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N150B - Fundamentals in Nursing > Fluid and Electrolytes > Flashcards

Fluid and Electrolytes Flashcards

1
Q

What are the 4 processes that move water and electrolytes between body compartments, maintaining equal osmolality?

A
  1. Active transport
  2. Passive diffusion
  3. Osmosis
  4. Filtration
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2
Q

What is active transport?

A

Cells maintain their high IC electrolyte concentration by active transport.

Active transport requires energy in adenosine triphosphate (ATP) to move electrolytes across cell membranes against the concentration gradient (from areas of lower concentration to areas of higher concentration). Ex: Na+- K+ pump, moves Na+ out of cell & K+ into cell and keeping ICF low Na+ and high K+

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3
Q

What is passive diffusion?

A

Passive movement of electrolytes or other particles down a concentration gradient (from areas of higher concentration to areas of lower concentration).

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4
Q

What is osmosis?

A

Movement of water across a partially permeable membrane from a region of high concentration to an area of low concentration.

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5
Q

What is filtration?

A

Filtration is when fluid moves into and out of capillaries (between the vascular and interstitial compartments).

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6
Q

CV causes of extracellular fluid volume deficit

A

blood/plasma loss, hemorrhage, burns

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7
Q

GI reasons for extracellular fluid volume deficit

A

vomiting, laxative overuse, drainage from fistulas or tubes, diarrhea

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8
Q

(Increased) renal output reasons for extracellular fluid volume deficit

A

diuretics, adrenal insufficiency (deficit of cortisol & aldosterone)

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9
Q

Physiological Effects of Extracellular Fluid Volume Deficit

A

FAST FLUDDS.

This stands for:

F - Flat neck veins
A - Sudden weight loss (overnight)
S - Slow vein filling
T - Tachycardia
F - Postural hypotension
L - Thready pulse
U - Dry mucous membranes
D - Dark yellow urine
S - Poor skin turgor when supine

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10
Q

Severe PE of Extracellular Fluid Volume Deficit

A

CRITICAL DASH.

This stands for:

C - Confusion
R - Restlessness
I - Hypotension
T - Thirst
I - oligUria (UO < 30 mL/hr)
C - Cold, clammy skin
A - Decreased LOC
L - Hypovolemic shock
D - Hypotension
A - Thirst
S - Restlessness
H - Hypovolemic shock

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11
Q

What are labs to monitor for fluid volume deficit?

A

↑Hct
↑BUN > 20 mg/dL (7.1 mmol/L) (hemoconcentration)
urine specific gravity > 1.030, unless renal cause

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12
Q

In patients with extracellular fluid volume deficit, Na+ & H2O intake is ______ than output, leading to isotonic _________.

A

less; loss

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13
Q

In patients with extracellular fluid excess, Na+ & H2O intake is __________ than output, leading to isotonic _____.

A

greater, gain.

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14
Q

Renal retention of Na+ and H2O can lead to? (4)

A
  1. heart failure
  2. cirrhosis
  3. aldosterone or glucocorticoid excess
  4. acute or chronic oliguric renal disease
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15
Q

PE of fluid volume excess

A

Sudden weight gain (overnight), edema (especially in dependent areas), full neck veins when upright or semi-upright, crackles in lungs

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16
Q

Severe PE of fluid volume excess

A

Confusion and pulmonary edema

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17
Q

What labs to monitor for fluid volume excess?

A

↓Hct, ↓ BUN < 10 mg/dL (3.6 mmol/L) (hemodilution)

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18
Q

What is hyponatremia?

A

H2O excess; water intoxication; hypoosmolar imbalance) – body fluids too dilute

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19
Q

What are some causes of hyponatremia?

A

increased ADH, pyschogenic polydipsia or forced excessive water intake, use of hypotonic irrigating solutions, and tap-water enemas.

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20
Q

Signs and symptoms of hyponatremia

A

↓ LOC (confusion, lethargy, coma), seizures if develops rapidly or is very severe

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21
Q

Labs for hyponatremia

A

Na+ < 136 mEq/L
Serum osmolality < 285 mOsm/kg.

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22
Q

What is hypernatremia?

A

Water deficit; hyperosmolar Imbalance) – concentrated body.

23
Q

What are some reasons someone might gain more salt than water (hypernatremia)?

A

salt tablets, tube feedings, hypertonic parenteral fluids
Lack of access to water, deliberate water deprivation, inability to respond to thirst (e.g., immobility, aphasia)
Dysfunction of osmoreceptor-driven thirst drive

24
Q

What are some reasons someone might lose more water than salt? (hypernatremia)

A

diabetes insipidus (ADH deficiency)
osmotic diuresis
large insensible perspiration & respiratory water output without ↑water intake

25
Q

What are some physical examination findings of someone with hypernatremia?

A

↓ LOC (confusion, lethargy, coma)
Thirst
seizures if develops rapidly/severe

26
Q

What are some labs to monitor for hypernatremia?

A

serum Na+ > 145 mEq/L
serum osmolality > 295 mOsm/kg

27
Q

What is the normal value for osmolality?

A

285-295 mOsm/kg H2O

28
Q

What is the normal range for sodium?

A

135-145 mEq/L

29
Q

Normal range for K+

A

3.5-5.0 mEq/L

30
Q

Normal range for chloride

A

98-106 mEq/L

31
Q

Normal range for total CO2

A

22-30 mEq/L

32
Q

Normal range for bicarbonate HCO3-

A

Arterial 21-28 mEq/L
venous 24-30mEq/L

33
Q

Normal range for total calcium

A

9.0-10.5 mg/dL

34
Q

Normal range for magnesium Mg2+

A

1.3-2.1 mEq/L

35
Q

Normal range for phosphate

A

3.0-4.5 mg/dL

36
Q

What are some general reasons for electrolyte imbalances?

A

Electrolyte imbalances may be caused by diarrhea, endocrine disorders & medications.

37
Q

What is plasma electrolyte excess?

A

Electrolyte intake > electrolyte output or a shift of electrolytes from cells or bone to the ECF

38
Q

What is plasma electrolyte deficit?

A

Electrolyte intake < electrolyte output or shift of electrolyte from the ECF into cells or bone

39
Q

What are some causes of hypokalemia?

A

↓K+ intake: IVF without added K+

K+ shifts into cells: alkalosis; treatment of diabetic ketoacidosis with insulin

↑K+ output: GI: vomiting; nasogastric or fistula drainage; diarrhea (acute/chronic)

Meds: use of K+-wasting diuretics; aldosterone excess; polyuria, glucocorticoid therapy

40
Q

How might the EKG appear in a patient with hypokalemia?

A

U wave, T wave flattened/inverted; ST segment depression, dysrhythmias

41
Q

GI complications of hypokalemia

A

abdominal distention, ↓bowel sounds, constipation**

42
Q

MS complications of hypokalemia

A

bilateral muscle weakness that begins in quadriceps & may ascend to respiratory muscles

43
Q

What are some causes of hyperkalemia?

A

↑K+ intake: ↑ingestion of K+ salt substitutes; IVF with too much K+; rapid infusion of stored blood

K+ shifts out of cells: massive cellular damage (e.g., crushing trauma, cytotoxic chemotherapy); insufficient insulin (e.g., diabetic ketoacidosis); some types of acidosis

↓K+ output: acute/chronic oliguria (e.g., severe ECV deficit, end-stage renal disease); K+-sparing diuretics; adrenal insufficiency (deficit of cortisol and aldosterone)

44
Q

How might an EKG appear in a patient who is hyperkalemic?

A

PR prolonged, QRS widened complex, T wave peaked, terminal sine wave pattern, dysrhythmias, cardiac arrest if severe

45
Q

GI complications of hyperkalemia

A

transient abdominal cramps, diarrhea

46
Q

MS complications of hyperkalemia

A

bilateral muscle weakness in quadriceps

47
Q

What are some causes of hypocalcemia?

A

↓Ca2+ intake & absorption: diet calcium deficient; vitamin D deficiency (includes end-stage renal disease [ESRD]) chronic diarrhea; laxative misuse; steatorrhea (fatty stool)

Ca2+ shifts into bone or inactive form: alkalosis; hypoalbuminemia; rapid administration of citrated blood; hypoparathyroidism; pancreatitis; hyperphosphatemia (ESRD)

↓Ca2+ output: chronic diarrhea, steatorrhea (fatty stool)

48
Q

What are the complications of hypocalcemia?

A

Neuro: ↓LOC, numbness & tingling of fingers, toes, & circumoral region, + Chvostek’s sign (contraction of facial muscles when facial nerve is tapped), tetany, seizures

CV: prolonged ST segments, dysrhythmias

Resp: laryngospasm

MS: hyperactive reflexes, muscle twitching & cramping; carpal & pedal spasms

49
Q

What are the causes of hypercalcemia?

A

↑Ca2+ intake & absorption: milk alkali syndrome

Ca2+ shifts out of bone: hyperparathyroidism; bone tumors; nonosseous cancers that secrete bone-resorbing factors; prolonged immobilization

↓Ca2+ output: use of thiazide diuretics

50
Q

What are the complications of hypercalcemia?

A

Neuro: ↓LOC, confusion, fatigue, lethargy, personality change

CV: shortened ST segments, heart block, cardiac arrest if severe

GI: anorexia, nausea, vomiting, constipation

MS: diminished reflexes

51
Q

What are the causes of hypomagnesemia?

A

↓Mg2+ intake & absorption: malnutrition; chronic alcoholism; chronic diarrhea; laxative misuse; steatorrhea

Mg2+ shifts into inactive form: rapid administration of citrated blood

↑Mg2+ output: vomiting, nasogastric or fistula drainage; chronic diarrhea, steatorrhea; use of thiazide or loop diuretics; aldosterone excess

52
Q

What are the complications of hypomegnesemia?

A

Neuro: positive Chvostek’s sign, grimacing, tetany, seizures, insomnia

CV: tachycardia, HTN, dysrhythmias, prolonged QT interval

GI: dysphagia

MS: muscle cramps & twitching

53
Q

What are the causes of hypermagnesemia?

A

↑Mg2+ Intake & Absorption: Excessive use of Mg2+-containing laxatives & antacids; parenteral overload of magnesium

↓Mg2+ Output: Oliguric end-stage renal disease; adrenal insufficiency

54
Q

What are the complications of hypermagnesemia?

A

Neuro: lethargy

CV: bradycardia, hypotension; dysrhythmias, prolonged PR interval, cardiac arrest

GI: transient abdominal cramps, diarrhea

MS: bilateral muscle weakness in quadriceps, hypoactive deep tendon reflexes

Skin: flushing, sensation of warmth

Severe acute hypermagnesemia: rate & depth of respirations

N150B - Fundamentals in Nursing (6 decks)

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