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Exam 1 NRS 202 > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Approximately __% of an adult is fluids (water and electrolyes)

A

60%

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2
Q

Intracellular fluid makes up how much of the bodys fluids?

A

2/3

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3
Q

Extracellular fluid makes up how much of the body’s fluids?

A

1/3

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4
Q

3 Types of ECF

A

Intravascular
Interstitial
Transcellular

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5
Q

Where is intravascular ECF found?

A

with blood vessels - aka plasma, erythrocytes, leukocytes, thrombocytes

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6
Q

Where is interstitial ECF found?

A

surrounding cells

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7
Q

Examples of transcellular fluid

A

CSF, pericardial fluid, and synovial fluid

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8
Q

Examples of interstitial ECF

A

lymph fluid

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9
Q

What are the major cations of the body?

A

Na+, K+, Ca++, Mg+, H+

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10
Q

What are the major anions of the body?

A

Cl-, Bicarb, Phosphate, Sulfate, and negatively charged protein ions

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11
Q

Gerontologic Considerations of Fluid and Electrolyte Imbalances

A

Subtle s/s
May cause delirium
Decreased cardiac reserve
Reduced renal function
Dehydration is common
Thin skin
Loss of strength and elasticity

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12
Q

FVE is AKA

A

hypervolemia

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13
Q

FVD is AKA

A

hypovolemia

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14
Q

Loss of water alone with increased serum sodium levels is?

A

Dehydration

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15
Q

Occurs when loss of ECF exceeds the intake ratio of water

A

hypovolemia (FVD)

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16
Q

Causes of hypovolemia (FVD)

A

Abnormal fluid losses (V/D/suction)
Decreased intake (N/lack of access)
3rd space fluid shifts (burns, ascites)
Diabetes insipidus
Adrenal insufficiency
Hemorrhage

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17
Q

Manifestations of FVD

A

Wt loss
Decreased skin turgor
Prolonged cap refill
Abnormal labs
Decreased BP
Tachycardia

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18
Q

What abnormal labs are seen in FVD?

A

Increased hemoglobin and hematocrit
Increased serum and urine osmolality and SG
Decreased urine sodium
Increased BUN/Cr

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19
Q

Medical management of FVD

A

Oral route preferred
IV for acute or severe losses

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20
Q

Nursing management of FVD

A

I&O at least every 8 hrs
Daily weights
VS
Assess Skin and tongue turgor
Assess Mental status
Admin of oral or IV fluids

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21
Q

Manifestations of FVE

A

Weight gain
Edema or ascites
Distended jugular veins
SOB and crackles
Increased BP
Cough
Increased RR
Increased output

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22
Q

What is the only solution that may be given with blood products?

A

0.9% NaCl

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23
Q

Solution that used to expand ECF

A

Isotonic

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24
Q

What type of solution is used to treat hypovolemia, resuscitative efforts, and shock?

A

Isotonic or hypertonic

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25
Q

Examples of isotonic solutions

A

0.9% NaCl
Lactated Ringers
5% dextrose in water

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26
Q

Example of hypotonic solution

A

0.45% NaCl

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27
Q

Examples of hypertonic solution

A

3% NaCl
5% NaCl
IV Mannitol

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28
Q

A solution with same osmolality as blood

A

isotonic

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29
Q

A solution with a higher osmolality than bood

A

Hypertonic

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30
Q

A solution with a lower osmolality than blood

A

Hypotonic

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31
Q

A solution that contains particles that are nonsoluble and evenly distributed throughout the solution

A

Colloid

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32
Q

What is FVE secondary to?

A

to an increase in the total body sodium content

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33
Q

Expansion of ECF caused by abnormal retention of water and sodium in approx the same proportions in which they normally exist in the ECF

A

FVE or hypervolemia

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34
Q

Causes of FVE

A

Heart failure
Kidney injury or failure
Cirrhosis of liver
Excessive salt intake

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35
Q

Do isotonic solutions move water?

A

No

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36
Q

How do hypotonic solutions effect water?

A

move water from ECF to ICF

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37
Q

How do hypertonic solutions effect water?

A

move water from ICF to ECF

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38
Q

What abnormal labs are seen in FVE?

A

Decreased hgb and hct
Decreased serum and urine osmolality
Decreased urine sodium and SG

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39
Q

Medical management of FVE

A

Pharm - diuretics
Dialysis
Nutrition - sodium restriction

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40
Q

Nursing management of FVE

A

I&Os
Daily weight
Assess lung sounds
Assess edema
Monitor response to diuretics and fluids
Monitor sodium intake

41
Q

Normal sodium range

A

135-145

42
Q

Causes of hyponatremia

A

Loss of water by vomiting, diarrhea, sweating, diuretics, adrenal insufficiency, SIADH

43
Q

Manifestations of hyponatremia

A

poor skin turgor
dry mucosa
headache
decreased BP
nausea
abdominal cramping
neuro changes - confusion, seizures

44
Q

Management of hypnonatremia

A

Treat underlying condition
Na+ replacement/dietary
I & O
Daily weights
Monitor CNS changes
Seizure precautions

45
Q

Causes of hypernatremia

A

Fluid deprivation
Excess sodium
Diabetes insipidus
Heat stroke
Hypertonic IV solutions

46
Q

Manifestations of hypernatremia

A

Increased thirst
Hyperreflexia
Elevated temp
Seizures
Swollen tongue
Lethargy
Irritability

47
Q

Management of hypernatremia

A

Gradual lowering of sodium with diuretics
Monitor CNS changes
Assess sodium source or source of water loss

48
Q

Normal range of potassium

A

3.5-5.0

49
Q

Causes of hypokalemia

A

GI losses
Medications
Suctioning
Hyperaldosteronism
Poor dietary intake

50
Q

Manifestations of hypokalemia

A

ECG changes
dysrhythemias
dilute urine
excessive thirst
fatigue
muscle weakness
paresthesia
decreased bowels

51
Q

What ECG changes are seen in hypokalemia?

A

flattened T waves, prominent U waves, ST depression, prolonged PR interval

52
Q

Management of hypokalemia

A

Potassium replacement
Monitor ECG changes
Monitor aBGs
Monitor patients taking digoxin for toxicity

53
Q

When do you not administer potassium if your patient has hypokalemia?

A

If oliguria is present

54
Q

Causes of hyperkalemia

A

impaired renal function
rapid admin of K+
Hypoaldosteronism
Medications
Tissue trauma
Acidosis

55
Q

Manifestations of hyperkalemia

A

ECG changes
Arrhythmias
Muscles weakness
Muscle cramps

56
Q

What ECG changes are seen with hyperkalemia?

A

tall tented T waves, prolonged PR interval and QRS duration, absent P waves, ST depression

57
Q

Management of hyperkalemia

A

Monitor ECG, heart rate, BP
I & O
Obtain apical pulse
Limit K+ intake, educate pt

58
Q

What is the emergent care for hyperkalemia?

A

IV calcium gluconate
IV sodium bicarbonate
IV regular insulin and hypertonic dextrose
Dialysis

Administer slowly w an infusion pump

59
Q

Normal range of calcium

A

8.6-10.4

60
Q

The serum calcium levels of the body are controlled by?

A

PTH and calcitonin

61
Q

Causes of hypocalcemia

A

Hypoparathyroidism
Malabsorption
Osteoporosis
Pancreatitis
Meds
Kidney injury

62
Q

Manifestations of hypocalcemia

A

Tetany
Numbness
Paresthesias
Trousseau sign
Chvostek sign
Seizures
Respiratory issues

63
Q

Management of hypocalcemia

A

IV calcium gluconate
Seizure precautions
Vit D supplements
Exercise
Educate pt r/t diet and medications

64
Q

Causes of hypercalcemia

A

Malignancy and hyperparathyroidism
Bone loss r/t immobility
Diuretics

65
Q

Manifestations of hypercalcemia

A

Polyuria
Thirst
Muscle weakness
Nausea
Abdominal cramps
Constipation
Diarrhea
ECG changes
Dysrhythmias

66
Q

Management of hypercalcemia

A

Treat underlying cause (cancer)
Admin IV fluids
Meds - ferosemide, phosphate, calcitonin, bisphosphonates
Increase mobility

67
Q

Normal range of magnesium

A

1.8-2.6

68
Q

Causes of hypomagesemia

A

alcoholism
GI losses
Enteral or parenteral feeding deficient in mag
meds
rapid admin of citrated blood

69
Q

Manifestations of hypomagnesemia

A

apathy
psychosis
neuromuscular irritability
ataxia
insomnia
confusion
tremors
ECG changes

70
Q

Management of hypomagnesemia

A

Magnesium sulfate IV
Monitor VS and urine output
Monitor dysphagia
Seizure precautions
Diet - green, leafy veggies; beans, lentils, almonds, PB)

71
Q

Causes of hypermagnesemia

A

kidney injury
diabetic ketoacidosis
excess magnesium
extensive soft tissue injuries

72
Q

Manifestations of hypermagnesemia

A

Hypoactive reflexes
drowsiness
muscle weakness
depressed respirations
ECG changes
dysrhythmias
Cardiac arrest

73
Q

Management of hypermagnesemia

A

IV calcium gluconate
Ventilatory support for resp depression
Hemodialysis
Loop diurectics
Limit mag intake
Monitor for LOC changes

74
Q

Normal range of phosphates

A

2.7-4.5

75
Q
A
75
Q
A
75
Q
A
75
Q
A
75
Q
A
76
Q
A
76
Q
A
76
Q
A
76
Q
A
77
Q

Causes of hypophosphatemia

A

Alcoholism
Refeeding syndrome
pain
heat stroke
respiratory alkalosis
hyperventilation
low mag
low potassium
meds

78
Q

Manifestations of hypophosphatemia

A

Confusion
Muscle weakness
Tissue hypoxia
Muscle and bone pain

79
Q

What labs should be run with hypophosphatemia?

A

24-hr urine collection
PTH (elevated)
Vit D
Calcium

80
Q

Management of hypophosphatemia

A

Prevention is goal
Phosphorus replacement
Monitor IV site
Monitor phosphorus, calcium, vit D
Encourage foods high phosphorus

81
Q

What foods are high in phosphorus?

A

milk
organ meats
beans
nuts
fish
poultry

82
Q

Causes of hyerphosphatemia

A

kidney injury
excess phosphorus
excess vit D
acidosis
hypoparathyroidism
chemotherapy

83
Q

Manifestations of hyperphosphatemia

A

soft tissue calcifications

84
Q

Management of hyperphosphatemia

A

treat underlying disorder
monitor labs
avoid high-phosphorus foods
patient education
Vit D and calcium-binding antacids
Loop diuretics
Dialysis

85
Q

Normal chloride range

A

97-107

86
Q

Causes of hypochloremia

A

Addison disease
Reduce chloride intake
GI losses
Excess sweating
Fever

87
Q

Manifestations of hypochloremia

A

agitation
irritability
weakness
hyperexcitability of muscles
dysrhythmias
seizures
coma

88
Q

Management of hypochloremia

A

Replace chloride with 0.45% NS
I&O
ABG values
Electrolyte values
Asses for changes in LOC
Educate about diet

89
Q

Foods high in chloride

A

Tomato juice
bananas
eggs
cheese
milk

90
Q

Causes of hyperchloremia

A

iatrogenically-induced

91
Q

Manifestations of hyperchloremia

A

Tachypnea
Lethargy
weakness
rapid, deep respirations
HTN
cognitive changes

92
Q

Management of hyperchloremia

A

Treat underlying cause
Hypertonic IV solutions
I & O
Assess resp, neuro, cardiac

Exam 1 NRS 202 (7 decks)

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