Fluid Electrolyte Balance Flashcards

Sodium
Terms Definitions
inhibitory
enterogastric reflex
Hypocalcemia: Nursing Planning
Goals:
Outcomes:
food ingested
700 ml
Hypomagnesemia: Nursing Interventions
Nutritional teaching
Adrenal
What gland secretes aldosterone?
Osmolality
concentration of solutes; determined by the total solute concentration within a fluid compartment
Major anion in intracellular fluids
Phosphate
Kidneys
contributes the most fluid balance.
vasopressin (ADH)
______________is a hypothalamic hormone which controls collecting duct permiability to H2O in a graded fasion, increase in ADH causes decrease in urine
What does isosmotic mean?
Equal osmolarity
Hypocalcemia: Assessment Findings
Numbness/Tingling
Muscle Tremors & Cramps
Cardiac dysrhythmias
Confusion, Anxiety
Diuretic
"causing urine" A diuretic drug promots or stimulates urine production.
CONTRIBUTING FACTOR OF DEHYDRATION
*DIARRHEA
*VOMITING
*INAPPROPRIATE USE OF DIURETIC
*DECREASED FLUID INTAKE
*EXCESSIVE HEAT IN SWEATING
*FEVER
*GI SUCTION
*CERTAIN MEDICATIONS
*HEMORRHAGE
*CERTAIN DISEASES-DM, DI, ADDISON DISEASE
Examples of transcellular fluid
cerebrospinal, pericardial, pancreatic, pleural, biliary, synovial fluids
Anabolic phase: Potassium moves _________ the cell during the formation of new tissue. a. into b. through c. out of d.around
a. into
Signs of Hypo and Hyper Kalemia
...
K+
the most abundant intracellular cation is
hypokalemia
insufficient amount of potassium in extracellular fluid; muscle weakness and leg cramps. normal potassium levels for adults: 3.5-5 mEq/L and kids: 3.4-4.7 mEq/L.
Antidiuretic Hormone
vasopressin, v1 (vasoconstriction) and v2 (kidney reabsorption) receptors
Are the hydrostatic and osmotic pressures equal? (Meaning does all the fluid that goes in return?)
No
Nursing Knowledge: Calcium (Ca+)
Function: regulates muscle contraction, neuromuscular and cardiac function
Normal levels: 4.5-5.5 mEq/L (8.5-10.5 mg/dl)
Sources: milk products, green leafy veggies, salmon, supplements
Regulation: bone-ECF, parathyroid and calcitrol, calcitonin
DEHYDRATION
*DEFICIENCY OF BODY WATER OR AN EXCESSIVE LOSS OF WATER FROM THE BODY
*BODY OUTPUT OF WATER IS GREATER THAN INTAKE
*CAN BE ASSOCIATED WITH AN INCREASE IN SODIUM OR A DISTURBANCE OF CERTAIN OTHER ELECTROLYTES SUCH AS POTASSIUM
EDEMA
*EXCESS ACCUMULATION OF FLUID IN THE INTERSITIAL SPACES
*CAN ALSO BE CALLED 3RD SPACE FLUID
*DUE TO DISRUPTION OF THE FILTRATION AND OSMOTIC FORCES OF THE BODY CIRCULATING FLUIDS
_____ contains oxygen, electrolytes, and glucose and constitutes approximately 2/3 of total body fluid
intracellular fluid (ICF)
K homeostasis keeps plasma k concentrations in a
narrow range
Rapid heart rate, flattened neck veins, and normal or decreased blood pressure [BP], shock are all symptoms of ______________ a. a. Edema b. Diarrhea c. Hypervolemia d. Hypertension
c. hypervolemia
Watch potassium levels when giving insulin to patients that might be predisposed to _____________. a. strokes b. seizures c. hypokalemia d. hypernatremia
c. hypokalemia
Overhydration
total volume of body fluids greater than normal.
ALERT ALERT
Notify physician if client shows change in mental status or cerebral perfusion such as a new unrelenting or wosenting headache, confusion, lethary, irritability, restlessness, or seizures.
Deficit
Causes Fluid Volume Excess or Deficit? Vomiting
daily water gain
fluids ingested, food ingested, metabolic water
hyperphosphatemia
failure of kidneys to excrete excess, rapid redistribution, excessive intake (abuse of laxatives, fleets enema)
_________ cells hold much of the body's water while _____ cells contain very little water.
Skeletalfat
What cells monitor the osmolarity of the plasma?
Osmoreceptors
Nursing Assessment for Fluid Balance: NURSING HISTORY
Age
PMH
Environmental Factors
Diet
Lifestyle
Medications
HYPOPHOSPHATEMIA
*LESS THAN 2.5 UNUSUAL BUT OFEN OCCURS WITH RESPIRATORY ALKALOSIS AND EXTENSIVE BURN INJURY
Functions of sodium
controls and regulates water balance (cl and water are reabsorbed with it)
fluid and solute lost from the body must be
replaced
Edema due to Decreased arteriolar resistance typically occurs due to ________________ drug responses. a. Opiods b. Calcium channel-blocking c. Beta-blocker d. Anti-depressants
b. Calcium channel-blocking
patients with any of these conditions may be _____________. Increased dietary intake (rare), Multiple blood transfusions, Potassium-sparing diuretics, Decreased renal excretion. a. hypernatremia b. hyperkalemia c. hyperchloremia d. hypercalifragilisticexp
b. hyperkalemia
Hypotonic solution
Osmotic pressure less than that of plasma (more water less solute)
intracellular fluid
fluid located within cells; 42% of body weight, most prevalent cation is potassium.
absences of vasopressin
decreases H2O permiability to nearly zero in the collecting duct, urine is dilute
Normal daily output and intake is about?
2600 ml
What is water directly regulated by?
Antidiuretic hormone (ADH)
Nursing Knowledge: Potassium (K+)
Function: Important for ICF Water balance, transmitting nerve impulses, regulating cardiac impulse and muscle contraction, acid base balance, smooth muscle function
Normal level: 3.5-5.0 mEq/L
Sources: fruits, veggies, meats, fish, OJ, milk
Regulation: Renal excretion and conservation
COMMON MEDICAL TREATMENT
*ORAL OR RECTAL MEDICATION MAY BE GIVEN TO DRAW ELECTROLYTES OUT OF THE BODY THROUGH THE GASTROINTESTINAL SYSTEM
*WHEN A DEFICIT OF BODY WATER EXISTS IN THE ECF OR ELECTROLYTE DEFICIT IS DETERMINED FLUIDS ELECTROLYTES AND OTHER SUBSTANCES CAN BE ADMINISTERED TO THE CLIENT TO HELP RESTORE HOMEOSTASIS
*IV ADMINISTRATION OF ELECTOLYTES USUALLY TREATMENT OF CHOICE
juxtaglomeralar cells or aldosterone promotes
Na retention in the kidneys
Hyperchloremia occurs when the pH is <, the _________ gap is normal and HCO3 is ____________. a. cation, normal b. anion, increased c. cation, decreased. d. anion, normal
d. anion, normal
Gastrointestinal System
Produces about 7-9 L of gladular and tissue secretions per day. This fluid contains many nutrients , including electrolytes. This fluid (volume in blood) is equivalent to the total body plasma level and basses throug the intestinal mucosa.
Water intoxication
The state in which the body retains water and serum sodium levels decrease
pulmonary & cardiovascular systems
____________have a more rapid response than renal compensation
About _____ of the body weight of a premature infant is water.
90%
A protein that acts like an enzyme and converts a plasma protein termed angiotensinogen into angiotensin I.
Renin
Physical Assessment: Skin and Mucous Membranes: FVD
Sunken, dry eyes
Sticky, dry mucosa
Dry cracked lips
Decreased salivation
Tongue furrows
There are many places in the body where transcellular fluid is found. Can you name ten of them?
Digestive tract
Urinary tract
Respiratory tract
Eyeballs
Abdominal cavity
Thoracic cavity
Pericardial sac
Pleural cavity
Kidney tubules
Ventricles of the brain and central canal of the spinal cord
Joints
P cell hormone enhances
Na, K, ATPas activity and increase open time of Na and K leak channels
Hypochloremia may be due to_________. a. cystic fibrosis b. vomiting c. loss of HCL or Na+ d. all of the above
d. all of the above
ADH (antidiuretic hormone)
What hormone causes the body to retain water?
production of dilute urine
is done by the nephron reabsorbing solute without H2O
When CO2 is removed faster than it is produced (like in hyperventilation), it can cause this.
respiratory alkalosis
S/S of hypertonic dehydration
thirst , fever, dry mucous membrane, muscle twitching, convulsions
____ is found within the cells of the body and is vital to normal functioning of the cell.
intracellular fluid (ICF)
to produce dilute urine, the nephron must
reabsorb solute w/o reabsorbing water
Symptoms of hyponatrimic volume depletion include all of the following EXCEPT a. Anorexia, Nausea & Fatigue b. Increased heart rate, Anxiety & Blurred vision c. Muscle weakness, Decreased BP & Headache d. Confusion, Cramps & Seizures
b. Increased heart rate, Anxiety & Blurred vision
normal lab value of potassium
3.5-5.5 meq/L. major ICF cation. plays a major role in transmission and conduction of nerve impulses, maintaining normal cardiac rhythm, skeletal muscle contraction, and acid-base balance.
What hormones are involved in the regulation of fluid balance?
ADH, aldosterone, and atrial natriuretic peptide
Plasma proteins exert an osmotic draw called ______ or ________ pressure, pulling water from the interstitial space into the vascular compartment to maintain vascular volume.
colloidal osmotic pressure or oncotic pressure
What is the Trousseau's sign?
To elicit the sign, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct.
1.excretion of wastes
2.regulation of body water, sodium, potassium
3.pH
4.secretion of hormones - erythropoetin, renin, vitamin D
These are the 4 functions of the kidneys.
Who is most susceptible to fluid loss
infants, kidneys are not fully matured and cannot retain fluid, they breath at faster rates leading to a greater loss of fluids
What is the Chvostek's sign?
When the facial nerve is tapped at the angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips) because of hypocalcaemia (ie from hypoparathyroidism, pseudohypoparathyroidism, hypovitaminosis D) with resultant hyperexcitability of nerves.
The amount of fluid filtered by the glomerulus is a function of what?
Hydrostatic pressure- the pressure of the pump
T/F TBW is the same for everyone.
False: it varies depending on age and fat distribution.
What happens to this excessive fluid in the interstitial space?
It is returned to circulation by the lympatic system
Where does ADH bind once it has been released?
A receptor on the collecting duct cell (Found only in the kidney)
skin
600 ml
posterior pituitary
release vasopressin
Hypermagnesemia: Nursing intervention
Nutritional teaching
hyperkalemia
decreased renal elimination, excessively rapid administration, movement from ICF to ECF.
s/s nausea, vomiting, diarrhea, weakness, muscle cramps, risk of cardiac arrest, peak t waves
Homeostasis-Fluid Compartments;
Intracellular fluid (ICF):
Within Cells
Constitutes largest portion of fluid weight
Contains Solutes such as O2, glucose, and electrolytes
hyperventilation pts. will exhibit
resp. alkalosis
ASSESSMENT
Health History: Clients chief complaint if related to fluid and electrolyte deficit compliants are usualoy r/t nausea, vomiting, iarrhea, anorexia, increasing fatigue and wekness, weight loss, fever, bloos loss, excess urine ouput or change inmental status.
If complaint is d/t fluid excess; it will be described as weight gain, cough, dyspnea, cardiac palpitaitons, pitting edema, decreasedurinary output, ormental status changes.
Relate to any previous illness, hospitalizations, surgeries trauma allergies etc to check if this could be cause. Collect data adn additional history on family etc.
:.
SIADH
syndrome of inappropriate antidiuretic hormone, failure of negative feedback system to inhibit ADH
Causes-Isotonic Dehydration
hemorrhage, burns, ileostomy, directics, NG Suction, oversecretion of aldosterone
Physical Assessment: Clinical Measurements
Daily Weights
rationale
Vital Signs
rationale
Input and Output
Hypercalcemia
too much calcium in the blood.
NURSING CARE INCLUDES
*DAILY OBSERVATION
*COLLECTION OF DATA
*DOCUMENTATION
*ADMINISTRATION AND OBSERVATION OF THE EFFECTS OF DIURETIC MAY BE INDICATED
*OFTEN A SODIUM RESTRICTED DIET IS ORDERED
Hyperosmolar imbalance
Dehydration, when solute concentration exceeds water concentration
When pH increases, CO2______________ a. stays the same b. decreases c. increases
b decreases
Removing NG Tube
Perform prliminary actions
Prepare client; Listen for Bowel sounds, do not remove is no bowel sounds (listen for at least 5 min) Place emesis basin and oepeneinplastic bag on table, clean gloves supplies etc. turn off suction machine and disconnect NG tube from suction tubing; unpin NG tube for gown or untape ; prevent stomachcontents from leading from tube. Instill 20mL ofair into NG to displace secretion back into cientes stomach or pinch tube as ou remove it. DONT FLUSH WITH AIR OR SALINE IF DOUBT ABOUT PLACEMENT.
Remove tube; instruct client to hold breath and pull tube out in one quick steady motion note intactness of tip of tube.
Finish procedure: Assis with skin and mouth care , describe bowel sound the tube rmoval and cient's reponse, contintue to monitor clients bowel status.
Parathyroid
What gland regulates calcium and phosphoorus balance?
1)constricts the vessels 2) causes distal nephron cells to insert aquaporins in their apical membrane
vasopressin
volume deficit
sodium normal, concentration normal, amount decreased, 'hypovolemia'
Osmolarity
Total solute concentration in a solution- osmoles/liter
Nursing Knowledge: Magnesium (Mg+)
Function: intracellular metabolism, protein and DNA synthesis, regulation of neuromuscular and cardiac function
Normal levels: 1.5-2.5 mEq/L
Sources: cereal grains, nuts, dried fruits, veggies, dairy, meat & fish
Regulation: Via Kidneys, intestine
EVALUATING
*HAVE SHORT TERM GOALS BEEN MET
*LONG TERM GOALS
*PLANNING FOR FURTHER NURSING CARE CONSIDERS THE CLIENTS PROGNOSIS AND COMPLICATIONS AND THE CLIENTS RESPONSE TO TREATMENT
ICF IMPORTANT ELECTROLYTES
*POTASSIUM K+ MOST DOMINANT INTERCELLULAR CATION 3.5-5.0 BODY FLUID BALANCE
*MAGNESIUM Mg++ 1.5-1.9mEq FUNCTION OF NEURONS AND MUSCLE CELLS
*SULFATE SO4++
*PHOSPHATE HPO4-- MOST DOMINANT ANION-1.7-2.6 mEq BODY FLUID BALANCE OSMOTIC PRESSURE
Obligatory losses
required to maintain normal body function such as kidneys need to filter at least 500ml of fluid to eliminate metabolic wastes.
filtrate leaving the ascending limb of the lp of henle is
dilute
Natriuretic hormones stimulate water & sodium _____________ . a. conservation b. excretion c. storage d. genesis
b. excretion
Hypotonic hyponatremia- caused by _______________ and characterized by mOSm< 280. a. water excretion b. ischemia c. water retention d. drug overdose
c. water retention
Capillary B/P
water pushing force; increase blood pressure
ADH (vasopressin)
stimulates H2O conservation at the kidneys, increases H2O reabsorption to conserve H2O
hypocalcemia
less than 8.5, caused by impaired ability to mobilize calcium from bone stores, abnormal losses from kidneys, increased protein binding, vitamin d deficiency
s/s: increased neuromuscular excitability, cardiovascular effects, nerve cells less sensitive to stimuli. chvostek and trousseau used to assess tetany and excitability.
Hypotonic dehydration can result in?
skeletal muscle weakness
Negative Balance
Substances exit the body faster then they enter, decrease in the amount of substances in the plasma
Cations carry a positive charge
Na+, K+, Ca2+, Mg2+
ENDOCRINE SYSTEM
*USES THE RELEASE AND ACTION OF HORMONES TO MAINTAIN HOMEOSTASIS
Function of Cl-
functions with sodium to regulate serum osmolality and blood volume. Major component of gastric juice, acts as buffer in the exchange of oxygen and carbon dioxide in RBC's
the largest H2o loss is
1.5 L/day in urine
Extracellular fluid (ECF) is all of the following except a. Intracellular b. hyperthermal c. Lymph & Transcellular fluids d. Intravascular
b. hyperthermal
a hyposmotic ECF results from a surplus of ___________. a. solute b. fluid c. heat d. hypnotists
b. fluid
hydrostatic pressure
the pushing of fluids and solutes against the walls of capillaries out into the interstitium.
countercurrent multiplier
the loop of henle is a ____________________ that creates high osmolarity in the medullary interstitial fluid by actively transporting Na+, Cl, K+ out of the nephron
Cardiovascular effects of dehydration?
increased pulse ratethready pulse qualitydecreased blood pressurepostural (orthostatic) hypotensionflat neck and hand veins in dependent positionsdiminished peripheral pulsesweight loss
What is exudate rich in?
Protein and blood cells
What organ puts out the most fluid?
Kidneys 1400 ml
If, however, the osmolarity of one compartment changes
It upsets the balance
Normally kidneys compensate by
excreting excess water
increased ECF, K stimulates
aldosterone secretion but increase ECF osmalarity inhibits it
Which of these does NOT decrease fluid volume? a. hemorrhage b. hypothermia c. heart failure d. none of the above
b. hypothermia
Increase renal clearance of free water due to impaired ______________ function a. renal tubular b. cardiac c. hepatic d. gastric
a. renal tubular
FOCUSED ASSESSMENT FOR DEFICIENT FLUID VOLUME Extracellular/Intracellular
EXTRACELLULAR: Generalized: Flattened neck veins in supine position, suddent wt loss, peripheral vein filling takes more than 5 seconds, decreased skin turgor, dry mucousm emebrans and furrowd tongue, speech changes, muscle weakness, in upper body, subnormal temp if severe loss, fever ifmoderate loss, depressedn fontanenla in infant soft and sunken eyebals
Cardiac Orthostatic hypotitension SBP falls more than 25 mmHg and diastolic BP falls more than 20mmHg with tahycardian up to 120 beats /min, weak thready pulse, narrow pulse pressure
Gastroindentinal - constipiation
Renal Urinary ouptu greatly exceeding intake and urininy output decreased if conpensatory response
Related Factors: Acuteness of loss, seveirty of loss, clients age and state of health, degree to which cleint combats deficit
INTRACELLULAR- dehydration intracellular more serious than extracellular b/c potential dysfuntion of mitochondrial formation of ATP ATP is critical to all cell function and transpot : characteristics include FEVER, thirst , central nervous system changes.
What are the causes of hypocalcemia?
Decreased intestinal absorption (Chron's, celiac's, gut removal, decreased vit D intake); glucocorticoids, Lasix; alkalosis (increased Ca binding to plasma proteins); hypoparathyroidism (low PTH) such as in thyroidectomy because parathyroid is sensitive so watch for low Ca in neck surgery patients.
ECF volume & osmolarity
___________will increase if you eat salty peanuts and drank H2O at the same time
In a typical 154 lb lean adult male, about _____ of body weight is water.
60%
What we take in should be... (Equal to, less than, or more than)what goes out
Equal to
ECF or extracellular fluid
Mainly the liquid part of blood consisting of Plasma and IF or interstitial fluid. Surrounds cells. foud in lymph, cerebrospinal fluid, muors of the eye and the synnovial hoint fluids. Smaller portion of body fluids are ECFs
The number of particles in a solution can be expressed as
• Milliosmoles(mOsm)/liter
o mOsm/liter = mmol/liter x number of particles in solution
to concentrate urine the nephron must
reabsorb water w/o reabsorbing solute
Which of the following does NOT cause edema due to decrease of colloidal osmotic pressure? a. loss of plasma proteins b. liver disease c. protein-losing kidney disease d. extensive burns
b. liver disease
Fluid Volume Deficit
Occurs when the body loses water and electrolytes isotonically, that is, in the same proportion as in the normal body fluid. Also, serum electrolyte levels remain normal.
sympathetic activation
patient is about to go to surgery to remove a tumor in the chest, 2 hrs before surgery patient begins with jitters causing elevated heart rate, BP, increase breathing, cold sweats & urge of urination, symptoms are a result of what???
Elevated osmolarity is indicative of what?
Increased solute (sodium) and decreased fluid (water)
Water levels in humans
Men 60% of body weight, women 50%, infants 80%. More Fat less water. After age 10 waterl levels decrease rapidly to the adult level.
Interventions for Isotonic Fluid Volume excess
monitor weight and vital signs, assess for edema, place in fowlers position, administer diuretics, restrict fluid intake, restrict sodium intake, assess breath sounds
the body's ph is regulated b/c
ph affects intracellular proteins such as enzymes and mem. channels
Tx: IV albumin (capillaries are damaged)
plasma proteins; synthetic or human plasma; giving albumin for burn does not help
normal lab value of sodium
135-145 meq/L. major ECF cation. plays a major role in generation and transmission of nerve impulses. hypernatremia > 145 meq (causes cell dehydration) and hyponatremia < 135 meq (causes the cell to swell).
Why are diabetics always thirsty?
Because there is an increased plasma osmolarity because of the increased glucose so the regulators are always being stimulated
Acidifying solutions to correct metabolic alkalosis are
5% dextrose in 0.45% NaCl and 0.9% NaCl
key s/s for a patient with fluid volume deficit
tachycardia, decreased blood pressure, faintness, blacking out, decreased urine output, rapid breathing, confusion.
What organs regulate water balance?
Kidneys, GI tract, lungs, and to a lesser extent skin
atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) enhance
Na excretion and urinary water loss by increasing GFR, inhibiting tubular reabsorption of NaCl and inhibiting release of renin, aldosterone, and vasopressin
fluid volume overload is also known as:
hypervolemia; state in which a person experiences or is at risk of experiencing intracellular or interstitial fluid overload.
What are the tubules of the kidney are important for?
Reabsorption and secretion of substances- modifying the filtrate.
What is the MAX rate for K+ administration?
Peripheral IV's = NO MORE THAN 10mEq/hr
Central lines = no more than 20mEq/hr
How does sodium loss affect the cells?
• It leads to movement of water into the cells (because they have a greater osmotic pressure than the interstitial fluid).
• Water in the neurons causes
o Headache, weakness, dizziness, coma
At the venous end, the net flow of water is where?
Back into the capillary due to the increased osmolarity of the plasma at the venous end
/ 149
Term:
Definition:
Definition:

Leave a Comment ({[ getComments().length ]})

Comments ({[ getComments().length ]})

{[comment.username]}

{[ comment.comment ]}

View All {[ getComments().length ]} Comments
Ask a homework question - tutors are online