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A. NCLEX > Electrolytes & Fluids > Flashcards

Electrolytes & Fluids Flashcards

(66 cards)

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1
Q

Total body water volume: (2)

A

40 L
60% body weight

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2
Q

Intracellular fluid (ICF): (3)

A

Fluid found in the cells.
K+ and Mg+ chief cation.
Phos chief anion

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3
Q

Extracellular fluid (ECF): (3)

A

All fluids found outside the cell.
NA and Cl-
Plasma has large protein amount

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4
Q

Fluid and food intake (2)

A

Fluid intake = 1500 ml
Food = 1000

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5
Q

Fluid loss through (5)

A

Urine 1500 ml
Sweat 100 ml
Skin 500 ml
Lungs 400 ml
Feces 200 ml

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6
Q

Fluid regulation by (in the brain) (1)

A

Hypothalamus: thirst center

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7
Q

The Hypothalamus’ function (3)

A

Osmoreceptors monitor osmolality
As osmolality increases thirst will increase
Can your client communicate or perceive thirst?

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8
Q

Antidiuretic hormone (ADH): (1) What it does, (1) where it is made, (1) where it is stored

A

Regulates amount of water kidney tubules absorb
Synthesized by hypothalamus
Stored in posterior pituitary gland

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9
Q

ADH and what happens when (1) you have dehydration or overly concentrated body fluid and (2) you have overly diluted body fluids

A

*Body fluid too concentrated → ADH increases → decreased urine output → Extreme SIADH (Soaked inside or swimming in fluid)
*Too dilute body fluids → ADH decreases → increases urine output → Extreme DI
*DI: Dry inside or diuresis increases
– Low urine osmolality and serum hypernatremia
– Fluid replacement, desmopressin or vasopressin

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10
Q

Fluid also regulated by (2)

A

Atrial natriuretic peptide (ANP) & Aldosterone

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11
Q

Atrial natriuretic peptide (ANP) function (3)

A

Released in situations of overload imbalance
Cells in right atrium release ANP when stretched
Inhibits AHD → increasing the loss of NA+ and water in the urine

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12
Q

Aldosterone function + increased & decreased in what condition (2)

A

Reabsorption of NA+ and water in fluid insufficient → increasing ECF
Influenced by renin → angiotensin → aldosterone loop
Increased in: Hemorrhage
Decreased in: Adrenal crisis

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13
Q

Measurement and management (fluids) (11)

A

Thirst
Vitals
Confusion
Mouth and mucous membranes
Body weight
Skin elasticity
Fluid balance records
Blood records
Total fluid volume fluctuates by less than 1%
Fluctuations in fluid volume by just 10% can have serious effects
20% can be fatal

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14
Q

Isotonic fluids (4)

A
  • Expands intravascular compartment
  • 5% dextrose is isotonic but becomes hypotonic when - glucose is metabolized
  • Elderly or kidney disease = risk of fluid overload
  • Lactated ringers = dont use with liver dysfunction or someone with lactic acidosis
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15
Q

Hypotonic fluids (7)

A

Moves fluid out of intravascular compartment hydrating the cells and interstitial environment
Good for DKA. Although you start with isotonic and move to hypotonic
Not good for fluid replacement in dehydration
Excessive infusion = intravascular fluid depletion
High risk in elderly
By pulling fluid into the cells the cells can rupture → cerebral edema
NO USE WITH RBCS OR SHOCK

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16
Q

Hypertonic fluids (6)

A

Moves water into the vascular space
Good for use in SIADH (because you are retaining fluid in SIADH causing diluted solutes and this causes ^^ solutes in body)
Reduce cerebral edema and PSI
Hypervolemia risk
Pulmonary edema risk
May irritate blood vessels

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17
Q

Isotonic solutions (3) fact, and 2 examples

A

same as intravascular space
Normal saline
Lactated ringers

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18
Q

Hypotonic solutions (3) fact and 2 examples

A

out of intravascular. Hydrating cells and interstitial.
5% dextrose
0.45% sodium chloride.

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19
Q

Hypertonic solutions (5 ish). Fact and examples

A

enter. Entering intravascular compartment.
3% sodium chloride
10 and –>
50% dextrose.
Colloids (on another slide)

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20
Q

Colloids: what it is and 3 examples

A

Proteins. Hypertonic. Shifts fluids into vessels.
Albumin, dextran, hetastarch

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21
Q

Potassium: Functions (6)

A

Resting membrane potential of nerve and muscle
Regulating intracellular osmolarity and promoting cellular growth
Plays role in acid base balance
Diet is major source
Kidneys are primary route for K loss
Excretion depends on serum content

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22
Q

Potassium range

A

Normal 3.5 -5 meq

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23
Q

Causes of hypokalemia (4)

A

*Gi Loss → vomiting, diarrhea, gastric suction
*Dietary → starvation, anorexia, bulimia, older adults
*Medications → corticosteroids, thiazide diuretics, loop diuretics, sodium penicillin, amphotericin B
*Disorders → Hyperaldosteronism, magnesium depletion, osmotic diuresis

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24
Q

S/S of hypokalemia 1/2 (4)

A

Fatigue and muscle weakness
Anorexia, nausea, vomiting
Polyuria
Illesu, Abdominal distention

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25
S/S of hypokalemia 2/2 (6)
Paresthesia Leg cramps Decreased reflexes Increased sensitivity to digoxin Decreased BP and weak irregular pulse ECG changes (flat t wave, depressed ST, U wave)
26
Correcting hypokalemia (6)
Replace Oral mild to moderate IV = if less than 2 meq Never safe to give IV Push or IM Magnesium replacement Monitor ECG
27
Prevention of hypokalemia (3)
Elderly at risk Those on laxatives and diuretics Eat bananas, melons, citrus, lean meats, milk, whole grains
28
Causes of hyperkalemia 1/2 (6)
Serum over 5 meq Kidney injury Infection and increase of potassium Medications Injuries like crush injuries and burns ACE inhibitors
29
Causes of hyperkalemia 2/2 (6)
NSAIDS Cyclosporine Blood transfusions Potassium sparing diuretics combined with renal insufficiency Disorders = addisons, hypoald. Acidosis = increase in serum K
30
S/S hyperkalemia (6)
Heart palpitations Tingling numbness Twitching Weakness Flaccid paralysis Diarrhea ECG changes (on another slide)
31
ECG changes in hyperkalemia
Loss P waves, prolonged PE, wide QRS, ST depression
32
Treatment of hyperkalemia (8)
Lower level Stop potassium replacements Furosemide Sodium polystyrene sulfonate - shit it out Hypertonic IV solutions to pull K Glucose and insulin to shift K into cells Dialysis Assess for heart complications = ECG
33
Sodum range
135 - 145
34
Sodum (3) what it does, where you get it from, where it leaves from
Maintains ECF From food Leaves in urine sweat and feces
35
Causes of hyponnatremia (6)
Water imbalances ECF decreased below level of intracellular fluid = cell burst Vomiting, diuretics Excessive admin of dextrose and water IVFs Low sodium diet Excessive water intake
36
S/S hyponatremia (4)
Brain swelling → increased ICP Mental status changes Relative → Too much fluid. Absolute hyponatremia → underlying cause
37
Excessive loss of sodium: what to do (3)
Withhold all diuretics Replace with isotonic = 0.9% NACL Encourage fluids
38
Water gain: what to do (2)
Loop diuretics Fluid restriction
39
Hypernatremia: causes (7)
Cells become irritable Hypertonic tube feedings without water supplements Steroids Ingestion of OTC drugs such as alka seltzer Burns DI → loss of fluids but no Na Diarrhea
40
S/S hypernatremia (7)
Due to fluid shifting out of cells and causing cell shrinkage --> Dehydration of brain cells results Most concerned with brain cell shrinkage → brain damage Mental status changes Confusion, drowsiness = No one is “just confused” on NCLEX Irregular muscle contractions Test reflexes = decreased or absent Cardiac changes
41
Relative hypernatremia is caused by (1)
fluid volume deficit
42
Absolute hypernatremia has the S/S of (1)
S/S of the cause like a burn
43
Treatment of hypernatremia
Know the cause and treat that Bring Na down slowly Hemodialysis for severe hypernatremia Med therapy Hypovolemia → 0.9% NACL or 5% dextrose Hypervolemia → Diuretics, furosemide, bumetanide
44
Calcium range: normal version + non ionized (2)
8.6 - 10.2 Non ionized 4.5 - 5.1
45
Calcium (6)
*Blood clotting, transmission of nerve impulses, myocardial contractions, muscle contractions *Source of calcium is from diet *To absorb must have Vitamin D *Parathyroid hormone helps regulate calcium levels *PTH increases bone resorption, increases GI absorption of calcium, and increases renal tubule reabsorption of calcium *Calcium and phosphate have inverse relationship
46
S/S of hypocalcemia (7)
Paresthesia around mouth, fingers, and toes Hyperreflexia and muscle spasms Seizures Intestinal cramping, diarrhea Positive chvostek signs Positive trousseau ECG: increased QT interval
47
Treatment of Hypocalcemia
*Oral calcium replacement *IV 10% calcium gluconate and monitor serum calcium
48
Hypercalcemia S/S (4)
Fatigue and weakness Nausea Mental status changes Kidney changes
49
Hypercalcemia ECG changes
shortened QT intervals, wide and depressed T waves, bradycardia, heart blocks
50
TX for hypercalcemia (6)
Severe = tx Oral phosphate Calcitonin to decreased PTH IV normal saline to flush calcium out Bisphonoates Emergency dialysis
51
Magnesium range
1.3 - 2.1 meq
52
Magnesium (3)
Responsible for ATP production Normal neuro function Intestines and kidneys regulate
53
S/S hypo magnesium (9)
Irritiabilty and behavior changes Increased neuromuscular excitability Convulsions Chvostek and trousseau signs positive Muscle cramps tetany Hypertension Hyper reflexes Tachycardia Cardiac dysrhythmias (torsades, A-fib)
54
TX hypomagnesemia (2)
Replace magnesium Oral intake increase = pumpkin and chia seeds, almonds, cashews, peanuts
55
Hypermagnesemia (3)
Mag is a drag Skeletal muscle depression Nerve impulse depression
56
Determine cause of hypermag (3)
Stop mag intake Examine their diet Consider dialysis
57
Fluid imbalance etiology: Hypovolemia (3)
Secondary to bleeding and hemorrhage Inadequate fluid intake Excessive fluid output
58
Fluid imbalance etiology: Hypovervolemia (3)
Increased NA+ in the body Excessive fluid that cannot be managed Disorders: renal, hepatic, cardiac failure
59
Hypovolemia S/S MILD: (6)
Impaired cognitive function reduced physical performance HA Fatigue Sunken eyes Dry, less elastic skin
60
Hypovolemia S/S MODERATE: (9)
Hypotension Tachycardia Weak thready pulse increased body temp Cold hands and feets Oliguria Cool, clammy skin Muscle weakness Cramps
61
Hypervolemia S/S (7)
Hypertension Tachycardia Strong, bounding pulse Dyspnea Adventitious breath sounds (rales, crackles) Edema Fatigue
62
Hypocalcemia causes (7)
Malnutrition (calcium and vitamin D deficiency) Hypoparathyroidism Blood transfusions (excess administration of citrated blood) Wound drainage (especially GI) Diarrhea Malabsorption syndromes (e.g. celiac disease, crohn's disease) Loop diuretics
63
Hypercalcemia causes (7)
Bone metastasis from breast, prostate, or cervical cancer Hyperparathyroidism (some tumors can secrete parathyroid hormone) Blood cancers Excessive calcium/vitamin D intake Sarcoidosis Acidotic states Thiazide diuretics
64
Hypomagnesemia causes (6)
Malnutrition Malabsorption syndromes Alcoholism Renal tubular dysfunction Loop diuretics and proton pump inhibitors Hyperglycemia
65
Hypermagnesemia causes (6)
Mag sulfate IV Antacid overuse Certain medications (anticholinergics, laxatives, lithium intoxication, opioids) Kidney injury or failure Extensive soft tissue injury or necrosis (e.g. shock, trauma, sepsis, cardiac arrest, severe burns) Hypothyroidism
66

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