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NURS 200 > Fluids + Electrolytes + Acid-Base Balance > Flashcards

Fluids + Electrolytes + Acid-Base Balance Flashcards

1
Q

describe FLUIDS; where are they found?

A
  • 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)
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2
Q

what do ELECTROLYTES have?

A

they have a SPECIFIC DEGREE OF ACIDITY

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3
Q

what must be keep in balance within the body?

A
  • our FLUID, ELECTROLYTE and ACID-BASE BALANCES
  • helped to maintain proper FUNCTION in our body systems
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4
Q

what are the FOUR CHARACTERISTICS of body fluids that must be considered?

A
  1. FLUID AMOUNT (VOLUME)
  2. CONCENTRATION (OSMOLALITY)
  3. COMPOSITION (ELECTROLYTE CONCENTRATION)
  4. DEGREE OF ACIDITY (pH)

**each of these characteristics are what is needed for BALANCE of normal cellular function

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5
Q

describe WATER

A
  • 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
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6
Q

describe the TWO DISTINCT COMPARTMENTS of fluid

A
  1. EXTRACELLULAR FLUID
    the fluid that is OUTSIDE the cells
    - takes up around 1/3 of total body water
  2. INTRACELLULAR FLUID
    the fluid that is INSIDE the cells
    - takes up around 2/3 of total body water
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7
Q

describe the MAJOR DIVISIONS of EXTRACELLULAR FLUID

A
  1. INTRAVASCULAR FLUID
    - the liquid part of the blood; blood plasma
  2. INTERSTITIAL FLUID
    - the fluid located between cells & is outside the blood vessels
  3. TRANSCELLULAR FLUIDS
    - csf fluids, synovial fluids, pleural, cerebrospinal fluids
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8
Q

definition of ELECTROLYTES

A

compound that begins to separate into IONS (specific CHARGED PARTICLES) when dissolved in water
- can be either be POSITIVE (CATION) or NEGATIVE (ANION)

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9
Q

what are our typical POSITIVELY CHARGED CATIONS?

A
  • sodium (Na+)
  • potassium (K+)
  • calcium (Ca2+)
  • magnesium (Mg2+)
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10
Q

what are our typical NEGATIVELY CHARGED ANIONS?

A
  • chloride (Cl-)
  • bicarbonate (HCO3-)
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11
Q

what happens if we COMBINE CATIONS and ANIONS?

A

they create SALTS!
ex. NaCl - when dissolved in water–separate into Na and Cl

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12
Q

definition of OSMOLALITY

A

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

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13
Q

what type of TONICITY TYPES can we have?

A
  • 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
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14
Q

describe pH scale

A

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

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15
Q

how do we LOSE FLUID?

A

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)

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16
Q

what are the MOVEMENT PROCESSES of water & electrolytes?

A
  • ACTIVE TRANSPORT
  • DIFFUSION
  • OSMOSIS
  • FILTRATION

each process is important for maintaining EQUAL OSMOLALITY in all compartments

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17
Q

describe ACTIVE TRANSPORT

A
  • helps to maintain INTRACELLULAR ELECTROLYTE CONCENTRATION
  • requires ATP (energy) to move ELECTROLYTES against the CONCENTRATION GRADIENT (lower conc –> higher conc.)
    ex. sodium-potassium pump
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18
Q

describe DIFFUSION

A
  • 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.)
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19
Q

describe OSMOSIS

A

specific to MOVEMENT OF WATER; moving through cell membrane that separates fluids with DIFFERENT particle concentrations
(lower conc. to higher conc.)

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20
Q

describe FILTRATION

A

describes fluid movement going in and out; use of HYDROSTATIC PRESSURE

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21
Q

how do we get our FLUID INTAKE?

A
  • from regular DRINKING or EATING
  • IV fluids
  • RECTAL (enema)
  • around ~2300 mL per day
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22
Q

how is FLUID DISTRIBUTED?

A
  • OSMOSIS; distributes between the ECF & ICF
  • FILTRATION; distributes between the intravascular and interstitial fluids
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23
Q

how is FLUID OUTPUT considered?

A
  • 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

24
Q

baseline measurements;

A

1 oz = 30 mL
1 cup = 8 oz = 240 mL
1 tbsp = 15 mL
1 tsp = 5 mL
4 oz = 120 mL

25
Q

describe EXTRACELLULAR VOLUME IMBALANCES

A

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

26
Q

describe OSMOLALITY IMBALANCES

A

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)

27
Q

what is the NORMAL RANGE of sodium for a patient?

A

has to be between range of 135 - 145 mEq/L

28
Q

what does it mean when a PATIENT is CLINICALLY DEHYDRATED?

A

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

29
Q

where do we INTAKE & ABSORB ELECTROLYTES?

A
  • general EATING and DIET
  • absorbed through DIGESTIVE TRACT –> enters into BLOODSTREAM (small intestine helps with transportation)
30
Q

where are ELECTROLYTE BALANCES DISTRIBUTED?

A
  • 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)
31
Q

normal ranges of electrolytes;

A

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

32
Q

where do we TYPICALLY see our ELECTROLYTES being used?
**specific body systems

A

NEURO (LOC…)
- sodium
MUSC./CARDIO/MUSCLE CRAMPS
- potassium
SKELETAL/NERVE SIGNALS/MUSC CONTRACTION
- calcium
NEUROMUSCULAR
- magnesium

33
Q

how does EXERCISE affect our ELECTROLYTES?

A

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

34
Q

describe POTASSIUM ELECTROLYTE IMBALANCES

A

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

35
Q

describe CALCIUM ELECTROLYTE IMBALANCES

A

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

36
Q

describe MAGNESIUM ELECTROLYTE IMBALANCE

A

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

37
Q

are any of the electrolytes connected in terms of EXCESS & DEFICIT?

A

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)

38
Q

describe the DIFFERENCE between pH and a BASE

A

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

39
Q

why is ACID-BASE BALANCE so important and how do we measure it?

A
  • often use ABGs to measure
  • important for the FUNCTIONING of metabolic processes
    (again, the optimal range is between 7.35 - 7.45)
40
Q

how is ACID PRODUCED?

A

often from KETONE, PHOSPHORIC, or LACTIC ACID processes

41
Q

how is ACID EXCRETED?

A

through either CARBONIC ACID (from the LUNGS) or METABOLIC ACIDS (from the KIDNEYS)

42
Q

can you briefly describe how these two pathways of ACID EXCRETION WORKS?

A
  1. begins with CELLS & METABOLIC PROCESSES; produces GAS **more specifically CO2 + METABOLIC ACIDS
  2. CO2 can then COMBINE with H2O = creating CARBONIC ACID (this is then excreted by the LUNGS)
  3. METABOLIC ACIDS (H+) excreted by the KIDNEYS
43
Q

how are ACID-BASE IMBALANCES CLASSIFIED?

A

they can be EITHER RESPIRATORY or METABOLIC

44
Q

what are the normal acid-base ranges for a patient?

A

CO2
35 - 45
O2
80 - 100 **this is BLOOD GAS
HCO3
21-28/22-26

45
Q

describe RESPIRATORY ACIDOSIS

A

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

46
Q

describe RESPIRATORY ALKALOSIS

A

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

47
Q

describe METABOLIC ACIDOSIS

A

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

48
Q

describe METABOLIC ALKALOSIS

A

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

49
Q

what are some aspects to remember about assessing FLUID + ELECTROLYTE + ACID-BASE BALANCE?

A
  • 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
50
Q

chronic illness assessment

A
  • 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
51
Q

how do BURNS create imbalances?

A
  • greater CELLULAR METABOLISM with GREATER ACID PRODUCTION
52
Q

what aspects to consider during PHYSICAL ASSESSMENT?

A
  • weight changes and fluid status
  • fluid intake and output
  • lab values
53
Q

list of NANDAS

A
  • FLUID IMBALANCE
  • DEHYDRATION
  • ELECTROLYTE IMBALANCE
  • ACID-BASE IMBALANCE
  • LACK OF KNOWLEDGE OF FLUID REGIME
54
Q

how can we use ACUTE CARE to fix imbalances?

A
  • enteral replacement **most safe
  • restrict fluids *will increase sodium
  • parenteral replacement
  • use of diff. solutions (iso, hypo, hyper)
55
Q

definition of INFILTRATION

A

where IV fluids enter the SUBQ tissue

56
Q

defintion of EXTRAVASATION

A

fluid contains additives and begins to damage tissue

57
Q

definition of PHLEBITIS

A

inflammation of the VEIN either from CHEMICAL, MECHANICAL, or BACTERIAL CAUSES

NURS 200 (24 decks)

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