Fluids and Electrolytes (Na and K)
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| intracellular fluid makes up how much of your body weight? | 40%
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| extracellular fluid make up how much of your body weight? | 20%
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| what are the 3 areas that extracellular fluid can be found? | intravascular, interstitial, transcellular
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| what is insensible fluid loss | losses that you cannot measure and cannot see (skin--evaporation not perspiration & lungs -- the faster you breath, the more fluid you lose)
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| what is sensible fluid loss | losses that you can see and measure (urine, feces, wounds, perspiration)
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| what electolytes are found outside of the cell? | sodium (Na), chloride (Cl), calcium (Ca) and bicarb (HCO3)
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| what electrolytes are found intracellular | potassium (K), phosporus (P), magnesium (Mg)
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| when cells are damaged by a burn, you would expect the damaged cells to release which major electrolyte: a. Calcium, b. Chloride, c. Potassium? | C
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| what happens when the body cannot compensate for the shifts in fluid? (3) | dehydration, hypovolemia, hypervolemia
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| What happens during dehydration? | The body will lose extracellular fluid 1st; as extracellular fluid deplets, the concentration of electrolytes will increase because it is more concentrated--increased osmolarity; intracellular fluid shifts to the outside of the cell and cell begins to shr
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| what are the signs of dehydration? | dry mucous membranes, poor skin turgor, increased specific gravity urine, weight loss (severe cases), fever (because you aren't able to perspire)
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| how is dehydration treated? | replace missing fluids either orally if not too badly dehydrated (avoid fluids high in sodium because sodium levels are already elevated) or by IV fluids (D5W) given slowly over 48 hrs to avoid cerebral edema
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| what is hypovolemia | loss of fluids AND solutes (electrolytes)
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| what are the signs of hypovolemia | tachycardia, increased pulse, decreased BP, decreased urine output, restless/anxious, thirsty, cool and clammy skin, shock
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| what is the treatment for hypovolemia | isotonic IV solutions (NS or LR) given to expand blood volume, O2, vasopressors for decreased BP, blood products if hemmorhage
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| of the following, the first step that you should take for a patient with hypovolemic shock is: A) assess for dehydration, B) administer IV fluids, C) insert a urinary catheter, D) raise the head of the bed | B) Administer IV fluids
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| what is hypervolemia | excess water and sodium in the extracellular space
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| who is at risk for hypervolemia | elderly and anyone iwth cardiac or renal problems
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| signs and symptoms of hypervolemia | rapid strong pulse, increased BP, distended veins, edema (ankles, hands, feet, etc), crackles, SOB, cough, frothy sputum
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| what is the treatment for hypervolemia | figure out what is actually causing this, restrict sodium and fluid intake, diuretics, renal dialysis for those that have poor kidney funciton, O2
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| Signs of hypervolemia include: A) clear watery sputum, B) hypotension, C) Rapid, bounding pulse, D) Increased urnine specific gravity | C) Rapid, bounding pulse
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| What is the normal sodim (Na) level | 135-145 mEq/l
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| where is Na mostly found | outside of the cell in the extracellular fluiid
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| What does Na do? | regulates osmolarity, attracts fluids, transmits impulses--nerve and muscle
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| What is the level that is considered hyponatremia? | Na level below 135 mEq/l
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| What are the physiological causes of hyponatremia? | excess water, increased Na loss, or deficient Na intake
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| What sort of things occur with patients that cause hyponatremia? | GI suctioning, diarrhea, vomiting, diuretics, inadequate salt intake
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| What are the signs and symptoms of hyponatremia? | headache, nausea, lethargy, abdominal cramps, confusion, muscle twitching, tremors, weakness
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| If Na levels fall lower than 110 mEq/l what should you be watching for? | seizures and coma
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| If a patient is hypovolemia along with hyponatremic, what will their pulse and BP look like? | weak pulse and low BP
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| If a patient is hypervalemic along with hyponatremic, what would their pulse and BP look like? | fast and strong pulse and BP will rise
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| If a patient is hypervolemic and hyponatremic, what is the treatment? | restrict fluids and replace Na withe sodium supplements
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| If a patient is hypovelemic and hyponatremic, what is the treatement? | IV NS and high sodium foods
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| In severe cases of hyponatremia (<110 mEq/l) and hypovolemia, what is the treatment? | slowly infuse hypertonic solution 3% or 5% saline solution--to draw water out of cell and put it into the extracellular space
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| When treating hyponatremia, what is important to be watching for in the patient? | monitor neurologic status during replacement--watch for level of consciousness, lethargy, worried about seizures, coma, etc.
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| What is hypernatremia and at what levell does this occur? | excess Na in extracellular fluid; anything above 145 mEq/l
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| What are the causes of hypernatremia? | M=medications,O=osmotic diuretics, D=diabetes insipedis, E=excessive water loss, L=low water intake
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| What are the signs and symptoms of hypernatremia? | S=skin flushed, A=agitation (neurologic symptoms seen), L=low grade fever, T=thirst
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| Besides its responsibility for fluid balance, sodium is also responsible for: A) good eyesight, B) renal function, C) bone structure, D) nerve impulse control | D=nerve impulse control
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| Symptoms of hyponatremia include: A) change in mental status, abdominal cramps, and muscle twitching, B) headache, rapid breathing, high energy, C) chest pain, fever, nystagmus | A=change in mental status, abdominal cramps, and muscle twitching
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| Your patient is being treated for hypernatremia. The nurse knows she should slowly infuse fluids. The nurse will do this to prevent what? | fluid from moving into the cells and causing them to swell
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| What is a normal level of potassium? | 3.5-5 mEq/l
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| Where is most of the potassium found? | inside of the cell
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| What is the function of potassium? | assists in skeletal and cardiac muscle contraction, controls heart rate and rthym
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| What is hypokalemia and at what level is it called hypokalemia? | decrease in potassium; < 3.5 mEq/l
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| What cause hypokalemia? | diuresis, vomiting, diarrhea, NG suctioning,poor intake, low magnesium levels
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| What are the signs and symptoms of hypokalemia? | fatigue and weakness, leg cramps, irregular pulse, orthostatic hypotension, ECG changes
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| How is hypokalemia treated? | dietary changes, oral potassium replacements, IV potassium replacement--given SLOWLY!!!--10-20mEq/hour
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| What is hyperkalemia and at what level is it called hyperkalemia? | excess potassium; >5 mEq/l
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| What causes hyperkalemia? | diet, supplements, medications, renal disease, injury--burns, trauma, crush injuries
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| What are the signs and symptoms of hyperkalemia? | muscle weakness--1st sign to appear and usually starts in the legs and progresses upward, decreased CO, decrease pulse and BP--irregular and slow
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| How is hyperkalemia treated? | loop diuretics, diet restricitons, possible hemodialysis, medications
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| Medications to be given when treating severe hyperkalemia include: A) sodium succinate and mannitol, B) mannitol and regular insulin, C) 10% calcium gluconate and regular insulin, D) insulin and potassium sparing diuretics | C=10% calcium glutonate (to treat cardiac changes) and regular insulin (to help move potassium back into the cells)
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