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z_NUR112: Exam 3 > Ch 42: Electrolytes and Fluid Balance > Flashcards

Ch 42: Electrolytes and Fluid Balance Flashcards

1
Q

Purpose of Na

A

Maintains blood pressure and fluid balance; regulates water in/out of cells

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2
Q

Purpose of K

A

Cardiac and nerve function

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3
Q

Purpose of Mg

A

Muscle and nerve function

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4
Q

Purpose of Ca

A

Bone formation and muscle contraction

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5
Q

Purpose of Ph

A

Critical for cellular metabolism b/c it is a component of ATP

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6
Q

Purpose of Cl

A

Cellular fluid balance Assist in maintenance of blood volume, pressure and pH

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7
Q

Normal range: Na

A

135-145

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8
Q

Normal range: K

A

3.5-5.0

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9
Q

Normal range: Mg

A

1.5-2.5

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10
Q

Normal range: Ca

A

8.5-10.5

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11
Q

Normal range: Ph

A

1.8-2.6

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12
Q

Normal range: Cl

A

98-105

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13
Q

Fluid moves in and out of a cell through the process of…

A

Osmosis

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14
Q

Osmosis is the movement of fluid from _____ concentrated to _____ concentrated.

A

less, more

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15
Q

Describe the concentration relationship within an Isotonic solution.

A

Concentration is equal inside and out

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16
Q

Why is an Isotonic solution used?

A

To increase extracellular fluid volume

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17
Q

What are some reasons for the loss of extracellular volume?

A
  • Blood loss - Dehydration (vomiting/diarrhea) - Surgery
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18
Q

Give four fluid types that are Isotonic solutions

A
  1. 0.9% NS
  2. 5% Dextrose in H2O (D5W)
  3. 5% Dextrose in 0.225% NS
  4. Lactated Ringers
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19
Q

Describe the concentration relationship within an Hypotonic solution.

A

Low concentration solution

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20
Q

What happens when you administer a hypotonic solution?

A

The water of the solution will be drawn to the higher concentration of sodium in the cell thus will move inside the cell causing cellular edema and eventually cytotysis

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21
Q

What is the biggest danger of administration of a hypotonic solution?

A

Brain tissue swelling and increased intercranial pressure, which can lead to brain damage or death.

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22
Q

What are the three types of Hypotonic solution?

A
  1. 0.45% NS (1/2 NS)
  2. 0.33% NS (1/3 NS)
  3. 0.225% NS (1/4 NS)
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23
Q

Describe the concentration relationship within an Hypertonic solution.

A

It is a high concentration solution

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24
Q

What happens when you administer a hypertonic solution?

A

The sodium in the solution will draw the water out of the cell and the cell will shrink.

25
Q

Give two examples that a hypertonic solution is good for treating.

A
  1. Hyponatremia - because it adds sodium to extracellular fluid
  2. Cerebral edema - because it shrinks the cells
26
Q

Would you administer a hypertonic solution quickly or slowly?

Why?

A
  • Slowly
  • The solution is hard on the veins and could cause phlebitus
27
Q

What solution is good for diabetic maintenance?

What type of solution is it?

A
  • D5W
  • Isotonic
28
Q

What type of solution is used for electrolyte maintenance and burn victims?

What type of solution is it?

A
  • LR
  • Isotonic
29
Q

What type of solution has concentrations of halves, thirds and quarters?

A

Hypotonic

30
Q

In terms of IV site prep, what does infiltration mean?

A

The needle has gone through the vein

31
Q

What are some signs of IV infiltration?

A
  • Blanching and skin coolness around insertion site
  • Inflammation and pain at site
  • Site should not hurt and is an indication something is wrong
32
Q

IV infiltration intervention?

What do we need to keep in mind for this intervention?

A
  • Remove and replace IV in a different location
  • Don’t need an order to insert IV.
  • Fluids/meds require MD order
33
Q

What is phlebitus?

A

Inflammation of a vein

34
Q

What are five signs of Phlibitis?

A
  1. Non-blanching
  2. Pain
  3. Erythema/redness
  4. Oozing
  5. Vein distention (bulging)
35
Q

What are 5 risks/complications of Phlebitis?

A
  1. Local infection
  2. Abscess formation
  3. Clot formation
  4. DVT
  5. Pulmonary embolism
36
Q

Phlebitis intervention?

A

Notify MD/HCP

37
Q

What is the setup for a blood transfusion before getting blood?

A
  • Get concent
  • Set IV
    • make sure its patent (clear)
    • use #20 needle minimum
  • Vitals
    • taken before, during, after
  • Check order
  • Then get blood
38
Q

After setup and blood is acquired, what should be done?

A
  • Get a second nurse
  • Double check medication, type, concents together
  • One reads, other checks and repeats
39
Q

When do blood transfusion reactions typically occur?

A

Within the first 15 minutes

40
Q

What are 6 symptoms of a blood transfusion reaction?

A
  1. Chills
  2. Fever
  3. SOB
  4. Chest pain
  5. Hypotension
  6. Hemoglobinuria (red urine)
41
Q

What is the only type of solution that should be given with a blood transfusion?

A
  • Normal Saline (sodium/water) - LR can also be used, but doesn’t last as long as NS - both are isotonic
  • Others contain additives that will destroy blood
42
Q

What do you do if there is a Hemolytic Transfusion reaction?

A
  • Stop transfusion immediately
  • Replace blood with secondary bag of NS - free flow - to flush out system
  • Double check blood type is correct/if not return blood and acquire correct
  • Start transfusion with correct.
  • MD will direct action
43
Q

At the end of the blood transfusion, what do you do?

A
  • Clamp blood
  • Flush remaining in lines through with saline
  • Run until lines are completely clear of blood
44
Q

What is hyponatremia?

Give levels.

A
  • Low blood Sodium, H2O excess
  • Level is <135
45
Q

Hyponatremia

Signs and Symptoms

A
  • Nausea, vomiting, diarrhea
  • Dizziness
  • Abdominal cramping
  • Tachycardia
  • Convulsions, Siezures, Coma
46
Q

Hypernatremia

Signs and Symptoms

A
  • Extreme thirst
  • Dry and flushed skin
  • Dry and sticky tongue and mucous membranes
  • Fever
  • Agitation, Restlessness and irritability
47
Q

Hypokalemia

Signs and Symptoms

A

“LOW AND SLOW”

  • Tired/Weakness/fatigue
  • Bradycardia
  • Dysrhythmias
  • Decreased bowel sounds w/ distention
  • Nausea/vomiting
48
Q

Hyperkalemia

Signs and Symptoms

A
  • Anxiety
  • Dysrhythmia
  • Paresthesia - painless tingling or numbness, skin crawling, or itching of the extremities
  • Weakness
  • Abdominal cramps, Diarrhea
49
Q

Hypocalcemia

Signs and Symptoms

A
  • Positive Trousseau’s sign – carpopedal spasm with hypoxia
  • Positive Chvostek’s sign – contraction of facial muscles when facial nerve tapped
  • Tetany, Muscle cramps
  • Pathological fractures (chronic hypocalcemia)
  • Numbness and tingling fingers and circumoral (around mouth) region
50
Q

Hypercalcemia

Signs and Symptoms

A
  • Excessive thirst and frequent urination
  • Stomach pain and digestive problems
  • Bone pain and muscle weakness
  • Confusion, lethargy, and fatigue
  • High blood pressure and abnormal heart rhythms.
51
Q

What is the treatment for HYPOKALEMIA?

A
  • Potassium chloride
  • Given slowly on pump
  • Too much can result in cardiac arrest
  • NEVER PUSH … IVP
52
Q

What is the treatment for HYPERKALEMIA?

A
  • Insulin - so Potassium shifts back into cells
  • Glucose - to maintain glucose blood levels and avoid hypoglycemia

Also,

  • Kayexalate (can be given orally or rectally)
    • Orally preferred unless obstructed
53
Q

Hypoglycemia

Signs and Symptoms

A
  • Tremors
  • Tachycardia
  • Diaphoresis
  • Dizzy
  • Anxious/Irritable
  • Hungry
  • Blurry vision
  • Weaknes/fatigue
  • Headache
54
Q

Hyperglycemia

Signs and Symptoms

A
  • Extreme thirst
  • Polyuria
  • Dry skin
  • Drowsy
  • Slow-healing wounds
55
Q

How do we assess Chvostek’s sign and what is it indicative of?

A
  • Facial twitches when face (CNVII) is touched
  • Indicative of
    • hypocalcemia
    • hypomagnesemia
    • metabolic alkalosis
56
Q

How do we assess Trousseau’s sign and what is it indicative of?

A
  • Blood pressure cuff inflated to 20mmHg over systolic pressure
  • Positive sign is indicated with finger and wrist contraction with some pronation
  • Indicative of
    • Hypocalcemia
    • Hypomagnesemia
    • Metabolic Alkalosis
57
Q

What is tetany?

A

Involuntary muscle spasms, which may be caused by disorders that increase the action potential frequency of muscle cells or the nerves that innervate them

58
Q

How long is an IV site and tubing good for?

A

72hrs (3 days)

z_NUR112: Exam 3 (7 decks)

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