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NP2 2011: Fluid & Electrolyte Prof.Kamhoot

What percent of the body is extracellular fluid? 34% one-third of total body fluid
What percent of the body is intracellular fluid? 66%
Extracellular fluid is... any fluid outside the cell, which includes intersitial (75% of ECF) fluid between the cells and tissues and Intravascular (20% of ECF) plasma within the vessels
Fluids are essential to the body because they... Transport nutrients to and from the cells Manintains blood volume Acts as a lubricant for tissues Aides in maintance of acid-base balance Assists in heat regulation via evaporation
Daily water intake and output is approx. _______ mL. 2500 mL
Average intake of fluids for food, and oxidation is... Food: 1000 mL Oxidation: 300 mL
Average Insensiable output of skin, sweat, feces, and lungs is... Skin & Lungs: 350-400 mL Sweat: 100 mL Feces: 100-200 mL
S/S of fluid volume deficit/Hypovolemia... thirst dizzines weakness poor skin turgor weight loss elevated HR postural hypotension decrease urine output mental status change dry mucus membranes weak,rapid pulse
S/S Orthrostatic/Postural Hypotension -Decrease in systolic pressure > 20mm Hg -Decrease in diastolic pressure 10mm Hg -10-20% increase in HR
Nursing Interventions for fluid volume deficit/hypovolemia are -Assess for causative factor -Daily weight, i&o, vs -Asses neuro status, safety issues -Administer IV fluids/encourage intake -Skin assessment and oral care -Monitor labs (Na,Hematocrit)
Causes of fluid volume excess/hypervolumia are... -Excessive intake of fluids -Abnormal retention of fluids -Interstitial to plasma shift
S/S of fluid volume excess/hypervolumia are... -Increase HR/BP -Tachypnea/dyspnea -Distended veins -Edema -Weight gain -I&O -Crackles in lungs -Pulmonary edema
Treatment of fluid volume excess/hypervolumia is... -Diuretics -Fluid restriction -Sodium restriction
Nursing interventions for fluid volume excess/hypervolumia -Asses for cause -Daily weights -I&O -Asses VS -Skin assessment/care -Assess/monitor respiratory rate -Restrict Na and fluid intake -Administer meds as ordered
Older adults are at risk for increased dehydration/hypovolumia d/t... replacement of lean muscles to fat, kidneys are less able to concentrate urine, decrease in mobility decreases thirst, incontinent, over salt food, mild disorientation, orthostatic hypotension, constipation
Nephrons filter blood at a rate of ___mL per minutes or about ___L/day. 125 mL, 180L
The kidneys must excrete a minimum of __mL/hr to eliminate waste products from the body. 30mL/hr
1 L of fluid = 1 kg or 2.2 lb
Substances entering the body begin their journey in the ____________ fluid. extracellular
Passive transport processes that move fluids into and out of cells are... Diffusion Osmosis Filteration
Active transport processes require ______ in order to be able to move fluids into and out of cells energy
Solute substances dissolved in a liquid, move from an area of higher concentration to an area of lower concentration
Solvent component of solution that dissolves a solute
Osmolarity (mOsm/L) (urine) used to describe fluids outside the body
Osmolality (mOsm/kg) (serum) used to describe fluids inside the body
Diffusion... movement of particles in all directions through a solution or gas; water can move freely
Osmosis... the movement of WATER from an area of lower concentration to an area of higher concentration through a selectively permeable membrane
Hypertonic solution... A solution of higher osmotic pressure, pulls fluids from the cells
Isotonic solution... A solution of same osmotic pressure, expands the bodys fluid volume without causing a fluid shift
Hypotonic solution... A solution of lower osmotic pressure, moves into cell, causing them to enlarge
Types of Hypertonic IV solutions used... D5 1/2NS: 5% dextrose in 0.45% sodium chloride D5NS: 5% dextrose in 0.9% sodium chloride D5LR: 5% dextrose in lactated ringers D10W: 10% dextrose
Types of Isotonic IV solutions used... NS: 0.9% sodium chloride LR: lactated ringers D5W: 5% dextrose in water
Types of Hypotonic solutions used... 1/2NS: 0.45% sodium chloride D2.5W: 2.5% dextrose
Osmotic pressure.... draws fluid across membrane, major force that PULLS fluid from the tissue space to the vascular space
Hydrostatic pressure... force within the fluid compartment, major force that PUSHES fluid out of the vascular system
Oncotic pressure... Osmotic pressure exerted by colloids,protein is a major colloid
Facillitated diffusion involves _______ ______ and requires _____ energy. carrier molecules, no
Filtration the transfer of water and dissolved substances from an area of higher pressure to an area of lower pressure hydrostatic pressure is the force pumping action is the heart
ADH is _________ by the hypothalamus, __________ by the posterior pituitary and released and _________ in a feedback loop. synthesized, secreted, inhibited
Aldosterone is adrenal gland hormone that has an ________ effect on water. Released and inhibited in a feedback loop as part of the _____-__________ system. indirect, renin-angiotension
Glucocorticoids (cortisol) is released and produced by the ___________, when the body is stressed. Promotes renal _________ of sodium and water. adrenal gland, promotes
Atrial natriuretic peptide (ANP) cardiac hormone that is released when the atria is ________ from ______ _______ ______ or _____ ___. stretched by high blood volume or high bp
Atrial natriurtic peptide (ANP) lowers blood volume and bp by.... causing vasodilation, decreasing aldosterone, decreasing ADH release, increasing GFR
Brain natriuretic peptide (BNP) is a _______ hormone. cardiac
Brain natriuretic peptide (BNP) decreases blood volume and pressure by... vasodilates, decreases release of aldosterone, causes diuresis with excretion of both Na+ and H20
Active transport ________ energy from ________ _________. requires, the chemical adenosine triphosphate
Active transport is the movement of molecules into cells without regard for their positive or negative charge and against concentration factors, moves fluids from an area of low concentration to an area of high concentration
Substances that require active transport are... sodium, potassium, calcium, iron, hydrogen, amion acids and glucose
During dehydration, the serum osmolality ________; during overhydration the serum osmolality _________. increases, decreases
__________ senses fluid deficit/increase in plasma osmolality Hypothalmus
The pituitary store/releases ______ ADH
The pituitary releases ADH when... increased osmolality, stress, nauses, nicotine, morphine
Diabetes insipidus affects the pituitary by... decrease ADH, dehydration
Increase in blood osmolality causes.... Osmoreceptors in hypothalmus stimulate posterior pituitary to screte ADH->ADH increases tubule permeability -> increase reabsorption of H20 into blood -> Unrine output decreases which causes serum/blood osmolality decreese as the water dilutes fluids
Decrese in blood osmolality causes.... ADH is suppressed-> ADH causes distal tubules to become less permable to water
Glucosteriods such as cortisol help regulate BOTH water and electrolytes by... increasing serum glucose,and has an antiinflammatory effect
Mineralcorticoids such as aldosterone help regulate BOTH water adn electrolytes by... enhancing sodium retention and potassium excretion
Normal SG is ______ 1.010-1.025
SG < 1.010 means.... dilute urine. may be caused by excess fluid intake, inability to concentrate unrine
SG > 1.025 means... concentrated urine. may be dehydration, excess solutes in urine
Atrial natruuretic factor (ANF) is released from cells in the atria of the heart in respone to ______ blood volume. ANF suppresses _____, _________, and ____ hormones. excess, renin, aldosterone and ADH
Atrial natriuretic factor (ANF) promotes ______ and ______ excretion, vasodialation and ________ inhibition. sodium and water, thrist
Normal serum sodium(Na+) levels are... 135-145 mEq/L
Sodium (Na+) function is regulate ECF volume and distribution, maintaining blood volume, transmitting nerve impulses and contraction muscles.
____ is the most abundant cation in ECF. Na+
Intracellular fluid (ICF) is 2/3 of bodys water and consists of cations that are mostly _______, some ________ and ________. Anions that are mostly _____ and some ________, ________, _______, and ________. potassium, sodium and magnesium phosphate, bicarbonate, protein, chloride and sulfate
Extracellular fluid (ECF) is 1/3 of bodys water and consists of cations mostly ______, some __________, ________, and magnesium. Also, anions of mostly _______, some ________, sulfate, and _________. sodium, potassium, calcium chloride, bicarbonate, phosphate
Cations are postitively charged and include.... Potassium (K+) Calcium (Ca+2) Sodium (Na+) Magnesium (Mg+2)
Anions are negatively charged and include... Sodium bicarbonate (HCO3-) Chloride (Cl-) Phosphate (PO4-3)
Hyponatremia (serum sodium < 135 mEq/L) caused by sodium loss s/s include... irritability, apprehension, confusion, postural hypertention, tachycarida, rapid thready pulse, jugular venous filling, nausea, dry mucous membranes, wt.loss, tremor, seizures, coma
Hyponatremia caused by loss of sodium can be caused by... GI losses Renal losses: SIADH, diuretic, adrenal insufficiency, Na+ wasting, renal disease Skin loss: burns, wound drainage, excessive sweating
Hyponatremia caused by gain of water (Na+ dilution) can be caused by... CHF, excessive hypotonic IV fluids, primary polydipsia, SIADH, excessive intake of water
Hyponatremia (serum sodium < 135 mEq/L) caused by gain of water s/s include.... h/a, fatigue, apathy, weakness, confusion, nausea, vomiting, wt.gain, postural hypotenstion, muscle spasms, seizure, coma
Hypernatremia (serum sodium > 145 mEq/L) caused by water loss (decreased ECF) can be caused by.... insensible water loss (diarrhea) and perspiration, diabetes insipidus, osmotic diuresis, water deprivation
Hypernatremia (serum sodium > 145 mEq/L) caused by water loss s/s are... intense thirst, dry swollen tongue, restlessness, agitation, twitching, confusion, seizure, coma, weakness, postural hypotension, wt.loss, low urinary output
Hypernatremia (serum sodium > 145 mEq/L) caused by sodium gain (increase ECF) s/s include... intense thirst, restlessness, agitation, twitching, seizure, coma, flushed skin, WEIGHT GAIN, peripheral and pulmonary edema
Hypernatremia (serum sodium > 145 mEq/L) caused by sodium gain (increase ECF) can be caused by... IV salin soulutions (D5NS, sodium bicarbonate, excessive NS), primary hyperaldosteronism, saltwater drowning, excessive salt intake
Nursing intervention for water/sodium imbalances... treat cause dietary adjustment treat fluid loss/gain
Potassium (K+) function transmission & conduction of nerve impulses, maintance of normal cardiac rhythm, skeletal & smooth muscle contraction, major intracellular cation, regulates intracellular osmolaltity, promotes cellular growth, leaves cells during tissue breakdown
Normal serum potassium levels are 3.5-5.0 mEq/L
Sources of potassiun include dark yellow and orange fruits, avocados, dark green leafy vegetables, sweet potatoes, meat, nuts and pb, cola drinks, instant tea and coffee
Hypokalemia (serum potassium < 3.5 mEq/L) caused by abnormal fluid loss can be caused by vomiting, diarrhea, fistules, NG suctioning, illeostomy, metabolic alkalosis
S/S of hypokalemia (serum potassium < 3.5 mEq/L) fatigue, muscle weakness, leg cramps, nausea, vomiting, ileus, soft flabby muscles, parethesias, decreased deep tendon reflexes, weak, irregular pulse, polyuria, hypergylcemia, venticular arrhythmia (PVC), bradycardia, enhanced digitalis effect
Treatment's of hypokalemia prevention of metabolic acidosis, treat diarrhea and vomiting, adequate dietary intake, potassium supplements, monitoring medication side effects
Hyperkalemia (serum potassium > 5.0 mEq/L) can be caused by renal failure(usually),,assive cell damage, rapid transfusion of blood products, catabolism, metabolic acidosis, adrenal insufficiency
S/S of hyperkalemia (>5.0 mEq/L) irritability, anxiety, abdominal cramping, diarrhea, weakness of lower extremities, paresthesias, irregular pulse, cardiac standstil, ventricular fibrillation
Treatment for hyperkalemia (> 5.0 mEq/L) calcium gluconate iv, regular insulin and glucose administered iv, sodium bicarbonate, dialysis, sodium polystyrene sulfonate (kayexalate)
Normal chloride (Cl-) serum level 95-108 mEq/L
Chloride is a major anion in ECF and functions to regulate acid base balance, functions with sodium, major component of gastric juice as hydrochloric acid (HCL), acts as buffer in the exchange of O2 and CO2 in RBC's
Hypochloremia (< 95 mEq/L) s/s increased muscle excitablility, tetany,decreased respirations
Hyperchloremia (> 108 mEq/L) s/s stupor, rapid deep breathing, muscle weakness
Sources of chloride (Cl-) bacon, ham, processed cheese, table salt (same as sources for sodium)
Normal calcium total serum includes bound and unbound calcium and is 8.5-10.5 mg/dL
Calcium functions coagulation, nerve impulse transmission, contraction and relaxation of skeletal muscles, hormone secretion, normal cell function and memebrane stability,
What percent of calcium is in bones/teeth? 99%
where is the 1% of calcium in the body located? plasma and cells; 50% free form or ionized or unbound; 40% bound to plasma (albumin); 10% bound to non-protein ions like phosphate, carbonate, and citrate
Calcium sources milk and milk products, cheese, dark green leafy vegetables, canned salmon, beans, nuts, cauliflower, egg yolks
S/S of hypercalcemia (>10.5 mg/dL or > 5 mEq/L) lethargy, depressed reflexes, decreased memory confusion, personality changes, psychosis, anorexia, vomiting, bone pain, fractures, polyuria, dehydration, stupor, coma, muscle tremors, parathesias, ventricular arrhythmias, increased digitalis effect
Normal ionized serum calcium 4.0-5.0 mEq/L
Causes of increased total calcium (hypercalcemia >10.5 mg/dL) multiple myeloma, other malignancy, prolonged immobilization, hyperparathyroidism, vit D overdose, thiazide diuretics, increased intestinal absorption, high bone turnover, ESRD, drugs
Causes of increased ionized calcium (hypercalcemia >5.0 mEq/L) acidosis
S/S of hypocalcemia (< 4.0 mEq/L or < 8.5 mg/dL) easy fatigability, depression, anxiety and confusions, numbness & tingling in extremities & around mouth, hyperreflexia, muscle cramps, chvostek's sign, trousseau sign, laryngeal spasm, tetany, seizures
Causes of hypocalcemia (< 4.0 mEq/L or < 8.5 mg/dL) chronic renal failure,elevated phosphorus,hypothyroidism,vit.D deficiency, Mg dificiency, acute pancreatitis, loop diuretics, chronic alcoholism, diarrhea, low albumnin, parathyroid hormone deficiency, malabsorption,hyptothermia,rabdomyolsis,tumor,drugs
Phosphorus is chiefly an __________ anion. inracellular
Normal phosphorus serum level 2.8-4.5 mg/dL
Phosphorus and ________ have an inverse relationship in the body; an increase in one causes a decrease in the other. calcium
The majority of __________ is found in bones and teeth combined with calcium phosphorus
Phosphorus function essential to function of muscles, RBC's, and nervous system
An adequate intake of Vitamin ____ is necessary for the absorption of both calcium and phosphorus D
Hypophosphatemia (< 2.8 mg/dL) is caused from diabetic ketoacidosis, dietary insufficiency, impaired kidney function, or misdistribution of phosphate
Hypophosphatemia (< 2.8 mg/dL) S/S possilbe muscle weakness
Treatment for hypophosphatemia (<2.8 mg/dL) oral supplement, foods high in phosphorus, may need iv of Na or K phosphate
Hyperphosphatemia (> 8.5 mg/dL) may be caused from renal insufficiency (most common), increase intake of phosphate or vit.D, chemotherapy
S/S of hyperphosphatemia (> 8.5 mg/dL) tetany, numbness & tingling around the mouth, and muscle spasms
Treatment of hyperphosphatemia (> 8.5 mg/dL) underlying cause, restrict foods with phosphorus, phosphate binding agents such as Basajel, Amphogel, Aluminet
Magnesium (Mg+)function energy production, synthesis of essential molecules (protien,DNA), active transport, cell signaling, cell migration-wound healing
Normal serum level of magnesium 1.5-2.5 mEq/L
More than half of _________ (electrolyte) is found in bone and muscle magnesium
Causes of hypermagnesiumia (> 2.5 mEq/L) renal insuffiency, medications like lithium, laxatives, & antacids with Mg+, volume depletion, rhabdomyolysis, hypothroidism, hyperparathyroidism, hypomotility disorders, bowel obstruction
S/S of hypermagnesiumia (> 2.5 mEq/L) lethargy,drowsiness, n/v, reflexes impaired, somnolence, EKG changes, hypotension,bradycardis, respiratory, cardiac arrest can occur
Nursing interventions for hypermagnesiumia (> 2.5 mEq/L) prevention/indentify and eliminate cause, EKG monitor, IV CaCl or calcium gluconate, fluids, neuro assessment, discontinue medications that contribute
Causes of hypomagnesiumia (< 1.5 mEq/L) diet-malnutrition, drinking ETOH, diarrhea and malabsorption, diabetes mellitus, diuretics, drugs
S/S of hypomagnesiumia (< 1.5 mEq/L) hyperactive deep tendon reflexes, tremors, seizures, cardiac arrthymias, confusion
Treatment of hypomagnesiumia (< 1.5 mEq/L) oral supplements, increase dietary intake
Plasma proteins, particularly albumin, are significant determinants of _______ volume plasma
Causes of Hypoprotienemia (rare) anorexia, malnutrition, starvation, fad dieting, poorly balanced vegetarian diets
S/S of hypoprotienemia edema, slow healing, anorexia, fatigue, anemia, muscle loss, ascites
Nursing interventions for hypoprotienemia high CHO, high protien diet, dietary protein supplement, enternal nurtrition or total parenteral nutrition
Bicarbonate is a manin anion of the ________ fluid extracellular
Normal serum level of bicarbonate 22-24 mEq/L
Bicarbonate is the main anion of the _______ fluid extracellular
Bicarbonate major function the regulation of the acid-base balance
Acid-base balance meaans _______ of the ________ ion concentration in the body fluids homeostasis, hydrogen
The hydrogen ion concentration is determined by the ratio of __________ acid to __________ in the extracellular fluid carbonic, bicarbonate
The symbol used to indicate hydrogen ion balance is _____ PH
Atrial blood gases (ABG) determine whether a solution is more ______, _________, or alkaline acidic, neutral
More hydrogen ions = acidic
Less hydrogen ions = alkaline (base)
ABG's measure PH, PaCO2, HCO3, PaO2, SaO2
Normal PH of ABG is 7.35-7.45
Normal PaC02 of ABG is 35-45 mm Hg
Normal HCO3 of ABG is 22-26 mEq/L
Normal PaO2 of ABG is 80-100 mm Hg
Normal Sa02 of ABG is 95-100%
The body's three systems that work to keep the PH in the narrow range of normal blood buffers, lungs, kidneys
Blood buffers work to keep the PH in the range of normal by circulating throughout the body in pairs, neutralizing excess acids or bases by contributing or accepting hydrogen ions
Blood buffers act immediately, are present in _______ & ________, and take up or releases extra ______ ions blood & tissues, H+
The lungs work to keep the PH in the range of normal by speeding up or slowing down respirations, the lungs can increase or decrease the amt. of carbon dioxide in the blood. Responds in minutes to hours
The kidneys work to keep the PH in the range of normal by excreting varying amts of acid or base, reabsorbs or secretes hydogen (H+) and bicarbonate (HCO3) Responds within hours to days
Respiratory Acidosis is any condition that impairs normal ventilation, perfusion, or diffusion
ABG results of respiratory acidosis a retention of carbon dioxide occurs with a resultant increase of carbonic acid in blood; PH < 7.35; PaCO2 > 45mg; HCO3 normal early on then it increases Compensation: kidneys retain HCO3
Respirtory Acidosis causes aspiration, cardiac arrest, severe pneumonia, emphysema, pulmonary edema, pneumothorax, obesity, stroke, head injury, COPD, respiratory infections, asthma
Clinical S/S of respiratory acidosis lethargy, disorientation, occipital h/a, decrease deep tendon reflexes, dizziness, tremors, weakness, tachycardia, hypertension, dyspnea
Treatment of respiratoy acidosis improve ventilation, use bronchodilators, administer oxygen, administer fluids, meds-possible anti infectives
Respiratory Alkalosis is an increase in respratory rate, depth, or both that results in loss of excessive amounts of carbon dioxide with a resultant lowering of the carbonic acid level in the blood.
ABG results of respiratory alkalosis PH > 7.45 PaCo2 < 35 mmHg HCO3 Normal Compensation: kidneys excrete HCO3
Respiratory alkalosis cause's hyperventilation, anxiety, fear, head injuries, ASA overdose, pneumonia, disorders of the CNS, hypoxia, high fever, pulmonary emboli
Clinical S/S of respiratory alkalosis anxious appearance, irritability, numbness & tingling of the hands/toes, fainting, dizziness, tachypnea, cardiac arrhythmias, tetany, muscle weakness, chest tightness & palpations
Treatment of respiratory alkalosis treat source of anxiety, breathe slowly into a paper bag, administer sedatives
Metabolic Acidosis is a gain of hydrogen ions or a loss of bicarbonate: retaining too many acids or losing too many bases
ABG results of metabolic acidosis PH < 7.35 PaCO2 Normal HCO3 < 22mEq/L Compensation: lungs excrete CO2
Metabolic acidosis cause's starvation, dehydration, diabetic ketoacidosis, renal failure, shock, diarrhea, drugs (ASA), acid indigestion, fistules, severe infection, excessive GI loss
Clinical S/S of metabolic acidosis nausea & vomiting, Kussmaul's breathing ( fast, shallow), h/a, drowsiness, increased breathing, diarrhe, lethargy, decrease LOC, cardiac arrhythmias
Treatment of metabolic acidosis reverse underlying cause, administer Na HCO3, insulin
Metabolic Alkalosis is when a significant amount of acid is lost from the body or an increase in the bicarbonate level
ABG results for metabolic alkalosis PH > 7.45 HCO3 > 24mEq/L PaCo2 Normal Compensation: lungs retain CO2
Metabolic alkalosis cause's excessive vomiting, prolong NG suctioning, electrolyte disturbance (hypokalemia), cushings disease, drugs (steriods, NaHCO3, diuretics & antiacids), hyperaldosteronism
Clinical S/S of metabolic alkalosis h/a, lethargy, irritability, decrease LOC, tachycardia, slow, shallow respirations, bradycardia, n/v, numbness & tingling in extremities, tetany
Treatment of metabolic alkalosis reverse underlying cause, thiazide diuretics discontinued, NG suctioning discontinued, administer antimetic, restore normal fluid volume
PH 7.29 PaCO2 54 HCO3 25 What is this? Respiratory acidosis
Created by: stilsl