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3910 Health Promotion & Caring: Client's with Health Challenges I > Week 1 Fluid Electrolyte Balance > Flashcards

Week 1 Fluid Electrolyte Balance Flashcards

1
Q

Hypervolemia

A
  • Too much fluid
  • Fluid volume overload
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2
Q

Hypovolemia

A
  • Too little fluid
  • Fluid volume deficit
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3
Q

Edema

A
  • Excess fluid in interstitial space
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4
Q

Osmosis

A
  • Movement of water
  • High concentration to low concentration
  • Across semi-permeable membrane
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5
Q

Diffusion

A
  • Movement of particles
  • High concentration to low concentration
  • Electrolytes require active (facilitated) diffusion - ion pumps
  • Across semi-permeable membrane
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6
Q

Filtration

A
  • Movement of fluid through cell/vessel membrane
  • Hydrostatic pressure differences
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7
Q

Hydrostatic Pressure

A
  • Pressing of water molecules outwards from confined space
  • High pressure to low pressure
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8
Q

Angiotensin II Function

A
  • Vasoconstriction
  • Stimulate thirst
    Stimulate aldosterone to retain water & sodium
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9
Q

Atrial Natriuretic Peptide (ANP)

A
  • Inhibits RAAS when in a state of overdrive
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10
Q

Hypovolemia Causes

A
  • Insufficient intake
  • Excessive loss
  • Fluid shifts in body
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11
Q

Intravascular Space Deficit

A
  • Difficulty perfusing body
  • Systems activate to raise BP
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12
Q

Hypervolemia Causes

A
  • Excessive intake
  • Abnormal retention - kidney/heart failure
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13
Q

Intravascular Space Overload

A
  • Raise BP
  • Stress on systems
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14
Q

Cardiovascular Hypovolemia Findings

A
  • Increased HR
  • Thready pulse
  • Decreased BP - orthostatic hypotension
  • Flat veins
  • Dysrhythmias
  • Decreased peripheral pulses
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15
Q

Respiratory Hypovolemia Findings

A
  • Increased RR
  • Dyspnea
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16
Q

Neuromuscular Hypovolemia Findings

A
  • Confusion
  • Dizziness, weakness, lethargy
  • Decreased LOC - coma
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17
Q

Integumentary Hypovolemia Findings

A
  • Dry mouth
  • Poor skin turgor - tearing
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18
Q

GI Hypovolemia Findings

A
  • Decreased bowel sounds & motility
  • Constipation
  • Weight loss
  • Thirst
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19
Q

Cardiovascular Hypervolemia Findings

A
  • Increased HR
  • Bounding pulse
  • Increased BP
  • Distended veins
  • Dysrhythmias
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20
Q

Respiratory Hypervolemia Findings

A
  • Increased RR
  • Dyspnea
  • Crackles on auscultation
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21
Q

Neuromuscular Hypervolemia Findings

A
  • Confusion
  • Headache
  • Decreased LOC - coma
  • Muscle spasms (electrolytes)
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22
Q

Integumentary Hypervolemia Findings

A
  • Cool, pale skin
  • Edema
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23
Q

GI Hypervolemia Findings

A
  • Increased bowel sounds & motility
  • Diarrhea
  • Weight gain
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24
Q

Nursing Management: Fluid Deficit

A
  1. Correct underlying cause of deficit
  2. Replace fluids & electrolytes
  3. Prevent & assess inadequate perfusion
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25
Q

Nursing Management: Fluid Overload

A
  1. Prevention in at-risk clients
  2. Correct underlying cause
  3. Limit sodium/fluid intake
  4. Administer diuretics
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26
Q

Furosemide (Lasix) Action

A
  • Increases renal excretion
  • Mobilize excess fluid
  • Decreases BP
27
Q

Furosemide (Lasix) Side Effects

A
  • Dizziness
  • Headache
  • Hypotension
  • Electrolyte imbalance
28
Q

Furosemide (Lasix) Nursing Considerations

A
  • Fall risk of older clients
  • Electrolyte imbalance
  • Pre-existing kidney function & impact
  • Monitor weight
  • Avoid taking at night nocturnal urination disrupts sleep
29
Q

Shock Causes

A
  • Hypovolemic - hemorrhage
  • Cardiogenic - myocardial infarction
  • Distributive
  • Neurogenic - spinal cord injury
  • Anaphylactic - severe allergic reaction
  • Septic - systemic infection
30
Q

Compensatory Shock Symptoms

A
  • Normal BP
  • Increased HR & RR
  • Blood shunting to vital organs
  • Pale skin
  • Hypoactive bowel sounds
  • Decrease urine output
  • Confusion
31
Q

Progressive Shock Symptoms

A
  • Decrease BP
  • Decrease LOC
32
Q

Healthy Tissue Perfusion

A

MAP - 70 to 100 mmHg

33
Q

Hypovolemic Shock

A
  • Decreased intravascular fluid volume
  • External fluid losses
  • Fluid shifts between intravascular & interstitial compartments (internal fluid losses)
34
Q

Nursing Management: Hypovolemic Shock

A
  • Call for help
  • Notify MPR
  • Position client in modified Trendelenburg
  • Administer IV fluids, meds, blood products - according to provider orders
  • Apply oxygen
35
Q

Trendelenburg Position

A
  • Head of bed down
  • Blood moves to brain with less gravity
  • Head of bed up - less gravity restricting breath, increases breath quality
36
Q

Potassium K+

A
  • 3.5-5mmol/L
  • Intercellular electrolyte
  • Maintains heart & muscle contraction
37
Q

Hypokalemia

A
  • <3.5mmol/L
  • Not consuming enough K
  • Loss (vomit, GI suction, sweat)
  • Medications that move K (diuretics, insulin (K+ move into cell)
38
Q

Hyperkalemia

A
  • > 5.0
  • Excessive intake
  • Renal failure
  • Medications that retain (ACE inhibitors, sparing diuretics, NSAIDs)
39
Q

Hypokalemia Symptoms (7 L’s)

A
  • Low BP & HR
  • Lethargy
  • Low shallow respirations (decreased ability to use accessory muscles)
  • Lethal cardiac dysrhythmias (ST depression, shallow T wave, projecting U wave)
  • Lots of urine
  • Leg cramps
  • Limp muscles (decrease deep tendon reflexes)
40
Q

Hyperkalemia Symptoms

A
  • Weak pulse, low HR
  • Muscle twitches, cramping
  • Resp failure
  • Peaked T waves
  • Prolonged PR interval
41
Q

Hypokalemia Interventions

A
  • Supplement K
  • IV admin, high alert, administer slow (NO PUSH)
  • Falls prevention
  • Cardiac monitoring
42
Q

Hyperkalemia Interventions

A
  • Meds to lower potassium & support cardiac health (insulin, diuretics)
  • Falls prevention
  • Cardiac monitoring
43
Q

Sodium Na+

A
  • 135-145mmol/L
  • Extracellular electrolyte
  • Regulates water inside & outside cells
44
Q

Hyponatremia Causes

A
  • <135mmol/L
  • Not consuming enough Na
  • Hypovolemic - excessive losses, diuretics, vomiting, sweating
  • Hypervolemic - excess fluid dilutes sodium
  • Decrease serum osmolality
  • Cells swell as water moves in
45
Q

Hypernatremia Causes

A
  • Overconsumption
  • Syndromes that causes high cortisol/aldosterone = retain Na
  • Water loss
  • Increase serum osmolality
  • Cellular dehydration
46
Q

Hyponatremia Impact on CNS - SALT LOSS

A
  • Seizures & stupor (decreased LOC, confusion)
  • Abdominal cramping
  • Lethargic
  • Tendon reflexes diminished - trouble concentrating
  • Loss of urine & appetite
  • Orthostatic hypotension, overactive bowel sounds
  • Shallow respirations
  • Spasms of muscles
  • Hypertension
47
Q

Hypernatremia Impact on CNS - no FRIED foods for you

A
  • Fatigue
  • Restless, agitated, confused
  • Increased reflexes
  • Extreme thirst
  • Decreased urine output, dry mouth/skin
  • Tachycardia/hypotension
48
Q

Hyponatremia Interventions

A
  • Isotonic (non-severe)
  • Na+ fluids <120
  • Normal/excess fluids: meds (diuretics promote water loss)
49
Q

Hypernatremia Interventions

A
  • Health teaching - Na restricted diet
  • Administer IV infusion - volume loss (hypotonic/isotonic)
  • Meds (diuretics promote Na loss - loop)
50
Q

Chloride Cl-

A
  • 95-105mEq/L
  • Blood pressure & volume maintenance
  • pH balance
  • Goes with Na, Na low = Cl low
51
Q

Magnesium Mg2+

A
  • 1.6-2.6mg/dL
  • Neuromuscular contractility
52
Q

Calcium Ca2+

A
  • 4.5-5.5 mEq/L
  • Neuromuscular contractility
  • Coagulation
  • Bone health
53
Q

Phosphate P

A
  • 1.9-2.6mEq/L
  • Bone & teeth health
  • Muscle & RBC function
  • Inverse relation to Ca, Ca high = P low
54
Q

Vascular Access Device Selection

A
  • Duration: PIV (short) CVAD (long)
  • Patency: PIV more risk for loss of patency
  • History of vascular access & comorbidities: difficult prior access, skin, vessels
  • Types of therapy: vesicant/irritants, pH
  • Patients preference
  • Always select smallest gauge (22 for PIV) & minimum # of lumens
55
Q

PIV Selection

A
  • Access to upper extremity
  • Short term therapy <7 days
  • Monitor for repeated failed/loss access
56
Q

CVAD Selection

A
  • PIV access unavailable
  • Long term therapy
  • Suitable for vesicant/irritant medications/nutrition
57
Q

CVAD Access

A
  • Large vein central circulation system
  • Tip of catheter sits in superior vena cava
  • Inserted by HCP with specialized knowledge
  • Ultrasound guided technique
58
Q

Common CVADs

A
  • PICC
  • Non tunneled
  • Tunneled
  • Implanted
59
Q

PICC

A
  • Enters body on upper arm
  • Catheter runs to superior vena cava
  • Very common in clinical settings
  • RNs can insert & remove
  • Medium term use
60
Q

Non-Tunneled CVAD

A
  • Enters body at vessel site (internal/external jugular, subclavian, femoral)
  • Catheter outside body at injection site
  • Common in critical care (shorter term)
61
Q

Tunneled CVAD

A
  • Hickman or broviac
  • Proximal end tunneled subcutaneously from insertion site & brought out through skin at exit site
  • Antimicrobial cuff
  • Long term use
62
Q

CVAD Infections

A
  • High risk for sepsis
  • PPE
  • Anti-microbials
63
Q

VAD Insertion

A
  • All can cause phlebitis at insertion site
  • Skin assessment

3910 Health Promotion & Caring: Client's with Health Challenges I (5 decks)

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