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Fluid & Electrolytes

Chronic Exam #1

Role of sodium (Na+) (extracellular) osmolarity, affects water distribution bw ECF and ICF
normal Na lab value 135-145 mEq/L
Purpose of potassium (K+) (intracellular) key role in cardiac, skeletal and sm ms contraction, generation and transmission of nerve impulses
normal lab values of K+ 3.5 - 5.0 mEq/m
Na sources cheeses and ham
K sources spinach, potatos, bananas, nuts, citrus fruits
Role of Calcium (Ca+) (cardiac/neuromuscular function), bl coagulation
normal lab values of Ca 9.0 - 10.5 mg/dL
sources of Ca nuts/seeds, leafy greens, fish, beans
oliguria <30 cc/hr
intracellular fluids fluids within cell membranes, 40% body weight, provides cells with internal aqueous medium necessary for chemical functions
extracellular fluids fluids outside cell membranes, 15-20% body weight, bodys transportaiton system
extracellular fluids consists of... interstitial fluid (fluid in tissues) and intravascular fluid (plasma)
4 means of movement of body fluids filtration, diffusion, osmosis, active transport
Filtration movement of fluid through a membrane as a result of hydrpstatic pressure differences
diffusion process by which solid, particulate matter moves from an area of higher concentration to an area of lower concentration
osmosis process by which a solvent (water) moves through a semipermeable membrane from a solution of lower concentration to a higher concentration
active transport movement of materials across a cell membrane by the use of metabolic activity and energy expenditure (Na/K pump)
Regulation of fluid intake regulated by thirst mechanism in hypothalamus, thirst stimulated by increased serum osmolarity and decreased bl volume, water acquired from food and oxidation of food during digestion
Regulation of fluid output losses occur through kidneys, GI tract, skin via sweat, lungs
sensible loss perceived by individual
insensible loss continued water loss not perceived by the individual
hormones in the regulation of fluid and electrolytes aldosterone, ADH
Aldosterone mineralcorticoid produced by adrenal cortex, causes kidneys to reabsorb Na and excrete K (increased Na causes increased water retention)
ADH (antidiuretic hormone) rel from post pituitary gland in response to stimulation from the hypothalamus, increases the reabsorption of water by the kidney tubules, rel is increased with a decrease in the bodys fluid volume
causes of fluid deficit excessive sweating, fever, impaired thirst or decreased fluid intake
specific causes of fluid deficit prolonged vomiting/diarrhea, hemorrhage, wound/fistula drainage, burn, diuretic therapy, diabetic ketoacidosis
assessment findings of fluid deficit dry skin and mucous membranes, poor skin turgor, coated tongue, low BP, collapsed veins, weak pulses, oliguria
laboratory findings of fluid deficit increased Hgb and Hct, increased BUN, increased specific gravtiy, increased serum osmolarity
Management of fluid deficit fluid/electrolyte restoration (oral/IV replacement), treat underlying cause
monitor for complications of fluid deficit I and O, vital signs, skin turgor, lab values, assess vein filling, provide oral hygiene, ,monitor daily weights (same time) A pint a pound, the world is round (500cc)
causes of fluid excess increased ingestion, decreased excretion of water (renal failure, inability of heart to circulate fluids)
assessment findings of fluid excess generalized edema, weight gain, crackles, bounding pulse, distended neck veins, headache, decreased orientation, visual changes, seizure, coma, low serum Na level
lab findings of fluid excess decreased Hgb and Hct, decreased BUN, decreased specific gravity, decreased serum osmolarity
management of fluid excess restrict fluids, restrict Na intake, promote increased urine output, improve cardiac function
monitor for complications of fluid excess I and O, daily weights, vital signs, lung sounds, edema, labs
ways to mobilize fluids TED hose, turning, positioning, elevating feet
How to prevent shortness of breath apply oxygen, position in high Fowlers
etiology of electrolyte imbalances decrease intake and availability or increase loss of an electrolyte, increase intake and retention or decrease excretion of kidneys
what is used to diagnose electrolyte imbalance? plasma levels in lab studies and through clinical manifestations
lab values for Hyponatremia <135 mEq/L Na
etiology of hyopnatremia water loss (diuretics, vomiting, diarrhea, excessive sweating), net water excess...intracellular edema due to fluid shofts (results from loss of sodium containing fluids
signs of hyponatremia confusion, nausea, vomiting, seizures, coma
management of hyponatremia restore Na+ levels, fluid restrictions
lab values for hypernatremia Na > 145 mEq/L
what is hypernatremia? elevated serum sodium occuring with water loss or sodium gain, leads to dehydration (excess fluid loss, excess Na intake)... increases myocardial depolarization
early symptoms of hypernatremia thirst, dry flushed skin, dry tongue and mucous membranes, polyuria, anorexia, weakness, restlessness, cramping
late symptoms of hypernatremia agitation, confusion, lethargy, seizures, coma, tremors, muscle twitching, rigid paralysis, discoordination
management for hypernatremia treat underlying cause, 5% dextrose in water, diuretics (excrete sodium)
lab values for hypokalemia K < 3.5 mEq/L
causes of hypokalemia abnormal losses fo K via the kidneys or GI tract, Mg deficiency, metabolic alkalosis
signs and symptoms of hypokalemia most serious are cardiac!!, skeletal ms weakness, respiratory ms weakness, decreased GI motility
management of hypokalemia KCl supplements orally or IV
lab values for hyperkalemia K > 5.0 mEq/L
causes of hyperkalemia massive intake, impaired renal excretion, shift from ICF to ECF
signs and symptoms of hyperkalemia weak or paralyzed skeletal muscles, ventricular fibrillation or cardiac standstill, abdominal cramping, diarrhea
management of hyperkalemia eliminate oral and parenteral K intake, increase elimination of K (diuretics, dialysis)
lab values for hypocalcemia Ca < 9.0 mg/dl
causes of hypocalcemia decreased production of PTH, acute pancreatitis, multiple bl transfusions, alkalosis, decreased intake
signs and symptoms of hypocalcemia positive Trousseau's or Chvosteks sign, laryngeal stridor, dysphagia, tingling around the mouth or extremities
management os hypocalcemia oral or IV calcium supplements, treat pain and anxiety to prevent hyperventilation
lab values for hypercalcemia Ca > 10.5-11 mg/dl
causes of hypercalcemia hyperparathyroidism, malignancy, vitamin D overdose, prolonged immobilization
signs and symptoms of hypercalcemia polyuria r/t osmotic diagnosis, anorexia, constipation, nausea, abdominal distension, fatigue, depression, muscle weakness
management of hypercalcemia excretion of Ca with loop diuretic, hydration with isotonic saline solution, synthetic calcitonin, mobilization
phosphate lab values 2.5-4.5 mg/dl
phosphate primary ICF anion, essential to function of muscle, red blood cells, and nervous system. deposited with Ca for bone and tooth structure, inversely related to calcium
lab values for Hypomagnesemia Mg < 1.5 mEq/L or 1.8 mg/dl
causes of hypomagnesemia related to less intake and absorption
signs and symptoms of hypomagnesemia confusion, hyperactive deep tendon reflexes, tremors, seizures, cardiac dysrhythmias
management of hypomagnesemia oral supplements, increase dietary intake, parenteral IV or IM Mg when severe
lab values for hypermagnesemia Mg > 2.5 mEq/L
causes of hypermagnesemia increased intake or ingestion of products containing Mg when renal insufficiency or failure is present
signs and symptoms of hypermagnesemia lethargy or drowsiness, N/V, impaired reflexes, respiratory and cardiac arrest
management os hypermagnesemia prevention, emergency treatment (IV CaCl or calcium gluconate... Ca inversely related) fluids to promote urinary excretion
Created by: waiddancer