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fluid&electrolytes
| Question | Answer |
|---|---|
| ____ % of weight in average adult is water | 60 |
| Components of extracellular fluid | Interstitial, intravascular, and transcellular fluid |
| Fluid between the cells and outside the blood vessels | interstitial fluid |
| Extracellular fluid containing lymph | Interstitial fluid |
| Liquid portion of the blood | intravascular fluid |
| Blood plasma found in the vascular system | intravascular fluid |
| Fluid that is separated from other fluids by a cellular barrier | transcellular fluid |
| Examples of transcellular fluid | CSF, pleural fluid, GI fluid, peritoneal fluid, intraocular, synovial fluids |
| Best indicator of fluid status | Daily weight |
| Positively charged ions | Na, K, Ca |
| Negatively charged ions | Cl, HCO3, SO4 (Chloride, bicarbonate, sulfate) |
| The number of grams of the electrolyte dissolved in a liter of plasma | mEq/L |
| Movement of a pure solvent from an area of lesser concentration to an area of greater concentration | Osmosis |
| Random movement of solute from an area of higher concentration to an area of lower concentration | Diffusion |
| Example of diffusion in the body | movement of CO2 and O2 between the alveoli in the lungs |
| Regulates fluid intake | thirst mechanism |
| Process by which water and diffusible substances move together across a membrane | Filtration |
| Movement from an area of higher pressure to an area of lower pressure | filtration |
| Example of filtration | Edema (intravascular to interstitial) |
| Filtration can be caused by: | congestive heart failure |
| Location of the thirst control center | hypothalamus |
| Transport that requires metabolic activity and energy | active transport |
| Allows cells to admit larger molecules | Active transport |
| Stimulated when excess fluid is lost | hypothalamus |
| Solute that is the greatest contributor to the osmolarity of a fluid | sodium |
| Most important regulator of fluid intake | thirst |
| Hormone stored in the pituitary that is released in response to changes in blood osmolarity | ADH |
| What types of IV fluids would be given to a dehydrated patient | hypotonic or isotonic |
| Works directly on renal tubules and collecting ducts to make them more permeable to water | ADH |
| Action of aldosterone | Retain Na and H2O, excrete K |
| Secreted from the atrial cells in response to stretching and an increase in circulating blood volume | ANP |
| Opposes ADH; acts as a diuretic causing Na loss | ANP |
| Average daily output | 1-2 L |
| 4 organs of water loss | kidneys, skin, lungs, GI tract |
| Insensible water losses | continuous and occurs through skin and lungs |
| About ___ L fluid circulates through the GI tract per day | 8 |
| Most fluid circulating through GI is reabsorbed in the: | small intestine |
| Insensible water losses can be significant with: | fever and burns |
| Sensible water loss | occurs through excess perspiration |
| Fluid volume deficit | hypovolemia |
| Risk factors for hypovolemia | lethargy, depression, vomiting, dementia, fever, difficulty swallowing, diarrhea, unable to speak, paralysis, anticholinergic drugs, etc |
| Reduced body fluid in both intracellular and extracellular compartments | hypovolemia |
| translocation of fluids from intravascular or intracellular space to tissue compartments | third-spacing |
| A high ratio of blood components | hemoconcentration |
| Problem with hemoconcentration | increases risk of blood clots and kidney stones |
| Early symptom of hypovolemia | thirst |
| Hematocrit levels and hypovolemia | elevated except in hemorrhage |
| normal hematocrit levels | Men: 37-52% women: 37-47% |
| Medical management of hypovolemia | increasing oral or IV fluids, antibiotics, antidiarrheals, antiemetics, control fluid loss |
| Report a loss of ___ or more lbs in 24 hours | 2 |
| 2 lb loss = ___ L of body fluid | 1 |
| Symptom of hypovolemia seen on the tongue | furrowing |
| Specific gravity of urine with hypovolemia | 1.020 |
| Fluid volume excess | hypervolemia |
| high volume of water in the intravascular fluid compartment | hypervolemia |
| Causes of hypervolemia | excessive oral intake, rapid IV infusion, heart failure, kidney disease, excessive salt intake, steroid drugs |
| At risk for hypervolemia | increased ADH production, steroids, excess consumption |
| CM of hypervolemia | weight gain, elevated BP, light yellow urine, pitting & dependent edema, JVD, confusion, etc. |
| Early symptoms of hypervolemia | weight gain, elevated BP, increased breathing effort |
| There is usually a ___L fluid volume excess before pitting will occur | 3 |
| Low blood cell count and hematocrit | Hemodilution |
| Urine specific gravity seen with hypervolemia | Low |
| Central venous pressure seen with hypervolemia | elevated |
| Medical management of hypervolemia | fluid restriction, diuretics, salt restriction |
| Pulmonary indications of hypervolemia | crackles |
| Best indicator of fluid retention | weight gain |
| +1 pitting edema | 2mm slight retention normal contours |
| Interstitial fluid volume of 1+ pitting edema | Associated with interstitial fluid volume 30% above normal |
| +2 pitting edema | Deeper pit (4mm) last longer than +1 fairly normal contour |
| +3 pitting edema | deep pit (6mm) remains after several seconds skin swelling obvious by inspection |
| CM of brawny edema | no pitting hard tissue skin surface may be shiny, warm, moist poor circulation |
| Interventions for hypervolemia | coughing, turning q2h, inspecting |
| Third-spacing is associated with: | loss of colloids, burns, allergic reactions, liver failure |
| Assessment of third-spacing | S/S hypovolemia except weight loss, localized enlargement of body cavity or organ |
| Medical management of third-spacing | restore circulatory volume and eliminate trapped fluid, administer IV fluids and blood products or albumin, IV diuretics |
| Normal value for sodium | 135-145 mEq/L |
| Main cation in extracellular fluid | Na |
| Electrolyte that maintains normal nerve and muscle activity | Na |
| Main role is to regulate and distribute fluid volume | Na |
| 2 main problems with hyponatremia | more H2O than Na (Na is diluted) Losing more Na than H2O (sweating, diarrhea, vomiting) |
| S/S: mental confusion, muscle weakness, anorexia, restlessness, tachycardia, seizures, coma | Hyponatremia |
| Serum osmolarity in hyponatremia | less than 280 (dilute blood) |
| Serum sodium in hyponatremia | less than 135 |
| IV treatment for hyponatremia | Fluids containing sodium cholride |
| Causes of hypernatremia | profuse watery diarrhea, excessive salt intake without sufficient water, high fever, decreased water intake, unconscious, diabetes insipidus |
| CM: dry, sticky mucous membanes, decreased urine output, fever, rough/dry tongue, restlessness, coma | Hypernatremia |
| Normal potassium levels | 3.5-5 mEq/L |
| Chief electrolyte found in intracellular fluid | potassium |
| Maintains electrical activity in the cells, assists in muscle contraction | potassium |
| Causes: Lasix, thiazide diuretics, fluid loss from GI, large doses of steroids, IV admin of insulin and glucose, alkalosis | hypokalemia |
| S/S May be flat T wave on ECG | hypokalemia |
| Hypokalemia treatment | increase K in diet, potassium sparing diuretics (Aldactone), IV potassium |
| What should be kept at the bedside of a patient with hypokalemia? | ambu bag |
| About ___ mEq of K is lost in each liter of urine | 40 |
| Dilution recommended for potassium infusions | no more than 1mEq/10mL solution |
| Maximum rate of potassium infusion | 5 to 10 mEq per hour; never exceed 20 mEq/hr |
| Acceptable routes for potassium administration | Oral or slow IV- NEVER give IV push, IM, or SubQ |
| Causes: renal failure, severe burns or crush injuries, acidosis, blood transfusions, addison's disease, chemo | hyperkalemia |
| CM: parasthesia, skeletal muscle weakness, hyperactivity in smooth muscles, decreased HR, irregular pulse, hypotension, cardiac arrest | hyperkalemia |
| Electrolyte imbalance that will have a widened QRS complex; tall, skinny, peaked T wave; and may have absence of P wave | hyperkalemia |
| Treatments for hyperkalemia | loop diuretics, potassium restrictions, kayexelate, calcium gluconate, sodium bicarbonate, 10 units regular insulin |
| Effect of insulin on potassium? | insulin sends K back into the cell |
| May be given to conteract effects on the heart seen with hyperkalemia, but does not bring K levels down | calcium gluconate |
| Cardiac monitoring of potassium if > ___? | 6mEq/L |
| If a patient with hyperkalemia is being given insulin, what should the nurse also monitor for? | hypoglycemia |
| If a patient with hyperkalemia is being given kayexelate, what should the nurse also monitor for? | serum sodium levels |
| Normal total calcium levels | 8.5-10 mg/dL |
| Normal ionized calcium levels | 4.5-5.5 mg/dL |
| __% calcium is found in the blood | 1 |
| Hormone that is released when blood Ca is low | PTH |
| Hormone that moves Ca back into the cells | calcitonin |
| Needed for blood clotting, muscle function, nerve impulses | Calcium |
| Needed for calcium absorption in the inestine | vitamin D |
| Calcium and ___ have an inverse relationship | Phosphorous |
| Hormone that takes calcium from the bones and puts it in the blood | PTH |
| Causes: vitamin D deficiency, hypoparathyroidism, severe burns, acute pancreatitis, corticosteroids, alkalosis, hypomagnesemia, alcoholism, high phosphorous | hypocalcemia |
| One of the most common causes of hypocalcemia | removed thyroid gland |
| Most common sign of hypocalcemia | tingling in the extremities and around the mouth |
| Positive Chvostek's or Trousseau's sign indicate what electrolyte imbalance? | hypocalcemia |
| CM: muscle cramps, diarrhea, laryngeal spasms, hyperactive reflexes, tetany, seizures, bleeding, dysrhytmias | hypocalcemia |
| Hypocalcemia treatment | IV calcium gluconate or calcium chloride; oral supplements with vit D |
| What should be kept at the bedside of a patient with hypocalcemia? | tracheostomy and suction |
| Often associated with parathyroid gland tumors, multiple fractures, Paget's disease, hyperparathyroidism, excessive vitamin D, chemo, prolonged immobilization, antacid abuse ,hypophosphatemia, acidosis | hypercalcemia |
| CM: bone pain, kidney stones, confusion, lethargy, hypertension, arrhythmias, decreased GI motility | hypercalcemia |
| Hypercalcemia treatment | decrease Ca in diet, hydration (NS IV), lasix, synthetic calcitonin (mithracin) |
| Which type of diuretic is not indicated for hypercalcemia? | thiazide (inhibit calcium excretion) |
| Normal Mg levels | 1.5-2.5 mEq/L |
| Involved in transmission of nerve impulses and muscle excitability | Mg |
| Activates the functioning of B vitamins and use of K and Ca | Mg |
| __% Mg contained in bones | 60 |
| Helps regulate Ca because it helps produce PTH | Mg |
| Levels in the blood regulated by GI and urinary systems | Mg |
| Causes of hypomagnesemia | alcoholism, DKA, kidney disease, burns, malnutrition, eclampsia, malaborption, excessive diuresis, hyperaldosteronism, prolonged diarrhea |
| S/S: CNS irritation, delusions, weak skeletal muscles, tremors, twitching, tetany, hyperactive DTNs | hypomagnesemia |
| Mg infusion rate | no more than 150 mg/min |
| How often should Mg levels be drawn from a person with hypomagnesemia? | after every bolus and every 6 hrs if on continuous drip |
| Causes of hypermagnesemia | kidney failure, advancing age, addison's disease, untreated DKA, excessive intake (antacids and laxatives) |
| S/S: decreased muscle and nerve activity, hypoactive DTRs, flushing, N/V, decreased LOC, shallow respirations | hypermagnesemia |
| Treatment of hypermagnesemia in an emergency situation | calcium gluconate IV |
Created by:
beshoe
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