Electrolyte and Fluid Balance

Question 1

Fluid and Electrolyte balance is an interplay between these 3 processes?

Answer 1

Input (and Absorption), Distribution & Output

Question 2

Fluid is….

Answer 2

is water and all that it contains inside the body

Question 3

Electrolytes include…

Answer 3

Sodium Na+
Potassium Ka+
Calcium Ca++
Magnesium Mg++

Question 4

Output (Typical)

Answer 4

Urine, feces, through the skin (i.e., perspiration), respiratory

Question 5

Output (Atypical)

Answer 5

Emesis, hemorrhage, draining fistulas or tubes

Question 6

Intake (Typical)

Answer 6

Oral

Question 7

Intake (Atypical)

Answer 7

IV, rectum, nasogastric tubes, infusion into subcutaneous tissue or bone marrow

Question 8

Anti Diuretic Hormone (ADH)

Answer 8

Stimulates water conservation at kidneys
Reducing urinary water loss
Stimulates thirst center
Promoting fluid intake

Question 9

Aldosterone

Answer 9

-A hormone secreted by suprarenal cortex in response to
Rising K+ or falling Na+ levels in blood

-Activation of renin–angiotensin system
- Increases water reabsorption, conserves Na+,
secretes K+

Question 10

Distribution (Passive transport)

Answer 10

Diffusion, Filtration, Osmosis

Question 11

Diffusion

Answer 11

tendency for molecules higher concentration  lower concentration

Question 12

Filitration

Answer 12

distributes ECF between interstitial and vascular spaces through a membrane via hydrostatic pressure

Question 13

Osmosis

Answer 13

distributes water between ECF and cells through a semi-permeable membrane

Question 14

Optimal Osmolality

Answer 14

Na+ = 135-145 mEq/L

Osm = 280-300 mosmol/kg

Question 15

Optimal K+ Concentration

Answer 15

K+ = 3.5-5 mEq/L

Question 16

Osmolality too dilute

Answer 16

NA+ < 135

Osm < 280 mosmol/kg

Question 17

Osmolality Too Concentrated

Answer 17

Na+ > 145 mEq/L

Osm > 300 mosmol/kg

Question 18

Hypokalemia

Answer 18

K+ < 3.5 mEq/L

Question 19

Hyperkalemia

Answer 19

K+ > 5.0 mEq/L

Question 20

Three Primary Factors for Fluid and Electrolyte Imbalance

Answer 20

• Fluid & electrolyte output greater than fluid and electrolyte input
• Fluid and electrolyte output less than fluid and electrolyte input
• Altered fluid and electrolyte distribution

Question 21

First thing we must do as a nurse with suspected F&E Imbalance….

Answer 21

ASSESS

Question 22

What do we assess?

Answer 22

Health history.
Diagnostic and laboratory data.
Physical assessment
Daily weight, vital signs, intake and output, thirst, skin, buccal (oral) cavity, eyes, jugular and hand veins, neuromuscular system.

Question 23

Clinical Manifestations of fluid and Electrolyte Imbalance

Answer 23

Extracellular Volume Imbalance and Osmolality Imbalance, Plasma K+, CA & Mg Imbalances

Question 24

Extracellular Volume Deficit S&S

Answer 24

Sudden weight loss, skin tinting, dry mucous membranes, vascular underload: rapid thready pulse, postural BP drop, lightheadedness, flat neck veins when supine, oliguria, syncope, shock if severe.

Question 25

Extracellular Volume Excess S&S

Answer 25

Sudden weight gain, dependent edema, vascular overload: bounding pulse, distended neck veins when upright, dyspnea, pulmonary edema if severe.

Question 26

Osmolarlity Imbalance Too Dilute (Hyponatremia)

Answer 26

Impaired cerebral function: decreased LOC, nausea, seizures if severe; serum Na+ < 130 mEq/L

Question 27

Osmolality Imbalance Too Concentrated (Hypernatremia)

Answer 27

Impaired cerebral function: decreased LOC, THIRST (not older adults), seizures if severe; serum Na+ >145 mEq/L

Question 28

Plasma K+ Imbalance (Hypokalemia)

Answer 28

Bilateral ascending flacid muscle weakness, abdominal distension, constipation, postural hypo-tension, polyuria, cardiac dysrhythmias; serum K+ <3.5 mEq/L

Question 29

Plasma K+ Imbalance (Hyperkalemia)

Answer 29

Bilateral ascending flaccid muscle weakness, cardiac dysrhythemias, cardiac arrest if severe; serum K+ >5.0 mEq/L

Question 30

Plasma Ca++ Imbalance (Hypocalcemia)

Answer 30

Increased neuromusclar excitability; positive Chvostek and Trouseasu's signs, muscle cramps, twitching, hyperactive reflexes carpel and pedal spasms, tetany, seizures, laryngospasms, cardiac dysrhythmias; serum total Ca++ < 9 mg/dl (4.5 mEq/L)

Question 31

Plasma Ca++ Imbalance (Hypercalcemia)

Answer 31

Decreased neuromuscular excitability; anorexia, nausea, constipation, muscle weakness, diminished reflexes, decreased LOC, cardiac dysrhythmias; serum total Ca++ > 11 mg/dL (5.5 mEq/L)

Question 32

Plasma Mg++ Imbalance (Hypomagnesemia)

Answer 32

Increased neuromusuclar excitability; positive Chvostek's and Trousseau's signs, insomnia, hyperactive reflexes, muscle cramps and twitching, nystagmus, tetany, seizures, cardiac dysrhythmias; serum Mg++ < 1.5 mEq/L

Question 33

Plasma Mg++ Imbalance (Hypermagnesemia)

Answer 33

Decreased neuromuscular excitability; flushing, diaphoresis, diminished reflexes, hypotension, decreased LOC, mucle weakness, respiratory depression, bradycardia cardiac dysrhythmias; serum Mg++ >2.5 mEq/L

Question 34

Diagnoses relevant to fluid imbalances may | include:

Answer 34

``` Fluid volume excess. Fluid volume deficit. Fluid volume deficit, risk for. Gas exchange, impaired. Cardiac output, decreased. Knowledge deficit. Breathing pattern, ineffective. Anxiety. Thought processes, altered. Injury, risk for. Oral mucous membrane, altered ```

Question 35

Fluid and Electrolyte Balance & Interrelated Concepts

Answer 35

Nutrition, Mobility, Cognition, Perfusion, Gas exchange, Acid-Base Balance, Elimination

Question 36

Acid-Base Balance

Answer 36

Process of regulating the pH, bicarbonate (HCO—3) concentration, and partial pressure of carbon dioxide (CO2) on body fluids

Question 37

Acid-Base Balance is a dynamic interplay between three control systems:

Answer 37

Acid production Acid buffering Acid excretion

Question 38

Optimal Acid-Base Balance

Answer 38

Ph 7.35-7.45

Question 39

Acidotic

Answer 39

Ph <7.5

Question 40

Alkalotic

Answer 40

Ph >7.5

Question 41

Acid production occurs through...

Answer 41

cellular metabolism

Question 42

2 Types of Acid

Answer 42

Carbonic H2CO 3 | Metabolic

Question 43

Acid buffering is..

Answer 43

.....a substance that attempts to maintain pH range or H+ ion concentration in the presence of added acids or bases.

Question 44

Three types of Acid buffering

Answer 44

Bicarbonate buffer system Phosphate buffer system Protein buffer system

Question 45

Bicarbonate Buffer System

Answer 45

works to regulate pH in both intracellular and extracellular fluids.

Question 46

Phosphate Buffer System

Answer 46

works to regulate the pH of intracellular fluid and fluid in kidney tubules.

Question 47

Protein Buffer System

Answer 47

works to regulate pH inside cells, especially red blood cells

Question 48

Acid Removal from the body occurs via...

Answer 48

Occurs via respiratory and renal processes If blood becomes too acidic, both systems excrete increased acid If blood becomes too alkalotic, both systems secrete decreased acid

Question 49

Conditions causing Acid-Base Imbalance

Answer 49

Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Question 50

Respiratory acidosis

Answer 50

Hypoventilation (Increased CO2)

Question 51

Respiratory alkalosis

Answer 51

Hyperventilation (Decreased CO2)

Question 52

Metabolic acidosis

Answer 52

Chronic diarrhea, intoxi-cation, pancreatic fistula

Question 53

Metabolic alkalosis

Answer 53

Excess bicarb use, excess diuretic use

Question 54

During Respiratory Acidosis how do the lungs respond

Answer 54

Hyperventilation

Question 55

During Respiratory Acidosis how do the Kidneys respond

Answer 55

increase secretion of H+

Question 56

During Respiratory Alkalosis how do the Lungs respond

Answer 56

Hypoventilation

Question 57

During Respiratory Alkalosis how do the Kidneys respond

Answer 57

decrease secretion of H+

Question 58

During Metabolic Acidosis how do the Lungs respond

Answer 58

hyperventilation

Question 59

During Metabolic Acidosis how do the Kidneys respond

Answer 59

Increase secretion of H+

Question 60

During Metabolic Alkolosis how do the Lungs respond

Answer 60

Hypoventilation

Question 61

During Metabolic Alkolosis how do the Kidneys respond

Answer 61

decrease secretion of H+

Question 62

How do we explore Acid-Base imbalance?

Answer 62

ASSESS

Question 63

How do you Assess for Acid-Base Imbalance?

Answer 63

Health history. Diagnostic and laboratory data. ABGs are definitive test. (hint hint) Physical assessment

Question 64

Interventions for Acid-Base Imbalance

Answer 64

Provide safety and comfort Support compensatory mechanisms Administer collaborative interventions i.e., medications ordered (insulin, for example) Monitor for any complications Educate to avoid repeat events / when to seek help