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fluid and electrolytes Flashcards

1
Q

describe intracellular

A

-in the cell
-ICF is critical for maintaining cell size
-70% of total body fluid
-about 40% of adult body weight is from ICF

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2
Q

describe extracellular

A

-outside cell
-30% of total body fluid and ~20% of body weight

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3
Q

describe intravascular fluid

A

plasma of the blood -> blood volume, impacts HR and BP

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4
Q

describe interstitial fluid

A

surrounds cells (like tissue)

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5
Q

describe trans cellular fluid

A

cerebrospinal, pleural, peritoneal, synovial, digestive secretions, sweat

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6
Q

what is osmolarity

A

concentration of particles in a solution (or its pullin power)

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7
Q

describe isotonic

A

-when osmolarity is equivalent to plasma
-isotonic fluid remains in the intravascular space
-no shift in cell size

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8
Q

describe hypertonic

A

-when osmolarity is greater than plasma
-hypertonic fluids pull water from the cells and into the intravascular spaces
-cells shrink

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9
Q

describe hypotonic

A

-when the osmolarity is less than plasma
-hypotonic fluids move from the intravascular spce to the ICF
-cells swell

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10
Q

give two examples of isotonic IV solutions

A

normal saline, lactated ringers

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11
Q

what does normal saline do

A

expand extracellular compartment, treat hypovolemia, hyponatremia, hyercalcemia, metabolic alkalosis

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12
Q

what does LR do

A

contains multiple electroltes in the same concentration as in plasma, treats hypovolemia, burns, and GI losses

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13
Q

give and example of hypertonic IV solution

A

5% dextrose in lactated ringers (D5LR)

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14
Q

what does D5LR do?

A

replaces electrolytes, provides calories, shifts fluid from cells to vascular space expanding vascular volume

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15
Q

give an example of hypotonic IV solution

A

half strength normal saline (0.45%)

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16
Q

what does hald strength normal saline do

A

often used as maintenance fluid, provides Na, Cl, and free water

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17
Q

describe fluid balance

A

-generally balance is achieved with oral intake of fluid matching the output of the kidney
-perfect balance is not always met every day, but over 2-3 days
-output can be sensible or insensible

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18
Q

what is sensible output

A

-things you can measure
-UOP, emesis, wound drainage, suction

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19
Q

what is insensible output

A

-harder to account for and not measurable
-sweat, respiratory vapors

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20
Q

describe volume overload

A

positive I&O balance

findings:
-crackles
-JVD
-edema
-dyspnea/SOB

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21
Q

describe volume deficit

A

negative I&O balance

findings:
-hypotension
-increased HR
-fatigue
-pale and cool
-dry mucus membranes
-dizziness

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22
Q

what are seom causes of abnormal fluid status

A

-CHF
-small bowel obstruction
-kidney disease
-liver dysfunction

kidneys, liver, heart, and GI

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23
Q

what are some tests to evaluate fluid balance

A

-CMP
-urinalysis
-daily weight
-telemetry

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24
Q

what organs and systems manage sluid and electrolyte balance

A

-kidneys
-heart and vascular
-lungs
-nervous system
-GI

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25
# organs and systems manage sluid and electrolyte balance kidneys
-filter 180L of plasma/day while excreting ~1.5L/day -manage ECF volume and osmolarity -regulates electrolyte levels by retaining or eliminating
26
# organs and systems manage sluid and electrolyte balance heart and vascular
-circulate fluid, adequate perfusion pressure in kidneys for filtration -stretch receptors respond to changes in olume and stimulate fluid retention when hypovolemia is present
27
# organs and systems manage sluid and electrolyte balance lungs
water vapor excreted/lost per day ~300ml/day
28
# organs and systems manage sluid and electrolyte balance nervous system
-osmoreceptors sense changes in ECF concentration and stimulate the pituitary gland to release or inhibit release of ADH -thirst center in the hypothalamus is activated by cellular dehydration
29
# organs and systems manage sluid and electrolyte balance GI track
absorbs water and nutrients
30
# hormonal control of fluid and electrolyte balance adrenal glands
-aldosterone secretion causes sodium (and water) retention and potassium loss -excess cortisol secretion can cause the same effect of aldosterone
31
# hormonal control of fluid and electrolyte balance pituitary gland
manages ADH
32
# hormonal control of fluid and electrolyte balance what does ADH do
-allows the body to retain water -released when osmotic pressure of ECF is greater than that of cells, when blood volume is decreased -suppressed when osmotic pressure of the ECF is less than that of the cells, or when blood volume is increased
33
# hormonal control of fluid and electrolyte balance thyroid gland
thyroxine secretion released to increased blood flow including to the kidneys, whey increases flitration rate and UOP
34
# hormonal control of fluid and electrolyte balance parathyroid gland
regulates calciuma dn phosphate balance through parathyroid hormone (PTH)
35
# hormonal control of fluid and electrolyte balance what does PTH do
-influences bone reabsorption, calcium absorption from the intestines and calcium reabsorption from the kidneys -increased PTH causes increased blood calcium and decreased phosphate -decreased PTH causes decreased calcium and increased phosphate
36
name some different fluid volume problems
-fluid volume deficit/hypovolemia -dehydration -fluid volume excess
37
describe fluid volume deficit/hypovolemia
-low circulating volume -loss of fluid and solutes from ECF
38
describe dehydration
loss of total body water, results in increased serum sodium
39
describe fluid volume excess
-retaining sodium and water in ECF -intravascular excess = hypervolemia -interstitial excess = edema
40
name and descrie a fluid distribution problem
third spacing -fluid moves into transcellular compartments (pleural, peritoneal, pericardial, joints, or bowels) or interstitial spaces -causes hypovolemia (fluid is unavailable for use) -no drastic change in weight
41
what are electrolytes
the basis for chemical interactions in the body necessary for metabolism and other functions
42
name some cations
sodium, potassium, calcium, hydrogen, magnesium
43
name some anions
chloride, bicarbonate, phosphate
44
-natremia
sodium
45
-kalemia
potassium
46
-calcemia
calcium
47
-magnesia
magnesium
48
-phosphatemia
phosphorus
49
-chloremia
chloride
50
# hyponatremia causes
diuretics, GI losses, excessive water intake
51
# hyponatremia symptoms
confusion, lethargy, twitching, seizures, coma
52
# hyponatremia treatment
-encourage sodium rich food -seizure precautions
53
# hypernatremia causes
-poor oral intake -increased fluid losses -increased salt intake -enteral feeding without water
54
# hypernatremia symptoms
-hallucinations -lethargy -seizures -coma
55
# hypernatremia treatment
-gradual rehydration -sodium restricted diet
56
# hypokalemia causes
-vomiting -diarrhea -GI losses -diuretics -poor intake -polyuria
57
# hypokalemia symptoms
-cardiac arrhythmias (increased excitability of cardiac tissue) -paresthesia -postural hypotension -EKG changes
58
# hypokalemia treatment
-critical values can be life threatening -PO (needs to be diluted) -IVPB -never IV push -monitor cardiac function/EKG/BP
59
# hyperkalemia causes
-end stage renal disease -acidosis -burns -tissue trauma -diuretics
60
# hyperkalemia symptoms
-vage muscle weakness -cardiac arrhythmias (decreased cardiac excitibility) -cardiac arrest -peak T wave
61
# hyperkalemia treatment
-kayexalate (binds K in GI tract and causes excretion via BM) this is used if pt is alert -severes tx with CA (cardioprotective), insulin, and glucose -can treat with diuretics and dialysis
62
if Mg is low, what else usually is too?
K
63
# hypomagnesia causes
-chronic alcoholism -diarrhea -NG suction -drugs
64
# hypomagnesia symptoms
tachyarrhythmias
65
# hypomagnesia treatment
monitor condition of airway bc laryngeal sridor can occur
66
# hypermagnesia causes
rare, ESRD or IV magnesium
67
# hypermagnesia symptoms
-hypotension -flushing -drowsiness
68
# hypermagnesia treatment
-admin of calcium gluconate -diuretics or dialysis
69
# hypocalcemia causes
-surgical -excessive administration of citrated blood
70
# hypocalcemia symptoms
-cardiac arrhythmias -spasm of laryngeal muscles
71
# hypocalcemia treatment
-seizure precautions -monitor airway -replace calcium
72
# hypercalcemia causes
-hyperparathyroidism -cancers
73
# hypercalcemia symptoms
cardiac arrest
74
# hypercalcemia treatment
monitor EKG changes
75
what are the clinical manifestations of hypocalcemia
increased excitability of muscles and nerves
76
what two test are used to determine hypocalcemia
-chvosteks sign -trousseau sign
77
describe chvosteks sign
tapping on facial nerve just anterior to the ear produces tetany (involuntary twitching) on the ipsilateral side of the patients face/upper lip
78
describe trousseau sign
inflate BP cuff above NSBP range. positive response in a pt with hypocalcemia is a wrist metacarpal and phalangeal/thumb flexiion
79
# hypophosphatemia causes
-refeeding after starvation -alcohol withdrawal
80
# hypophosphatemia symptoms
respiratory failure
81
# hypophosphatemia treatment
replace carefully and slowly. can cause hypocalcemia
82
# hyperphosphatemia causes
ERSD, chemotherapy
83
# hyperphosphatemia symptoms
-tetany -long term can lead to calcification of soft tissues
84
# hyperphosphatemia treatment
phosphate binders given with meals
85
describe history assessment of fluid and eectrolyte balance
risk factors: -illnesses (DM, HF, renal failure) -abnormal fluid losses (vomiting, diarrhea, draining wounds), burns, trauma, surgery -medications (laxatives, diuretics) -weight changes -lab studies (CBC electrolytes, BUN, creatinine, specific gravity)
86
describe physical exam forthe assessment of fluid and electrolyte balance
-skin (turgor, mucous membranes) -cardiac (edema, HR, rhythm, BP, JVD) -respiratory (lung sounds) -neuromuscular (mental status, reflexes, muscle tone)
87
what are some nursing diagnoses for fluid and electrolyte imbalance
-excess fluid volume -deficient fluid volume -impaired oral mucous membrane integrity r/t fluid volume deficit
88
what are some preventions of fluid and electrolyte imbalance
-education -monitor I&O, daily weights, labs
89
what are some treatments of fluid and electrolyte imbalance
-fluid management -encourage or restrict oral fluid intake -IV fluid administration as prescribed
90
describe encouraging oral fluid intake
offer preferred fluids, set goals, always have some fluids available for the pt
91
describe restricing oral fluid intake
set goals, use smaller cups, provide ice chips instead, avoid salty foods, keep drinks out of sight, good oral hygiene, communicate with other caregivers
92
describe electrolyte management
-administer replacement electrolytes as ordered -be aware of admin instructions. many IV preparations must be diluted and given very slowly (over hours!)
93
escribe med management for fluid and electrolyte imbalance
diuretics may be ordered to assist with fluid or ekectrolyte imbalance

nursing 20030 (31 decks)

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