NUR 118 - WEEK 11 - ELECTROLYTES

Question 1

LECTURE OBJECTIVE

Distinguish between intracellular, extracellular (interstitial, intravascular), and transcellular body fluid​

Answer 1

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.

Question 2

Composition of Body Fluids

Answer 2

Intracellular electrolytes: K+, Mg+, Phosphate -

Extracellular electrolytes: Na+, Cl-, bicarbonate -

Question 3

LECTURE OBJECTIVE

Explain osmosis, diffusion​, filtration and active transport

Answer 3

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

Question 4

Body make up of Fluid
Recommended water intake

Answer 4

80% from fluids
20% from food

Women 2700 mL/day​
Men 3700 mL/day​
Older adults 1500 – 2000 mL/day​

Question 5

LECTURE OBJECTIVE

List 10 signs and symptoms of need for fluids​

Answer 5

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

Question 6

LECTURE OBJECTIVE

Explain role of antidiuretic hormone (ADH) in regulation of fluid balance​

Answer 6

ADH (Anti-Diuretic Hormone) : Released by pituitary gland

Low fluid volume - ADH released to HOLD onto water
High fluid volume - inhibits release of ADH

Question 7

Renin-Angiotensin System

Answer 7

If low fluid volume, kidneys release renin which = release of Angiotensin II
Angiotensin II = kidneys hold on to water and sodium, increase blood pressure

Question 9

Labs for Fluid/Electrolytes

Answer 9

CBC: Fluid decrease, hematocrit increased; and vice versa

Serum electrolytes: 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

Question 10

LECTURE OBJECTIVE

Describe & identify hypovolemia
signs & symptoms

Answer 10

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:

Question 11

LECTURE OBJECTIVE

Nursing interventions for Hypovolemia

Answer 11

Correct fluid volume status
- IVF: Isotonic - 0.9% normal saline
Identify and treat cause (i.e. vomiting/diarrhea)
Monitor VS and consciousness
Daily weights
Monitor intake / output

Question 12

What do we give to hypovolemic patients?

Answer 12

IVF: Isotonic 0.9% normal saline

Question 13

LECTURE OBJECTIVE

Vital signs associated with Hypovolemia

Answer 13

Weak, thready pulse​
Tachycardia​
Tachypnea​
Hypotension​
Elevated Temperature

Question 14

LECTURE OBJECTIVE

Describe & identify hypervolemia
signs & symptoms, and nursing interventions​

Answer 14

Hypervolemia: Excess fluid in intravascular space

s/s:
Edema
Weight gain
Jugular Vein Distention
labs: BUN, HCT, Urine specific gravity decreases

Question 15

LECTURE OBJECTIVE

Vital signs associated with Hypervolemia

Answer 15

Bounding pulse​
Hypertension​
^ RR rate

Question 16

LECTURE OBJECTIVE

Nursing interventions for increasing fluid intake and restricting fluid intake​

Answer 16

Correct fluid volume status (diuretic)
ID and treat root cause
Elevate legs
Diet:
Decrease Na+
Fluid restriction

Question 17

LECTURE OBJECTIVE

Distinguish between isotonic, hypotonic, and hypertonic intravenous solutions​

Answer 17

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

Question 18

LECTURE OBJECTIVE

Know normal values, signs & symptoms of excess values and signs of symptoms of deficient values of the following electrolytes:​ Sodium, potassium, calcium, magnesium

Answer 18

Sodium: 135-145 mEq/L
Potassium
Calcium
Magnesium

Answer 19

Sodium: 135-145 mEq/L
Potassium
Calcium
Magnesium

Hyponatremia s/s:
Altered mental status (Confusion, disorientation)
Weakness
Lethargy, muscle cramps
Seizures

Treatment:

Question 20

Hypernatremia

Answer 20

Na+ > 145

s/s:
Thirst, dry mouth
Increased temp

Question 21

Hypokalemia

Answer 21

K+ < 3.5

s/s:
Dysrhythmias
Muscle weakness

Treatment:
Foods high in potassium

Question 22

Hyperklemia

Answer 22

Causes:
Renal failure
Potassium sparing diuretics

s/s:
Dysrhythmia
Muscle Weakness

Treatment
Monitor I/O
Caution of potassium rich food intake

Question 23

Hypercalcemia

Answer 23

Cause:
Prolonged immobilization

s/s:
ANV
Muscle weakness

Question 24

Fluid Restriction: Patient teaching

Answer 24

Reserve liquids for BETWEEN meals, not during
Offer Ice chips
Bring liquids in for medications then take away
DO NOT leave liquids at bedside

Question 25

What is the preferred method of fluids?
What would we do the alternate?

Answer 25

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