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NUR 101 Assessment #3 > Fluids, Electrolytes, & Intravenous Therapies > Flashcards

Fluids, Electrolytes, & Intravenous Therapies Flashcards

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1
Q

Composition of Body Fluid

A

Water

Gases

Solutes

* Electrolytes

* Nonelectrolytes

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2
Q

?

These develop an electrical charge when dissolved in water

e.g. Na+, K+

A

electrolytes

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3
Q

?

These do not conduct electricity within water

e.g. glucose

A

Nonelectrolytes

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4
Q

The total amount of body fluid varies and is based on age, sex, and amount of adipose tissue present

A
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5
Q

Function of Body Fluids

  • Maintain blood volume
  • Regulate body temperature (sweating)
  • Transport material to and from cells
A

Function of Body Fluids cont’d

  • Serve as medium for cellular metabolism
  • Assist with digestion of food
  • Serve as a medium for excreting waste
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6
Q

?

Is body fluid that is contained within the cells

Contains ___ (potassium, magnesium) and ___ (phosphate)

A

Intracellular fluid

cations, anions

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7
Q

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Is body fluid that is found outside of the cells

Contains sodium, chloride, bicarbonate, albumin, transcellular fluids

A

Extracellular fluid

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8
Q

?

Plasma in the blood; main function is to transport blood cells

A

Intravascular fluid

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9
Q

?

Lies in spaces between body cells

edema - is excess fluid within this ___ space

A

Interstitial fluids

interstitial

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10
Q

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Specialized fluids contained within body spaces

e.g. CSF, peritoneal fluid, digestive secretions

A

Transcellular fluid

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11
Q

?

Occurs where fluid is trapped in another compartment, not within interstitial cells or within the intravascular space

Due to low albumin levels, hypervolemia (fluid overload), decreased sodium levels

Creates a sort of generalized edema; seen in the legs, thighs, abdomen, and face

A

Third spacing

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12
Q

?

Occurs when molecules move across a cellular membrane against a concentration gradient

Requires energy expenditure

Vital for maintaining the composition of both the extracellular and intracellular compartments

A

Active transport

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13
Q

?

In the presence of ATP, actively moves ___ from the cell into the extracellular fluid and ___ from the extracellular fluid into the cell

A

Sodium-Potassium Pump

sodium; potassium

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14
Q

?

Releases from the cell to enable substances to acquire the energy needed to pass through the cell membrane

A

Adenosine Triphosphate (ATP)

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15
Q

?

Is a type of passive transport

Movement of water or other pure solute across a membrane from an area of a less concentrated solution to an area of a more concentrated solution

Solutes can be crystalloids or colloids

A

Osmosis

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16
Q

?

A form of passive transport

Process where solute molecules move through a cell membrane from an area of higher concentration to an area of lower concentration

Movement occurs until the concentrations are equivalent on both sides of the membrane

A

Diffusion

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17
Q

?

Is another type of passive transport

A

Filtration

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18
Q

What is a major regulator of fluid intake?

Fluids should be non-caffeinated; no sugar added

A

Thirst

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19
Q

Fluid Intake

Recommended Daily Intake

Men: ___ mL/day

Women: ___ mL/day

Older Adults: ___ to ___ mL/day

A

3,700

2,700

1,500 - 2,000

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20
Q

Thirst

Increased by excessive fluid loss, excessive sodium intake, and decreased fluid intake

A

Thirst cont’d

Decreased by high fluid intake, fluid retention, excessive intravenous infusions, and low sodium intake

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21
Q

Fluid Output

A

Common Sources of Fluid Loss

Urine: ~150 mL/day

Feces: ~100-200 mL/day

Skin: ~600 mL/day

Lungs: ~300 mL/day

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22
Q

?

Is fluid loss that we do not easily perceive, not easily measured

e.g. perspiration/sweating/breathing

A

Insensible Fluid Loss

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23
Q

?

Is fluid loss that is measurable and perceived

e.g. urine, diarrhea, ostomy/gastric drainage

A

Sensible Fluid Loss

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24
Q

Hormones Affecting Fluid Regulation

A

Antidiuretic Hormone

Renin-Angiotensin System

Aldosterone

Thyroid Hormone

Brain Natriuretic Peptide (BNP)

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25
Q

?

Causes the kidneys to retain fluid; based on fluid pressures in the vascular system

Triggered by fever, pain, stressor in response to opioids

A

Antidiuretic Hormone

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26
Q

?

Occurs in response to decreased ECF volume

Glomeruli in kidneys release ___ which converts ___ to ___ which then acts on nephrons to retain Na+ and H2O

Directs adrenal cortex to release aldosterone

A

Renin-Angiotension System

renin

angiotension

angiotension II

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27
Q

?

Stimulates distal tubules of kidneys to reabsorb Na+ and excrete K+; causes a passive reabsorption of H2O

A

Aldosterone

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28
Q

?

Can influence/increase cardiac output which in turn increases glomerular filtration rate and urine output

A

Thyroid Hormone

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29
Q

?

Can be measured in serum samples at the bedside

Used to help distinguish heart failure from pulmonary edema (both are issues that can affect fluid regulation and fluid overload)

A

Brain Natriuretic Peptide (BNP)

30
Q

Fluid Volume Deficit (___)

Loss of fluid and electrolytes from the extracellular fluid

Body weight matters here

Losing fluid, NOT fat, muscle

Older adults are at the highest risk here

Sudden loss of body weight of 5% (is clinically significant), 8% (is severe), 15% (is usually fatal)

A

Hypovolemia

31
Q

?

Is negative fluid balance (due to insufficient fluid intake or excess fluid loss [vomiting, diarrhea] or with fluid shifts [burns])

The first symptom of this is thirst

Heart rate increases (tachycardia), blood vessel constriction - WHAT WILL THIS CAUSE? (___)

A

Dehydration

hypertension

32
Q

?

Involves rapid heart rate (tachycardia) with orthostatic hypotension; the volume loss has continued to severe levels

Dry skin, dry mucous membranes, decreased skin turgor, decreased urine output, temperature increase

A

Hypovolemic Shock

33
Q

Fluid Volume Excess (___)

Retention of sodium and water in the extracellular fluid increases osmotic pressure and causes fluids to shift from the cells into the ECF

Results from excessive salt intake, decreased kidney function, decreased liver function, or poor pumping of the heart

A

Hypervolemia

34
Q

Signs and Symptoms of Fluid Overload:

Elevated blood pressure (hypertension), bounding pulse (4+), increased shallow respirations (tachypnea), cool and pale skin (pallor), distended neck veins (jugular vein distension), edema, crackles in the lungs (assess all lobes), dyspnea, excess peritoneal fluid (ascites)

A

Monitor I&O

Use electronic IV pumps for fluid administration

35
Q

Impact of Fluid Imbalance and Laboratory Studies

___ results in an increase in hematocrit, serum osmolality, urine osmolality, and urine specific gravity

___ results in a decrease in hematocrit, serum osmolality, urine osmolality, and urine specific gravity

Key Takeaway: Can cause concentration or dilution of any bodily fluid samples

A

Fluid Volume Deficit

Fluid Volume Excess

36
Q

?

This looks at the % of blood made up by cells; if less intravascular fluid, there is a greater % of cells

A

hematocrit

37
Q

Nursing Diagnoses (Problem)

Deficient Fluid Volume / Excess Fluid Volume

Risk for Deficient Fluid Volume / Risk for Imbalanced Fluid Volume

A

Overall goal is to restore balance

38
Q

Nursing Diagnoses (Etiology) [the cause]

A

Activity intolerance r/t excessive fluid and electrolyte loss

Oral mucous membrane integrity r/t deficient fluid volume

Decreased cardiac output r/t hypovolemia

39
Q

Sodium (Na+)

Primary function is to ___

Recommended Daily Intake: ___ mg/day (___ mg/day if other health issues)

Sources: table salt, cheese, milk, processed foods

Normal Serum Level: ___ to ___ mEq/L

Hypernatremia vs. Hyponatremia

A

regulate fluid volume

2,300; 1,500

135-145

40
Q

?

Serum sodium greater than 145

Causes: excessive sodium intake, water deprivation, increased water loss

Symptoms: thirst, elevated temperature, dry mouth, dry mucuous membranes, hallucinations, irritability, seizures

Treatment: sodium restriction, increase water intake, IV infusions not containing sodium

A

Hypernatremia

41
Q

?

Serum sodium less than 135

Causes: diuretics, vomiting, diarrhea, excessive intake of hypotonic fluids

Symptoms: anorexia, nausea, vomiting, weakness, lethargy, confusion, muscle cramps, twitching, seizures

Treatment: increase sodium intake, administer saline infusion, seizure precautions

A

Hyponatremia

42
Q

Potassium (K+)

Key electrolyte in ___

Recommended Daily Intake: ___ mg/day

Sources: bananas, oranges, carrots, potatoes, tomatoes, spinach, dairy, meats

Normal Serum Level: ___ to ___ mEq/L

Hyperkalemia vs. Hypokalemia

A

cellular metabolism

4,700

3.5 - 5

43
Q

?

This is associated with increases in blood pressure, salt sensitivities, kidney stones, and risk of bone turnover

Has also been associated with increased risk of stroke

These organs eliminate excess K+ ?

A

Moderate potassium deficiency

kidneys

44
Q

?

Serum potassium greater than 5

Causes: renal failure, potassium-sparing diuretics, acidosis, trauma, high intake

Symptoms: muscle weakness, dysrhythmias, flaccid paralysis, intestinal colic, EKG changes

Treatment: limit potassium-rich foods

Rx: Kayexalate (available as an oral suspension or enema; served “best on ice”)

A

Hyperkalemia

45
Q

?

Serum potassium less than 3.5

Causes: diuretics, vomiting, diarrhea, steroids, anorexia, bulimia

Symptoms: fatigue, nausea, vomiting, muscle weakness, decreased GI motility, dysrhythmias, paresthesia

Treatment: foods rich in potassium, potassium supplements

A

Hypokalemia

46
Q

?

Responsible for bone health, neuromuscular and cardiac function, and is an essential factor in ___

Recommended Daily Intake: ___ to ___ mg/day

Sources: milk and milk products, dark green leafy vegetables, calcium fortified foods

Normal Serum Level: ___ to ___ mg/dL

Hypercalcemia vs. Hypocalcemia

A

Calcium (Ca2+)

blood clotting

1,000 - 1,200

8.5 - 10.5

47
Q

Calcium is very abundant in the body; 99% within the bones and teeth; 1% circulating in blood volume

You need ___ to absorb calcium

Tums i.e. calcium carbonate

A

Vitamin D

48
Q

?

Serum calcium is less than 8.5

Causes: hypoparathyroidism, malabsorption, pancreatitis, alkalosis, vitamin D deficiency

Symptoms: diarrhea, paresthesia of extremities, muscle cramps, tetany (muscle spasms), convulsions, cardiac irritability

Treatment: encourage calcium dietary intake, supplements as needed

A

Hypocalcemia

49
Q

?

Serum calcium greater than 10.5

Causes: hyperparathyroidism, malignant bone disease, prolonged immobilization, excess calcium

Symptoms: muscle weakness, constipation, nausea, vomiting, polyuria, polydipsia, bradycardia

Treatment: limit calcium intake, avoid calcium-based antacids (i.e. Tums)

A

Hypercalcemia

50
Q

Magnesium (Mg2+)

Mineral that is used in more than 300 biochemical reactions in the body

About 1% circulating in blood volume

Levels may be low in clients who have high alcohol intake

Recommended Daily Intake: ___ to ___ mEq/day

Sources: green vegetables, cereal grains, nuts

Normal serum level: ___ to ___ mEq/L

Hypermagnesemia vs. Hypomagnesemia

A

18 - 30

1.6 - 2.6

51
Q

?

Serum magnesium less than 1.6

Causes: chronic alcoholism, malabsorption, diabetic ketoacidosis

Symptoms: neuromuscular irritability, disorientation, dysrhythmias

Treatment: avoid alcohol intake, encourage foods high in magnesium, supplement if needed

A

Hypomagnesemia

52
Q

?

Serum magnesium greater than 2.6

Causes: renal failure, adrenal insufficiency, excess intake

Symptoms: flushing (can happen when giving an IV)/warmth of the skin, hypotension, lethargy, hypoactive reflexes, depressed respirations, bradycardia

Treatment: avoid magnesium-based antacids and laxatives, limit intake

A

Hypermagnesemia

53
Q

Serum electrolytes are measured in a basic metabolic panel (BMP) or comprehensive metabolic panel (CMP)

A

Teaching Clients to Prevent Fluid and Electrolyte Imbalances

Is individualized to the client

  • What is the typical amount of fluid they require per day?
  • Are they on any medications that can increase the risk of imbalances?
  • At what age do adults begin to lose the thirst sensation?
  • How does urine color inform us of hydration status?
  • What should be limited in the diet?
  • What should be promoted in the diet?
  • When should the healthcare provider be contacted?
54
Q

?

Are fluids given any route outside of the alimentary canal (pathway from mouth to anus); not through GI tract

Provide replacement fluids, sugars, electrolytes, and nutrients to clients unable to obtain orally; provide access for administration of medication

Drug guides should always be checked to ensure compatability of medication and intravenous fluid, as well as between medications

A

Parenteral agents/preparations

55
Q

Types of Intravenous Solutions

A

Isotonic fluids

Hypotonic fluids

Hypertonic fluids

56
Q

?

Remain in the intravascular compartment

Reflect normal blood serum and osmolality

Useful for clients with ___ or ___

Commonly used: 0.9% sodium chloride (Normal Saline), Lactated Ringers

Clients at risk for fluid volume ___ must be closely monitored when they receive this fluid replacement because they may easily develop fluid overload

A

Isotonic fluids

hypotension; hypovolemia

excess

57
Q

?

Pull water out of the intravascular compartment and into the interstitial fluid compartment

Less than normal blood serum osmolality

Useful for ___ conditions

Commonly used: 5% dextrose in water (D5W), 0.45% sodium chloride (half Normal Saline)

Administer these carefully to prevent a sudden fluid shift from the intravascular space to the cells.

Never give to clients at risk for increased intracranial pressure as it can worsen cerebral edema.

A

Hypotonic fluids

hyperglycemic

58
Q

?

Pull water into the intravascular compartment from the interstitial compartment

Greater than normal blood serum osmolality

Useful for stabilizing blood pressure, increasing water output

Commonly used: D5NS, D51/2NS, D5LR

A

Hypertonic fluids

59
Q

?

Administration of essential proteins, amino acids, carbohydrates, vitamins, minerals, trace elements, lipids, and fluids via a ___ preparation

Used to improve or stabilize nutritional status who cannot do so orally

Composition is based on patient needs, discovered within the nutritional assessment

Assess health status, age, metabolic needs

Use cautiously in clients with unstable cardiovascular or fluid and electrolyte issues due to potential changes in fluid status

A

Parenteral nutrition

60
Q

Peripheral Vascular Access Devices

  • Intravenous catheters (IV) are sized by their diameter - the gauge

* Smaller the diameter, larger the gauge

  • Peripheral Intravenous Lock (PIV)
  • Midline Peripheral Catheter - inserted into the antecubital and threaded up the arm
A
61
Q

Complications of Intravenous Therapies

Hematoma

Infiltration

Extravasation

Phlebitis

Local infection

A

Complications of Intravenous Therapies cont’d

Thrombophlebitis

Nerve injury

Septicemia (sepsis)

Fluid overload

Embolus (air or catheter)

62
Q

?

Is a thrombosis and inflammation

Edema, tenderness, palpable cord in vein

Restart IV in opposite extremity

A

Thrombophlebitis

63
Q

?

Is inflammation of the vein

Redness, pain, warmth, swelling

May feel a palpable cord along the vein

Cold to warm compresses given

A

Phlebitis

64
Q

?

Is a seepage of solution or medication into surrounding tissues

Might see swelling, tenderness, hardness on client

IV has moved out of the vein; occlusion may be noted on pump

A

Infiltration

65
Q

?

Is a seepage of a vesicant (can cause a lot of damage) solution in the tissues

Can see blistering, tissue necrosis; pain, burning, blanching at site

A

Extravasation

66
Q

?

A localized blood mass that occurs outside of the blood vessel; looks like a bruise

Apply pressure when removing the IV catheter

A

Hematoma

67
Q

Central Venous Access Devices

Advances into the superior vena cava

Peripherally Inserted Central Catheters (PICC)

* Used for parenteral nutrition, chemotherapy, prolonged antibiotic use

Nontunneled Central Venous Catheters

* Inserted into jugular, subclavian, femoral

* Are sutured into place

* Single, double, triple lumen (denotes how many ports come off it)

* For short term use (<6 weeks)

A

Central Venous Access Devices cont’d

Tunneled Central Venous Catheters

* Long term use

* Reduce risk of systemic infection

Implanted Ports

* Placed surgically

* For long term use

68
Q

Advantages/Disadvantages of CVAD

  • Accomodates highly irritating solutions
  • Accessible even when severe fluid depletion is present
  • May be used long term
  • Allows for parenteral nutrition (central only; NOT peripheral)
  • Decreased risk of phlebitis, extravasation, and infiltration
  • Can withdraw blood for laboratory tests (peripheral you can only draw off of when you first place it)
A

Advantages/Disadvantages of CVAD cont’d

  • Specialized training needed for insertion, management
  • Is treated as a minor surgical procedure
  • Sterile technique required for placement and dressing changes
  • High risks, such as sepsis, air embolus, ventricular dysrhythmias
  • Account for 90% of catheter-associated bloodstream infections
69
Q

Regulating Intravenous Infusions

Gravity flow - check hourly

Volume-control set - when clients are at risk for high fluid volume loss

Infusion pump - most common; absence of alarm is not absence of problem

You are responsible for maintaining the correct rate of flow and for monitoring the client’s response to an infusion

A

The greater the distance between the solution and the patient’s heart, the faster that infusion will be

Any pressure on the arm will decrease flow

As BP rises, more force is needed to infuse into the vein

The smaller the diameter of the catheter, the slower the infusion

Remember to check tubing; peripheral IV’s can become dislodged

70
Q

Calculating IV Flow Rates

IV infusion pumps (mL/hr)

Volume (mL) / Time (hr)

Example: The provider orders an intravenous fluid bolus of 750 mL Normal Saline to infuse over 2 hours

What would the nurse set the pump at?

A

Calculating IV Flow Rates

Gravity Flow = Drops Per Minute

Flow Rate (mL/hr) x Drop Factor (gtts/mL) divided by time (minutes)

Example: The provider orders an intravenous fluid bolus of 750 mL Normal Saline to infuse over 2 hours. The tubing available has a drop factor of 10 gtts/mL

What would the nurse set the drops per minute to?

NUR 101 Assessment #3 (11 decks)

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