N368 Final Fluids and Electrolytes Flashcards
1
Q
The most important regulator of fluid is:
A
thirst
2
Q
Thirst center is located in:
A
the hypothalmus
3
Q
What are the primary regular of fluid output?
A
kidneys
4
Q
Mechanisms that influence fluid output
A
Renin-angiotensin-system
Aldosterone
Antidiuretic hormone
5
Q
Aldosterone causes the conservation of:
A
sodium, and excretion of potassium
6
Q
Increased sodium leads to…
A
increased water and increased BP
7
Q
Drugs that interfere with aldosterone production are used as:
A
antihypertensives
8
Q
Osmolality
A
absolute concentration of osmotic solution
9
Q
Greatest contributor of osmolality is:
A
sodium
10
Q
Sodium controlled by the hormone
A
aldosterone
11
Q
Tonicity
A
relative concentration of intravenous fluid
12
Q
Isotonic IV fluid
A
No fluid shift
Used to treat fluid loss due to vomit, diarrhea, or surgical procedures, ESPECIALLY WHEN BP IS LOW
13
Q
Hypertonic IV fluids
A
Water moves from interstitial space to plasma
14
Q
What is hypertonic IV fluids used to relieve?
A
cellular edema, especially cerebral edema
15
Q
Hypotonic intravenous fluid
A
Water moves from plasma to interstitial space
16
Q
Hypotonic is used to treat
A
dehydration when BP is normal
17
Q
Fluid deficit can cause
A
dehydration or shock
18
Q
Fluid deficit can be treated with
A
oral or intravenous fluids
19
Q
Fluid excess can be treated with
A
diuretics
20
Q
When replacing fluids and electrolytes you use:
A
crystalloids and colloids
21
Q
Causes of water and electrolyte loss:
A
Volume loss in intravascular space due to lack of fluid volume
Volume loss in intravascular space due to transfer of fluid into third space
22
Q
Examples of volume loss due to transfer of fluid into third space
A
kidney failure and liver failure
23
Q
Examples of volume loss due to lack of fluid volume
A
NAME?
24
Q
Treatment of volume loss due to transfer of fluid into third space
A
Crystalloids as first drug of choice
25
Treatment of volume loss due to transfer of fluid into third space
Colloids
26
Colloid helps reduce:
3rd space accumulation, reduces volume loss in intravascular space
27
How are crystalloids different from colloids?
Crystalloids are capable of leaving plasma and moving to interstitial spaces and intracellular fluid
28
Types of crystalloids
Isotonic
Hypertonic
Hypotonic
29
Crystalloids primary use
to replace fluids and promote urine output
30
What type of crystalloid is used to treat dehydration with LOW BP?
Isotonic solution (ex. normal saline, because the priority is to treat the low BP)
31
What type crystalloid is used to treat dehydration with NORMAL BP?
Hypotonic solution
32
What type of crystalloid is used to treat hypernatremia with cellular dehydration?
Hypotonic solution
33
Colloid molecules
large molecule solutes so they cannot easily cross capillary membrane
34
Colloid mechanism of action
draw water from intracellular fluid and interstitial spaces into plasma
35
What do colloids do?
#NAME?
36
Colloid primary use
fluid replacement with hypovolemic shock from hemorrhage, surgery, severe burns
37
Adverse effects of colloids
Hypersensitivity reactions
Fluid overload
Hypertension
38
Nursing considerations when using colloids
Monitor fluid volume status
Assess neurological status and urinary output
Teach client to report hypersensitivity or fluid volume overload
39
Electrolytes are essential to:
nerve conduction, membrane permeability, water balance, and other critical body functions
40
Major electrolytes
```
Calcium
Magnesium
Phosphate
Potassium
Sodium
```
41
What stimulates adrenal gland which releases aldosterone?
Lack of sodium of increase of potassium
42
What happens when aldosterone increases sodium re absorption?
Increase in potassium excretion so increase in sodium in plasma
43
What is considered hypernatremia?
Sodium level above 145 mEq/L
44
What is the most common cause of hypernatremia?
kidney disease
45
Normovolemic hypernatremia
Caused by excessive sodium intake, no water changes
46
Hypervolemic hypernatremia
Caused by decreased excretion (ex. kidney disease)
47
Hypovolemic hypernatremia
Caused by high net-water loss
| not enough water intake or excessive water loss due to diarrhea, fever, burns, ect.
48
Signs and symptoms of hypernatremia
THIRST, fatigue, muscle twitching
49
Treatment of hypernatremia caused by excessive sodium intake
Low salt diet
50
Treatment of hypernatremia due to dehydration
| hypovolemic hypernatremia
give hypotonic solution
51
Treatment of hypernatremia due to kidney failure
| hypervolemic hypernatremia
give diuretics
52
What is considered hyponatremia?
Sodium level below 135 mEq/L
53
Causes of hyponatremia
#NAME?
54
Examples of hyponatremia caused by excessive sodium loss
Vomiting, diarrhea, GI suctioning, diuretic use, sweat
55
Examples of hyponatremia caused by excessive dilution of plasma
Excessive ADH secretion
| Excessive administration of hypotonic IV solution
56
How does ADH cause concentration of urine
b/c it causes water to be retained into the body, too much ADH can cause fluid retention
57
Treatment of hyponatremia caused by excessive dilution
loop diuretics to cause isotonic diuresis
58
Treatment of hyponatremia caused by sodium loss
oral sodium chloride or IV fluids containing salt
- Normal saline
- Lactated ringers
59
Sodium replacement prototype drug
Sodium chloride
60
Primary use of sodium replacement (sodium chloride)
to treat hyponatremia when serum level falls below 130 mEq/L
61
Adverse effects of sodium replacement therapy
hypernatremia and pulmonary edema
62
Sodium effect vs potassium effect
Sodium effects water, potassium effects muscle (heart)
63
Potassium effects...
muscle contractility
64
What is the most abundant intracellular cation?
potassium
65
Potassium is essential for:
proper nerve functioning and maintaining acid-base balance
66
How is potassium influenced by aldosterone?
For each sodium ion reabsorbed, one potassium ion is secreted into renal tubules
67
Fatal imbalances of potassium are usually a result of:
cardiac toxicity
68
Normal range of potassium
3.5-5 mEq/L
69
What constitutes hyperkalemia?
Potassium above 5 mEq/L
70
Causes of hyperkalemia
#NAME?
71
Hyperkalemia due to decreased excretion is usually caused by
renal disease
72
Hyperkalemia does what to cell excitation?
increases cell excitation
73
Serious signs/symptoms of hyperkalemia
dysrhythmias and heart block/bradycardia with alternation of ventricular fibrillation and cardiac arrest
74
Early phase symptoms of hyperkalemia
muscle twitching, fatigue, parasthesias, cramping
75
Treatment of hyperkalemia
#NAME?
76
How does kayexalate and sorbitol treat hyperkalemia?
Laxatives excrete potassium in stool
77
How does administering glucose and insulin treat hyperkalemia?
helps move potassium into the cell by activating the potassium sodium pump, potassium going into the cell decreases the serum level
78
How does administering calcium treat hyperkalemia?
to counter act the potassium toxicity on the heart
79
What is considered hypokalemia?
Potassium level below 3.5 mEq/L
80
Hypokalemia is caused by
#NAME?
81
Examples of hypokalemia caused by excessive loss of potassium
#NAME?
82
Signs and symptoms of hypokalemia
#NAME?
83
Treatment of mild hypokalemia
increase dietary intake
84
Treatment of severe hypokalemia
give oral supplements or parenteral potassium supplements
85
Nursing consideration when taking oral potassium
take with glass of milk to avoid GI irritation
86
Potassium replacement therapy prototype drug
potassium chloride
87
Potassium replacement mechanism of action
electrolyte/potassium supplement
88
When is potassium replacement therapy contraindicated?
#NAME?
89
Potassium should be closely monitored when used with:
digoxin
90
High pH is...
alkalosis
| pH above 7.45
91
Low pH is...
acidosis
| pH below 7.35
92
Normal pH
7.35-7.45
93
Two main buffering systems to help maintain normal pH
Bicarbonate ions and phosphate ions
94
Carbonic acid
H + HCO3
95
Acid removal mechanism
CO2 is removed by lungs during exhalation
| Acid metabolites are removed by kidney in form of hydrogen ion by excreting urine
96
How is respiratory acidosis caused by narcotic OD
Narcotic overdose damages brain respiratory center, breathing rate goes down, cant remove enough CO2
97
Causes of metabolic acidosis
```
Severe diarrhea
Kidney failure: H+ not removed
Diabetes
Excess alcohol ingestion
Starvation
```
98
How can diarrhea cause metabolic acidosis
Stool usually has bicarbonate in it, if you lose all bicarbonate you are much more likely to has acidosis
99
Causes of respiratory alkalosis
Hyperventilation, anxiety, high altitude
100
How can anxiety cause respiratory alkalosis
Panic attack causes too much loss of CO2 (acid)
101
Causes of metabolic alkalosis
Constipation
Ingestion of excess sodium bicarb
Severe vomitting
Diuretics causing potassium depletion
102
How can constipation cause metabolic alkalosis?
Stool usually removes bicarb
103
How can vomitting cause metabolic alkalosis?
you lose too much acid
104
Breathing pattern of respiratory alkalosis
INCREASED breathing
105
Breathing pattern of respiratory acidosis
DECREASED breathing
106
How do you monitor for acidosis and alkalosis
monitor ABG (arterial blood gas)
107
Acidosis signs and symptoms
increased HR, arrhythmia, SOB due to rapid deep breathing, coughing, confusion, lethargy, CNS depression, coma
108
Prototype drug for treating metabolic acidosis
sodium bicarbonate
109
Sodium bicarbonate mechanism of action
raises pH of body fluids
110
Primary use of sodium bicarbonate
to correct metabolic acidosis
111
Adverse effects of sodium bicarbonate
metabolic alkalosis caused by removing too much bicarbonate ion
hypokalemia
112
Rapid/deep breathing is referred to as:
Kussmaul respiration
113
Metabolic alkalosis signs and symptoms
slow shallow breathing, nervousness, HYPERactive reflexes, convulsion, dysrhythmias
114
Prototype drug to treat metabolic alkalosis
ammonium chloride
115
Ammonium chloride mechanism of action
to decrease pH of body fluids by making more H+ ion
| NH4CL -> NH3 + HCL
116
Primary use of ammonium chloride
to reverse severe metabolic alkalosis
117
Adverse effect of ammonium chloride
possible acidosis
118
When is ammonium chloride contraindicated?
In patients with liver failure
119
When is hypertonic IV solution used?
brain aneurism or swelling of an organ
120
When is hypotonic solution used
if patient is dehydrated (cells need fluid)
be sure to check BP first
121
If BP is low you do not want to give what type of solution?
hypotonic
122
Why do kidney failure patients look puffy?
Because they cannot produce urine
123
Kidney failure usually leads to metabolic....
acidosis
124
Normal range of GFR
100-130
125
What should you do if patient has kidney failure and doctor orders CT scan?
Do not administer CT contrast in pt with GFR of less than 50
126
Complications of chronic renal failure
HYPERvolemia: fluid imbalance because patients cant make urine, which leads to urine retention
HYPERvolemia: fluid imbalance because patients cant make urine, which leads to urine retention
HYPOcalcemia: patients can't release calcitrol make by kidneys to absorb calcium
Anemia: kidneys can't make erythropoietin to stimulate RBC
