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FLUIDS & LYTES
F & E
| Question | Answer |
|---|---|
| Fluids located inside cells is called | intracellular |
| Fluids outside cells is called | extracellular |
| ECF is divided into 3 types....name them | interstitial, intravascular and transcellular |
| Water that surrounds the body cells including lymph is called? | interstitial |
| fluid and electrolytes move between what types of fluid referred to as plasma? | interstitial and intravascular fluid |
| where is transcellular fluid found? | CSF, digestive juices and synovial joints |
| what hormone controls water primarily | ADH |
| where is ADH released from? | pituitary gland |
| what is the most common example of active transport? | sodium potassium pump |
| where is the sodium and potassium pump located? | in the cell membrane |
| what type of transport is it when there is no energy expended? | passive |
| what are the 3 passive transports? | diffusion, filtration and osmosis |
| what does filtration do? | moves water, nutrients and waste products in the capillaries |
| What is osmosis? | movment of water from an area of lower substance concentration to an area of higher concentration |
| what is the normal osmolarity of blood | 270-300 milliosmoles per liter |
| what is another term for osmolarity? | tonicity |
| what are the 3 classifications of tonicity? | isotonic, hypotonic, hypertonic |
| what happens on a cellular level when a hypotonic solution is given to a patient? | water leaves the blood and other ECF areas |
| what happens when a h ypertonic solution is given to a patient? | water leaves the cells and enters the bloodstream and other ECF spaces |
| Why are older adults more prone to FV deficit? | they have diminished thirst reflex and kidneys do not function as effectively |
| how much sensible and insensible fluid does an adult lose each day? | 2500 ml |
| What are sensible losses? | those that occur with the person recognizing the loss |
| Why are infants at risk for FV deficit | because they take in and excrete a large portion of their total body water each day |
| When does hypovolemia occur? | when a person is hemorrhaging or when fluids from other body parts is lost |
| What is 3rd spacing? | when fluid from the intravascular space moves into the interstitial fluid space |
| When can 3rd spacing occur? | burns , trauma, liver cirrhosis |
| What is tenting? | poor skin turgor where skin remains at a pulled up position for a prolonged period of time |
| at what point is dehydration considered when referring to urinary output | when <30ml/hr |
| why does a dehydrated person become constipated | because water is pulled from the feces in an attempt to rehydrate the body |
| What 2 lab levels would you expect to see elevated with dehydration | BUN, Hct |
| what type of fluid is used commonly for dehydration | isotonic |
| where do you assess for skin turgor on the elderly | forehead or sternum |
| what is the most reliable indicator of fluid loss or gain | weight |
| how often should someone in the hospital for dehydration be weighed? | daily |
| when should someone be weighted | at the same time before breakfast using the same scale |
| what is the expected clinical outcome when someone is treated for dehydration | adequate hydration and not experience any further episode of dehydration |
| What culture may place themselves at risk for dehyration during Ramadan? | Muslims |
| what is the most common result of fluid overload? | hypervolemia |
| what conditions cause FV overload? | excessive intake of fluid, poorly controlled IVs and excessive irrigation of wounds or body cavities |
| what conditions can result in fluid volume excess? | renal failure, heart failure, SIADH |
| what are the signs and symptoms of FV overload? | elevated BP, pulse bounding, respirations increased but shallow, pitting edema in LE, skin cool, pale |
| how does the urine appear in FV overload? | diluted, like water |
| what respiratory symptom is found on auscultation with FVO? | crackles |
| what happens to BUN and HCT with FVO? | they tend to decrase due to hemodilution |
| what happens to the specific gravity of the urine in FVO? | decreases |
| what position is desired with FVO? | semi or high fowler's |
| with COPD what is the max desired oxygen delivery rate? | 2 L/min |
| what drugs are frequently used to address FVO? | Lasix, diuretics |
| What med is used normally in conjunction with lasix? | potassium |
| How much weight gain is considered fluid retention? | 1-2 lb per day |
| what foods are typically highest in potassium? | oranges, citrus, melons, bananas, and potatoes |
| in the home setting how often should a person be weighed if he is at risk for FVO? | 3 times weekly |
| what are the 2 types of electrolytes | cations and anions |
| what electrolytes have a positive charge | cations |
| what are some common cations? | sodium, magnesium, potassium, calcium |
| what is a common anion? | chloride |
| How much sodium does 1 tsp of table salt have? | 2000mg |
| what veggie has a high amount of potassium | avocado |
| what is the normal sodium level? | 135 to 145 mEq/L |
| What is the sodium level with hyponatremia? | less than 135 mEq/L |
| what is the s/sx of hyponatremia? | vague normally associated with the s/sx of the fluid status |
| What may the patient experience with low sodium level? | mental status changes, disorientation, confusion and personality changes, cerebral edema, weakness, nausea, vomiting and diarrhea |
| what happens in severe hyponatremia? | respiratory arrest, coma |
| what is the IV solution of choice in one with hyponatremia? | isotonic or 3% saline |
| what is administered with those with cerebral edema? | steroids |
| What is the sodium level in hypernatremia? | >145 mEq/L |
| what is the difference between relative or actual increase in sodium? | actual = when someone takes in too much sodium relative= when someone is unable to excrete sodium |
| What is usually the first symptom to appear in hypernatremia? | thirst |
| what happens "at first" with hypernatremia with regards to signs? | muscle twitches and unusual contractions |
| What are the later signs of hypernatremia? | skeletal muscle weakness, leading to respiratory failure |
| What is the most reliable test for hypernatremia? | serum sodium level |
| if there is a fluid imbalance with hypernatremia what is treated first ? | fluid balance is treated first |
| what may be needed if kidneys are not functioning properly | hemodialysis |
| What is the most common electrolyte in the ECF? | potassium |
| what is potassium especially important for? | cardiac, skeletal and smooth muscle function |
| What is the K level in hypokalemia | below 3.5 mEq/L |
| when does hypokalemia most often occur? | as a result of medication |
| what meds commonly cause hypokalemia | diuretics, digitalis, steroids |
| What also contributes to hypokalemia (think GI) | vomiting, diarrhea, prolonged suction, major surgery ahdn hemorrhage |
| What occurs with both hypo and hyperkalemia with regards to signs? | muscle cramping |
| What are the signs of hypokalemia? | skeletal muscle activity dminishes, shallow ineffective respirations, pulse is weak, irregular and thready, dysrhythmia, orthostatic hypotension |
| what nervous system changes are seen with a lab potassium value of 2.8 mEq/L? | changes in mental status, lethargy |
| What happens to the GI system with hypokalemia? | slowed , nausea, vomiting, abdominal distention, constipation |
| what complication from hypkalemia puts a patient at risk for death? | dysrhythmia |
| what is the goal of treatment with hypokalemia? | replace potassium |
| what is given for treatment of severe hypokalemia? | IV potassium |
| can potassium be given IVP? | NO |
| What is the lab value associated with hyperakalemia? | K greater than 5 mEq/L |
| What may cause hyperkalemia?> | salt substitues, excess intake of potassium supplement, potassium sparing diuretics, renal failure |
| What is the classic manifestation of hyperkalemia on assessment? | muscle twitches and cramps |
| What follows muscle twitching and cramps with hyperkalemia? | profound muscle weakness, increased GI motility, slow irregular heart rate, decreased BP |
| what is the med treatement for hyperkalemia>? | kayexalate |
| What is the normal value for Caclium levels | 9-11mg/dL or 4.5 to 5.5 mEq/L |
| what is the lab reference for hypocalcemia? | below 9mg/dL or 4.5 mEq/L |
| who is most at risk for hypocalcemia | postmenopausal woman |
| what is the condition called when the parathyroid stimulates calcium from bone to be released? | osteoporosis |
| who is at highest risk for osteoporosis? | thin, petite, caucasian women |
| What GI disease is often associated with hypocalcemia? | Crohns |
| How much calcium should an adult age 19 to 50 take? | 1000mg |
| what should the intake of calcium be for adults over age of 50 | 1200mg |
| What is an inexpensive suggestion for calcium supplements? | TUMS |
| When is chronic hypocalcemia usually diagnosed? | when someone breaks a bone usually a hip |
| When does acute hypocalcemia occur? | after surgery or in patient with acute pancreatitis |
| What are the signs and symptoms of acute hypocalcemia? | incr. and irreg heart rate, mental status changes, hyperactive deep tendon reflexes, increased gi motiltiy and diarrhea |
| a tap on the face below and infront of the ear resulting in a twitch on that side of the face is called what sign? | Chvostek's |
| What IV preparations of calcium are given? | calcium chloride or calcium gluconate |
| What med should be available for emergency use after thyroid or parathyroid surgery? | calcium gluconate or calcium chloride |
| What can cause chronic hypercalcemia? | excess intake, renal failure, cancers, hyperparathyroidism |
| What is the sign and symptoms of chronic or slow onset hypercalcemia? | none |
| What are the signs of acute hypercalcemia? | incrased heart rate and blood pressure, skeletal muscle weakness, decreased GI motility, decreased clotting capability |
| What is the most useful IV solution in treating hypercalcemia? | saline |
| What may be used if the hypercalcemia is severe? | hemodialysis, peritoneal dialysis, ultrafiltration |
| What is the normal lab reference for magnesium? | 1.5 to 2.5 mEq/L |
| What are the causes of hypomagnesemia? | malnutrition and starvation diets, severe diarrhea, Crohn' |
| What is one of the MAJOR causes of hypomagnesemia? | alcoholism |
| What types of drugs contribute to hypomagnesemia? | loop and osmotic diuretics, aminoglucosides, anticancer agents |
| what is the goal of management of hypomagnesemia? | replacement and treating the underlying cause |
| When are the signs of hypermagnesemia usually present? | when the serum level exceeds 4 mEq/L |
| What are the signs and symptoms of hypermagnesemia? | bradycardia, hypotension, lethargy, drowsiness, skeletal muscle weakness, |
| What is the treatment option for hypermagnesemia with those in renal failure? | dialysis |
Created by:
Kelly Quijano
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