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FOUNDATIONS 310 > Fluid and Electrolyte > Flashcards

Fluid and Electrolyte Flashcards

1
Q

How much of us is fluid?

A 
at least 50% at any point in our life
newborn 80
childhood 65
adults 55
older adult 50
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2
Q

What is osmolality?

A

particles in a given WEIGHT of fluid

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3
Q

what is osmolarity?

A

particles in a given VOLUME of fluid

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4
Q

a serum ______ is a method of determining if someone is over/de hydrated

A

a serum osmolarity is a method of determining if someone is over/de hydrated

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5
Q

normal serum osmolarity range

A

280-300 mOsm/L

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6
Q

too high a serum osmolarity indicates

A

dehydration (too many solutes)

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7
Q

too low a serum osmolarity indicates

A

fluid overload (less solutes)

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8
Q

where is majority of fluid?

A

intracellular

-2/3

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9
Q

Intracellular fluid contains

A

potassium, phosphate, sulfate

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10
Q

fluid volume outside of the cell

A

1/3 extracellular

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11
Q

extracellular fluid contains

A

sodium, chloride, bicarbonate

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12
Q

what is the fluid called that is inside the blood vessels?

A

intravascular

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13
Q

what is the fluid called in between the cells?

A

interstitial

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14
Q

what 3 components determine the fluid balance in extracellular compartments?

A
  1. protein (keeps fluid in vascular space)
  2. Bld vessel integrity (keeps fluid in vascular space)
  3. hydrostatic pressure (push fluid into interstitial space)
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15
Q

what is osmotic pressure?

A

pressure exerted to prevent movement of water out of the intravascular space

pressure exerted to keep h20 in blood vessels

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16
Q

what is colloid oncotic pressure?

A

proteins attract water and hold onto water

  • more stuff in water = keep it in BV and not leek
  • type of osmotic pressure**
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17
Q

what is hydrostatic pressure?

A

pressure of blood against the vessel wall

-causes filtration of a fluid from an area of high pressure to low pressure

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18
Q

what effects hydrostatic blood pressure?

A

arterial BP, Venous pressure, rate of blood flow

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19
Q

What is filtration pressure?

A
  • process that transfers nutrients and oxygen into cells
  • hydrostatic pressure minus osmotic pressure
  • causes fluid to move into tissues @ arterial end
  • causes fluid to move into vessel @ venous end
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20
Q

How does tonicity effect movement of fluid?

A

disrupts filtration pressure

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21
Q

3 kinds of tonicity

A

isotonic, hypotonic, hypertonic

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22
Q

What is an isotonic solution?

A
  • equal osmotic pressure in extracellular and intracellular

- equal concentration of water and electrolytes

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23
Q

what is a hypotonic solution in relation to cells?

A

-concentration of electrolytes outside cell is lower
-concentration of water outside cell is higher
(more water with less stuff outside the cell)

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24
Q

what is hypertonic solution in relation to cells?

A

-concentration of electrolytes outside cell is higher
-concentration of water outside cell is lower
(less water with more stuff outside the cell)

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25
Q

Stop, draw a picture of isotonic, hypotonic, hypertonic

A

yay! you did it

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26
Q

Cell is 0.9% NaCl inside
A .45% NaCl is administered (so fluid outside cell is 0.45%)
What direction will the fluid go?

A
  • water will flow into cell!
  • b/c….higher concentration of a solute, the lower the concentration of water
  • water flows high to low
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27
Q

hypotonic is _____% NaCl

A

0.45%

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28
Q

Isotonic solution is _____% NaCl

A

0.9%

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29
Q

which fluid type is used with blood product administration?

A

Isotonic

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30
Q

Examples of hypertonic solutions

A

3% NaCl
Dextrose 5% in 0.45% NaCl
Dextrose 5% in 0.9% NaCl

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31
Q

what kind of fluid do you use for hypernatremia and DKA

A

hypotonic 0.45%

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32
Q

What is a crystalloid fluid?

A
  • aqueous solution with electrolyes

- can be hypo/hyper/iso tonic

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33
Q

what is a colloid fluid? what does it do to pressure?

A

contains large molecules (ex: albumin) that do not transport outside of the intravascular space

fxn: increase osmotic pressure
- ->pulls cellular volume into blood vessels

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34
Q

3 fluid types

A
  1. crystalloid
  2. colloid
  3. blood products
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35
Q

Nursing consideration with colloids-

too much colloid can cause?

A

must be administered carefully or can cause signs of fluid volume excess

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36
Q

What are packed red blood cells used for? when use (specific hgb volume) ?

A
  • used for blood loss
  • 1 unit increased hgb by 1g/dL
  • use if hgb <7 or 8 g/dL
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37
Q

When are platelets used?

A

given when reduced level of platelets

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38
Q

when is fresh frozen plasma used (FFP)?

A

trauma, burns, shock, bleeding, clotting disorders

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39
Q

when is Crypoprecipitate used?

A

-used for clients with hereditary disorders that lead to inadequate clotting

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40
Q

What do you match to determine right type of blood donor for patient?

A

blood type

Rh factor

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41
Q

What is the difference b/w type/screen and crossmatch?

A 
type/screen = what patient is
crossmatch = blood match patient
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42
Q

Universal donor?

A

O negative

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43
Q

Universal recipient?

A

AB positive

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44
Q

What do you need before administering blood products?

A

CONSENT

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45
Q

Signs and symptoms of a transfusion reaction?

A
  • fever,chills
  • altered BP
  • Resp difficulty
  • allergic reaction
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46
Q

Definition of dehydration

A

loss of body water but electrolytes remain consistent

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47
Q

definition of fluid volume deficit

A
  • loss of both body fluid and electrolytes
  • can also include loss of circulating blood volume and perfusion to tissues
  • hypovolemia
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48
Q

definition of fluid volume excess

A

too much fluid

too much or same electrolyte

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49
Q

What can cause edema- fluid volume excess or deficiency?

A

can relate to both deficit and excess of fluid

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50
Q

causes of dehydration

A
  • inadequate water intake
  • vomiting/diarrhea
  • fever
  • meds that increase thirst like SSRI, benzo
  • DKA* use ketones- cells deficient in fluid, polyphagia and polyuria
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51
Q

labs that correlate with dehydration

A
  • increase: serum osmolarity, creatinine, BUN, urine specific gravity
  • hypernatremia
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52
Q

fluid volume deficit signs and sxs

A
  • hypotension
  • tachycardia
  • orthostatic hypotension
  • decreased urine output
  • flat neck veins
  • weak pulse
  • third spacing
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53
Q

what is third spacing?

A
  • occurs in fluid volume deficit

- too much fluid in interstitial space and not enough in intravascular space

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54
Q

fluid volume deficit treatments

A
  • replacement of fluids
  • safety education (fall risk)
  • third spacing treatment
55
Q

how do you treat third spacing? What is lacking in third spacing? (what tonicity is needed?)

A
  • third space is lacking protein
  • give Albumin IV
  • hypertonic crystalloids
56
Q

What causes a reduced colloid oncotic pressure?

A

reduced levels of albumin

57
Q

what keeps fluid in intravascular space?

A

albumin

58
Q

what happens to fluid when there is a reduced colloid oncotic pressure?

A
  • fluid goes into intravascular space and into interstitial space
  • -> edema!
59
Q

causes of decreased colloid oncotic pressure?

A

malnutrition, liver failure, nephrosis

60
Q

what causes increased hydrostatic pressure?

A

increase BP, fluid overload, decreased cardiac output (heart failure)

61
Q

what causes increased capillary permeability?

A
  • allergies
  • septic shock –> endotoxins
  • pulmonary edema
62
Q

how can someone have a fluid volume deficit if they have too much fluid somewhere?

A

fluid in interstitial space but dehydrated @ cellular level

  • sometimes treatment is just about moving fluid from one space to the other b/c patient has enough fluid
  • why tonicity matters!
63
Q

causes of fluid volume excess in intravascular space

A
  • congestive heart failure
  • renal failure
  • cirrhosis
  • excess IV fluid
  • medication causing sodium and water retention (steroids/anti-diuretics)

(heart, liver, kidneys, IV fluids, meds)

64
Q

signs and symptoms of fluid volume excess

A
  • weight gain more than 0.5 kg/day
  • hypertension
  • bounding pulse
  • distended neck veins
  • dyspnea
  • crackles
  • orthopnea
65
Q

fluid volume excess treatment? meds? restrictions?

A
  • diuretics (furosemide, spirolactone, bumetanide, hydrochlorothiazide)
  • restrictions: fluid
66
Q

potassium sparing diuretic?

A

spironolactone

67
Q

functions of electrolytes

A
  1. maintain balance of water in body
  2. balancing blood pH
  3. move nutrient in, waste out
  4. fxn of muscles, hearts, nerves, brain
68
Q

Potassium range

A

3.5-5 mEq/L

69
Q

sodium range

A

135-145 mEq/L

70
Q

calcium ranges

A

serum: 8.9-10.5 mg/dL
ionized: 4.5-5.6 mg/dL

71
Q

Magnesium ranges

A
  1. 8-2.3 mg/dL

1. 3-2.1 mEq/L

72
Q

which electrolyte is a reflection of bodies water balance, support neuro fxn, and BP regulation?

A

sodium

73
Q

what electrolyte controls neuro function and cardiac activity?

A

magnesium

74
Q

what electrolyte functions for synaptic transmission, wound healing, teeth/bone structure?

A

calcium

75
Q

what electrolyte fxns in cardiac, neural, muscular and is controlled by insulin and aldosterone?

A

potassium

76
Q

causes of hypokalemia

A

-diuretics, metabolic acidosis, folic acid deficiency, GI losses, decreased potassium intake

77
Q

hypokalemia signs/sxs

A

mild: cardiac arrythmias, constipation, fatigue
severe: resp. paralysis, paralytic ileus, hypotension, rhabdo

78
Q

hypokalemia treatment

A
  • priority is determining underlying cause
  • supplements
  • dietary changes
  • IV only
  • switch to potassium sparing diuretics
79
Q

when do you push Potassium?

A

never! only infuse slowly

80
Q

safe potassium concentration IV and side effects

A

10mEq-100 ml

-patient report burning

81
Q

hyperkalemia causes

A
  • acute renal failure
  • dehydration
  • diabetes
  • burns
  • acidosis
  • blood transfusion
82
Q

hyperkalemia signs and sxs

A

mild: nausea, vomit, muscle aches, weakness, dysrhythmias
severe: paralysis, heart failure, death

83
Q

hyperkalemia treatment

A
  • hemodialysis if renal failure is cause
  • loop diuretics if no renal failure
  • calcium gluconate
  • sodium polystrene sulfonate
  • IV insulin
84
Q

how does calcium gluconate/chloride treat hyperkalemia?

A

-reduce effects of hyperkalemia on the heart

85
Q

how does sodium polysytrene sulfonate treat hyperkalemia?

A

binds to potassium and excrete it in feces

86
Q

How does IV insulin treat hyperkalemia?

A
  • insulin helps to push potassium into cell

- must have glucose monitored to prevent hypoglycemia

87
Q

Hyponatremia causes?

A
  • severe V/D
  • excess H2O
  • excess Alc
  • thiazide diuretics
  • liver/heart diease
88
Q

hyponatremia signs and sxs

A

mild: nausea, feeling unwell
severe: cerebral edema, lethargy, confusion, irritability, seizure, coma

89
Q

hyponatremia treatment

A
  • increase Na levels slowly
  • if cause is too much water: fluid restriction
  • if cause thiazide diuretics: give isotonic or hypertonic fluids slowly infused
  • alter treatment for heart and liver failure
90
Q

why give Na slowly?

A

prevent rapid fluid shifts in neurological cells

91
Q

Hypernatremia causes

A

dehydration (v/d, CKD, diabetes, impaired thirst repsonse)

high Na intake

92
Q

signs and symptoms of hypernatremia

A

neuro, vomiting

93
Q

hypernatremia treatment

A
  • hypotonic fluids

- diet education

94
Q

what can cause cerebral edema with hypernatremia treatment?

A

if Na is lowered to quickly

–> why water is not used for hypernatremia treatment

95
Q

causes of hypocalcemia

A
  • inadequate vitamin d
  • decreased estrogen
  • hypoparathyroidism
  • renal disease
  • low albumin
  • stimulant laxatives
  • chronic steroid use (decrease intestinal Ca absorption)
  • proton pump inhibitors (decrease intestinal Ca absorption)
96
Q

signs and symptoms of hypocalcemia

A
  • chvostek and trousseau sign
  • chest pain
  • dysrhythmia
  • renal calculi
  • numbness/tingling
  • muscle cramping
  • confusion
  • osteopenia
  • dental problems

(heart, bones, muscles, neuro)

97
Q

chvostek sign- what is it and what does it indicate

A

to a twitch of the facial muscles that occurs when gently tapping an individual’s cheek, in front of the ear.
-hypocalcemia

98
Q

trousseau sign - what is it and what does it indicate?

A

Trousseau’s sign is considered positive when a carpopedal spasm of the hand and wrist occurs after an individual wears a blood pressure cuff inflated over their systolic blood pressure for 2 to 3 minutes
-hypocalcemia

99
Q

what is serum calcium?

A

-accounts for ALL calcium whether it is free ionized or bound to proteins

100
Q

what is ionized calcium?

A

detected active or unbound form of calcium in body

101
Q

which is more accurate- serum or ionized calcium?

A

ionized

102
Q

when do serum calcium?

A

shows up on lab with other electrolyte values and it done upon initial assessment

103
Q

when do ionized calcium?

A

if signs/sxs / abnormal serum suggest calcium issue

104
Q

hypocalcemia treatment

A

calcium/vit d supplements
diet
Ca injections

105
Q

hypercalcemia causes (3)

A
  • cancer
  • hyperparathyroidism
  • Vit D toxicity
106
Q

what over the counter medication for heartburn contains calcium carbonate?

A

Tums

107
Q

Ca has an inverse relationship with

A

phosphorous

108
Q

signs and sxs of hypercalcemia

A

mild: constipation, abd pain, n/v
severe: confusion, renal failure, arrhythmias, coma, death

109
Q

hypercalcemia treatment

A
  • administer phosphate
  • loop diuretics
  • IV saline bolus
  • hemodialysis if severe
110
Q

hypomagnesemia causes

A
  • chron’s/celiac
  • diarrhea/pancreatitis
  • Type 2 diabetes
  • hypocalcemia or hypokalemia
  • decreased intake
  • increased renal excretion
111
Q

s/s hypomagnesemia

A

mild: decreased appetite, fatigue, nausea, weakness
severe: muscle cramping, numbness, tingling, seizure, tetany, personality change*

112
Q

hypomagnesemia treatment

A
  • oral/iv Mg
  • diet education
  • treat Ca/K imbalance first*
113
Q

hypermagnesemia causes

A

kidney disease

  • acidosis
  • hypothyroidism
  • trauma
  • meds that slow digestion (opioids/anticholinergics)
  • laxatives/ antacids that contain Mg
114
Q

s/s hypermagnesemia

A

mild: dizziness, nausea, weakness, confusion
severe: confusion, blurred vision, headache, bladder paralysis, bradycardia, decrease RR, loss of deep tendon reflex, death

115
Q

hypermagnesemia treatment

A
  • calcium chloride/gluconate
  • IV saline with diuretics
  • hemodialysis
116
Q

Foods high in electrolytes

A

look over the chart…too lazy to type all those in

117
Q

hydrostatic pressure- push or pull?

A

PUSH

118
Q

Colloid oncotic pressure - push or pull?

A

PULL

119
Q

if hydrostatic > oncotic pressure =

A

fluid move out of capillaries

120
Q

if oncotic pressure > hydrostatic pressure =

A

move into capillaries

121
Q

if hyponatremia cause is too much water:

A

fluid restriction

122
Q

if hyponatremia cause is thiazide diuretics:

A

give isotonic or hypertonic fluids slowly infused

123
Q

2 electrolyte imbalances you can treat with loop diuretics?

A

hyperkalemia

hypercalcemia

124
Q

dehydration leads to which 2 electrolyte imbalances?

A

hypernatremia

hyperkalemia

125
Q

diabetes is the cause of which electrolyte imbalances?

A

hypomagnesemia
hyperkalemia
hypernatremia

126
Q

calcium gluconate treats which electrolyte imbalance?

A

hyperkalemia

hypermagnesemia

127
Q

which electrolyte imbalances result in dys/a rhythmias?

A

hypercalcemia
hypocalcemia
hyperkalemia

128
Q

renal disease results in which electrolyte imbalances

A

hyperkalemia
hypermagnesemia

hypomagnesemia (increased renal excretion)
hypocalcemia

129
Q

which electrolyte imbalances are characterized by muscle cramping/pain?

A

hypocalcemia
hypomagnesemia
hyperkalemia

130
Q

which electrolyte imbalance can result in a paralytic ileus?

A

hypokalemia

131
Q

low albumin will cause

A
  • decrease colloid oncotic pressure (third spacing)

- hypocalcemia

132
Q

vomiting and diarrhea can cause hyper or hyponatremia?

A

both!
hyper- dehydration
hypo-Na follows stomach acid

133
Q

calcium gluconate/chloride, what is it good for?

A

hyperkalemia and hypermagnesemia

134
Q

fluids for hyponatremia if thiazide diuretics is cause?
fluids for hypernatremia?
fluids for hypernatremia if from shock/lowbp?

A

hypo/thiazide –> hyper/isotonic
hypernatremia –> hypotonic
hypernatremia shock/low bp–> isotonic

FOUNDATIONS 310 (28 decks)

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