Fluids And Electrolytes

Front 1

ion that carries a negative charge

Back 1

anion

Front 2

ion that carries a positive charge

Back 2

cation

Front 3

substance that dissociates in solution into ions; a molecule of sodium chloride (NaCl) in solution becomes Na+ and Cl-

Back 3

electrolyte

Front 4

ions are what?

Back 4

charges particles, either positively or negatively charged

Front 5

an ion that has the combining power of one H+ atom

Back 5

monovalent

Front 6

substance that does not dissociate into ions in solution, glucose and urea

Back 6

nonelectrolyte

Front 7

a measure of the total solute concentration per kilogram of solvent

Back 7

osmolality

Front 8

a measure of the total solute concentration per liter of solution

Back 8

osmolarity

Front 9

substance that is dissolved in a solvent

Back 9

solute

Front 10

homogenous mixture of solutes dissolved in a solvent

Back 10

solution

Front 11

substance that is capable of dissolving a solute (liquid or gas)

Back 11

solvent

Front 12

the degree of combing power of an ion

Back 12

valence

Front 13

TRUE OR FALSE:
a pt with metastatic breast or lung cancer may develop hypercalcemia as a result of bone destruction from tumor invasion

Back 13

TRUE

Front 14

50-60% of body weight is what?

Back 14

water

Front 15

solvent in which body salts, nutrients and wastes are disovled or transported

Back 15

water

Front 16

TRUE OR FALSE:
lean tissue holds more water

Back 16

TRUE

Front 17

TRUE OR FALSE:
men and younger people have more water than women and older adults.

Back 17

TRUE

Front 18

TRUE OR FALSE:
infants and elderly are at high risk for fluid-related problems than younger adults.

Back 18

TRUE

Front 19

what is necessary in regulating body temperature?

Back 19

water

Front 20

what lubricates joints and membranes and is a medium for food digestion?

Back 20

water

Front 21

one liter of water weighs how much?

Back 21

2.2 lbs or 1 kg

Front 22

movement of molecules from an area of high concentration to an area of low concentration?

Back 22

diffusion

Front 23

what is a process in which molecules move against the concentration gradient and uses external energy?

Back 23

active transport

Front 24

where is ATP produced?

Back 24

in the cells mitochondria

Front 25

what is the movement of water between two compartments seperated by a semipermeable membrane?
(from low solute concentration to an area of high solute concentration)

Back 25

osmosis

Front 26

what is the amount of pressure required to stop the osmostic flow of water?

Back 26

osmotic pressure

Front 27

fluids with the same osmolality as the cell interior are called:
(stays the same size)

Back 27

isotonic

Front 28

solutions in which the solutes are less concentrated than the cells are called:
(cell will expand)

Back 28

hypotonic

Front 29

fluids whose solutes are more concentrated than cells are called:
(cell will shrink)

Back 29

hypertonic

Front 30

TRUE OR FALSE:
if a cell is surrounded by hypotonic fluid, water moves into the cell, causing it to swell and possible burst.

Back 30

TRUE

Front 31

TRUE OR FALSE:
if a cell is surrounded by hypertonic fluid, water leaves the cell to dilute the ECF, the cell shrinks and may eventually die.

Back 31

TRUE

Front 32

___ ____ is osmotic pressure exerted by colloids in solution.

Back 32

oncotic pressure

Front 33

the major colloid in the vascular system contributing to the total osmotic pressure is ?

Back 33

protein

Front 34

if capillary or interstitial pressures are altered, fluid may abnormally shift from one compartment to another, resulting in what?

Back 34

dehydration or edema

Front 35

accumulation of fluid in the interstitium is called what?

Back 35

edema

Front 36

increasing the pressure at the venous end of the capillary inhibits fluid movement back into the capillary which results in edema. what type of pressure is effected and what are the causes?

Back 36

elevation of venous hydrostatic pressure caused by fluid overload, heart failure, liver failure, obstruction of venous return to the heart (like from tourniquets, restrictive clothing) and venous insufficiency (varicose veins)

Front 37

what primarily have an anti-inflammatory effect and increase serum glucose levels?

Back 37

glucocorticoids (cortisol)

Front 38

what enhance sodium retention and potassium excretion?

Back 38

mineralcorticoids (aldosterone)

Front 39

TRUE OR FALSE:
many body functions, including fluid and electrolyte balance, are affected by stress

Back 39

TRUE

Front 40

the primary organs for regulating fluid and electrolyte balance are the?

Back 40

kidneys

Front 41

how many liters of urine are produced a day?

Back 41

1.5 L of urine a day

Front 42

as the filtrate moves through the renal tubules, selective reabsorption of water and electrolytes and secretion of electrolytes result in the

Back 42

production of urine that is greatly different in compostion and concentration than the plasma. this process helps maintain normal plasma osmolality, balance, blood volume, and acid-base balance.

Front 43

daily water intake and output are normally between what range?

Back 43

2000 and 3000 mL

Front 44

invisible vaporization from the lungs and skin assists in regulating body temperature is called what? and how much is lost a day?

Back 44

insensible water loss and 600-900 mL is lost a day
(the higher your temperature and more exercise the more lost)

Front 45

TRUE OR FALSE:
loss of subcutaneous tissue and thinning of the dermis lead to increased loss of moisture through the skin and an inability to respond to heat or cold quickly.

Back 45

TRUE

Front 46

hypovolemia is what?

Back 46

low volume (ECF volume deficit)

Front 47

hypervolemia is what?

Back 47

ECF volume excess (too much volume)

Front 48

ECF volume imbalances are typically accompanied by one or more electrolyte imbalances, particulary changes in the serum ___ level.

Back 48

sodium

Front 49

name 3 electrolyte anions?

Back 49

bicarbonate, chloride, phosphate

Front 50

bicarbonate (HCO3-) normal serum electrolyte values are:

Back 50

22-26 mEq/L
(22-26 mmol/L)

Front 51

Chloride (Cl-) normal serum electrolyte values are:

Back 51

96-106 mEq/L
(96-106 mmol/L)

Front 52

Phosphate (PO43-) normal serum electrolyte values are:

Back 52

2.4 - 4.4 mg/dL
(0.78-1.42 mmol/L)

Front 53

name 4 electrolyte cations:

Back 53

potassium, magnesium, sodium, calcium (calcium total and calcium ionized)

Front 54

Potassium (K+) normal serum electrolyte values are:

Back 54

3.5-5.0 mEq/L
(3.5-5.0 mmol/L)

Front 55

Magnesium (Mg2+) normal serum electrolyte values are:

Back 55

1.5-2.5 mEq/L
(0.75-1.25 mmol/L)

Front 56

Sodium (Na+) normal serum electrolyte values are:

Back 56

135-145 mEq/L
(135-145 mmol/L)

Front 57

Calcium (Ca2+) (total) normal serum electrolyte values are:

Back 57

8.6-10.2 mg/dL
(2.15-2.55 mmol/L)

Front 58

Calcium (ionized) normal serum electrolyte values are:

Back 58

4.6-5.3 mg/dL
(1.16-1.32 mmol/L)

Front 59

2 primary forms of treatment for fluid volume excess?

Back 59

diuretics and fluid restriction while restriction of sodium intake may also be indicated

Front 60

name some reasons for ECF volume deficits?

Back 60

diabetes,hemorrhage, GI losses like vomitting, diarrhea, NG suction, overuse of diuretics, inadequate fluid intake, high fever, heat stroke

Front 61

name some reasons for ECF volume excess?

Back 61

IV fluids, heart failure, renal failure, primary polydipsia, SIADH, cushing syndrome, long term use of corticosteroids

Front 62

clinical manifestations of ECF volume deficits:

Back 62

restlestness, drowsiness, lethargy, confusion, thirst, dry mouth, low skin turgor, increased pulse, low CVP, low urine output, concentrated urine, high resp rate, weakness, dizziness, wt loss, seizures, comas

Front 63

clinical manifestations of ECF volume excess:

Back 63

ha, confusion, lethargy, peripheral edema, bounding pulse, high bp, high CVP, polyuria, dyspnea, crackles, pulmonary edema, muscle spasms, wt gain, seizures, comas

Front 64

readings of urine specific gravity greater than 1.025 indicates what?

Back 64

concentrated urine

Front 65

readings of urine specific gravity less than 1.010 indicates what?

Back 65

dilured urine

Front 66

name a few nursing implementations for ECF volume imbalances?

Back 66

measure I/O's, monitor for cardiovascular changes, monitor for respiratory changes, monitor for neurologic changes, get daily weights, inspect skin turgor and skin mobility, monitor IV rates of infusion, NPO for NG pts, encourage adequate oral intake

Front 67

what is the main cation of the ECF and plays a major role in maintaining the concentration and volume of the ECF?

Back 67

sodium

Front 68

what is most important in the generation and transmission of nerve impulses and regulation of acid-base balance?

Back 68

sodium

Front 69

causes of hypernatremia?
(sodium imbalance)

Back 69

excessive sodium intake (iv fluids, near drowning in salt water), inadequate water intake (cognitively impaired), excessive water loss (high fever, heat stroke, prolonged hyperventilation), disease states (diabetes, cushings syndrome)

Front 70

causes of hyponatremia?
(sodium imbalance)

Back 70

excessive sodium loss (GI losses, skin losses, renal losses), inadequate sodium intake (fasting diets), excessive water gain (IV fluids, polydipsia), disease states (SIADH, heart failure, hypoaldosteronism)

Front 71

clinical manifestations of hypernatremia with decreased ECF volume:

Back 71

restlessness, agitation, twitching, seizures, comas, intense thirst, dry/swollen tongue, sticky mucous membranes, postural hypotension, low CVP, wt loss, weakness, lethargy

Front 72

clinical manifestations of hypernatremia with normal/increased ECF volume:

Back 72

restlessness, agitation, twitching, seizures, comas, intense thirst, flushed skin, wt gain, peripheral and pulmonary edema, high bp, high CVP

Front 73

clinical manifestations of hyponatremia with decreased ECF volume:

Back 73

irritability, apprehension, confusion, dizziness, personality changes, tremors, seizures, comas, dry mucous membranes, hypotension, loc CVP, tachycardia, thready pulse, cold and clammy skin

Front 74

hyponatremia with normal increased ECF volume clinical manifestations:

Back 74

ha, apathy, confusion, muscle spasms, seizures, coma, n/v/d, abd cramps, wt gain, high bp, high CVP

Front 75

TRUE OR FALSE:
excessive sodium intake with inadequate water intake can also lead to hypernatremia

Back 75

TRUE

Front 76

name #1 of 3 nursing diagnosis for hypernatremia?

Back 76

risk for injury related to altered sensorium and seizures secondary to adnormal CNS function

Front 77

name #2 of 3 nursing diagnosis for hypernatremia?

Back 77

risk for electrolyte imbalance related to excessive intake of sodium and/or loss of water

Front 78

name #3 of 3 nursing diagnosis for hypernatremia?

Back 78

potential complication: seizures and coma leading to irreversible brain damage

Front 79

TRUE OR FALSE:
the goal of treatment in hypernatremia is to treat the underlying cause.

Back 79

true, in primary water deficit, the continued water loss must be prevented and water replacement must be provided.

Front 80

what will be your IV solution for hypernatremia?

Back 80

5% dextrose in water

Front 81

name 1 of 3 nursing diagnosis for hyponatremia?

Back 81

risk for injury related to altered sensorium and decreased level of consciousness secondary to adnormal CNS function

Front 82

name 2 of 3 nursing diagnosis for hyponatremia?

Back 82

risk for electrolyte imbalance related to excessive loss of sodium and/or excessive intake or retention of water

Front 83

name 3 of 3 nursing diagnosis for hyponatremia?

Back 83

potential complication: severe neurologic changes

Front 84

what IV solution is given for hyponatremia?

Back 84

saline solution (3% NaCl)

Front 85

what drugs are given for hyponatremia?

Back 85

vasopressin and convaptan (vaprisol) tolvaptan (samsca)

Front 86

TRUE OR FALSE:
because the ration of ECF and ICF potassiums is the major factor in the resting membrane potential of nerve and muscle cells, neuromuscular and cardia function are commonly affected by potassium imbalances

Back 86

TRUE, potassium is critical for many cellular and metabolic functions

Front 87

what is the source of potassium?

Back 87

diet

Front 88

fruits, dried fruits and vegetables good source of your daily intake of potassium, how much is needed daily?

Back 88

50-100 mEq of potassium needed daily

Front 89

what is the primary route for potassium loss? and how much is eliminated?

Back 89

the kidneys eliminate about 90% of the daily potassium intake, the remainder is lost in stool and sweat

Front 90

TRUE OR FALSE:
if kidney function is significantly impaired toxis levels of potassium may be retained

Back 90

TRUE

Front 91

TRUE OR FALSE:
the ability of the kidneys to conserve potassium is weak even when body stores are depleted

Back 91

TRUE

Front 92

the most common cause of hyperkalemia is ____ failure?

Back 92

renal failure

Front 93

what are the following signs of:
irritabiliy, anxiety, abd cramping, diarrhea, weakness oof the lower extremeties, parestesias, irregular pulse, cardiac arrest if sudden or severe?

Back 93

hyperkalemia

Front 94

what are the following signs of:
fatigue, muscle weakness, leg cramps, n/v, paralytic ileus, soft flabby muscles, paresthesias, decreased reflexes, weak and irregular pulse, polyuria, hyperglycemia?

Back 94

hypokalemia

Front 95

what is #1 of 3 nursing diagnosis for hyperkalemia?

Back 95

risk for electrolyte imbalance related to excessive retention or cellular release of potassium

Front 96

what is #2 of 3 nursing diagnosis for hyperkalemia?

Back 96

risk for injury related to lower extremity muscle weakness and seizures

Front 97

what is #3 of 3 nursing diagnosis for hyperkalemia?

Back 97

potential complication: dysrhythmias

Front 98

name 4 nursing implementations for hyperkalemia?

Back 98

1. eliminate oral and parenteral potassium intake
2. increase elimination of potassium (diuretics, dialysis) also increase fluid intake (more you drink more you pee, more you pee the more potassium can hitch a ride and leave out)
3. IV insulin to force potassium from the ECF and ICF
4. administer calcium gluconate intravenously to reverse membrane potential

Front 99

TRUE OR FALSE:
all pts with clinically significant hyperkalemia should be monitored electrocardiographically to detect dysrhythmias and to monitor the effects of therapy.

Back 99

TRUE

Front 100

____ is released when the circulating blood volume is low, it causes sodium retention in the kidneys but loss of potassium in the urine.

Back 100

Aldosterone

Front 101

____ deficiency may contribute to the development of potassium depletion , low plasma magnesium stimulates renin release and subsequent increased aldosterone levels, which in turn results in potassium excretion.

Back 101

Magnesium

Front 102

the following electrocardiogram changes are signs of what:
tall and peaked T wave, prolonged PR interval, ST segment depression, loss of
P wave, widening QRS, ventricular fibrillation, ventricular standstill ?

Back 102

hyperkalemia (the depolarization and repolarization gets affected)

Front 103

the following electrocardiogram changes are signs of what:
ST segment depression, flattened T wave, presence of U wave, ventricular dysrhythmias, bradycardia, enhanced digitalis effect ?

Back 103

hypokalemia (hyperpolarization occurs)

Front 104

name #1 of 3 nursing diagnosis for hypokalemia?

Back 104

risk for electrolyte imbalance related to excessive loss of potassium

Front 105

name #2 of 3 nursing diagnosis for hypokalemia?

Back 105

risk for injury related to muscle weakness and hyporeflexia

Front 106

name #3 of 3 nursing diagnosis for hypokalemia?

Back 106

potential complication: dysrhythmias

Front 107

TRUE OR FALSE:
SAFETY ALERT:
KCl (potassium chloride) given intravenously must always be diluted

Back 107

TRUE

Front 108

TRUE OR FALSE:
SAFETY ALERT:
Never give KCl (potassium chloride) via IV push or in concentrated amounts

Back 108

TRUE

Front 109

TRUE OR FALSE:
SAFETY ALERT:
IV bags containing KCl (potassium chloride) should be inverted several times to ensure even distribution in the bag

Back 109

TRUE

Front 110

TRUE OR FALSE:
SAFETY ALERT:
Never add KCl (potassium chloride) to a hanging IV bag to prevent giving a bolus dose

Back 110

TRUE

Front 111

how is calcium obtained?

Back 111

from ingested foods

Front 112

only 30% of calcium from foods is absorbed where?

Back 112

in the GI tract

Front 113

TRUE OR FALSE:
more than 99% of the bodys serum calcium is combined with phosphorous and concentrated in the skeletal system.

Back 113

TRUE

Front 114

the functions of ____ include transmission of nerve impulses, myocardial contractions, blood clotting, formation of teeth and bone, and muscle contractions.

Back 114

calcium

Front 115

there are 3 forms of calcium present in the serum, free or ionized, bound to protein (primarily albumin) and what?

Back 115

complexed with phosphate, citrate or carbonate

Front 116

TRUE OR FALSE:
a decreased plasma pH (acidosis) decreases calcium binding to albumin, leading to more ionized calcium.

Back 116

TRUE

Front 117

TRUE OR FALSE:
an increased plasma pH (alkalosis) increases calcium binding, leading to decreased ionized calcium.

Back 117

TRUE

Front 118

TRUE OR FALSE:
low albumin levels result in a drop in the total calcium level , although the level of ionized calcium is not affected.

Back 118

TRUE

Front 119

____ _ is important for absorption of calcium in the GI tract

Back 119

vitamin D

Front 120

causes of hypercalcemia are ?

Back 120

multiple myeloma, malignances with bone metastasis, prolonged immobilization, hyperparathyroidism, vit D overdose, thiazide diuretics, milk-alkali syndrome

Front 121

causes of hypocalcemia are?

Back 121

chronic kidney disease, elevated phosphorus, hypoparathyroidism, vit D deficiency, acute pancreatitis, loop diuretics, chronic alcoholism, diarrhea, low serum albumin

Front 122

the following clinical manifestations are signs of what?
lethargy, weakness, depressed reflexes, decreased memory, confusion, personality changes, psychosis, anorexia, n/v, bone pain, fractures, polyuria, dehydration, nephrolithiasis, stupor, and coma

Back 122

hypercalcemia

Front 123

the following clinical manifestations are signs of what?
easy fatigability, depression, anxiety, confusion, numbness and tingling in extremeties and region around mouth, hyperreflexia, muscle cramps, tetany, seizures, laryngeal spasms, chvostek's signs

Back 123

hypocalcemia

Front 124

TRUE OR FALSE:
about 2/3 of hypercalcemia cases are caused by hyperparathyroidism and 1/3 are caused by malignancy, especially from breast cancer, lung cancer, and multiple myeloma.

Back 124

TRUE

Front 125

malignancies lead to hypercalcemia through ___ ________ from tumor invasion

Back 125

bone deconstruction

Front 126

TRUE OR FALSE:
excess calcium leads to reduced excitability of both muscles and nerves

Back 126

TRUE

Front 127

name #1 of 3 nursing diagnosis for hypercalcemia?

Back 127

risk for electrolye imbalance related to excessive bone destruction

Front 128

name #2 of 3 nursing diagnosis for hypercalcemia?

Back 128

risk for injury related to neuromuscular and sensorium changes

Front 129

name #3 of 3 nursing diagnosis for hypercalcemia?

Back 129

potentail complication: dysrhythmias

Front 130

what is the basic treatment for hypercalcemia?

Back 130

the basic treatment of hypercalcemia is promotion of excretion of calcium in the urine by adminsitration of a loop diuretic AND hydration of the pt with isotonic solution saline infusions.

Front 131

TRUE OR FALSE:
mobilization with wt bearing activity is encouraged to enhance bone mineralization.

Back 131

TRUE

Front 132

FYI:
Plicanycin (Mithracin) a cytotoxic antibiotic, inhibits bone reabsorption and thus lowers the serum calcium levels

Back 132

FYI for hypercalcemia

Front 133

FYI:
n hypercalcemia the drug of choice for malignancies is pamidronate (Aredia) it inhibits the activity of osteoclasts

Back 133

FYI:
this drug is preferred over Mithracin because it does not have cytotoxic side effects and it inhibits bone reabsorption without inhibiting bone formation and mineralization.

Front 134

TRUE OR FALSE:
the pt who receives multiple blood transfussions can become hypocalcemic because the citrate used to anticoagulate the blood binds with the calcium.

Back 134

TRUE, important FYI

Front 135

increased nerve excitabilty and sustained muscle contraction is referred to as ____

Back 135

tetany

Front 136

clinical signs of tetany include what 2 things?

Back 136

Trousseau's signs and Chvosteks's signs

Front 137

____ ___ refers to carpal spasms induved by inflating a blood pressure cuff for 3 minutes above pts normal systolic pressure

Back 137

Trousseau's signs

Front 138

____ ___ is a contraction of facial muscles in response to a tap over the facial nerve in front of the ear.

Back 138

Chvosteks's signs

Front 139

during the postoperative care of a 76-y-o pt the nurse monitors the pts I/O carefully, knowing that the pt is at risk for fluid/electrolyte imbalances primarily because:
a. older adults have an impaired thirst mechanism and need reminding to drink fluids
b. small losses of fluid are more significant because body fluids account for only about 50% of body wt in older adults.

Back 139

B. small losses of fluid are more significant because body fluids account for only about 50% of body wt in older adults.

Front 140

if a hypertonic IV solution is administered, the mechanism involved in equalizing the fluid concentration between the ECF and the cells is:
a. osmosis
b. diffusion

Back 140

a. osmosis

Front 141

an elderly woman was admitted to the medical unit with dehydration. a clinical inducation of this problem is:
a. weight loss
b. full bounding pulse

Back 141

a. weight loss

Front 142

implementation of nursing care for the pt with hypnatremia includes:
a. fluid restriction
b. administation of hypotonic IV fluids

Back 142

a. fluid restriction

Front 143

a pt is receiving a loop diuretic, the nurse should be alert for which symptoms?
a. restlessness and agitation
b. weak, irregular pulse and poor muscle tone

Back 143

b. weak, irregular pulse and poor muscle tone

Front 144

which pt would be at greatest risk for the potential development of hypermagnesemia?
a. 83 y-o man with lung cancer and hypertension
b. 42 y-o woman with systemic lupus erythematous and renal failure

Back 144

b. 42 y-o woman with systemic lupus erythematous and renal failure

Front 145

it is especially important for the nurse to assess for which clinical manifestations in a pt who has just undergone a total thyroidectomy?
a. confusion and personality changes
b. positive Chvostek's signs

Back 145

b. positive Chvostek's signs

Front 146

the nurse anticipates that the pt with hyperphophatemia secondary to renal failure will require:
a. calcium supplements
b. potassium supplements

Back 146

a. calcium supplements

Front 147

the lungs act as an acid-base buffer by:
a. increasing resp rate and depth when CO2 levels in the blood are high, reducing acid load
b. increasing resp rate and depth when CO2 levels in the blood are low, reducing acid load

Back 147

increasing resp rate and depth when CO2 levels in the blood are high, reducing acid load

Front 148

a pt has the following arterial blood gas results: pH 7.52, PaCO2 30 mmHg, HCO3- 24 mEq/L. the nurse determines that these results indicate:
a. respiratory alkalosis
b. metabolic alkalosis

Back 148

a. respiratory alkalosis

Front 149

the typical fluid replacement for the pt with a fluid volume deficit is:
a. 5% dextrose in 0.45% saline
b. Lactated Ringers

Back 149

b. Lactated Ringers

Front 150

the nurse is unable to flush a central venous access device and suspects occlusion. the best nursing intervention would be:
a. apply warm moist compress to the insertion site
b. instruct the pt to change positions, raise arm, and cough

Back 150

b. instruct the pt to change positions, raise arm, and cough