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F&E Flashcards

0
Q

Extra cellular fluid

A

1/3 body fluid
14L
Made up of interstitial fluid and vascular fluid
Main electrolytes sodium and chloride

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1
Q

Intracellular fluid

A

2/3 body fluid
28L
Most stable
Main electrolytes are potassium and phosphate

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2
Q

Osmosis

A

Water moved from low concentration to high concentration through semi- permeable membrane
Cell membranes or capillary membranes are the permeable membrane
Passive movement

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3
Q

Diffusion

A

Solutes move from high to low concentration

Passive movement

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4
Q

Active transport

A

Cell membranes move molecules
Low concentration to high concentration
Requires metabolic work (ATP)
Ex. K, Na, H, Fe, Cl, I

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5
Q

Osmolality

A

Concentration of solute per Kg of h2o

Higher the osmolality the greater it’s pulling power for water

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6
Q

Osmolality

A

Concentration of solute per L of solution

1L water=1Kg

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7
Q

Serum osmolality

A

Concentration of particles in the plasma
Normal=275-295milliosmoles/L (mOsm/L)
Sodium is major solute in plasma
Number 1 lab for checking fluid deficit/status
Urea (BUN) and glucose increase serum osmolality

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8
Q

Capillary filtration

A

Hydrostatic pressure and oncotic pressure

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9
Q

Hydrostatic pressure

A

Pushing force of fluid against the walls of the space it occupies. ( pushing out)

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10
Q

Oncotic pressure (colloid osmotic pressure)

A

Pulling force of proteins in vascular space. (Pulling in)

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11
Q

Chemical regulation of fluid balance

A 
Antidiuretic hormone (ADH)
Aldosterone 
Glucocorticoid (cortisol)
Atrial natriuretic peptide (ANP) 
Brain natriuretic peptide (BNP)
Thirst sensation
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12
Q

Nephrons filter how many liter per day?

A

150-180L/day
This is glomerular filtration rate (GFR)
If body looses 1-2% body fluid then conservation begins

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13
Q

ADH (vasopressin)

A

Hypothalamus->post pituitary-> distal tubules regulate water
Decrease Blood pressure or volume or rise in blood osmolality = excretes ADH to conserve water
Rise in BP or blood volume then drop in blood osmolality = inhibits ADH ( excretes water)

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14
Q

Aldosterone

A

Adrenal gland -> kidneys retain Na & water & excrete K
Decrease bp, blood volume and Na increase K= reabsorb Na & water follows Na= blood volume increases
Rise in bp or volume or Na & drop in K= excrete Na & water follows Na= blood volume decreases

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15
Q

Glucocorticoids

A

Cortisol released by adrenal gland
Stress
Causes kidneys to retain Na & water

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16
Q

ANP (atrial natriuretic peptide)

A 
Released when atria stretched 
Lowers bp and blood volume
 Causes vasodilation
 Decreases aldosterone 
 Decreases ADH
 Increases glomerular filtration rate= more urine production and water excretion
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17
Q

BNP ( b-type natriuretic peptide)

A 
Released when ventricles stretched 
Lowers blood volume & bp
 Causes vasodilation 
 Decreases aldosterone 
 Dieresis of water and Na
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18
Q

Thirst

A

Small shift in serum osmolality
Receptors in hypothalamus detect 1 mOsm/L changes
Stimulate ADH and aldosterone
30-60 min for fluid to be absorbed & distributed

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19
Q

Daily sensible fluid output

A

Kidneys-1500ml/day

Intestines- 100ml/day

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20
Q

Daily insensible fluid output

A

Skin-600ml/day

Lungs-400ml/day

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21
Q

Total daily fluid output

A

2600ml

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22
Q

Daily fluid intake

A

Liquids- 1500ml
Solid food- 800ml
Water of oxidation-300ml

Total= 2600ml

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23
Q

Isotonic FVD

A

Fluid and solute lost in proportional amounts

Most common

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24
Hypotonic FVD
Greater loss of electrolytes than water | Decreased plasma osmolality
25
Hypertonic FVD
More water is lost than solute | Increased plasma osmolality
26
Acute weight loss or gain
Mild FVD:2% Moderate FVD: 5% Severe FVD: 8% or more
27
Isotonic fluid loss (causes)
``` Not enough intake Excessive GI fluid loss Excessive renal loss Excessive skin loss Third space lost ```
28
Hypertonic dehydration (causes)
``` Inadequate fluid intake Prolonged or severe isotonic fluid losses Watery diarrhea Diabetes insipidus ( no ADH secreted) Increase solute intake ```
29
Isotonic IV fluids
``` Same osmolality as normal plasma Replaces ECF and electrolyte losses Used to expand volume quickly No calories or free water 0.9% NaCl Ringers solution Lactated ringers solution (LR) 5% dextrose in water (becomes hypotonic) ```
30
Hypotonic IV fluids
``` Lower osmolality than normal plasma Used to prevent/treat cellular dehydration Contraindicated in acute brain injuries Requires freq VS, LOC, circulation 1/2 NS (.45% NaCl solution) 1/4 NS ( .225% NaCl solution) ```
31
Hypertonic IV fluids
``` Higher osmolality than normal plasma Limited doses Use infusion pump Frequent close monitoring 3% sodium chloride 5% sodium chloride D10W (10% dextrose in water) 50% dextrose D51/2NS, D5NS, D5LR, D51/4NS ```
32
Isotonic FVE
(Hypervolemia & edema) Proportional gain in fluid& solute Excess interstitial fluid volume
33
Isotonic FVE causes
``` Renal failure Heart failure Excess intake High corticosteroid levels High aldosterone levels ```
34
Hypotonic FVE
( water intoxication) More fluid than solute gained Serum osmolality falls
35
Hypotonic FVE causes
``` Plain water irrigation Hypotonic IV fluids Over zealous plain water intake Infants-diluted formula SIADH ( syndrome of inappropriate ADH) Psychogenic polydipsia Severe or prolonged FVE w/ existing disease states ```
36
Edema causes
``` Increased capillary hydrostatic pressure -caused by hypertension & hypervolemia Decreased capillary oncotic pressure -decreased albumin - injury, inflammation, malnutrition, liver dysfunction Lymphatic obstruction or removal Sodium excess ```
37
Assessment of FVE
``` Bulging fontanels High CVP w/ venous engorgement Third spacing - peripheral edema - pulmonary edema - ascites Vital signs ```
38
Interventions for FVE
``` Restrict fluid intake Promote excretion - diuretics - digoxin, ACE inhibitors - protein intake Monitor during therapy Prevent more FVE Remain alert for acute pulmonary edema Patient education ```
39
Eval of corrected FVE
``` Resolves edema, soft flat fontanels Lungs- clear, unlabored VS- return to baseline LOC-return to baseline Labs- return to baseline Weight- return to baseline Resolution of underlying causes Verbalize understanding ```
40
Sodium range
135-145 mEq/L
41
Sodium balance & imbalance
Normal ECF range 135-145mEq/L Responsible for water balance & determination of plasma osmolality Attracts chloride Assists w/ acid-base balance Promotes neuromuscular response & stimulates nerve & muscle fiber impulse transmission
42
Hyponatremia
<135 mEq/L | Occurs in hypervolemia,euvolemia, & hypovolemia
43
Hyponatremia cellular transport/ response
- Low Na in ECF-> fluid shift to ICF due to response of decreased plasma volume (baroreceptors), ADH, aldosterone - edema results - cerebral edema- demyelination
44
Hyponatremia causes
Actual Inadequate Na intake Loss of body fluid NPO Relative (dilution) Hyperglycemia SIADH Irrigation w/ hypotonic fluids
45
Hyponatremia assessment
- signs related to nerve impulse transmission & muscle contraction - cardiovascular - integument - renal - neuromuscular - gastrointestinal
46
Nursing dx for Hyponatremia
``` Risk for excess fluid volume Disturbed sensory/perception Risk for injury Impaired oral mucous membranes Disturbed thought processes Risk for impaired skin integrity ```
47
Interventions to correct Hyponatremia
``` Replacement therapies Oral- Parenteral- Continued monitoring Restoration of balance ```
48
Hyponatremia + hypvolemic
Correct ECF deficit
49
Hyponatremia + hypervolemia
Treat underlying cause
50
Acute Hyponatremia
Hypertonic solution
51
Hypernatremia
``` > 145 mEq/L Euvolemic, hypervolemic, hypovolemic Cells shrink Increased neurological activity occurs Thirst mechanism responds ```
52
Hypernatremia causes
``` Actual Excessive ingestion Hyperaldosteronism Corticosteroid Renal failure ``` ``` Relative NPO Increase metabolism Watery diarrhea Hyperventilation ```
53
Assessment of Hyponatremia
- related to cellular dehydration and Na role in nerve impulses & muscle contraction - tachycardia, NPH, decreased cardiac contractility - skin dry, sticky, flushed, rough dry tongue - CNS irritability - watery diarrhea, nausea, thirst - if slow rise, may be asymptomatic for some time
54
Lab findings for Hypernatremia
``` Na elevated Increased u.o, SG 1.015-1.030 Elevated Cl Serum osmolality >290 mOsm/kg Incresed BUN and Hct ```
55
Risk factors for Hypernatremia
Age Medications Diet
56
Nursing dx for Hypernatremia
Risk for injury Risk for DFV Disturbed sensory/perception Impaired oral mucous membranes
57
Interventions for Hypernatremia
Decrease Na intake Promote Na excretion Continued monitoring of client Restoration of balance
58
Hypernatremia + euvolemic
Water, identify the cause
59
Hypernatremia + hypovolemia
NS then D5W
60
Hypernatremia + hypervolemia
Remove source of excess, diuretics, water
61
Normal potassium range
3.5-5.0 mEq/L
62
Potassium balance & imbalance
Normal serum range3.5-5.0 mEq/L K shifts w/ H Insulin & catecholamines (epinephrine) increase cellular uptake of K Adequate intake 40-60 mEq/Day
63
Adequate K intake
40-60 mEq/day
64
Hypokalemia
<3.5 mEq/L Actual Hypokalemia= loss of K or inadequate intake Inadequate intake Excessive renal losses- loop diuretics Excess GI losses Relative Hypokalemia= K moves ECF to ICF transcompartmental shift Alkalosis causes K to migrate into cell as H moves out Increases insulin= K goes to skeletal muscle & hepatic cells Tissue repair Water intoxication
65
Clinical manifestation of Hypokalemia
Rarely develops before drop below 3.0 mEq/L unless drop is rapid - cardiovascular- increase risk of digoxin toxicity - respiratory-metabolic alkalosis - renal- unable to concentrate urine - GI - neuromuscular - CNS
66
Monitoring Hypokalemia
Serum potassium ECG changes Electrolyte levels I & O
67
Lab findings for Hypokalemia
Plasma levels- trending Elevated pH & bicarb levels ( alkalosis) Elevated glucose - concurrent decrease in Cl, Mg, & Ca
68
Risk factors for Hypokalemia
Age Alcoholism Medications Dietary
69
Nursing dx for Hypokalemia
- Risk for injury r/t muscle weakness & hyporeflexia - Ineffective breathing pattern r/t neuromuscular impairment - decreased cardiac output r/t dysrhythmias - Constipation r/t smooth muscle atony - imbalanced nutrition r/t poor dietary levels - fatigue r/t neuromuscular weakness
70
Intervention for Hypokalemia
``` Replacement therapies Diet Supplements- not if UO< 0.5 ml/kg/hr Parenteral Continued monitoring Restoration of balance K sparing diuretics ( spinolactone & triamterene) ```
71
Hyperkalemia
>5.0 mEq/L Rare w/ normal functioning kidneys **Myocardium is most sensitive to increase K Sudden increase shows changed at 6-7 mEq/L Slow increase shows change at 8 mEq/L
72
Actual Hyperkalemia
``` K in ECF is elevated Excessive intake Deceased excretion ( adrenal insufficiency, renal insufficiency/failure, K sparing diuretics, ACE inhibitors) ```
73
Relative Hyperkalemia
``` K moves ICF to ECF Cellular release (burns, trauma) Pseudohyperkalemia- hemolysis Transcellular shifting ( insulin deficiency) Addison's disease (decrease aldosterone) ```
74
Clinical manifestation for Hyperkalemia
Cardiovascular-irreg, slow HR, dec BP, ECG Respiratory- not until very high Neuromuscular- twitching, cramps, irritable GI- hypermotility, cramps, N/V/D, weight loss
75
Assessment for Hyperkalemia
Monitor Serum K, ECG changes, I&O Identify risk factors Age, meds, diet, disease states & therapeutic treatments
76
Lab findings for Hyperkalemia
K >5.0 mEq/L If cause is dehydration Hct, Hgb, Na, Cl If cause is renal failure Creatine and BUN also ABG to monitor for metabolic acidosis
77
Nursing dx for Hyperkalemia
Risk for injury r/t muscle weakness & seizures Risk for dec cardiac output r/t dysrhythmias Imbalance nutrition r/t dec renal function or incr intake Diarrhea r/t neuromuscular changes & irritability
78
Interventions for Hyperkalemia
Decrease K intake Promote K excretion Monitor K, s/s Hyperkalemia, cardiac status, metabolic acidosis Restore balance Dialysis if Hyperkalemia cannot be controlled in timely manner
79
Medications for Hyperkalemia
Exchange resins - kayexalate (Na polystyrene sulfonate) oral or enema IV - calcium gluconate - regular insulin & 50% dextrose - sodium bicarbonate Potassium wasting diuretics Aerosolized beta2 agonist (albuterol)
80
Calcium
Cause contraction & coagulation & nerve impulses 9.0-10.5mg/dL Parathyroid hormone & vitamin d control Bone resorption Intestinal uptake Kidney excretion
81
Normal calcium level
9.0-10.5mg/dL
82
Calcium in ECF
Protein bound (mostly albumin) Chelated (citrate,phosphate,sulfate) Ionized (50% of total) Free to leave vascular compartment & participate in cellular functions
83
Hypocalcemia
``` <9.0mg/dL -little changes have big effect -low serum increases sodium -movement across membrane causing depolarization to occur more easily & inappropriately -acute- life threatening Chronic- body adjusts (osteoporosis) ```
84
Causes of Hypocalcemia
Impaired ability to mobilize calcium & bone Decreased intake or absorption Abnormal renal losses Increased protein binding or chelation
85
Hypocalcemia assessment
- overstimulation of nerves and muscles - paresthesias to cramps/spasms - trousseaus signs ( bp cuff makes arm spasm) - chovsteks sign - weak thready pulse - prolonged ST and QT interval - increased peristalsis - chronic= bone changes
86
Hypocalcemia interventions
Drug therapy Nutrition therapy Environmental management Injury prevention
87
Hypercalcemia
>10.5mg/dL - little changes have big effect - causes excitable - affected most: heart,muscles,nerves,intestinal smooth muscles - faster clotting time, inappropriate clots
88
Hypercalcemia assessment
- first increase hr & bp then decrease - shortened qt interval, dysrhythmias - hypertension - muscle weakness - altered loc - decreased peristalsis - chronic: osteopenia, osteoporosis
89
Hypercalcemia interventions
Drug therapy Rehydrate IV normal saline promotes kidney excretion Dialysis Cardiac monitoring
90
Phosphorus
3.0-4.5mg/dL Needed for ATP formation Balanced with calcium Regulated by parathyroid hormone
91
Normal phosphorus level
3.0-4.5mg/dL
92
Hypophosphatemia
<3.0mg/dL Body effected w/ chronic low levels Decreased energy metabolism Increased calcium levels
93
Hypophosphatemia causes
``` Malnutrition Antacids Hyperparathyroidism Hyperglycemia (dka) Alcohol abuse Hypercalcemia ```
94
Hypophosphatemia assessment
Neuro: ataxia, confusion, seizures Musculoskeletal: weakness, stiffness, bone pain Blood disorders: platelet dysfunction, impaired WBC formation
95
Hypophosphatemia interventions
Drug therapy IV replacement Nutrition therapy
96
Hyperphosphatemia
``` >4.5mg/dL Increase membrane excitability Coincides with Hypocalcemia Caused by -decreased renal excretion -release from tissue injury -hypoparathyroidism -tumor lysis syndrome ```
97
Magnesium
``` 1.8-3.0mg/dL Most stored in bones and cartilage Skeletal muscle contraction CHO metabolism ATP formation Vitamin activation Cell growth Blood coagulation formation ```
98
Normal magnesium levels
1.8-3.0mg/dL
99
Hypomagnesemia
s disease | - medication
100
Hypomagnesemia assessment
``` Skeletal muscle weakness Increased impulse transmission -tremors,athetoid movements Tachycardia Hypertension Cardiac arrythmias ```
101
Hypomagnesemia interventions
Dc medications: loop diuretics, osmotic diuretics IV magnesium sulfate Possibly replace calcium also
102
Hypermagnesemia
>3.0mg/dL Excitable membranes need more stimulus Caused by increased intake or decreased renal excretion
103
Hypermagnesemia assessment
Bradycardia, hypotension Prolonged pr interval w/ widened qrs complex Drowsy, lethargic Weak, reduced, reflexes
104
Hypermagnesemia interventions
Dc all magnesium supplements If no renal failure -IV fluids -loop diuretics
105
Chloride
98-106mEq/L - Works w/ Na in ECF - Formation of hydrochloric acid - Chloride shift decreases plasma chloride - Bicarbonate most common exchange - Imbalance occurs from other electrolyte imbalances - **Excessive vomiting/prolonged gastric suctioning
106
Normal chloride levels
98-106mEq/L

nursing theraputics (2 decks)

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