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NUR 520 > Fluid and Electrolyte balance > Flashcards

Fluid and Electrolyte balance Flashcards

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1
Q

What is the primary requirement for proper functioning of all body systems?

A

Fluid and electrolyte balance (Homeostasis)

Homeostasis is crucial for maintaining stable internal conditions in the body.

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2
Q

What percentage of body fluid is intracellular fluid (ICF)?

A

40%

ICF is the fluid located inside cells.

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3
Q

What percentage of body fluid is extracellular fluid (ECF)?

A

20%

ECF includes fluid outside cells, comprising intravascular, interstitial, and transcellular fluids.

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4
Q

Fluid % Intravascular and Interstitial

A

Intravascular (Plasma) 5%
Interstitial (surrounds tissues/cells) 14%

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5
Q

What is the best indicator of fluid loss or gain?

A

Change in daily weight
-Weight-in at the same time each day wearing the same clothes

1 L of water is equal to 1 kg of body weight.
1 L of water weighs 2.2 lbs

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6
Q

Define electrolytes.

A

Substances whose molecules dissociate into ions when placed in water

Electrolytes are crucial for various physiological functions.

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7
Q

What is the prevalent cation/anion in intracellular fluid (ICF)?

A

K+ (Potassium)
(PO4)3-

K+ is essential for cell function and electrical activity.

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8
Q

What is the prevalent cation/anion in extracellular fluid (ECF)?

A

Na+ (Sodium)
Anion- Cl-

Na+ is vital for maintaining fluid balance and nerve function.

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9
Q

What is diffusion?

A

Movement of molecules across a permeable membrane from high to low concentration

Diffusion is a passive process that does not require energy.

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10
Q

Facilitated Diffusion

A

Uses carrier to help move molecules

Protein channels- no energy required

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11
Q

What is osmosis?

A

Movement of water ‘down’ concentration gradient
-From a region of low solute concentrarion to one of high solute concentration
-across a semipermeable membrane

Osmosis occurs across a semipermeable membrane and does not require outside energy.

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12
Q

Active Transport

A

Process in which molecules move against concentration gradient
External energy is needed for this process

AKA sodium/potassium pump

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13
Q

What does osmotic pressure measure?

A

Amount pressure/force required to stop osmotic flow of water

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14
Q

Calculate plasma osmolality using the formula: Plasma Osmolality = (2 × Na) + (BUN / 2.8) + (glucose / 18). What is the normal range?

A

Normal plasma osmolality is between 280 and 295 mOsm/kg

Values outside this range indicate- water deficit and water exess

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15
Q

What does hypotonic mean?

A

Solutes less concentrated than in cells

Hypotonic solutions can cause cell swelling.

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16
Q

What does hypertonic mean?

A

Solutes more concentrated than in cells

Hypertonic solutions can lead to cell shrinkage.

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17
Q

What is hydrostatic pressure?

A

Force of fluid in a compartment
the pressure that exists within a fluid that is not moving. It’s caused by the weight of the fluid, or the force of gravity acting on the fluid.
(static)

Hydrostatic pressure is generated by the heart’s contraction.

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18
Q

Oncotic Pressure

A

Colloid osmotic pressure
Osmotic pressure caused by plasma proteins

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19
Q

What causes edema?

A

Shifts of plasma to interstitial fluid, elevation of venous hydrostatic pressure, decrease in plasma oncotic pressure, elevation of interstitial oncotic pressure

Edema is an abnormal accumulation of fluid in interstitial spaces.

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20
Q

What is fluid spacing?

A

First spacing: Normal distribution; Second spacing: Abnormal accumulation of interstitial fluid (edema); Third spacing: Fluid is trapped where it is difficult or impossible for it to move back

Understanding fluid spacing is critical in assessing fluid imbalances.

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21
Q

What is the primary function of the kidneys in fluid balance?

A

Regulating fluid and electrolyte balance by adjusting urine volume and selectively reabsorbing water and electrolytes

The kidneys are essential for maintaining homeostasis.

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22
Q

Adrenal cortical regulation

A

Releases hormones to regulate water and electrolytes (cortisol/aldosterone)

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23
Q

Gerontologic considerations

A

-Structural changes in kidneys decrease ability to conserve water
-Hormonal changes include a decrease in renin and aldosterone and increase in ADH and ANP
-Subcutaneous tissue loss leads to increased moisture lost

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24
Q

Developmental considerations: Older adults

A

Increased risk for dehydration due to:
Less total body water
Decreased thirst mechanism
Decreased mobility difficulty obtaining fluids
Medications that increase fluid excretion

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25
What is hypovolemia?
Fluid volume deficit (FVD) ## Footnote Hypovolemia is characterized by an abnormal loss of body fluids or inadequate fluid intake.
26
What are common clinical manifestations of hypovolemia?
Weak heart rate, low blood pressure, decreased respiratory rate, dry mucous membranes, confusion, dark amber urine, sudden weight loss ## Footnote These signs indicate significant fluid loss.
27
What is hypervolemia?
Fluid volume excess (FVE) ## Footnote Hypervolemia results from excessive fluid intake or abnormal retention.
28
What are common clinical manifestations of hypervolemia?
Weight gain (most common), increased respiratory rate, dyspnea on exertion, pitting edema, headache, skeletal muscle weakness ## Footnote These manifestations indicate fluid overload. Can lead to heart failure or pulmonary edema
29
Nursing interventions: hypovolemia (ways to restore normal volume in fluid compartments)
-Oral fluid replacement if dehydration isn’t severe -IV fluids if dehydration is severe or patient cannot tolerate oral liquids -Type and amount of IV fluid depends on severity of dehydration and blood osmolality **Assess IV site at least hourly for signs of infiltration, extravasation, and phlebitis
30
Monitor for signs of fluid overload:
Bounding pulse Difficulty breathing Neck vein distension in the upright position Presence of dependent edema
31
Nursing considerations for Hypovolemia
Interprofessional Care -Correct the underlying cause and replace water and electrolytes *Orally *Blood products *Balanced IV solutions Goals: Prevent further fluid losses Prevent injury Restore fluid volume compartments to normal volumes (oral, IV, and replace electrolytes)
32
Clinical manefestations of Hypovolemia
Increased HR Weak Peripheral pulses Decreased BP Flat neck and hand veins Decreased Respiratory rate Decreased Skin Turgor Dry, pale mucous membranes confusion low grade fever Decreased Urine output Dark amber urine Sudden weight loss
33
Lab Values for hypovolemia
INCREASED: Hemoglobin Hematocrit Glucose Protein BUN Electrolytes
34
What is the purpose of diuretics in fluid management?
Remove fluid without changing electrolyte composition or osmolality of ECF ## Footnote Diuretics help manage fluid overload conditions.
35
What is the role of glucocorticoids and mineralocorticoids in fluid balance?
Regulate water and electrolytes ## Footnote These hormones are released from the adrenal cortex.
36
True or False: The elderly have a decreased risk for dehydration.
False ## Footnote Older adults are at increased risk for dehydration due to various physiological changes.
37
What is extracellular fluid overload?
An overload of extracellular fluid with a significant increase in intracellular fluid volume.
38
What is the primary role of sodium in the body?
* ECF volume and concentration * Generating and transmitting nerve impulses * Muscle contractility * Regulating acid-base balance
39
What causes hypernatremia?
High serum sodium may occur with inadequate water intake, excess water loss, or sodium gain.
40
What are the manifestations of hypernatremia?
* Thirst * Changes in mental status (drowsiness, restlessness, confusion, lethargy, seizures, coma) * Symptoms of fluid volume deficit
41
What nursing diagnoses are associated with hypernatremia?
* Electrolyte imbalance * Fluid imbalance * Risk for injury * Potential complication: Seizures and coma
42
What is the primary water deficit treatment for hypernatremia?
Replace fluid orally or IV with isotonic or hypotonic fluids.
43
What is hyponatremia?
Results from loss of sodium-containing fluids and/or from water excess.
44
What are the clinical manifestations of hyponatremia?
* Mild: headache, irritability, difficulty concentrating * More severe: confusion, vomiting, seizures, coma
45
What nursing interventions are appropriate for severe hyponatremia?
Give a small amount of IV hypertonic saline solution (3% NaCl).
46
What are the primary sources of potassium?
* Protein-rich foods * Fruits and vegetables * Salt substitutes * Potassium medications (PO, IV) * Stored blood
47
What causes hyperkalemia?
* Impaired renal excretion * Shift from ICF to ECF * Massive intake of potassium * Some drugs
48
What are the manifestations of hyperkalemia?
* Dysrhythmias * Fatigue, confusion * Tetany, muscle cramps * Weak or paralyzed skeletal muscles * Abdominal cramping or diarrhea
49
What management strategies are used for hyperkalemia?
* Stop oral and parenteral potassium intake * Increase potassium excretion (diuretics, dialysis) * Force potassium from ECF to ICF by IV insulin with dextrose * Stabilize cardiac cell membrane by administering calcium gluconate IV
50
What causes hypokalemia?
* Increased loss of potassium via the kidneys or gastrointestinal tract * Increased shift of potassium from ECF to ICF * Dietary potassium deficiency * Renal losses from diuresis
51
What are the manifestations of hypokalemia?
* Cardiac most serious * Skeletal muscle weakness (legs) * Weakness of respiratory muscles * Decreased GI motility * Hyperglycemia
52
What is the nursing implementation for potassium chloride supplementation?
Always dilute IV KCl, NEVER give KCl via IV push or as a bolus, and should not exceed 10 mEq/hr.
53
What are the functions of calcium in the body?
* Formation of teeth and bone * Blood clotting * Transmission of nerve impulses * Myocardial contractions * Muscle contractions
54
What are the causes of hypercalcemia?
* Hyperparathyroidism (two-thirds of cases) * Cancer
55
What are the manifestations of hypercalcemia?
* Fatigue, lethargy, weakness, confusion * Hallucinations, seizures, coma * Dysrhythmias * Bone pain, fractures, nephrolithiasis * Polyuria, dehydration
56
What nursing implementation strategies are used for hypocalcemia?
* Treat cause * Calcium and Vitamin D supplements * IV calcium gluconate * Rebreathe into paper bag * Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis
57
What is hyperphosphatemia?
High serum phosphate caused by acute kidney injury, chronic kidney disease, excess intake of phosphate or vitamin D, and hypoparathyroidism.
58
What are the manifestations of hyperphosphatemia?
* Tetany * Muscle cramps * Paresthesias * Hypotension * Dysrhythmias * Seizures
59
What management strategies are used for hypophosphatemia?
* Oral supplementation * Ingestion of foods high in phosphorus * IV administration of sodium or potassium phosphate * Monitor serum calcium and phosphorus levels every 6 to 12 hours
60
What is the role of magnesium in the body?
* Cofactor in enzyme for metabolism of carbohydrates * Required for DNA and protein synthesis * Blood glucose control * BP regulation * Needed for ATP production
61
What causes hypermagnesemia?
Increased intake of products containing magnesium when renal insufficiency or failure is present, or excess IV magnesium administration.
62
What are the manifestations of hypermagnesemia?
* Hypotension * Facial flushing * Lethargy * Nausea and vomiting * Impaired deep tendon reflexes * Muscle paralysis * Respiratory and cardiac arrest
63
What is hypermagnesemia?
High serum Mg caused by increased intake of magnesium products during renal insufficiency or failure, and excess IV magnesium administration. ## Footnote Hypermagnesemia can lead to serious health complications.
64
List the manifestations of hypermagnesemia.
* Hypotension * Facial flushing * Lethargy * Nausea and vomiting * Impaired deep tendon reflexes * Muscle paralysis * Respiratory and cardiac arrest ## Footnote These symptoms highlight the severity of hypermagnesemia.
65
What is the first step in managing hypermagnesemia?
Prevention first—restrict magnesium intake in high-risk patients. ## Footnote Identifying at-risk patients is crucial for effective management.
66
What treatments are available for symptomatic hypermagnesemia?
* IV CaCl or calcium gluconate * Fluids and IV furosemide to promote urinary excretion * Dialysis ## Footnote These treatments help to quickly reduce serum magnesium levels.
67
What is hypomagnesemia?
Low serum Mg caused by prolonged fasting, chronic alcoholism, fluid loss from the GI tract, prolonged parenteral nutrition without supplementation, diuretics, proton-pump inhibitors, or hyperglycemic osmotic diuresis. ## Footnote Hypomagnesemia can have various causes, often related to dietary and medical factors.
68
List the manifestations of hypomagnesemia.
* Resembles hypocalcemia * Muscle cramps, tremors * Hyperactive deep tendon reflexes * Chvostek’s and Trousseau’s signs * Confusion, vertigo, seizures * Dysrhythmias ## Footnote Symptoms may overlap with other electrolyte imbalances.
69
What is the management for hypomagnesemia?
* Treat underlying cause * Oral supplements * Increase dietary intake * Parenteral IV or IM magnesium when severe ## Footnote Addressing the root cause is essential in treating hypomagnesemia.
70
Fill in the blank: A patient is admitted with renal failure and an arterial blood pH level of 7.29. The expected serum potassium level would be _______.
5.9 mEq/L ## Footnote This level indicates potential complications related to renal failure.
71
True or False: Muscle paralysis is a manifestation of hypermagnesemia.
True ## Footnote Muscle paralysis can occur due to elevated magnesium levels affecting neuromuscular function.
72
Which electrolyte imbalance resembles hypocalcemia?
Hypomagnesemia ## Footnote Both conditions can present with similar neuromuscular symptoms.
73
What are common causes of hypomagnesemia?
* Prolonged fasting or starvation * Chronic alcoholism * Fluid loss from the GI tract * Prolonged parenteral nutrition without supplementation * Diuretics * Proton-pump inhibitors * Hyperglycemic osmotic diuresis ## Footnote Understanding these causes aids in prevention and treatment.
74
What is hypovolemia?
Fluid volume deficit ## Footnote Loss of extracellular volume exceeds the intake of fluid.
75
What are the causes of hypovolemia?
* Abnormal fluid loss * At risk: Elderly, burns, surgery, hemorrhage
76
What are the clinical manifestations of hypovolemia?
* Weight loss * Decreased skin turgor * Oliguria * Concentrated urine * Change in blood pressure (postural hypotension) * Cool/clammy skin * Dry mucus membranes * Weak/rapid heart rate * Delayed cap refill * Thirst
77
What is the medical management for hypovolemia?
Fluid replacement (PO or IV depending on severity) Isotonic solution initially.
78
What nursing interventions are recommended for hypovolemia?
* I & O * Daily weight * LOC * Breath sounds * Skin temp/color * Vitals
79
What is hypervolemia?
Fluid volume excess ## Footnote Isotonic expansion of the extracellular fluid caused by abnormal retention of water and sodium.
80
What are the causes of hypervolemia?
Excessive fluid replacement Kidney failure (late stage) Heart failure Long term steroid therapy Syndrome of inappropriate ADH secretion (SIADH) Psychiatric conditions with polydipsia Water intoxication
81
What are the clinical manifestations of hypervolemia?
increase pulse increase blood pressure Increased central venous pressure increase neck and hand veins Weight gain Increased respiratory rate Dyspnea on exertion Crackles heard on auscultation Pitting edema in dependent areas Skin pale and cool to touch Headache Skeletal muscle weakness Paresthesias Enlarged liver
82
What is the medical management for hypervolemia?
* Diuretics * Restricting fluids and sodium
83
What nursing interventions are recommended for hypervolemia?
* I & O * Daily weight * Monitor edema * Teach about sodium and fluid restriction * Monitor intake
84
Lab indicators for hypervolemia
Electrolytes usually normal Decreased Hgb/Hct Decreased serum protein levels
85
What is the normal range for sodium levels?
135-145 mEq/L
86
What is hyponatremia?
< 135 mEq/L
87
What are the causes of hyponatremia?
* Vomiting * Diarrhea * Fistulas * Prolonged/excessive sweating * Diuretics * Low salt diet * Water intoxication * SIADH * Psychogenic polydipsia
88
What are the clinical manifestations of hyponatremia?
* Poor skin turgor * Dry mucosa * Headache * Nausea * Abdominal cramping * Edema * Crackles * JVD * Altered mental status * Lethargy * Seizures * General weakness
89
What is the medical management for hyponatremia?
* Sodium replacement * Water restriction
90
What nursing interventions are recommended for hyponatremia?
* I & O * Daily weight * Neuro assessment * Safety
91
What is hypernatremia?
> 145 mEq/L
92
What are the causes of hypernatremia?
* Fluid deprivation * Enteral feedings without adequate water flushes * Watery diarrhea (dilutional) * Diabetes insipidus * Kidney failure * Excessive sodium intake * Dehydration (dilutional)
93
What are the clinical manifestations of hypernatremia?
* Restlessness * Weakness * Disorientation * Hallucinations * Thirst * Dry mucous membranes * Flushed skin * Peripheral/pulmonary edema * Increased muscle tone * Increased deep tendon reflexes
94
What is the medical management for hypernatremia?
* Gradually lowering serum sodium level with infusion of hypotonic solution * Restrict dietary sodium * Diuretics that promote NA+ loss
95
What nursing interventions are recommended for hypernatremia?
* I & O * Safety * Offer fluids at regular intervals
96
What is the normal range for potassium levels?
3.5-5/5.2 mEq/L
97
What is hypokalemia?
< 3.5 mEq/L
98
What are the causes of hypokalemia?
* Use of diuretics * Diarrhea * Vomiting * Gastric suction * Recent ileostomy * Intestinal drains * Decreased intake (NPO, anorexia, alcoholism, fasting) * Metabolic alkalosis
99
What are the clinical manifestations of hypokalemia?
* Fatigue * Anorexia * Nausea * Vomiting * Muscle weakness * Leg cramps * Decreased bowel motility * Paresthesia * Arrhythmias * Decreased muscle strength * Decreased tendon reflexes * ECG changes (flat T wave, inverted T wave, elevated U wave)
100
What is the medical management for hypokalemia?
* Oral or IV potassium replacement * Typically replace anything <3.5 mEq/L especially if on diuretic or symptomatic
101
What nursing interventions are recommended for hypokalemia?
* Continued assessments * Encourage patients at risk to eat potassium-rich foods * Monitor kidney function * Administer replacement as ordered
102
What is hyperkalemia?
> 5/5.2 mEq/L
103
What are the causes of hyperkalemia?
* Increased intake * Medications that increase (potassium-sparing diuretics, ACE inhibitors) * Crushing injuries * Burns * Trauma * Intravascular hemolysis * Rhabdomyolysis * Kidney failure
104
What are the clinical manifestations of hyperkalemia?
* Cardiac rhythm changes (peaked/narrow T waves, depressed ST-segment) * Skeletal muscle weakness * Paralysis * Nausea * Intermittent intestinal colic * Diarrhea * Acidosis
105
What is the medical management for hyperkalemia?
* Restriction of dietary potassium * Kayexalate (cation exchange) * Dangerously high levels: calcium gluconate, sodium bicarbonate, IV regular insulin, hypertonic dextrose solution * Loop diuretics * Beta-2 agonists
106
What nursing interventions are recommended for hyperkalemia?
* Assess neuro, cardiac, and GI * Avoid potassium-rich foods
107
What is the purpose of interpreting arterial blood gases (ABGs)?
Helps identify a potential acid-base imbalance in the body.
108
What are the types of acid-base imbalances that can occur in the body?
* Respiratory acidosis * Respiratory alkalosis * Metabolic acidosis * Metabolic alkalosis
109
What is the normal blood pH range?
7.35-7.45
110
What does the ROME method stand for?
* Respiratory * Opposite * Metabolic * Equal
111
In the ROME method, what does 'Respiratory Opposite' mean?
CO2 and pH will be OPPOSITE of each other.
112
In the ROME method, what does 'Metabolic Equal' mean?
HCO3 and pH will be EQUAL.
113
What are the normal lab values for CO2?
35-45 mmHg
114
What are the normal lab values for HCO3?
22-26 mEq/L
115
What pH value is considered acidic?
< 7.35
116
What pH value is considered alkalotic?
> 7.45

NUR 520 (12 decks)

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