Fluid And Electrolytes Flashcards
1
Q
What is the best indicator of fluid volume balance?
A
Daily weight.
2
Q
How many calories makes 1 pound?
A
3500 calories
3
Q
What are the two major fluid compartments?
A
Intercellular and Extracellular
4
Q
What fraction of total body water does I intracellular fluid make up?
A
2/3 of body water
5
Q
What fraction of total body water does extracellular fluid make up?
A
1/3 of body water
6
Q
Where is intracellular fluid found?
A
Inside the cells
7
Q
Where is extracellular fluid found?
A
Outside the cells
8
Q
What are three types of extracellular fluid?
A
Plasma, Interstitial, and Transcellular
9
Q
Where is interstitial fluid found?
A
Around the cells in the tissues.
10
Q
Where is transcellular fluid found?Provide 3 examples.
A
In the organs. E.g. Cerebral spinal fluid, intraocular fluid, peritoneal fluid.
11
Q
Which type of fluid is not taken into consideration when calculating input and output?
A
Transcellular fluid
12
Q
What three main components of body fluids exert pressure?
A
Sodium, Albumin, Glucose
13
Q
What is isotonic tonicity?
A
When fluid and electrolytes are appropriately balanced.
14
Q
What is hypertonic tonicity?
A
Too many particles in the body fluids.
15
Q
What is hypotonic tonicity?
A
Not enough particles in body fluids.
16
Q
What type of fluid does tonicity refer to?
A
Extracellular fluid
17
Q
What happens when extracellular fluids are hypertonic?
A
Fluid is pulled out of the cells resulting in dehydration.
18
Q
What happens when extracellular fluid is hypotonic?
A
Fluid is pulled into the cells resulting in edema.
19
Q
What is the simplest mechanism for maintaining fluid balance and where does it originate?
A
Thirst, the hypothalamus
20
Q
The hypothalamus signals the pituitary to produce what hormone and why?
A
Antidiuretic Hormone (aka ADH, aka Vasopressin). When the hypothalamus senses low blood volume and increased serum osmolality, it signals the pituitary gland.
21
Q
Why affect does ADH have?
A
It causes the kidneys to retain water resulting in increased blood volume and decreased serum osmolality.
22
Q
What system do the kidneys use to keep fluid volume balance?
A
Renin-Angiotensin-Aldosterone System
23
Q
When is renin produced in the kidneys?
A
When blood flow to the glomerulus drops, juxtaglomerular cells secrete renin into the blood stream.
24
Q
What does Renin do?
A
Converts angiotensinogen to angiotensin 1.
25
What happens to angiotensin 1 after being converted?
Travels to the lungs where it is converted to angiotensin II via angiotensin converting enzyme (ACE).
26
What 2 effects does angiotensin II have?
1. Causes vasoconstriction (which raises blood pressure)
| 2. Travels to the adrenal glands to stimulate aldosterone.
27
What effect does Aldosterone have?
1. Increases resorption of sodium and water with the nephrons of the kidneys.
This leads to retention of water which increases fluid volume and blood pressure.
28
What is the function of hypertension medications called ACE inhibitors?
Prevents Angiotensin converting enzyme (ACE) from converting angiotensin I to angiotensin II. This in turns prevents vasoconstriction and the retention of salt and water, lowering blood pressure.
29
When is brain natriuretic peptide (BNP) released and by which organ?
Secreted by the ventricles in response to stretching, such as is seen in fluid overload.
30
What is the normal value of BNP?
<100pg/ml
31
When is BNP assessed?
To assess heart failure.
32
When does dehydration occur?
When fluid loss exceeds fluid gained.
33
What are 2 effects of dehydration?
1. Increased blood tonicity
| 2. Cell shrinkage
34
Name 7 groups that are at high risk for dehydration.
1. Confused (e.g. dementia)
2. Comatose
3. Bedridden
4. Infants
5. Decreased kidney function
6. Elderly
7. Highly concentrated tube feeding w/o additional water
35
Name 8 things that accelerate fluid loss, causing dehydration
1. Diabetes insipidus
2. Prolonged fever
3. GI issues such as diarrhea, prolonged emesis, or NG drainage.
4. Renal failure
5. Hyperglycemia
6. Medications such as diuretics or laxatives.
7. Excessive diaphoresis
8. Fistulas
36
10 signs of dehydration
1. Mental status changes
2. Fever
3. Dry skin
4. Dry mucous membranes
5. Poor skin turgor
6. Tachycardia
7. Hypotension
8. Seizures
9. Decreased urine output
10. Weight loss
37
3 symptoms of dehydration
1. Dizziness
2. Weakness
3. Extreme thirst
38
What specific mental status changes might you see in a person with dehydration?
Restlessness and anxiety
39
What 4 lab test will show as elevated?
1. Hematocrit
2. Serum osmolality
3. Sodium
4. Urine specific gravity
40
What is the best way to replace missing fluids? What if dehydration is severe?
Oral replacement, IV replacement id severe dehydration
41
What type of solutions should be used when replacing fluids? What if blood pressure is too low?
Hypotonic solutions. Isotonic if BP is too low.
42
What is hypervolemia and what causes it?
An excess of isotonic fluid that occurs when compensatory mechanisms fail.
43
What are three effects of hypervolemia?
1. Cell expansion
2. Heart failure
3. Pulmonary edema
44
Causes of hypervolemia?
1. Too much IV replacement
2. Blood volume replacement
3. Fluid and sodium retention in heart failure
4. Cirrhosis of the liver
5. Kidney disease
6. Some medications (e.g. Corticosteroids)
7. Administration of hypertonic solutions (e.g. Albumin)
45
5 signs of hypervolemia.
1. Rapid, bounding pulse
2. Increased blood pressure
3. S3 develops
4. Distended veins
5. Edema in the tissues and lungs
46
2 late signs of hypervolemia
1. Falling blood pressure
| 2. Decreased cardiac output
47
What labs will be low or decreased in hypervolemia?
Low hematocrit, K+, and BUN
| Decreased serum osmolality
48
What lab will be normal with hypervolemia?
Serum sodium
49
What might a chest X-ray reveal in a patient with hypervolemia?
Pulmonary congestion
50
3 ways to treat hypervolemia
1. Restrict fluid and sodium
2. Medicate to prevent heart failure and pulmonary edema (e.g. Diuretics)
3. Treat cause of hypervolemia and any complications
51
4 functions of electrolytes
1. Regulate fluid distribution
2. Govern acid-base balance
3. Function in the transmission of nerve impulses
4. Instrumental in the production of energy and in blood clotting
52
What is a cation?
A positively charged particle
53
What is the main cation in extracellular fluid?
Sodium
54
What is a normal level of sodium (Na)?
135-145 mEq/L
55
What electrolyte is essential for impulse transmission in nerve and muscle cells?
Sodium
56
Sodium combines with other ions to maintain acid-base balance. What ions does it combine with?
Chloride (Cl-) and Bicarbonate (HCO3)
57
What serum sodium level is considered hyponatremia?
<135 mEq/L
58
How does hyponatremia affect ECF?
ECF will move into the cells causing them to swell.
59
5 Neurological signs and symptoms of hyponatremia once levels are below 125 mEq/L
1. Headache
2. Irritability
3. Disorientation
4. Lethargy
5. Confusion
60
If serum sodium falls to 110 mEq/L, cerebral edema results. What 5 signs and symptoms would you expect to see?
1. Stupor
2. Delirium
3. Ataxia
4. Seizures
5. Coma
Later death.
61
What 5 signs would indicate hyponatremia coupled with hypovolemia?
1. Poor skin turgor
2. Dry cracked mucous membranes
3. Weak, rapid pulse
4. Low blood pressure
5. Orthostatic hypotension
62
What 4 signs would indicate hyponatremia coupled with hypervolemia?
1. Edema
2. Hypertension
3. Weight gain
4. Rapid, bounding pulse
63
5 labs to know with hyponatremia.
1. Serum osmolality <280
2. Serum Na+ <135 mEq/L
3. Urine specific gravity <1.010
4. Elevated Hct
5. Elevated plasma protein
64
Treatment for mild hyponatremia with hypervolemia.
Restrict fluids and oral Na+ supplements
65
Treatment for hyponatremia with hypovolemia.
Isotonic IV fluids and high sodium foods.
66
Treatment with severe hyponatremia (<120 mEq/L) with hypovolemia.
ICU placement, Hypertonic IV solution administered slowly to avoid overload and diuretics such as furosemide.
67
How is hypernatremia defined?
serum Na+ >145 mEq/L
68
3 things hypernatremia can lead to.
1. Seizures
2. Coma
3. Permanent neurological damage
69
What is the mortality rate with hypernatremia?
>50%
70
Name 6 external causes of hypernatremia.
1. Water deficit
2. High protein feedings w/o adequate water
3. Use of salt tablets
4. High sodium foods
5. Medications (e.g. Kayexalate)
6. Excessive IV administration of a hypertonic solution
71
Name 5 disease processes that may cause hypernatremia.
1. Inability to ingest fluids
2. Hypothalamic disorders
3. Hyperosmolar hyperglycemic nonketoic syndrome (severe water loss seen in type 2 diabetics)
4. Diabetes insipidus
5. Cushing's syndrome
72
4 neuromuscular signs of hypernatremia
1. Twitching
2. Hyperreflexia
3. Ataxia
4. Tremors
73
5 early signs and symptoms of hypernatremia
1. Restlessness
2. Agitation
3. Anorexia
4. Nausea
5. Vomiting
74
6 late signs and symptoms of hypernatremia
1. Weakness
2. Lethargy
3. Confusion
4. Stupor
5. Seizures
6. Coma
75
What is orthostatic hypotension an important indicator of?
Fluid deficit
76
3 lab tests to know in regards to hypernatremia
1. Serum Na+ >145 mEq/L
2. Urine specific gravity > 1.030
3. Serum osmolality >300
77
4 Treatments for hypernatremia
1. Correct underlying disorder
2. Fluid replacement. If using IV, use a salt free solution such as D5W.
3. Restrict sodium intake
4. Diuretics to increase sodium loss
78
What is the main intracellular cation?
Potassium (K+)
79
What is the normal range for potassium?
3.5-4.5 mEq/L
80
How does potassium assist in keeping pH balanced?
Exchanges places with hydrogen (H+) ions to correct acidosis.
81
4 causes of hypokalemia
1. Decreased intake
2. Transcellular shift with alkalosis
3. Non-renal losses such as vomiting and diarrhea, etc.
4. Renal losses
82
7 disease processes that can cause hypokalemia
1. Hepatic disease
2. Hyperaldosteronism
3. Acute alcoholism
4. Heart failure
5. Malabsorption
6. Nephritis
7. Acute leukemias
83
3 Cardiac signs of hypokalemia
1. Weak and irregular pulse
2. Orthostatic hypotension
3. Palpitations
84
What 5 changes would you see on an EKG with a patient with hypokalemia?
1. Flat or inverted T Wave
2. U wave
3. Depressed ST segment
4. Ventricular arrhythmias
5. Cardiac arrest
85
How does hypokalemia affect a patient taking digoxin?
Can cause the patient to become digitalis toxic.
86
3 Musculoskeletal signs and symptoms of hypokalemia.
1. Weakness, especially in the legs.
2. Leg cramps
3. Decreased reflexes
87
2 Respiratory signs and symptoms of hypokalemia
1. Weak respiratory muscles
| 2. tachypnea
88
3 GI signs and symptoms of hypokalemia
1. Decreased bowel sounds
2. Constipation
3. Ileus (obstruction of the ileum)
89
6 labs to look for when your patient is hypokalemic.
1. Serum K+ < 3.5 mEq/L
2. Elevated pH
3. Elevated bicarbonate levels
4. Decreased serum Magnesium (Mg)
5. Increased digoxin levels if patient is on this med
6. Slightly elevated blood glucose
90
3 Treatments for hypokalemia
1. A high potassium, low sodium diet.
2. Okay K+ supplements
3. IV replacement therapy
91
How would an IV push of potassium affect the hypokalemic patient.
It would kill them.
92
External causes of hyperkalemia
1. Medications (e.g. potassium sparing diuretics, NSAIDs)
2. Multiple blood transfusions
3. Too much intake
4. Excessive use of K+ based salt substitutes
93
5 Disease processes that might cause hyperkalemia
1. Oliguric renal failure
2. Metabolic acidosis
3. Rhabdomyolsis
4. Insulin deficiency with hyperglycemia
5. Tumor lysis syndrome
94
3 musculoskeletal signs and symptoms of hyperkalemia
1. Muscle cramps
2. Weakness
3. Flaccid Paralysis
95
1 neurological symptoms of hyperkalemia
Drowsiness
96
3 GI/GU signs and symptoms of hyperkalemia
1. Abdominal cramping
2. Diarrhea
3. Oliguria
97
What 6 changes would you see on an EKG with a patient with hyperkalemia?
1. Tall peaked T-wave
2. Flattened P-wave
3. Widened QRS
98
2 Lab tests to look for with hyperkalemia
1. Serum potassium >5.0 mEq/L
| 2. Decreased arterial pH (acidosis)
99
5 treatments for hyperkalemia
1. Potassium restricted diet
2. Eliminate potassium sparing diuretics or K+ supplements
3. Medications (e.g. loop diuretics, sodium polystyrene)
4. Treat underlying disorders
100
How does sodium polystyrene correct hyperkalemia?
Causes loose stools, thus K+ is lost through the bowels.
101
What can be given in a hyperkalemic emergency?
IV calcium gluconate, glucose and insulin. This causes potassium to move back into the cells.
102
What is the last resort to correct hyperkalemia?
Dialysis
103
What is the major cation in teeth and bones?
Calcium
104
What is the normal range for calcium?
8.5-10.5 mg/dL
105
Which type of fluid is calcium found in?
Both ICF and ECF.
106
What does calcium bind to?
Protein (Albumin)
107
What hormone promotes increase of serum calcium levels by pulling it from the bones?
Parathyroid hormone (PTH)
108
What hormone promotes a decrease of serum calcium levels by helping to put calcium back into bone?
Calcitonin
109
What must be present in order for calcium to be absorbed by the intestines and kidneys?
Vitamin D
110
What is the difference between total serum calcium and ionized calcium?
Total serum calcium is attached to albumin. Ionized calcium is free floating and not attached to albumin.
111
How does pH affect calcium binding to protein and what does that mean for ionized calcium levels.
High pH (alkalosis) increases binding and thus decreases levels of ionized calcium. Low pH (acidosis) decreases binding and thus increases levels of ionized calcium.
112
3 main functions of calcium.
1. Necessary for muscle contraction
2. Assists in coagulation
3. Affects permeability and firing level of cells.
113
What mineral inhibits calcium absorption in the intestines?
Phosphorus
114
Calcium has an inverse relationship with what?
Phosphorus
115
What lab value defines hypocalcemia?
Serum Ca+ < 8.5 mg/dL
116
What 4 populations have higher risk of insufficient intake of calcium?
1. Alcoholics
2. Breast fed infants if mom's levels are low
3. Elderly
4. Persons with insufficient sunlight (low vit D)
117
What are 4 causes of malabsorption of calcium?
1. Diarrhea
2. Laxative abuse
3. Chronic malabsorption syndrome
4. Lack of vitamin D (due to being on anti-convulsants or use of sunscreen)
118
What are 3 causes of excessive loss of calcium?
1. Pancreatic insufficiency
2. Reduced or eliminated PTH secretion
3. Medications (e.g. calcitonin or mithramycin)
119
What is the most common cause of hypocalcemia?
Low serum albumin
120
How does hyperphosphatemia cause hypocalcemia?
Combines with Ca+ to form a salt, removing Ca+ from circulation.
121
What type of injuries cause hypocalcemia?
Burns and infections
122
What are the 3 most common findings with hypocalcemia?
1. Altered nerve transmission
2. Altered muscle function
3. Altered heart function
123
4 neurological signs and symptoms of hypocalcemia
1. Anxiety
2. Confusion
3. Irritability
4. Seizures
124
4 cardiovascular signs of hypocalcemia
1. Ventricular fibrillation
2. Heart block
3. Decreased cardiovascular output
4. Decreased myocardial contractility which may lead to angina, bradycardia, hypotension and heart failure.
125
7 neuromuscular signs of hypocalcemia
1. paresthesia of toes, fingers and face
2. Twitching
3. Muscle cramps
4. Laryngo- and bronchospasm
5. Tetany
6. Positive Trousseau's sign
7. Positive Chvostek's sign
126
1 gastrointestinal sign of hypocalcemia
Diarrhea
127
What 2 changes might be noted on an EKG with hypocalcemia?
1. Prolonged ST segment
| 2. Lengthened QT interval
128
Other than serum calcium, what other lab test will you look for in a patient with hypocalcemia?
Low albumin
129
6 treatments for hypocalcemia
1. Address the underlying cause
2. Diet adjustment
3. Mg replacement
4. If chronic, Vitamin D supplements
5. If acute, IV calcium gluconate
6. If in cardiac arrest, IV calcium chloride
130
Hypercalcemia is caused by resorption of Ca+ from the bone. What are the 2 main causes?
1. Hyperparathyroidism
| 2. Cancer
131
What are 5 less common causes of hypercalcemia?
1. Increased intestinal absorption of calcium
2. Decreased excretion of calcium by kidneys
3. Antacid abuse
4. Acidosis
5. Excessive Vitamin D ingestion
132
7 neurological signs and symptoms of hypercalcemia
1. Fatigue
2. Confusion
3. Altered mental status
4. Depression
5. Personality changes
6. Lethargy
7. Coma
133
3 musculoskeletal signs and symptoms of hypercalcemia
1. Muscle weakness
2. Hyporeflexia
3. Loss of muscle tone
134
2 cardiac signs of hypercalcemia
1. Bradycardia
| 2. Cardiac arrest
135
What serum calcium level is consider a crisis, with death likely?
>15 mg/dL
136
5 gastrointestinal signs and symptoms of hypercalcemia
1. Anorexia
2. Nausea
3. Vomiting
4. Decreased bowel sounds
5. Constipation
137
How does hypercalcemia affect the kidneys?
Kidneys work overtime, possibly leading to kidney failure.
138
4 EKG changes seen with hypercalcemia
1. Shortened QT interval
2. Prolonged PR interval
3. Flattened T waves
4. Heart block
139
2 lab results with hypercalcemia
1. Serum Ca+ >10.5 mg/dL
| 2. Digoxin toxicity
140
3 treatments for asymptomatic hypercalcemia
1. Decrease dietary intake
2. Stop any medications containing Ca+
3. Hydrate
141
2 treatments for symptomatic hypercalcemia or in presence of renal failure.
1. Hemodialysis or peritoneal dialysis
| 2. Dialysate with NO Ca+
142
2 medications used to treat hypercalcemia
1. IV corticosteroids
2. Biphosphates
3. Mithramycin
143
What is normal serum phosphorus (P-)?
2.5-4.5 mg/dL
144
8 functions of phosphorus
1. Helps maintain cell membrane integrity
2. Muscle and neurological functioning
3. Metabolism of nutrients (proteins, carbs & fats)
4. Part of RBCs
5. Important for phagocytosis and platelet functioning
6. Buffers acids and bases
7. Important for cellular energy
8. Essential for healthy bones and teeth
145
What hormone increases serum phosphorus levels?
PTH
146
What moves phosphorus into cells?
Insulin and alkalosis
147
3 causes of hypophosphatemia
1. A shift of P- from ECF to ICF
2. Decreased GI absorption
3. Increased renal excretion
148
3 causes of P- shift from ECF to ICF
1. Respiratory alkalosis
2. Hyperglycemia
3. IV administration for 3+ days w/o phosphorus
149
3 Musculoskeletal signs and symptoms of hypophosphatemia
1. Weakness
2. Malaise
3. Anorexia
150
4 CNS signs and symptoms of hypophosphatemia
1. Parasthesia
2. Irritability
3. Apprehension
4. Confusion
151
2 Cardiac signs and symptoms of hypophosphatemia
1. Hypotension
| 2. Decreased cardiac output
152
Hematological signs and symptoms of hypophosphatemia
1. Decreased O2 delivery to tissues
2. Angina
3. Hemolytic anemia
4. Phagocytosis interference (susceptible to infection)
5. Platelets not functional (susceptible to bleeding)
153
4 Lab tests to look for with
1. Serum phosphorus <2.5 mg/dL
2. Decreased magnesium
3. Increased calcium
4. If with Rhabdomyolysis, elevated creatine kinase
154
3 treatments for hypophosphatemia
1. Treat the underlying cause
2. Dietary adjustments if mild
3. IV replacement if severe
155
7 Foods that contain phosphorus
1. Eggs
2. Nuts
3. Whole grain
4. Organ meats
5. Fish
6. Poultry
7. Milk
156
What does should intravenous phosphorous be administered?
Never more than 10 mEq/hr
157
What is the most common cause of hyperphosphatemia?
Poor renal excretion
158
What are 3 less common causes of hyperphosphatemia?
1. Increase release of P- from damaged cells
2. Excessive intake
3. Acidosis causes a shift from ICF to ECF
159
Hyperphosphatemia doesn't cause symptoms, but it does cause ___________ which will show symptoms.
Hypocalcemia
160
4 Lab tests to look for with hyperphosphatemia
1. Serum P- >4.5 mg/dl
2. Serum Ca+ <8.5 mg/dl
3. Increased BUN
4. Increased Creatinine
161
Treatments for hyperphosphatemia
1. Treat underlying cause
2. Reduce intake if due to diet
3. Medications (P- binding meds such as calcium sup)
4. If severe, IV normal saline to promote excretion, diuretics and dialysis
162
What should you never give to a patient with hyperphosphatemia and renal failure?
Anything containing magnesium such as milk of magnesia.
163
What is the normal range for magnesium (Mg+)?
1.5-2.5 mEq/L
164
7 functions of magnesium
1. Regulates muscle contractions, including heart
2. Promotes enzyme reactions during carbohydrate metabolism
3. Helps produce and use ATP
4. Synthesis of DNA and protein
5. Transmission of nerve impulses
6. Essential to production of PTH
7. Assists in transport of Na+ and K+ across cell membranes.
165
4 causes of hypomagnesemia
1. Poor dietary intake
2. Poor absorption by GI tract
3. Excessive loss from GI tract
4. Excessive loss from urinary tract
166
11 neurological symptoms of hypomagnesemia
1. Altered LOC
2. Ataxia
3. Confusion
4. Delusions
5. Hallucinations
6. Depression
7. Emotional lability
8. Insomnia
9. Psychosis
10. Seizures
11. Vertigo
167
6 neuromuscular signs of hypomagnesemia
1. Tremor
2. Twitching
3. Tetany
4. Hyperactive deep tendon reflexes
5. Paresthesia
6. Foot or leg cramps
168
What 2 signs would indicate that hypomagnesemia is affecting respiratory muscles?
1. Dyspnea
| 2. Laryngeal stridor
169
2 cardiovascular signs of hypomagnesemia
1. Disrhythmias (can be seen on EKG)
| 2. Digoxin toxicity (low Mg+ increases retention)
170
4 gastrointestinal signs and symptoms of hypomagnesemia
1. Anorexia
2. Dysphagia
3. Nausea
4. Vomiting
171
4 lab results to look for with hypomagnesemia
1. Serum Mg+ <1.5 mEq/L
2. Low albumin level
3. Other electrolyte abnormalities
4. Elevated digoxin levels if relevant
172
What should you always check before starting hypomagnesemia replacement therapy?
Renal functioning
173
4 treatments for hypomagnesemia
1. Treat underlying cause
2. Dietary change
3. Oral supplements
4. IV or deep IM
174
What is the most common cause of hypermagnesemia?
Renal failure
175
Starting at age 30, what percent of renal function do you lose every year?
1% per year
176
3 less common causes of hypermagnesemia
1. Excessive intake (e.g. laxatives, milk of magnesia)
2. Total parenteral nutrition (TPN) w/ too much Mg+
3. Continuous IV infusion
177
Magnesium is a neuromuscular depressant. What 5 signs and symptoms might you see with hypermagnesemia?
1. Decreased muscle and nerve activity
2. Hypoactive DTRs
3. Facial paresthesia
4. Generalized weakness that may develop into paralysis
5. Occasional nausea and vomiting
178
Magnesium is a CNS depressant. What 3 signs and symptoms might you see with hypermagnesemia?
1. Drowsy, lethargic
2. Decreased LOC leading to coma
3. Slow, shallow, depressed respiration leading to arrest due to weak respiratory muscles
179
7 cardiovascular signs and symptoms of hypermagnesemia
1. Weak pulse
2. Bradycardia
3. Heart block
4. Arrest
5. Vasodilation causing a flushed feeling
6. Low BP
7. Dysrhythmias
180
Lab results to look for with hypermagnesemia
Serum Mg+ >2.5 mEq/L
181
5 treatments for hypermagnesemia
1. Fluids
2. Loop diuretic
3. Calcium gluconate IV
4. Mechanical ventilation
5. Hemodialysis
182
What is the most abundant anion in ECF?
Chloride (Cl-)
183
What is the normal range for Cl-?
98-108 mEq/L
184
3 functions of Cl-
1. Travels with Na+ to maintain fluid balance
2. Works with Na+ to form cerebral spinal fluid (CSF)
3. Secreted in stomach to form HCl acid
185
6 causes of hypochloremia
1. Decreased intake
2. Malabsorption
3. Increased losses
4. Changes in Na+
5. Changes in acid/base balance
6. Certain medications (e.g. bicarb, corticosteroids, laxatives, diuretics
186
9 signs of and symptoms of hypochloremia
1. Signs of acid-base imbalance
2. Signs of hypokalemia or hyponatremia
3. Alkalosis
4. Tetany or
5. Hyperactive deep tendon reflexes
6. Muscle cramps
7. Twitching
8. Weakness
9. Irritability
187
4 lab results to look for with hypochloremia
1. Serum Cl- < 98 mEq/L
2. Serum Na+ < 135 mEq/L
3. Serum pH > 7.45
4. Serum bicarbonate > 26 mEq/L
188
Chloride has an inverse relationship with what?
Bicarbonate
189
3 treatments for hypochloremia
1. Correct the underlying problem
2. Oral replacement (salty broth)
3. IV normal saline solution
190
5 causes of hyperchloremia
1. Hypernatremia
2. Low bicarbonate (HCO3)
3. Increased intake or absorption
4. Retention by kidneys
5. Medications (Polystyrene sulfonate)
191
What signs would you expect to see with hyperchloremia?
Signs of metabolic acidosis
192
4 Lab results to look for with hyperchloremia
1. Serum Cl- > 108 mEq/L
2. Serum Na+ > 145 mEq/L
3. Serum pH < 7.35
4. HCO3 < 22 mEq/L
193
4 treatments for hyperchloremia
1. Correct the underlying cause
2. Fluids if dehydrated
3. IV NaHCO3 if severe
194
What are 3 clinical measurements that a nurse can do that are important to detecting fluid and electrolyte imbalance?
1. Daily weights
2. Vital signs
3. Intake and output
195
How should daily weight be done?
Same time of day
Same scale
Same clothing
196
1 kg of weight is equal to what volume of fluid?
1 liter
197
3 diagnostic tests to always look for.
1. Electrolytes
2. Osmolality (solute concentration of blood)
3. Urine Specific Gravity (urine concentration)
198
Nursing diagnoses appropriate for fluid and electrolyte imbalance.
1. Fluid volume excess
| 2. Fluid volume deficit
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Medications to expect when treating fluid and electrolyte imbalance
1. Electrolyte supplements
2. Colloids (to increase osmolality)
3. Crystalloids (IV solutions that contain electrolytes)
4. Diuretics
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What to monitor when a patient is on colloids.
1. patient condition
2. labs
3. renal function
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What to monitor when a patient is on electrolyte supplements
1. labs
2. intake and output
3. vital signs
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What type of medications are considered colloids?
1. Albumin
| 2. Dextran 40
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What types of IV solutions are considered crystalloids?
1. 5% dextrose in water (D5W) with added electrolytes
2. normal saline with added electrolytes
3. lactated ringers
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What to monitor when a patient is on crystalloids
1. electrolyte status
| 2. intake and output
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What do diuretics promote?
diuresis
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What are common diuretic medications?
1. furosemide
2. hydrachlorothiazide
3. aldactone
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What to monitor when a patient is on diuretics
1. Intake and Output
2. daily weights
3. electrolyte status
4. hydration status
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10 Nursing interventions for fluid and electrolyte imbalance
1. Monitor symptoms
2. Monitor vital signs
3. Daily weight
4. Accurate intake/output
5. IV access as ordered
6. Watch for overload if replacing fluids
7. Monitor for excess or deficit
8. Monitor serum sodium, urine osmolality and specific gravity
9. Provide safe environment (consider fall risk)
10. Document
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3 parts of patient evaluation (after nursing interventions, compare to baseline)
1. physical assessment
2. clinical measures
3. lab tests
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In order, what are the 3 lines of defense to maintain acid/base balance?
1. Buffering
2. Respiratory
3. Kidneys
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What are the main components of the acid/base buffering system?
1. bicarbonate
2. phosphates
3. proteins
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How do bicarbonates help to maintain the acid/base balance?
They reduce the strength of acids and buffer acids.
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How do phosphates help to maintain the acid/base balance?
They form compounds
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How do proteins help to maintain the acid/base balance?
They neutralize acids and bases.
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How does the respiratory system help to maintain the acid/base balance?
Varies respiratory rate to either eliminate CO2 through rapid breathing or retain CO2 through slow breathing.
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How do the kidneys help to maintain the acid/base balance?
They can retain or excrete acids or bases and can also produce bicarbonate as needed.
