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electrolytes
concepts 3
| Question | Answer |
|---|---|
| What percentage of body weight is water in an average adult vs. an infant? | An average adult is 50-70% water, while infants are 65-80% water, making them the highest population percentage |
| How is total body fluid distributed between intracellular and extracellular spaces? | Intracellular Fluid (ICF) accounts for 2/3 of body fluid inside cells. Extracellular Fluid (ECF) accounts for 1/3 outside cells, which is further split into plasma (inside blood vessels) and interstitial fluid (tissue spaces between cells) |
| Osmosis, | Water moves across a semipermeable membrane to equalize concentrations. |
| Diffusion | Solute molecules passively move from an area of higher to lower concentration. |
| Filtration | Solids are physically separated from liquids or gases |
| What primary physiological triggers and hormones regulate daily fluid balance? | Thirst (regulated by osmoreceptors in the hypothalamus), Antidiuretic Hormone (ADH), Aldosterone, Atrial Natriuretic Factor (ANF), and insensible fluid loss via sweating and respiration |
| ADH | ADH (vasopressin): Triggered by concentrated blood; acts on kidneys to increase water reabsorption, making urine concentrated. |
| Aldosterone | Regulates fluids and electrolytes by telling kidneys to reabsorb sodium. |
| ANF | Responds to excessive blood volume; acts on kidneys to increase urinary output and lower blood pressure |
| What are the early signs of hypovolemia (dehydration)? | Low blood pressure, increased heart rate, and a weak pulse. |
| late clinical signs of hypovolemia (dehydration)? | Poor skin turgor, cracked lips, no urine output (anuria), and sunken eyes |
| What are the priority nursing interventions for a patient experiencing a fluid volume deficit? | Administer antiemetics (if vomiting), replace fluids, provide specialized mouth care, check and track urinary output, and perform daily weights |
| What are the signs and symptoms of hypervolemia (fluid volume excess) | High blood pressure, bounding pulse, rapid breathing, short of breath (SOB), jugular vein distention (JVD), crackles in the lungs, sudden cough, edema, and pink frothy sputum |
| What are the priority nursing interventions for a patient with hypervolemia? | Administer ordered diuretics, closely monitor Intake and Output (I&O), assess lung sounds, track daily weights, check and manage salt intake in meals, and monitor vital signs |
| What are the normal laboratory serum ranges for Potassium | 3.5–5.3 mEq/L bananas |
| What are the normal laboratory serum ranges for Chloride | 97–107 mEq/L hot tub |
| What are the normal laboratory serum ranges for Sodium | Sodium: 135–145 mEq/L big boss |
| What are the normal laboratory serum ranges for Phosphorus | 2.5–4.5 mg/dL (p. 3). half a heart 2+2 |
| What are the normal laboratory serum ranges for Calcium | (Total): 8.2–10.2 mg/dL (Ionized: 4.64–5.28 mg/dL) 911 |
| What are the normal laboratory serum ranges for Magnesium | 1.6-2.2 mg/dL magnify glass |
| What are the signs, symptoms, and nursing actions for Hyponatremia | Vomiting, anorexia, nausea, headache, lethargy, muscle weakness, twitching. Actions: Administer additional sodium per order, infuse IV 0.9% Normal Saline, assess vitals (hypotension, increased pulse), and monitor I&O. |
| What are the signs, symptoms, and nursing actions for Hypernatremia? | Excessive thirst, oliguria, sticky mucus, dry mouth, flushed skin, hallucinations, pulmonary edema |
| Contrast the manifestations of Hypochloremia | Metabolic alkalosis, muscle excitability, agitation, irritability. Actions: Monitor I&O, check labs, measure fluid loss, check for respiratory/neuro depression, and encourage foods high in NaCl. |
| Contrast the manifestations of Hyperchloremia. | Metabolic acidosis, increased respiratory rate and depth, dyspnea, increased pulse, arrhythmias, severe edema, and decreased level of consciousness (LOC) |
| What is the golden safety rule of Potassium administration | NEVER give Potassium via IV push (causes life-threatening arrhythmias) |
| what are the signs of potassium imbalance hypokalemia | Nausea, vomiting, decreased deep tendon reflexes, muscle weakness, prickly sensations. (Treat with supplements, monitor labs, encourage foods like baked potatoes, yogurt, white beans, halibut, bananas) |
| what are the signs of potassium imbalance hyperkalemia | Bradycardia, life-threatening arrhythmias, vomiting, diarrhea, abdominal cramping. (Treat with Kayexalate or loop diuretics) |
| What are the clinical signs of Hypomagnesemia | Vomiting, positive Chvostek’s and Trousseau’s signs, dizziness, muscle weakness, tremors. Actions: Monitor I&O, assess potassium/calcium/magnesium balances, encourage nuts, seeds, and broccoli. |
| What are the clinical signs of Hypermagnesemia? | Paralysis, diaphoresis, lethargy, hypoactive reflexes, decreased BP, decreased pulse, decreased respirations. Actions: Monitor calcium IV, give diuretics, daily dialysis, avoid OTC antacids/laxatives |
| What physical assessment signs are positive in both Hypocalcemia and Hypomagnesemia? | Chvostek's sign (facial twitching when tapping the facial nerve) and Trousseau's sign (carpal spasm when inflating a blood pressure cuff) |
| signs of Hypocalcemia | Positive Chvostek’s/Trousseau’s signs, bronchospasms, numbness of toes/fingers/mouth, muscle spasms. Actions: Give calcium tablets and Vitamin D, monitor spasms. |
| signs of Hypercalcemia. | Easily fractured bones/osteoporosis, polydipsia, severe constipation, lethargy, polyuria, bradycardia. Actions: Encourage fluids, monitor heart rate |
| Hypophosphatemia signs | Chest pain, bone pain, respiratory failure, extremity paresthesia. Actions: Check for malnutrition/laxative use, give IV phosphorus |
| Hyperphosphatemia signs. | Tetany, tingling in fingers/toes, muscle twitching, stuttering, seizures, increased pulse. Actions: Associated with chronic kidney disease; encourage a low phosphorus diet |
| What is the normal physiological pH range, and which organ acts as the fastest acid regulator? | The normal range is 7.35–7.45. The lungs provide fast acid-base control by regulating Carbon Dioxide which acts as an acid in the body |
| Respiratory Acidosis based on breathing patterns. | Caused by hypo ventilating (slow/shallow breathing), which retains too much carbon dioxide |
| Respiratory Alkalosis based on breathing patterns. | Caused by hyperventilating (rapid/deep breathing), which blows off too much carbon dioxide |
| Metabolic Acidosis | Characterized by a build-up of hydrogen ions or a significant drop in bicarbonate |
| Metabolic Alkalosis | Characterized by an excessive loss of hydrogen ions or a significant jump in bicarbonate |
| What are the primary reasons for initiating intravenous (IV) fluid therapy? | To maintain daily body fluids for patients unable to ingest orally, replace abnormal or excessive fluid and electrolyte losses (from sweating, breathing, gastric suction, vomiting, or diarrhea) |
| Isotonic | Matches normal body concentration; maintains fluid equilibrium without changing cell size. Used for trauma, sepsis, and hypovolemia (e.g., 0.9% NaCl, Lactated Ringer's) |
| Hypotonic | Has a lower solute concentration than blood; forces fluid to shift into cells, making them swell. Used for cellular rehydration in DKA or hypernatremia (e.g., 0.45% NaCl / half Normal Saline) |
| Hypertonic | Has a higher solute concentration than blood; draws water out of cells, causing them to shrink. Used to reduce swelling in cerebral edema, treat severe hyponatremia, or provide nutrition (e.g., D5NS, D5 1/2 NS, 10%-50% Dextrose) |
| smaller the gauge number | (22G–24G): Indicated for young children, older adults, and individuals with fragile or small veins |
| larger the needle diameter | (18G–20G): Indicated for blood transfusions, trauma, rapid infusions, or severe hemorrhage/shock risks. |
| preferred for IV site selection | Forearm veins (cephalic, basilic, median antebrachial) of the non-dominant arm. |
| Avoid IV site on Extremities on | Same side as a mastectomy, paralysis, or a dialysis access device. Avoid flexible joints, hard/sclerotic veins, bruised/red areas, or infected sites |
| Infiltration | Leakage of non-vesicant solution into tissue. Signs: tightness, edema, blanching/pallor, cool to the touch. |
| Phlebitis | Inflammation of the inner vein. Signs: edema, erythema, warmth, burning discomfort, vein feels hard. |
| Extravasation | Leakage of vesicant fluid causing tissue necrosis, blistering, and severe tissue death |
| What is an Air Embolism | air bubble traveling in the circulatory system |
| what to do when there is an air embolism | immediately stop the infusion, aspirate to remove air before restarting, call for help/crash cart, notify the provider, place the patient on their left side in Trendelenburg position, and apply oxygen |
| What is Speed Shock | Shock resulting from rapid IV drug/fluid administration |
| signs of speed shock and the immediate nursing response? | flushed skin, dizziness, headache, hypotension, chest tightness, irregular pulse, syncope, or cardiac arrest. Response: Stop the infusion ASAP, call for assistance, notify the provider, and get the crash cart |
| essential safety steps required to initiate a blood transfusion? | Verify a provider's order and patient consent, use a separate IV line with a large gauge (18G or 20G), use ONLY 0.9% Normal Saline to dilute/flush blood products |
| nurse requirements for blood transfusion verification | require 2 Registered Nurses (RNs) to double-check the blood at the bedside, and have the nurse continuously monitor the patient for the first 15 minutes |
| What are the primary types of blood transfusion reactions | Acute hemolytic (chest/back pain, burning vein), Bacterial (high fever, flushed), Allergic (SOB, wheezing), Febrile (nausea, increased temperature, chills), Circulatory overload, and Anaphylactic reaction. |
| first priority action when blood transfusion reactions happen | stop infusion immediately |
| safe iv drug administration | check allergies, sterile technique, iv access integrity, expected effects, possible adverse effects and correct dosage |
| secondary tubing should hang | above primary tubing utilizing gravity |
| gastric suctioning and vomiting depletes | hydrochloric acid, potassium, and sodium chloride |
| fluids are lost through? | kidneys, intestinal tract, skin and lungs |
| IV equipment includes: | IV needle, winged butterfly, iv tubing, iv infusion pump, prn locks, and iv start kit |
| IV start kit includes: | tourniquet, antiseptic prep pad, sterile gauze, sterile adhesive, label and tape |
| what does asepsis iv therapy prevent | sepsis, thrombus, discomfort, anxiety, lack of trust, lack of rapport, and nurse workload |
| always check before IV administration | order verification, pt medical record, condition and diagnosis. reason for iv access, pt age, mental condition and allergies |
| good veins should feel | rounded, spongey, elastic and bouncy. NOT FLAT |
| Tip for dilating veins | Never slap the skin |
| signs of septicemia | FEVER, chill, shivering, diaphoresis, nausea, vomiting, diarrhea, tachycardia, tachypnea, hypotension, confusion |
| to prevent air embolism | prime tubing, remove air from syringe, never let catheter run dry |
| packed RBC's, separated from plasma | acute blood loss, hemoglobin less than 8-10g/dl, NS required yo dilute for IV infusion |
| signs and symptoms of circulatory fluid overload | cough, anxiety, distention of neck veins, edema, crackles in lungs, SOB |
| thrombophlebitis | inflammation of vein and clot formation |
| localized infection | infection at site |
| septicemia | infection in the bloodstream |
| severed cannula | piece break off inside vein |
| circulatory fluid overload | excessive fluid volume in cardiovascular sustem |
| what IV supplies need to be kept sterile | IV needle, opening to hub, open end of iv tubing, iv solution bag insertion port, iv solution, adhesive side of dressing, all connection points |
| hypotonic solution and use | 1/2 NS or 0.45% NaCl, water replacement |
| isotonic solution and use | D5W, provide free water, calories for energy. NS or 0.9% NaCl, replacement of nutrients and electrolytes, and used to initiate and d/c blood transfusion (LR) replaces all type of dehydration |
| hypertonic solution and use | DS 1/2 NS, replace nutrients and treat dehydration D5NS, expand blood volume, supply calories D10W, D20W, D50W, prefilled, treat severe hypoglycemia, no conti IV |
| is it true if calcium is high phosphorus is high | false, if calcium is low phosphorus is low |
| yankauer is used for | orphphangeal suctioning |
| diagnostic tests detects fluid deficit | elevated urine specific gravity, high hemotocrit level, elevated BUN |
Created by:
muvamayi