Fluid & Electrolytes Part 2 (A) Flashcards
1
Q
Homeostasis =
A
Body’s natural balance
2
Q
Homeostasis is achieved when what characteristics of body fluids remain in balance?
A
Volume, Concentration (Osmolality), Composition (Electrolyte Composition), Acidity (pH)
3
Q
Lack of just fluid =
A
Dehydration
4
Q
Lack of water + electrolytes =
A
Hypovolemia
5
Q
Hypovolemia is a -
A
Fluid volume deficit
6
Q
Hypovolemia can be thought of as-
A
Isotonic dehydration
7
Q
Lack of circulating volume =
A
Fluid volume deficit
8
Q
BUN (Blood Urea Nitrogen) is a lab value that does what?
A
Measures the amount of urea nitrogen levels in the blood.
9
Q
A BUN helps the provider determine -
A
If the kidney’s are properly functioning
10
Q
Hematocrit is a part of the-
A
Complete Blood Panel (CBC)
11
Q
The hematocrit lab value helps measure-
A
The % of RBC’s in the blood
12
Q
The Urine Specific Gravity compares-
A
The density of your urine to the density of water
13
Q
Urine Specific Gravity helps identify if the PT has -
A
Dehydration, kidney problems, or diabetes insipidus
14
Q
When a PT’s body is dry, the BUN and Urine Specific Gravity are all-
A
Elevated
15
Q
Causes of Hypovolemia:
A
GI Loss + Excessive Loss via Skin + Excessive Renal Loss + Third Spacing + Hemorrhage + Alteration in Intake of Fluids + Meds + Underlying healthcare conditions + Decline in total body fluid that they have + Decreased kidney function
16
Q
What is Third Spacing?
A
When the fluid shifts from the Intravascular space (veins) to the interstitial (or third space)
17
Q
Who’s at risk for hypovolemia and why?
A
Older adults have a decreased thirst response.
Infants & young children have an increased metabolic rate & increased body water content.
18
Q
The most common cause of dehydration is-
A
Vomiting + Diarrhea
19
Q
Mild to moderate dehydration can be treated with oral rehydration solutions in-
A
Small increments (5-10 ml) every 5-10 minutes to see if they can tolerate it
20
Q
Dehydration Causes:
A
Hyperventilation + Excessive perspiration + Prolonged fever + Diabetic ketoacidosis (KDA) + Inadequate water consumption + Diabetes insipidus + Osmotic diuretics + Excessive sodium intake + Excessive hypertonic fluids
21
Q
Expected findings of hypovolemia:
A
Alterations in vital signs + Neuromuscular alterations + GI effects + Renal Effects + Other
22
Q
What alterations in vitals can you expect from a hypovolemia PT?
A
Hypothermia (low body temp) + Tachycardia (this is the body’s attempt to maintain normal BP) + Thready pulse (due to decreased blood volume) + Hypotension + Orthostatic hypotension (due to low amount of circulating blood volume) + Decreased central venous pressure + Tachypnea (to compensate for lack of blood volume) + Hypoxia
23
Q
What neuromuscular alterations can you expect from a hypovolemia PT?
A
Dizziness + Syncope + Confusion + Weakness + Fatigue
24
Q
What GI Effects can you expect from a hypovolemia PT?
A
Thirst (one of the first signs of the earliest signs of fluid volume depletion) + Dry furrowed tongue + Nausea + Vomiting + Anorexia + Acute weight loss
25
What Renal Effects can you expect from a hypovolemia PT?
Oliguria (decreased urine production + concentration of urine)
26
Aside from alterations in vitals, neuromuscular effects, GI effects, and renal effects, what other things can you expect to find in a hypovolemia PT?
Decreased cap refill + Cool clammy skin + Diaphoresis + Sunken eyeballs + Flattened neck veins + Poor skin turgor & tenting + Weight loss
27
What happens to Anti-Diuretic Hormone (ADH) in hypovolemia?
It Increases
28
Why does ADH increase when you have hypovolemia?
Because you need to retain water
29
More ADH =
More body water
30
More body water =
Less urine output
31
Name off 6 expected findings of hypovolemia:
Hypovolemia effects are greater in older adults + Loss of Elasticity + Decreased GFR (Glomerular Filtration Rate) + Concentrating ability of the kidneys + Loss of muscle mass + Decreased thirst sensation
32
Muscle holds-
More body water
33
Adipose tissue holds-
Less body water
34
Dehydration can have what as a cause or finding?
A fever
35
Rapid & severe dehydration can cause a PT to have-
Seizures
36
What do Hematocrit (HCT) levels look like in hypovolemic PT’s?
High
37
BUN levels should look like what in hypovolemic PT’s?
High (Above 25mg/dL) due to hemoconcentration
38
Urine Specific Gravity should look like what in hypovolemic PT’s?
High (greater than 1.030)
39
Blood Sodium should look like what in dehydrated PT’s?
High (greater than 145 mEq/L)
40
Blood Osmolality should be high in-
Dehydrated PT’s + Hypernatremia PT’s
41
Fluid loss due to a hemorrhage cause there to be-
No Hemoconcentration, which means that there should be a low BUN (Because you’re losing a lot of blood)
42
Normal BUN values =
8 - 25 mg/dL
43
Normal HCT levels =
36 - 54%
44
Minimum accepted urinary output =
30 ml/hour
45
Hemoconcentration =
Everything becomes more concentrated
46
What is hemoconcentration caused by?
A fluid volume deficit
47
Does HCT get higher or lower when you’re dry?
Higher
48
The volume of the RBC’s in 100 mL’s is expressed as a -
Percentage (This is how you determine hemoconcentration)
49
How does a nurse manage a PT with hypovolemia?
Oral or IV Therapy + Strict Input & Output + Monitor Vital Signs + Monitor changes in mental status + Monitor weight daily + Assess Gait + PT should change positions slowly + Replace fluids & electrolytes (Can be done with LR for balancing fluid and electrolytes, 0.9% normal saline for rapid volume replacement, or a blood transfusion if due to blood loss)
50
Monitoring weight is the-
Most accurate measurement of fluid gain / loss
51
Are hypovolemic PT’s a fall risk?
Yes
52
What would you want to educate a dehydration PT about?
Tell them to increase fluid intake.
Educate them on the causes of dehydration.
53
Causes of dehydration include:
Vomiting, Wound Exudate, Diarrhea, or Excessive Ostomy Losses
54
Occurs with significant loss of blood (lost ~ 1/5th of blood in the body) =
Hypovolemic Shock
55
Hypovolemic shock manifestations include:
Slowed tissue perfusion, decreased perfusion, cells become unable to carry enough oxygen because of loss of RBC’s
56
Nursing Actions for Hypovolemic Shock include:
Oxygen administration + Monitor oxygen saturation (<70% = medical emergency) + Stay with PT if unstable + Check vital signs every 15 minutes + Administer fluid replacement (Colloids / Crystalloids) + Vasoconstrictors (dopamine, norepinephrine, phenylephrine) + Agents to improve myocardial perfusion (sodium nitroprusside) + Positive inotropic meds (Dobutamine, milrinone) + Hemodynamic monitoring.
*Dont need to know meds yet. Yippee!*
57
Why do male adults have more water?
Lean body mass holds more water. Adult males have more lean body mass
58
Adipose has less water, so this puts what age/ gender demographic at the most risk?
Older Adult Females
59
Who is most at risk of Fluid Volume Deficit (FVD) and why?
Obese, Older Adults.
Fat cells = less water.
Older adults have less need for ICF + have more body fat.
60
1 L =
2.2 lbs
61
2% Weight Loss =
Mild Fluid Loss
62
5% Weight Loss =
Marked/ Moderate Fluid Loss
63
8% Fluid Loss =
Severe Fluid Loss
64
Overhydration causes:
Excessive intake.
Ineffective removal from the body.
65
Excess fluid/water can cause -
Hemodilation
66
Excess fluid can be called-
Fluid Overload
67
Excess water + electrolytes =
Hypervolemia
68
Excessive sodium causes-
Fluid Retention
69
Why do PT’s with a lot of edema (like congestive heart failure PT’s) have their sodium restricted?
Because sodium causes fluid retention
70
Severe excess of fluid can lead to -
Pulmonary Edema + Heart Failure
71
How do you get rid of excess water + sodium (thus treating hypervolemia?)
Natriuretic Peptides cause an increased excretion of excess water + sodium by the kidneys. Also causes an increase of aldosterone
72
PT’s with heart disease or impaired kidney function need-
To be on a reduced sodium diet.
Fluid intake needs to be restricted.
73
What Regulatory System problems can cause Hypervolemia?
Heart Failure + Kidney Disease + Cirrhosis
74
Aside from regulatory system problems, what else can cause Hypervolemia?
Overdose of fluids + Fluid shifts due to burns + Prolonged use of corticosteroids + Stress (severe) + Hyperaldosteronism
75
What are some causes of Overhydration?
Water replacement without electrolyte replacement + Syndrome of Inappropriate Antidiuretic Hormone (SIADH) + Excessive administration of D5W (IV Fluid), use of hypotonic solutions for irrigations
76
Fluid Volume Overload
Expected Findings, Vital Signs:
Tachycardia + Bounding Pulse + Hypertension + Tachypnea + Increased Central Veinous Pressure
77
Fluid Volume Overload
Expected Findings, Neuromuscular:
Weakness + Visual changes + Parasthesia’s (Pins & needles feeling) + Altered level of consciousness + Seizures (If severe) + Sudden hyponatremia / water excess
78
Fluid Volume Overload
Expected Findings, GI:
Ascites (fluid builds up in abdomen) + Increased motility + Enlarged liver
79
Fluid Volume Overload
Expected Findings, Respiratory:
Crackles + Cough + Dyspnea
80
Fluid Volume Overload
Expected Findings, Other Signs:
Peripheral Edema + Distended neck pains + Polyuria + Cool skin & Pallor
81
What lab results can you expect from someone with Fluid Volume Overload?
Decrease in Hematocrit (HCT) & Hemoglobin (HGB) + Decrease blood Osmolarity with fluid/water excess + Decrease in urine sodium & urine specific gravity + Decrease in BUN due to plasma dilution + X-Ray reveals possible pulmonary congestion
82
Nursing care for Fluid Volume Excess:
I/O + Daily Weight + Assess breathing sounds + Monitor peripheral edema (pitting/non-pitting) + Maintain sodium level (restrict sodium) + Fluid restrictions if prescribed + Encourage rest + Administer diuretics/ monitor the PT + Semi/High Fowler’s position + Pressure reduction mattress + Pad bony prominences/ assess + Monitor sodium & potassium levels
83
You’re checking for pitting edema, 1+ is how many mm?
2 mm
84
You’re checking for pitting edema, 2+ is how many mm?
4 mm
85
You’re checking for pitting edema, 3+ is how many mm?
6 mm
86
You’re checking for pitting edema, 4+ is how many mm?
8 mm
87
What things do you need to educate your PT with fluid volume excess about?
Daily weights + Low sodium diet + how to read food labels + How to keep daily record of sodium intake + Fluid restriction (divide allotment throughout the day)
88
Pulmonary Edema is caused by-
Several Fluid Overload/ Excess
89
Pulmonary Edema Manifestations =
Anxiety + Tachycardia + Increased vein distention + Premature ventricular contractions (PVC’s) + Dyspnea at rest + Change in Level Of Consciousness (LOC) + Restlessness + Lethargy + Crackles + Productive cough with frothy pink-tinged sputum
90
Nursing actions for pulmonary edema =
High Fowler’s position + Oxygen + Positive Airway Pressure (CPAP or BIPAP) + Possible intubation with mechanical ventilation + Morphine, nitrates, & diuretics as prescribed
91
Major electrolytes in the body=
Sodium + Potassium + Magnesium + Calcium + Phosphorus + Chloride
92
Reference Ranges:
Sodium=
136 - 145 mEq/L
93
Reference Ranges:
Calcium=
9 - 10.5 mg/dL
94
Reference Ranges:
Potassium=
3.5 - 5 mEq/L
95
Reference Ranges:
Magnesium=
1.3 - 2.1 mEq/L
96
Reference Ranges:
Chloride=
98 - 106 mEq/L
97
Reference Ranges:
Phosphorus=
3 - 4.5 mg/dL
98
Major cation in ECF =
Sodium
99
Where is sodium found?
In many body fluids (saliva, GI, bile)
100
How does sodium regulate water balance & distribution =
Maintains appropriate ECF osmolality + Maintains fluid volume by keeping correct amount of fluid in ECF + Influences H20 movement & distribution between ECF and ICF (This fluid shift helps to restore homeostasis & normal osmolality)
101
Sodium Imbalance =
Water Imbalance + Osmolality Changes
102
How do the kidneys regulate sodium?
By using ADH & Aldosterone
103
Has role in nerve impulse transmission =
Sodium
104
Regulates water balance and distribution =
Sodium
105
Main determinant of Osmolality =
Sodium
106
Whenever sodium is reabsorbed, what is absorbed with it?
Chloride & Water
107
More sodium = Increased ECF Osmolarity = Stimulates more ADH =
More water’s reabsorbed, less output
108
Less sodium = Decreased ECF Osmolarity = Inhibits ADH (Less ADH) =
More water excreted + more output
109
Is sodium AND water balance regulated by aldosterone production?
Yeah
110
More sodium = decreased aldosterone production =
Excretion of sodium & water
111
Less sodium = Increased aldosterone production =
Increased sodium & water reabsorption
112
Sodium is not stored-
In the body, must be consumed
113
The minimum daily range of sodium is-
< 3 gr
114
Foods high in Na+ =
Table salt + Canned foods (especially soups, vegetables, tuna, etc.) + Processed & packaged foods (cheese, hotdogs, bologna, jerky) + Cured meats (bacon & ham) + Pickled foods & snack foods + Condiments (ketchup, pickles, green olives) + Pizza + Cottage cheese + Vegetable juice + Buttermilk + Shrimp + Sausage
115
A Hyponatremia PT has a blood sodium level that’s-
Less than 136 mEq/L
116
Hyponatremia is caused by-
Excessive water intake in plasma or a loss of sodium rich foods
117
Delays/ slows depolarization =
Hyponatremia
118
Hyponatremia causes water to move from-
ECF into the intracellular fluid (brain cells + system swells)
119
Where fluids go, electrolytes-
Go
120
Most common cause of hyponatremia =
Excess water in the body
121
Hyponatremia causes =
Loss of sodium + Gain of water
122
Sodium lost = ECF gets-
Less concentrated
123
Examples that can cause hyponatremia via loss of sodium are:
GI fluid loss (suction, vomiting, diarrhea) + Renal loss (diuretics) + Skin loss (burns, wound drainage, sweating) + Irrigations with tap water (wounds, Nasogastric Tubes/NGT, sweating) + Low sodium diet (especially combine with above losses)
124
Examples that can cause hyponatremia via gain of water are:
Excess drinking of water w/o electrolyte replaced + Infusion of hypotonic solutions + Hypotonic tube feedings + Hypotonic IVF (like prolonged D5W)
125
Water gained =
ECF gets less concentrated
126
Hyponatremia causes the serum osmolarity to-
Decrease as fluid shifts from ECF to intracellular.
127
Causes of hyponatremia that drain sodium from the body are nicknamed-
The 4 D’s
128
What are the 4 D’s?
Drains + Diuretics + Diarrhea + Diuresis
129
Aside from the 4 D’s, what else can cause hyponatremia via sodium loss?
SIADH + Adrenal Insufficiency (Addison’s Disease) + Heat exhaustion or high fever
130
SIADH =
They retain water and dilute the sodium which becomes hemodilution
131
Adrenal insufficiency wastes sodium by-
Excreting it via the urine
132
Expected hyponatremia PT findings (Vitals) =
Hypothermia + Tachycardia + Rapid thready pulse + Hypotension + Orthostatic hypotension
133
Expected hyponatremia PT findings (neuromuscular alterations) =
Headache + Confusion + Lethargy + Muscle weakness with possibility of respiratory compromise + Fatigue + Decreased deep tendon reflexes + Seizures + Coma
134
Expected hyponatremia PT findings (GI) =
Increased GI motility + Hyperactive bowel sounds + Abdominal cramping + Anorexia + Nausea + Vomiting
135
Nursing care for hyponatremia involves-
Monitoring I&O, Daily Weights, Na+ labs, Vital signs, Behavioral changes.
Restrict fluid intake or high sodium intake if allowed.
Ensure safe environment.
IVF Replacement.
136
Type of IVF fluid replacement for treatment of hyponatremia depends on -
Severity
137
Moderate hyponatremia should be treated with what IVF replacement?
0.9% NS or LR
138
Severe hyponatremia should be treated with what IVF replacement?
3.0% NS (Hypertonic IVF)
139
PT with hypernatremia should be educated about:
Weigh daily + Notify HCP if weight gain of 1-2 pound in a 24-hour period or 3 pounds in a week + High-sodium diet + Food diary + Read nutrition levels
140
Hypernatremia =
High sodium over 145 mEq/L
141
How do you get hypernatremia?
Loss of water/ poor intake of water
Or
Excessive gain of sodium
142
Sodium gain =
ECF gets more concentrated
143
Name 7 examples of how a PT can gain too much sodium:
Excess salt ingestion (Table salt, high sodium diet) + Infusion of hypertonic fluids + Hypertonic IVF’s (D5NS, D5LR, D10W) + Hypertonic tube feedings without adding water + Poorly diluted baby formulas + Renal disease + Excess aldosterone secretion
144
Dehydration helps confirm the presence of-
Hypernatremia
145
Water deprivation =
Too little intake of water
146
Diarrhea is considered severe if it causes a loss of-
More H20 than Na+
147
When water is lost, ECF-
Gets more concentrated
148
Examples of hypernatremia caused by loss of water/ poor intake of water:
Water deprivation + Severe watery diarrhea + Increased insensible water loss (Excessive sweating, high fever)
149
Thirst protects against-
Hypernatremia
150
High Na =
Thirsty
151
Thirsty =
Drink fluids
152
Drink fluids =
Correct hypernatremia
153
A problem situation for hypernatremia is not-
Being able to drink or rapid Na overload
154
High Na means High-
Osmolality
155
Hypernatremia Manifestations & Lab Findings =
Key symptoms due to dehydrated cells, Na+ > 145 mEq (Serum Osmolarity > 295 mOsm), Thirst + Dry Sticky Mucous Membranes, Oliguria/ Anuria (Anuria means no urine or without urine).
NeuroCognitive: Irritable, Restless, Agitated, Seizures, Poor Memory.
Muscular: Weakness, Lethargy
156
Nursing Interventions for Hypernatremia =
Monitor I&O, Daily Weights, Na+ Labs, Vitals, LOC & Behavioral Changes.
Restrict sodium, Force fluids, Oral care.
Provide safe environment.
Type of IVF replacement = Hypotonic IVF (0.45% NS or 0.33% NS)
157
Whenever administering Hypotonic IVF to a patient, it should be administered gradually to prevent-
Fluid shift into the cells + any Cerebral Edema
158
Serum Potassium level should normally be-
3.5 - 5 mEq/L
159
Potassium is a principal-
Cation in ICF
160
Transmits life-sustaining electrical impulses =
Potassium
161
Potassium impacts what?
Cardiac muscle + Nerve tissue + Skeletal tissue + Muscle contraction
162
Potassium is primarily regulated by-
The Kidney
163
Is potassium stored in the body?
No, it must be ingested
164
Fruits, vegetables, spinach, and dairy products are all high in-
Potassium
165
Hyperkalemia is high potassium over-
5.0 mEq/L
166
Causes for Hyperkalemia include-
Decreased K+ Excretion & High K+ Intake
167
Examples of decreased potassium excretion are-
Impaired excretion; Renal Failure
Meds = Potassium-Sparing Diuretics (K+ Retained)
High K+ Intake
168
Examples of High K+ intake include-
Potassium supplements (Oral/ IV).
Excessive intake of dietary or K+ salt substitutes.
Excessive or rapid infusion of IV Potassium.
Massive cell damage (burns/trama).
169
Hyperkalemia Manifestiations + Labs =
Cell excitability + Cardiac & EKG changes, Cardiac dysrhythmia, cardiac arrest + Skeletal & abdominal muscles: leg pain, muscle cramping, followed by muscle weakness & numbness.
Lab values = K+ > 5.0 mEq/L; EKG Abnormalities
170
Hyperkalemia Nursing Interventions =
Check Kidney Function: U/A, BUN, Serum Creatinine + Strict I&O + Restrict dietary K+ and salt substitutes + Meds to reduce K+ (Kayexalate & Loop Diuretics) + Monitor serum K+ levels + Cardiac Monitoring + Renal Dialysis
