NUR 118 - WEEK 11 - ELECTROLYTES Flashcards
LECTURE OBJECTIVE
Distinguish between intracellular, extracellular (interstitial, intravascular), and transcellular body fluid
Intracellular (ICF) - Inside Cell (about 40% bodyweight)
Extracellular (ECF) - Outside Cells
- Interstitial: In tissues between cells and blood vessels
- Intravascular: In blood vessels
Transcellular - Specialized fluids in respective body spaces
Ex: Cerebrospinal, pleural, synovial fluid, etc.
Composition of Body Fluids
Intracellular electrolytes: K+, Mg+, Phosphate -
Extracellular electrolytes: Na+, Cl-, bicarbonate -
LECTURE OBJECTIVE
Explain osmosis, diffusion, filtration and active transport
Osmosis - Movement of water across membrane from lower concentration (of solutes) to higher concentration (of solutes)
Diffusion -Movement of molecules of a solute from area of higher concentration to lower concentration
Filtration - Movement of water and small particles from area of high pressure to area of low pressure
Active Transport - Movement of electrolytes from LOW concentration to HIGH concentration; requires energy (ATP) for movement to occur
Body make up of Fluid
Recommended water intake
80% from fluids
20% from food
Women 2700 mL/day
Men 3700 mL/day
Older adults 1500 – 2000 mL/day
LECTURE OBJECTIVE
List 10 signs and symptoms of need for fluids
THIRST
Headache
Fatigue
Concentrated and decreased urine
Weight loss
Increased heart rate and low blood pressure
Dry mouth and eyes
Constipation
Lack of coordination
Muscle cramps
Weakness, trembling, lack of mental clarity d/t extreme dehydration
LECTURE OBJECTIVE
Explain role of antidiuretic hormone (ADH) in regulation of fluid balance
ADH (Anti-Diuretic Hormone) : Released by pituitary gland
Low fluid volume - ADH released to HOLD onto water
High fluid volume - prevents release of ADH
Renin-Angiotensin System
If low fluid volume, kidneys release renin which = release of Angiotensin II
Angiotensin II = kidneys hold on to water and sodium, increase blood pressure
Labs for Fluid/Electrolytes
CBC: Fluid decrease, hematocrit increased; and vice versa
Serum electrolytes (included in CMP): Sodium, potassium, chloride, bicarbonate
Urinalysis: Fluid decrease = more acidic urine; urine pH normally = 5.0 to 9.0
- Specific gravity increases when fluid decreases; and vice versa
LECTURE OBJECTIVE
Describe & identify hypovolemia
s/s
interventions
Hypovolemia - Fluid deficit
Causes:
Inadequate fluid intake
Fluid loss
Increased metabolic rate: fever, infection
s/s:
Thirst
Dry mucus membranes
Weakness, dizziness
Poor skin turgor
labs: Increased hematocrit, increased urine specific gravity, elevated BUN, increased Na+ > 145
Interventions:
Correct fluid volume status (IVF, encourage fluid intake)
Identify/treat cause (vomiting, diarrhea)
Monitor vs & loc (level of consciousness)
What do we give to hypovolemic patients?
IVF: Isotonic 0.9% normal saline
LECTURE OBJECTIVE
Nursing interventions for Hypervolemia
Correct fluid volume status
Monitor VS and IO
Monitor Weight
Medications: Diuretics
Diet: Decrease Na+, fluid restriction
LECTURE OBJECTIVE
Vital signs associated with Hypovolemia
Weak, thready pulse
Tachycardia
Tachypnea
Hypotension
Elevated Temperature
LECTURE OBJECTIVE
Describe & identify hypervolemia
signs & symptoms, and nursing interventions
Hypervolemia: Excess fluid in intravascular space
s/s:
Edema
Weight gain
Jugular Vein Distention
labs: BUN, HCT, Urine specific gravity decreases
LECTURE OBJECTIVE
Vital signs associated with Hypervolemia
Bounding pulse
Hypertension
^ RR rate
LECTURE OBJECTIVE
Distinguish between isotonic, hypotonic, hypertonic and colloid intravenous solutions
Crystalloids:
Isotonic - Same osmolarity of body fluids; stays intravascularly
- For dehydrated patients
Hypotonic - Lower osmolarity than body fluids; goes into the cells, may cause lysis
Hypertonic - Higher osmolarity than body fluids
Colloids:
Stays in vascular and increase osmotic pressure
- Packed RBCs
- Albumin
- Plasma
LECTURE OBJETIVE
Normal electrolyte levels/range
Sodium
Calcium
Potassium
Magnesium
SCPM (Scoop ‘em)
Sodium: 135-145 mEq/L
Calcium 8.5 – 10.5 mg/dL
Potassium 3.5 – 5.0 mEq/L
Magnesium 1.6 – 2.1 mEq/L
Hyponatremia
s/s
Na+ < 135
s/s:
Altered mental status (Confusion, disorientation)
Weakness
Lethargy, muscle cramps
Seizures
-salt excess/deficit = altered mental status
Hypernatremia
Na+ > 145
s/s:
Thirst, dry mouth
Increased temp
Hypokalemia
K+ < 3.5
s/s:
Dysrhythmias
Muscle weakness
Treatment:
Foods high in potassium
- Potassium = dysrhythmia & muscle weakness
Hyperkalemia:
Causes
s/s
Treatment
K+ > 5.0 mEq/mL
Causes:
Renal failure
Potassium sparing diuretics
s/s:
Dysrhythmia
Muscle Weakness
Flaccid paralysis
Potassium = Dysrhythmia & Muscle weakness
Hypocalcemia
s/s
Ca2 < 8.5
s/s:
muscle cramps
tetany
seizure
cardiac irritability
Positive Trousseau’s sign
-hand/wrist spasms
Positive Chvostek’s sign
- facial spasms (Chvostek = cheek)
Calcium = muscle & Cardiac
Hypercalcemia:
Cause
s/s
Ca2 > 10.5
Cause:
Prolonged immobilization
s/s:
ANV (anticipatory nausea and vomiting)
Muscle weakness
Bradycardia
Constipation
Calcium = Muscle & Cardiac
Hypomagnesemia
level
s/s
Mg2 < 1.3
s/s:
Neuromuscular irritability
dysrhythmias
Disorientation
Sensitivity to digoxin
Magnesium = neuromuscular & cardiac
Hypermagnesemia
Level
s/s
Mg2 > 2.1
s/s:
Hypoactive reflexes
bradycardia
flushing/warmth of skin
Hypotension
Drowsiness, lethargy
Fluid Restriction: Patient teaching
Reserve liquids for BETWEEN meals, not during
Offer Ice chips
Bring liquids in for medications then take away
DO NOT leave liquids at bedside
What is the preferred method of fluids?
What would we do the alternate?
Preferred: Enteral
Parenteral (IV):
-To supply fluids when clients are unable to take in an adequate volume of fluids by mouth.
-To provide a route for medications.
-To provide route for electrolytes
-To provide route for nutrition
-To provide access for blood transfusions and to obtain blood sampling
