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NURS 470 > High acuity fluids and electrolytes > Flashcards

High acuity fluids and electrolytes Flashcards

1
Q

osmosis

A

movement of H20 between compartments across permeability membrane

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2
Q

osmolality

A

concentration of solute in body of water

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3
Q

starling forces

A

governs the passage exchange of water between the capillary microcirculation and the interstitial fluid
an equation that illustrates the role of hydrostatic and oncotic forces

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4
Q

hydrostatic pressure

A

pressure exerted by fluid in the interstitial or capillary space against the cell wall
arterial=high
venous=low

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5
Q

oncotic pressure

A

pressure exerted by plasma proteins in the capillary or within the interstitial space

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6
Q

second space edema

A

pitting and non-pitting edema
in the interstitial space

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7
Q

third space fluid

A

ascites
body cavities that normally don’t have fluid

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8
Q

isotonic solutions

A

closely approximates normal serum plasma osmolality
NS and LR

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9
Q

hypotonic solutions

A

shifts fluids from the intravascular compartment into intracellular compartments
FLUID INTO CELL
1/2NS, D5W

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10
Q

hypertonic solutions

A

shifting fluids from ICF and ECF into intravascular compartment (expands blood volume)
D10W, D51/2NS, 3%NS

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11
Q

hypernatremia causes

A

renal losses
hypertonic feedings (tube feeds)
increased Na intake
hyperaldosteronism
high stress & increased cortisol
diabetes insipidus

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12
Q

hypernatremia symptoms

A

FRIED SALT
flushed skin and fever
restless, irritable, anxious, confused
increased blood pressure and fluid retention
edema: peripheral and pitting
decreased urine output
skin flushed
agitation
low-grade fever
thirst

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13
Q

hypernatremia treatment

A

depends on cause (treat cause)
fluids
DI -> give ADH
reduce Na intake
tx aldosteronism

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14
Q

hyponatremia causes

A

use of diuretics
vomiting
diarrhea
diaphoresis
urination
hypovolemia
SIADH

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15
Q

hyponatremia symptoms

A

SALTLOSS
stupor/coma
anorexia, nausea, vomiting
lethargy
tendon reflexes (decreased)
limp muscles (weakness)
orthostatic hypotension
seizures/headache
stomach cramping

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16
Q

hyponatremia treatment

A

increase Na to H2O ratio
give Na
tx underlying cause
restrict fluid
normalize serum osmolality
assess volume status of patient
assess urine sodium concentration

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17
Q

diabetes insipidus

A

“water diabetes”
abnormal secretion or action of ADH

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18
Q

diabetes insipidus s/s

A

up to 20L urine/day
low specific gravity
low osmolarity
hypovolemia
increased thirst
tachycardia
hypotension

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19
Q

4 types of DI

A

central
nephrogenic
gestational
primary polydipsia

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20
Q

central diabetes insipidus

A

decreased secretion of ADH
causes: idiopathic, head trauma, pituitary tumor, neurosurgery

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21
Q

nephrogenic diabetes insipidus

A

kidney resistance to ADH
causes: lithium toxicity, renal disease, hypokalemia, pregnancy, meds

22
Q

diagnostic criteria for DI

A

low urine osmolality
high serum osmolality
low urine specific gravity
hypernatremia

23
Q

DI treatment

A

hormonal replacement therapy with Desmopressin or Vasopressin

24
Q

DI collaborative management

A

frequent neuro assessments
monitor I&O hourly
monitor electrolytes
replace fluids
hormonal replacement

25
Q

SIADH

A

increased production of ADH
increased water reabsorption in renal tubules
increased water retention and dilutional hyponatremia with a low serum osmolality

26
Q

causes of SIADH

A

brain damage: meningitis, SAH
infective: pneumonia, lung or brain abscess
hypothyroidism
malignancy: SCLC
drugs: carbamazepine, SSRIs, amitriptyline, morphine

27
Q

SIADH pathophysiology

A

increased production/release of ADH
increased water reabsorption/retention
water intoxication

28
Q

SIADH s/s

A

oliguria (<400mL/24hr) in absence of hypovolemia
hyponatremia
high urine specific gravity (>1.02)

29
Q

SIADH lab manifestations

A

low serum Na (<130)
low serum osmolality (<280)
high urine osmolality (>500)
high urine Na (>20)

30
Q

SIADH collaborative interventions

A

frequent neuro assessment
water restriction
seizure precautions
high sodium diet
NS IV or hypertonic saline
demeclocycline (derivative of tetracycline)

31
Q

rhabdomyolysis definition

A

rapid release of cellular contents from damaged skeletal muscle cells

32
Q

rhabdomyolysis causes

A

muscle injury: trauma, burns, electrocution, immobilization, metabolic disorders, DKA, hyponatremia, hypokalemia, hypophosphatemia, ischemia, compression, vascular injury, SCD
meds/illicit drugs
increased muscular activity: sport, seizures, status asthmaticus, infections, inflammatory myopathies, hypo/hyperthermia, idiopathic

33
Q

s/s of rhabdomyolysis

A

myoglobinuria (brown urine)
hyperuricemia
hyperkalemia
hyperphosphatemia
hypocalcemia -> cardiac arrythmias
elevated Creatinine kinase

34
Q

rhabdomyolysis complications

A

AKI
compartment syndrome
DIC
MODS

35
Q

rhabdo collaborative management

A

alkalinization of urine
correct electrolyte imbalances (reverse acidosis)
IV hydration and diuresis (NPO status)
fasciotomy
dialysis

36
Q

tumor lysis syndrome definition

A

rapid tumor cell death resulting from cancer therapy causing rapid release of intracellular contents

37
Q

highest risk tumor types for tumor lysis syndrome

A

non-hodgkins lymphoma
acute leukemias
chronic lymphoblastic leukemia
solid tumors

38
Q

pathophysiology of tumor lysis syndrome

A

complex series of events causing spilling of intracellular contents from tumor cells,
an inability of the kidneys to excrete and maintain normal serum levels

39
Q

s/s of tumor lysis syndrome

A

hyperuricemia
hyperphosphatemia
hypotension
hyperkalemia
hypocalcemia -> cardiac arrythmia and arrest
fluid overload, weight gain, edema -> respiratory failure
anuria
oliguria
weakness
lethargy
cramping
tetany
renal insufficiency
flank pain
N/V/D

40
Q

s/s of hyperuricemia

A

N/V
azotemia
oliguria/anuria
decreased urine pH
uric acid crystals found in urinalysis

41
Q

hyperkalemia s/s

A

EKG changes: flat P, wide QRS, high T
weakness
twitching
hyperactive bowel sounds
nausea
diarrhea

42
Q

hyperphosphatemia s/s

A

hypocalcemia
joint/muscle pain
renal failure
hypertension
edema

43
Q

hypocalcemia s/s

A

cramping
tetany
Chvostek’s sign: muscle twitch on cheek
Trousseau’s sign: arterial blood flow occlusion with fingers extending
EKG changes: prolonged QT

44
Q

tumor lysis syndrome collaborative management

A

administer allopurinol
alkalinization or urine
correct electrolyte imbalance
aggressive hydration starting prior to chemo
dialysis

45
Q

hepatorenal syndrome

A

occurrence of renal failure in a patient with advanced liver disease in the absence of an identifiable cause of renal failure

46
Q

HRS etiology

A

serious complication of liver cirrhosis with poor prognosis
portal vein HTN fluids back up into abdomen

47
Q

2 types of HRS

A

type 1: decreased systemic circulation (BP)
type 2: severe ascites, refractory to diuresis

48
Q

HRS pathophysiology

A

portal hypertension -> splanchnic vasodilation -> decreased effect circulatory volume -> RAAS activation -> renal vasoconstriction -> HRS

49
Q

hepatic-related ascites

A

liver cirrhosis is most common cause
ascites is caused by a combo of increased hydrostatic pressure in liver veins (Portal HTN) and decrease in colloid osmotic pressure

50
Q

HRS s/s

A

type 1: rapid, progressive
type 2: chronic, slowly progressive
general:
liver failure w/ increased LFTs
oliguria
decreased serum and urine Na
increased BUN and Cr
decreased GFR

51
Q

HRS collaborative management

A

fluid restriction
CRRT
pharm: midodrine, octreotide, albumin
surgical: liver transplant, transjugular intrahepatic portosystemic (TIPS) shunt

52
Q

NANDAs

A

excess fluid volume
deficient fluid volume
electrolyte imbalance
impaired liver function

NURS 470 (28 decks)

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