Fluid & Electrolytes Lecture (Nac1)

Front 1

What are 6 functions of body water?

Back 1

1. maintains body temperature
2. maintains cell shape
3. transports nutrients, electrolytes, and oxygen to cells
4. excretes waste products
5. lubricates joints and membranes
6. medium for food digestion

Front 2

Water accounts for ____% of body weight in adults.

Back 2

60

Front 3

Water accounts for ___-___% of body weight in infants.

Back 3

70-80%

Front 4

What are the three major fluid compartments in the body?

Back 4

1. Intracellular
2. Extracellular
3. Transcellular

Front 5

Extracellular fluid (ECF) is further divided into what 2 compartments?

Back 5

- intravascular (plasma)
- interstitial

Front 6

Approximately ___ liter(s) of fluid is contained in the transcellular compartment.

Back 6

1

Front 7

Transcellular fluid is found in what 5 compartments of the body?

Back 7

1. cerebrospinal fluid
2. GI tract
3. pleural spaces
4. synovial spaces
5. peritoneal fluid spaces

Front 8

To remain properly hydrated, water intake must equal what?

Back 8

water output

Front 9

(def)

substances whose molecules dissociate, or split into ions, when placed in water

Back 9

electrolytes

Front 10

(def)

positively charged electrolytes

Back 10

cation

Front 11

(def)

negatively charged electrolytes

Back 11

anion

Front 12

(def)

measurement of the chemical combining power of an ion

Back 12

milliequivalent

Front 13

(def)

cations and anions balance each other when expressed in milliequivalents

Back 13

electrical neutrality

Front 14

(def)

each body fluid compartment has its own normal composition of electrolytes.

Back 14

normal composition

Front 15

What are 6 mechanisms that control fluid and electrolyte movement?

Back 15

1. diffusion
2. facilitated diffusion
3. active transport
4. osmosis
5. hydrostatic pressure
6. oncotic pressure

Front 16

All movement of fluids and electrolytes is done in an effort to maintain what?

Back 16

homeostasis

Front 17

(def)

the normal distribution of fluid in ICF and ECF

Back 17

first spacing

Front 18

(def)

an abnormal accumulation of interstitial fluid

Back 18

second spacing

Front 19

(def)

fluid accumulation in a part of the body where it is not easily exchanged with ECF

Back 19

third spacing

Front 20

When you consider the volume and osmolality of body fluids, you should look primarily at what 2 things?

Back 20

sodium and water

Front 21

The ________ (total/relative) amount of water and solutes determines the ECF volume.

Back 21

total

Front 22

The ________ (total/relative) amount of water and solutes determines the ECF osmolality.

Back 22

relative

Front 23

Fluid volume excess is also known as what?

Back 23

hypervolemia

Front 24

(def)

water and solutes are gained together

Back 24

hypervolemia (fluid volume excess)

Front 25

What are 3 causes of hypervolemia?

Back 25

1. excessive intake of fluids
2. abnormal retention of fluids
3. interstitial-to-plasma fluid shift

Front 26

What are 4 signs/symptoms of hypervolemia?

Back 26

1. HTN
2. Pulmonary Edema
3. Peripheral Edema
4. Changes in LOC

Front 27

A fluid volume deficit is also known as what?

Back 27

hypovolemia

Front 28

(def)

water and solutes are lost together

Back 28

hypovolemia (fluid volume deficit)

Front 29

What are 3 causes for hypovolemia?

Back 29

1. loss of normal body fluid
2. decreased intake
3. plasma-to-interstital fluid shift

Front 30

What are 4 signs/symptoms of hypovolemia?

Back 30

1. Oligurea
2. Orthostatic hypotension
3. decreased C.O./low BP/shock
4. dehydration

Front 31

True/False:

If the osmolality of one body fluid compartment changes, water will shift until osmolality is equal.

Back 31

true

Front 32

What occurs to body cells when ECF osmolality increases?

Back 32

cells shrink

Front 33

What happens to body cells with ECF osmolality decreases?

Back 33

fluid shift to cells (may cause cerebral edema)

Front 34

If there is an imbalance between plasma and interstitial fluid, it is known as what?

Back 34

ECF distribution imbalance

Front 35

ECF distribution imbalance if often due to what 2 things?

Back 35

1. change in plasma protein concentration
2. alteration in capillary permeability

Front 36

The movement of fluid in/out of capillaries is determined by what 4 things?

Back 36

1. capillary hydrostatic pressure
2. plasma oncotic pressure
3. interstitial hydrostatic pressure
4. interstitial oncotic pressure

Front 37

Plasma to interstitial fluid shifts result in what?

Back 37

edema

Front 38

What body system promotes the return of fluid and protein from the interstitial spaces back to the vascular spaces?

Back 38

lymphatic system

Front 39

True/False:

Plasma proteins that shift into the interstitial spaces cannot be reabsorbed into the blood vessels.

Back 39

true

Front 40

What is the main cation of ECF?

Back 40

sodium

Front 41

What electrolytes primarily affects the water distribution between ECF and ICF?

Back 41

sodium

Front 42

What are 4 common causes of hypernatremia?

Back 42

- excessive sodium intake
- inadequate water intake
- excessive water loss
- disease status (diabetes insipidus, cushing syndrome, uncontrolled DM)

Front 43

What are the 4 most common causes of hyponatremia?

Back 43

- excessive sodium loss (ng suction, diarrhea, vomiting, renal disease, burns, etc.)
- inadequate sodium intake (diets)
- excessive water gain (polydipsia, hypotonic solutions)
- disease status (heart faiulre, hypoaldosteronism)

Front 44

Normal sodium serum osmolality is what?

Back 44

135-145 mEq/L

Front 45

Other than sodium, what other electrolyte makes a major contribution to ECF osmolarity?

Back 45

Chloride

Front 46

Chloride is required for the formation of what?

Back 46

stomach acid (HCl)

Front 47

Chloride plays a major role in regulating what?

Back 47

pH

Front 48

Chloride has a strong attraction to what 3 electrolytes?

Back 48

Na+, K+, and Ca2+ (passively follows all)

Front 49

Chloride's homeostasis is achieved as an effect of what?

Back 49

Sodium's homeostasis

Front 50

What is the normal adult range of chloride?

Back 50

95-113 mEq/L

Front 51

What is the most essential cation of the cells?

Back 51

potassium

Front 52

Altered levels of potassium can lead to what?

Back 52

cardiac arrhythmias

Front 53

Potassium plays a key role in what 4 body processes?

Back 53

1. transmission and conduction of nerve impulses
2. maintenance of normal cardiac rhythm
3. skeletal muscle contraction
4. acid-base balace

Front 54

What is the normal range for potassium?

Back 54

3.5-5.0 mEq/L

Front 55

Magnesium influences what 2 things?

Back 55

1. muscle contractions
2. intracellular activity

Front 56

What percent of magnesium is contained in bone?

Back 56

50-60%

Front 57

What electrolyte is a coenzyme in the metabolism of proteins and carbohydrates?

Back 57

magnesium

Front 58

Factors that regulate calcium balance appear to influence what other electrolyte's balance?

Back 58

magnesium

Front 59

True/False:

Magnesium produces a sedative effect.

Back 59

True

Front 60

What are the normal lab values of magnesium?

Back 60

1.5-2.5 mEq/L

Front 61

What electrolyte blocks sodium transport and stabilizes the cell membrane?

Back 61

calcium

Front 62

What are 5 functions of calcium?

Back 62

1. transmission of nerve impulses
2. myocardial contractions
3. blood clotting
4. formation of teeth and bone
5. muscle contractions

Front 63

What is the normal adult range for calcium? what is optimal?

Back 63

normal range= 8.5-10.3
optimal= 9.4

Front 64

What is the primary anion in ICF?

Back 64

phosphorus

Front 65

Phosphorus is essential to the function of what 3 things?

Back 65

- muscle
- RBCs
- nervous system

Front 66

What is the normal adult range of phosphorus? what is optimal?

Back 66

normal range= 2.5-4.7 mEq/dl
optimal= 3.5

Front 67

What are some general, common manifestations of electrolyte imbalances? (6)

Back 67

1. vital sign changes (alterations in BP, pulse, temp., respirations)
2. cardiac arrhythmias
3. GI s/s (N&V, diarrhea, slow/fast intestinal motility, cramping)
4. Alteration in muscle function (irritability, weakness, paresthesia, cramping, tetany)
5. Neurological s/s (restlessness, agitation, confusion, seizure)
6. hyperactive or flaccid reflexes

Front 68

True/False:

Potassium has a wide therapeutic range

Back 68

False- it has a very narrow range

Front 69

When administering potassium, what should you especially be alert to?

Back 69

EKG changes, cardiac arrhythmias

Front 70

(def)

deposition of calcium-phosphate precipitates in tissues

Back 70

hyperphosphatemia

Front 71

What are 3 external indicators that may be observed in a patient experiencing hypocalcemia?

Back 71

1. laryngeal stridor
2. positive Trousseau's sign
3. positive Chvostek's sign

Front 72

Describe Trousseau sign and how to test for it.

Back 72

- induced spasm of the muscles of the hand and forearm
- test by inflating a BP cuff to a pressure above the systolic pressure and holding in place for 3 minutes. (occludes brachial artery and induces neuromuscular irritability causes by hypocalcium)

Front 73

Describe Chvostek sign and how to test for it.

Back 73

- an abnormal reaction to the stimulation of the facial nerve
- tap the facial nerve at the angle of the jaw (facial muscles on the same side will contract momentarily b/c of hypocalcemia)

Front 74

When assessing for F&E imbalances, what historical information should be obtained?

Back 74

predisposing factors, such as disease, medications, diet, lifestyle, and activity level

Front 75

When assessing for F&E imbalances, postural changes in BP and a decrease in pulse pressure indicates what?

Back 75

volume deficit

Front 76

When assessing for F&E imbalances, an increased BP may indicate what?

Back 76

volume overload

Front 77

When assessing for F&E imbalances, a distended jugular vein indicates what?

Back 77

fluid overload

Front 78

When assessing for F&E imbalances, increased central venous and pulmonary artery pressure indicates what?

Back 78

fluid volume excess

Front 79

When assessing for F&E imbalances, a weak, thready, rapid pulse may indicate what?

Back 79

fluid deficit

Front 80

When assessing for F&E imbalances, a bounding pulse may indicate what?

Back 80

fluid overload

Front 81

When assessing for F&E imbalances, an irregular pulse may indicate what?

Back 81

electrolytes disturbances

Front 82

When assessing for F&E imbalances, edema indicates what?

Back 82

fluid excess

Front 83

When assessing for F&E imbalances, a decrease in skin turgor may indicate what?

Back 83

fluid deficit

Front 84

An increased rate of respirations may increase what?

Back 84

insensible losses

Front 85

When assessing for F&E imbalances, cough, dyspnea, orthopnea, and crackles indicate what?

Back 85

fluid overload

Front 86

When assessing for F&E imbalances, an elevated temp may indicate what?

Back 86

dehydration

Front 87

As a result of dehydration, an elevated temperature will also increase what type of loss in the body?

Back 87

insensible loss

Front 88

In an adult, an extra heart sound (s3) may indicate what?

Back 88

fluid overload

Front 89

When assessing for F&E imbalances, an irregular rhythm may indicate what?

Back 89

an electrolyte imbalance

Front 90

Dry skin and mucous membranes may indicate what?

Back 90

fluid deficit

Front 91

When assessing for F&E imbalances, excessive thirst may indicate what?

Back 91

volume deficit

Front 92

Excessive perspiration may lead to what?

Back 92

volume deficit

Front 93

Excessive drainage from wounds/fistulas may lead to what?

Back 93

volume deficit

Front 94

Behavioral changes or a decrease in LOC may be caused by what 3 things?

Back 94

1. swelling of cerebral cells
2. electrolyte imbalance
3. dehydration

Front 95

When assessing for F&E imbalances, paresthesias may indicate what?

Back 95

electrolyte imbalance

Front 96

When assessing for F&E imbalances, muscle weakness, fatigue, or cramping may indicate what?

Back 96

electrolyte imbalance

Front 97

When assessing for F&E imbalances, changes in neuromuscular function is indicative of what?

Back 97

electrolyte imbalance

Front 98

When assessing for F&E imbalances, changes in GI function may be caused by what 2 things?

Back 98

- electrolyte disturbance
- volume disturbance

Front 99

What 2 primary purposes does recording I&O serve when assessing F&E?

Back 99

1. diagnose imbalances
2. calculate daily fluid replacement needs

Front 100

When assessing for F&E imbalances, a decrease in HCT indicates what?

Back 100

dilution of blood from fluid overload

Front 101

When assessing for F&E imbalances, an increased HCT indicates what?

Back 101

fluid or ECF volume depletion

Front 102

When assessing for F&E imbalances, an increase in hemoglobin would indicate what about the ECF?

Back 102

hyperosmolarity

Front 103

When assessing for F&E imbalances, a decrease in hemoglobin would indicate what about the ECF?

Back 103

hypoosmolarity

Front 104

When assessing for F&E imbalances, an increase in BUN would indicate what?

Back 104

ECF fluid depletion

Front 105

A decrease in plasma proteins results in what?

Back 105

fluid shifts to the interstitial spaces

Front 106

When assessing for F&E imbalances, what might an EKG be used to detect?

Back 106

electrolyte imbalances

Front 107

True/False:

Urine specific gravity decreases with fluid deficit.

Back 107

False- it increases

Front 108

True/False:

Urine osmolality is increased with a fluid deficit.

Back 108

True

Front 109

Acidosis or alkalosis is caused by what?

Back 109

electrolyte disturbances

Front 110

True/False:

The older adult has a lower risk for developing fluid/electrolyte imbalances.

Back 110

False- the older adult is at a greater risk due to normal physiologic changes associated with aging

Front 111

What structural changes are seen with the elderly regarding fluid and electrolytes? (4)

Back 111

- decrease in renal perfusion
- decrease in glomerular filtration rate
- decrease creatinine clearance
- loss of ability to concentrate and conserve water

Front 112

Elderly patients experience what hormonal changes related to fluids/electrolytes?

Back 112

- decrease in renin and aldosterone
- increase in ADH and ANP

Front 113

How does the loss of subcutaneous tissue (as seen in the elderly) result in fluid/electrolyte disturbances?

Back 113

leads to loss of moisture and the inability to respond to heat or cold quickly

Front 114

True/False:

The elderly's thirst mechanism is decreased.

Back 114

true

Front 115

What musculoskeletal changes do the elderly experience that leads to fluid/electrolyte problems?

Back 115

- decreased mobility
- stiffness in hands