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ADN002 MED SURG > Week 6 Fluid and Electrolytes > Flashcards

Week 6 Fluid and Electrolytes Flashcards

1
Q

Movement of fluid through capillary walls depends on

A

Hydrostatic pressure exerted on walls of blood vessels

Osmotic Pressure- exerted by protein in plasma- oncotic pressure by albumin

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2
Q

The direction of fluid movement depends on differences

A

Hydrostatic and Osmotic pressure

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3
Q

Most abundant protein in plasma is

A

Albumin

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4
Q

Where is albumin synthesized at?

A

Liver hepatocytes and rapidly excreted into the blood stream

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5
Q

Serum Albumin function

A

Oncotic pressure

transporter of endogenous and exogenous ligands

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6
Q

Patient nutritional marker for sensitivity is

A

Serum albumin labs

Also aid in liver function of patients

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7
Q

Colloid fluid given for people in need of fluid resuscitation

A

Albumin

Especially in trauma setting or in large volume paracentesis

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8
Q

Excess protein in urine

A

Hypoalbuminemia

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9
Q

Fluid retention that causes swelling in feet or hands

A

Hypoalbuminemia

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10
Q

Signs of hypoalbuminemia

A

Jaundice- Indicates liver disease
Feelings of weakness or exhaustion
Rapid Heartbeat
Prolonged vomiting, diarrhea
Appetite changes- nausea

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11
Q

Hyperalbuminemia Causes

A

Excessive fluid losses
Dehydration, diarrhea, vomiting
High protein diet

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12
Q

Routes of gains

A

Dietary intake of fluid, food, or enteral feeding

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13
Q

Parenteral Fluids

A

IV fluids, Medications, TPN

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14
Q

Inability to release fluids

A

Retains
Sweat, cry, GFR

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15
Q

Route of Losses

A

Loss
- Kidney, urine output
- Skin
- Lungs
- GI Tract
-Other

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16
Q

Gerontological Considerations

A

Reduced homeostatic mechanisms
-Cardiac, Renal, Resp. Function

Decreased body fluid %
Medication Use
Presence of concomitant conditions

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17
Q

Fluid Volume Deficit

A

Hypovolemia

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18
Q

Fluid Volume Excess

A

Hypervolemia

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19
Q

Nursing Dx for fluid imbalances

A

Fluid balance, readiness for enhanced
Fluid Volume deficit
Fluid volume excess
Fluid volume risk for
Fluid volume risk for imbalance

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20
Q

Loss of extracellular fluid exceeds intake ratio of water

A

Fluid Volume Deficit

Electrolytes lost in the same proportion as they exist in normal body fluids

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21
Q

Loss of water along with increased sodium levels

A

Dehydration

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22
Q

Causes of Fluid Volume Deficit

A

Fluid loss from: vomiting, diarrhea, GI suctioning, sweating, decreased intake, inability to gain access to fluid

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23
Q

Risk Factors of fluid Volume Deficit

A

DI
Osmotic Diuresis
Adrenal Insufficiency
Hemorrhage
Coma
3rd spacing shifts

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24
Q

Manifestations of FVD

A

Rapid weight loss, decreased skin turgor, oliguria, concentrated urine, postural HTN, rapid weak pulse, increased temperature, cool clammy skin, thirst, nausea, muscle weakness, cramps

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25
Q

Elevated BUN and HCT in

A

FVD

Serum Electrolyte may change

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26
Q

Medical Management of FVD

A

Oral fluids
IV solutions

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27
Q

FVD nursing management

A

I and O
Daily weight
Monitor S/S- skin and tongue turgor, mucosa, urine output, mental status

Measures to minimize fluid loss
Oral care
Administration of parenteral fluids

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28
Q

FVE

A

Due to overload or diminished homeostatic mechanisms

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29
Q

Risk Factors

A

Heart failure, renal failure, cirrhosis of liver

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30
Q

Contributing factors for FVE

A

Excessive dietary sodium or sodium containing iv solutions

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31
Q

Manifestations of FVE

A

Edema, distended neck veins, abnormal lung sounds, tachycardia, increased BP, pulse pressure, increased weight, increased urine output, SOB and wheezing

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32
Q

Medical Management of FVE

A

Directed at cause, restriction of fluids and sodium, administration of diuretics

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33
Q

FVE Nursing management

A

I&O and daily weights, Assess lung sounds, edema, other symptoms
Monitor responses to medications- Diuretics
Promote adherence to fluid restrictions, pt teaching related to sodium and fluid restrictions
Monitor, avoid sources of excessive sodium, including medications
Promote rest
Semi fowlers for orthopnea
Skin care: positioning and turning

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34
Q

General Characteristics of diuretics

A

Act on kidneys to decrease reabsorption of sodium, chloride, water, other substances

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35
Q

Major Subclasses

A

Thiazide Diuretics
Thiazide -Like
Loop Diuretics
Potassium Sparing Diuretics
Osmotic Diuretics
Combination Drugs

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36
Q

Hydrochlorothiazide

A

Not strong and only works if UOP adequate

Decrease reabsorption of sodium, water, chloride, and bicarbonate in DCT

Use: mild and moderate HTN and Edema

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37
Q

Renal pt helpful with edema but decreases GFR

A

Thiazide Diuretics

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38
Q

Adverse effects of thiazide diuretics

A

Hypotension, weak, dizzy, diarrhea, constipation, lyte imbalance, hyperglycemia

Example drugs :Chlorothiazide, chlorthalidone, indapamide, metolazone

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39
Q

Loop diuretics

A

Furosemide

Diuretic of choice when rapid effects needed and renal function impaired

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40
Q

Action of loops

A

Inhibit sodium and chloride reabsorption in the ascending loop of henle, where most sodium is reabsorbed

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41
Q

Use of loops

A

HTN, Pulmonary edema, HF, hepatic, renal disease

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42
Q

Adverse effects of Loops diuretics

A

Lyte/ fluid imbalance, ototoxicity, hypotension

Bumetanide, ethacrynic, torsemide

43
Q

Potassium sparing diuretics

A

Spironolactone
Mild diuretic

Acts on the DCT decreases sodium reabsorption and potassium excretion

Blocks the effects of aldosterone in renal tubules

44
Q

Use of potassium sparing diuretics

A

HF, Ascites, HTN, hyperaldosteronism

45
Q

Adverse effects of Potassium Diuretics

A

Dizzy, h/a, ABD cramps, diarrhea, deep voice, gynecomastia, mensural changes, testicular atrophy, not for severe renal impairment

Ex: amiloride, triamterene

46
Q

Osmotic Diuretics

A

Mannitol

47
Q

Combination Products

A

Aldactizide
Dyazide, maxide
Maxide
Modiuretic

48
Q

Principle of therapy of diuretics

A

Drug selection and dosing depend on pt condition

Loop is preferred when rapid diuretic effect is necessary with renal impairment
Potassium sparing used concurrently to prevent hypokalemia

49
Q

Prevention and management of Potassium Imbalances

A

Hypokalemia is cardiotoxic

Low dosing of diuretics

Use supplemental potassium along with potassium losing medications

Increase intake potassium intake
Restrict sodium intake

50
Q

Causes of hyponatremia

A

Adrenal insufficiency, water intoxication, SIADH or losses of vomiting, diarrhea, sweating, diuretics, excessive water drinking

51
Q

Manifestations Hyponatremia

A

Poor skin turgor, dry mucosa, headache, decreased salivation, decreased blood pressure, nausea, abd. cramping, neuro changes due to brain swelling

52
Q

Medical management of hyponatremia

A

Water restriction, sodium replacement

53
Q

Nursing Management Hyponatremia

A

Assessment and prevention, dietary sodium and fluid intake, identify and monitor at risk patients , effects of medication

54
Q

Causes of Hypernatremia

A

Excess water loss, dehydration, excess sodium administration, DI, heat stroke, Hypertonic IV solutions

55
Q

Manifestations of Hypernatremia

A

Thirst
Elevated temperature
Dry swollen tongue
sticky mucosa
Neuro symptoms
Restlessness
Weakness

56
Q

Medical management of hypernatremia

A

Hypotonic electrolyte solution and D5W

57
Q

Nursing management of hypernatremia

A

Assessment and prevention, assess for otc sources of sodium, offer and encourage fluids to meet patient needs, provide sufficient water with tube feedings

58
Q

Trousseaus Sign

A

Carpopedal spasm that results from ischemia such as pressure induced by blood pressure cuff

Can be caused by hyperventilation

59
Q

Chovesteks Sign

A

Described as twitching of facial muscles in response to tapping over facial nerve

Nerve excitability

60
Q

Hypocalcemia

A

Serum levels in conjunction with albumin

61
Q

Causes of hypocalcemia

A

Hypoparathyroidism
Malabsorption
Vitamin D deficiency
Pacreatitis
Massive transfusion of citrated blood, renal failure, medications and others

62
Q

Manifestations of hypocalcemia

A

Tetany, circumoral numbness, parathesis, hyperactive deep tendon reflexes, trousseaus signs, Chvostek’s sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety

63
Q

Medical Management of hypocalcemia

A

IV of calcium gluconate
calcium and vitamin d supplements and diet

64
Q

Nursing management of hypocalcemia

A

Assessment
Severe hypocalcemia is life threatening
Weight bearing exercises decrease bone calcium loss
Pt teaching related to diet and medications

Nursing related to Iv calcium administration

65
Q

Each 1g of albumin will lower total calcium concentration by

A

0.8 mg/dl

66
Q

Chovostek Sign

A

Found in respiratory alkalosis
Hyperventilation
Decrease in Ca by shifting to albumin

67
Q

If you see a pt hyperventilating and you see this

A

Have pt rebreathe CO2 with nonrebreather mask

do not add supplemental o2

assess pt every 15 min

remove mask and teach purse lipped breathing

68
Q

Hypercalcemia causes

A

Malignancy and hyperparathyroidism
Bone loss related to immobility

69
Q

Manifestations of hypercalcemia

A

Muscle weakness, incoordination, anorexia, constipation, nausea and vomiting, abd. and bone pain, polyuria thirst, ecg changes, dysrhythemias

70
Q

Medical management of Hypercalcemia

A

Treat underlying cause, fluids, furosemide, phosphates, calcitonin, biphosphantes

71
Q

Nursing management of hypercalcemia

A

Assessment, hypercalcemic crisis has high mortality, encourage ambulation, fluids of 3 to 4, provide fluids containing sodium, fiber for constipation, ensure safety

72
Q

Causes of hypomagnesmia

A

Alcholism, GI losses, parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood, contributing causes of DKA, sepsis, burns, hypothermia

73
Q

Manifestations of hypomagnesemia

A

Neuromuscular irratibility, muscle weakness, tremors, athetoid movements, ecg changes and dysrhythemias, alterations in mood and LOC

Medical management: diet, oral mag., mag sulfate IV

74
Q

Nursing management of hypomag

A

Assessment, ensure safety, pt teachingrelated to diet, medications, alcohol use, and nursing care related to IV magnesium sulfate

75
Q

Hypomagnesium often accompanied by hypocalcemia

A

Need to monitor, treat potential hypocalcemia

76
Q

Dysphasia common in magnesium depleted patients

A

True

Assess ability to swallow with water before administering food or meds

77
Q

causes of hypermag

A

renal failure, DKA, excessive administration of mag

78
Q

Manifestations of hypermag

A

Flushing, lowered BP, nausea, vomiting, hypoactive, DTR, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias

79
Q

Medical management of hypermag

A

IV calcium gluconate, loops, IV NS or RL, hemodialysis

80
Q

Nursing management of hypermag

A

Assessment

Do not administer meds with mag
Pt teaching regarding OTC meds with mag

81
Q

Phosphates occur naturally in

A

foods
Phosphorus supports bones and teeth to develop and turn food into energy for the body to use

82
Q

Most common cause is

A

CKD
Not associated with classic symptoms

83
Q

Underlying causes of hyperphosphatemia

A

Kidney disease
Uncontrolled diabetes
DKA
Hypoparathyroidism
Hypocalcemia

84
Q

Hypophosphatemia causes include

A

Malnutrition
DKA
Severe alcoholism
Severe burns

Symptoms- very low levels
-muscle weakness, stupor, coma, death

Acute drop may result in dysrhythemias

85
Q

Chronic low levels of hypophosphatemia causes

A

Hyperparathyroidism
Chronic diarrhea
Chronic use of diuretics
Large amounts of aluminum based antacids
Large amounts of theophylline

86
Q

In mild chronic hypophosphatemia

A

bones can weaken and resulting in bone pain and fractures
People may become weak and lose their appetite

87
Q

Name the 3 types of body fluids

A

Hypertonic
Hypotonic
Isotonic

88
Q

Purpose of IV fluids

A

Maintenance
When oral intake is not adequate

Replacement
When losses have occurred

Serum OSM- 270-300

89
Q

Hypotonic IV fluids

A

Replaces cellular fluid, provides free water for excretion of body wastes

More water than electrolytes

Water moves from ECF -ICF by osmosis into cells

90
Q

0.45 NaCL, o.33 Nacl, 2.5 % dextrose, D5W

A

Hypotonic solutions

91
Q

Expands only ECF, no net loss or gain from ICF

A

OSM250-275

Isotonic

92
Q

O.9 Nacl, LRs

A

Isotonic solution

93
Q

Intially expands and raises the osm of ECF- out of cells

A

Hypertonic solutions

Requires frequent monitoring of
- BP
-Lung sounds
- Serum sodium levels

94
Q

5% dextrose in.45 NaCl, 5% dextrose in 0.9% NaCl, 5% dextrose in LR, 10% dextrose in water

A

Hypertonic Solutions

95
Q

Kidneys regulate bicarb in the

A

ECF

96
Q

Lungs regulate

A

Under control of medulla regulate CO2, carbonic acid in ECF

97
Q

Symptoms include sudden increase of pulse, rr, and bp

Mental changes, feeling of fullness

A

Resp. Acidosis

Tx aimed improving ventilation

98
Q

Resp. Acidosis

A

Rapid shallow respirations
Decreased BP
Skin pale
Headache
Cyanotic
Hyperkalemia
Dysrhythemias
Drowsiness, dizziness, disorientation
Muscle weakness

Causes Resp. depression
Overdose
Increased ICP

Airway obstruction

99
Q

Resp. Alkalosis

A

Due to hyperventilation

Manifestations : Lightheadedness, inability to concentrate, numbness, tingling, loss of consciousness

Correct the cause of hyperventilation

100
Q

S/S of Resp. Alkalosis

A

Seizures
Deep rapid breathing
Tachycardia
Hyperventilation
decrease Bp
hypokalemia
Lethargy and confusion
Nausea and vomiting

101
Q

Metabolic Alkalosis

A

Most commonly due to vomiting or gastric suction

May also because of meds or diuretics

102
Q

Hypokalemia will produce what?

A

Alkalosis

103
Q
A

ADN002 MED SURG (18 decks)

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