Fluid and Electrolytes

Question 1

What is Fluid

Answer 1

Fluid is necessary for life and homeostasis. 60% of the human body is fluid. It exists in two compartments Extracellular (outside the cell) & Intracellular (inside the cell). 2/3 of the fluid is in the intracellular space.

Question 2

What are Electrolytes?

Answer 2

Active ions that carry charges.
Cations are Na+, Ca+, K+, Mg+
Anions are Cl-, HC03-, P04-
Concentrations vary depending on the compartment

Question 3

Magnesium Lab Value

Answer 3

1.8 -2.6

Question 4

Sodium Lab Value

Answer 4

135-145

Question 5

Potassium Lab Value

Answer 5

3.5-5

Question 6

Calcium Lab Value

Answer 6

8.8-10.4

Question 7

Phosphate Lab Value

Answer 7

2.5-4.5

Question 8

Chloride Lab Value

Answer 8

98-106

Question 9

Regulation of Fluid

Answer 9

Movement of fluid through capillary walls depends on differences of hydrostatic & osmotic pressure.

Question 10

Osmotic Pressure

Answer 10

Movement of fluid from a greater concentration to a lower concentration

Question 11

Hydrostatic Pressure

Answer 11

pressure exerted on the walls of the blood vessel

Question 12

What is the difference between hypotonic and hypertonic?

Answer 12

Hypotonic- hydrates the cell

Hypertonic - Fluid moves out of the cell

Question 13

Lifespan Consideration for Infants and Children (Less than 2 yr.)

Answer 13

Infants have an increased risk of fluid and electrolyte imbalance because they have a higher respiratory rate & metabolic rate and immature kidneys. When infants are FVD their mucous membranes are dry, sunken soft spot and become lethargic.
***AT MOST RISK is preterm infants because of immature kidneys effect their ability to concentrate urine

Question 14

Lifespan Consideration for Older Adults

Answer 14

The thirst sensation in the elderly is blunted resulting in decreased fluid intake. Decrease body mass which decreases the amount of water in the body. Decreased renal reserve due to decrease in the number of nephrons.

Question 15

What is a consideration with gender?

Answer 15

Males have a decreased amount of fat in comparison to females. Fat= water content

Question 16

What is a consideration for African Americans?

Answer 16

They have increased sensitivity to salt.

Question 17

What are causes of Fluid Volume Deficit?

Answer 17

Vomiting
Diarrhea
Decreased fluid intake
Third space fluid shifts- which fluid becomes inaccessible to the body ex- Burns

Question 18

Clinical Manifestations of Fluid Deficit

Answer 18

Thirst
Dizziness & Decreased LOC (water shift outside brain cells)
Weight Loss - of 1kg or more withing 24 hr.
Low blood pressure
Flat neck veins
Rapid thready pulse
Decreased skin turgor

Question 19

Treatments for Fluid Volume Deficit

Answer 19

Encourage Fluid Intake 
Antiemetic via IV 
Oral hygiene and lubricating lips 
Education on prevention of fluid loss 
Monitor labs to assess kidney function

Question 20

What is Fluid Volume Excess?

Answer 20

abnormal retention of water and sodium

Question 21

What causes Fluid Volume Excess?

Answer 21

Heart failure 
Kidney Injury 
Cirrhosis of the liver 
TOO much SALT 
Excess administration of sodium containing fluids

Question 22

Clinical Manifestation of Fluid Volume Excess

Answer 22

BIG AND BLOATED 
Dependent Edema 
Bounding pulses 
Distended Neck Veins 
Elevated blood pressure 
Weight Gain
**** REQUIRED: Na+ restriction

Question 23

Treatment for Fluid Volume Excess

Answer 23

Assess I &O, daily weight, auscultate lung sound (crackles), edema
Monitor response to diuretics and parenteral fluids
Teach pt. adherence to fluid restrictions and decreased sodium intake
Monitor and avoid sources of excessive sodium intake including medications (Corticosteroids)
Promotes rest

Question 24

Hyperkalemia

Answer 24

TIGHT & CONTRACTED 
Decreased LOC 
Hypotension & bradycardia 
Diarrhea & hyperactive bowels  
Paralysis in extremities 
Decreased DTR

Question 25

Hyperkalemia Treatment & Causes & Diets

Answer 25

``` Treatment- A-Assess EKG/ABG I-IV potassium chloride ***NEVER IV PUSH*** D-Diet Causes G-GI loss (vomiting) O-Osmotic diuresis T-Thiazides & loop diuretics S-Severe acid imbalance H-Hyperaldosteronism O-Other medications (corticosteroids) T-Transcellular shift Diet Oranges Dried fruits Tomatoes Avocados Dried peas Meats Broccoli Bananas Dairy products Whole grans ```

Question 26

Hypokalemia

Answer 26

``` LOW & SLOW Cardiac dysthymias Shallow respirations Irritability Confused & Lethargic Flaccid limbs - skeletal muscle weakness Hypoactive Bowel - paralytic ileus ```

Question 27

Hypernatremia

Answer 27

``` BIG & BLOATED Flush, red and rosy Edema & low-grade fever Polydipsia- Thirsty Severe Symptoms- swollen furrowed tongue, N/V, decreased muscle tone ```

Question 28

Hyponatremia

Answer 28

``` DEPRESSED & DEFLATED Seizures and Coma Tachycardia & weak thready pulses Hypotension Respiratory arrest ***REQUIRES FLUID RESTRICTION ```

Question 29

What is the relationship between Sodium & Chloride?

Answer 29

They are BESTIES! If sodium is LOW chloride is LOW

Question 30

Hyperchloremia

Answer 30

N/V Swollen dry tongue Confusion

Question 31

Hypochloremia

Answer 31

Diarrhea Vomiting Sweating Fever

Question 32

Magnesium

Answer 32

Magnesium acts like LAW & ORDER in the muscle and keeps the peace. Required for calcium and vitamin D absorption. Magnesium and Calcium are BESTIES!

Question 33

Hypermagnesemia

Answer 33

``` Calm & Quiet Bradycardia & Hypotension Decreased DTR Deep shallow respirations GI is Calm & Quiet ```

Question 34

Hypomagnesemia

Answer 34

``` BUCK WILD Tachycardia & Dysrhythmia's Increased DTR - Hyperreflexia EYE- nystagmus (dancing eyes) GI- diarrhea ***AT RISK: Chronic alcoholics ```

Question 35

What is the relationship between calcium & Phosphate?

Answer 35

Calcium and Phosphate are ENEMIES They operate inversely if Ca is HIGH ---- P04 is LOW P04 is HIGH ------ Ca is LOW Calcium keeps BONES, BLOOD & BEATS strong!!!!

Question 36

Hypercalcemia

Answer 36

``` SWOLLEN & SLOW MOANS- constipation GROANS- Bone pain STONES- kidney stones Decreased DTR & muscle weakness ```

Question 37

Hypocalcemia

Answer 37

Trousseau Sign - arm twerk with blood pressure cuff Chvostek's Sign - smile stroking the cheek Diarrhea Tingling around the mouth AT RISK FOR BONES, BEAT AND BLOOD

Question 38

Hyperphosphatemia

Answer 38

Trousseau Sign - arm twerk with blood pressure cuff Chvostek's Sign - smile stroking the cheek Diarrhea Weak 3 B's

Question 39

Hypophosphatemia

Answer 39

``` Constipation Decreased DTR Severe muscle weakness Decreased HR & RR Increased BP ```

Question 40

Independent Nursing Interventions Fluid & Electrolyte Imbalances

Answer 40

Provide safety & comfort (PT with altered LOC) Fluid Restrictions- Swish and Spit Oral hygiene- moisturize lips Keeping fluids out of sight Na+ restriction - altered taste buds, encourage herbs and spices Encourage appropriate fluids at the pt. preferred temperature Prevention - encourages pt. to monitor their I&O and to appropriately replace what is lost

Question 41

Furosemide

Answer 41

Loop Diuretic | Hypokalemia, volume depletion, hypotension, CNS effects, GI upset, hyperglycemia

Question 42

Bumetanide

Answer 42

Loop Diuretic | Hypokalemia, volume depletion, hypotension, CNS effects, GI upset, hyperglycemia

Question 43

Torsemide (Demadex)

Answer 43

Loop Diuretic | Hypokalemia, volume depletion, hypotension, CNS effects, GI upset, hyperglycemia

Question 44

Hydrochlorothiazide (HCTZ)

Answer 44

Thiazide | GI upset, CNS complications, hypovolemia