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Nursing 3910 > Week 1: Fluid and Electrolyte Balance I > Flashcards

Week 1: Fluid and Electrolyte Balance I Flashcards

1
Q

Fluid Compartment: Intracellular

A
  • fluid within the cells
  • 2/3 of body fluid (primarily in muscle mass)
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2
Q

Fluid Compartment: Extracellular

A

Fluid outside the cells
1/3 of body fluid

Transports electrolytes, enzymes and hormones

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3
Q

intravascular

A

Fluid within the blood vessels

Contains plasma (half of total blood volume)

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4
Q

Interstitial

A

Contains fluid that surrounds the cell

11-12 L in adults

Lymph fluid

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5
Q

Transcellular

A

Smallest space

1L in adults

Cerebrospinal, pericardial, synovial, intraocular, pleural fluids, sweat, digestive secretions

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6
Q

Third Spacing

A

loss of ECF into a space that does not contribute to equilibrium

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7
Q

What are the signs and symptoms of Third Spacing?

A

decreased urine output (despite adequate intake), increased heart rate, decreased blood pressure, decreased central venous pressure, edema, increased body weight, imbalanced intake and output (I&O)

Symptoms can look as if the patient is retaining fluid but are presenting as dehydrated

Caused by: intestinal obstruction, pancreatitis, crushing traumatic injuries, bleeding, peritonitis, major venous obstruction

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8
Q

Cations

A

sodium, potassium, calcium, magnesium, hydrogen ions

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9
Q

Anions

A

chloride, bicarbonate, phosphate, sulphate, proteinate ion

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10
Q

Osmosis

A

movement of water across selectively permeable membrane from an area of HIGH concentration, to area of LOW concentration; based on osmolality

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11
Q

Diffusion

A

movement of particles across semi-permeable membrane from area of HIGH concentration, to area of LOW concentration

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12
Q

Filtration

A

movement of fluid through a cell or vessel membrane due to hydrostatic pressure differences
Hydrostatic pressure: pressing of water molecules outwards from a confined space, forces water to move from area of HIGH pressure to area of LOW pressure

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13
Q

Renin-Angiotensin-Aldosterone System (RAAS)

A

Decrease in perfusion to kidneys = renin release

Renin converts angiotensinogen to angiotensin I in blood

Angiotensin I converted to angiotensin II in lungs

Angiotensin II = vasoconstriction, stimulate thirst, stimulate aldosterone to retain water and Na

Atrial Natriuretic Peptide (ANP) inhibits this system when in state of overload

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14
Q

Hypovolemia

A

Occurs when loss of ECF volume exceeds the intake of fluid.

decrease in fluid in body

due to: insufficient intake, excessive loss or fluid shifts in body (third spacing)

fluid deficit in intravascular space = difficulty perfusing body, systems activate to raise BP

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15
Q

S&S of Hypovolemia

A

decreased weight
decreased skin turgor
weak, rapid pulse
low BP
thirst
Confusion

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16
Q

Causes of hypovolemia

A

vomiting, diarrhea, GI suctioning, sweating, nausea, third spacing shifts

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17
Q

Hypervolemia

A

retention of fluid in the body (retention of sodium)

due to: excessive intake, abnormal retention (kidney/heart)

fluid overload in intravascular space = raise BP, stress on systems

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18
Q

Hypervolemia causes

A

heart failure
kidney injury
cirrhosis of the liver
excessive consumption of sodium

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19
Q

S&S of hypervolemia

A

edema
distended neck veins
dyspnea
cough
Shortness of breath (SOB)
crackles

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20
Q

Fluid Volume Deficit: Nursing Management

A
  1. Correct the underlying cause of the deficit (eg. vomiting)
  2. Replace fluids and electrolytes (oral + IV rehydration)
  3. Prevent and assess inadequate perfusion
  • Signs of improvement:
    Stable blood pressure and heart rate
    Expected skin turgor
    Client moves towards other expected findings
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21
Q

Fluid Volume Overload: Nursing Management

A
  1. Correct underlying cause of deficit (eg. heart failure, kidneys)
  2. Limit sodium/fluid intake
  3. Administer diuretics
  • Signs of improvement:
    Daily weight checks
    Stable blood pressure
    Crackles in lung sounds
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22
Q

Pharmacological interventions for Fluid volume overload

A

Furosemide (Lasix)

Loop diuretic
Increases renal excretion, mobilizes fluid, decreases BP

Side effects – dizziness, headache, hypotension, electrolyte imbalance

Nursing considerations:
Fall risk
Electrolyte imbalance
Pre-existing kidney function + impact on kidneys

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23
Q

what is the complication associated with fluid volume deficit

A

hypovolemic shock

24
Q

what is the complication associated with fluid volume overload?

A

pulmonary edema, heart failure, impaired gas exchange

25
Q

Causes of Hypovolemic Shock

A

hypovolemic = e.g. hemmorage
cardiogenic = e.g. MI

distributive:
Neurogenic = SCI
Anaphylactic
septic = systemic infection

26
Q

Shock Symptoms

A

Compensatory
Normal BP
↑ HR
↑ RR
Blood shunting to vital organs
Pale skin
Hypoactive bowel sounds
↓ U/O
Confusion

Progressive
↓ BP
↓ LOC

Irreversible
Severe and permanent organ damage leading to death

27
Q

Hypovolemic Shock

A

Cause: Decreased intravascular fluid volume

external fluid losses - fluid is lost externally

internal fluid losses - fluid shifts between intravascular and interstitial compartments (third spacing)

28
Q

Hypokalemia causes

A

potassium loss, inadequate intake, movement of K+ from ECF to ICF

29
Q

Hyperkalemia causes

A

excessive intake or decreased excretion

30
Q

S&S Hypokalemia

A

Decrease GI motility, decrease bowel sounds
Muscle cramps, decreased DTR
Confusion, depression, lethargy

Cardiac: Dysrhythmia, irregular pulse, postural hypotension, cardiac arrest
ECG changes (U wave)

31
Q

S&S Hyperkalemia

A

Increase GI motility, Abdominal cramping increase bowel sounds
Muscle twitching, progressing to muscle weakness, flaccid paralysis
Irritability

Cardiac: Bradycardia, hypotension, irregular pulse, cardiac arrest
ECG changes

32
Q

Hypokalemia Interventions

A

Supplement K (potassium supplements, increase intake)

IV admin: high alert, need to be administered slowly, NEVER IV push

Falls prevention *muscle weakness

Cardiac monitoring

33
Q

hyperkalemia Interventions

A

Administer medications that lower potassium levels and support cardiac health (ex. Kayexalate, calcium gluconate, diuretics, insulin)

Falls prevention

Cardiac monitoring

34
Q

Sodium

A

Maintains osmolality as sodium levels determine where water is retained, moved, or excreted

35
Q

Potassium

A

Intercellular Electrolyte
Maintains Heart and Muscle Contraction

36
Q

Hyponatremia causes + results

A

Actual: Na excretion or decrease Na intake

Relative: fluids dilute

results in - decreased serum osmolality

37
Q

Hypernatremia causes + results

A

Actual: increase Na intake or decreased excretion

Relative: fluid loss without Na loss or decrease fluid intake

results in - increased serum osmolality

38
Q

S&S Hyponatremia

A

Impacts the Central Nervous System

Behaviour changes, increased ICP, confusion, seizures
Muscle weakness
Increase GI motility, N/V/D, cramping
CV symptoms dependent on fluid status (hypervolemia vs hypovolemia)

39
Q

S&S Hypernatremia

A

Impacts CNS

Behaviour changes, seizure
Muscle twitching, cramping, weakness
Thirst, dry mucous membranes
CV symptoms dependent on fluid status (hypervolemia vs hypovolemia)

40
Q

Hyponatremia Interventions

A

Administer sodium containing fluids
With normal or excess fluids: Administer medications (diuretic medications that promote water loss, rather than Na loss)

41
Q

Hypernatremia interventions

A

Provide health teaching on Na restricted diet
Administer IV infusion: If related to volume loss (hypotonic or isotonic)
Administer medications (Diuretic medications that promote Na loss)

42
Q

Chloride

A

Involved in blood pressure and blood volume maintenance and pH balance

43
Q

Magnesium

A

involved in neuromuscular contractility

44
Q

Calcium

A

Involved in neuromuscular contractility, coagulation and bone health

45
Q

Phosphate

A

Bone and Teeth Health, muscle and RBC function, Acid-Base Balance

46
Q

Clinical significance of Potassium

A

Essential for cardiac electrical conduction

If too high or too low, rhythm changes can occur in heart and be life threatening

47
Q

Clinical Significance of Sodium

A

Sodium moves to area of lesser concentration

High=concentrated=fluid volume loss

Low=diluted=fluid volume overload

48
Q

Vascular Access Device Selection

A

Duration: PIV for shorter, CVAD for longer

Patency: PIV more at risk of loss of patency

History of vascular access and comorbidities: difficult prior access, skin, vessels

Type of therapy: vesicant/irritants, pH

Patient’s preference

49
Q

PIV (peripheral intravenous)

A

Access in upper extremity
Short term therapy (<7 days)
Monitor for repeated failed/loss access

50
Q

CVAD (Central venous access devices)

A

Use when suitable PIV access is unavailable

Long term therapy

Suitable for vesicant/irritant medications/nutrition

Inserted into a large vein in the central circulation system, where the tip of the catheter terminates in the superior vena cava (SVC) that leads to an area just above the right atrium
Inserted by HCP with specialized knowledge
Often inserted with ultrasound guided technique

51
Q

Common CVADs

A

Peripherally Inserted Central Catheter (PICC)
Non tunneled CVAD
Tunneled CVAD
Implanted CVAD

52
Q

PICC

A

Enters body on upper arm, catheter runs to superior vena cava
VERY common in clinical settings
RNs can insert and remove (specialized skill!)
Medium term use

53
Q

Non-Tunneled CVAD

A

Enters body directly at vessel site (internal or external jugular, subclavian, or femoral vein), catheter runs to superior vena cava
Catheter outside of the body at the insertion site

Common in critical care patients (shorter term)

54
Q

Tunneled CVAD

A

Tunneled (Hickman or Broviac)

Proximal end tunnelled subcutaneously from the insertion site and brought out through the skin at an exit site.

Antimicrobial cuff

Long term use

55
Q

Implanted CVAD

A

Implanted (Port-A-Cath)
Device may be placed in the chest, abdomen, or inner aspect of the forearms
Accessed by special needle (specialized skill!)
Long-term use

56
Q

What do I need to know about CVADs?

A

Infections=high risk for sepsis!
Patient populations
PPE
Anti-Microbials

Nursing 3910 (12 decks)

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