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Med-Surg > Adult: Electrolyte/Fluid Balance > Flashcards

Adult: Electrolyte/Fluid Balance Flashcards

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1
Q

What are the reasons that edema occurs ?

A
  • decreased oncotic pressure (low plasma protein/albumin)
  • increased hydrostatic pressure (fluid overload, obstruction (clot/tourniquet)
  • increased interstitial oncotic pressure
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2
Q

What is the third space ?

A

fluid accumulation in non-functional areas between cells where it is difficult/impossible to move back into cells or blood vessels
- pleural cavity, or peritoneal cavity

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3
Q

Where does the blood plasma get the oncotic pressure ?

A
  • protein
  • albumin
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4
Q

How does fluid stay in the vascular system ?

A

capillaries/veins/arteries hold it in
- oncotic pressure pulls the fluid into the blood vessels

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5
Q

What does Anti-Diuretic Hormone (ADH) control ?

A

how much fluid the body holds onto
- activated by stress, decreased BP, and pain

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6
Q

What can disrupt and cause the imbalance in overall body fluid ?

A
  • alterations in ADH
  • thirst mechanism (may decline with age)
  • kidney function (responsible for making urine)
  • GI changes (N,V,D)
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7
Q

What are special considerations about fluid balance for older adults ?

A
  • can lose the function of thirst mechanism
  • hormonal changes can increase risk of fluid and electrolyte imbalances
  • loss of subQ tissue can lead to increase loss of moisture
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8
Q

What is hyperosmolarity ?

A

> 295 mOsm/kg
- increased solute (Na) and decreased water
- deficit

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9
Q

What is hypoosmolarity ?

A

< 275 mOsm/kg
- decreased solute (Na) so increased water
- excess

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10
Q

What are causes of Fluid Volume Deficit ?

A
  • hemorrhage
  • H20 loss/perspiration
  • inadequate fluid intake
  • overuse of diuretics
  • GI loss ( vomit, diarrhea, or suctioning)
  • osmotic diuresis ( increased glucose levels)
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11
Q

What are some signs and symptoms of Fluid Volume Deficit ?

A
  • thirst
  • dry mucous membranes
  • cold, clammy skin
  • weight loss
  • decreased urine output and concentrated urine
  • decreased skin turgor
  • postural hypotension
  • tachycardia and increased respirations
  • seizures/coma
  • confusion and restlessness
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12
Q

What is the best indicator for fluid volume gain/loss ?

A

daily weights
- 1 L of fluid= 1 kg body weight
- weight everyday preferable in the morning

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13
Q

What are other ways to assess fluid volume status ?

A
  • I and O’s
  • skin turgor
  • urine specific gravity
  • serum/blood osmolality
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14
Q

What does urine specific gravity say about fluid volume status ?

A

normal= 1.010-1.025
- elevated= urine is concentrated (fluid deficit)
- low= urine is dilute (fluid excess)

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15
Q

What does serum/blood osmolality say about fluid volume status ?

A
  • elevated= fluid deficit
  • low= fluid excess
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16
Q

What is normal plasma osmolality ?

A

280-295 mOsm/kg

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17
Q

What is hyperosmolality ?

A

greater than 295 mOsm/kg
- increased solute (Na), too little water (water deficit)

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18
Q

What is hypoosmolality ?

A

less than 275 mOsm/kg
- decreased solute (Na), too much water (water excess)

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19
Q

What does an elevated Blood Urea Nitrogen (BUN) tell you ?

A

not enough urine to excrete the urea/nitrogen
- so the levels are elevated
- sign of dehydration of renal insufficiency

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20
Q

What are some causes of fluid volume excess ?

A
  • excess Iso/Hypotonic IV fluids
  • heart failure
  • renal/kidney failure
  • syndrome of inappropriate ADH
  • polydipsia
  • cushing syndrome
  • corticosteroids
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21
Q

What are some S&S of fluid volume excess ?

A
  • weight gain
  • peripheral edema
  • jugular venous distension
  • respiratory crackles, dyspnea
  • S3 heart sound
  • bounding pulse
  • elevated BP
  • seizures/coma
  • confusion & changed in LOC
  • HA
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22
Q

If you have fluid volume excess, how may your RBCs appear ?

A

RBCs counts may appear low due to dilution of the blood

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23
Q

What is tx for fluid volume excess ?

A
  • diuretics
  • fluid restriction
  • paracentesis or thoracentesis if fluid is in the peritoneal or thoracic cavity
  • skin care
  • elevate edematous extremities (not if pt’s has HF because it puts extra work on the heart and fluid goes to the heart)
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24
Q

What are some facts about Furosemide (Lasix) ?

A

Loop diuretic
- Assessments: I&O’s, BP (can decrease), assess for fluid excess/deficit, Potassium levels
- Admin: given PO or IV push (when IV push give slow if not it can cause ototoxicity so it can cause ears to ring and temporary hearing loss)
- Adverse Effects: dehydration (too much urine output), Hypokalemia

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25
For Hypotonic fluids, does the water move into or out of the cells ?
will move water into the cells - cells swell
26
For Hypertonic fluids, does the water move into or out of the cells ?
will move water out of the cells - cells shrink
27
For Isotonic fluids, does the water move into or out of the cells ?
there is no water shift - fluid has the same osmolality as the cell interior - only fluid that can be given fast - preferred for fluid volume deficit
28
What is the Isotonic fluid ,0.9% Sodium Chloride (NaCl) for ?
can increase Na and Cl levels if given in large amounts or if those levels were low
29
What is the Isotonic fluid, Lactated Ringer's for ?
contains Na, K, Cl, Ca and lactate - good for patient's experiencing trauma or major GI loss (post-trauma, surgery, etc.)
30
What types of fluids are Isotonic ?
- 0.9% Sodium Chloride (NaCl) aka Normal Saline - Lactated Ringer's
31
What is the Hypotonic fluid, 0.45% Sodium Chloride "1/2 NS" for ?
preferred for hypernatremia or for continuous, slow hydration
32
What is the Hypotonic fluid, Dextrose 5% in water for ?
preferred for pt needing some dextrose/calories and continuous slow cell hydration, also for hypernatremia - dextrose is quickly absorbed so you are basically giving straight water
33
What is the Hypertonic fluid, 3% Sodium Chloride for ?
preferred for severe hyponatremia or traumatic head injury - only given in progressive/intensive care
34
What is the Hypertonic fluid, Dextrose 10% in water for ?
preferred for patient with hypoglycemia or risk for hypoglycemia
35
What are some adverse effects for Hypertonic fluids ?
- hypernatremia - extracellular fluid volume overload - Assess BP, lungs, and Na levels - these solutions are vesicants so give via central line if possible
36
What types of fluids are Hypertonic ?
3% Sodium Chloride, Dextrose 10% in water
37
What types of fluids are Hypotonic ?
0.45% Sodium Chloride "1/2 Normal Saline", and Dextrose 5% in water
38
What are colloids used for ?
to expand volume in the vasculature (blood vessels)
39
What types of fluids are colloids ?
Albumin (25% most common) & Packed Red Blood Cells
40
What is the Colloids fluid, Albumin used for ?
preferred for cirrhosis (low protein) patients, burns, ascites - may be given in lower concentrations to increase the plasma volume (5% will not pull fluid in)
41
What does Albumin do in the body ?
it's a protein product from blood plasma that helps pull fluid into the blood vessels
42
What is the Colloid fluids, Packed Red Blood Cells used for ?
preferred for pt who has lost blood
43
What is the normal values of Sodium and Potassium ?
- Na: 135-145 meq/L - K: 3.5-5 meq/L
44
How does Sodium affect the body ?
- primary determinant in the way fluid shifts in the body - helps generate/transmit nerve impulses - primary determinant of osmolality - impacts both neuro like (muscles and brain function)
45
How does Potassium affect the body ?
- main factor in resting potential of nerve and muscle cells - impacts neuromuscular and cardiac function - excreted via urine so kidney function is key to proper excretion of K
46
What role does Insulin have in Potassium ?
insulin is needed to pull K back into the cells
47
Does a lack of insulin cause Hypo or Hyperkalemia ?
hyperkalemia
48
What EKG changes does hypokalemia cause ?
- flattened T Waves - prolonged QRS
49
What EKG changes does hyperkalemia cause ?
- tall/peaked T waves - wide QRS
50
Why don't we give IV Potassium IV push or fast ?
can cause cardiac arrest
51
Before giving someone supplemental K, what do we have to ensure the pt is doing ?
have to be voiding because we get rid of excess Potassium through excretion
52
If a pt is experiencing Hyperkalemia then what meds should we give ?
- Meds to decrease K levels: Diuretics (Furosemide), Sodium Polystyrene (Kayexalate), and Sodium Zirconium (Lokelma) - Calcium Gluconate is also given to protect the cardiac cells from serious dysrhythmias
53
What foods are rich in Potassium ?
- potato - broccoli - banana - tomato
54
What are some facts about Sodium Polystyrene (Kayexalate) ?
Cation Exchange Resin: exchanges K+ ions for Na ions in the intestine - excretes the K+ by way of GI tract (pt will poop) - Assessments: output and K+ levels - Adverse Effects: abdominal cramping, diarrhea, Hypernatremia, loss of Mg and Ca - Admin: given orally (liquid), NG tube, or enema
55
What are some causes of hypokalemia ?
- GI loss (N/D) and skin loss (diaphoresis) - renal loss/urination, and suctioning - dialysis - poor diet/starvation, fasting - Meds: diuretics (furosemide), and insulin (in large amounts)
56
What are some S&S of hypokalemia ?
- leg cramps/muscle weakness - irregular pulse - fatigue, irritability - EKG changes: flattened T-waves, prolonged QRS - shallow respirations - decreased muscle tone/reflexes
57
What are some causes of Hyperkalemia ?
- excessive K+ intake - rapid admin of IV fluids with K+ - renal/kidney disease - adrenal insufficiency - Addison's disease - Meds: ACE inhibitors "prils", K+ sparring diuretics (spironolactone) - lack of insulin
58
What are some S&S of hyperkalemia ?
- muscle cramps/twitching - urine abnormalities (oliguria) - respiratory distress - decreased cardiac contractility and palpations - EKG changes: tall/peaked T-Waves, wide QRS) - reflexes (hypo or hyper-reflexive)
59
What are some tx for hyperkalemia ?
- encourage excretion via diuretic or bowel movement - severe kidney failure pt's may need dialysis - insulin IV push will draw K+ back into the cells and B-agonist (albuterol) for more effectiveness (with D50 to prevent hypoglycemia)
60
What are some causes of hyponatremia ?
- GI loss (V/D) - diuretics, adrenal insufficiency - burns, draining wounds - excessive hypotonic IV fluid - polydipsia - diseases causing fluid retention (heart failure and cirrhosis)
61
What are some S&S of hyponatremia ?
- confusion - fatigue and feeling of weakness - low BP - loss of consciousness - convulsions/seizures - N and V
62
What are some causes of hypernatremia ?
- hypertonic IV fluid or excessive isotonic - hypertonic tube feed without enough H2O - insufficient H2O intake and drowning in salt water - loss of pure H2O like in high fevers, heatstroke, prolonged hyperventilation - Endocrine related syndromes: Cushing's syndrome, Diabetes Insipidus, hyperaldosteronism
63
What are some S&S of hypernatremia ?
- flushed skin and fever (low grade) - restlessness, irritable, anxious and confused - increased BP and fluid retention - edema (peripheral) and pitting - decrease urine output and dry mouth - thirst

Med-Surg (23 decks)

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