Fluid Balance & Electrolytes Flashcards
(95 cards)
1
Q
What is osmosis
A
Movement of WATER down a concentration gradient
From region of low SOLUTE concentration to one of high solute concentration across a SEMIPERMEABLE MEMBRANE
2
Q
When does osmosis stop
A
Stops when concentration differences disappear OR when hydrostatic pressure builds and opposes further movement
3
Q
what is diffusion
A
Movement of molecules from an area of high concentration to a lower concentration
4
Q
when does diffusion stop
A
Movement stops when concentrations are equal in both areas
5
Q
What 2 electrolytes are outside the cell
A
sodium and chloride
6
Q
what 4 electrolytes are primarily inside the cell
A
potassium, magnesium, phosphate, and sulfer
7
Q
what is osmotic pressure
A
the amt of pressure needed to prevent the movement of water across a cell membrane
8
Q
What are the 3 Primary colloids
A
albumin, globulin, fibrinogen
9
Q
how are colloids measured
A
Total protein level
10
Q
What do colloids do?
A
move fluid from interstitial compartment to plasma (blood) compartment
11
Q
what is hydostatic pressure
A
Force of fluid in compartment pushing AGAINST A CELL MEMBRANE (or vessel wall)
12
Q
what generates hydrostatic pressure
A
Generated by blood pressure
13
Q
what does hydrostatic pressure do at the capillary level
A
major force that pushes water OUT of the vascular system into interstitial space
14
Q
Oncotic pressure
A
Caused by plasma colloids (large molecules) in solution
Major colloids in vascular system= albumin
15
Q
T/F colloids are abundant in plasma and fewer in interstitial space
A
True, Plasma proteins attract water, pulling fluid from tissue space into vascular space
16
Q
What does hydrostatic pressure do?
A
pushes fluid out of the capillary
17
Q
what does oncotic pressure do
A
pulls fluid INTO the capillary
18
Q
What 5 things do electrolytes influence
A
Fluid balance acid base balance nerve impulses muscle contraction heart rhythm other cell functions
19
Q
what are electrolytes
A
substances that are ELECTRICALLY charged when in solution
20
Q
what 4 things are concentrations of electrolytes dependent on
A
intake
absorption
distribution
excretion
21
Q
What electrolytes have the highest INTRACELLULAR concentration
A
Potassium (+)
Magnesium (+)
Phosphorous (-)
22
Q
What electrolytes have the highest EXTRACELLULAR concentration
A
Sodium (+)
Chloride (-)
Bicarbonate(-)
23
Q
Normal range of sodium
A
136-145 meq/L
24
Q
normal range of potassium
A
3.5-5.0meq/L
25
normal range of magnesium
1.7-2.2 mg/dl
26
normal range of calcium
9-11 mg/dl
27
normal range of phosphate
3.2-4.3 mg/dl
28
What does Na+ activate
muscle and nerve cells. ion movement important in action potentials
29
4 characteristics of Na+
main ECF cation
Governs osmolality
influences water distribution
aids in acid-base balance
30
5 Causes of hyponatremia
| Na < 136
```
GI loss
Renal loss
Skin loss
Fasting diets
Excess hypotonic fluid
```
31
S/S of hyponatremia
CONFUSION/ ALTERED LOC
anorexia
muscle weekness
can lead to seizures/coma
32
Dilutional hyponatremia =
Hypervolemic
33
depletional hyponatremia =
hypovolemic
34
5 characteristics of dilutional hyponatremia
```
hypervolemia
increase BP
weight gain
bounding rapid pulse
increae urine sp gravity
```
35
6 characteristics of depletional hyponatremia
```
hypovolemia
decrease BP
tachy pulse
dry skin
weight loss
decrease sp gravity
```
36
5 characteristics for treatments for hyponatremia
```
sodium replacement (slowly)
PO/IV
IV - normal saline
Fluid restriction
Treat underlying problems
```
37
Sodium Bicarbonate MOA
Dissociates to provide bicarbonate ion which neutralizes ion concentration and raises blood and urinary pH
Increases concentration of sodium in plasma
38
Sodium Bicarbonate Indication
metabolic acidosis
39
Adverse effects of Sodium Bicarbonate
edema,
cerebral hemorrhage, hypernatremia,
lots of electrolyte abnormalities, metabolic alkalosis, flatulence with PO, tetany,
pulmonary edema, heart failure exacerbation
40
4 nursing considerations for Sodium Bicarbonate
Do not give IV for hyponatremia- VESICANT at high concentrations
If IV, monitor patency thoroughly!
Lots of drug interactions if the drug mixing with is diluted with sodium solutions
PO- give 1-3 after or before meals
41
3 causes of Hypernatremia
| >145
IV fluids, tube feeds, near drowning in salt water = excess sodium intake
Not enough water intake or too much water loss = cognitively impaired, diarrhea, high fever, heatstroke
Profound diuresis
42
S/S of Hypernatremia
| >145
Alter LOC/Confusion, seizure, coma
Extreme thirst (hyperosmolality)
Dry, sticky mucous membranes
Muscle cramps
43
Hypernatremia treatment
If H20 loss is cause_ ADD WATER
| If sodium excess is cause_ REMOVE SODIUM
44
T/F you should quickly correct sodium levels
False, GRADUALLY achieve normal sodium level over a 48 hours period to avoid edema of cerebral cells
45
6 characteristics of potassium
Intracellular cation
Helps regulate cell excitability and electrical status
Helps control intracellular osmolality
Diet is main source
Kidneys main source of potassium loss Pee out Potassium
Normal Values: 3.5-5 mEq/L
46
2 causes of Hypokalemia <3.5
Renal or GI losses
DIURESIS
Acid base disorders (potassium in ECF goes into ICF)
47
S/S of hypokalemia
Cardiac rhythm disturbances can be lethal
Muscle weakness, leg cramps
Decreased bowel motility- constipation, nausea, ileus
48
Potassium chloride (KCl) indications
Treat/prevent K+ depletions when dietary measures prove inadequate
49
4 nursing implications for KCl (PO)
```
DILUTE with water/juice to ↓ GI distress
tastes awful! powder/tablets
may cause GI ulcers/bleeding
assess for N/V
Critical Point: IV MUST ALWAYS be diluted; NEVER IV Push!!
```
50
4 nursing indications for KCl (IV)
IV: MUST BE DILUTED!!! and ADMINISTERED SLOWLY
Give only to clients with documented urine output
May cause phlebitis/pain
IV solutions should not contain more than 40 mEq/L of K+; rate should not exceed 10-20 mEq/hr
51
2 Contraindications for KCl
Renal Failure
| Dialysis
52
what can undiluted potassium cause
ventricular fibrillation
53
Should you give K+ IV push?
NEVER
54
3 Causes of hyperkalemia
Decreased potassium OUTPUT (renal failure, not peeing)
Burns, crush injuries, sepsis anything with massive cell injury
Drugs– potassium sparing diuretics, ACE, ARBs NSAIDs
55
S/S of Hyperkalemia
CARDIAC RHYTHM DISTURBANCES
Muscle weakness, cramps
Abdominal cramping, diarrhea, vomiting
56
Kayexalate/sodium polystyrene sulfonate class
cation exchange resins
57
Kayexalate/sodium polystyrene sulfonate route
available as oral suspension, oral and rectal powder, oral and rectal suspension, rectal enema
58
Kayexalate/sodium polystyrene sulfonate Indication
To treat high levels of potassium in the blood (hyperkalemia
59
Kayexalate/sodium polystyrene sulfonate MOA
kayexalate binds to potassium in the digestive tract replacing potassium ions for sodium ions. Potential to drop K by 0.5-1.0 meq/L in 4-6H
60
Adverse Reactions to kayexalate
Constipation, diarrhea, N/V, hypokalemia
| Serious: intestinal obstruction and intestinal necrosis
61
precaution of kayexalate
use only in patient with normal bowel function
62
MOA of D50/Insulin
combo shifts potassium into cell temporarily (10units of regular insulin to 1 ampule of D50)
63
Lytic Cocktail
Reduces potassium level
1. 10% 10cc calcium gluconate - protects heart by stabilize myocardium
2. dextrose 50 - 500cc - counteract effect of insulin
3. insulin - iv actrapid 10 unit - drive K+ into cells
64
3 charateristics of magnesium
Helps to stabilize cardiac muscle cells
Blocks/controls movement of K+ out of cardiac cells
Helps to stabilize smooth muscle
65
causes of hypomagnesium
diuresis, GI or renal losses, limited intake (fasting or starvation), alcohol abuse, pancreatitis, hyperglycemia
66
S/S of hypomagnesium
S/S: hyperactive reflexes, confusion, cramps, tremors, seizures
Nystagmus
67
oral treatment of hypomagnesium
Mylanta
| Magnesium sulfate
68
IV treatment of hypomagnesium
IV Magnesium sulfate
Replace over several days
Can give IV push if necessary
69
Hypermagnesemia causes
increased intake accompanied by renal failure
Chronic renal failure who take milk of mag
OB patients
70
S/S of hypermagnesium
lethargy, floppiness, muscle weakness, decreased reflexes, flushed/warm skin, decreased pulse/BP
71
Treatment of hypermagnesemia
Treatment: stop replacement, if chronic decrease intake = dialysis
72
Mag Sulfate and Mag Oxide MOA
replaces magnesium
73
Mag Sulfate and Mag Oxide indication
hypomag, prevent/treat seizures in pre-eclampsia, treat cardiac rhythm disturbances [constipation PO]
74
Mag Sulfate and Mag Oxide adverse effects
hypermag confusion, sluggish, slow movements, SOB, nausea, dizzy [low calcium], abnormal heart rhythm
75
What is calcium
Hormones released by the thyroid and parathyroid glands are controllers for the amount of calcium that is released from and absorbed into the bone
76
5 characteristics of calcium
Enzyme reactions
Effects membrane potentials and nerve excitability
Necessary for contraction of skeletal, cardiac and smooth muscle
Helps in release of hormones, neurotransmitters and chemical mediators
Influences cardiac contractility and automaticity
Necessary for blood clotting (part of the clotting cascade)
77
treatment of hypocalcemia (IV)
```
IV calcium
Calcium Chloride (ionized form and preferred) = given through central only at UK
Calcium Gluconate = prefer to give through central line
```
78
Oral treatment of hypocalcemia
Elemental calcium, calcium carbonate (Tums)
May also need Vit D
Active form in impaired liver &/or kidney function
79
causes of hypercalcemia
hyperparathyroidism, cancers
80
S/S of hypercalcemia
calcium acts like a sedative, fatigue, lethargy, confusion, weakness, leading to seizures, coma
Kidney stones
81
4 treatments of hypercalcemia
Adequate hydration
Increased urine output
Diuretics and NaCl (sodium excretion is accompanied by calcium excretion)
Dialysis in renal failure
82
T/F low calcium = high phosphate
True
83
5 MOAs of phosphorus
```
Role in bone formation
Essential for ATP formation and enzymes needed for glucose, protein and fat metabolism
Part of DNA and RNA
Acid-base buffer
Normal function of WBCs and platelets
```
84
percentage of phosphorus found in bone
85%
85
percentage of phosphorus found intracellular
14%
86
causes of Hypophosphatemia
```
Decreased absorption
Antacids overdose
Severe diarrhea
Increased kidney elimination
Malnutrition
Alcoholism
TPN
Recovery from malnutrition
```
87
manifestations of hypophosphatemia
```
mild-moderate few, severe:
Tremor
Paresthesia
Confusion to coma
Seizure
Muscle weakness
Joint stiffness
Bone pain
Hemolytic anemia
Plt dysfunction
Impaired WBC function
```
88
causes of Hyperphosphatemia
```
Kidney failure
Laxatives/enemas with phosphorus
Shift from intra- to extracellular compartment
Massive trauma
Heat stroke
Hypoparathyroidism
```
89
manifestations of Hyperphosphatemia
```
Usually asymptomatic
Typically only symptoms of hypocalcemia:
Muscle spasms
Paresthesia
Tetany
```
90
treatment for Hypophosphatemia
```
IV or oral replacement
Given IV over a LONG period of time
Increase oral intake
Take care with CKD or hypercalcemia
Increased risk of calcifications
```
91
treatment for Hyperphosphatemia
Treat the cause
Calcium-based phosphate binders
Hemodialysis – Renal failure
92
Chvostek's sign
ipsilateral twitching of the circumoral muscles in response to gentle tapping of the facial nerve just anterior to the ear
93
Trousseau's sign
carpal spasm upon inflation of a BP cuff to 20 mmHg above the patient's systolic blood pressure for three minutes
94
T/F Low Mag= Low calcium
True
95
Causes of Hypocalcemia
```
Unable to mobilize bone
increased renal loss
increased binding
decreased intake of absorption (Decreased vitamin D)
Acute pancreatitis
thyroid and parathyroid surgery
increased neuromuscular excitability
cardiac insufficiency
positive chvosteks sign
positive trousseaus sign
```
