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HLSC 220 Pharmacotherapeutics for Health Professionals 💊 > Fluids and Electrolytes - Ch. 45 > Flashcards

Fluids and Electrolytes - Ch. 45 Flashcards

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1
Q

What are the 3 main components of total body water?

A

Intracellular fluid (ICF) 67%
Interstitial fluid (IF) 25%
Plasma volume (PV) 8%

IF + PV = ECF (33%)

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2
Q

What are the components of ECF?

A

Interstitial fluid
Blood (Plasma and cells)`

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3
Q

What determines the distribution of fluid in ECF?

A

Bulk flow
-Starling forces

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4
Q

What pressures need to be balanced during fluid balance?

A

Hydrostatic pressure, aka blood pressure
Colloid osmotic pressure due to plasma proteins

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5
Q

What is equal to maintain water balance?

A

Water intake = Water loss

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6
Q

What can occur when fluid is out of balance?

A

Edema
Dehydration
Fluid loss

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7
Q

Why are IV fluids administered?

A

Dehydration
Electrolyte imbalances
Blood component deficiencies
Nutrition

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8
Q

What are the types of IV fluids?

A

Crystalloids
Colloids
Blood and blood products

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9
Q

What are Crystalloids?

A

Solutions (contain water) with
-electrolytes (Na, K, Cl)
-small molecules (glucose, lactate)

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10
Q

Crystalloids DO NOT contain what?

A

Proteins/large molecules

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11
Q

Examples of crystalloids?

A

Normal saline
Hypertonic saline
Half normal saline
Lactated RInger (LR)
D5W
Normosol/Plasmalyte

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12
Q

Osmolarities of Normal saline?

A

Na 154
Cl 154
K 0

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13
Q

Osmolarities of Hypertonic saline?

A

Na 513
Cl 513
K 0

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14
Q

Osmolarities of Lactated Ringer (LR)?

A

Na 130
Cl 109
K 4

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15
Q

Osmolarities of D5W?

A

Na 0
Cl 0
K 1

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16
Q

What percentatge of sodium chloride is in each kind of saline?

A

Normal saline 0.9% NaCl
Half normal saline 0.45% NaCl
Hypertonic saline 3% NaCl

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17
Q

In what ways are crystalloids used as replacement/maintenance fluids?

A

Compensate for insensible fluid losses (eg, NS)
To replace fluids (eg NS)
To manage specific fluid and electrolyte disturbances (eg Ringer’s lactate)
Promote urinary flow (eg NS)
Expand plasma volume (eg 3% NaCl)

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18
Q

What indications require Crystalloids?

A

Acute liver failure
Acute nephrosis
Burns
Hypovolemic shock
Renal dialysis

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19
Q

Normal saline-based fluids (0.9% NaCl) are used with the administration of which products?

A

Blood cell products

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20
Q

What adverse effects are associated with Crystalloids?

A

Edema (Peripheral or pulmonary)
Dilute plasma proteins

-Short-lived effects, lots of other effects

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21
Q

How do crystalloids cause edema?

A

Fluid overload

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22
Q

How do colloids work?

A

Increase colloid osmotic pressure (COP)
-Move fluid from the interstitial compartment to the plasma compartment

Plasma volume expanders -restore BP

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23
Q

What do colloids initiate?

A

Diuresis
e.g, removal ascites in patients with portal hypertension

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24
Q

Examples of colloids?

A

Dextran 40 or 70
Hetastarch/hydroxyethyl starch (HES)
Modified gelatin
Albumin (human donors)

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25
What are Dextran 40 or 70?
BIG glucose polymers
26
What are Hetastarch/hydroxyethyl starch (HES)?
Synthetic and derived from cornstarch
27
What indications require colloids?
Trauma Burns Sepsis Hypovolaemic shock
28
What do colloids contain that crystalloids do not?
Proteins/large molecules
29
What fluids are more expensive, crystalloids or colloids?
Colloids
30
What adverse effects are associated with colloids?
They are usually safe -some concerns in renal failure
31
What disadvantages are associated with colloids?
May cause altered coagulation -bleeding No oxygen-carrying capacity
32
What are the most expensive and least available fluids?
Blood and blood products -require human donors
33
What are some examples of blood/blood product fluids?
Whole blood RBC products carry oxygen Increase the supply of various products e.g, clotting factors from plasma Platelets
34
What are packed RBCs and whole blood used for?
Increase oxygen-carrying capacity -anemia -substantial hemoglobin deficits -blood loss >25% of Total blood volume
35
What is fresh frozen plasma (FFP) used for?
Increase clotting factor levels in clients with demonstrated deficiency = coagulation disorders e.g, disseminated intravascular coagulation (DIC)
36
What are cryoprecipitate and plasma protein factors (PPF) used for?
Fibrinogen, Factor VIII, prothrombin complex concentrates
37
What adverse effects are associated with blood products?
Transfusion reaction -Blood type, cross-match Transmission of pathogens to the recipient -Hepatitis B and C, HIV
38
What should you do to ensure client care when administering IV fluids?
Administer colloids slowly Monitor for fluid overload and possible heart failure Monitor closely for signs of transfusion reactions
39
Advantages of crystalloids?
Few side-effects Low cost Wide availability
40
Disadvantages of crystalloids?
Short duration of action May cause edema
41
Advantages of colloids?
Longer duration of action Less fluid is required to correct hypovolaemia
42
Disadvantages of colloids?
Higher cost May cause volume overload May interfere with clotting Risk of anaphylactic reactions
43
What are the principal ECF electrolytes?
Sodium Chloride
44
What is the principle ICF electrolyte?
Potassium
45
What is potassium responsible for?
Skeletal muscle contraction Transmission of nerve impulses Regulation of heartbeat Maintenance of acid-base balance
46
What is the most abundant positively charged electrolyte inside cells?
Potassium
47
What percentage of the body's potassium is intracellular?
95%
48
What is the normal potassium concentration in ECF?
3.5 to 5mmol/L
49
What electrolyte levels are critical to normal body function?
Potassium
50
What is a way potassium is obtained?
Dietary aka via Food -Fruit, fish, vegetables, poultry, meats, dairy products
51
How is excess dietary potassium excreted?
Via kidneys
52
Impaired kidney function can lead to what in regards to potassium levels?
Higher serum levels and possibly toxicity
53
What is the name for a deficiency of potassium?
Hypokalemia
54
What is the potassium concentration that is considered hypokalemia?
<3.5 mmol/L
55
What is hypokalemia?
Excessive potassium loss -Not poor dietary intake
56
What can cause hypokalemia?
**Loop and thiazide diuretics **Vomiting **Diarrhea Malabsorption Large amounts of real black licorice Alkalosis Glucocorticoids Crash diets Ketoacidosis
57
What are some symptoms of hypokalemia?
Muscle weakness or lethargy Cardiac dysrhythmias (irregular pulse) Paralytic ileus (decreased bowel motility)
58
Oral preparations of potassium can cause what adverse effects?
Diarrhea, nausea, vomiting, GI bleeding, ulceration
59
IV administration of potassium can cause what adverse effects?
Pain at the injection site Phlebitis
60
Excessive potassium administration can cause what condition?
Hyperkalemia
61
What is the concentration of potassium that is considered hyperkalemic?
>5 mmol/L
62
What can cause hyperkalemia?
**Potassium-sparing diuretics Supplements ACE inhibitors Renal failure Loss from cells Burns Trauma Metabolic acidosis Addison's disease (Hypoaldosteronism)
63
What are some symptoms of hyperkalemia?
Cardiac rhythm irregularities -Possible Vfib and cardiac arrest Muscle weakness, paralysis Paresthesia (tingling)
64
How is hyperkalemia treated?
IV sodium bicarbonate calcium salts dextrose with insulin sodium polystyrene sulfonate (kayexalate) Hemodialysis to remove excess
65
What kind of infusions need to be monitored very closely?
Parenteral infusions of potassium
66
What should the rate of parenteral potassium infusions be?
Never exceed 10 mmol/hour
67
You should never give potassium as what?
IV bolus or undiluted
68
Oral forms of potassium must be?
Diluted in water/juice to minimize GI irritation -Monitor for nausea, vomiting, GI pain or bleeding
69
What is the most abundant positively charged electrolyte outside cells?
Sodium
70
What is the normal concentration of sodium outside cells?
135 to 145 mmol/L
71
What foods provide the dietary intake of sodium chloride?
Salt, fish, meats, foods flavoured/preserved with salt
72
What is sodium responsible for?
Control of water distribution Fluid and electrolyte balance Osmotic pressure of body fluids Participates in acid-base balance
73
What is hyponatremia?
Sodium loss or deficiency
74
What concentration or serum level is considered hyponatremic?
<135 mmol/L
75
What are some symptoms of hyponatremia?
Lethargy Stomach cramps Hypotension Vomiting diarrhea seizures
76
What causes hyponatremia?
Same causes as hypokalemia Prolonged diarrhea or vomiting renal disorders
77
What is an excess of sodium called?
Hypernatremia
78
What concentration of sodium is considered hypernatremic?
>145 mmol/L
79
What are some symtpoms of hypernatremia?
Edema, hypertension Red, flushed skin dry, sticky mucous membranes Increased thirst Elevated temperature Decreased urine output
80
What causes hypernatremia?
Kidney malfunction Inadequate water consumption and dehydration
81
How is mild sodium depletion treated?
Oral sodium chloride and/or fluid restriction
82
How is severe sodium depletion treated?
IV normal saline or lactated Ringer's solution
83
What adverse effects are associated with the oral administration of sodium?
Nausea Vomiting Cramps
84
What adverse effects are associated with IV administration of sodium?
Venous phlebitis
85
What should you do to ensure client care when administering electrolytes?
Monitor serum electrolyte levels during therapy Monitor infusion rate, appearance of fluid or solution, infusion site Observe for infiltration, other complications of IV therapy
86
How does a nurse monitor for a therapeutic response?
Check for normal lab values -RBCs, WBC, Hgb and Hct, electrolyte levels Improved fluid volume status Increased tolerance to activities Monitor for adverse effects

HLSC 220 Pharmacotherapeutics for Health Professionals 💊 (31 decks)

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