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Health And Illness 2 > Fluid and Electrolyte > Flashcards

Fluid and Electrolyte Flashcards

(57 cards)

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1
Q

Intracellular Fluid ( Hypotonic )

A

2/3 of body fluid

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2
Q

Extracellular

A

1/3 of body fluid
Interstital
Intravascular
Transcellular

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3
Q

Fluid Intake

A

2,5000 mL a day

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4
Q

Fluid Output

A

1,4000-1,5000 mL

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5
Q
  1. Filtration
A

Is the movement of fluid through a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of membrane.
Ex: Blood Pressure
Higher —> lower

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6
Q
  1. Diffusion
A

Movement of solution from an area of high concentration to low concentration.
- Smaller substances diffuse more easily!
Molecules intermerge

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7
Q

Facilitated Diffusion / Active transport

A

The transport of substances across a biological membrane from an area of higher to lower concentration WITH the help of a transport molecule.
- Regulates what goes in/out of cell.
Ex: Sodium / P pump

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8
Q
  1. Osmosis
A

Movement of water across the cellular membrane from an area of lower concentration to higher.
- Helps regulate fluid balance.

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9
Q

Hypovolemia

A

Isotonic Loss
Risk Factors: GI loss, skin loss, burns, high intake of salt, hyperventilation, low water intake.
Cardio: Increased heart rate, low BP
Respiratory: Increased rate
Skin: Poor skin turgor
Neuro: Cognition changes
Kidney: Concentrated urine, strong odor, < 500 mL = Concerning!
Labs: Multiple labs + S/S

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10
Q

Third Spacing

A

From vascular space to other areas
Trapped fluid= volume loss
Causes: Burns, trauma, surgery, sepsis

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11
Q

Diagnostics Fluid Deficit

A

HcT increased
BUN increased
Elevated Urine Specific Gravity
Na+ elevated
Increased blood osmolarity

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12
Q

Interventions for Dehydration

A

-Oral Fluids if awake
-Pedialyte
- IV Fluids: 0.9% NS
- Monitor I&O
-DAILY WEIGHTS!!!!
- Meds: antiemetics, antipyretics, desmopressin ( diabetes insipidus )

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13
Q

Hypovolemic Shock

A

Cells no longer carry oxygen to the blood
- Administer Oxygen
- Monitor VS
- Fluid Replacements
- Vasoconstrictors

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14
Q

Hypervolemia

A

Causes: Heart failure, kidney failure, overdose of fluids, corticocosterioids
Cardio: Increased pulse, high bp, distended neck veins
Resp: Increased rate, crackles
Skin: Edema
Neuro: HA, weakness
GI: Increased motility, enlarged liver
*** increased CVP

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15
Q

Hypervolemia Diagnostics

A

Decreased HCT
Decreased blood osmolarity
Decreased urine specific gravity
Decreased BUN

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16
Q

Fixing Fluid Overload?

A

-Drug therapy: Removing Excess fluid; * Diuretics such as furosemide ( loop )
-Nutrition: Fluid restriction possible for chronic cases.
-Monitoring: I&O and daily weights!

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17
Q

What response does the nurse expect as a result of infusing 500 mL of a 3% NS solution over a 1 hr time period?

A

Plasma volume osmolarity increases; blood pressure increases
- Solutes going into blood = High BP

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18
Q

Which clinical indicators are most relevant for the nurse to monitor during IV fluid replacement for a client with dehydration?

A

BP
Pulse Rate
Urine output

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19
Q

Cations

A

NA-
K+
Mg+
CA+

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20
Q

Anions

A

Phosphate
Cl-

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21
Q

Sodium

A

Most abundant in ECF

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22
Q

Hyponatremia

A

Is when the serum sodium level is below 136 mEq/L
Sodium most abundant in electro in ECF
No Na+”
NA+ excretion increased with renal problems: Loss of sodium and water!
- NG suction, vomitting, over use of diuretics, sweating, diarrhea
Overload of fluid with CHF
- Water follows sodium
- Sodium decreasing because of dilution: renal failure, hypotonic fluid infusions

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23
Q

Hyponatremia manifestations

Study These Flashcards
A

***Neuro: HA, Increased intracranial pressure, seizures, coma can occur
Musc: Muscle Weakness, DTR diminish
Intestinal: Increased motility causing N/V, diarrhea, hyperactive BS
Cardio: Rapid, weak, thready pulse, decreased BP

24
Q

Hyponatremia Interventions

Study These Flashcards
A

Always bring up Na+ SLOWLY! Never exceed 12 meQ in 24 hr time period
- Drug Therapy: Reduce diuretics bc of sodium loss, IV Saline, promote excretion of water rather than sodium when caused by fluid excess.
- Increase oral sodium

25
Hypernatremia Risk factors
Kidney failure, cushings, cortico, excessive oral sodium intake, fevers, sweating -Above 145
26
Hypernatremia Manifestations`
Neuro: AMS, short attention span, agitated, confused - *** hypernatremia and fluid overload can cause lethargy, stupor, coma Skeletal Muscle: Muscle twitching, weak, deep tendon reflexes are absent, occurs bilaterally, no pattern Cardio: Increased pulse rate, hypotension = hypernatremia and hypovolemia Decreased pulse rate, distended neck veins, increased BP = hypernatremia and hypovolemia
27
Hypernatremia Interventions
Drug: Need diuretics that promote sodium loss ( furosemide, bumetanide ) Nutriton: Ensure adequate fluid intake - Dietary sodium restriction ALWAYS CONTINUE TO ASSESS THE PATIENT FOR INDICATIONS OF EXCESSIVE LOSSES OF FLUID, SODIUM, POTASSIUM
28
Potassium
Normal Range: 3.5-5.0 - Commonly altered by changes in K+ intake - Essential in NA/K pump -Foods high: Meat, fish, fruits, veggies -Foods low in: Eggs,bread, grains - Facilitates glycogen storage in lover and skeletal muscle cells - Main ion in ICF 98%
29
Hypokalemia
Serum potassium level below 3.5 - Low K+ levels reduce exitability of cells, causing excitable tissues to respond to less stimuli Excessive Fluid Loss: Vomiting, Diarrhea, NG suction Diuretic Drugs Kidney Disease Cushings Wound Drainage Diuresis Heart Failure Rapid infusion of insulin... because drug increases the activity of Sodiumm- Potassium pump forcing more blood potassium levels are linked to magnesium Stress reaction
30
S/S of Hypokalemia
Muscle: skeletal muscle weakness, DTR reflexes reduced = flaccid paralysis *** Cardio: Thready, weak pulse. Orthostatic Hypotension. - Perform an ECG. Can include ST- segment depression, flat T wave, increased U waves. Dysrhymias can lead to death. Neuro: AMS, irrability, anxiety Ints: N/V, constipation, abdominal distension - Shallow respirations
31
How to fix Hypokalemia?
1. Preventing K+ loss - Potassium Sparing Diuretic - Sprinlactone 2. Increasing K+ Levels - Potassium Supplements: Potassium chloride, glucanate, citrate given oral or IV. 3. Resp Monitoring: Nail bed pallor or cyanosis.
32
Potassium Chloride Dosages
A concentration of ***10 meQ KCL/100 mL can be administered through a peripheral vein; You can run 20 mEq/100 mL though a central venous catheter or PICC.
33
Hyperkalemia
Level higher than 5.0 mEq / L - Increase exitability of cells, causing excitable tissues to respond to less intense stimuli. - Can lead to V-Fib - Sudden potassium rises cause severe problems at serum levels betweem 6-7. When serum potassium rises slowly, problems may not occur until K+ levels reach 8+.
34
Examples of Hyperkalemia can occur..
- Over ingestion of potassium containing foods / meds. - Rapid infusions - Burns, MI *** - Kidney failure -Potassium sparing diuretics - ACE'S 1 *** -Acidosis *** - Diabetes ( uncontrolled )
35
Hyperkalemia Manifestations
***CV: Brady, hypotension, ECG changes of tail peaked T waves, aystole and V Fib Neuro: Twitching, tingling, burning, numbness, muscle weakness and flaccid paralysis Intest: Increased motility with diarrhea
36
Hyperkalemia 3 Solutions
1. First Intervention: Insulin ( IVP 10-15 Units of regular insulin along with 50 mL of 50% dextrose to prevent hypoglycemia ) will lead to shift of potassium ions into the cell secondary to increased activity of the sodium - potassium pumps. Can be repeated. 2. Biocarbonate ( e.g. 1 ampule ( 50 meQ ) infused over 5 mins ) is effective in shifting potassium into the cell. The biocarbonate ion will stimulate an exchange of cellular H+ ( moves it out cell ) for Na+ leading to stimulation of pumps. 3. Albuterol ( beta 2 agonist; inhaled as neb ) : This drug lowers blood levels of K+ by promoting its movement into cells.
37
If client has ECG changes ( tall, peaked T waves )....
Calcium gluconate should be given before insulin / dextrose - Stabilize cardiac muscle
38
Hyperkalemia Perm Fixes
1. Loop Diuretics ( Furosemide ) - gets the client to urinate and potassium leaves the body completely again need a patient who makes urine. 2. Sodium Polystyrene Sulfonate - Given PO or as enema. Potassium is exchanged for sodium in intestines and excreted in stool. Causes frequent stooling; dont give to someone with impaired bowel function ---> intestinal necrosis - Monitor s/s of fluid overload: crackles, edema, HTN, JVD distention, assess abdomen, monitor K+ lab 3. Dialysis usually hemodyalysis: If this is AKI patient might just have a few runs of hemo --> until kidney function improves.
39
Calcium
9.0-10.5 - Must be kept in narrow range ECF -Absorbed through intestinal tract. -Requires active form of VIT D
40
Hypocalcemia how it can occur...
- Common in renal failure - * Hypothyroidism -Hypomagnsemia - Vit D deficiency -Pancreatis -Alkalosis - * Malabsorption syndrome -Diarrhea -Would drainage
41
Hypocalcemia Manifestations
NeuroM: Parathesia occurs first, with sensations of tingling and numbness. Frequent painful muscle spasms- thigh, foot, calf during sleep. - Charli Horse - Trousseau's - Chvstek's CV: HR could be slower or faster, weak, thready pulse. Severe hypotesnion. Prologned QT Intest: Hyperactive BS Skelt: osteoporosis, curv of spine
42
Hypocalcemia How to fix it?
Drug Therapy: Oral or IV calcium & Vit D to enhance absorption. Treating hypothy with Vit D - *Phosphate: binding agents may be required to reduce serum phosphurus in patients w chronic renal failure. - Take w meals ^ Nutrtion: Increase calcium rich foods
43
Hypercalcemia
Serum level above 10.5 mg/dl or 2.62 mmol/l - Causes exitable tissues to be less sensitive to normal stimuli thus requiring stonger stimulus to function. - Most affects heart, skeletal muscles, nerves, intestinal smooth muscles.
44
Causes of Hypercalcemia
- Excessive intake of calcium -Excessive oral intake of vit D - Kidney Failure - Thiazide diuretics *** -Hyperthyroidism - Gluccocorticosteroids
45
Hypercalcemia S/S
Cardio: Most serious: - 1. Causes increased heart rate and BP. 2. Severe depresses electrical conduction slowing heart rate. - Short QT interval - Monitor for blood clots NeuroM: Muscle weakness, decreased deep tendon reflexes with paraesthesia. Confused, lethargic. Intestinal: Constipation, abdominal pain
46
Hypercalcemia Treatment
1. Fluid Volume Replacement: 0.9% NACL 2. Drug Therapy: - *** Thiazide diuretics are discontinued and replaced with diuretics that enhance discretion of calcium, such as furosemide. Calcium chelators help lower calcium levels. -Drugs to prevent hypercalcemia include agents that inhibit calcium resorption ( movement out ) from bone such as ****phosphurs*, calcitonin, bisphosphonates, and prostaglandin synthesis inhibitors ( NSAIDS, aspirin ) 3. Dialysis if severe
47
Magnesium is essential for
Skeletal Muscle Contraction Carbo Metabolism Generation of energy stores Vit Activation Blood Coag Cell growth
48
Hypomagnesemia Risk Factors
*Malnutrition Diarrhea Celiac Disease Crohns Disease Drugs ( diuretics ) *Ethanol Ingestion ( alcohol abuse )
49
Hypomagnesemia Manifestations
Cardio: Can increase risk of hypertension, athersclerosis, hypertrophic left ventricle, dysrhymias Neuro: Caused by increase nerve impulse transmission - Hyperactive deep tendon reflexes, numbness, tingling, painful muscle contractions - Positive Chvostek, Trosseau signs Intestinal: Decreased peristalis, constipation, N/V, paralytic illeus
50
Hypomagnesemia How to fix it?
Hypomagnesemia and Hypocalcemia go hand in hand! - Disc drugs that promote Mag loss... - Loop diuretics, osmotic diuretics, aminoglycoside antibiotics, phosphurus Mag is replaced with magnesium sulfate * - IV replacement
51
Hypermagnesemia
Serum level above 2.6 meQ - Increased intake of antiacids, too much IV, decreased kidney excretion = kidney disease
52
Hypermagnesemia Manifestions
****Cardio: Brady, cardiac arrest, peripheral vasodilation, hypotension, ECG changes - Grave danger for cardiac arrest CNS: Depressed nerve impulse, drowsiness, coma NeuroM: Absent tendon relfexes, muscle contractions Resp: Weak, shallow respirations
53
How do we fix Hypermagnesemia?
Discontinue drugs that increase Mag levels: - All oral/ parenteral mag - Administer mag free IV - Loop diuretics can further reduce serum levels - ***When cardiac problems are severe giving calcium may reverse the cardiac effects of hypermagensemia
54
With which client does the nurse remain alert for and. assess most frequently for s/s of hypokalemia?
22 yr old receiving an IV infusion of reg insulin to manage ep of ketoacidosis
55
Potassium level went from 4.6-6.1 which assessment first?
Pulse rate and rhythm
56
Which condition in the client with a serum sodium level at 149 indicates to the nurse that this electrolyte imbalance is caused by dehydration/
Hematocrit is 52%; HC is higher is definite sign
57
Which electrolytes are most affected by low mag levels
Calcium, Potassium

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