F&E Flashcards
(90 cards)
1
Q
Osmolality
A
Osmolality are particles in a given weight of fluid
2
Q
Osmolarity
A
are particles in a given volume of fluid
3
Q
A serum osmolarity, Normal range, too high, too low?
A
is a method of determining if someone is overhydrated or dehydrated
- Normal range is roughly 280 to 300
- Too high indicates dehydration
- Too low indicates fluid overload
- For our purposes they will be interchangeable
4
Q
Intracellular
A
is the fluid inside the cell
-2/3 of fluid volume
Primary electrolytes
Potassium
Phosphate
Sulfate
5
Q
Extracellular
A
is the fluid outside the cell
1/3 of fluid volume
Primary electrolytes
Sodium
Chloride
Bicarbonate
6
Q
What is the fluid called that is inside the blood vessels?
A
intravascular
7
Q
What is the fluid called in-between the cells?
A
interstitial
8
Q
What three components determine the fluid balance in these compartments?
A
- Protein– keeps fluid invascualr space (colloid oncontic pressure)
- Blood vessel integrity – keeps fluid in vascular space
- Hydrostatic pressure- pushes fluid into interstitial space
9
Q
Osmotic Pressure is impacted by what?
A
Osmolality- Pressure exerted to prevent movement of water out of the intravascular space
Colloid Oncotic pressure- Proteins attract water and hold onto water
10
Q
Hydrostatic Pressure
A
Arterial blood pressure (higher)
Venous pressure (lower)
Rate of blood flow
11
Q
Filtration Pressure
A
-Process that transfers nutrients and oxygen to cells
Hydrostatic minus osmotic
-At the arterial end of the capillary the fluid is pushed into tissues
-At the venous end the fluid is brought back into circulation
12
Q
Tonicity
A
Concentration of fluid
13
Q
Isotonic
A
Equal concentration of water and electrolytes
14
Q
Hypertonic
A
- Concentration of electrolytes outside cell is higher
- Concentration of water outside cell is lower
Hypertonic solution : cause cells to shrink
15
Q
Hypotonic
A
- Concentration of electrolyte outside cell is lower
- Concentration of water outside cell is higher
Hypotonic solution cause cells to swell
16
Q
Hypotonic Solutions (<250 mOsm/ L)
A
- 0.45% sodium chloride also known as “half normal saline”
- Used for: hypernatremia and diabetic ketoacidosis. Due to tonicity can cause hypotension
17
Q
Isotonic (250 – 375 mOsm / L)
A
- 0.9% sodium chloride also known as “normal saline”
- Most common fluid used for hydration. Only solution used with blood product administration
- Lactated Ringers
- Used with surgery, trauma, burns. Not recommended for patients with renal problems
18
Q
Hypertonic (> 375 mOsm/L)
A
-3% sodium chloride
Used in emergency situations for cerebral edema
Dextrose 5% in 0.45% sodium chloride or called “D5 ½ normal saline”
-used for hypovolemia with hypernatremia
D5 normal saline- used with electrolyte and fluid loss
19
Q
Crystalloids
A
-Aqueous solution with electrolytes
Hypotonic, isotonic, and hypertonic solutions (chart from last slide)
20
Q
Colloids
A
-Contain large molecules that do not transport outside of the intravascular space
Also called “volume expanders”
21
Q
Blood products
A
A fluid type only administer normal saline with blood!
22
Q
Functions of Colloids
A
- Function to increase the osmotic pressure in the intravascular space leading to fluid being pulled into the intravascular space
- Albumin, Dextran, Hetastarch
23
Q
Nursing consideration of colloids
A
-Must be administered carefully or can cause signs of fluid volume excess (listed out on the fluid volume excess slide)
24
Q
Packed RBCs
A
Used for blood loss
- 1 unit roughly increases hemoglobin by 1 g/dL
- Usually reserved for a hemoglobin less than 7 or 8 g/dL
25
Platelets
Given when there is a reduced level of platelets
26
Fresh, Frozen, Plasma
-Used for trauma, burns, shock, or bleeding and clotting disorders
27
Cryoprecipitate
Used for clients with hereditary disorders that lead to inadequate clotting
28
Nursing Considerations for Blood products
| -Should consent be obtained before administering blood products
-Blood type and Rh factor protein are determined to match a person with the right type of donor
Type and crossmatch performed
-A consent must be obtained before administration of any blood products
29
Universal Donor
O neg
30
Universal Recipient
AB positive
31
Signs for Transfusion reaction
- Fever, chills
- Altered blood pressure
- Respiratory difficulty
- Signs of an allergic reaction
32
Dehydration
Loss of body water but electrolytes remain consistent
33
Fluid Volume Deficit
- Loss of both fluid and electrolytes.
- Can also include a loss of circulating blood volume and perfusion to tissues
- Hypovolemia
34
Fluid volume excess
-Electrolytes are same or altered
35
Edema
-Can relate to both deficit and excess
36
Dehydration Causes
- Inadequate water intake
- Increased GI losses
- Fever
- SSRIs and Benzo decrease thrist mechanism
- DKA
37
Dehydration lab tests
- Elevated serum osmolality
- Elevated creatinine
- Elevated BUN
- Increased urine specific gravity
- Hypernatremia: why is this one if electrolytes remain consistent?
- Electrolyte level is constant, but the amount of body fluid is reduced. The serum is more concentrated and electrolyte levels will be higher due to concentration
38
Fluid Volume deficit s/s
```
Hypotension
Tachycardia
Orthostatic hypotension
Decreased urine output
Flat neck veins
Weak pulse
```
39
What is Third spacing
Too much fluid in interstitial space and not enough in the intravascular space
40
TX for deficit and third spacing
Replacement of fluids
Safety education: Advise patient to sit or stand slowly
For third spacing:
- Give protein IV: albumin and it comes in diff %
- Give Hypertonic solution
41
What causes a reduced colloid oncotic pressure?
-Reduced levels of albumin
42
What does Protein do
-keeps fluid in intravascular space
43
What happens to the fluid when there is a reduced colloid oncontic pressure?
Fluid leaves the intravascular space and into interstitial space
-edema occurs
44
Mechanism of edema: increased hydrostatic pressure causes
- elevated BP
- Fluid overload
- decreased cardiac output
45
Causes of decreased oncotic pressure
Malnutrition, Liver failure, Nephrosis
46
Causes of blocked or removal of lymph nodes
Mastectomy and Lymphoma
47
causes of increased capillary permeability
allergies, septic shock, pulm edema
48
How can someone have a fluid volume deficit if they have too much fluid somewhere?
- ECF and ICF need a certain level of fluid to function
| - Tx can just be moving fluid from one area to another within a compartment rather than giving more fluid overall
49
Causes of Excess Fluid Volume
- HF, Renal Failure, Cirrhosis, Excess IV fluid, Medications that cause sodium and water retention
50
S/s of Fluid volume excess
```
Weight gain of more than 0.5 kg a day
Hypertension
Bounding pulse
Distended neck veins AKA jugular venous distention
Dyspnea
Crackles
Orthopnea
```
51
Treatment for Fluid Volume Excess
- Diuretics: Furesomide, Spirnoalctone, butanamide, hydrochlorothiazide
- Fluid restriction on patinets door
52
Funcitons of Electrolytes
Maintaining balance of water in the body
Balancing the blood pH
Moving nutrients into the cells
Moving wastes out of the cells
Maintaining proper function of the body’s muscles, heart, nerves, and brain
53
Potassium range and fxn
range: 3.5-5.0
Fxn: Cardiac, neuro, and muscular fxn controlled by aldosterone and insulin
54
Sodium range and fxn
range: 135-145
Fxn: Reflection of body's water balance
-supports neuro and muscular fxn
- Blood Pressure regualtion
55
Calcium range and fxn
range: 8.9-10.5 serum
ionized: 4.5-5.6
F: Synaptic transmission, wound healing, muscle contractility, teeth and bone structure.
- Controlled by PTH hormone
56
Calcium as an inverse relationship with?
Phosphorus
57
Magnesium range and Fxn
1. 8-2.3 mg/ dL
1. 3- 2.1 mEq/L
- NM and Cardiac activity
58
Hypokalemia Causes
```
Diuretics
Metabolic alkalosis
Folic acid deficiency
Gastrointestinal losses
Decreased intake of potassium
Chronic kidney disease
```
59
Hypokalemia S/s (LOW and SLOW)
Mild: cardiac arrthymias, constipation, fatigue
Severe: Respiratory paralysis, paralytic ileus, tetany, hypotension, rhabdomyolysis, life threatening arrythmias
60
Hypokalemia Tx
-Potassium supplementation, potassium sparing diuretics, making dietary changes, IV potassium
61
Do you push Potassum IV?
-NEVER! Give it slowly can cause burning in patients
62
Hyperkalemia Causes
- Acute renal failure
- Dehydration
- diabetes
- Burns
- Acidosis
- Blood Transfusion
- CPR
63
Hyperkalemia S/s (Tight and Contracted)
Mild: N/v, muscle aches, weakness, dysarrthymias
Severe: Paralysis, HF, Death
64
Hyperkalemia TX:
- Hemodialysis for acute renal failure
- Calcium Gluconate or calcium chloride for heart
- loop diuretics if renal failure is not present
- Sodium polysstyrene sulfonate: binds to K and excretes it
- Intravenous insulin: Insulin helps to push K into cell but glucose needs to be monitored
65
Hyponatremia Causes
```
Severe vomiting or diarrhea
Drinking excess water
Excess alcohol intake
Thiazide diuretics
Liver or Heart disease
```
66
Hyponatremia S/S Depressed/ Deflated
Mild
Nausea, feeling unwell
Severe
Cerebral edema, lethargy, confusion, irritability, seizure, coma
67
Hyponatremia Tx
- Raise sodium levels slowly
- If hyponatremia was caused due to excess fluid use a fluid restriction
-Cause is due to thiazide diuretics:
Isotonic IV fluids
-Hypertonic is only used in cerebral edema
-
68
Hypernatremia Cause
```
Dehydration and things that cause a state of dehydration
Vomiting
Chronic kidney disease
Diabetes
Impaired thirst response
Consumption of high sodium items
```
69
Hypernatremia S/s: Big and Bloated
Similar to hyponatremia
70
Hypernatremia Tx
- Restore fluid status
- Give isotonic fluids
- IF BP is low or in shock give hypotonic
- -Water is not used for treatment
- Educate clients on dietary measures to reduce sodium
71
Hypocalcemia Cause
```
Inadequate vitamin D
Decreased estrogen production
Hypoparathyroidism
Renal disease
Low albumin levels
Stimulant laxatives
Chronic steroid use
Proton pump inhibitors
```
72
S/s of hypocalcemia (spastic)
```
Chest pain
Dysrhythmias
Renal calculi
Numbness and tingling
Muscle cramping
Confusion
Osteopenia
Dental problems
```
73
What 2 signs can you see with hypocalcemia
- Chvosteks and Trousseau sign
74
Ionized Calcium
- Serum calcium accounts for all calcium, whether it is in the free ionized form or if it is bound to proteins.
- it can detect unbound and active which leads it to be the most accurate
- Serum is used more commonly though
- Ionized is performed if signs/symptoms or abnormal serum levels of calcium suggest a calcium issue
75
Hypocalcium TX
Calcium and vitamin D supplementation
Increased dietary intake
Calcium injections
76
Hypercalcemia Cause
Cancer
Hyperparathyroidism
Vitamin D toxicity
What over the counter medication for heartburn contains calcium carbonate?
Tums, too much can contribute to hypercalcemia
77
Hypercalcemia s/s (slow and swollen)
```
Mild symptoms
Constipation
Abdominal pain
Nausea
Vomiting
```
```
Severe symptoms
Confusion
Renal failure
Arrhythmias
Coma
Death
```
78
Hypercalcemia TX
- IV Phosphate bolus
- loop diuretic
- hemodialysis in severe cases
79
Hypomagnesium cause
```
Crohn’s disease or celiac disease
Diarrhea or pancreatitis
Type 2 diabetes
In the presence of hypokalemia and hypocalcemia
Decreased intake
Increased renal excretion
```
80
S/s of hypomagnesium (Buck Wild)
Mild symptoms
Decreased appetite, fatigue, nausea, weakness
Severe
Muscle cramps, numbness and tingling, seizures, tetany, and personality changes
81
Hypomagnesium Tx
Oral or intravenous magnesium
Educate clients on foods high in magnesium
82
What might have to be treated first before magnesium can be given?
Restore calcium or potassium balance
83
Hypermagnesium Cause
Kidney disease
Acidosis
Hypothyroidism
Trauma
Medications that increase dwell time of food in the intestines (opioids or anticholinergics)
Laxatives or antacids that contain magnesium
84
Hypermagnesium S/s (Calm and quiet)
-Mild symptoms
Dizziness, nausea, weakness, confusion
-Severe symptoms
Confusion, blurred vision, headache, bladder paralysis, bradycardia, reduced respiratory rate, loss of deep tendon reflexes, death
85
Hypermagnesium TX
- Calcium chloride and gluconate for cardiac issues
- IV saline w/ diuretics
- Severe: Hemodialysis
86
Sources of Sodium
-Sodium chloride, MSG, soy sauce
87
Sources of potassium
-Fruits ( bananas), veggies (avocado), orange juice, tomato juice
88
Calcium sources
-Dairy and green dark veggies and salmon, oysters
89
Magnesium sources
-Nuts and peanut butter, egg yolk, milk
90
Phosphorus sources
Dairy, meat, fish, bran and wheat cereals
