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Fundamentals of Nursing > Fluid and Electrolytes > Flashcards

Fluid and Electrolytes Flashcards

1
Q

What is the intracellular space ?

A

space within the cell
- holds about 67% of the body’s water

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2
Q

What is the extracellular space ?

A

space outside the cell (includes the interstitial and intravascular)
- holds 25% of the body’s water

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3
Q

How much water does the intravascular space hold ?

A

8% of the body’s water

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4
Q

What is the interstitial fluid ?

A

fluids between cells and outside the blood vessels
- include lymph

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5
Q

What is the intravascular fluid ?

A

blood plasma found in the vascular system

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6
Q

What is the transcellular fluids ?

A

secreted by epithelial cells and include cerebrospinal, pleural, peritoneal, and synovial fluids

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7
Q

What does the hemoglobin test measure ?

A

the amount of hemoglobin in blood and is a good measure of the blood’s ability to carry oxygen throughout the body

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8
Q

What does the hematocrit test measure ?

A

amount of space (volume) red blood cells take up in the blood
- value is given as a % of RBCs in a volume of blood
- Ex.) hematocrit of 38 means that 38% of the blood’s volume is made of RBCs

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9
Q

What is the best indicator of fluid retention and overload ?

A

weight gain
- congestive heart failure and renal failure and great examples of diseases that can retain large amounts of fluid

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10
Q

How much of weight gain does one gain per liter ?

A

2.2 lbs= 1 L (1000mL)

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11
Q

What are some causes of hypervolemia ?

A
  • excessive intake of fluids
  • abnormal retention of fluids
  • heart failure
  • renal failure
  • long term corticosteroid therapy
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12
Q

What is hypervolemia ?

A

where the liquid portion of the blood (plasma) is too high
- or fluid in the body is too high

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13
Q

What are signs and symptoms of hypervolemia ?

A
  • increased pulse: full and bounding distended neck veins
  • increased BP
  • polyuria/nocturia
  • edema
  • SOB
  • moist crackles
  • headache
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14
Q

What is a classic sign of hypervolemia ?

A

full and bounding distended neck veins

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15
Q

What are some nursing consideration for hypervolemia ?

A
  • maintain oxygenation (semi or full fowler’s to improve gas exchange)
  • fluid restriction: I & O
  • promote excretion of excess fluids
  • monitor electrolytes (prevent tissue injury)
  • evaluate feet for edema and discoloration when pt is OOB (out of bed)
  • observe suture line on surgical pt’s (potential evisceration due to fluid retention)
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16
Q

What are some causes of hypovolemia ?

A
  • abnormal fluid loss
  • diarrhea
  • hemorrhage
  • fever (increased perspiration)
  • inadequate intake
  • DKA (diabetic ketoacidosis)
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17
Q

What are some signs and symptoms of hypovolemia ?

A
  • increased HR (due to SNS: sympathetic NS)
  • weak/thready pulses
  • change in position may cause increased HR or decreased BP
  • dizziness/light-headedness
  • UO <500 mL/day
  • altered mental status
  • restlessness
  • lethargy
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18
Q

What are some RN considerations for hypovolemia ?

A
  • maintain pt’s safety
  • Skin care: edematous tissues protected from extreme temps, pressure, and trauma
  • frequent skin care and changes in position
  • elevate edematous extremities to promote venous return and fluid reabsorption
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19
Q

What is the goal of IV therapy ?

A
  • correct or prevent fluid and electrolyte disturbances
  • provide direct access to the vascular system
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20
Q

What is isotonic fluid ?

A

fluid with the same concentration of normal blood
- most common

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21
Q

What is isotonic fluid used for ?

A

used for volume replacement (after prolonged vomiting)
- 0.9% sodium chloride (normal saline)
- LR

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22
Q

What is hypotonic fluid ?

A

fluid that is more dilute than blood

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23
Q

What is hypotonic fluid used for ?

A

used to rehydrate the cells
- 0.45% NaCl
- D5 0.45% NaCl (once infused, dextrose enters cells rapidly leaving free water)

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24
Q

What is hypertonic fluid ?

A

fluid is more concentrated than normal blood

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25
Q

What is hypertonic fluid used for ?

A

to increase vascular volume
- use with caution due to risk for fluid overload
- 3% normal saline (NS)

26
Q

Why should Potassium Chloride (KCl) be given cautiously ?

A

it can cause hyperkalemia which can cause fatal cardiac dysrhythmias
- NEVER GIVE IV PUSH (can stop heart)
- must be given slowly
- KCl irritates the veins and pt’s will complain of pain (can be given with other fluids to reduce irritation)

27
Q

What is the primary extracellular electrolyte ?

A

sodium

28
Q

How does sodium work in the body ?

A
  • helps maintain BP by balancing the volume of water in the body
  • works with other electrolytes to promote nerves, muscles, and other body tissues to work properly
29
Q

What are the causes of hypernatremia ?

A
  • inadequate water intake
  • NPO status
  • excessive water loss
  • gastroenteritis/vomiting/watery diarrhea
  • NG suction
  • severe burns
  • high fever
  • diuretic therapy
  • excessive sweating
  • disease states (kidney disease or failure, uncontrolled DM)
30
Q

What are the symptoms of hypernatremia ?

A
  • restlessness
  • agitation
  • confusion
  • seizures
  • thirst
  • dry, swollen tongue
  • hypotension
  • flushed skin
  • edema (peripheral and pulmonary)
  • weight gain
31
Q

What is hypernatremia ?

A

too much sodium in the body
- >145

32
Q

What are the treatments for hypernatremia ?

A
  • treat underlying cause
  • water replacement: oral, Na-free isotonic fluids to dilute serum NA, then 0.45% NS to prevent hyponatremia
  • diuretics (to promote excretion of Na)
  • dietary NA may be restricted
33
Q

What are some causes of hyponatremia ?

A
  • vomiting
  • diarrhea
  • NG suctioning
  • diuretic
  • burns
  • wounds
  • excessive water gain
  • tap water enemas
34
Q

What are some symptoms of hyponatremia ?

A
  • N, V, D
  • lethargy
  • confusion
  • headache
  • restlessness
  • irritability
  • tremors, seizures, coma
  • weight gain
  • increased BP
35
Q

What are some treatments for hyponatremia ?

A
  • treat underlying cause
  • potential fluid restriction
36
Q

What is the largest intracellular electrolyte ?

A

potassium
- contributes to intracellular osmotic pressure

37
Q

How does Potassium get used in the body ?

A
  • supports transmission of electrical impulses in the nerves and muscles (skeletal, cardiac, and smooth muscle contractions)
  • regulates glucose use and storage
  • small changes have a profound effect and is poorly tolerated
  • kidneys eliminate approx. 90% of K
38
Q

What are the causes of hyperkalemia ?

A
  • failure to eliminate K (renal disease, K+ sparing diuretics, ACE inhibitors)
  • excess K intake
  • excessive or rapid parenteral administration
  • shift of K out of cells (acidosis, crushing injury, tissue catabolism fever, sepsis, burns)
39
Q

What are the symptoms of hyperkalemia ?

A
  • irritability
  • abdominal cramping, diarrhea
  • weakness of lower extremities
  • irregular pulse
  • cardiac arrest if hyperkalemia sudden or severe
  • EKG: Vfib, V standstill
40
Q

What is hyperkalemia ?

A

high potassium levels

41
Q

What are treatments of hyperkalemia ?

A
  • eliminate K intake, both oral and IV
  • dialysis (if due to renal failure)
  • diuretics (K wasting)
  • insulin (pushes K into the cell)
42
Q

What is given to treat mild to moderate hyperkalemia ?

A

Kayexalate
- ion-exchange resin
- used if kidney function is not normal

43
Q

What are some causes of hypokalemia ?

A
  • Potassium loss
  • GI losses (D, V, fistulas, NG suction, NPO status)
  • renal losses: diuretics
  • skin losses: diaphoresis
  • dialysis
  • shift of K into cells (alkalosis)
  • lack of K intake (starvation, diet let in K, fail to include K in parenteral fluids if NPO, TPN)
44
Q

What are symptoms of hypokalemia ?

A
  • fatigue
  • constipation
  • muscle weakness, leg cramps
  • N, V, paralytic ileus
  • soft, flabby muscles
  • dysrhythmias (PVCs)
  • bradycardia
45
Q

What are treatments for hypokalemia ?

A
  • treat underlying cause
  • K supplementation
  • NEVER IV PUSH K
46
Q

Where is Calcium found in the body ?

A

blood and cells
- but 99% is stored in the bones and teeth

47
Q

What is calcium need for in the body ?

A

mineralization of bones, muscle contractions, nerve transmission, clotting, hormone secretion, and cardiac function

48
Q

What are some causes of hypercalcemia ?

A
  • increased total calcium
  • cancer
  • hyperparathyroidism
  • prolonged immobilization
  • thiazide diuretics
  • renal failure
49
Q

What are some symptoms of hypercalcemia ?

A
  • GI (1st to occur): constipation, abdominal pain, N, V, anorexia
  • lethargy, weakness
  • depressed reflexes (DTR)
  • confusion, personality changes, psychosis
  • bone pain, fractures
  • flank pain/renal calculi
  • ventricular dysrhythmias
50
Q

What are some treatments for hypercalcemia ?

A
  • phosphate
  • admin of IV fluids followed by loop diuretics (excretion of Ca is followed by excretion of Na)
  • calcitonin via IV to promote renal excretion of Ca
  • stool softeners given for constipation
  • cardiac monitoring
  • dialysis: for severe hypercalcemia
  • management of renal calculi
51
Q

What are cause of hypocalcemia ?

A
  • vita. D deficiency
  • hypoparathyroidism
  • hormonal changes (menopause)
  • chronic renal failure
  • loop diuretics (furosemide)
  • multiple blood transfusions
52
Q

What are symptoms of hypocalcemia ?

A
  • Chvostek’s & Trousseau’s sign
  • chest pain, dysrhythmias, heart failure, syncope
  • numbness and tingling in extremities around mouth, hyperreflexia, muscle cramps
  • confusion lethargy, seizures, personality changes
  • wheezing, laryngeal spasm, dysphagia
53
Q

Where is magnesium found in the body ?

A

intracellular
- 50 to 60% in the bones

54
Q

What is the use of Magnesium in the body ?

A
  • regulation of nerve and muscle function
  • maintain BP, glucose
  • bone/teeth health
55
Q

What are the causes of hypermagnesemia ?

A
  • renal failure
  • pt’s who ingest large amounts of Mg- containing antacids such as Tums, Maalox, Mylanta
56
Q

What are some symptoms of hypermagnesemia ?

A
  • nausea, dizziness, weakness, confusion
  • bradycardia, hypotension
  • severe hypermagnesemia: cardiac arrest
  • lethargic
  • coma
  • deep tendon reflexes- reduced or absent
  • skeletal muscle contractions because progressively weaker and finally stop
57
Q

What are treatments of hypermagnesemia ?

A
  • treat underlying cause
  • IV diuretics
58
Q

What are some causes of hypomagnesemia ?

A
  • malabsorption disorders
  • inflammatory bowel disease (IBD)
  • diarrhea/pancreatitis
  • certain abdominal surgeries
  • alcoholism
  • diuretics
59
Q

What are some symptoms of hypomagnesemia ?

A
  • N, V, decreased appetite
  • weakness, fatigue
  • confusion
  • neuromuscular changes
  • tremors/seizures
  • hyperactive deep tendon reflexes
  • painful muscle contractions
60
Q

What are some treatments for hypomagnesemia ?

A
  • treat underlying cause
  • Mg supplement

Fundamentals of Nursing (14 decks)

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