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OSCE Y2! > Fluids & Electrolytes > Flashcards

Fluids & Electrolytes Flashcards

1
Q

what is IV fluid therapy?

A

the infusion of sterile fluids intraveneously into the circulatory system

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2
Q

why is IV fluid therapy chosen/used?

A

to maintain fluid and electrolyte balance

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3
Q

why would IV fluid therapy be chosen over another route?

A

when oral/enteral routes are inappropriate

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4
Q

what is hypernatremia?

A

a comon electrolyte problem; too much sodium in the blood

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5
Q

what are electrolytes?

A

chemicals which conduct electricity when in water and are essential to bodily functions

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6
Q

list common electrolytes?

A
  • sodium (salt/ Na)
  • potassium (K)
  • calcium
  • bicarbonate
  • magnesium
  • chloride
  • phosphate
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7
Q

what is osmosis?

A
  • movement of water molecules from a solution of high concentration of water molecules to a lower one
  • down a concentration gradient
  • through a cell’s partially permeable membrane
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8
Q

Types of dehydration?

A
  • isotonic
  • hyponatraemic
  • hypernatraemic
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9
Q

what is isotonic dehydration?

A
  • blood sodium (salt) concentration unchanged
  • salt and water is lost in equal proportions
  • loss of plasma/ECF
  • common in burns & haemorrhaging
  • may need to replace losses urgently due to hypovolaemia risk
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10
Q

what does the term fluid balance mean?

A

the balance of input and output of fluids in the body, to allow metabolic processes to function properly

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11
Q

how much water does the average human body hold?

A

42-45Litres of water

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12
Q

how much water does an adult requiere per day?

A

1.5-2.5Litres

  • roughly 6-8 cups of water
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13
Q

what is ECF and where is is located?

A
  • extracellular fluid
  • fluid not contained within the cells but which surrounds them
  • found in the blood, lymph, and body cavities lined within the serious (moisture-exuding) membranes
  • makes up 1/3rd of total body water
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14
Q

what is ICF and where is it located?

A
  • intracellular fluid
  • fluid contained within the cells
  • largest component; 2/3rds of total body water
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15
Q

what is interstitial fluid and where is it located?

A
  • also found out-with the cells, like ECF
  • difference between the two; interstitial fluid is found out-with the blood, and which surrounds the cells and tissues
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16
Q

what is osmotic concentration?

A
  • also known as osmolarity
  • the measure of solute concentration, i.e., of the blood
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17
Q

what are osmoreceptors?

A

a sensory receptor (brain cells) located primarily in the hypothalamus that detects changes in osmotic pressure

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18
Q

what happens to our osmotic concentratin of our blood when we are dehydrated? what impact does this have?

A

the osmotic concentration of our blood when dehydrated increases (not enough water to equalise; think specific gravity), causing osmosis of ICF out of the cells

  • this dehydrates specific brain cells called osmoreceptors and stimulates the release of ADH; reducing water loss through retention and therefore concentrated urine
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19
Q

what happens when water intake is high?

A

less ADH is released, resulting in the kidneys excreting large quanities of dilute urine

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20
Q

what is ADH and what does it do?

A
  • anti-diuretic hormone
  • produced by the hypothalamus & released by the pituitary gland
  • causes the kidneys to release less water by decreasing urine production and excretion
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21
Q

what is a diuretic?

A

any substance which promotes diuresis; increased production of urine

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22
Q

what is an anti-diuretic?

A

any substance which opposes diuresis and aids retention of fluid

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23
Q

what is ADH also known as?

A

human vasopressin & vasopressin hormone

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24
Q

what is polyuria and what causes it?

A

the excessive proudction and excretion of urine, caused by;

  • diabetes/ hyperglycaemia
  • overuse of diuretics
  • renal impairment
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25
Q

what is the role of calcium?

A

contracting muscles

signalling nerves

blood clotting

forming and maintaining bones/teeth

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26
Q

what is the role of sodium (salt)?

A

maintain fluid balance

support muscle contractions

help signal nerves

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27
Q

what is the role of potassium (K)?

A

help maintain BP

regulate heart contractions

assist with muscle functions

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28
Q

what is the role of magnesium?

A

support muscle contractions

maintain proper heart rhythms

support nerve functions

help fluid balance

29
Q

what is the role of chloride?

A

help maintain fluid balance

support muscle contractions and relaxations

30
Q

three types of treatment for dehydration?

A

mild; oral rehydtration

moderate; oral & IV fluid therapy

severe; accurate IV fluid therapy replacement

31
Q

balance; positive & negative?

A

input & ouput are the same; balanced fluids/no change

input increased over output; positive balance; increased fluids

output increased over input; negative balance; decreased fluids

32
Q

what is hypovolaemia?

A

low blood volume circulating in body

33
Q

what is hypERnatraemic and causes?

A

MORE WATER LOSS than salt loss

  • e.g., excesss sweating or water diarrhhoea
  • unconscious and unable to drink
34
Q

what is hypOnatraemia and causes?

A

MORE SALT LOSS than water loss

  • loss of sodium-rich fluid from the gut or kidenys
  • too much water intake which ‘waters down’ the sodium
35
Q

two types of IV fluids?

A
  • crystalloids
  • colloids
36
Q

what are crystalloids solutions?

A
  • clear solutions that move between the bloodstream and the tissues
  • they contain NO plasma proteins
  • generally consist of differeing strengths of NaCL, Dextrose, or both
37
Q

what are colloid solutions?

A
  • contain solutes that stay in the blood because they are too big to pass through capillary walls
  • used to increase blood volume
38
Q

what are the 5Rs of I.V. fluid therapy?

A

healthcare professionals should use the 5Rs/5 principles when prescribing and admonistering IV fluid therapy to do so effectively and safely.

Resuscitation

Routine maintenance

Redistribution

Replacement

Reassessment

39
Q

what is Resuscitation?

A
40
Q

total body water % for males & females?

A

males; 60% roughly

females; 52% roughly

41
Q

why do females have less body water % than males?

A
  • muscles are made of 75% of water whereas adipose (fat) tissue is oly 10%
  • females have a higher percentage of body fat than males, meaning females therefore hold less body water %
42
Q

what is the enteral route?

A

routes in which the drug is absorbed in the GI tract, e.g., PO, sublingual, buscal, rectal

43
Q

what is tissue fluid/also known as?

A
  • fluid between body cells
  • also known as interstitial fluid
44
Q

Fluid Compartments

A

Intracellular fluid (ICF); located within cells 2/3rds of total body water

Extracellular fluid (ECF); located outwith the cells, surrounding and bathing them 1/3rd total body water

Interstitial fluid (IF); the other constituent/part of ECF, that is not located in the blood like the rest of ECF, but is located around/bathing the cells. IF is the medium through which substances diffuse from blood to cells

45
Q

what are the two constituents of ECF?

A
  • Blood plasma; fluid component of the blood
  • Interstitial fluid (IF); surrounds all the cells but is not in the blood
46
Q

signs of electrolyte imbalance

A
  • confusion
  • dizziness
  • irritability
  • muscle spasms
  • anxiety
  • changes in heartbeat
47
Q

what are osmoles?

A

an individual ion within a solution

48
Q

what is osmolality?

A

the concentration of osmoles in the mass of a solvent (e.g., a liquid)

49
Q

what is osmoregulation?

A

the process of maintaining salt and water balance (osmotic balance)

50
Q

what is saline?

A
  • a mixture of sodium chloride (salt) and water
  • abbreviated; NaCL (normal saline)
  • used to clean wounds, treat drye eyes, maintain contact lenses
  • used to treat dehydtration intraveneously
51
Q

what is dextrose?

A
  • a suguar substitute that is chemically identical to glucose
  • abbreivated; C₆H₁₂O₆
  • used to treat dehydtration, hypoglycaemia, insulin shock and also provides nutritional support to those unable to eat
52
Q

what does Resuscitation refer to?

A
  • refers to pts requiering IV fluids urgently to restore circulation to vital organs following a loss of blood plasma
  • can be caused by excessive external fluid and electrolyte losses, haemmorage and plasma loss
53
Q

what does Routine Maintenance refer to?

A
  • refers to pts unable to maintain normal fluid levels orally or via other enteral route(s)
  • these pts are otherwise well in terms of fluid and electrolyte balance. they are haemodynamically stable
  • some pts requiering routine maintenance may be unable to eat/drink properly and therefore need electrolyte supplementation
  • calculating pt’s weight, oral intake and ither IV output is vital for pts requiering routine maintenance IV fluid therapy, to prevent fluid overload
54
Q

what does Replacement refer to?

A
  • for pts needing fluid to correct water and/or electrolyte deficits or ongoing abnormal losses
  • e.g., from high-ouput ileostomies, diarrhoea, vomitting, etc.
55
Q

what does Redistribution refer to?

A
  • some pts have complex fluid & electrolyte balance issues, due to the shift/lack of shift of fluid between different body compartments
  • e.g., in pts who are septic, critically ill following surgery, have major comorbidities, etc.
  • healthcare pros shuld consider if a pt requieres IV fluids to for their natural fluids to be redistributed correctly
56
Q

what does Reassessement refer to?

A
  • pts should be reassessed continiously regarding their IV fluid therapy to avoid under and over administering fluid intraveneosly
57
Q

difference between dehydtration and depletion?

A
  • dehydration; usually describes a greater proportion of water loss than salt loss fron the body, e.g., during diarrhoea and vomitting
  • depletion (hypovolaemia); reduction in circulatory volume, i.e., loss of blood or blood plasma
58
Q

can dehydtration and depletion occur together?

A

they can occur together or independently

59
Q

what happens when too much IV fluid is administered?

A
  • can cause odema and fluid overload
  • tachycardia will present as the heart must work harder to pump normal & excess fluid around body
60
Q

what happens when not enough IV fluid is administered?

A
  • dehydtration and therefore renal insufficency more likely
61
Q

what are ascites?

A

a condittion where fluid collects in the abdomen, and cause the following symptoms;

  • abdominal pain
  • abdominal swelling
  • naseua & vomitting
  • impacts other organs, e.g., heart, lungs, kidneys
62
Q

most common electrolytes found in ECF?

A
  • sodium (Na)
  • Chloride (CI-)

this means that blood plasma and tissue fluid (IF) are salty

63
Q

most common electrolytes found in ICF?

A
  • potassium (K+)
  • magnesium (Mg++)
  • phosphate
64
Q

why is electrolyte composition different inside and outside of cells?

A

the cell membrane is selectively permeable to ions, and some ions are too big to cross cell membranes

65
Q

three reasons why 0.9% saline is a good choice as a Resuscitation fluid?

A

1.) it is isotonic to ECF; meaning it will not upset interal fluid balance

2.) it will increase plasma volume (blood volume)

3.) it is safe; no transfusion reactions, allergies, viruses risks, etc.

66
Q

isotonic fluid?

A

IV fluids that have a similair concentration of dissolved particles as the blood. an example of an isotonic fluid is 0.9% NaCL!

cells placed into an isotnic fluid will not shrink or shirvel by osmosis as a result

67
Q

difference between hypotonic solutions and hypertonic solutions

A
  • hypotonic solution; has a lower concentration of solutes than the blood. solution is dilute and therefore RBCs will swell due to osmosis
  • hypertonic solution; has a greater concentration of solutes than the blood. solution is concentrated and RBC will shrunk due to osmosis
68
Q

can Na+ and CI- readily cross cell membranes into cells?

A

no

69
Q

why would a post-op ‘nil by mouth’ pt be given 5% dextrose (glucose) as part of their fluid maintenance regime?

A

1.) to prodive a source of energy (calories) for cells in the absence of nutrition (food)

2.) ^ to prevent the rapid breakdown of bdoy fat for energy, as this can produce ketone bodies and acidosis

3.) this replacement 5% dextrose fluid will behave as a hypotonic fluid, distirbute into cells and correct dehydtration in pt not drinking

OSCE Y2! (13 decks)

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