Fluid & Electrolytes

Question 1

What are the two main compartments that fluid is divided into in the body?

Answer 1

Extracellular fluid (ECF)

Intracellular fluid (ICF)

• interstitial fluid (fluid b/w cells, blood, plasma
• transcellular fluid (CSF)

Question 2

Where is most of the body’s fluid located?

Answer 2

Intracellular space (25 liters)

Question 3

Water-pushing pressure
The force that pushes water outward from a confined space through a membrane
Example: BP

Answer 3

Hydrostatic Pressure

Question 4

Clinical significance of changes in normal hydrostatic pressure

Answer 4

Edema

Question 5

Water-pulling pressure created by proteins (notably albumin) in the circulatory
Pulls water into the circulatory system

Answer 5

Oncotic pressure/colloid osmotic pressure

Question 6

Measurable fluid intake

Answer 6

PO fluids, IV fluids, Enteral feedings, irrigation fluids

Question 7

Measurable fluid output

Answer 7

urine, sweating, emesis, feces

Question 8

The kidneys release ____ in response to a decreased BP

Answer 8

Renin

Question 9

Explain the renin-angiotensin II pathway

Answer 9

• Kidneys release renin
• Renin converts angiotensinogen (released by the liver) into angiotensin I
• Angiotensin I converted to Angiotensin II in the lungs
• Angiotensin II causes vasoconstriction and increases BP

Question 10

How do ACE Inhibitors work?

Answer 10

Prevents the conversion of angiotensin I to II

Helps the body vasodilator and decrease BP

Question 11

1 L of water = ____ kg

Answer 11

1 kg

therefore weight change of 1 lb = fluid volume change of about 500 mL

Question 12

Assessment findings of fluid overload

Answer 12

Pulmonary crackles, lower extremity edema, JVD

Question 13

Normal K+

Answer 13

3.5 - 5

Question 14

What is the impact of hypokalemia on ECG?

Answer 14

ST depression, shallow/depressed T wave, prominent U wave

Question 15

S/S of hypokalemia

Answer 15

dysrhythmias, constipation, palpitations, excessive fatigue, muscle damage/spasms numbness/tingling

Question 16

IV K+ should not exceed ____ mEq/liter

is best at ____ mEq/liter

rate max is ____ mEq/hr

Answer 16

60

40

10-20

Question 17

Important to remember about hypokalemia tx

Answer 17

check urine output - should be at least .5 mL/kg

oral K+ replacement are big pills that can be difficult to swallow - don’t crush/break these

IV: tough on veins, monitor for pain at IV site

Question 18

What is the impact of hyperkalemia on ECG?

Answer 18

Widened QRS, ST elevation, narrow/peaked T wave

Can also lead to V fib and ventricular standstill

Question 19

S/S of hyperkalemia

Answer 19

irritability, abdominal cramping, diarrhea, weakness, irregular pulses, cardiac arrest if sudden/severe

Question 20

Tx for hyperkalemia

Answer 20

Kayexalate (binds to K+ in the colon in exchange for Na) - causes diarrhea

IV Calcium Gluconate

IV insulin/dextrose - moves K+ into the cells

Lasix - K+ wasting diuretic

Question 21

Normal Na

Answer 21

135 - 145

Question 22

Causes of hyponatremia

Answer 22

Loss of Na- excessive sweating, GI, diuresis

Dilutional- polydipsia, renal disease, increased ADH

Question 23

S/S of hyponatremia

Answer 23

Impact is mainly on the nervous system

muscle cramps, weakness, fatigue

below 125 - progressive neuro symptoms, seizures, coma

Question 24

Tx of hyponatremia

Answer 24

Fluid restriction - monitor Na levels q 6 hr and adjust accordingly

IV fluids w/ Na

Question 25

Causes of hypernatremia

Answer 25

Loss of fluid - diarrhea, dehydration, diuretics, DI, fever

Gain of Na - Hypertonic IV fluids, saltwater near drowning, etc

Question 26

S/S of hypernatremia

Answer 26

Nervous system symptoms

intense thirst, restlessness, agitation, altered mental status, seizures, coma

Question 27

Tx of hypernatremia

Answer 27

Hypotonic IVF (low in Na), oral fluids

Question 28

Normal Ca

Answer 28

8.8 - 10.5

Question 29

Causes of hypocalcemia (book says below <9)

Answer 29

inadequate intake, inadequate Vit D, End stage kidney disease, diarrhea

acute pancreatitis, immobility, removal/destruction of parathyroid (secretes PTH which increases serum Ca)

Question 30

S/S of hypocalcemia

Answer 30

think muscles and neuro

fatigue, depression, numbness, tingling, hyperreflexia, muscle cramps, tetany, seizures

Trousseau’s sign: BP cuff on arm causes flexion of the hand

Chvostek’s sign: eye twitch

Question 31

Tx of hypocalcemia

Answer 31

Foods high in Ca, oral replacement, IV Ca gluconate

Question 32

Causes of hypercalcemia

book says >11

Answer 32

kidney failure, hyperparathyroidism, immobility, use of steroids, dehydration

Question 33

S/S of hypercalcemia

Answer 33

weakness, lethargy, confusion, coma, decreased reflexes, bone pain, fractures

Shortened QT interval, increased HR & BP

Higher risk for kidney stones

Question 34

Tx of hypercalcemia

Answer 34

lasix, hydration (PO, fluids, Isotonic IV fluids), calcitonin (decreases calcium levels), weight bearing activities

Question 35

Normal Cl

Answer 35

95 - 105

Question 36

Normal Mg

Answer 36

1.8 - 3

Question 37

Normal Phosphorus

Answer 37

3 - 4.5

Question 38

Causes of hyperchloremia

Answer 38

metabolic acidosis, respiratory alkalosis, hypercortisolism

Question 39

Causes of hypochloremia

Answer 39

fluid overload, excessive vomiting/diarrhea, adrenal insufficiency, diuretics

Question 40

Causes of hypermagnesemia

Answer 40

kidney disease, hypothyroidism, adrenal insufficiency

Question 41

Causes of hypomagnesemia

Answer 41

malnutrition, alcoholism, ketoacidosis

Question 42

Causes of hyperphosphatemia

Answer 42

kidney disease, hypoparathyroidism, acidosis, hypocalcemia

Question 43

Causes of hypophosphatemia

Answer 43

chronic antacid use, hyperparathyroidism, hypercalcemia, Vit D deficiency, alcoholism, malnutrition