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Nursing N368 Pharmacology I > N368 Final Fluids and Electrolytes > Flashcards

N368 Final Fluids and Electrolytes Flashcards

1
Q

The most important regulator of fluid is:

A

thirst

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2
Q

Thirst center is located in:

A

the hypothalmus

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3
Q

What are the primary regular of fluid output?

A

kidneys

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4
Q

Mechanisms that influence fluid output

A

Renin-angiotensin-system
Aldosterone
Antidiuretic hormone

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5
Q

Aldosterone causes the conservation of:

A

sodium, and excretion of potassium

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6
Q

Increased sodium leads to…

A

increased water and increased BP

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7
Q

Drugs that interfere with aldosterone production are used as:

A

antihypertensives

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8
Q

Osmolality

A

absolute concentration of osmotic solution

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9
Q

Greatest contributor of osmolality is:

A

sodium

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10
Q

Sodium controlled by the hormone

A

aldosterone

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11
Q

Tonicity

A

relative concentration of intravenous fluid

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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

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13
Q

Hypertonic IV fluids

A

Water moves from interstitial space to plasma

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14
Q

What is hypertonic IV fluids used to relieve?

A

cellular edema, especially cerebral edema

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15
Q

Hypotonic intravenous fluid

A

Water moves from plasma to interstitial space

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16
Q

Hypotonic is used to treat

A

dehydration when BP is normal

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17
Q

Fluid deficit can cause

A

dehydration or shock

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18
Q

Fluid deficit can be treated with

A

oral or intravenous fluids

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19
Q

Fluid excess can be treated with

A

diuretics

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20
Q

When replacing fluids and electrolytes you use:

A

crystalloids and colloids

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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

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22
Q

Examples of volume loss due to transfer of fluid into third space

A

kidney failure and liver failure

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23
Q

Examples of volume loss due to lack of fluid volume

A

NAME?

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24
Q

Treatment of volume loss due to transfer of fluid into third space

A

Crystalloids as first drug of choice

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25
Q

Treatment of volume loss due to transfer of fluid into third space

A

Colloids

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26
Q

Colloid helps reduce:

A

3rd space accumulation, reduces volume loss in intravascular space

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27
Q

How are crystalloids different from colloids?

A

Crystalloids are capable of leaving plasma and moving to interstitial spaces and intracellular fluid

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28
Q

Types of crystalloids

A

Isotonic
Hypertonic
Hypotonic

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29
Q

Crystalloids primary use

A

to replace fluids and promote urine output

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30
Q

What type of crystalloid is used to treat dehydration with LOW BP?

A

Isotonic solution (ex. normal saline, because the priority is to treat the low BP)

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31
Q

What type crystalloid is used to treat dehydration with NORMAL BP?

A

Hypotonic solution

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32
Q

What type of crystalloid is used to treat hypernatremia with cellular dehydration?

A

Hypotonic solution

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33
Q

Colloid molecules

A

large molecule solutes so they cannot easily cross capillary membrane

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34
Q

Colloid mechanism of action

A

draw water from intracellular fluid and interstitial spaces into plasma

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35
Q

What do colloids do?

A

NAME?

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36
Q

Colloid primary use

A

fluid replacement with hypovolemic shock from hemorrhage, surgery, severe burns

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37
Q

Adverse effects of colloids

A

Hypersensitivity reactions
Fluid overload
Hypertension

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38
Q

Nursing considerations when using colloids

A

Monitor fluid volume status
Assess neurological status and urinary output
Teach client to report hypersensitivity or fluid volume overload

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39
Q

Electrolytes are essential to:

A

nerve conduction, membrane permeability, water balance, and other critical body functions

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40
Q

Major electrolytes

A 
Calcium 
Magnesium
Phosphate
Potassium
Sodium
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41
Q

What stimulates adrenal gland which releases aldosterone?

A

Lack of sodium of increase of potassium

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42
Q

What happens when aldosterone increases sodium re absorption?

A

Increase in potassium excretion so increase in sodium in plasma

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43
Q

What is considered hypernatremia?

A

Sodium level above 145 mEq/L

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44
Q

What is the most common cause of hypernatremia?

A

kidney disease

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45
Q

Normovolemic hypernatremia

A

Caused by excessive sodium intake, no water changes

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46
Q

Hypervolemic hypernatremia

A

Caused by decreased excretion (ex. kidney disease)

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47
Q

Hypovolemic hypernatremia

A

Caused by high net-water loss

not enough water intake or excessive water loss due to diarrhea, fever, burns, ect.

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48
Q

Signs and symptoms of hypernatremia

A

THIRST, fatigue, muscle twitching

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49
Q

Treatment of hypernatremia caused by excessive sodium intake

A

Low salt diet

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50
Q

Treatment of hypernatremia due to dehydration

hypovolemic hypernatremia

A

give hypotonic solution

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51
Q

Treatment of hypernatremia due to kidney failure

hypervolemic hypernatremia

A

give diuretics

52
Q

What is considered hyponatremia?

A

Sodium level below 135 mEq/L

53
Q

Causes of hyponatremia

54
Q

Examples of hyponatremia caused by excessive sodium loss

A

Vomiting, diarrhea, GI suctioning, diuretic use, sweat

55
Q

Examples of hyponatremia caused by excessive dilution of plasma

A

Excessive ADH secretion

Excessive administration of hypotonic IV solution

56
Q

How does ADH cause concentration of urine

A

b/c it causes water to be retained into the body, too much ADH can cause fluid retention

57
Q

Treatment of hyponatremia caused by excessive dilution

A

loop diuretics to cause isotonic diuresis

58
Q

Treatment of hyponatremia caused by sodium loss

A

oral sodium chloride or IV fluids containing salt

  • Normal saline
  • Lactated ringers
59
Q

Sodium replacement prototype drug

A

Sodium chloride

60
Q

Primary use of sodium replacement (sodium chloride)

A

to treat hyponatremia when serum level falls below 130 mEq/L

61
Q

Adverse effects of sodium replacement therapy

A

hypernatremia and pulmonary edema

62
Q

Sodium effect vs potassium effect

A

Sodium effects water, potassium effects muscle (heart)

63
Q

Potassium effects…

A

muscle contractility

64
Q

What is the most abundant intracellular cation?

65
Q

Potassium is essential for:

A

proper nerve functioning and maintaining acid-base balance

66
Q

How is potassium influenced by aldosterone?

A

For each sodium ion reabsorbed, one potassium ion is secreted into renal tubules

67
Q

Fatal imbalances of potassium are usually a result of:

A

cardiac toxicity

68
Q

Normal range of potassium

A

3.5-5 mEq/L

69
Q

What constitutes hyperkalemia?

A

Potassium above 5 mEq/L

70
Q

Causes of hyperkalemia

71
Q

Hyperkalemia due to decreased excretion is usually caused by

A

renal disease

72
Q

Hyperkalemia does what to cell excitation?

A

increases cell excitation

73
Q

Serious signs/symptoms of hyperkalemia

A

dysrhythmias and heart block/bradycardia with alternation of ventricular fibrillation and cardiac arrest

74
Q

Early phase symptoms of hyperkalemia

A

muscle twitching, fatigue, parasthesias, cramping

75
Q

Treatment of hyperkalemia

76
Q

How does kayexalate and sorbitol treat hyperkalemia?

A

Laxatives excrete potassium in stool

77
Q

How does administering glucose and insulin treat hyperkalemia?

A

helps move potassium into the cell by activating the potassium sodium pump, potassium going into the cell decreases the serum level

78
Q

How does administering calcium treat hyperkalemia?

A

to counter act the potassium toxicity on the heart

79
Q

What is considered hypokalemia?

A

Potassium level below 3.5 mEq/L

80
Q

Hypokalemia is caused by

81
Q

Examples of hypokalemia caused by excessive loss of potassium

82
Q

Signs and symptoms of hypokalemia

83
Q

Treatment of mild hypokalemia

A

increase dietary intake

84
Q

Treatment of severe hypokalemia

A

give oral supplements or parenteral potassium supplements

85
Q

Nursing consideration when taking oral potassium

A

take with glass of milk to avoid GI irritation

86
Q

Potassium replacement therapy prototype drug

A

potassium chloride

87
Q

Potassium replacement mechanism of action

A

electrolyte/potassium supplement

88
Q

When is potassium replacement therapy contraindicated?

89
Q

Potassium should be closely monitored when used with:

90
Q

High pH is…

A

alkalosis

pH above 7.45

91
Q

Low pH is…

A

acidosis

pH below 7.35

92
Q

Normal pH

93
Q

Two main buffering systems to help maintain normal pH

A

Bicarbonate ions and phosphate ions

94
Q

Carbonic acid

95
Q

Acid removal mechanism

A

CO2 is removed by lungs during exhalation

Acid metabolites are removed by kidney in form of hydrogen ion by excreting urine

96
Q

How is respiratory acidosis caused by narcotic OD

A

Narcotic overdose damages brain respiratory center, breathing rate goes down, cant remove enough CO2

97
Q

Causes of metabolic acidosis

A 
Severe diarrhea
Kidney failure: H+ not removed
Diabetes
Excess alcohol ingestion 
Starvation
98
Q

How can diarrhea cause metabolic acidosis

A

Stool usually has bicarbonate in it, if you lose all bicarbonate you are much more likely to has acidosis

99
Q

Causes of respiratory alkalosis

A

Hyperventilation, anxiety, high altitude

100
Q

How can anxiety cause respiratory alkalosis

A

Panic attack causes too much loss of CO2 (acid)

101
Q

Causes of metabolic alkalosis

A

Constipation
Ingestion of excess sodium bicarb
Severe vomitting
Diuretics causing potassium depletion

102
Q

How can constipation cause metabolic alkalosis?

A

Stool usually removes bicarb

103
Q

How can vomitting cause metabolic alkalosis?

A

you lose too much acid

104
Q

Breathing pattern of respiratory alkalosis

A

INCREASED breathing

105
Q

Breathing pattern of respiratory acidosis

A

DECREASED breathing

106
Q

How do you monitor for acidosis and alkalosis

A

monitor ABG (arterial blood gas)

107
Q

Acidosis signs and symptoms

A

increased HR, arrhythmia, SOB due to rapid deep breathing, coughing, confusion, lethargy, CNS depression, coma

108
Q

Prototype drug for treating metabolic acidosis

A

sodium bicarbonate

109
Q

Sodium bicarbonate mechanism of action

A

raises pH of body fluids

110
Q

Primary use of sodium bicarbonate

A

to correct metabolic acidosis

111
Q

Adverse effects of sodium bicarbonate

A

metabolic alkalosis caused by removing too much bicarbonate ion
hypokalemia

112
Q

Rapid/deep breathing is referred to as:

A

Kussmaul respiration

113
Q

Metabolic alkalosis signs and symptoms

A

slow shallow breathing, nervousness, HYPERactive reflexes, convulsion, dysrhythmias

114
Q

Prototype drug to treat metabolic alkalosis

A

ammonium chloride

115
Q

Ammonium chloride mechanism of action

A

to decrease pH of body fluids by making more H+ ion

NH4CL -> NH3 + HCL

116
Q

Primary use of ammonium chloride

A

to reverse severe metabolic alkalosis

117
Q

Adverse effect of ammonium chloride

A

possible acidosis

118
Q

When is ammonium chloride contraindicated?

A

In patients with liver failure

119
Q

When is hypertonic IV solution used?

A

brain aneurism or swelling of an organ

120
Q

When is hypotonic solution used

A

if patient is dehydrated (cells need fluid)

be sure to check BP first

121
Q

If BP is low you do not want to give what type of solution?

122
Q

Why do kidney failure patients look puffy?

A

Because they cannot produce urine

123
Q

Kidney failure usually leads to metabolic….

124
Q

Normal range of GFR

125
Q

What should you do if patient has kidney failure and doctor orders CT scan?

A

Do not administer CT contrast in pt with GFR of less than 50

126
Q

Complications of chronic renal failure

A

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

Nursing N368 Pharmacology I (16 decks)

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