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Pathophysiology > Fluids and Electrolytes- T2 > Flashcards

Fluids and Electrolytes- T2 Flashcards

1
Q

intracellular fluids

A

fluids WITHIN cells

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2
Q

extracellular fluids

A

fluid OUTSIDE of cells

-interstitual and plasma

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3
Q

electrolytes

A

substances that dissociate in a solution to form a charged particle

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4
Q

ions

A

are the charged particles

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5
Q

non-electrolytes

A

substances that do not dissociate into charged particles

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6
Q

magnesium

A

1.3-2.1 mg/dL

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7
Q

potassium

A

3.5-5.0 mEq/L

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8
Q

calcium

A

8.5-10.0

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9
Q

bicarbonate

A

24-31

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10
Q

chloride

A

98-106

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11
Q

sodium

A

135-145

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12
Q

what are capillaries?

A

the smallest diameter vessels connecting the arterial to the venoul

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13
Q

what do the lymph channel do?

A

take some fluids and substances that are pushed out

- can get obstructed

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14
Q

hydrostatic pressure

A

pushing force exerted by a fluid (pushing it out)

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15
Q

arterial capillary pressure (hydrostatic pressure)

A

about 30 mmHg and venous 10

  • in relationship to BP
  • normal BP 120/80
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16
Q

interstitual fluid (in hydrostatic pressure)

A

may have negative hydrostatic pressure of about (-3mm) which contributes to outward movement of fluid from capillary

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17
Q

colloidal (protein) osmotic pressure

A

pulling force of plasma proteins that cannot pass thru the capillary membrane (pulling back into blood vessels)
-assist the movement of fluid back into the capillary

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18
Q

intracellular fluids

A

contained in all body cells, including blood cells

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19
Q

extracellular fluid

A

contained in the vascular system (blood plasma) and fluid contained in the interstitial spaces

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20
Q

third spacing

A

-abnormal
fluid trapped in one of several possible transcellular spaces
- this fluid is not available for ECF or ICF uses since its trapped or “sequestered”

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21
Q

osmosis

A

movement of water from an area of LOWER concentration –> to area of HIGHER concentration of solutes (electrolytes)

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22
Q

osmolarity of fluids

A

has many clinical implications, thus it’s an important concept

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23
Q

osmolarity of blood plasma (serum)

A

determined largely by the amount of sodium (Na+) contained in the plasma
- a pt with elevated serum Na+ will have serum

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24
Q

gains

A

main source normally is oral intake

-metabolism of nutrients supplies an additional small amount of H2O

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25
Q

losses

A

urine output, perspiration, lungs

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26
Q

normal homeostatic

A

thirst, increased or decreased secretion of ADH

- increase and decrease urine output

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27
Q

kidneys

A

major source of water loss (urine)

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28
Q

obligatory urine output

A

300-500ml/ 24 hrs for an adult (hourly urine output may need to be carefully assessed)

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29
Q

skin (water loss)

A

normal perspiration (may be “insensible”)

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30
Q

abnormal for water loss in skin

A

diaphoresis (“drenched in sweat”)

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31
Q

lungs (water loss)

A

normal breathing is another source of insensible water loss

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32
Q

abnormal water loss for lungs

A
  • pneumonia

- breathing more rapidly –> more water loss

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33
Q

thirst

A
  • homeostasis mechanism

- considered potential problems, such as babies, small child, elderly unable to ask or drink

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34
Q

hypodipsia

A

a disorder causing loss of ability to sense thirst

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35
Q

urine

A
  • homeostasis mechanism
  • increased or decreased output; specific gravity changes
  • determine based on color (normal: yellow-amber)
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36
Q

hormones

A
  • homeostasis

- ADH changes (from pituitary)

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37
Q

abnormal states of hydration

A

normally both fluid and osmolarity is in physiological balance

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38
Q

fluid volume deficit

A

dehydration

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39
Q

isotonic

A

equal loss of water and sodium

- common cause: vomiting, diarrhea, misuse of diuretics

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40
Q

medical presciption (Rx) for isotonic volume deficit

A

IV fluid replacement with isotonic (0.9% saline)

-aka normal saline

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41
Q

hypertonic

A

more water loss than sodium

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42
Q

causes of hypertonic

A
  • osmotic diuresis
  • excessive sweating
  • loss of thirst sensation
  • being unable to obtain or drink fluids
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43
Q

Rx for hypertoninc

A

drinking plain water or IV of Dextrose 5% in Water (D-%-W)

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44
Q

hypotonic fluid volume deficit

A

more Na+ is lost than water

-serum Na+ is low

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45
Q

what is the cause for hypotonic?

A
  • excess renal losses of Na+

- aldosterone deficiency (aldosterone “saves” or retains Na+)

46
Q

Rx for hypotonic

A
  • if mild, IV of 0.9 saline (normal saline)

- if severe, a 3% solution of sodium might be ordered

47
Q

signs of fluid volume deficit

A
  • dry skin and mucous membranes, such as the tongue; poor skin turgor
  • decreased urine output; “concentrated”
  • in babies, a depressed fontanel (soft spot on top of head); eyes may also appear “sunken”
  • BP may decrease, with heart rate increasing
48
Q

what can inadequate kidney perfusion(blood flow to kidneys) lead to?

A

result in acute renal failure

49
Q

how can acute renal failure be prevented?

A

need fluid replacement and adequate fluid amount if in deficient to prevent kidney from being loss or damage

50
Q

first thing to do to avoid acute renal failure?

A

RECOGNITION

-then treatment with IV fluids or blood (if blood was loss)

51
Q

fluid overload

A

when kidney is already damage bc kidney not able to process blood going thru it

52
Q

what are the causes of fluid volume overload?

A
  • impaired KIDNEY function –> decreased output of urine
  • HEART failure or cardiac insufficiency
  • excessive intake of water and sodium
  • fluid retention related to (R/T) stress response
53
Q

S/S of Fluid Volume Excess

A
  • acute weight gain: result from not cleaning out fluids
  • increase BP result to increase vascular volume
  • strong “bonding” pulse
  • possible SOB
  • possible jugular venous distention (JVD)
  • edema
54
Q

hematocrit

A

a blood test that shows the % or proportion of RBC to the plasma (fluid)

55
Q

hematocrit (male)

A

40-50%

56
Q

hematocrit (female)

A

37-47%

57
Q

in patient with dehydration (fluid volume deficit), HCT is increased bc…

A

less plasma and fluids to the number of cells –> which HCT higher

58
Q

urine specific gravity

A

a lab test that measures the density (weight) of urine, compared to the density of water, which is 1.000

59
Q

normal range for urine specific gravity

A

1.010-1.025

60
Q

low specific gravity vs high specific gravity

A
  • low specific gravity is seen in DILUTED urine

- high specific gravity is seen in concentrated urine sample (cause: dehydration)

61
Q

what happens if glucose or protein is in urine?

A

specific gravity will be elevated because these elements increase the density of urine

62
Q

urine osmolality

A

reflects the kidney;s ability to produce a concentrated or dilute urine based on serum omolarity and the need for water conservation or excretion

63
Q

furosemide (lasik)

A
  • a drug to decrease fluid volume
  • a loop diurertic (works in the Loop of Henle in the kidneys)
  • pulls excess water (esp in heart failure)
64
Q

hydrochlorothiazide (HCTZ)

A
  • a drug to decrease fluid volume
  • a thiazide diuretic
  • a kind of diuretic to decrease fluid volume and start in people with hypertension
65
Q

spironolactone (aldactone)

A
  • a drug that decreases fluid volume
  • an aldosterone receptor antagonist (use with minor hypertension)
  • POTASSIUM SPARING
  • doesnt lose as much fluids
66
Q

causes of edema

A
  • increase hydrostatic pressure
  • increase capillary permeability
  • lymphatic channel obstruction
67
Q

lowered plasma oncotic pressure (due to decreased plasma proteins -albumin)

A

causes edema

68
Q

lasix (furesomide)- mechanism of action

A

acts in ascending loop of henle to block sodium and chloride reabsorption –> causing profound diuretics

69
Q

route of lasix

A

given orally, IV, and occasinally IM

  • action begins within 60 min when given orally
  • 5 min when given IV
70
Q

When do you give lasix?

A

given for pulmonary edema, CHF, cardiac and other edemas unresponsive to less powerful diuretics
- may be combined with THIAZIDE DIURETICS

71
Q

What is furosemide inteaction?

A

digoxin induced dysryththmias when hypokalemia is present

-ototoxity is increased with other ototoxic drugs such as aminoglycosides

72
Q

thiazide diuretics-mechanism of action

A

blocks reabsorption of sodium and chloride in distal convoluted tubule
-produces much less loss of urine than lasix and adequate urine function must be present

73
Q

thiazide diuretics indication

A

essential hypertension, edema of mild to moderate heart failure

74
Q

potassium sparing diuretics

A
  • spironolactone (aldactone)

- useful for blocking loss of potassium when pt also on lasix

75
Q

potassium sparing diuretics -mechanism of action

A
  • blocks the action of aldosterone in the distal nephron

- promotes sodium uptake in exchange for potassium secretion (not as much diuresis as thiazides)

76
Q

potassium sparing diuretics- indication

A

hypertension and edema

77
Q

potassium sparing diuretics- adverse effects

A

hyperkalemia (give insulin to lower potassium)

78
Q

potassium sparing diuretics- patient education

A

NEVER use salt substitutes when using aldactone

79
Q

why should diuretics be closer to the glomerulus?

A

the better and stronger they are

80
Q

isotonic dehydration

A

the situation in which sodium and water are lost in isotonic proportions

81
Q

cause of isotonic dehydratoin

A

severe vomiting and diarrhea, kidney disease, and overuse of diuretics
-use isotonic fluids to replace volume

82
Q

is tap water isotonic?

A

only use tap water when its mild dehydration

83
Q

is distilled water isotonic?

A

distilled water has nothing in it so it’s better to use tap water

84
Q

is salt water isotonic?

A

salt water has increased sodium sp NO

85
Q

drugs that can cause sodium hyponatremia

A
  • diuretics (loses sodium)
  • some antineoplastics
  • some antipsychotics
  • sedatives such as barbiturates and morphines
86
Q

diagnosis of sodium hyponatremia

A
  • lab values: serum sodium level < 135 mEq/L
  • pt volume’s status
  • presence of s/s
  • serum osmolarity for hyponatremia:<280 mOsm/kg
  • urine specific gravity: < 1.010
  • increase urine SG and urine sodium in SIADH
  • decreased HCT and plasma proteins
87
Q

treatment for sodium hyponatremia

A
  • treat the underlying cause
  • hyponatremia is caused by water excess-treat with fluid restriction
  • oral or IV administration of saline solution if sodium deficiency present, also salt supplements or high sodium foods (#1 cause is diuretics so you would need to cut back)
  • severe hyponatremia (<110 mEq/L and seizures)-hypertonic (3% or 5%) saline solution
  • be careful with hypertonic solution which can cause shifting of water out of brain cells and brain damage
88
Q

diagnosis of sodium hyperatremia

A
  • history, physical exam, and lab results
  • serum sodium: >145
  • urine specific gravity: > 1.030 except in diabetes insipidus where it is low
  • serum osmolality: > 300m Osm/Kg
89
Q

treatment for sodium HYPERatremia

A
  • address underlying problem
  • careful replacement of fluids: orally or IV
  • fluids should be given gradually to avoid cerebral edema
90
Q

dietary sources of potassium

A
  • fruits, oranges, bananas, apricots, and cantaloupe
  • meats
  • veggies, potatoes, mushroom, tomatoes, and carrots
  • dried fruits, nuts and seeds
  • chocolate
91
Q

treatment for potassium HYPOkalemia

A
  • replacement with potassium-containing foods when appropriate
  • replacement with oral supplements or IV
92
Q

medications for potassium hypokalemia

A
  • K dur (oral)

- IV potassium chloride

93
Q

potassium

A
  • indications: use for potassium deficiency/ replacement to prevent losses
  • can be given IV and oral
  • MUST be diluted when giving IV or will always cause death
  • NEVER push potassium IV, must be given by IV fushion
  • dilute liquid potassium in orange juice or a juice of hte pt’s choice to disguise bitter taste
94
Q

potassium hyperkalemia

A

potassium > 5.0 mEq/L

normal: 3.5-5.0 mEq/L

95
Q

sodium HYPERnatremia

A

sodium > 145 mEq/L

normal: 135-145

96
Q

sodium HYPOatremia

A

sodium <135 mEq/L

normal: 135-145

97
Q

treatment for potassium HYPERkalemia

A

holds potassium-containing food and potassium-sparing medications

98
Q

potassium hyperkalemia medication

A
  • sodium polystyrene (kayexalate)

- combination of glucose and insulin (calcium gluconate)

99
Q

what do you give to pt with severe potasssium hyperkalemia?

A

hemodialysis may be indicated for pt with renal failure

100
Q

calcium HYPOcalcemia

A

calcium <8.0 mg/dL

normal: 8.0-10.5 mg/dL

101
Q

calcium hypocalcemia treatments (meds)

A
  • calcium IV and meds
  • calcium chloride
  • calcium gluconate
102
Q

calcium HYPERcalcemia

A

calcium > 10.5 mg/dL

normal: 8.0-10.5 mg/dL

103
Q

calcium hypercalcemia treatment

A
  • correct underlying cause of serum calcium excess

- promote urinary excretion of calcium

104
Q

calcium HYPERcalcemia meds

A

calcitonin (comes from thyroid)

105
Q

magnesium hypomagesemia

A

< 1.8 mg/dL

normal: 1.8-3.0 mg/dL

106
Q

magnesium hypomagnesemia treatment

A
  • replacement with magnesium

- medication/ route of administration depends on severity of deficiency

107
Q

magnesium hypomagnesemia- meds

A
  • magnesium hydroxide (milk of magnesia)

- magnesium sulfate

108
Q

magnesium hypermagesemia

A

magnesium > 3.0

normal: 1.8-3.0

109
Q

magnesium hypermagesemia- treatment

A
  • cessation of Mg adminstration

- administration of calcium

110
Q

serum calcium

A

8.0-10.5 mg/dL

111
Q

plasma protein (albumin)

A

3.4-4.7 g/dL

Pathophysiology (4 decks)

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