chapter 40 - fluid and electrolytes

Question 1

what are the functions of water in the body?

Answer 1

medium for transport
needed for cellular metabolism
solvent for electrolytes
maintains body temperature
aids in digestion and elimination
acts as a lubricant

Question 2

what makes up what percent of adult body weight?

Answer 2

55-60%

Question 3

what is the average output per hour to maintain renal function?

Answer 3

30-60mL/hr

Question 4

What is the hypothalamus responsible for?

Answer 4

thirst receptors

monitors serum osolarity

Question 5

what does the pituitary regulate?

Answer 5

releases ADH in response to increasing serum osmolarity

Question 6

intracellular fluid

Answer 6

the fluid inside the cell

2/3 of the body’s water is in the ICF

Question 7

extracellular fluid & types

Answer 7

fluid on the outside of the cell
1/3 of the body’s water
the body is more prone to loss of this fluid

Question 8

how does the body gain water

Answer 8

ingestion of liquids and foods (2300 mL/day)

during cellular respiration and dehydration synthesis (200mL/day)

Question 9

how does the body lose water

Answer 9

through the:
kidneys (1500mL/day)
evaporation from the skin (600 mL/day)
the exhalation from the lungs (300mL/day)
feces (100mL/day)

Question 10

interstitial fluid

Answer 10

the fluid around/between cells

lymph

Question 11

intravascular fluid

Answer 11

The fluid in the blood vessels (plasma)

Question 12

transcellular fluid

Answer 12

CSF, synovial fluid, pleural fluid, cardiac fluid, etc

Question 13

osmosis

Answer 13

water (solvent) passes from an area of lesser solute concentration and more water to an area of greater solute and less water concentration

Question 14

osmolarity

Answer 14

the concentration of particle in a solution

Question 15

isotonic

Answer 15

remains in the intravascular space without any net flow across the semipermeable membrane
isotonic = same osmolarity as plasma

Question 16

Hypotonic

Answer 16

moves out of the intravascular space into the ICF, causing cells to swell and possibly lyse
less osmolarity than plasma

Question 16

Hypertonic

Answer 16

water moves out of the cells and in drawn into the intravascular compartment, causing cells to shrink
has greater osmolarity through plasma

Question 17

name hypertonic fluids

Answer 17

5% dextrose in Lactated Ringer’s

5% dextrose in 0.9% NaCl

Question 18

name isotonic fluids

Answer 18

0.9% NaCl (normal saline)

Lactated Ringer’s solution

Question 19

name Hypotonic solutions

Answer 19

0. 33% NaCl (1/3 strength normal saline)

0. 45% NaCl (1/2 strength normal saline)

Question 20

Diffusion

Answer 20

solutes move freely throughout a solvent. Moves from an area of higher concentration to an area of low concentration
ex. O2 and CO2

Question 21

active transport

Answer 21

the process that requires energy for the movement of substances through a cell membrane, against the concentration gradient from an area of lesser solute to a higher area of solute
*uses ATP

Question 22

Filtration

Answer 22

the passage of fluid through a permeable membrane from an area of high pressure to low pressure

Question 23

Fluid Volume Deficit

Answer 23

Loss of water and electrolytes from ECF

Question 24

causes of fluid volume deficit

Answer 24

``` increased output hemorrhage vomiting diarrhea burns or thirs spacing ```

Question 25

what is third spacing

Answer 25

a distributional shift of body fluids into the transcellular compartment

Question 26

Dehydration

Answer 26

the loss of or deprivation of water from the body or tissues

Question 27

Hypovolemia

Answer 27

fluid loss. can also be termed dehydration

Question 28

Causes of Hypovolemia

Answer 28

``` loss of fluid from anywhere hemorrhage Trauma Vomiting/diarrhea Third spacing: burns & ascites Polyuria: Diabetes, Diuretics ```

Question 29

signs and symptoms of hypovolemia

Answer 29

``` flat neck veins increased HR increased R increased Urine Specific Gravity low BP low cardiovascular pressure decreased weight decreased skin turgor decreased urine output dry muscous membranes increased Hematocrit increased sodium increased BUN *thirst ```

Question 30

treatment/considerations for Hypovolemia

Answer 30

fluid replacement (PO or IV) monitor for fluid overload risk for falls due to orthostatic hypertension daily I&O and weights

Question 31

Hypervolemia

Answer 31

fluid volume overload (over hydration)

Question 32

causes of Hypervolemia

Answer 32

Heart Failure kidney dysfunction cirrhosis increased sodium intake

Question 33

Signs and Symptoms of Hypervolemia

Answer 33

``` distended neck veins increased HR increased BP increased weight increased cardio vascular pressure *edema polyuria decreased urine specific gravity decreased hematocrit decreased sodium decreased BUN ```

Question 34

treatment/considerations for Hypervolemia

Answer 34

low sodium diets daily I&O and weight Diuretics high fowlers/semi fowlers position for ease of breathing

Question 35

Sodium

Answer 35

controls and regulate the volume of body fluids normal: 135-145 mEq/L major cation regulated by the kidneys/hormones needed for nerve impulses and muscle fiber transmission

Question 36

Hypernatremia signs and symptoms | hint: fried salt

Answer 36

``` sodium >145 mEq/L flushed skin restlessness, anxious, confused, irritable increased BP & fluid retention Edema (pitting) Decreased Urine output Skin flushed & dry Agitation Low grade fever Thirst (dry mucous membranes) ```

Question 37

risk factors of hypernatremia

Answer 37

increased sodium intake via ingestion, IV administration loss of fluids: diarrhea, diabetes insipidus, excessive diaphoresis, infection decreased sodium excretion: kidney problems

Question 38

treatment of Hypernatremia

Answer 38

administer IV fluids give diuretic to promote sodium loss restrict sodium and fluid intake as perscribed

Question 39

Hyponatremia signs & symptoms | hint: Salt loss

Answer 39

``` sodium < 135 mEq/L Stupor/coma Anorexia (N/V) Lethargy (weakness/fatigue) Tachycardia (thready pulse) Limp muscles (muscle weakness) Orthostatic hypotension Seizures/headaches Stomach cramping (hyperactive bowels) ```

Question 40

Risk factors for hyponatremia | hint: 4 D's

Answer 40

``` increased sodium excretion: Diaphoresis Diarrhea & vomiting Drains (NGT suction) Diuretics SIADH adrenal insufficient inadequate sodium intake kidney disease heart failure ```

Question 41

treatment of Hyponatremia | hint: add salt

Answer 41

Administer IV sodium chloride infusions for hypovolemia Diuretics Daily weights Safety - risk for falls (othrostatic hypertension) Airway protections (NPO) increased risk of aspiration Limit water intake Teach about foods high in sodium

Question 42

Potassium (K)

Answer 42

``` main electrolyte of ICF normal: 3.5- 5 mEq/L major mineral in all cellular fluids aids in muscle contraction, nerve impulse conduction, regulates enzyme activity, regulate IC water content regulated by: kidneys/hormones inversely proportional to Sodium ```

Question 43

Hyperkalemia signs and symptoms | hint: murder

Answer 43

``` serum > 5 mEq/L Muscle cramps and weakness Urine abnormalities Respiratory distress Decreased cardiac contractility (low HR low BP) ECG changes Reflexes (high DTR) ```

Question 44

risk factors of Hyperkalemia

Answer 44

``` Medications (ACE inhibitors, NSAIDs Potassium sparing diuretics) excessive potassium intake Kidney disease or those on dialysis Adrenal insufficiency tissure damage acidosis hyperuricemia Hypercatabolism ```

Question 45

Hyperkalemia management and treatment

Answer 45

``` Monitor ECG Discontinue IV and PO potassium Initiate a potassium restricted diet prepare PT for dialysis avoid use of salt substitutes or other potassium containing substances ```

Question 46

Hypokalemia signs and symptoms

Answer 46

``` serum < 3.5 mEq/L thready weak and irregular pulse orthostatic hypertension shallow respirations anxiety, lethargy, confusion, coma Parethesias Hyporflexia Hypoactive bowel sounds (constipation) N/V - abdominal distension ECG changes ```

Question 47

Hypokalemia Risk Factors

Answer 47

actual total body potassium loss inadequate potassium intake (NPO/fasting) movement of potassium from the extracellular fluid to the intracellular fluid (alkalosis) Dilution of serum potassium

Question 48

Hypokalemia Management and treatment

Answer 48

oral potassium supplements liquid potassium chloride potassium retaining diuretic NEVER ADMINISTER BY IV PUSH