FLUIDS AND ELECTROLYTES Flashcards by SHRIENLEY KATE CRISOSTOMO

Major element in blood plasma that is used to transport nutrients, oxygen, and electrolytes throughout the body.

Fluid

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Total Body Water (TBW%)
Intracellular Fluid (ICF)
Extracellular Fluid (ECF)

INFANTS

TBW - 75
ICF - 45
ECF - 30

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Total Body Water (TBW%)
Intracellular Fluid (ICF)
Extracellular Fluid (ECF)

ADULT MALE

TBW - 60
ICF - 40
ECF - 20

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Intracellular FluidTotal Body Water (TBW%)
Intermediate Care Facility (ICF)
Extracellular Fluid (ECF)

ADULT FEMALE

TBW - 50
ICF - 35
ECF - 15

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FLUID
COMPARTMENTS

Intracellular fluids
extracellular fluids

extracellular - interstitial fluid and plasma (intravascular fluid)

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Fluid not lost in the body but
unavailable for use by either
ICF/ECF

occurs when too much fluid moves from the intravascular space (blood ve

3RD SPACE SHIFTING

Third-spacing

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Manifested by decrease in
urine output despite fluid
intake, edema, JVD

3RD SPACE SHIFTING

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ELECTROLYTES

MAJOR IONS

Sodium (Na+)
Potassium (K+)
Calsium (Ca2+)
Magnesium (Mg2+)
Chloride (Cl-)
Phosphate (HPO4-)

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ELECTROLYTES

Location (ICF and ECF)
-mEq/L

Sodium (Na+)
Potassium (K+)
Calsium (Ca2+)
Magnesium (Mg2+)
Chloride (Cl-)
Phosphate (HPO4-)

12; 145
150; 4
5; <1
40; 2
103; 4
4; 75

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Type of diffusion specifically for water molecules moving across a semi-permeable membrane

ADDITIONAL INFO

Osmosis

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Movement of molecules from an area of high concentration to an area of lower concentration

ADDITIONAL INFO

Diffusion

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TONICITY

Isotonic - water in and out of blood cell; has similar concentration of fluid (blood shape maintained)
Hypotonic - water out; has a lower concentration of fluid (blood shape balloon)
Hypertonic - water in; has a higher concentration of fluid (blood shape flat/shrinked)

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OSMOTIC FORCES

OSMOTIC PRESSURE
ONCOTIC PRESSURE
OSMOTIC DIURESIS

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amount of hydrostatic pressure needed to stop the flow of water by
osmosis (concentration of solutes)

OSMOTIC PRESSURE

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osmotic pressure exerted by proteins (albumin)

ONCOTIC PRESSURE

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increase in urine output caused by excretion of substances (glucose,
mannitol, contrast agents)

OSMOTIC DIURESIS

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TRANSPORT MECHANISMS

Filtration

K+ in (cytoplasm) Na+ out ECF

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AVERAGE INTAKE

(mL)

oral liquids - 1300
water in food - 1k
water produced by metab- 300
total gain = 2600

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AVERAGE OUTPUT

(mL)

urine - 1500
stool - 200
insensible lungs - 300
insensible skin - 600
total loss = 2600

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State of equilibrium in the
body with respect to
functions and composition
of fluids and tissues

HOMEOSTASIS

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HOMEOSTASIS

involves

Kidneys
Lungs
Heart
Adrenal Glands
Parathyroid glands
Pituitary glands

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regulates ECF volume and osmolality by retention and excretion of fluids

FLUID CYCLE

Kidneys

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Regulation of electrolyte levels

FLUID CYCLE

Kidneys

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Regulation of pH of the ECF by retention of hydrogen ions

FLUID CYCLE

Kidneys

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Excretion of metabolic wastes | FLUID CYCLE

Kidneys

Pumps blood with sufficient pressure to allow urine formation | FLUID CYCLE

Heart

Hypothalamus makes ADH > stored and released by pituitary gland (posterior) to conserve water | FLUID CYCLE

Pituitary Gland

Maintains acid-base balance and exhalation of moisture | FLUID CYCLE

Lungs

Secretes aldosterone (zona glomerulosa) in the cortex to retain sodium and lose potassium | FLUID CYCLE

Adrenal Gland

Regulates calcium and phosphate | FLUID CYCLE

Parathyroid Gland

SNS (constricts arterioles) and PNS (dilates arterioles) neural activities | FLUID CYCLE (others)

Baroreceptors

Thirst center in the hypothalamus from intracellular dehydration | FLUID CYCLE (others)

Thirst

FLUID CYCLE (others)

RAAS and ANP

secreted by the Juxtaglomerular Apparatus [JGA] when: 1. JGA detects a drop in afferent arteriole pressure [reduced stretch] 2. Macula Densa – detects low Na+ concentration in the filtrate | RAAS MECHANISM

Renin

protein the blood produced by the liver | RAAS MECHANISM

Angiotensinogen

proteolytic enzyme in capillary beds | RAAS MECHANISM

Angiotensin-converting Enzyme

Hormone that causes VASOCONSTRICTION | RAAS MECHANISM

Angiotensin II

Increases the rate of ALDOSTERONE, sensation of THIRST, SALT APPETITE and ADH secretion | RAAS MECHANISM

Angiotensin II

Released by adrenal gland and goes to the DCT and Collecting Ducts | RAAS MECHANISM

ALDOSTERONE

Increase carrier proteins for Na+ | RAAS MECHANISM

ALDOSTERONE

Also known as vasopressin | RAAS MECHANISM

Anti-Diuretic Hormone [ADH]

Released from posterior pituitary | RAAS MECHANISM

Anti-Diuretic Hormone [ADH]

When blood osmolality increases or when blood pressure declines, ADH is secreted to reabsorb water | RAAS MECHANISM

Anti-Diuretic Hormone [ADH]

promotes aquaporin molecule insertion | RAAS MECHANISM

Anti-Diuretic Hormone [ADH]

# [](http://)[](http://) Secreted from cardiac muscles | CHECKS AND BALANCE

ATRIAL NATRIURETIC HORMONE [ANH]

Inhibits Na+ reabsorption and ADH secretion | CHECKS AND BALANCE

ATRIAL NATRIURETIC HORMONE [ANH]

Resulting to increased volume of urine and lowers blood volume and BP | CHECKS AND BALANCE

ATRIAL NATRIURETIC HORMONE [ANH]

Also called fluid volume deficit | FLUID VOLUME ALTERATIONS

HYPOVOLEMIA

Not simply dehydration = loss of water with increased serum sodium levels | FLUID VOLUME

HYPOVOLEMIA

Occurs when loss of ECF volume exceeds the intake of fluid, serum electrolytes essentially are unchanged | FLUID VOLUME

HYPOVOLEMIA

HYPOVOLEMIA CAUSES | FLUID VOLUME

Vomiting Diarrhea GI Suctioning Decreased Fluid intake Third Space fluid shift Diseases

HYPOVOLEMIA MANIFESTATIONS | FLUID VOLUME

Weight Loss, acute Decreased skin turgor Oliguria Weak, rapid HR Flattened neck veins Increased temp Thirst Delayed CRT Cool, clammy pale skin Lassitude Muscle weakness Cramps BUN:Crea Ratio = greater than 20:1 Elevated Hematocrit

Nursing Management to HYPOVOLEMIA | FLUID VOLUME

1. Measure I&O q8hrs/ q1 2. Daily body weight checking (1L = 1kg) 3. V/S 4. Tissue turgor (pinch the skin over sternum, inner aspects of thigh or forehead) 5. Tongue turgor (not affected by age) 6. Monitor labs esp, urine concentration and electrolyte values (should be greater than 1.020 good renal conservation of fluid) 7. Mental function monitoring 8. Frequent mouth care

Medical Management to HYPOVOLEMIA | FLUID VOLUME

GOAL: CORRECT FLUID LOSS 1. If deficit is not severe, oral route is preferred 2. If severe, IV route is preferred 3. Rate of fluid administration is based on severity of loss and hemodynamic responses

Also called Fluid Volume Excess | FLUID VOLUME

HYPERVOLEMIA

Isotonic expansion of the ECF by abnormal retention of water and sodium | FLUID VOLUME

HYPERVOLEMIA

CAUSES Heart failure Renal failure Liver cirrhosis Excessive IVFs | FLUID VOLUME

HYPERVOLEMIA

HYPERVOLEMIA MANIFESTATIONS | FLUID VOLUME

Edema Distended neck veins Crackles Tachycardia Increased BP, CVP and Pulse Pressure Increased weight Increased U/O SOB/ Wheezing

NURSING MANAGEMENT to HYPERVOLEMIA | FLUID VOLUME

Monitor I&O Weight daily Monitor breath sounds Monitor degree of edema Diet: Sodium restriction as prescribed Avoid OTC medications Maintain regular rest periods Regular position change/turning

PITTING EDEMA - HYPERVOLEMIA | FLUID VOLUME

0+ no pitting edema; 0 mm 1+ Mild; 2 mm depression disapears rapidly 2+ moderate; 4 mm depression disapears 10-15 sec. 3+ moderatley severe; 6 mm depression last more than 1 minute 4+ severe; 8 mm depression last more than 2 minute

MEDICAL MANAGEMENT to HYPERVOLEMIA | FLUID VOLUME

1. Discontinue excessive sodium-containing fluids 2. Administer diuretics as prescribed 3. Restrict sodium and fluids as prescribed 4. Dialysis if with severe renal impairment

Block sodium retention in the distal tubule * HydroDIURIL, Cotrazid, Hydrax, Hydrochlorothiazide (HCTZ) | SIDEBAR: DIURETICS

THIAZIDE

Block sodium reabsorption in the ascending * Furosemide (Lasix), Bumetanide, Torsemide | SIDEBAR: DIURETICS

LOHLOOP

LABORATORY VALUES | ELECTROLYTE - NORMAL VALUE ## Footnote under ELECTROLYTE IMBALANCE

Calcium (total) = 8.6-10.2 mg/dL Chloride = 96-106 mEq/L Magnesium = 1.5-2.5 mEq/L Phosphorus = 2.4-4.4 mg/dL Potassium = 3.5-5.0 mEq/L Sodium = 135-145 mEq/L

Blocks retention at the last distal tubule * Spironolactone (Aldactone) | SIDEBAR: DIURETICS

K-SPARING

ELECTROLYTES | MAJOR CATION

Sodium Potassium Calcium Magnesium

ELECTROLYTES | MAJOR ANION

Chloride Cl Bicarbonate HCO3 Phosphate HPO4 Protein

LOCATIONS (ELECTROLYTES) | INTRACELLULAR

POTASSIUM MAGNESIUM PHOSPHATE

LOCATIONS (ELECTROLYTES) | OUT [EXTRACELLULAR]

SODIUM CALCIUM CHLORIDE

Contributing Factors: Loss of sodium, use of diuretics, loss of GI fluids, renal disease, SIADH, medications, psychogenic polydipsia | SODIUM

HYPONATREMIA

Manifestations: N&V, headache, lethargy, dizziness, muscle cramps, muscular twitching, seizures | SODIUM

HYPONATREMIA

Labs: Decreased serum and urine sodium, decreased urine spec. gravity | SODIUM

HYPONATREMIA

Contributing Factors: Water deprivation, hypertonic tube feedings, DI, heatstroke, hyperventilation, diarrhea, burns, diaphoresis, salt-water drowning | SODIUM

HYPERNATREMIA

Manifestations: Thirst, elevated body temp, swollen, dry tongue, lethargy, seizures, hyperreflexia | SODIUM

HYPERNATREMIA

Labs: Increase serum, decreased urine sodium, increased urine spec gravity, decreased CVP | SODIUM

HYPERNATREMIA

HYPONATREMIA MGT | SODIUM

1. Administration of sodium by mouth, NGT or parentera 2. PLR or PNSS may be prescribed (Overcorrected ( more than 140 mEq/L) may cause symmetric myelin destruction causing paraparesis, dysarthria, dysphagia or coma ) 3. Highly hypertonic sodium (2-3%) should be administered only in the ICU 4. Water restriction (800mL in 24 hours) 5. IV conivaptan HcL (Vaprisol) – stimulates free water excretion

Most commonly caused by fluid deprivation in unconscious patients | SODIUM

Hypernatremia

1. Infusion of hypotonic solutions (0.3%) or isotonic solutions 2. Rapid decrease in sodium may lead to cerebral edema 3. Desmopressin, antidiuretic hormone, can be given is with Diabetes insipidus | SODIUM

Hypernatremia

NURSING MGT | Hypernatremia ## Footnote SODIUM

1. Monitor electrolyte values and progression of symptoms 2. Monitor I&O carefully 3. Monitor for behavior changes 4. Obtain medical and pharmacological history 5. Weight daily

Contributing Factors: Diarrhea, vomiting, gastric suction, steroid administration, bulimia, alkalosis, starvation, diuretics, digoxin toxicity | POTASSIUM

HYPOKALEMIA

Manifestations: Fatigue, anorexia, N&V, muscle weakness, polyuria, decrease bowel motility, ventricular asystole/ fibrillation, ileus, | POTASSIUM

HYPOKALEMIA

Labs: ECG: flattened T waves, prominent U waves, ST depression, prolonged PR Interval | POTASSIUM

HYPOKALEMIA

Contributing Factors: Oliguric renal failure, use of K- conserving diuretics, metabolic acidosis, burns, crush injury, stored bank blood transfusions, rapid IV adm of K, medications | POTASSIUM

HYPERKALEMIA

Manifestations: Muscle weakness, tachycardia > bradycardia, dysrhythmias, flaccid paralysis, irritability, paresthesia | POTASSIUM

HYPERKALEMIA

Labs: ECG: tall tented T waves, prolonged PR interval and QRS duration, absent P waves, ST depression | POTASSIUM

HYPERKALEMIA

98% of the this is inside the cells

POTASSIUM

Affects neuromuscular, skeletal and cardiac muscle activity

POTASSIUM

80% of the potassium is excreted by way of

kidneys

patients with persistent insulin hypersecretion may experience?

hypokalemia (TPN)

can produce small bowel lesions

oral potassium

MGT (HYPOKALEMIA)

Replace potassium in the body and resolve underlying cause IV potassium supplements given only after the patient voids POTASSIUM IS NEVER GIVEN VIA IV PUSH

MGT (HYPERKALEMIA)

Dietary limits of potassium Discontinue potassium losing diuretics Kayexalate [exchange resin] Administer glucose and insulin Severe levels, adm IV calcium gluconate, sodium bicarbonate

| CALCIUM

FLUIDS AND ELECTROLYTES Flashcards

(96 cards)