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nursing theraputics > F&E > Flashcards

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
Q

Hypotonic FVD

A

Greater loss of electrolytes than water

Decreased plasma osmolality

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25
Q

Hypertonic FVD

A

More water is lost than solute

Increased plasma osmolality

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26
Q

Acute weight loss or gain

A

Mild FVD:2%
Moderate FVD: 5%
Severe FVD: 8% or more

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27
Q

Isotonic fluid loss (causes)

A 
Not enough intake
Excessive GI fluid loss
Excessive renal loss 
Excessive skin loss 
Third space lost
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28
Q

Hypertonic dehydration (causes)

A 
Inadequate fluid intake
Prolonged or severe isotonic fluid losses 
Watery diarrhea 
Diabetes insipidus ( no ADH secreted) 
Increase solute intake
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29
Q

Isotonic IV fluids

A 
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)
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30
Q

Hypotonic IV fluids

A 
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)
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31
Q

Hypertonic IV fluids

A 
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
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32
Q

Isotonic FVE

A

(Hypervolemia & edema)
Proportional gain in fluid& solute
Excess interstitial fluid volume

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33
Q

Isotonic FVE causes

A 
Renal failure
Heart failure
Excess intake 
High corticosteroid levels
High aldosterone levels
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34
Q

Hypotonic FVE

A

( water intoxication)
More fluid than solute gained
Serum osmolality falls

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35
Q

Hypotonic FVE causes

A 
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
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36
Q

Edema causes

A 
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
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37
Q

Assessment of FVE

A 
Bulging fontanels 
High CVP w/ venous engorgement 
Third spacing
  - peripheral edema
  - pulmonary edema 
  - ascites 
Vital signs
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38
Q

Interventions for FVE

A 
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
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39
Q

Eval of corrected FVE

A 
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
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40
Q

Sodium range

A

135-145 mEq/L

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41
Q

Sodium balance & imbalance

A

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

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42
Q

Hyponatremia

A

<135 mEq/L

Occurs in hypervolemia,euvolemia, & hypovolemia

43
Q

Hyponatremia cellular transport/ response

A
  • Low Na in ECF-> fluid shift to ICF due to response of decreased plasma volume (baroreceptors), ADH, aldosterone
  • edema results
  • cerebral edema- demyelination
44
Q

Hyponatremia causes

A

Actual
Inadequate Na intake
Loss of body fluid
NPO

Relative (dilution)
Hyperglycemia
SIADH
Irrigation w/ hypotonic fluids

45
Q

Hyponatremia assessment

A
  • signs related to nerve impulse transmission & muscle contraction
  • cardiovascular
  • integument
  • renal
  • neuromuscular
  • gastrointestinal
46
Q

Nursing dx for Hyponatremia

A 
Risk for excess fluid volume
Disturbed sensory/perception 
Risk for injury
Impaired oral mucous membranes 
Disturbed thought processes 
Risk for impaired skin integrity
47
Q

Interventions to correct Hyponatremia

A 
Replacement therapies 
  Oral-
  Parenteral- 
Continued monitoring
Restoration of balance
48
Q

Hyponatremia + hypvolemic

A

Correct ECF deficit

49
Q

Hyponatremia + hypervolemia

A

Treat underlying cause

50
Q

Acute Hyponatremia

A

Hypertonic solution

51
Q

Hypernatremia

A 
> 145 mEq/L
Euvolemic, hypervolemic, hypovolemic
Cells shrink
Increased neurological activity occurs 
Thirst mechanism responds
52
Q

Hypernatremia causes

A 
Actual
 Excessive ingestion
 Hyperaldosteronism 
 Corticosteroid 
 Renal failure
Relative
 NPO
 Increase metabolism 
 Watery diarrhea 
 Hyperventilation
53
Q

Assessment of Hyponatremia

A
  • 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
Q

Lab findings for Hypernatremia

A 
Na elevated
Increased u.o, SG 1.015-1.030
Elevated Cl
Serum osmolality >290 mOsm/kg
Incresed BUN and Hct
55
Q

Risk factors for Hypernatremia

A

Age
Medications
Diet

56
Q

Nursing dx for Hypernatremia

A

Risk for injury
Risk for DFV
Disturbed sensory/perception
Impaired oral mucous membranes

57
Q

Interventions for Hypernatremia

A

Decrease Na intake
Promote Na excretion
Continued monitoring of client
Restoration of balance

58
Q

Hypernatremia + euvolemic

A

Water, identify the cause

59
Q

Hypernatremia + hypovolemia

A

NS then D5W

60
Q

Hypernatremia + hypervolemia

A

Remove source of excess, diuretics, water

61
Q

Normal potassium range

A

3.5-5.0 mEq/L

62
Q

Potassium balance & imbalance

A

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
Q

Adequate K intake

A

40-60 mEq/day

64
Q

Hypokalemia

A

<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
Q

Clinical manifestation of Hypokalemia

A

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
Q

Monitoring Hypokalemia

A

Serum potassium
ECG changes
Electrolyte levels
I & O

67
Q

Lab findings for Hypokalemia

A

Plasma levels- trending
Elevated pH & bicarb levels ( alkalosis)
Elevated glucose

  • concurrent decrease in Cl, Mg, & Ca
68
Q

Risk factors for Hypokalemia

A

Age
Alcoholism
Medications
Dietary

69
Q

Nursing dx for Hypokalemia

A
  • 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
Q

Intervention for Hypokalemia

A 
Replacement therapies 
  Diet
  Supplements- not if UO< 0.5 ml/kg/hr
  Parenteral 
Continued monitoring
Restoration of balance
K sparing diuretics ( spinolactone & triamterene)
71
Q

Hyperkalemia

A

> 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
Q

Actual Hyperkalemia

A 
K in ECF is elevated 
 Excessive intake
 Deceased excretion ( adrenal insufficiency, renal insufficiency/failure, K sparing diuretics, ACE inhibitors)
73
Q

Relative Hyperkalemia

A 
K moves ICF to ECF 
 Cellular release (burns, trauma)
 Pseudohyperkalemia- hemolysis 
 Transcellular shifting ( insulin deficiency) 
 Addison's disease (decrease aldosterone)
74
Q

Clinical manifestation for Hyperkalemia

A

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
Q

Assessment for Hyperkalemia

A

Monitor
Serum K, ECG changes, I&O

Identify risk factors
Age, meds, diet, disease states & therapeutic treatments

76
Q

Lab findings for Hyperkalemia

A

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
Q

Nursing dx for Hyperkalemia

A

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
Q

Interventions for Hyperkalemia

A

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
Q

Medications for Hyperkalemia

A

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
Q

Calcium

A

Cause contraction & coagulation & nerve impulses

9.0-10.5mg/dL

Parathyroid hormone & vitamin d control
Bone resorption
Intestinal uptake
Kidney excretion

81
Q

Normal calcium level

A

9.0-10.5mg/dL

82
Q

Calcium in ECF

A

Protein bound (mostly albumin)
Chelated (citrate,phosphate,sulfate)
Ionized (50% of total)
Free to leave vascular compartment & participate in cellular functions

83
Q

Hypocalcemia

A 
<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
Q

Causes of Hypocalcemia

A

Impaired ability to mobilize calcium & bone
Decreased intake or absorption
Abnormal renal losses
Increased protein binding or chelation

85
Q

Hypocalcemia assessment

A
  • 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
Q

Hypocalcemia interventions

A

Drug therapy

Nutrition therapy

Environmental management

Injury prevention

87
Q

Hypercalcemia

A

> 10.5mg/dL

  • little changes have big effect
  • causes excitable
  • affected most: heart,muscles,nerves,intestinal smooth muscles
  • faster clotting time, inappropriate clots
88
Q

Hypercalcemia assessment

A
  • first increase hr & bp then decrease
  • shortened qt interval, dysrhythmias
  • hypertension
  • muscle weakness
  • altered loc
  • decreased peristalsis
  • chronic: osteopenia, osteoporosis
89
Q

Hypercalcemia interventions

A

Drug therapy
Rehydrate
IV normal saline promotes kidney excretion

Dialysis

Cardiac monitoring

90
Q

Phosphorus

A

3.0-4.5mg/dL
Needed for ATP formation
Balanced with calcium
Regulated by parathyroid hormone

91
Q

Normal phosphorus level

A

3.0-4.5mg/dL

92
Q

Hypophosphatemia

A

<3.0mg/dL
Body effected w/ chronic low levels
Decreased energy metabolism
Increased calcium levels

93
Q

Hypophosphatemia causes

A 
Malnutrition
Antacids 
Hyperparathyroidism 
Hyperglycemia (dka) 
Alcohol abuse
Hypercalcemia
94
Q

Hypophosphatemia assessment

A

Neuro: ataxia, confusion, seizures
Musculoskeletal: weakness, stiffness, bone pain
Blood disorders: platelet dysfunction, impaired WBC formation

95
Q

Hypophosphatemia interventions

A

Drug therapy

IV replacement

Nutrition therapy

96
Q

Hyperphosphatemia

A 
>4.5mg/dL
Increase membrane excitability 
Coincides with Hypocalcemia 
Caused by
  -decreased renal excretion
  -release from tissue injury 
  -hypoparathyroidism 
  -tumor lysis syndrome
97
Q

Magnesium

A 
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
Q

Normal magnesium levels

A

1.8-3.0mg/dL

99
Q

Hypomagnesemia

A

s disease

- medication

100
Q

Hypomagnesemia assessment

A 
Skeletal muscle weakness 
Increased impulse transmission 
  -tremors,athetoid movements 
Tachycardia
Hypertension
Cardiac arrythmias
101
Q

Hypomagnesemia interventions

A

Dc medications: loop diuretics, osmotic diuretics
IV magnesium sulfate
Possibly replace calcium also

102
Q

Hypermagnesemia

A

> 3.0mg/dL
Excitable membranes need more stimulus
Caused by increased intake or decreased renal excretion

103
Q

Hypermagnesemia assessment

A

Bradycardia, hypotension
Prolonged pr interval w/ widened qrs complex
Drowsy, lethargic
Weak, reduced, reflexes

104
Q

Hypermagnesemia interventions

A

Dc all magnesium supplements
If no renal failure
-IV fluids
-loop diuretics

105
Q

Chloride

A

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
Q

Normal chloride levels

A

98-106mEq/L

nursing theraputics (2 decks)

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