Week 2 Fluid and Electrolytes Balance and Disturbance Flashcards
1
Q
Movement of fluid from region of low solute to region of high across semipermeable membrane
A
Osmosis
2
Q
Changes in water or volume related to water pressure
A
Hydrostatic Pressure
3
Q
Movement of solutes from area of greater concentration to lesser concentration
Solutes in an intact vascular system are unable to move so diffusion normally should not be taking place
A
Diffusion
4
Q
Movement of molecules against the concentration gradient and requires ATP as energy; process typically takes place at cellular level and is not involved in vascular volume changes
A
Active Transport
5
Q
What is the nursing role in Fluid and Electrolyte balance
A
Help prevent, treat fluid and electrolyte disturbances
Understand physiology of F&E and Acid Base balances to anticipate, identify and respond to possible imbalances
6
Q
The body is approximately how many % of fluid?
A
60%
7
Q
Intracellular is ?
A
28 L
8
Q
Extracellular fluid is how many?
A
14L
9
Q
Extracellular fluid is broken into
A
- Intravascular-3-4 L
- Interstitial - 10-11 L
- Transcellular
10
Q
Loss of ECF into space that does not contribute to equilibrium
Moves from intravascular to interstitial (Nonfunctional area between cells)
A
Third Spacing
11
Q
Fluid is not available in the ICF or ECF
Does not contribute to equilibrium between ICF/ ECF
A
Third Spacing
Sign is decreased urine output Hallmark Sign
12
Q
Third Spacing is seen in what kind of patients
A
- Decreased Potassium
- Decreased Fe
- Severe liver dz
- Alcholishm
- Hypothyroidism
- Malabsorption
- Burns
- Fluid Volume Overload
- Cancer
13
Q
As volume deficits are detected by the kidneys they retain fluids in an effort to
A
Maintain CO and BP
Examples ascites, pleural effusion, pericardial effusion
14
Q
Other compensatory signs of Third Spacing includes
A
Increased HR
Decreased BP
Decreased CVP
edema
Increased body wt
Imbalance
I & O’s
15
Q
Low oncotic pressure exerted by plasma proteins is loss from?
A
IV space
Will result in leakage into the tissues
16
Q
Name causes of fluid shifts
A
Albumin losses can occur in liver failure, liver dysfunction, and malnutrition
- Albumin losses can lead to fluid shifting into the peritoneum causing ascites
- Destruction of endothelial cells such in bowel surgery can cause fluid to move and be trapped in interstitial spaces
Fluid trapped in the lungs can lead to pulmonary edema
17
Q
Active chemicals that carry positive and negative charges are
A
Electrolytes
cation= +
anions= -
18
Q
Name the major cations
A
Sodium
Potassium
Calcium
Magnesium
Hydrogen Ions
19
Q
Name the major anions
A
Chloride
Bicarbonate
Phosphate
Sulfate
Proteinate
20
Q
Electrolyte concentrations differ in fluid compartments
A
True
21
Q
Most in extracellular fluid includes
A
Na
Ci
Osmolality
HCo3
22
Q
Most in intracellular fluids include
A
Potassium
Mg
Phosphates
Osmolality
23
Q
How can we regulate fluid?
A
Osmosis
Diffusion
Filtration
Active Transport
24
Q
Regulation of fluid is movement through capillary walls depends on what?
A
Direction of fluid movement depends on differences of hydrostatic, osmotic pressure
25
Average intake includes?
Metabolism-10%,250 ml
Foods-30%-750ml
Beverages-60%1500ml
26
Average output includes?
Feces- 4%, 100 ml
Sweat- 8%, 200ml
Insensible losses via skin and lungs- 28%, 700ml
Urine-1500ml, 60%
27
Gain is what?
Dietary intake of fluid, food or enteral feeding
Parenteral fluids
28
Routes of losses includes
Kidney : Urine output
Skin loss: Sensible/ insensible losses
-Lungs
- GI tract
29
As blood flows through the lungs what happens?
Co2 removed and 02 is added
30
What moves in Cells? Out of cells?
In cells are nutrients
Out of cells are metabolic wastes move out of cells
31
Kidneys clear
Plasma filtrate of nitrogenous wastes, ion excesses, etc
32
Name homeostatic mechanisms
Kidney
Heart and Blood vessels
Lung
Pituitary
Adrenal
Parathyroid
Baroreceptors
RAAS
ADH
Osmoreceptors
Natriuretic Peptides
33
Gerontologic Considerations includes
Reduced Homeostatic mechanisms, cardiac, renal, and resp. function
Decreased body fluid percentage
Medication use
Presence of concomitant conditions
34
Imbalance may be subtle
Fluid deficit may cause delirium
Decreased cardiac reserve
Reduced renal function
Dehydration is common
Age - related thinning of skin and loss of strength and elasticity
Gerontologic Considerations
35
Fluid Volume deficit is also known as
Hypovolemia
36
FVE is also known as
Hypervolemia
37
What is the relationship between Volume and osmolarity?
Decrease volume, increased Osmol
Decreased Osmol, Increased Volume
38
This may occur alone or in combination with other imbalances
FVD
Hypovolemia
39
-Loss of extracellular fluid exceeds intake ratio of water
- Electrolytes lost in same proportion as they exist in normal body fluids
Fluid Volume Deficit
- Hypovolemia
40
Not the same as FVD
- Loss of water alone, with increased serum sodium levels
Dehydration
41
-Abnormal Fluid Losses
- Decreased Intake
- Third Space Fluid Shifts
- Additional Causes
Causes of FVD
42
Manifestations of this include
- Rapid weight loss
- Decreased skin turgor
- Oliguria
- Concentrated urine
- Postural hypotension
- Rapid weak pulse
- Increased temperature
- Cool clammy skin due to vasoconstriction
- Lassitude
- Thirst
- Nausea
- Muscle weakness
- Cramps
Fluid Volume Deficit
43
Lab Data is showing
- Elevated BUN in relation to serum creatinine
- Increased HCT
- Increased serum and urine osmo and specific gravity
- Decreased urine Na
FVD
- Serum Electrolyte changes may occur
44
Medical Management of FVD
Provide fluids to meet body needs
----Oral Fluids
----Iv Solutions
FVD
45
Name the risk for Dehydration or Hypovolemia
1. Diminished kidney function
2. Elevated Temperature
3. Highly concentrated tube feedings without enough supplemental water
4. Young infant with diaper- Inaccurate assessment of output
5. Diarrhea; diuretic overuse; diabetes
6. Reduction in body water content; LOC, temp. and fluids= Tachycardia
--esp. in elderly
7. ADH production decreases
8.Thirst mechanism reduced
9. Increase in serum glucose
10. Other conditions-N/V
11. Not able to obtain fluid without help
46
Concept Map RAAS
Slide 29
47
Regulation of water intake and output
Slide 30
48
Labs are all increased
- HCT
- Serum Osmolality
- Protein level
- BUN
- Na
- Glucose
- Urine Specific Gravity
FVD or Dehydration
49
System Specific assessment
- Decreased moisture of mucous membranes
- Decrease in vascular volume= Tachycardia
- Decrease in postural BP= Syncope
- Decrease in neck vein (Flat)
- Decrease in UO
- Decrease BP too much= Shock
- Decrease in skin turgor- not valid in elderly
50
What is the normal Serum Osmol?
270-300 mOsm/ kg
50
Fluid replacement is determined based on how the fluid was loss
Crystalloids- Small molecules
Colloids- Large molecules
50
-This is due to fluid overload or diminished homeostatic mechanisms
- Risk factors: Heart failure, renal failure, cirrhosis
FVE
50
Contributing factors includes
- Excessive dietary sodium or sodium containing IV solutions
FVE
51
Manifestations include
- Edema
- Distended Neck Veins
- Abnormal lung sounds( crackles)
-Tachycardia
- Increased Blood pressure
- Pulse pressure and CVP
- Increased weight
- Increased urine output
- SOB
- Wheezing
FVE
51
Medical management includes
- Directed at cause
- Restriction of fluids and sodium
- Administration of diuretics
FVE
51
ANP/ ANF does what?
increases
- NaCl concentration
- Blood volume
- Blood Pressure
Then stretches increase of atria
Then increases ANP/ ANF release from cardiac cells in the atria
52
Then the atria ANP/ ANF
- Decreases suppression of RA system, angiotensin II
- Decreases Aldosterone release by adrenal cortex
- Decreases ADH release by posterior pituitary gland
- Increase GFR and increases Na excretion
53
With decrease ADH release it increases what?
Urine production and water excretion
54
Increase rate of urine production and water excretion does what?
Decreases
- Blood volume
- CVP
- CO
- Arterial Blood pressure
- Preload
- HR
55
System Specific Assessment of FVE includes
Increase Pulse - may be bounding
-Increase BP
- Increase confusion
- Increase in edema
- Increase wt more than 2ILBS/ 24 hr
- Increase in ascites
- Increase crackles in lungs
- Increase RR, dyspnea, orthopnea
- Increase neck veins JVD
- Increase R/F skin breakdown
56
FVE Labs will show what?
Decreased
- HCT
- Protein Level
- Na
- Urine SG
- Serum Osmolality
- BUN
- Glucose
57
This includes
- Postural hypotension
- Tachycardia
- Absence of JVP
- Decreased skin turgor
- Dry mucosa
- Supine Hypotension
- Oliguria
- Organ Failure
Volume Depletion
58
This includes
- HTN
- Tachycardia
- Raised JVP/ Gallop rhythm
- Edema
- Pleural Effusions
- Pulmonary Edema
- Ascites
- Organ Failure
Volume Overload
59
Sodium- Hyponatremia/ Hypernatremia
Potassium- Hypokalemia/ Hyperkalemia
Calcium- Hypocalcemia/ Hypercalcemia
Magnesium- Hypo magnesium/ Hyper magnesium
Phosphorus- Hypophosphatemia/ Hyperphosphatemia
Chloride- Hyperchloremia/ Hypochloremia
Electrolyte Imbalances
60
Serum Sodium less than is 135
Hyponatremia
61
Causes include Adrenal Insufficiency
- Water intoxication
- SIADH
-Losses by vomiting
- Diarrhea
- Sweating
- Diuretics
- Renal Disease
Hyponatremia
- Na deficit
FVE - Dilutional
62
Name the S/S of hyponatremia
- Poor skin turgor
- Dry mucosa
- Headache
- Decreased salivation
- Decreased BP
- Nausea
- Muscle weakness
- Abd. cramping
- Neurologic changes
- Seizures
63
Name the medical management of Hyponatremia
- Water restriction
- Sodium replacement
64
What is the nursing management of hyponatremia?
- Assessment and prevention
- Dietary sodium and fluid intake
- Identify and monitor at- risk patients
- Effects of medications - ( diuretics, Lithium)
65
System Specific Assessment Solution Deficit includes
- Decrease in cerebral function
- Decrease LOC- risk for seizures
- Decrease muscle strength
- Decrease DTR
- Decrease volume= Increase HR
- Decrease BP; orthostatic
- Decrease UO
- Decrease weight
- Decrease sodium intake
66
System specific assessment solution deficit includes both cause depending on ECF includes
Decrease in cerebral function
Decrease LOC risk for seizures
Decrease muscle strength
67
Name system Specific Assessments Dilutional Water excess includes
1. Decrease Cerebral function
2. Decrease LOC- risk for seizures
3. Decrease muscle strength
4. Decrease DTR
5. Decrease UO
6. Increase BP
7. Increase weight
8. Increase HR
68
Causes of this includes
- Excess water loss, excess sodium administration, DI, heat stroke, Hypertonic IV solutions
Hypernatremia more than 145
69
S/S include
- Thirst
- Elevated Temp.
- Dry, swollen tongue
- Sticky mucosa
- Neuro symptoms
restlessness
- Weakness
Hypernatremia
70
Thirst may be impaired in the ?
Elderly
ill
71
_________________________ occurs in patients with normal fluid volume, FVD, FVE
Hypernatremia
72
In hypernatremia what is the serum osmolality
Greater than 300mOsm/ kg
73
Increased urine specific gravity and osmolality
Hypernatremia
74
Fluid Deficit Dried Specific System Assessments
- Dryness of mucous membranes
-----Increase concentration in urine/ decrease UO
-Red Flushed Skin
----Increase restless progressing to confusion
- Increased Temp. ; I &O
---- Increase concentration in urine/ decrease UO
- Increase thirst ( may not be present in elderly)
- Increase risk for seizure
-Elevated HR
- Decreased weight, BP, CVP, and UO
75
Name the system specific Assessments "Edema"
- Fluid excess/ Na retention
1. Edema
2. Decrease in HCT; diet high in Na
3. Elevated weight; elevated BP and HR
4. Mentation decreased - Lethargic
5. A flushing of the skin
76
Interventions for hypernatremia
Restrict fluid intake with retention
- restrict foods high in Na
Evaluate for cerebral changes-(HA, nausea, seizure precautions)
- Strict I&0 safety falls
- BP is elevated d/t excess fluid excess. BP is low - Fluid deficit
- Review origin of hypernatremia
- Fluid deficit- hypotonic IV fluids
- Check daily weight; neuro assessments
- The excess fluids removed by diuretics
77
Below normal potassium may occur with normal potassium levels with ALKALOSIS due to shift of potassium into cells
Hypokalemia
78
Name the causes of Hypokalemia
GI losses/ NGT, medications, alterations of acid- base balance, hyperaldosterism, poor dietary intake
79
Name s/s of hypokalemia
- Fatigue
- Anorexia
- Nausea
- Vomiting
- Dysrhythmias
- Muscle weakness
- Cramps
- Paresthesias
- Glucose intolerance
- Decreased muscle strengths
- DTRs
80
Medical management of hypokalemia includes
Increased dietary potassium
Potassium replacement
IV for severe deficit
81
Nursing Management of hypokalemia
Assessment
Severe hypokalemia is life threatening
- Monitor ECG and ABGs
- Dietary potassium
- Nursing care related to IV potassium administration
82
Name foods high in potassium
1. tomatoes
2. Avocados
3. Bananas
4. Orange
83
________ substitutes are ______ in ____
Salt; potassium
84
Potassium level higher than 5.0
What are causes of this?
Hyperkalemia
1. Usually treatment related
2. Impaired renal function
3. Hypoaldosteronism
4. Tissue Trauma
5. Acidosis
85
Name the S/S of hyperkalemia includes
- Cardiac changes and dysrhythmias
- Muscle weakness with potential respiratory impairment
- Paresthesia
- Anxiety
- GI manifestations
86
Name the medical management of Hyperkalemia
- Monitor ECG
- Limitation of dietary potassium
- Cation exchange resin ( Kayexalate)
- IV sodium bicarbonate
- IV calcium gluconate
- Regular insulin
- Hypertonic dextrose IV
- Dialysis
87
Nursing Management of Hyperkalemia
Assessment of serum potassium levels
- Ivs containing K
- Monitor medication affects
- Dietary potassium restrictions/ dietary teaching for patient's at risk
88
________ may result in false lab result positive of hyperkalemia
Hemolysis or drawing of blood above IV site
89
______ sub. may contain potassium
Salt
90
What may cause elevation of potassium
Potassium sparing diuretics
- Not used in renal DZ
91
-Renal Function deteriorates with age
-Elimination is decreased due to decrease in oral fluid intake
-Note that plasma renin and aldosterone decrease with age
- Alteration in renal blood flow
-Likely to take meds that interfere with K excretion
Hyperkalemia in Elderly Adults
92
Hyperkalemia and the EKG
Peaked T waves
Flat Ps
93
What is C-BBIG-K?
Calcium Gluconate or CaCI- Cardio protective- Prevents deleterious cardiac effects
BBIG- K back into the cell
--B2 agonist
- Bicarb-- if acidosis
- I and G- Insulin and glucose together
K - Get rid of the potassium
- Kayexalate
- Diuretics
- Dialysis
94
Hypocalcemia has normal output but low intake/ absorption
- Low Ca rich foods
- Vit D deficiency
- Malabsorption Crohns
95
Hypocalcemia increased output not balanced by increase Ca intake and absorption
- Binds Ca in GI secretions in addition to the intake of Ca in diet- steatorrhea
96
Hypocalcemia is serum less than
8.6 must be considered in conjunction with serum albumin levels
97
Causes of hypocalcemia
Hypoparathyroidism
Malabsorption, Pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure medications
98
S/S neuromuscular Hypocalcemia
Tetany
Circumoral numbness
Parethesias
DTRs
Trousseaus
Chovstek's
Seizures
Resp. symptoms of dyspnea and laryngospasm
- abnormal clotting
- Anxiety
99
Cuff of blood pressure is what sign seen in hypocalcemia
Trousseau's
100
Tapping of the cheek is a sign of what?
Hypocalcemia and is known as Chvostek's sign
101
System Assessments for Hypocalcemia
T- Trousseau's
W- Watch for dysrhythmias
I- Increases bowel sounds/ diarrhea
T- Tetany, twitching, tingling, seizures, spasms at rest can progress to tetany
C- Chvostek's
H- Hypotension, Hyperactive DTRs
102
First to do priority Interventions Hypocalcemia "SAFE"
S- seizure precautions
A- administer Ca supplements
F- foods high in C ( dairy, greens) educate client
E- emergency equipment on standby
103
Name the medical management of Hypocalcemia includes
- IV calcium gluconate
- Calcium and vitamin D supplements
- Diet
104
_____________ _____________ is life threatening
Severe hypocalcemia
105
What type of exercises one can do to decrease bone calcium loss?
Weight Bearing
Also teach patient about related diet and medications
Nursing care is related to IV calcium administration
106
Name the drugs associated with hypocalcemia
A- aluminum containing antacids
A- anticonvulsants
B- beta blockers
C- caffeine
C- corticosteroids
D- diuretics (loop)
107
Serum level is above 10.5
Hypercalcemia
108
Name the s/s of hypercalcemia
- muscle weakness
- low coordination
- anorexia
- constipation
- N/V
- Abd bone pain
- polyuria
- thirst
- ECG changes
- Dysrhythmias
109
Name the causes of hypercalcemia
- Malignancy
- Hyperparathyroidism
- Bone loss related to immobility
110
Medical Management of hypercalcemia
-Treat underlying causes
- fluids
- Furosemide
- phosphates
- calcitonin
- bisphosphonates
111
______ normal output, increased Ca and intake and absorption
hypercalcemia
112
Decreased output not balanced by decrease Ca intake
Thiazide Diuretics
Hypercalcemia
113
Rapid Ca shift from bone to ECF ..
- Hyperparathyroidism
- Metastatic malignancy that secretes bone resorbing factors
Padgett's disease
Chronic immobility
114
System specific Assessment for Calcium includes
C- cardiac dysrhythmias ( decrease QT, short ST); CNS is decreased
A- anorexia, nausea, constipation
L- LOC decreased
C- Ca level above 10.5
I- increase in drowsiness
u- Underactive reflexes
M- muscle weakness
F- fat Ca
115
Serum is less than 1.3 mg/ dL and evaluate with serum albumin
Hypomagnesemia
116
Name causes of Hypomagnesemia
- Alcoholism
- GI losses
- IBS/ IBD medications
- Rapid administration of citrated blood
- Contributing causes include DKA
- Sepsis
- Burns
- Hypothermia
117
S/S of hypomagnesemia include
- Neuromuscular irritability
- Muscle weakness/ fatigue
- Tremors/ convulsions
- ECG changes
- ALOC
- Nystagmus
118
What is the medical management of Hypomagnesemia?
Includes
- Diet
- Oral magnesium
Mag sulfate IV
119
Mg has similar relation to?
Calcium
120
Assessment for Magnesium
TWITCH
T- Trousseau's
W- watch for dysrhythmias
I- Increase neuromuscular excitability
T- Tetany, twitching ( seizures)
C- Chhvostek's sign
H- Hypoactive bowel sounds, constipation, hyperactive DTR; HTN
121
Interventions for low mag.
SAFE
S- Seizure/ fall precautions
A- Administer Mg sulfate IV per order
F- foods high in Mg
E- Emergency equipment stand by, eliminate drugs that decrease magnesium, Evaluate DTRs
122
What is the nursing management of hypomag.?
Assessment
- Ensure safety
- pt teaching related to diet
- medications
- alcohol use
- Nursing care related to IV mag sulfate
- Often accompanied by hypocalcemia
- Dysphagia common in mag. depleted patients
123
Name foods high in Mg
Nuts
Dark chocolate
Seafood
Introduce Peas and dry beans
Use whole grain bread and cereal
Meats
124
Rhythm to watch with Mg is
Torsades de Pointes
125
Hypermagnesemia is serum above
2.3
126
Name causes of Hypermagnesemia
- Renal Failure
- DKA
- Excessive administration of mg
127
S/S of Hypermag
- Low BP
- n/v
- hypoactive reflexes
- drowsiness
- muscle weakness
- depressed respirations
- ECG changes
- Dysrhythmias
128
Medical management of hypermag. includes?
IV calcium gluconate, Loop diuretics, IV NS of RL
- Hemodialysis
129
Nursing management of Hypermag.
- Assessment
- Do not administer medications containing magnesium
- Pt teaching regarding magnesium containing OTC medications
130
Name the similarities between Ca and Mg
- Both predominantly in bone
- Assessments are similar
- Both can twitch
- Elevated levels, drowsiness, decrease muscle tone, dysrhythmias
- differences - diarrhea- too much Mg
- Constipation- too much calcium
131
Below serum of 2.5
Hypophosphatemia
132
Name S/S of hypophosphatemia
- Neurologic symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, increased susceptibility to infection
133
What is the nursing management of Hypophosphatemia?
- Assessment
- Encourage food high in phosphorus
- Gradually introduce calories for malnourished patients receiving paternal nutrition
134
Name the causes of hypophosphatemia
- Alcoholism, refeeding of patients after starving
- Pain, heat stroke, resp. alkalosis, hyperventilation
- DKA
- Hepatic encephalopathy
- Major Burns, Hyperparathyroidism
- Low Mg
- Low potassium
- Diarrhea
- Vitamin D deficiency
- Use of diuretic and antacids
135
Name the medical management of hypophosph.
- Oral or IV phosphorus replacement
136
Serum above 4.5 is known as
Hyperphosphatemia
137
Name the S/S of hyperphosphatemia
- Soft tissue calcifications
- Symptoms include and associated with hypocalcemia
138
Nursing management of Hyperphosphatemia include ?
- Assessment
- Avoid high phosphorus foods
- Pt teaching related to diet
- Phosphate containing substances and signs of hypocalcemia
139
Name the causes of Hyperphosphatemia
- Renal Failure
- Excess phosphorus
- Excess vitamin D
- Acidosis
- Hypoparathyroidism
- Chemotherapy
140
Name the medical management of Hyperphosphatemia
- Treat underlying disorder
- Vitamin D preparations
- Calcium Binding antacids
- Phosphate Binding gels or Antacids
- Loop Diuretics
- NS IV
- Dialysis
141
Hypochloremia is less than
97
142
Name the causes of hypochloremia
- Addison's disease
- Reduced chloride intake
- GI loss
- DKA
- Excessive sweating
- Fever
- Burns
- Medications
- Metabolic Alkalosis
143
Loss of __________________ occurs with loss of other electrolytes, potassium, sodium
Chloride
144
S/S of hypochloremia includes
- Agitation
- Irritability
- Weakness
- Hyperexcitability of muscles
- Dysrhythmias
- Seizures
- Coma
145
Medical management of hypochloremia
- Replace chloride IV NS
or 0.45 NS
146
What is the nursing management of hypochloremia?
- Assessment
- Avoid free water
- Encourage high chloride foods
- Patient teaching related to high chloride foods
147
Serum more than 107 mEQ/ L is
Hyperchloremia
148
Name causes of hyperchloremia
- Excess sodium infusions with water loss
- Head injury
- Hypernatremia
- Dehydration
- Severe diarrhea
- Resp. Alkalosis
- Metabolic acidosis
- Hyperparathyroidism
- Medications
149
Name the S/S of hyperchloremia
- Tachypnea
- Lethargy
- Weakness
- Rapid deep respirations
- HTN
- Cognitive changes
150
Hyperchloremia includes
Normal serum anion gap
151
Medical management of hyperchloremia includes
Restore electrolyte and fluid balance
- LR
- Sodium Bicarbonate
- Diuretics
152
Name the nursing management of Hyperchloremia
- Assessment
- Pt teaching r/t diet and hydration
