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Flashcards in Fluid and Electrolytes Deck (77):
1

Sodium

135-145 mEq/L

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Potassium

3.5-5.0 mEq/L

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Chloride

98-106 mEq/L

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Bicarbonate

24-31 mEq/L

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Calcium

8.5-10.5mg/dL

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Phosphorus

2.5-4.5 mg/dL

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Magnesium

1.8-3.0 mg/dL

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Isotonic Solution

solutions are equally concentrated

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Hypotonic Solution

Lower solute concentration

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Hypertonic solution

higher solute concentration

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Baroreceptor Reflex

responds to a fall in arterial blood pressure
located in the artrial walls, vena cava aortic arch and sinus

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What does the baroreceptor reflex do?

Constricts afferent arterioles of the kidney resulting in retention of fluid.

13

Volume receptors

respond to fluid in the atria and great vessels.

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what do volume receptors create?

they create a strong renal response that increases urine output

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renin

responds to low blood pressure

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antidiuretic horomone

also called vasopressin

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dehydration

loss of body fluids, increased concentration of solutes in the blood

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what happens to the cells in dehydration?

fluid shifts out of the cells into the blood stream to restore balance. Cells shrink from fluid loss and can no longer function properly.

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what does a dehydrated person present with

irritability, confusion, dizziness, weakness, extreme thirst, decreased urine output, fever, dry mucous membranes, sunken eyes, poor skin turgur, tachycardia

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What do we do?

fluid replacement, monitor symptoms and vitals, maintain I&O, maintain IV access, skin and mouth care.

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hypovolemia

isotonic fluid loss from the extracellular space

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what is hypovolemia caused by

excessive fluid loss, decreased fluid intake, third space fluid shift

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what do you see in hypovolemia

mental status deteoriation, tachycardia, delayed cap refill, cool pale extremities, weight loss, orthostatic hypotension, urine output less than 30 mll/ hour

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What do we do for a patient with hypovolemia

fluid replacement, albumin replacement, blood transfusions for hemmorhage, dopamine to maintain BP, assess for overload with treatment.

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hypervolemia

excess fluid in the extracellular compartment as a result of fluid or sodium retention, excessive intake, or renal failure.

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what does hypervolemia lead to

CHF and pulmonary edema

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what do you see in a hypervolemia patient

tachypnea, dyspnea, crackles, rapid bounding pulse, hypertension, JVD, acute weight gain, edema.

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anasarca

severe generalized edema

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edema

fluid is foced into tissues by the hydrostatic pressure

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what do we do for patients with edema

fluid and Na+ restriction, diuretics, monitor vital signs, hourly I & O, breath sounds, monitor ABG's, Daily weights

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water intoxication

hypotonic extracellular fluid shifts ino cells to attempt to restore balance, Cells swell

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what are some causes of water intoxication

SIADH, rapid infusion of hypotonic solution

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what do you see with patients with early water intoxication

cahnges in loc, muscle weakness, twitching, cramping

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what do you see with patients with late water intoxication

bradycardia, widened pulse pressure, seizures, coma

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what do you do for patients with water intoxication

prevention is the best treatment, assess neuro status, monitor I&O and vital signs, fluid restrictions, IV access, daily weights, monitor serum Na+, seizure precautions

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cations

sodium, potassium, calcium, magnesium

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anions

chloride, bicarbonate, phosphate, sulfate

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major cations in the ECF

sodium

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Major cations in the ICF

potassium

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Sodium function

attracts fluid and helps preserve fluid volume. Combines with chloride and bicarbonate to help regulate acid-base balance

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SIADH

syndrome of inappropriate antidiuretic hormone--when ADH is released and the body doesn't need it causing water retention and sodium excretion.

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Hypornatremia

Sodium level less than 135 mEq/L

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dilutional hyponatremia

results from Na+ loss, water gain

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depletional hyponatremia

insufficient Na+ intake

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hypovolemic hyponatremia

Na+ loss is greater than water loss; can be renal (diuretic use) or non-renal ( vomiting)

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Hypervolemic hyponatremia

water gain is greater than Na+ gain; edema occurs

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Isovolumic hyponatremia

normal Na+ level, too much fluid

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what do you expect your patients to present with in hyponatremia

headache, Nausea and vomiting, muscle twitching, altered mental status, stupor, seizures ,coma

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What do you expect to see in Hypervolemic hyponatremia

edema, hypertension, wiehg gain, bounding tachycardia

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what do you expect to see in hypovolemic hyponatremia

poor skin turgor, tachycardia, decreased BP, orthostatic hypo-tension

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what do we do for a mild case of hyper/isovolumetric hyponatremia

restrict fluid intake

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what do we do for a mild case of hypovolemic hyponatremia

Iv fluids or increase po Na+ intake

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What do we do for a severe case of hyponatremia

infuse hypertonic NaCl solution, furosemide to remove excess fluid, monitor client in the ICU

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hypernatremia

More sodium in the blood than water, when this occurs fluid shifts outside the cells.

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What is hypernatremia caused by

water deficit or over-ingestion of Na+

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What do you see in Hypernatremic patients

S-A-L-T
Skin flushed
Agitation
Low grade fever
Thirst

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What do we do for hypernatremic patients

correct underlying disorder, gradual fluid replacement, monitor for s/s of cerebral edema, monitor serum Na+ levels, seizure precautions

58

untreated changes in potassium levels can lead to serious

neuromuscular and cardiac problems

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most potassium ingested is excreted by

the kidneys

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what are the three other influential factors in potassium

Na+/K+ pump, renal regulation, pH level

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sodium potassium pump

uses ATP to pump potassium into cells, pumps sodium out of cells and creates a balance

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Renal Regulation

aldosterone secretion causes Na+ reabsorption and K+ excretion

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what happens to potassium in acidosis

K+ moves out of cells

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what happens to potassium in alkalosis

K+ moves into cells

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Hypokalemia

too little potassium

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what can cause hypokalemia

GI losses, diarrhea, insufficient intake, non K+ sparing diuretics

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what are non K+ sparing diuretics

thiazide, furosemide

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what do you see in a patient with hypokalemia

SUCTION
Skeletal muscle weakness
Uwave (EKG changes)
Constipation, ileus
Toxicity of digialis glycosides
Irregular, weak pulse
Orthostatic hypotension
Numbness (paresthesias)

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What do we do for patients with hypokalemia

increase dietary k+
oral KCl supplements
IV and K+ replacements
Change to K+ sparing diuretics
Monitor EKG changes

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Hyperkalemia

Too much serum potassium
Caused by altered kidney function, increased intake, blood transfusions, meds

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What do you see in a patient with hyperkalemia

irritability, paresthesia, muscle weakness, EKG changes, irregular pulse, hypotension, nausea, abdominal cramps, diarrhea

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what do we do for a patient with mild hyperkalemia

give them loop diuretics and put them on dietary restrictions

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what do we do for a patient with moderate hyperkalemis

kayexalate

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what do we do with someone who is in emergency hyperkalemia

calcium gluconate for cardiac effects and sodium bicarbonate for acidosis,

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magnesium function

helps produce ATP, role in protein synthesis and carbohydrate metabolism, regulates muscle contractions

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Hypomagnesemia

Too little magnesium
Caused by poor dietary intake, poor GI absorption, excessive GI/urinary losses

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Who is at risk for hypomagnesemia

chronic alcohol users, Sepsis, burns wounds needing debridement.