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NURS2500 Patho/Pharma > Week 5: Fluid and Electrolytes > Flashcards

Week 5: Fluid and Electrolytes Flashcards

1
Q

what are some concepts that connect to fluid and electrolytes?

A

nutrition
mobility
hormonal regulation
cognition
perfusion
gas exchange (with perfusion as well)
acid-base balance
elimination

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2
Q

in previous courses, how did homeostasis connect to fluid and electrolyte balance

A
  • homeostatic mechanisms are in place to maintain optimal fluid balance in a variety of conditions

ex. normal intake - normal output
decreased intake - decreased output
increased intake - increased output

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3
Q

what are the three components that are connected to fluid or water

A

plasma in our blood vessels aka vascular space
interstitial space: fluid in the space BETWEEN cells
intracellular space: fluid in the space INSIDE the cells

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4
Q

which compartments of fluid has the least amount? the most?

A

least: plasma
most: intracellular

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5
Q

which two electrolytes do we need to know?

A

sodium Na+ and Potassium K+

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6
Q

which electrolyte is more prominent in the plasma?

A

Na+

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7
Q

which electrolyte is more prominent in the intracellular?

A

K+

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8
Q

true or false: When we draw labs, we can only measure the concentrations of these electrolytes IN the blood, not inside the cells

A

true

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9
Q

when looking at a lab value, what does normal range of hemoglobin and hematocrit mean?

A

shows optimal levels of body water present in the blood

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10
Q

what is hemodilution an indicator of?

A

over hydration, too much fluid in the vascular space (plasma)

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11
Q

hemodilution: what would your labs show up as?

A

low (not as much salts), increase in fluid in blood, lymph and vascular space

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12
Q

hemoconcentration: what would your labs show up as?

A

high!!, fluid value is low, too much solutes in blood, lymph and vascular space

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13
Q

true or false: When a gradient exists, water movement through membranes (filtration) occurs until the hydrostatic pressure is the same in both spaces

A

true

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14
Q

true or false: Water moves through the porous membrane (filters) from the space with higher hydrostatic pressure to the space with lower pressure.

A

true

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15
Q

is bp an example of hydrostatic filtering force?

A

yes it is

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16
Q

what is diffusion?

A

Diffusion is the movement of particles (solute) across a permeable membrane from an area of higher particle concentration to an area of lower particle concentration (down a concentration difference or “gradient”).

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17
Q

how can diffusion be used in clinical practice?

A

Diffusion transports most electrolytes and other particles through cell membranes.

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18
Q

what is the difference between cell membranes and capillary membranes?

A

Cell membranes - selective

capillary membranes - not selective

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19
Q

what is one example where diffusion can not help with clinical practice?

A

GLUCOSE

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20
Q

what is insensible water loss?

A

no mechanisms control it - water loss occurs through the skin, lungs, and intestinal tract, salivation, drainage from fistulas and drains, and GI suction.

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21
Q

why is aldosterone secreted?

A

what Na+ levels are low (water is low) and it works to help reabsorb water for the body

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22
Q

does Natriuretic peptides (NPs) create affects that are opposite to aldosterone?

A

yes

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23
Q

what is the main controller of the ECF potassium level?

A

sodium-potassium pump, found in all body cells.

This pump moves extra sodium ions from the ICF and moves extra potassium ions from the ECF back into the cell.

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24
Q

true or false: Kidney excretion of potassium is enhanced by aldosterone.

A

true

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25
Q

is osmolarity another word for plasma concentration?

A

yes

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26
Q

what it the value when water is deficit? what about when water excess?

A

deficit - more then 295
excess - less then 285

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27
Q

what are the ICF and the ECF normally?
a) hypertonic
b) isotonic
c) hypotonic

A

b)

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28
Q

what is hydrostatic pressure? what is oncotic pressure?

A

hydrostatic pressure: pressure against the vessel towards the tissue, essentially wants to push water out of the cell

oncotic pressure: pressure from the tissue to the vessel (bring it back to the vessel)

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29
Q
A
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30
Q

when there’s a high hydrostatic pressure and a low oncotic pressure, what can occur?

A

swelling, when hydrostatic pressure it pushing towards tissue, and the oncotic pressure is not matching - causes pressure on tissue = swelling

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31
Q

what specific part of the body regulates water balance (think brain)

A

the hypothalamus-pituitary gland

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32
Q

how does the hypothalamus pituitary gland work to regulate water?

A

contains hypothalamic osmoreceptors - these can detect ex. high osmolality (water loss, too much Na+) and the hypothalamus detects this!!

  • trigger thirst
  • ADH released by pituitary gland (kidney) - free water reabsorption (no Na+)
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33
Q

difference between ADH and aldosterone?

A

ADH directly increases how much water is reabsorbed, and aldosterone directly increases how much salt is absorbed (water as well)

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34
Q

how can ADH release be triggered?

A

increased plasma osmolality, stress, nausea, nicotine, and morphine

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35
Q

What is ADH?

A

antidiuretic hormone - kidneys reabsorb more water, NOT Na+. This dilutes our blood so the Na+ concentration drops

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36
Q

how does the GI regulate water?

A

intake: this is a source of new water to the body

output: diarrhea and vomit - excess water loss and electrolyte loss

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37
Q

how does Genitourinary regulate water?

A

OUTPUT: urine
renal excretion provides LARGEST output

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38
Q

what is insensible water loss

A

approx. 900 ml per day

water loss from breathing and insensible perspiration (water only)

Excessive sweating (sensible perspiration) may lead to excessive water and electrolyte loss (fever, hot environment)

Water used in metabolic proccesses (GI)

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39
Q

true or false: the trigger of thirst is increased in older adults

A

false; decreased

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40
Q

what are some age related considerations related to fluid and electrolytes?

A

there is an increased risk of imbalances

Reduced renal function
Reduced hormone regulation Reduced thirst trigger
Reduced temperature regulation
Impaired functional and cognitive ability may interfere with oral consumption of water

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41
Q

what are some nursing implementations with fluid and electrolytes?

A

1 intake and output: use a 24hr record of I&O

types of fluid intake - drinking. eating, IV’s, GI tubes
types of output - urine, vomit, diarrhea, sweat, breathing

Accurate daily weight estimates volume status
Rapid increase of 1 kg body weight approximates 1000 mL
(1 L) of fluid retention
Obtained under standardized conditions (same time every day, with the same clothes, same scale)

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42
Q

you have a patient that needs monitoring I&O and you decide to use daily weight measurements via the bed. Last night your patients was complaining that it was cold so you provided her with some blankets. Her average weight is 50 KG but when you measured her today she weighed 55kg via the bed. Would this rapid increase of approx. 5 ml of fluid be a emergency?

A

most likely not BECAUSE you never removed the blankets! always remember to use the same clothes for accurate measurements via bed

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43
Q

what are some examples of oral intake?

A

free water - tap water, no significant Na, provide water to dilute plasma Na, if not needed the kidneys will excrete excess water

Electrolyte-replacement beverages (sports drinks, Pedialyte) provide electrolytes commonly lost through sweat, vomiting, diarrhea as well as water

Food and other beverages – most food also contains water!!!

Caffeine beverages may result in increased urine output, can cause dehydration

When a patient cannot swallow fluids/foods – GI tube may be inserted down a nasal passage and into the stomach or small bowel – fluids/liquid food may be instilled through this tube (tube feeds)

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44
Q

what does a fluid volume deficit look like?

A

decrease intake - normal output (dehydration osmolarity is high)

intake - increased output (diarrhea, vomit)

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45
Q

what does a fluid volume excess look like?

A

excessive or rapid intake - output (too much water intake/food)

intake - decreased output (unwell kidney)

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46
Q

what is hypernatremia?

A

high levels of Na+ in the blood

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47
Q

what is hyponatremia?

A

low levels of Na+ in the blood

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48
Q

what is hypo/hyperaluminemia?

A

too low/high amounts of albumin(protein) in the blood

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49
Q

what is hypervolemia? what about hypovolemia?

A

hypervolemia: volume excess
hypovolemia: volume deficit

starts in vessels/blood - then to IF - then in the cells

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50
Q

true or false: Na, Protein and Glucose are all osmotically active and influence the movement of water between compartments (osmotic pressure)

A

true

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51
Q

what are the three levels of fluid spacing?

A

First spacing: normal ICF ECF
Second spacing: edema in tissue (too much IF, may cause too much in ICF)
Third spacing: accumulates in body spaces-“potential spaces” - ascites in abdominal cavity, pleural effusion in pleural space, blisters etc NOT ABLE TO MOVE BACK INTO THE PLASMA

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52
Q

what is hypovolemia?

A

low circulating volume

can occur with loss of normal body fluids (diarrhea, fistula drainage, hemmorage) decrease intake or plasma to interstitial fluid shift (3rd spacing)

Goal: treat cause, replace water and electrolytes give blood if due to herrohage

IV fluids to replace quickly

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53
Q

what is hypervolemia?

A

High circulating volume

May result from excessive intake of fluids, abnormal retention of fluids (CHF), or interstitial-to-plasma fluid shift

AKA overhydration, fluid volume overload

Goal: remove Na+ & water without causing other electrolyte imbalances

Treat with diuretics & fluid restriction

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54
Q

hypovolemia occurs due to

A

vomitting diarrhea, suctioning gastric or intestinal fluid, wound drainage, overuse of some diuretic, hemmorhage, massive diaphoresis

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55
Q

what are the clinical manifestations of hypovolemia?

A
  • ↓Weight
  • ↓B/P
  • weak thready pulse (1+)
  • ↑HR(fromSNSresponse-baroreceptors)
    trying to maintain CO
  • Flat neck veins
  • Prolonged capillary refill
  • Pre-syncope, dizziness or syncope
  • ↓blood flow to kidney→RAAS&
    Aldosterone
  • low urine output-oliguria, ↑ urine Specific
    Gravity
  • Slow fluid loss→ ↓tissue turgor (tenting)
  • Mucosa dry, tongue furrowed/cracked
  • Constipation, hard stools
  • Eyes sunken
  • If extreme loss of tears and sweating
  • Infants may have sunken fontanelle
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56
Q

hypervolemia occurs due to

A

the opposite… from IV fluid overload (NS, R/L) many pathos that increase aldosterone or cause the kidney to fail and some drugs like corticosteroids

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57
Q

what are the purposes of IV fluids?

A

to maintain and replace water that have been lost

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58
Q

True or false: Isotonic only expands the ECF

A

true

59
Q

are IV’s used frequently?

A

yes

60
Q

What do hypotonic IV fluids provide?

A

provides more water than electrolytes, dilutes the ECF - moves water into cells

61
Q

what does hypertonic IV fluids provide?

A

essentially raise the osmolality of ECF and expands it
draws fluid out of cells
used infrequently in special circumstances

62
Q

can hypertonic iv fluids cause intravascular fluid volume excess and cellular dehydration?

A

yes

63
Q

which Iv fluid needs SPECIAL monitoring?
a) hypertonic
b) isotonic
c)hypotonic

A

a)

64
Q

what are crystalloids? do they contain proteins?

A

fluids for IV admin that supply water and electrolytes, NO

65
Q

what are the further details of crystalloids?

A

help to maintain osmotic gradient between extravascular and intravascular components

have plasma volume expanding capacity that is related to Na+ concentration

contains fluids and electrolytes that are normally found in the body

66
Q

are crystalloids better for treating dehydration than for expanding the plasma volume?

A

yes

67
Q

crystalloids are used to maintain fluids and

A
  • to compensate for insensible fluid loss
    -to replace fluids
    -to manage specific fluid and electrolyte disturbances
    -to promote urinary flow
68
Q

what are the three saline solutions under crystalloids - saline?

A

normal saline - NS 0.9%
0.45% Normal Saline - 1/2 NS (hypotonic)
3% Saline (hypertonic)

69
Q

what is normal saline - NS 0.9%

A

isotonic
no calories
slightly more NaCl than ECF
EXPANDS IV fluid
preferred fluid for immediate response
risk for fluid overload higher
DOES NOT change ICF volume

70
Q

what is 0.45% Normal Saline - 1/2 NS

A

Hypotonic
Free water, Na+, and Cl-
Promotes movement of water from ECF to ICF
Caution—overuse may lead to cellular swelling!!!!!!!

71
Q

what is 3% Saline?

A

Hypertonic
* Caution-must be administered slowly and with extreme caution
* May cause dangerous intravascular volume overload & pulmonary edema

72
Q

what are the three crystalloid solutions - dextrose?

A

Dextrose 5% in water - D5W
Dextrose 10% in water - D10W (hypertonic)
Dextrose 5% in 0.45% Normal Saline- D5 1⁄2 NS

73
Q

what is Dextrose 5% in water - D5W?

A

Isotonic
Provides 170 kcal/L
Free water-becomes hypotonic
Moves into ICF: caution with ↑Intra Cranial Pressure
moves fluid inside

74
Q

what is Dextrose 10% in water - D10W ?

A
  • Hypertonic
  • Provides 340 kcal/L
  • Free water
  • Upper limit of dextrose concentration that may be infused peripherally
75
Q

what is Dextrose 5% in 0.45% Normal Saline- D5 1⁄2 NS ?

A

hypertonic in the bag - hypotonic in the body
Provides calories! Prevents ketosis (process when body does not have enough cals)

76
Q

what is Lactated Ringers (LR or RL) - crystalloid

A

Isotonic
more similar to plasma than NS
Has less NaCl than NS
Has K, Ca, PO4, lactate (metabolized to HCO3)
Expands ECF
Common replacement fluid
used for very sick patients, more electrolytes and acid/base balance

77
Q

what are Colloids - IV solutions?

A

also known as plasma expanders
protein substances that INCREASE the colloidal osmotic pressure (COP) and more fluid from the interstitial compartment to the plasma compartment

78
Q

what would you use to treat this condition: When the protein level in the blood falls, fluid shifts out of the blood vessels & into tissues.

A

colloids

79
Q

what are some indications of colloids?

A

Treat a wide variety of conditions
Are superior to crystalloids in plasma volume expansion but more expensive

80
Q

what are some contraindications of colloids

A

Known drug allergy Hypervolemia
Severe electrolyte disturbance, usually an end of life treatment

81
Q

do colloids help with symptom control(does not fix completely), when they have low albumin?

A

yes

82
Q

what are some common colloids?

A

Dextran 70
Dextran 40
Hetastarch
5% Albumin
25% Albumin

83
Q

true or false: Albumin is a colloid fluid that can increase the oncotic pressure in the blood

A

true

84
Q

true or false: a person with sever dehydration should be treated with normal saline 0.45%

A

true

85
Q

The IV fluid known as Lactated Ringer’s expands ECF volume and contains many electrolytes

A

yes

86
Q

what is hyponatremia?

A

low serum sodium
relative excess of H2O in relationship to sodium
serum is more dilute than normal - low osmolarity
low osmolarity causes fluid to shift from plasma to cells (high con. to low)

87
Q

what are the clinical manifestations of hyponatremia?

A

Non-specific CNS dysfunction R/T cells (brain cells)
swelling with fluid
Malaise
Anorexia
N & V
Headaches → confusion → lethargy → seizures → coma
Severe swelling in brain → herniation/fatal

88
Q

what is hypernatremia?

A

High serum sodium

Relative excess of sodium in relation to water

High Na in the plasma (elevated serum osmolality) ‘pulls’ fluids out of the IF and ICF cells shrink & become dysfunctional

89
Q

what are the clinical manifestations of hypernatremia?

A

Again CNS dysfunction but now because of shrinking brain cells

Lethargy → agitation → seizures → coma
Intense Thirst (diminished in elderly)
Oliguria
Severe hypernatremia → death

90
Q

what is the ethology behind hyponatremia?

A

Etiology: gaining more water than salt
Diseases that cause too much antidiuretic hormone to be secreted—kidney reabsorbs water & not Na
* SIADH
* Pain, nausea, stressors (common in post-
op patients)
Excessive IV fluids without Na (D5W) or hypotonic solutions 0.45% NS
Excessive water drinking
Meds: diuretics

91
Q

what is the etiology behind hypernatremia? two ways

A
  1. Gain of salt more than water
    Highly concentrated tube feeds, hypertonic IV fluids (3% NS), older folks with diminished thirst
  2. Loss of more water than salt
    Conditions (Diabetes insipidus): lack of ADH so water is not reabsorbed
    Prolonged Vomiting, Diarrhea, diaphoresis
92
Q

what is the treatment for hypernatremia?

A

Caused by water loss:
Treat underlying cause
Replace with isotonic fluid like NS 0.9%

Caused by excess sodium:
Treat underlying cause
Replace with salt-free IV solution like D5W
Excrete sodium with diuretics

93
Q

what is the treatment for hyponatremia?

A

Caused by Water excess:
Fluid restriction
If seizures can use small amount of Saline 3% to increase sodium (dangerous)

Caused by fluid loss:
IV replacement of fluids containing sodium

94
Q

what organ does potassium affect the most?

A

the heart - cardiac!!!

95
Q

what can you tell me about potassium?

A

most abundant positively charged electrolyte inside cells
95% of the body’s K+ is intracellular
potassium levels are critical to normal body functions

96
Q

what are some sources of potassium?

A

fruit and fruit juices, fish, vegetables, poultry, meats, dairy products

97
Q

how is excess K removed from the body

A

via your kidneys!!

98
Q

can impaired kidney function lead to higher serum levels (K+), toxicity?

A

yes

99
Q

what is potassium responsible for?

A

Potassium is responsible for: Muscle contraction
Transmission of nerve impulses Regulation of heartbeat Maintenance of acid–base balance
Many other functions in the body

100
Q

what are the 3 major causes of hypokalemia?

A
  1. potassium loss
  2. potassium shift into cells
  3. lack of potassium intake
101
Q

what is potassium loss linked to ?

A

GI loss: diarrhea, vomiting, NG sunction, Diuretics

102
Q

what is potassium shift into cells linked to?

A

increased insulin, alkalosis, tissue repair, increase epinephrine (stress)

103
Q

what is the lack of K+ intake linked to?

A

starvation
low potassium diet

104
Q

what are the clinical manifestations of hypokalemia?

A

early:
* Anorexia
* Hypotension
* Lethargy
* Confusion
* Muscle weakness
* Nausea

late:
* Cardiac dysrhythmias
* Neuropathy
* Paralytic ileus
* Secondary alkalosis

treatment: replace K+

105
Q

what are the three major causes of Hyperkaemia?

A

excess potassium intake
-rapid excess IV med admin
-K+ containing drugs

shift out of cells
-Acidiosis
-tissue catabolism(fever, sepsis, burns)
-crush injury
-tumour lysis syndrome

failure to eliminate
Renal disease-most common
K+ sparing diuretics
adrenal insufficency
ACE inhibitors

106
Q

what are the clinical manifestations of Hyperkalemia?

A

muscular - weak skeletal muscle, leg cramps/pain
nausea and vomiting and diarrhea

cardiac - EKG changes, Irregular pulse Ventricular fibrillation or cardiac standstill may occur

107
Q

what does kayexalate do?

A

it simply helps the body remove excess K+

108
Q

what is the generic name for Sodium polystyrene sulfonate?

A

kayexalate

109
Q

what is the mechanism of action: Sodium polystyrene sulfonate

A

as resin passes through GI, resin removes K+ ions by exchanging it for Na+ ions. most occurs in large intestine.

110
Q

is the process of Sodium polystyrene sulfonate fast of slow?

A

slow, may take hours to days

111
Q

is Sodium polystyrene sulfonate used to treat hypo or hyperkalemia?

A

hyper!!

112
Q

what is two diuretics used to control the kidneys?

A

Furosemide & Spironolactone

113
Q

Furosemide is what kind of diuretic?

A

loop diuretic

114
Q

what is the mechanism action of Furosemide ( loop diuretic )?

A

inhibits the sodium potassium pump in ascending loop of henle, decreasing reabsorption of sodium and water

115
Q

what are the indications of Furosemide ( what do we use it for?)

A

Edema ( used to treat edema)
Hypertension ( HTN)

116
Q

contraindications of Furosemide

A

electrolyte imbalances, hypovolemia

117
Q

what are side effects of furosemide?

A

hypotension, hypokalemia, tinnitus

118
Q

what kind of diuretic is spironolctone

A

potassium sparing diuretics

119
Q

what is the mechanism of action of spironolactone

A

inhibition of water and sodium reabsorption in the kidney while saving potassium

120
Q

what are the indications of Spironolactone

A

like furosemide however counteract potassium loss ( may be used with furosemide)

121
Q

true or false. Spironolactone can be used with Furosemide

A

true

122
Q

what are the contraindications of spironolactone

A

hyperkalemia, hypovolemia

123
Q

what are the side effects of spironolactone?

A

hyperkalemeia, hypotension

124
Q

What are the Diuretic Nursing Considerations?

A

Monitor BP, weights, UO, labs

EVALUATION AFTER ADMINISTRATION!

125
Q

ADH dysfunction, what can happen?
hint : there’s two things that can happen

A

Syndrome of Inappropriate ADH ( SIADH)- excessive ADH secretion

diabetes insipidus ( DI)- lack of ADH secretion

126
Q

SIADH -what is the pathophysiology?
Recall: ADH released despite low or normal serum osmalility.

A

causes of SIADH:
malignancies : ADH secreting tumour, pituitary tumour

CNS disorders: meningitis / brain trauma

pulmonary disorders

drugs

127
Q

SIAH- What are the manifestations?

A

Fluid retention = decreased urine output and increased body weight

Symptoms are primarily related to decreased Na+
- muscle cramps, twitching, weakness
vomiting, abdominal cramping, anorexia
lethargy, confusion, headache, seizure, coma

128
Q

SIADH- How is it diagnosed?

A

stimulatenous measurements of serum and urine osmality

  • serum osmolality - decreased
    urine ormalility- increased

other lab results
- decreased serum Na
decreased Hemoglobin and hemotocrit

129
Q

SIADH- what’s should the nurse do?

Choose from the following : ( multi-select)
Monitor for
a. sudden weight gain
b. urine with a decreased concentration
c. change in LOC
d. blood pressure only

A

a and c

b is wrong, urine decreased does not indicate SIADH, urine with an increased concentration is the one we should monitor

d is wrong: it should not only be. blood pressure but every vital signs should be monitored

130
Q

What are the treatments for SIADH?

A

treat underlying cause
fluid retention
diareutics

131
Q

What are we describing here ?
deceased production or secretion of ADH ( or lack of renal response to ADH) = inability to conserve water

A

Diabetes Insipidus

132
Q

What are the two types of Diabetes Insipidus ? and explain what they are

A

central ( neurogenic ) - interference with ADH synthesis or release

nephrogenic - inadequate renal response to ADH

133
Q

what is polydipsia?

A

excessive thrist

134
Q

what is polyuria ?

A

urinate more than normal

135
Q

Would polydipsia and polyuria be an indication of DI?

A

yes

136
Q

What are the manifestations for DI

A

Polydipsia
abrupt polyuria
fatigue
constipation
weight loss
dehydration
decreased LOC, seizures, shock, coma

137
Q

How is DI diagnosed?

A

history and physical exam
labs
water deprivation test ( for your interest only)

138
Q

go into further details in how Di is diagnosed

A

History and physical exam - may help determine origin
- can be caused by brain trauma, brains surgery so due to damage to the pituitary ( Central DI) or by renal issues ( not responsive to ADH, called nephrogenic DI)

Labs
- urine osmolality /specific gravity is low
serum osmolality - high ( or high normal if compensating well with oral intake)

139
Q

True or false. When treating DI, treat the primary cause and goal is to maintain fluid and electrolyte balance.

A

true

140
Q

What are the two treatments we could specify when it comes to DI?

A

Central DI
- acute- hypotonic IV saline to replace urine output
- DDAVP ( desmopressin acetate) - hormone replacement due to lack of ADH

Nephrogenic DI
- dietary measures ( low sodium )
- Thiazide diuretics

141
Q

true or false. Do we treat DI like a hypovolemic person? as they have a change of dying first ?

A

yes we treat the patient like a hypovolemeic person, ( no volume inside of their body/fluid)

142
Q

what should u monitor as a nurse when dealing with a DI pateint?

A

vital signs
measurements of their weight
inoout/output

143
Q

DI- What is the nurse to do ? Assesment and client teaching

A

DDAVP - a synthethic version of the ADH. given orally ( doesn’t have to know)

NURS2500 Patho/Pharma (16 decks)

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