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Module 4 > Unit 1 IV Fluids and Electrolytes > Flashcards

Unit 1 IV Fluids and Electrolytes Flashcards

1
Q

What are the functions are performed by electrolytes? List 4

A
  1. Promote neuromuscular irritability
  2. Maintain body fluid osmolality
  3. Regulate acid base balance
  4. Regulate distribution of blody fluid amoung body fluid compartments.
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2
Q

What is the best way to assess fluid balance?

A

Monitor daily weight– same time, same clothes, same scale

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3
Q

When assessing electrolyte balances what are we assessing?

A
  1. Look at EKG to detect changes
  2. Assess nutritional status
  3. Evaluate health history for medical conditions that may alter F&E
  4. Evaluate med hx for prescriptions or OTC drugs that can interfere
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4
Q

What are some factors that influence body fluid?

A
  1. Age- Younger people have a higher % of water than older people.
  2. Gender- men have more body fluid than women– except when pregnant
  3. Body Fat- Obese patients have less fluid than those who are thin because fat cells contain low water.
  4. Skeleton (Bone)- Vs-Muscle, skin, and blood: Bone has lower water content. Highest amount of water is found in the muscle skin and blood.
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5
Q

What are the two main body fluid compartments in the body?

A
  1. ICF
  2. ECF
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6
Q

What two electrolytes are found in your ICF?

A
  1. Potassium
  2. Magnesium
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7
Q

What are the different subtypes of ECF?

A
  1. Intravascular: Contains plasma “liquid part of your blood”– half fluid is plasma other half wbc, rbc and other cells– usually about 6L
  2. Interstitial: inbetween the circulatory system and your cells- “Lymphatic system” 11-12L
  3. Transcellular: Working in its own way apart from the circulatory system. Cerebral spinal fluid, pericardium, intraocular, sweat, digestive gland are types
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8
Q

Shifting of fluid between compartment is typically normal. However, there are times when it is abnormal. What type of fluid shift is this?

A
  1. 3rd spacing- Acities
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9
Q

What is the manifestations of 3rd spacing.

A
  1. Decreases urine output
  2. Increase heart rate
  3. Decreased BP, Decreased CVP
  4. Edema
  5. Increase body weight
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10
Q

What do we normally see as a result of second spacing?

A
  1. Edema
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11
Q

What electrolytes are cations?

A
  1. Sodium Na+
  2. Potassium K++
  3. Calcium Ca++
  4. Magnesium Mg++
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12
Q

What electrolytes are anions?

A
  1. Bicarbonate HCO3-
  2. Chloride Ch-
  3. Phosphate PO4-
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13
Q

What process helps regulate out body fluids?

A
  1. Osmosis and osmolality
  2. Diffusion (concentrations)
  3. Filtration (Pressures)
  4. Sodium Potassium Pump (Active transport)
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14
Q

What are some different routes of gains and losses of fluid

A
  1. Kidney
  2. Skin
  3. Lungs
  4. GI tract
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15
Q

Kidneys
Hypothalamus
pituitary gland
Adrenal cortex

The above helps with what in our body?

A

Fluid balance

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16
Q

How do our kidneys help our fluid balance?

A
  1. Major filtering process… must have proper pressure
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17
Q

How does our hypothalamus help our fluid balance?

A
  1. Located in the bottom of the brain… In charge of our thirst feelings
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18
Q

How does our posterior pituritary gland help with our fluid balance?

A
  1. Made in the hypothalamus, releases and inhibits ADH. ADH–focuses on holding and letting go of water
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19
Q

How does the adrenal cortex help with our fluid balance?

A
  1. Regulates our sodium by releasing aldosterone
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20
Q

What may cause abnormal fluid movement?

A
  1. Increase in hydrostatic pressure as a result of:
    -Venous obstruction
    -Sodium and water retention
    Heart failure and renal failure are great example.
  2. Decrease in plasma oncotic pressure may be caused by:
    • Loss or decrease in plasma albumin.
  3. Obstructions in the lymphatic system may be caused by:
    -inflammation, tumors, surgical removal.
  4. Increase in capillary permeability may be caused by
    -inflammation, immune response
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21
Q

What are some complications of edema?

A
  1. Pressure injuries
  2. Infections
    3.Life-threatening influence on the body
    -brain, lungs, larynx
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22
Q

If a patients albumin levels are low what do you expect to see when you assess the patient?

A

Edema

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23
Q

What are the different types of edema?

A
  1. pulmonary
  2. vascular
  3. acities
  4. pitting and non pitting
  5. cerebral
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24
Q

What is the purpose of IV therapy?

A
  1. Provide H20, Electrolytes, Nutrients, blood
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25
Q

What are some advantages of IV therapy?

A
  1. Allows or maintains access to the circulatory system
  2. Offers route of admin when other routes are unavail.
  3. Therapeutic blood levels of medications are maintained with continuous fluids
  4. control over rate of admin
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26
Q

What are some disadvantages to IV therapy?

A
  1. Damage
  2. Overload
  3. Overdose
    4.Infections
  4. Patient activity
  5. Incompatibility
  6. Adverse reactions
  7. Electrolyte imbalance
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27
Q

Amount and type of IV fluid and electrolyte replacement is determined by what?

A
  1. Normal daily maintenance requirements
  2. imbalances identified by lab results.
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28
Q

What are the different types of crystalloids?

A
  1. Isotonic
  2. Hypotonic
  3. Hypertonic
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29
Q

What are the types of IV solutions?

A
  1. Crystalloids
  2. Colloids
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30
Q

How are the IV solutions classified?

A
  1. by the concentration or tonicity
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31
Q

What is the osmolality of blood?

A
  1. concentration of all chemical particles found in the fluid part of the blood.
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32
Q

Your osmolality of blood primary reflects the concentration of?

A
  1. Sodium
  2. Blood/Urea/Nitrogen BUN
    3.Glucose
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33
Q

If your sodium is low your osmolality is what?

A

LOW- direct relationship

34
Q

Your serum osmolality is how much water is in the blood compared to how much what?

A

Solutes- which is the particles or chemicals in your blood.

35
Q

What are factors increasing osmolality?

A
  1. Dehydration
  2. Free water loss
  3. Diabetes insipidus
  4. Hypernatremia
  5. Hyperglycemia
  6. Stroke of head injury
  7. Renal Tubular Necrosis
36
Q

Normal osmolality is between what ranges?

A

280-290 mOsm/kg

37
Q

An osmolality level greater than 295 mOsm/kg indicates what?

A
  1. The concentration of solute is too great, or the water concent is to little
38
Q

An osmolality level greater than 295 mOsm/kg indicates that the concentration of solute is too great, or the water content is too little. What would this condition be termed?

A

Water deficit

39
Q

An osmolality level less than 275 mOsm/kg indicates what?

A

Too little solute for the amount of water or too much water for the amount of solute.

40
Q

An osmolality level less than 275 mOsm/Kg indicates that there is too little solute for the amount of water or too much water for the amount of solute. What would this condition be termed?

A

Water excess

41
Q

What factors decrease osmolality?

A
  1. Fluid volume excess4
  2. SIADH
  3. Renal failure
  4. Hyponatremia
  5. Overhydration
42
Q

What should we remember about ISOtonic solutions?

A
  1. Similar osmolarity as ECF
  2. Given to “replace” fluid
  3. Do not cause RBC’s to shrink or swell
  4. Osmolality is about 280-300 m0sm/kg
43
Q

What are different types of isotonic solutions?

A
  1. 5% dextrose in water D5W
  2. Normal Saline (NS, NACL, 0.9%)
  3. Lactated ringers (LR, RL)
44
Q

What is important to know about D5W?

A
  1. Supplies water and glucose
  2. Isotonic outside the body HYPOtonic in the body.
    -Dextrose rapidly metabolized
    -Can cause HYPERglycemia
45
Q

Which patient population should you use D5W cautiously?

A

diabetics and hypernatremic (neuro) patients

46
Q

What is important in normal saline (0.9% sodium chloride)

A
  1. Corrects extracellular volume deficit
    -hypovolemic states, resuscitative effort, shock, metabolic alkalosis, hypercalcemia, na+ deficits
  2. Does not supply calories
  3. Used with blood admin
  4. Replaces large sodium loses
47
Q

D5W is used for the treatment of what electrolyte imbalance?

A
  1. Hypernatremia patients (neuro patients)
48
Q

Normal Saline (0.9% sodium chloride) is NOT used for

A

CHF, Pulmonary edema, Renal impairment

49
Q

What should we know about LR (Lactated ringers).

A
  1. Supplies potassium, calcium and sodium chloride
  2. Corrects dehydration, Na+ depletion and GI loss
50
Q

Which patient population/conditions should you use caution with when using LR?

A
  1. CHF
  2. Renal insufficiency
  3. Edema
  4. Na+ retention
  5. Hyperkalemia
51
Q

What should we remember about HYPOtonic solutions?

A
  1. Osmolarity is lower than serum (<280 m0sm/l)
  2. Dilutes ECF, lowering serium osmolality
  3. Causes water to move into the interstitial spaces and cells– causes them to swell
  4. Can cause fluid shifts which in turn can cause intravascular fluid depletion, low bp, cellular edema
52
Q

What are the different types of HYPOtonic solutions?

A
  1. 0.45% sodium chloride (1/2NS)
  2. 0.33 % sodium chloride (1/3 NS)
  3. 0.225% sodium chloride (1/4 NS)
  4. 2.5 % dextrose in water (D2.5W)
53
Q

Do NOT give HYPOtonic solutions to—

A

1.Patients at risk for ICP, CVA, Head Trauma
2. patients who suffer from burns, trauma, malnutritoin,liver disesase
3. Can worsen hypotension.

54
Q

What should we remember about HYPERtonic solutions?

A
  1. Osmolarity is higher than plasma (>300mOsm/L)
  2. Causes water to move out of the cells and into the vascular space
  3. Decrease risk of edema, stabilizes B/P, regulates urine output.
  4. Used to repair electrolyte and acid/base imbalances, TPN
  5. Used cautiously in pt with diabetes, and impaired heart or kidney.
55
Q

When should hypertonic solutions be used cautiously?

A
  1. In patients with diabetes and impaired heart or kidney function
56
Q

What should you monitor closely when using hypertonic solutions?

A
  1. Monitor closely for circulatory overload.
57
Q

What are the different types of HYPERtonic solutions?

A
  1. 5% dextrose in 0.9 % sodium chloride (D5NS)
  2. 5% dextrose in 0.45% sodium chloride (D5 1/2NS)
  3. 5% dextrose in 0.225% sodium chloride (D5 1/4NS)
  4. 5% dextrose in Lactated ringers (D5LR)
  5. 10% dextrose in water (D10W)
58
Q

What are colloids?

A
  1. Large molecules that do not dissolve and can not pass through a membrane
59
Q

When are colloids used?

A
  1. Used clinically for volume expansion
  2. Pulls fluid into the bloodstream.
60
Q

What are the different types of colloids?

A
  1. Albumin-osmotically = to plasma
  2. Dextran- plasma volume expander
  3. Hetastarch-synthetic volume expander
  4. Mannitol- (alcohol sugar)
61
Q

When a patient is recieving collids what do we need to montior during infusion?

A
  1. increase in bp
  2. dyspnea
  3. bounding pulse
  4. fluid overload
  5. anaphylaxis
62
Q

What electrolytes should you be watching when a patient is receiving colloids?

A
  1. Potassium
  2. sodium
63
Q

What are causes of a fluid volume deficit?

A
  1. vomiting
  2. severe dehydration
  3. trauma
  4. Burns
  5. Medication- diuretics
64
Q

What are some s/s of fluid volume deficit?

A

Moderate
1. Dry mucous membranes
2. Excessive thirst
3. Postural hypotension
4. Thready pulse
5. Dark urine

Severe
1. Body will try to compensate and vessels will try to vasoconstrict
3. HR increases

65
Q

What are nursing interventions for fluid volume deficit?

A
  1. Oral rehydration
  2. Increasing fluid intake
  3. IV hydration
66
Q

What are causes fluid volume overload?

A
  1. Rapid infusion rate
  2. Hepatic, cardiac or renal disease
  3. Can be come common in elderly
67
Q

What are fluid volume overload signs and symptoms?

A
  1. Edema
  2. Weight gain
  3. Palpable veins
  4. Crackles in lungs
  5. Pulmonary edema
  6. Increase BP and CVP
  7. JVD
  8. Moist crackles, dyspnea
  9. Shallow respirations
  10. Edema, weight gain
  11. Periorbital edema
  12. Decreased lab values.
68
Q

What are our prevention and interventions?

A
  1. infuse IVF via pump
  2. Monitor patients closely
  3. Decrease IV rate
  4. Monitor V/S, assess resp status.
69
Q

Where is sodium obtained?

A
  1. Diet
70
Q

Where is sodium absorbed?

A

Intestines

71
Q

How is soidum excreted

A

Kidney

72
Q

Sodium is a major electrolyte in the ____

A

ECF

73
Q

What is the normal lab value of sodium?

A

135-145 mEq/L

74
Q

If serum sodium is low serum osmoality is….

A

Low- causing the dilute extracellular fluid

75
Q

If serum sodium is low the ECF is ____

A

dilute – water is drawn into the cells

76
Q

If serum sodium is hgh the ECF is ____

A

concentrated- water is pulled out of the cell

77
Q

When sodium goes into the cell what electrolyte moves out

A

Potassium

78
Q

What is the function of sodium?

A
  1. Blood pressure regulators
  2. Blood volume
  3. PH level
79
Q

How is sodium regulated?

A
  1. ADH (Antidiuretic hormone) (keeps water in our body and not in the potty)
  2. Aldosterone (Hold Na inside the body by blocking it at the kidney)
  3. Sodium Potassium pump (Moves Na out of the cells via ATP)
80
Q

What are the causes of HYPOnatremia? Think No Na+

A

N: Na+ excretion increase w/renal problems, NG suction, vomiting, diuretics, sweating, diarrhea, decreased secretion of aldosterone (DI)
O: Overload of fluid (CHF, RF, Hypotonic fluids infusion)

N:Na+ intake low (Low salt diet, NPO)
A: Antidiuretic hormone oversecreation (SIADH)

81
Q

HYPOnatremia level is

A

Below 135

82
Q
A

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