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Fluid/Electrolyte
Fluid & Electrolytes LPN
| Question | Answer |
|---|---|
| Intracellular Fluid (inside cells) | More Fluid |
| Extracellular Fluid (outside cells) | Less Fluid |
| Organs of fluid loss | Kidneys, skin, lungs, GI tract |
| Osmosis (fluid/water) | Movement of fluid from an area of lower solute concentration to an area of higher solute concentration with eventual equalization |
| Diffusion (solutes) | Movement of solutes from an area of greater concentration to an area of lesser concentration. |
| Hypervolemia | Equal/isotonic expansion of Extra-cellular plasma. Retention of sodium & H2O in equal proportions. |
| Hypervolemia | Almost always result of increased total body sodium |
| Hypervolemia Causes | Excessive salt intake, renal failure, heart failure, cirrhosis of the liver |
| Hypervolemia clinical manifestations | Edema, distended neck veins, abnormal lung sounds, increased weight, increased urine output, tachycardia, increased B/P |
| Hypervolemia Diagnostics | BUN and hematocrit levels decreased due to plasma dilution (too much water) |
| Hypervolemia Diagnostics | Sodium, Urine specific gravity, physical exam, chest x-ray |
| Sodium | 135-145 mEq/L |
| BUN (kidney function) | 10-20 mg/dl |
| Hematocrit | 42-52% male35-47% female |
| Hypervolemia management | Restrict sodium and fluid, TED hose improve venous return, diuretics, dypsnea can occur, dialysis if severe |
| Potassium sparing (weakest) | spironolactone can cause hyperkalemia |
| Thiazide (moderate) | hydrochlorothiazide, can cause hypokalemia (potassium low) and hyponatremia (low sodium) |
| Loop Diuretics (most potent) | Rapid onset, can cause hypokalemia (potassium low) and hyponatremia (low sodium) ototoxicity: hearing loss |
| Hypovolemia | Fluid volume deficit H20 & electrolytes lost in equal proportions |
| Hypovolemia Risk Factors | Fever, tachypnea (rapid breathing), vomiting, diarrhea, gi suctioning, sweating, hemorrhage, excercising |
| Hypovolemia Risk Factors | Malnutrition, sepsis, burns, ascites, diabetes insipidus, adrenal insufficiency, incapacitated, elderly |
| Diabetes insipidus | condition characterized by excessive thirst and excretion of large amounts of severely diluted urine |
| Hypovolemia Clinical manifestations | Thirst, anorexia, nausea, fatigue, muscle weakness, cramps, increased HR, increased B/P, cool, clammy skin if severe |
| Hypovolemia Labs | BUN = 20:1, usually 10:1, hematocrit increased, Urine specific gravity increased |
| Hematocrit (Percentage of RBC's) | 42-52% male, 35-47% female |
| Urine Specific Gravity | 1.010-1.025 |
| Hypovolemia (management) | Replace fluids PO if not severe, Isotonic IV fluids, Anti-emetics for vomiting, Anti-diarrheals, accurate & frequent I&O |
| Hypovolemia (management) | Frequent Assessment & VS, level of consciousness, skin color, skin turgor, weight (1L=2.2lbs), breath sounds |
| Hypovolemic Shock | Significant fluid lost from intravascular space occurs in hemorrhage, burns, GI loses |
| Hypovolemic Shock | Symptoms: increased pulse, increased B/P, Urine output <30 ml/hr, thirst, neuro changes |
| Hypovolemic Shock | Actions: Fluid replacement with colloids (blood products) Isotonic (normal saline) Supine position-elevate legs, Monitor vital signs, I/O's |
| Third Spacing | Sometimes fluid is not lost from the body but is unavailable for use by either the ICF or ECF. |
| Third Spacing | The movement of body fluid to a non-functional space, occurs frequently and can be potentially fatal |
| Third Spacing | Decrease in urine output, occurs in ascites (edema within peritoneal cavity), burns, peritonitis, trauma, lymphatic obstruction |
| Anasarca | Severe, widespread accumulation of fluid in all of the tissues and cavities of the body at the same time. |
| Third Space | Peripheral edema, organ edema |
| MEq | measure of chemical activity |
| Cations | Positive charge, Sodium (Na+) Potassium (K+) Calcium (Ca+) Magnesium (Mg+) |
| Intracellular | Contains K+ Potassium |
| Extracellular | Contains Na+ Sodium |
| Most common electrolyte imbalances | Potassium and Sodium |
| Sodium | Most abundant solute in ECF, responsible for muscle contraction & transmission of nerve impulses |
| Aldosterone | Conserves sodium, regulate Na+ balance |
| Hyponatremia | Serum Na <135 |
| Hyponatremia Risk Factors | Renal: diuretics, Adrenal insufficiency, low aldosterone, Non renal: vomitting, diarrhea, excessive sweating, excessive water intake, hypervolemia, IV therapy, head injury |
| Hyponatremia management | Na+ replacement slowly not to exceed >12 mEq/L in 24 hrs., isotonic solution, water restriction |
| Hypernatremia | Na+ >145 |
| Hypernatremia Risk Factors | Dehydration, elderly, infants, comatose, GI diarrhea, high Na+ diet, diabetes insipidus, heat stroke |
| Dehydration | Behavioral changes in elderly |
| Hypernatremia Clinical Manifestations | Flushed skin, dry, swollen tongue, peripheral edema, pulmonary edema |
| Hypernatremia prevention & mangement | Diuretics, IV fluids, hypotonic electrolyte solution, 0.3% sodium chloride |
| Potassium (3.5-5) | Major intracellular electrolyte, influences skeletal & cardiac muscles, 80% excreted from kidneys, 20% lost bowel & sweat |
| Hypokalemia <3.5 causes risks | Too much insulin, insulinemia, burns, vomiting, diarrhea, NG suctioning, diuretics |
| Hypokalemia clinical manifestations | Cardiac: dysrhythmias & weak pulse, flat/inverted T-waves on ECG, cardiac & respiratory arrest |
| Hypokalemia Prevention & management | K+ replacement slowly, never administer IV push, cardiac arrest |
| Hyperkalemia K+ >5 | Prolonged use of tourniquet, anemia, K+ intake (salt substitutes) renal failure most common |
| Hyperkalemia clinical manifestations | Cardiac, slow irregular puse, hypotension, restlessness, irritability, weakness, paralysis, diarrhea |
| Hyperkalemia management | Diuretics, PO or rectal enema, Insulin, dialysis |
Created by:
angienoriega
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