Fluids and Electrolytes 2 Flashcards

Health Care
Terms Definitions
Vomiting
MAlkal.
Hypocalcemia (symptoms)
-tachycardia
-anxiety
-psychosis
-trousseau and Chvostek
** assessment method unique to CA
d5 1/2 ns
hypotonic
Mg
1.8-3.0 (cation +/intracellular)
Hypomagnesemia-clinical manifestations
tremorshyperactivitytetanypositive Trousseau'sConfusionAgitation
intravascular
in the blood vessels
ECF
Interstitial, Intravascular, and Trancellular
Colloid
solution that contains proteins
Hyponatremia
Interventions
SODIUM
seizure precautions, increased sodium intake, withhold fluids, daily weight, I &O, use hypertonic and isotonic fluids, monitor LOC and vitals
Major anions
chloride, bicarbonate, phosphate, sulfate, proteinate ions
Active transport
movement AGAINST concentration gradient
ascites
excess fluid in the peritoneal/abdominal cavity
hypomagnesia is more_________ than hypermagnesia
twitchy
Hypernatremia
Elevated temperature, CNS symptoms, infant irritability, high pitched cry
Potassium- function
Cellular metabolismTransmission of neuromuscular impulsessupports cardiac cycleAcid base balanceAny condition that increases urinary output decreases potassium
Potassium
This electrolyte affects the heart, and is the major intracellular electrolyte.
interstitial fluid
is found between the cell
Cations and Anions
Cations: positive electrical charge
Anions: negative electrical charge
Colliods expand blood volume aka...
plama expanders
Metabloic Alkalosis
High HCO3 and High pH
Thirst Mechanism
principle regulator of fluid balance
What is a cation?
Positively charged ion
edema
excessive fluid shift to the interstitial space
Hypercalcemia
These Meds treat what?: etidronate disodium (Didronel) ; calcitonin- salmon (Calcimar) or calcitonin - human (Cibacalcin) ; alendronate (Fosamax)
Normal serum calcium level
9.0- 10.5 mEq/L
Diabetes Insipidus- interventions
Administer FluidsAdminister Pitressin (synth ADH)
Hyponatremia
SIGNS
increased HR, decreased BP, decreased DTR, muscle weakness ^bowl sounds, Diarrhea
K+
the acceptable level of ________ is 3.5-5.0 mEq/liter
lungs
by speeding up or slowing down respirations, this an increase or decrease the amount of carbon dioxide in the blood
Low _____ can greatly increase the toxicity of digitialis prepartions and precipitate ventricular dysrrhythmias.
potassium
the movement of water through a membrane to an area of more dissolved. water will move to an area of greater concentration to lesser concentration
osmosis
Transcellular space (3rd space)
smallest ECF compartment;
CSF, peritoneal, pleural, pericardial;
3rd spacing: TCS becomes enlarged with fluid not easily exchanged with other spaces in ECF
Kidneys compensate for _______loss or retention of _______.
lung; CO2
K+ and Na+ have a(n) _______ relationship
inverse
Acidosis
a condition that occurs with increases in blood carbonic acid or with decreases in blood bicarbonate; blood pH below 7.35
Bicarbonate
major chemical base buffer within the body found in ECF and ICF
Arterial 22-26 mEq/L
Venous 24-20 mEq/L
Sodium Na+
creates osmotic pressure in ECF, needed for electrical activity in neurons & muscles
Hyponatremia- causes
Sweating followed by large plain water intake causes dilution of plasma sodiumIncreased ADHAdrenal Insufficiency (decreased aldosterone so Na levels fall)
Mg+ Significance
Important in neuromuscular fx; Stored in bones and soft tissue
Hypernatremia management
assess over the counter sources of sodium, offer and encourage fluid to meet patient needs, provide sufficient water with tube feeding; sodium restricted diet
Name the etiologies of hypophosphatemia
intestinal malabsorption (antacid), increased renal excretion
Respiratory alkalosis caused
(high pH >7.45)
(paCO2 <35 mm Hg)
always due to hyperventilation
Magnesium (Mg)
metabolism of carbs & proteins, vital actions involving enzymes
Diffusion
Solutes move from an area of higher concentration to one of lower
Sodium (Na)
Normal range: 135 - 145 mEq/L
-Excess: hypernatremia, thrist, CNS depression, incr. interstital fluid
-Deficit:hyponatremia, CNS depression
treatment of low phosphorus
prevent it, prevent infection, administer carefully, not to exceed 10 mg/dL/hr, watch site carefully can cause necrosis
hypovolemic hyponatremia
sodium loss is greater than water loss
24 hours
Whats the longest a bag/bottle can hang for with an IV?
Serum calcium level of less than 9.0 mg/dL
hypocalcemia
magnesium nursing implication
monitor those at risk, especially those with renal failuremonitor vitals, particularly bp, respsevaluate reflexes, grip strength, respiratory muscle functionseizure precautionsrespiratory precautions
Abnormally low values of Cl-
Hypochloremia < 96 mEq/L
Total Parental Nutrition-TPN
50% glucose
must go into a central vein
higher potential of infection
Nursing care for FVD
monitor I/O and volumetric solution, monitor skin and tongue turgor, mucosa, MENTAL STATUS, provide oral care, admin fluids and parenteral fluids
what are the electrolytes that contribute to the normal functioning of neurons and muscle cells?
sodium, potassium and calcium
Osmosis
The movement of WATER from an area of lower concentration to an area of higher concentration through a selectively permeable membrane is known as what?
Dehydration
refers to the loss of pure water alone without corresponding loss of sodium
What organ is most affected by Na+ changes?
the brain
Factors that affect ADH production
Pain, stress, circulating blood volume, and some drugs
Ca++(Calcium) range (blood lab)
8.5-10.5 mg/dLshows: level of calcium in the blood
Abnormally high values of Na+/ Hypernatremia
Hypernatremia > 145 mEq/L
Name the clinical manifestations of CHF
decreased urine output, hypertension, weight gain, pleural effusion, edema, adventitious lung sounds, JVD
What are 3 blood proteins that normally maintain COP?
albumin, globulin, and fibrinogen
fluid imbalance is restored by:
1. treating underlying disorder, 2. increasing oral intake, 3. IV fluids replacement, 4. controlling fluid losses
isotonic iv solution
- osmolarity value of 275 - 295
-same amount of particles as plasma
- 0.9 NS
-RL (ringers lactate)
-D5W
-most common given
hypernatremia definition, s/s, tx
most common cause is fluid loss without loss of sodiums/s: dry tissues, low urine output, tachycardia, neuro changestx: replace fluidsmay also occur with full strength protein tube feedings, fever, burn victims, athletes
Metabolic alkalosis cause
(high pH >7.45)
(bicarbonate >26 mEq/L)
due to vomiting or gastric suction; may also be caused by medications, especially long-term diuretic use
_____ ____ ____ is the tissue fluid of the central nervous system (CNS)
cerebral spinal fluid
What are the RF's for hypomagnesia?
Poor diet intake/absorption and excess loss through kidneys and GI
alkaline fluids for met acidosis
if severe, sodium bicarb if pH<7.20, salts of organic acid (lactate, citrate), tromethamine THAM
kidneys react to fluid excessess by
excreting a more dilute urine; this rids the body of excess fluid and conserves electrolytes
What are the clinical manifestations r/t GI of hypernatremia?
Increased GI motility, hyper BT, abd cramping, /N/ and thirst
What are the therapeutic uses of colloids?
superior to crystalloids in ability to increase plasma volume. (Crystalloids are less expensive & less likely to promote bleeding, but more needed so cause more edema
movement of molecules from area of high concentration to low concentration
what 3 factors affect rates of diffusion
What are the risk factors that contribute to hypernatremia?
NPO, decrease of H2O due to fever, Excess Na+ intake/retention secondary to renal disease, Cushing's, hyperaldosteronism, and glucocorticoids
Causes of Abnormally high values of Cl-
Loss of HCO3 via kidneys or GI tract resulting in ↑ Na+ and Cl-;Acidosis
&#10;&#10;&#10;&#10;&#10;&#10;&#10;&#10;Extracellular volume imbalances&#8212;involve
&#10;&#10;&#10;&#10;&#10;&#10;&#10;&#10;a change in the amount (volume) of the extracellular fluid. These are also called saline imbalances because they are disorders of isotonic salt water.
creatine male
107-139
Anion Gap
8-14 mEq/L
hypercalcemia symptom
kidney stone
normal sodium
135-145 mEq/L
Cardiac dysrrhythmias, neuropathy, paralytic ilieus (constipation), and secondary alkalosis are all ______ symptoms of hypokalemia.
late
hypomagnesemia
clinical manifestations : Hyperreflexia
Personality changes, confusion, convulsions
Hypomagnesemia is often accompanied by
hypocalcemia
Hyponatremia intervention
water restriction, sodium replacement
osmotic pressure
drawing power of water
Extracellular
NA+ is an _________ fluid
Hyponatremia can be labeled __________
floppy
electrolytes
substances whose molecules dissociate, or split into ions, when placed in water
maintaining the heartbeat is controlled by what electrolyte
potassium
Hypokalemia manifestations
fatigue, anorexia, nausea, vomiting, dysrhythmias, muscle weakness, cramps, paresthesias, glucose, intolerance, decreased muscle strength, deep tendon reflexes (DTRs), decreased cardiac output
Sodium
• Regulates fluid volume
• Helps maintain blood volume
• Interacts with calcium to maintain muscle contraction
• Stimulates conduction of nerve impulses
Hypertonic
*initially raises osmolality of ECF and expands it
*treatment of HYPOVOLEMIA
*treatment of HYPONATREMIA
-risk for excess fluid
*10% dextrose in water
*3.0% saline
*5% dextrose in saline: .45% and .9%
homeostasis
body fluid balance throughout the internal environment of the body
Tonicity
Fluid tension within the extracellular fluid
high osmolarity shows
low level of fluid
respiratory acidosis
impaired respiratory function causes an inadequate exchange of oxygen and CO2, any increase in co2 causes a corresponding increase in H ions. CO2 retention causes acidosis
Active mediated transport
(solutes)Requires energy. Action against resistance or osmotic concentration. Maintains the difference between K and NA. (sodium-potassium pump..heart)
calcium needed for what
muscle contraction/relaxationnerve impulse transmissioncoagulation
35-45
this is the normal levels for pCo2
(Na+) hypo causes
kidney disease, prolonged sweating, diuretics, water excess
Tetany
spasms of hands and feet; excitability of body
Pediatric and geriatric clients may be more sensitive to the effects of _____.
potassium
osmoreceptors
meurons in the hypothalamus that are sensitive to teh fluid concentration in the blood plasma and regulate the secretion of ADH
Parental Nutrition
Nursing assessments for using ___ includes Monitor hyperglycemia, electrolyte imbalance, Infection, Rebound hypoglycemia when discontinued
Hyperkalemia Signs and Symptoms
Anxiety, dysrhythmias, paresthesia, weakness, abdominal cramps, and diarrhea
obstruction of the lymphatic system
Can cause edema
Pitting edema edema in which firm finger pressure on the skin produces an indentation (pit) that remains for several seconds
...
Hypovolemia
abnormally low blood volume, as with vomiting and hemorrhage
proteins
mechanism of Edema :
2. increased interstitial fluid osmotic pressure inflammation increases capillary permeability and BLANK leak into interstitial fluid
SALT hypernatremia
S: skin flushedA: agitationL: low grade feverT: thirst
What are you loosing in Diabetes Insipidus?
H20
What is hyperkalemia?
Serum K+ levels > 5.0mEq/L
High levels can cause ventricular dysrhythmias & CARDIAC ARREST!
Causes: renal failure, burns, hyperaldosteronism, trauma, infections, metabolic acidosis, potassium-sparing diuretics, potassium supplements, excessive loss from cells
Toxicity & mgt of overdose: dietary restrictions; IV admin of sodium bicarbonate, calcium gluconate, other calcium salts, & 5% Dextrose w/ insulin.
acid-base balance
means homeostasis of the hydrogen ion concentration in the body fluids; hydrogen ion concentration is determined by the ratio of carbonic acid to bicarbonate in the extracellular fluid; the ratio needed for homeostasis is 1 part carbonic acid to 20 parts bicarbonate; the symbol used to indicate hydrogen ion balance is pH; arterial blood gases determine whether a solution is acid, neutral, or alkaline; the more hydrogen ions in a solution, the more aid is the solution, and the fewer hydrogen ions the more alkaline is the solution
Passive transport
No cellular energy required to move from a high concentration to a low concentration.
kidneys helps regulate PH by excreting or conserving hydrogen ions
renal system
To much Na+(same as fluid deficeny:to little H2O)
Complications
pulmonary edema
Ascitets
CHF
weight gain
Priority Assessment During Rehydration
Pulse rate & quality
Urine output
bicarb deficit
<22 creates metabolic acidosis, ph and this are too low
Hyperphosphatemia
an excess of phosphate in the blood plasma
protein
stays in the cell K+ and Na+ diffuse
neuromuscular s/s of hypokalemia include
diminished deep tendon reflexes
Treatment hyponatremia and fluid overload
sodium, fluid restrictions, diuretics
treatment of hypocalcemia
high calcium diet or oral calcium salts, iv calcium as 10% cacl or 10% calcium gluconate, close monitoring of serum ca an digitalis levels, vitamin d therapy
Chvostek's sign is
A contraction of facial muscles in response to a light tap over the facial nerve in front of the ear.
when an amino acid amino group pick up a hydrogen ion from the body fluid is acting as a ____
base
What is a hypotonic solution?
When hypotonic solution surround cells, water crosses into the cells causing them to swell.
ADH maintains fluid balance how
-causes kidneys to retain water
-increased blood osmolarity triggers release of ADH
- decreased blood osmolarity causes osmoreceptors to swell inhibiting ADH
Alkalosis-Respiratory Etiology
Anything that causes a decrease in CO2 (like blowing on a pinwheel) S/SX ABG increase pH decrease PCO2 dyspnea, SOB (shortness of breath) light headed, dizzy, numbness and tingling, difficulty concentrating, blurred vision
what can be given if a patient has high potassium
kayexelate
Aldosterone
1. Secreted from adernal cortex. 2. causes active transport of Na from distal tubules and collecting ducts into blood. 3. Water follows.
K
K - A banana cost 3.50 to 5.50 each (3.5-5.5 mEq/L)
what is the most important system in the intracellular fluid?
protein buffer system
How long does it take for the lungs to compensate?
seconds
respiratory system (acid base regulator)
uses hypo or hyperventilation to regulate acid excretion or retention within minutes of a pH change
>>> causes of FVE (10)
renal failure, heart failure, excess fluid intake (without electrolytes), high corticosteroids, high aldosterone, plain water enema, NG irrigations, excess hypotonic IV fluids, SIADH, inappropriately prepared formula (dilute formula)
Define osmolality
the # of dissolved solutes in 1 L of H2O
water, oxygen, and carbon dioxide
What molecules can move through the semi-permeable membrane with out the use of energy?
The kidneys normally excrete excess potassium from the body; therefore, most cases of hyperkalemia are caused by disorders that reduce the kidney's ability to excrete potassium, such as
acute kidney failure, chronic kidney failure, lupus nephritis, rejection of a kidney transplant, glomerulonephritis
Treatments for Abnormally low values of P-/Hypophosphotemia
P- replacement; High phosphorus foods; Check use of OTC antacids and laxatives
What sort of nursing specific management should be provided to a client with Fluid Volume Deficit?
Monitor intake and output (I&O) and volumetric solution (VS), monitor for symptoms like skin and tongue turgor, mucosa, urinary output, and mental status. Iniitate measures to minimize fluid loss, provide oral care. Administer parenteral fluids
LABS of a person in respiratory ALKALOSIS
decreased PaCO2 and decreased Carbonic acid. pH greater than 7.45 and CO2 less than 35
Intake and output-how does fluid leave the body?
Fluid leaves the body through the kidneys, lungs, skin and GI tract
What is diabetes insipidus and what is its effect on fluid balance and sodium levels?
Deficient ADH resulting in dehydration and hypernatremia
the role of bicarbonate in the blood is to
bind with hydrogen ions to decrease acidity
Hypocalcemia
Below 8.0
Hypocalcemia: Etiology
Hepatic cirrhosis Acute PancreatitisMalnutritionHyperphosphatemiaHypoparathyroidismRespiratory alkalosisChronic renal failure Low albumin levelsVitamin D deficiencyMagnesium deficencyChronic malabsorption syndromeMassive transfusionsGastric surgeryPostthyroidectomyRadical neck dissection
Hypercalcemia: treatment
Decrease ionized calciumIncrease excretion (hydration, lasix)Decrease intestinal absorption (phosphate)Decrease bone reabsorption (encourage activity)
Hpyercalcemia: nursing diagnoses
Decreased cardiac output r/t bradydysrhymiaDisturbed thought processes r/t elevated calcium levels that cause paranoia, decreased level of consciousnessImbalanced nutrition: less than body requirements r/t gastrointestinal manifestations of hypercalcemia (nausea, anorexia, ileus)Impaired physical mobility r/t decreased tone in smooth and striated muscles
Water is what % of total body weight?
60%
AVP is released from____due to a ____ in plasma osmolality.
poterior pituitary
increase
What are some forms of abnormal fluid loss?
Fever, Vomiting, Diarrhea, Naso-gastric suctioning, Drains/Ostomies, Hyperventilation, Increased Metabolism
What factors should be monitored when a patient in receiving fluids?
hemodynamics, urine output, serum electrolytes, weight, serum/urine osmolarity, specific gravity
How do you calculate serum Osmolality?
= (2 x serum Na) + (Glucose mg/dL)   + BUN mg/dl
                               18                     2.8
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