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Exam 1 NRS 202 > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Approximately __% of an adult is fluids (water and electrolyes)

A

60%

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2
Q

Intracellular fluid makes up how much of the bodys fluids?

A

2/3

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3
Q

Extracellular fluid makes up how much of the body’s fluids?

A

1/3

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4
Q

3 Types of ECF

A

Intravascular
Interstitial
Transcellular

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5
Q

Where is intravascular ECF found?

A

with blood vessels - aka plasma, erythrocytes, leukocytes, thrombocytes

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6
Q

Where is interstitial ECF found?

A

surrounding cells

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7
Q

Examples of transcellular fluid

A

CSF, pericardial fluid, and synovial fluid

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8
Q

Examples of interstitial ECF

A

lymph fluid

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9
Q

What are the major cations of the body?

A

Na+, K+, Ca++, Mg+, H+

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10
Q

What are the major anions of the body?

A

Cl-, Bicarb, Phosphate, Sulfate, and negatively charged protein ions

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11
Q

Gerontologic Considerations of Fluid and Electrolyte Imbalances

A

Subtle s/s
May cause delirium
Decreased cardiac reserve
Reduced renal function
Dehydration is common
Thin skin
Loss of strength and elasticity

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12
Q

FVE is AKA

A

hypervolemia

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13
Q

FVD is AKA

A

hypovolemia

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14
Q

Loss of water alone with increased serum sodium levels is?

A

Dehydration

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15
Q

Occurs when loss of ECF exceeds the intake ratio of water

A

hypovolemia (FVD)

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16
Q

Causes of hypovolemia (FVD)

A

Abnormal fluid losses (V/D/suction)
Decreased intake (N/lack of access)
3rd space fluid shifts (burns, ascites)
Diabetes insipidus
Adrenal insufficiency
Hemorrhage

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17
Q

Manifestations of FVD

A

Wt loss
Decreased skin turgor
Prolonged cap refill
Abnormal labs
Decreased BP
Tachycardia

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18
Q

What abnormal labs are seen in FVD?

A

Increased hemoglobin and hematocrit
Increased serum and urine osmolality and SG
Decreased urine sodium
Increased BUN/Cr

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19
Q

Medical management of FVD

A

Oral route preferred
IV for acute or severe losses

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20
Q

Nursing management of FVD

A

I&O at least every 8 hrs
Daily weights
VS
Assess Skin and tongue turgor
Assess Mental status
Admin of oral or IV fluids

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21
Q

Manifestations of FVE

A

Weight gain
Edema or ascites
Distended jugular veins
SOB and crackles
Increased BP
Cough
Increased RR
Increased output

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22
Q

What is the only solution that may be given with blood products?

A

0.9% NaCl

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23
Q

Solution that used to expand ECF

A

Isotonic

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24
Q

What type of solution is used to treat hypovolemia, resuscitative efforts, and shock?

A

Isotonic or hypertonic

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25
Examples of isotonic solutions
0.9% NaCl Lactated Ringers 5% dextrose in water
26
Example of hypotonic solution
0.45% NaCl
27
Examples of hypertonic solution
3% NaCl 5% NaCl IV Mannitol
28
A solution with same osmolality as blood
isotonic
29
A solution with a higher osmolality than bood
Hypertonic
30
A solution with a lower osmolality than blood
Hypotonic
31
A solution that contains particles that are nonsoluble and evenly distributed throughout the solution
Colloid
32
What is FVE secondary to?
to an increase in the total body sodium content
33
Expansion of ECF caused by abnormal retention of water and sodium in approx the same proportions in which they normally exist in the ECF
FVE or hypervolemia
34
Causes of FVE
Heart failure Kidney injury or failure Cirrhosis of liver Excessive salt intake
35
Do isotonic solutions move water?
No
36
How do hypotonic solutions effect water?
move water from ECF to ICF
37
How do hypertonic solutions effect water?
move water from ICF to ECF
38
What abnormal labs are seen in FVE?
Decreased hgb and hct Decreased serum and urine osmolality Decreased urine sodium and SG
39
Medical management of FVE
Pharm - diuretics Dialysis Nutrition - sodium restriction
40
Nursing management of FVE
I&Os Daily weight Assess lung sounds Assess edema Monitor response to diuretics and fluids Monitor sodium intake
41
Normal sodium range
135-145
42
Causes of hyponatremia
Loss of water by vomiting, diarrhea, sweating, diuretics, adrenal insufficiency, SIADH
43
Manifestations of hyponatremia
poor skin turgor dry mucosa headache decreased BP nausea abdominal cramping neuro changes - confusion, seizures
44
Management of hypnonatremia
Treat underlying condition Na+ replacement/dietary I & O Daily weights Monitor CNS changes Seizure precautions
45
Causes of hypernatremia
Fluid deprivation Excess sodium Diabetes insipidus Heat stroke Hypertonic IV solutions
46
Manifestations of hypernatremia
Increased thirst Hyperreflexia Elevated temp Seizures Swollen tongue Lethargy Irritability
47
Management of hypernatremia
Gradual lowering of sodium with diuretics Monitor CNS changes Assess sodium source or source of water loss
48
Normal range of potassium
3.5-5.0
49
Causes of hypokalemia
GI losses Medications Suctioning Hyperaldosteronism Poor dietary intake
50
Manifestations of hypokalemia
ECG changes dysrhythemias dilute urine excessive thirst fatigue muscle weakness paresthesia decreased bowels
51
What ECG changes are seen in hypokalemia?
flattened T waves, prominent U waves, ST depression, prolonged PR interval
52
Management of hypokalemia
Potassium replacement Monitor ECG changes Monitor aBGs Monitor patients taking digoxin for toxicity
53
When do you not administer potassium if your patient has hypokalemia?
If oliguria is present
54
Causes of hyperkalemia
impaired renal function rapid admin of K+ Hypoaldosteronism Medications Tissue trauma Acidosis
55
Manifestations of hyperkalemia
ECG changes Arrhythmias Muscles weakness Muscle cramps
56
What ECG changes are seen with hyperkalemia?
tall tented T waves, prolonged PR interval and QRS duration, absent P waves, ST depression
57
Management of hyperkalemia
Monitor ECG, heart rate, BP I & O Obtain apical pulse Limit K+ intake, educate pt
58
What is the emergent care for hyperkalemia?
IV calcium gluconate IV sodium bicarbonate IV regular insulin and hypertonic dextrose Dialysis Administer slowly w an infusion pump
59
Normal range of calcium
8.6-10.4
60
The serum calcium levels of the body are controlled by?
PTH and calcitonin
61
Causes of hypocalcemia
Hypoparathyroidism Malabsorption Osteoporosis Pancreatitis Meds Kidney injury
62
Manifestations of hypocalcemia
Tetany Numbness Paresthesias Trousseau sign Chvostek sign Seizures Respiratory issues
63
Management of hypocalcemia
IV calcium gluconate Seizure precautions Vit D supplements Exercise Educate pt r/t diet and medications
64
Causes of hypercalcemia
Malignancy and hyperparathyroidism Bone loss r/t immobility Diuretics
65
Manifestations of hypercalcemia
Polyuria Thirst Muscle weakness Nausea Abdominal cramps Constipation Diarrhea ECG changes Dysrhythmias
66
Management of hypercalcemia
Treat underlying cause (cancer) Admin IV fluids Meds - ferosemide, phosphate, calcitonin, bisphosphonates Increase mobility
67
Normal range of magnesium
1.8-2.6
68
Causes of hypomagesemia
alcoholism GI losses Enteral or parenteral feeding deficient in mag meds rapid admin of citrated blood
69
Manifestations of hypomagnesemia
apathy psychosis neuromuscular irritability ataxia insomnia confusion tremors ECG changes
70
Management of hypomagnesemia
Magnesium sulfate IV Monitor VS and urine output Monitor dysphagia Seizure precautions Diet - green, leafy veggies; beans, lentils, almonds, PB)
71
Causes of hypermagnesemia
kidney injury diabetic ketoacidosis excess magnesium extensive soft tissue injuries
72
Manifestations of hypermagnesemia
Hypoactive reflexes drowsiness muscle weakness depressed respirations ECG changes dysrhythmias Cardiac arrest
73
Management of hypermagnesemia
IV calcium gluconate Ventilatory support for resp depression Hemodialysis Loop diurectics Limit mag intake Monitor for LOC changes
74
Normal range of phosphates
2.7-4.5
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77
Causes of hypophosphatemia
Alcoholism Refeeding syndrome pain heat stroke respiratory alkalosis hyperventilation low mag low potassium meds
78
Manifestations of hypophosphatemia
Confusion Muscle weakness Tissue hypoxia Muscle and bone pain
79
What labs should be run with hypophosphatemia?
24-hr urine collection PTH (elevated) Vit D Calcium
80
Management of hypophosphatemia
Prevention is goal Phosphorus replacement Monitor IV site Monitor phosphorus, calcium, vit D Encourage foods high phosphorus
81
What foods are high in phosphorus?
milk organ meats beans nuts fish poultry
82
Causes of hyerphosphatemia
kidney injury excess phosphorus excess vit D acidosis hypoparathyroidism chemotherapy
83
Manifestations of hyperphosphatemia
soft tissue calcifications
84
Management of hyperphosphatemia
treat underlying disorder monitor labs avoid high-phosphorus foods patient education Vit D and calcium-binding antacids Loop diuretics Dialysis
85
Normal chloride range
97-107
86
Causes of hypochloremia
Addison disease Reduce chloride intake GI losses Excess sweating Fever
87
Manifestations of hypochloremia
agitation irritability weakness hyperexcitability of muscles dysrhythmias seizures coma
88
Management of hypochloremia
Replace chloride with 0.45% NS I&O ABG values Electrolyte values Asses for changes in LOC Educate about diet
89
Foods high in chloride
Tomato juice bananas eggs cheese milk
90
Causes of hyperchloremia
iatrogenically-induced
91
Manifestations of hyperchloremia
Tachypnea Lethargy weakness rapid, deep respirations HTN cognitive changes
92
Management of hyperchloremia
Treat underlying cause Hypertonic IV solutions I & O Assess resp, neuro, cardiac

Exam 1 NRS 202 (7 decks)

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