Week 1: Fluid and Electrolyte Balance I

Question 1

Fluid Compartment: Intracellular

Answer 1

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

Question 2

Fluid Compartment: Extracellular

Answer 2

Fluid outside the cells
1/3 of body fluid

Transports electrolytes, enzymes and hormones

Question 3

intravascular

Answer 3

Fluid within the blood vessels

Contains plasma (half of total blood volume)

Question 4

Interstitial

Answer 4

Contains fluid that surrounds the cell

11-12 L in adults

Lymph fluid

Question 5

Transcellular

Answer 5

Smallest space

1L in adults

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

Question 6

Third Spacing

Answer 6

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

Question 7

What are the signs and symptoms of Third Spacing?

Answer 7

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

Question 8

Cations

Answer 8

sodium, potassium, calcium, magnesium, hydrogen ions

Question 9

Anions

Answer 9

chloride, bicarbonate, phosphate, sulphate, proteinate ion

Question 10

Osmosis

Answer 10

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

Question 11

Diffusion

Answer 11

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

Question 12

Filtration

Answer 12

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

Question 13

Renin-Angiotensin-Aldosterone System (RAAS)

Answer 13

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

Question 14

Hypovolemia

Answer 14

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

Question 15

S&S of Hypovolemia

Answer 15

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

Question 16

Causes of hypovolemia

Answer 16

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

Question 17

Hypervolemia

Answer 17

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

Question 18

Hypervolemia causes

Answer 18

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

Question 19

S&S of hypervolemia

Answer 19

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

Question 20

Fluid Volume Deficit: Nursing Management

Answer 20

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

Question 21

Fluid Volume Overload: Nursing Management

Answer 21

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

Question 22

Pharmacological interventions for Fluid volume overload

Answer 22

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

Question 23

what is the complication associated with fluid volume deficit

Answer 23

hypovolemic shock

Question 24

what is the complication associated with fluid volume overload?

Answer 24

pulmonary edema, heart failure, impaired gas exchange

Question 25

Causes of Hypovolemic Shock

Answer 25

hypovolemic = e.g. hemmorage cardiogenic = e.g. MI distributive: Neurogenic = SCI Anaphylactic septic = systemic infection

Question 26

Shock Symptoms

Answer 26

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

Question 27

Hypovolemic Shock

Answer 27

Cause: Decreased intravascular fluid volume external fluid losses - fluid is lost externally internal fluid losses - fluid shifts between intravascular and interstitial compartments (third spacing)

Question 28

Hypokalemia causes

Answer 28

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

Question 29

Hyperkalemia causes

Answer 29

excessive intake or decreased excretion

Question 30

S&S Hypokalemia

Answer 30

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)

Question 31

S&S Hyperkalemia

Answer 31

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

Question 32

Hypokalemia Interventions

Answer 32

Supplement K (potassium supplements, increase intake) IV admin: high alert, need to be administered slowly, NEVER IV push Falls prevention *muscle weakness Cardiac monitoring

Question 33

hyperkalemia Interventions

Answer 33

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

Question 34

Sodium

Answer 34

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

Question 35

Potassium

Answer 35

Intercellular Electrolyte Maintains Heart and Muscle Contraction

Question 36

Hyponatremia causes + results

Answer 36

Actual: Na excretion or decrease Na intake Relative: fluids dilute results in - decreased serum osmolality

Question 37

Hypernatremia causes + results

Answer 37

Actual: increase Na intake or decreased excretion Relative: fluid loss without Na loss or decrease fluid intake results in - increased serum osmolality

Question 38

S&S Hyponatremia

Answer 38

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)

Question 39

S&S Hypernatremia

Answer 39

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

Question 40

Hyponatremia Interventions

Answer 40

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

Question 41

Hypernatremia interventions

Answer 41

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)

Question 42

Chloride

Answer 42

Involved in blood pressure and blood volume maintenance and pH balance

Question 43

Magnesium

Answer 43

involved in neuromuscular contractility

Question 44

Calcium

Answer 44

Involved in neuromuscular contractility, coagulation and bone health

Question 45

Phosphate

Answer 45

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

Question 46

Clinical significance of Potassium

Answer 46

Essential for cardiac electrical conduction If too high or too low, rhythm changes can occur in heart and be life threatening

Question 47

Clinical Significance of Sodium

Answer 47

Sodium moves to area of lesser concentration High=concentrated=fluid volume loss Low=diluted=fluid volume overload

Question 48

Vascular Access Device Selection

Answer 48

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

Question 49

PIV (peripheral intravenous)

Answer 49

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

Question 50

CVAD (Central venous access devices)

Answer 50

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

Question 51

Common CVADs

Answer 51

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

Question 52

PICC

Answer 52

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

Question 53

Non-Tunneled CVAD

Answer 53

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)

Question 54

Tunneled CVAD

Answer 54

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

Question 55

Implanted CVAD

Answer 55

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

Question 56

What do I need to know about CVADs?

Answer 56

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