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Fundamentals 2 Exam 1 Flashcards > Fluid & Electrolytes Part 2 (A) Flashcards > Flashcards

Fluid & Electrolytes Part 2 (A) Flashcards

1
Q

Homeostasis =

A

Body’s natural balance

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2
Q

Homeostasis is achieved when what characteristics of body fluids remain in balance?

A

Volume, Concentration (Osmolality), Composition (Electrolyte Composition), Acidity (pH)

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3
Q

Lack of just fluid =

A

Dehydration

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4
Q

Lack of water + electrolytes =

A

Hypovolemia

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5
Q

Hypovolemia is a -

A

Fluid volume deficit

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6
Q

Hypovolemia can be thought of as-

A

Isotonic dehydration

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7
Q

Lack of circulating volume =

A

Fluid volume deficit

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8
Q

BUN (Blood Urea Nitrogen) is a lab value that does what?

A

Measures the amount of urea nitrogen levels in the blood.

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9
Q

A BUN helps the provider determine -

A

If the kidney’s are properly functioning

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10
Q

Hematocrit is a part of the-

A

Complete Blood Panel (CBC)

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11
Q

The hematocrit lab value helps measure-

A

The % of RBC’s in the blood

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12
Q

The Urine Specific Gravity compares-

A

The density of your urine to the density of water

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13
Q

Urine Specific Gravity helps identify if the PT has -

A

Dehydration, kidney problems, or diabetes insipitus

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14
Q

When a PT’s body is dry, the BUN and Urine Specific Gravity are all-

A

Elevated

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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

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16
Q

What is Third Spacing?

A

When the fluid shifts from the Intravascular space (veins) to the interstitial (or third space)

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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.

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18
Q

The most common cause of dehydration is-

A

Vomiting + Diarrhea

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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

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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

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21
Q

Expected findings of hypovolemia:

A

Alterations in vital signs + Neuromuscular alterations + GI effects + Renal Effects + Other

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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

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23
Q

What neuromuscular alterations can you expect from a hypovolemia PT?

A

Dizziness + Syncope + Confusion + Weakness + Fatigue

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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

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25
Q

What Renal Effects can you expect from a hypovolemia PT?

A

Oliguria (decreased urine production + concentration of urine)

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26
Q

Aside from alterations in vitals, neuromuscular effects, GI effects, and renal effects, what other things can you expect to find in a hypovolemia PT?

A

Decreased cap refill + Cool clammy skin + Diaphoresis + Sunken eyeballs + Flattened neck veins + Poor skin turgor & tenting + Weight loss

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27
Q

What happens to Anti-Diuretic Hormone (ADH) in hypovolemia?

A

It Increases

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28
Q

Why does ADH increase when you have hypovolemia?

A

Because you need to retain water

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29
Q

More ADH =

A

More body water

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30
Q

More body water =

A

Less urine output

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31
Q

Name off 6 expected findings of hypovolemia:

A

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

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32
Q

Muscle holds-

A

More body water

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33
Q

Adipose tissue holds-

A

Less body water

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34
Q

Dehydration can have what as a cause or finding?

A

A fever

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35
Q

Rapid & severe dehydration can cause a PT to have-

A

Seizures

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36
Q

What do Hematocrit (HCT) levels look like in hypovolemic PT’s?

A

High

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37
Q

BUN levels should look like what in hypovolemic PT’s?

A

High (Above 25mg/dL) due to hemoconcentration

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38
Q

Urine Specific Gravity should look like what in hypovolemic PT’s?

A

High (greater than 1.030)

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39
Q

Blood Sodium should look like what in dehydrated PT’s?

A

High (greater than 145 mEq/L)

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40
Q

Blood Osmolality should be high in-

A

Dehydrated PT’s + Hypernatremia PT’s

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41
Q

Fluid loss due to a hemorrhage cause there to be-

A

No Hemoconcentration, which means that there should be a low BUN (Because you’re loosing a lot of blood)

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42
Q

Normal BUN values =

A

8 - 25 mg/dL

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43
Q

Normal HCT levels =

A

36 - 54%

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44
Q

Minimum accepted urinary output =

A

30 ml/hour

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45
Q

Hemoconcentration =

A

Everything becomes more concentrated

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46
Q

What is hemoconcentration caused by?

A

A fluid volume deficit

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47
Q

Does HCT get higher or lower when you’re dry?

A

Higher

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48
Q

The volume of the RBC’s in 100 mL’s is expressed as a -

A

Percentage (This is how you determine hemoconcentration)

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49
Q

How does a nurse manage a PT with hypovolemia?

A

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)

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50
Q

Monitoring weight is the-

A

Most accurate measurement of fluid gain / loss

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51
Q

Are hypovolemic PT’s a fall risk?

A

Yes

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52
Q

What would you want to educate a dehydration PT about?

A

Tell them to increase fluid intake.
Educate them on the causes of dehydration.

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53
Q

Causes of dehydration include:

A

Vomiting, Wound Exudate, Diarrhea, or Excessive Ostomy Losses

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54
Q

Occurs with significant loss of blood (lost ~ 1/5th of blood in the body) =

A

Hypovolemic Shock

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55
Q

Hypovolemic shock manifestations include:

A

Slowed tissue perfusion, decreased perfusion, cells become unable to carry enough oxygen because of loss of RBC’s

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56
Q

Nursing Actions for Hypovolemic Shock include:

A

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!

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57
Q

Why do male adults have more water?

A

Lean body mass holds more water. Adult males have more lean body mass

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58
Q

Adipose has less water, so this puts what age/ gender demographic at the most risk?

A

Older Adult Females

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59
Q

Who is most at risk of Fluid Volume Deficit (FVD) and why?

A

Obese, Older Adults.

Fat cells = less water.
Older adults have less need for ICF + have more body fat.

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60
Q

1 L =

A

2.2 lbs

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61
Q

2% Weight Loss =

A

Mild Fluid Loss

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62
Q

5% Weight Loss =

A

Marked/ Moderate Fluid Loss

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63
Q

8% Fluid Loss =

A

Severe Fluid Loss

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64
Q

Overhydration causes:

A

Excessive intake.
Ineffective removal from the body.

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65
Q

Excess fluid/water can cause -

A

Hemodilation

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66
Q

Excess fluid can be called-

A

Fluid Overload

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67
Q

Excess water + electrolytes =

A

Hypervolemia

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68
Q

Excessive sodium causes-

A

Fluid Retention

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69
Q

Why do PT’s with a lot of edema (like congestive heart failure PT’s) have their sodium restricted?

A

Because sodium causes fluid retention

70
Q

Severe excess of fluid can lead to -

A

Pulmonary Edema + Heart Failure

71
Q

How do you get rid of excess water + sodium (thus treating hypervolemia?)

A

Natriuretic Peptides cause an increased excretion of excess water + sodium by the kidneys. Also causes an increase of aldosterone

72
Q

PT’s with heart disease or impaired kidney function need-

A

To be on a reduced sodium diet.

Fluid intake needs to be restricted.

73
Q

What Regulatory System problems can cause Hypervolemia?

A

Heart Failure + Kidney Disease + Cirrhosis

74
Q

Aside from regulatory system problems, what else can cause Hypervolemia?

A

Overdose of fluids + Fluid shifts due to burns + Prolonged use of corticosteroids + Stress (severe) + Hyperaldosteronism

75
Q

What are some causes of Overhydration?

A

Water replacement without electrolyte replacement + Syndrome of Inappropriate Antidiuretic Hormone (SIADH) + Excessive administration of D5W (IV Fluid), use of hypotonic solutions for irrigations

76
Q

Fluid Volume Overload

Expected Findings, Vital Signs:

A

Tachycardia + Bounding Pulse + Hypertension + Tachypnea + Increased Central Veinous Pressure

77
Q

Fluid Volume Overload

Expected Findings, Neuromuscular:

A

Weakness + Visual changes + Parasthesia’s (Pins & needles feeling) + Altered level of consciousness + Seizures (If severe) + Sudden hyponatremia / water excess

78
Q

Fluid Volume Overload

Expected Findings, GI:

A

Ascites (fluid builds up in abdomen) + Increased motility + Enlarged liver

79
Q

Fluid Volume Overload

Expected Findings, Respiratory:

A

Crackles + Cough + Dyspnea

80
Q

Fluid Volume Overload

Expected Findings, Other Signs:

A

Peripheral Edema + Distended neck pains + Polyuria + Cool skin & Pallor

81
Q

What lab results can you expect from someone with Fluid Volume Overload?

A

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
Q

Nursing care for Fluid Volume Excess:

A

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
Q

You’re checking for pitting edema, 1+ is how many mm?

A

2 mm

84
Q

You’re checking for pitting edema, 2+ is how many mm?

A

4 mm

85
Q

You’re checking for pitting edema, 3+ is how many mm?

A

6 mm

86
Q

You’re checking for pitting edema, 4+ is how many mm?

A

8 mm

87
Q

What things do you need to educate your PT with fluid volume excess about?

A

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
Q

Pulmonary Edema is caused by-

A

Several Fluid Overload/ Excess

89
Q

Pulmonary Edema Manifestations =

A

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
Q

Nursing actions for pulmonary edema =

A

High Fowler’s position + Oxygen + Positive Airway Pressure (CPAP or BIPAP) + Possible intubation with mechanical ventilation + Morphine, nitrates, & diuretics as prescribed

91
Q

Major electrolytes in the body=

A

Sodium + Potassium + Magnesium + Calcium + Phosphorus + Chloride

92
Q

Reference Ranges:

Sodium=

A

136 - 145 mEq/L

93
Q

Reference Ranges:

Calcium=

A

9 - 10.5 mg/dL

94
Q

Reference Ranges:

Potassium=

A

3.5 - 5 mEq/L

95
Q

Reference Ranges:

Magnesium=

A

1.3 - 2.1 mEq/L

96
Q

Reference Ranges:

Chloride=

A

98 - 106 mEq/L

97
Q

Reference Ranges:

Phosphorus=

A

3 - 4.5 mg/dL

98
Q

Major cation in ECF =

A

Sodium

99
Q

Where is sodium found?

A

In many body fluids (saliva, GI, bile)

100
Q

How does sodium regulate water balance & distribution =

A

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
Q

Sodium Imbalance =

A

Water Imbalance + Osmolality Changes

102
Q

How do the kidneys regulate sodium?

A

By using ADH & Aldosterone

103
Q

Has role in nerve impulse transmission =

A

Sodium

104
Q

Regulates water balance and distribution =

A

Sodium

105
Q

Main determinant of Osmolality =

A

Sodium

106
Q

Whenever sodium is reabsorbed, what is absorbed with it?

A

Chloride & Water

107
Q

More sodium = Increased ECF Osmolarity = Stimulates more ADH =

A

More water’s reabsorbed, less output

108
Q

Less sodium = Decreased ECF Osmolarity = Inhibits ADH (Less ADH) =

A

More water excreted + more output

109
Q

Is sodium AND water balance regulated by aldosterone production?

A

Yeah

110
Q

More sodium = decreased aldosterone production =

A

Excretion of sodium & water

111
Q

Less sodium = Increased aldosterone production =

A

Increased sodium & water reabsorption

112
Q

Sodium is not stored-

A

In the body, must be consumed

113
Q

The minimum daily range of sodium is-

A

< 3 gr

114
Q

Foods high in Na+ =

A

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
Q

A Hyponatremia PT has a blood sodium level that’s-

A

Less than 136 mEq/L

116
Q

Hyponatremia is caused by-

A

Excessive water intake in plasma or a loss of sodium rich foods

117
Q

Delays/ slows depolarization =

A

Hyponatremia

118
Q

Hyponatremia causes water to move from-

A

ECF into the intracellular fluid (brain cells + system swells)

119
Q

Where fluids go, electrolytes-

A

Go

120
Q

Most common cause of hyponatremia =

A

Excess water in the body

121
Q

Hyponatremia causes =

A

Loss of sodium + Gain of water

122
Q

Sodium lost = ECF gets-

A

Less concentrated

123
Q

Examples that can cause hyponatremia via loss of sodium are:

A

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
Q

Examples that can cause hyponatremia via gain of water are:

A

Excess drinking of water w/o electrolyte replaced + Infusion of hypotonic solutions + Hypotonic tube feedings + Hypotonic IVF (like prolonged D5W)

125
Q

Water gained =

A

ECF gets less concentrated

126
Q

Hyponatremia causes the serum osmolarity to-

A

Decrease as fluid shifts from ECF to intracellular.

127
Q

Causes of hyponatremia that drain sodium from the body are nicknamed-

A

The 4 D’s

128
Q

What are the 4 D’s?

A

Drains + Diuretics + Diarrhea + Diuresis

129
Q

Aside from the 4 D’s, what else can cause hyponatremia via sodium loss?

A

SIADH + Adrenal Insufficiency (Addison’s Disease) + Heat exhaustion or high fever

130
Q

SIADH =

A

They retain water and dilute the sodium which becomes hemodilution

131
Q

Adrenal insufficiency wastes sodium by-

A

Excreting it via the urine

132
Q

Expected hyponatremia PT findings (Vitals) =

A

Hypothermia + Tachycardia + Rapid thready pulse + Hypotension + Orthostatic hypotension

133
Q

Expected hyponatremia PT findings (neuromuscular alterations) =

A

Headache + Confusion + Lethargy + Muscle weakness with possibility of respiratory compromise + Fatigue + Decreased deep tendon reflexes + Seizures + Coma

134
Q

Expected hyponatremia PT findings (GI) =

A

Increased GI motility + Hyperactive bowel sounds + Abdominal cramping + Anorexia + Nausea + Vomiting

135
Q

Nursing care for hyponatremia involves-

A

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
Q

Type of IVF fluid replacement for treatment of hyponatremia depends on -

A

Severity

137
Q

Moderate hyponatremia should be treated with what IVF replacement?

A

0.9% NS or LR

138
Q

Severe hyponatremia should be treated with what IVF replacement?

A

3.0% NS (Hypertonic IVF)

139
Q

PT with hypernatremia should be educated about:

A

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
Q

Hypernatremia =

A

High sodium over 145 mEq/L

141
Q

How do you get hypernatremia?

A

Loss of water/ poor intake of water
Or
Excessive gain of sodium

142
Q

Sodium gain =

A

ECF gets more concentrated

143
Q

Name 7 examples of how a PT can gain too much sodium:

A

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
Q

Dehydration helps confirm the presence of-

A

Hypernatremia

145
Q

Water deprivation =

A

Too little intake of water

146
Q

Diarrhea is considered severe if it causes a loss of-

A

More H20 than Na+

147
Q

When water is lost, ECF-

A

Gets more concentrated

148
Q

Examples of hypernatremia caused by loss of water/ poor intake of water:

A

Water deprivation + Severe watery diarrhea + Increased insensible water loss (Excessive sweating, high fever)

149
Q

Thirst protects against-

A

Hypernatremia

150
Q

High Na =

A

Thirsty

151
Q

Thirsty =

A

Drink fluids

152
Q

Drink fluids =

A

Correct hypernatremia

153
Q

A problem situation for hypernatremia is not-

A

Being able to drink or rapid Na overload

154
Q

High Na means High-

A

Osmolality

155
Q

Hypernatremia Manifestations & Lab Findings =

A

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
Q

Nursing Interventions for Hypernatremia =

A

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
Q

Whenever administering Hypotonic IVF to a patient, it should be administered gradually to prevent-

A

Fluid shift into the cells + any Cerebral Edema

158
Q

Serum Potassium level should normally be-

A

3.5 - 5 mEq/L

159
Q

Potassium is a principal-

A

Cation in ICF

160
Q

Transmits life-sustaining electrical impulses =

A

Potassium

161
Q

Potassium impacts what?

A

Cardiac muscle + Nerve tissue + Skeletal tissue + Muscle contraction

162
Q

Potassium is primarily regulated by-

A

The Kidney

163
Q

Is potassium stored in the body?

A

No, it must be ingested

164
Q

Fruits, vegetables, spinach, and dairy products are all high in-

A

Potassium

165
Q

Hyperkalemia is high potassium over-

A

5.0 mEq/L

166
Q

Causes for Hyperkalemia include-

A

Decreased K+ Excretion & High K+ Intake

167
Q

Examples of decreased potassium excretion are-

A

Impaired excretion; Renal Failure
Meds = Potassium-Sparing Diuretics (K+ Retained)

High K+ Intake

168
Q

Examples of High K+ intake include-

A

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
Q

Hyperkalemia Manifestiations + Labs =

A

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
Q

Hyperkalemia Nursing Interventions =

A

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

Fundamentals 2 Exam 1 Flashcards (18 decks)

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