNATREMIA due to the EXCESSIVE LEVELS OF SODIUM
**sodium levels are ABOVE 145
where do we INTAKE & ABSORB ELECTROLYTES?
- general EATING and DIET
- absorbed through DIGESTIVE TRACT –> enters into BLOODSTREAM (small intestine helps with transportation)
where are ELECTROLYTE BALANCES DISTRIBUTED?
- can depend on various body systems; different CONCENTRATION DIFFERENCES
**only focusing on BLOOD SAMPLES specifically; there are DIFFERENT REFERENCE VALUES in CELLS/BONES
(due to this values such as K+, Ca2+, Mg+ or phosphate (Pi) are more LOW in blood)
normal ranges of electrolytes;
sodium (Na+) 135 - 145 mEq/L
calcium (Ca+) 9.0 - 10.5 mg/dL
magnesium (Mg2+) 1.3 - 2.1 mEq/L
potassium (K+) 3.5 - 5.0 mEq/L
phosphate (Pi) 3.0 - 4.5 mg/dL
where do we TYPICALLY see our ELECTROLYTES being used?
**specific body systems
NEURO (LOC…)
- sodium
MUSC./CARDIO/MUSCLE CRAMPS
- potassium
SKELETAL/NERVE SIGNALS/MUSC CONTRACTION
- calcium
NEUROMUSCULAR
- magnesium
how does EXERCISE affect our ELECTROLYTES?
the GREATER EXERCISE, the GREATER LOSS of electrolytes; need to REPLACE
- at times, water is NOT SUFFICIENT for replacement
- can supplement with food/bananas/IV
describe POTASSIUM ELECTROLYTE IMBALANCES
can be either DEFICIT or EXCESS
[3.5 - 5.0 mEq/L]
HYPOKALEMIA
- LOWER than 3.5
- UOP increased
- CHRONIC KIDNEY ISSUES/VOMITING/DIARRHEA
- DIURETICS
symptoms;
- often presents as MUSCLE WEAKNESS
HYPERKALEMIA
- HIGHER than 4.5
- UOP decreased
- DIALYSIS PTs/KIDNEY ISSUES/potassium-sparing diuretics (aldacktone)
symptoms;
often presents as MUSCLE WEAKNESS, CARDIAC DYSRHYTHMIAS/CARDIAC ARREST
describe CALCIUM ELECTROLYTE IMBALANCES
can be either DEFICIT or EXCESS
[9.0 - 10.5 mg/dL]
HYPOCALCEMIA
- LOWER than 9.0
- PANCREATITIS/DIARRHEA/LAXATIVE USE
symptoms;
- often presented by NUMBNESS, TINGLING, HYPERACTIVE REFLEXES
HYPERCALCEMIA
- HIGHER than 10.5
- BONE CANCER PTs/DIURETIC USE/BED REST PATIENTS
symptoms;
- often presented by N/V, FATIGUE/LETHARGY, lower LOC/CONFUSION
describe MAGNESIUM ELECTROLYTE IMBALANCE
can be either DEFICIT or EXCESS
[1.3 - 2.1 mEQ/L]
HYPOMAGNESEMIA
- LOWER than 1.3
- LAXATIVE/DIURETIC USE/DIARRHEA
- ALCOHOLIC PTs.
- MALNUTRITION/NOT EATING
symptoms;
- often presented by HYPER DTRs, MUSC. CRAMPES, HYPERTENSION
HYPERMAGNESEMIA
- HIGHER than 2.1
- POOR KIDNEY FXN./HIGH MAGNESIUM LAXATIVES/ANTACIDS
symptoms;
- often presented by HYPO DTRs/BRADYCARDIA/HYPOTENSION
are any of the electrolytes connected in terms of EXCESS & DEFICIT?
yes!
Mg - if LOWER, can also LOWER Ca
(PTH hormone is produced/released by Mg, PTH is important in regulating Ca)
Mg - if LOWER, can also LOWER K
(Mg helps transport K ions out of the cell)
describe the DIFFERENCE between pH and a BASE
pH - is a POTENTIAL of hydrogen; reflects the amount of HYDROGEN ions within the blood
- indicates the DEGREE OF ACIDITY
BASE - is what ACCEPTS the hydrogen ions; known as BICARBONATE
- indicates the ALKALINITY/how BASIC the blood is
why is ACID-BASE BALANCE so important and how do we measure it?
- often use ABGs to measure
- important for the FUNCTIONING of metabolic processes
(again, the optimal range is between 7.35 - 7.45)
how is ACID PRODUCED?
often from KETONE, PHOSPHORIC, or LACTIC ACID processes
how is ACID EXCRETED?
through either CARBONIC ACID (from the LUNGS) or METABOLIC ACIDS (from the KIDNEYS)
can you briefly describe how these two pathways of ACID EXCRETION WORKS?
- begins with CELLS & METABOLIC PROCESSES; produces GAS **more specifically CO2 + METABOLIC ACIDS
- CO2 can then COMBINE with H2O = creating CARBONIC ACID (this is then excreted by the LUNGS)
- METABOLIC ACIDS (H+) excreted by the KIDNEYS
how are ACID-BASE IMBALANCES CLASSIFIED?
they can be EITHER RESPIRATORY or METABOLIC
what are the normal acid-base ranges for a patient?
CO2
35 - 45
O2
80 - 100 **this is BLOOD GAS
HCO3
21-28/22-26
describe RESPIRATORY ACIDOSIS
this is where our LUNGS are unable to EXCRETE ENOUGH CO2
- have a LOWER pH (more acidic) and HIGHER CO2 (more acidic), LOWER bicarb
- often see HYPOVENTILATION ex. COPD
describe RESPIRATORY ALKALOSIS
this is where our LUNGS EXCRETE TOO much CARBONIC ACID
- have a HIGHER pH (more basic) and LOWER CO2 (more basic), HIGHER bicarb
- often see HYPERVENTILATION ex. pain
**the faster we breathe, the faster CO2 is blown off
describe METABOLIC ACIDOSIS
this is where we have an INCREASE OF METABOLIC ACID or a DECREASE OF BASE
- have LOW pH (more acidic) and LOW HCO3 (more acidic)
- often due to ALCOHOLISM - increase of acid /DIARRHEA - loss of base
describe METABOLIC ALKALOSIS
this is where we have a DIRECT INCREASE OF BASE/DECREASE of METABOLIC ACID
- have HIGH pH (more basic), and HIGH HCO3 (more basic)
- sometimes can have HIGHER CO2 – type of compensation method of body
- often due to VOMITING; increases BASE and decreases ACID
what are some aspects to remember about assessing FLUID + ELECTROLYTE + ACID-BASE BALANCE?
- age; can have diff. amt of fluids (infants - have the greatest amt of fluids 70-80%/older adults have the least amt. of fluids 50%)
- environment (hot?)
- diet
- lifestyle - alcohol intake
- medications - diuretics/antacids
chronic illness assessment
- GI outputs
- CANCER; hypercalemia **
- HEART FAILURE; decrease in CO = decreases kidney function; this is why often want the patient on sodium restrictions and fluid
- OLIGURIC RENAL DISEASE - CFD patients, nephritis
how do BURNS create imbalances?
- greater CELLULAR METABOLISM with GREATER ACID PRODUCTION
what aspects to consider during PHYSICAL ASSESSMENT?
- weight changes and fluid status
- fluid intake and output
- lab values
list of NANDAS
- FLUID IMBALANCE
- DEHYDRATION
- ELECTROLYTE IMBALANCE
- ACID-BASE IMBALANCE
- LACK OF KNOWLEDGE OF FLUID REGIME
how can we use ACUTE CARE to fix imbalances?
- enteral replacement **most safe
- restrict fluids *will increase sodium
- parenteral replacement
- use of diff. solutions (iso, hypo, hyper)
definition of INFILTRATION
where IV fluids enter the SUBQ tissue
defintion of EXTRAVASATION
fluid contains additives and begins to damage tissue
definition of PHLEBITIS
inflammation of the VEIN either from CHEMICAL, MECHANICAL, or BACTERIAL CAUSES
