electrolyte imbalance Flashcards

fluid volume excess
Terms Definitions
Signs and Symptoms of Hyponatremia: (7)
1. headache
2. muscle weakness
3. fatigue
4. apathy
5. confusion
6. abdominal cramps
7. orthostatic hypotension (drop in systolic BP more than 20 mm Hg)--Take BP with pt. lying or sitting and then standing to determine if there is significant drop
Causes of Hyponatremia: (7)
1. excessive intake of water without Sodium
2. Excessive loss of Sodium (vomiting, diarrhea, diaphoresis)
3.use of distilled water to irrigate body cavities
4. excessive secretion of antidiuretic hormone (ADH)
5. congestive heart failure
6. liver cirrhosis
7. nephrotic syndrome
Tx of Hyponatremia: (5)
1. restriction of fluids while kidneys excrete excess water
2. IV normal saline or Rigner's lactate may be ordered.
3. if sodium falls below 115 mEq/L, hypertonic sodium may be ordered
4. diuretic furosemide (Lasix) may be ordered b/c of its ability to promote water loss that exceeds sodium loss
5. patient has SIADH, drugs such as demeclocycline and lithium that antagonize antidiuretic hormone may be ordered.
Causes of Hypernatremia: (4)
1. vomiting
2. diarrhea
3. diaphoresis (profuse sweating)
4. insufficient antidiuretic hormone
Signs and Symptoms of Hypernatremia: (8)
1. thirst
2. flushed skin
3. dry mucous membrane
4. low urine outout
5. restlessness
6. increase HR
7. convulsions
8. postural hypotension
Tx of Hypernatremia: (2)
1. restore the fluid balance slowly to prevent cerebral edema resulting from excessive dilution of ECF
2. if pt. has an ECF volume deficit, IV fluids with decreasing amts. of sodium may be ordered.--) low sodium diet is prescribed
Causes of Hypokalemia: (7)
1. vomiting
2. diarrhea
3. nasogastric sunction
4. inadequate dietary intake of potassium
5. diabetic acidosis
6. excessive aldosterone secretion
7. drugs such as potassium-wasting diuretics and corticosteroids
Signs and Symptoms of Hypokalemia: (14)
1. aneroxia
2. abdominal distention
3. vomiting
4. diarrhea
5. muscle cramps
6. weakness
7. dysrhythimas (abnormal cardiac rhythms
8. postural hypotension
9. dyspnea
10. shallow respirations
11. confusion
12. depression
13. polyuria(excessive urine)
14. nocturia
Tx of Hypokalemia:
1. potassium replacement by the intravenous or oral route may be prescribed
Causes of Hyperkalemia: (3)
1. Decreased renal function
2. people in metabolic acidosis
people taking K+ supplement
3. Pts. with secere traumatic injuries b/c of loss of potassium from damaged cells into ECF.
Signs and symptoms of hyperkalemia: (7)
1. Bradycardia, then tachycardia --> risk of cardiac arrest
2.gastrointestinal systems, it can cause explosice diarrhea & vomiting
3. neuromuscular effects are muscle cramps and weakness and paresthesia (tingling sensation)
4. irratability
5. anxiety
6. abdominal cramps
7. decreased urine outout
Tx of hyperkalemia: (3)
1. correcting the underlying causes & restrictimng potassium intake
2. Polystyrene sulfonate (Kayexalate), drug given orally or rectally, promotes excretion of excess potassium through intestinal tract
3. IV calcium gluconate may be given to decrease the effects of potassium on the myocardium
What is hyperchloremia?
High serum chloride associate with metabolc acidosis
What is hypochloremia:
Low serum chloride, usually occurs when sodium is lost b/c chloride is most frequently bound with sodium
Causes of hypochloremia?
1. vomiting
2. uncontrolled diabetes
What is hypocalcemia?
Low serum level of calcium stimulates PTH secretion
Results of Hypocalcemia: (3)
2. inadequate dietary intake of calcium or vit. D
3. multiple blood transfusions
What is Hypercalcemia:
Increased serum levels of calcium
Causes of hypercalcemia?(4)
1. high calcium or vit. D intake
2. hyperparathyroidism
3. immobility that causes stores of calcium in the bones to enter bloodstream
4. complications of certain types of cancer
Results of hypomagnesemia:
1. decreased gastrointestinal absorption or excessive gastrointestinal loss , usually from vomiting and diarrhea, or from increased urinary loss

FYI..often associated w/ hypocalcemia and hypokalemia
What is hypomagnesemia?
A lower than normal concentration of magnesium in the bloodstream
What is hypermagnesemia?
A higher than normal concentration of magnesium in the bloodstream
Hypermagnesemia occurs:
1. Excessive use of magnesium-containing medications or IV solutions in pts. w/ renal failure or preeclampsia of pregnancy
List the four types of acid-base imbalances:
1. respiratory acidosis
2. respiratory alkalosis
3. metabolic acidosis
4. metabolic alkalosis
Cause of respiratory acidosis?
Cause of respiratory alkalosis?
Causes of metabolic acidosis? (4)
1. Diabetic ketoacidosis
2. Lactic acidosis
3. Diarrhea
4. Renal insufficiency
Causes of metabolic alkalosis? (4)
1. Vomiting
2. Bicarbonate retention
3. Volume depletion
4. Potassium depletion
List 10 conditions that have great potential for altering fluid balance:
1. Vomiting
2. Diarrhea
3. Kidney Disease
4. Diabetes
5. Salicylate poisoning
6. Burns
7. Congestive heart failure
8. Cerebral injuries
9. Ulcerative colitis
10. Hormonal imbalances
3 locations where skin turgor is best measured:
1. Pinching the skin over the sternum
2. Inner aspects of the thighs
3. Forehead
4 parts of the body against which skin is pressed to test for edema?
1. Tibia
2. Fibula
3. Sacrum
4. Sternum
What is the most serious effect of hykerkalemia?
Potential for life threatening dysrhythmia.
Hypervolemia: (3)
1. Dilute urine
2. Decreased urination
3. Stimulates aldosterone
Hypovolemia: (2)
1. Stimulates thirst
2. Inhibits ADH
Stimulates ADH release
Increased plasma osmolality
Inhibits ADH release
Decreased plasma osmolality
Stimulates aldosterone release
V/S changes in Fluid volume excess: (3)
1. Bounding pulse
2. Increased blood pressure
3. Subnormal body temp.
V/S changes in Hyperkalemia:
Weak, irregular, and rapid pulse
V/S changes in Hyponatremia:
Weak, irregular, and rapid pulse
V/S changes in Hypomagnesemia:
Increased pulse
V/S changes in Hypermagnesemia:
Decreased pulse
V/S changes in Metabolic acidosis:
Deep, fast, respirations
V/S changes in Metabolic alkalosis:
Slow, shallow respirations w/ intermittent periods of apnea
V/S changes in Fluid volume deficit: (4)
1. Fall in systolic blood pressure >20 mm Hg from lying to standing
2. Fever
3. Increased respiratory rate
4. Hypotension
The major electrolytes in extracellular fluid are: (2)
Sodium & chloride
Extracellular fluid is made up of _________ fluid and ___________ fluid.
interstitial, intravascular
What two major compartments are body fluids located within?
Intracellular & extracellurar body fluids
Negatively charged ions?
Positively charged ions?
The concentration of electrolytes in a solution or body fluid compartments is measured in:
milliequivalents (mEq)
What stimulates osmoreceptors in the hypothalmus to give the sensation of thirst?
increased plasma osmolality
Water loss via the skin and lungs increases in a:
hot, dry environment
What percentage of the plasma is filtered by the glomerulus?
Because the retention of sodium causes water retention, aldosterone acts as a regulator of:
blood volume
One way the body trie to compensate for fluid volume deficits is to:
increase heart rate
ADH is decreased in response to:
fluid volume deficit
The body tries to compensate for fluid volume excess by:
inhibiting aldosterone
The 2 electrolytes that causes a majority of health problems when there is an imbalance are:
sodium and potassium
The major cation involved in the structure of bones and teeth is:
When your body goes without fluid intake, which hormone increases water reabsorption?
Low levels of serum potassium can result in serious distrurbances of: (2)
neuromuscular function and cardiac function
An extracellular anion that is usually bound with other ions are? (3)
Sodium, potassium, and chloride
Which of the following drugs cause hypokalemia? (2)
Diuretics and corticosteroids
99% of the body's calcium is concentrated in the: (2)
bones and teeth
If more calcium is needin in the bones, it is tajen from the blood as well as reabsorbed through the:
Next to potassium, the most abundant cation in the intracellular fluid is:
Hard, edematous tissue, called brawny edema, occurs commonly after:
Radical mastectomy
One liter of fluid retention equals a weight gain of:
2.2 lbs.
Which assessment finding is reliable indicator of fluid status in an 80 yr. old person? (3)
1.pitting perioheral edema
2. intake and output
3. mucous membrane moisture
If a depression reminas in the tissue after pressure is applied with a fingertip, the edema is described as:
A deep and persistent pit that is approx. 1 in. deep is described as:
When the edema is so severe that pitting is not possible and the tissue feels hard, the edema is described as:
A red, swollen tongue suggests an excess of:
A dry mouth may be the result of:
fluid volume deficit
Distention of the jugular neck vein can indicate:
fluid volume excess
If the veins take longer than 3 to 5 sec. to fill when placed in a dependent position, the patient may have:
Weakness and muscle cramps are syptmoms of:
The normal range for urine pH is:
A urine specimen that is not tested within 4 hours of collection may become:
A measure of the kidney's ability to dilute or concentrate urine is called:
specific gravity
In most instances, normal urine specific gravity is between:
1.010 and 1.025
A good indicator of fluid balance is urine:
specific gravity
A more precise measurement of the kidney's ability to concentrate urine than the specific gravity is:
urine osmolality
A 24-hr urine specimen is required for:
creatine clearance
When the blood is more concentrated in a patient with fluid volume deficit, which blood study results is expected?
increased blood urea nitrogen (BUN)
BUN provides a measure of:
renal function
In a patient whith fluid volume excess, which blood study result would you expect?
decreased osmolality
What is a symptom of hyponatremia?
What amt. of fluid per day is needed by the average person for adequate hydration?
1500-2000 ml/day
When breathing problems occur in a patient with fluid volume excess, the patient should:
have head of bed elevated 30 degrees.
If pitting edema is present in patients with fluid volume excess, patients should:
be turned every 2 hours
To prevent hyponatremia in patients with feeding tubes, what should be used for irrigation?
normal saline
The heart rate of patines on digitalis should be closely watched b/c hypokalemia can contribute to:
digitalis toxicity
In order to prevent gastrointestinal irritation, oral potassium supplements should be given w/:
a full glass of water or fruit juice
Which must be checked before starting an intravenous infusion of potassium:
urine output
Decreased renal function can cause:
The homeostasis of the hydrogen ion concentration in the body fluids is:
acid- base balance
The respiratory system regulates the pH by:
removing carbon dioxide from the blood
When the respiratory system fails to eliminate the appropriate amt. of carbon dioxide to maintain the normal acid-base balance, what occurs?
respiratory acidosis
Nursing care for patiens with hypokalemia includes: (2)
monitoring serum potassium levels and EKG
Patients may develop high levels of magnesium in their blood if they are taking:
Hyperventilation is treated by having the patien:
breathe slowly
When patients with respiratory alkalosis are hyperventilating, they should be encourages to breath:
slowly into a paper bag
When the body retains too many hydrogen ions or loses too many bicarbonate ions, what occurs?
Metabolic acidosis
With too many acids and too few bases present in metabolic acidosis, the blood:
pH drops
When cells are damaged b/c of an injury, which cation is released?
Metabolic acidosis may be treated with intravenous infusion:
sodium bicarbonate
An increase in bicarbonte levels or a loss of hydrogen ions results in:
metabolic alkalosis
Potassium is a critical facto for the transmission of nerve impulses, b/c it is necessary for:
membrane excitability
In addition to its role in regulating fluid balance, sodium is also necessary for:
nerve impulse conduction
Symptoms of hyponatremia include: (2)
confusion, abdominal cramps
Most common cause of hypocalcemia is related to problems with which hormone?
Approx. ___ to ___ of the human body is composed of water.
50% to 60%
To maintain homeostasis, the body must be able to _____________.
regulate the fluids within it.
Process of homeostasis involves:
delivery of nutrients and oxygen to the cells and removal of wastes, including carbon dioxide, from the cells.
What is the function of extracellular fluid?
Responsible for the transport of nutrients and wastes throughout the body.
What are electrolytes?
Substances that develop an electricl charge when dissolved in water, maintain a balance between positive and negative charges to keep the body in homeostasis.
The fluid compartments of the body are seperated by _______________ that control the movement of water and certain solutes.
selectively permeable membrane
Water solutes move between intracellular and extracellular fluid compartments by one or more of the following processes:
1. diffusion
2. active transport
3. filtration
4. osmosis
Primary regulators of fluid balance in the body, and the nephrons conduct the work through the processes of filtration, reabsorption, and secretion?
Hormones that have a major effect on fluid balance includes:
Renin, aldosterone, antidiuretic hormone (ADH), and atrial natriuretic factor (ANF).
What is the renin?
Secreted when blood volume or blood pressure falls. It stimulates release of aldosterone and helps produce angiotensin I, which is converted to angiotensis II- a potent vasocontrictor.
What is the aldosterone?
Secreted by the adrenal glands and promotes sodium retention.
What is antidiuretic hormone (ADH)?
Produced by the hypothalmus and secreted by the posterios pituitary gland, promotes water retention.
What is atrial natriuretic factor (ANF)?
Secreted when stretch receptors in atria detect an increase in blood volume. It promotes excretion of water and sodium, decreases renin synthesis, inhibits release of aldosterone and ADH, & causes vasodilation.
The thirst center creates a desire to drink fluids when _____________________.
extracellular fluid becomes concentrated.
In a healthy adult the 24-hr. fluid intake and output are ___________.
approx. equal
The body attempts to compensate for fluid volume deficits by: (2)
increasing the heart rate and conserving water in the kidneys.
The body attempts to compensate for fluid volume excess by:
increasing urine outputkidney
Primary regulators of electrolytes in the blood?
2 electrolytes that cause the majority of problems when there is an imbalance:
sodium and potassium
A good indicator of fluid loss or rentention:
change in body weight
Result of an edema?
Reflects sodium retention, which can result from excessive reabsorption or inadequate secretion b/c of failing kindey function.
Because of older adults often have a reduced thirst sensation and may not conserve water efficiently, they are at risk for:
fluid volume deficit
What is acid-base balance?
The homeostasis of the hydrogen ion concentration in the body fluids
What are the mechanisms that maintain acid-base balance are:
blood bufferes, respiratory control of carbon dioxide, and renal regulation of bicarbonate
Acid-base imbalance occurs when:
an imbalance in the functioning of the lungs, kidneys, or both exists.
The largest portion of a person's body weight is contributed by:
A hormone with physiologic effects that decrease blood pressure is:
atrial natriuretic facto (ANF)
Older adults risk of fluid and electrolyte imbalance?
Older adults have limited reserves to maintain fluid balance when abnormal losses occur.
A pt. is receiving diuretics to eliminate excess fluid that has been retained in body tissues. In 2 days the pt. lost 4.4 lps in body weight. This represents how much fluid loss?
2 Liters
You gently pinch the skin over a patient's sternum. The skin does not flatten right away, leading you to suspect:
Fluid volume excess can be classified as intracellular or:
When a pt. has a potassium imbalance, what nursing assessment is most important?
Monitor heart rate and rhythm
What is the mechanisms that maintain acid-base balance?
Buffers, respiratory regulation, renal regulation
What is the physiologic function of deep, rapid respirations in metabolic acidosis?
Reduces PaCO2, resulting in a rise in blood pH and correction of acidosis.
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