iv fluid and electrolytes

Question 1

central venous access devices (CVADs)

Answer 1

catheters placed in large blood vessels of ppl who need freq or special access to the vascular system

Question 2

hydrostatic pressure

Answer 2

pressure pushing out of cell

Question 3

oncotic pressure

Answer 3

pressure keeping fluids in cells

Question 4

hypertonic solution
- what kind of fluids?

Answer 4

solution that has higher osmolality than plasma, draws water out of cell
–> D5.45, D5.9, D5LR, 3% Sodium

Question 5

hypotonic solutions
–> what kind of fluids?

Answer 5

solution with an osmolality lower than plasma, pulls fluid back into cells
–> 0.45, 0.33, 0.22, D5W

Question 6

isotonic solutions
–> what kind of fluids?

Answer 6

solution with osmolality the same as plasma, will cause no fluid change
–> LR, 0.9 NS

Question 7

osmolality

Answer 7

measure number milliosmoles/kg of water

Question 8

what is the most common fluid and electrolyte disorder ?

Answer 8

dehydration

Question 9

body water % for infant, adult, elderly?

Answer 9

infant = 75%
adult = 60%
elderly = 55%

Question 10

osmosis

Answer 10

diffusion of water across a semipermeable membrane

Question 11

explain why there are fluid movement changes at the capillary arterial/venous end of capillaries?

Question 12

t/f: isotonic solutions only expands intravascular space

Answer 12

true

Question 13

what are other regulations for fluid balance (7)

Answer 13

1. hypothalamus/pituitary (thirst center)
2. renal –> RAAS
3. cardiac –> ANP and BNP
4. stress
5. GI (vomit, diarrhea)
6. Insensible losses (sweating, burns)
7. Lymphatic system (drain)

Question 14

explain how hypothalamus/pituitary gland can regulate dehydration?

Answer 14

dehydration (H2O deficit) –> hypothalamus osmo-receptors stimulated –> pituitary gland secretes ADH –> kidneys reabsorb water –> osmolality falls

Question 15

explain how kidneys can regulate dehydration?

Answer 15

dehydration = decreased renal perfusion –> renin increases –> angiotensin increases –> aldosterone increases –> Na retention and water

Question 16

explain how cardiac system can regulate excess/high bp?

Answer 16

increase in atrial pressure –> increase in ANP and BNP –> excretion of Na and H2O

Question 17

t/f: stress leads to the excretion of fluid

Answer 17

false = stress leads to retaining fluid

Question 18

what are considerations for elderly populations and fluid?

Answer 18

• decreased body water % (45-55%)
• decreased thirst mech, confusion
• decreased mobility, GFR, organ function
• increased moisture loss
• increased drug interactions

Question 19

normal lab values for osmolality?

Answer 19

275-295

Question 20

normal lab values for BUN?

Answer 20

8-25

Question 21

normal lab values for urine specific gravity?

Answer 21

1.010 - 1.030

Question 22

normal lab values for Na+ ?

Answer 22

135-145n

Question 23

normal lab values for K+ ?

Answer 23

3.5-5.0

Question 24

normal lab values for hematocrit ?

Answer 24

45%-55%

Question 25

how can you tell if a fluid imbalance has moved to an intracellular problem ?

Answer 25

CNS changes (confusion)

Question 26

what to administer to pt with ECFVD? why?

Answer 26

ECFVD = dehydration --> admin isotonic solution to replenish vascular system (LR, 0.9NS)

Question 27

what to administer pt with ICFVD? why?

Answer 27

ICFVD = cells are shrinking (rare unless elder with acute water loss) --> admin hypotonic fluid to push fluids back into cells (0.45, D5W)

Question 28

what to administer to pt with ECFVE? why?

Answer 28

ECFVE = intravascular hypovolemia --> admin isotonic fluid for irrigations --> admin diuretics to get rid of excess

Question 29

what to administer pt with third spacing? why?

Answer 29

third spacing --> fluid in interstitial (useless) space --> admin albumin then hypertonic to shift fluids to vascular space to get rid of it --> admin diuretics once in vascular space

Question 30

what to administer to pt with ICFVE? why?

Answer 30

ICFVE = water intoxication --> admin hypertonic solution to bring fluid out of cells (3% NaCl) --> admin diuretics to get rid of excess

Question 31

what are some causes of hyponatremia?

Answer 31

- drinking too much water - SIADH - not replenishing Na+

Question 32

what are some clinical manifestations of hyponatremia?

Answer 32

(SALT LOSS) - seizure, stupor - abdominal pain, cramping (high GI motility) - lethargic - tendon reflex decrease - loss of urine output - overactive bowel - spasms of muscle - shallow respirations

Question 33

what are some causes of hypernatremia?

Answer 33

- water loss (ADH insufficiency) - Na+ gain - aldosterone excess

Question 34

what are some clinical manifestations of hypernatremia?

Answer 34

(FRIED) - fatigue - restless/really agitated - increased tendon reflex - extreme thirst - decreased urine output

Question 35

what are some causes for hypokalemia?

Answer 35

- increased GI losses - decreased K+ intake - K+ wasting diuretic

Question 36

what are some clinical manifestations of hypokalemia?

Answer 36

(7 Ls) - lethargic - low, shallow respirations - limp muscles - lethal cardiac dysrhythmias - low BP, low HR - leg cramp - LOTS of urine

Question 37

what are some causes for hyperkalemia?

Answer 37

- renal failure (K+ retention) - injured cells/burns - K+ sparing diuretics

Question 38

what are some clinical manifestations for hyperkalemia?

Answer 38

(MURDER) - muscle weakness - urine output little to none - respiratory failure - decreased cardiac contractibility - early muscle twitch - rhythm changes (heart)

Question 39

ekg for hypkalemia

Answer 39

"u wave" - flat t wave - st depression

Question 40

ekg for hyperkalemia

Answer 40

(tall tented t wave) - peaked t wave - st elevation