Fluids And Electrolytes Pharm (Kee) C.14.p203

Front 1

Of the 60% of adult body water how much is in the intracellular

Back 1

40%

Front 2

How much water is in extracellular.
The extracellular fluid is made up of interstitial tissue fluid and intravascular or vascular fluid.

Back 2

20%

Front 3

How much water is in the interstitial (tissue) fluid.

How much water is in the vascular fluid.

Back 3

15%


5%

Front 4

Iso-osmolar fluid

Back 4

Has the same proportion of weight of particles (eg. sodium, glucose, urea, protein) and water.

Front 5

Hypo-osmolar fluid

Back 5

Has few particles than water

Front 6

Hyperosmolar fluid
>275 mOsm/kg (more particles - less water)

Back 6

Has more particles than water. The plasma/serum osmolality (concentration of circulating body fluids) can be calculated if the serum sodium level is known or the sodium, glucose, and BUN leverls are known.

Front 7

Formula to estimate serum osmolarity is

Back 7

double the serum sodium (Na) = serum osmolarity.

Front 8

Normal serum osmolarity

Back 8

275-275 mOsm/kg.

Front 9

Hypo-osmolar

Back 9

<275 mOsm/kg (less particles - more water).

Front 10

Hypo-osmolarity may be caused by what? (not enough salt)

Back 10

fluid overload caused by an inability to excrete enough water.

Front 11

hyperosmolarity (too much salt) dehydration

Back 11

Could be caused by severe diarrhea, increased salt and solutes (protein) intake, inadequate water intake, diabetes, ketoacidosis or sweating.

Front 12

What is the difference between osmolality and tonacity?

Back 12

Osmolality it the CONCENTRATION of body fluids.

TONACITY is the effect on celular volume.

Front 13

What is a better indicator of the concentration of solutes in body fluids

Back 13

serum osmolarity

Front 14

When is tonicity primarily used.

Back 14

as a measurement of the concentration of IV solutions.

Front 15

What is the average isotonicity range for an IV solution?

Back 15

240 to 340 mOsm/L.

Front 16

How do you determine the isotonicity range of an IV solution?

Back 16

It is determined by using a factor of 50: subtract 50 from 290 mOsm to equal 240 and add 50 to 290 to equal 340.

Front 17

After doing the 'tonicity' calculation; and the tonicity of the IV solution is <240 mOsm is it hypo or hypertonic

Back 17

hypontonic

Front 18

After doing the 'tonicity' calculation; and the tonicity of the IV solution is >340 mOsm is it hypo or hypertonic

Back 18

hypertonic

Front 19

What are the isotonic solutions

Back 19

dextrose 5% in water (D5W)
normal saline or 0.9% NaCl (sodium chloride)
lactated ringers
and ringers solution

Front 20

isotonic solutions have osmolarities similar to which fluids in the body

Back 20

extracellular and intracellular

Front 21

With fluid volume loss, ---------- IV solution are usually indicated.

Back 21

isotonic

Front 22

Dextrose in water when used continuously or administered rapidly, becomes what kind of a solution ......

Back 22

hypotonic

Front 23

How should D5W NEVER be administered

Back 23

Sub-q

Front 24

Normal saline slution or an ISOTONIC solution of dextrose and saline may be administered how

Back 24

SC

Front 25

What are the four classifications of IV solutions used for fluid replacements

Back 25

crystalloids
colloids
blood and blood products
lipids

Front 26

What are crystalloids

What are crystalloids used for

Back 26

they include dextrose, saline and lactated Ringer's solutions.
This group of solutions is used for replacement and maintenance fluid therapy.

Front 27

What are colloids

Back 27

volume expanders

Front 28

What do colloids include

Back 28

dextran solutions
amino acds
hetastarch
Plasmanate

Front 29

What is of note about the colloid Dextran

Back 29

Dextran 40 tends to interfere with platelet function and can prolong bleeding time.

Front 30

When is Hetastarch (isotonic 310mOsm/l) contraindicated

Back 30

for clients with bleeding disorders, CHF and renal dysfunction.

Front 31

What is the purpose of using Plasmanate

Back 31

Used instead of plasma or albumin to replace body protein.

Front 32

What are blood and blood products specifically

Back 32

colloids: and are whole blood, packed rbc, plasma and albumin. A unit of packed RBC contains whole blood without plasma.

Front 33

What are the advantages of using packed packed cells instead of whole blood.

Back 33

There is a decreased chance of causing circulatory overload, a smaller risk of a reaction to plasma antigens and a possible reduction in the risk of transmitting serum hepatitis.

Front 34

Whole blood SHOULD NOT be used for what

Back 34

to correct anemia unless the anemia is severe.

Front 35

A unit of whole blood elevates the Hg by what

and a unit of RBCs elevates the hct by what

Back 35

0.5 to 1.0 g

3 points

Front 36

Lipids (colloids) are used when and what are they

Back 36

are usually indicated when IV therapy lasts longer than 5 days.

They are administered as fat emulsion solutions. Lipids add to balancing the pts nutritional needs.

Front 37

TPN ~ long or short-term

Back 37

Normally Long-term

Front 38

Daily water needs

Back 38

15ml per pound. A client weighing 150 LBs should receive 2250 ml of water daily. (150 x 15 = 2250)

Front 39

If a client has a fever, water needs to increase by what %

Back 39

15%

Front 40

How much water lost through the skin daily

Back 40

400-500 ml
400-500 ml through bx
100-200 ml feces
1000-1200 ml urine

Front 41

When in the assessment stage, if the nurse notes elevated BUN and creatinine this could mean what

Back 41

dehydration (so increased BUN and creatinine means dehydration)

Front 42

If BUN is >60 mg/dl what can this mean

Back 42

renal impairment

Front 43

What should normal urine output be

Back 43

>35 ml/h or 1000 to 1200 ml/day

Front 44

When should urine output become worrysome

Back 44

If <25 ml/h or 600 ml/day

***CLARE CHECK WHY NOT <35ml **

Front 45

What is normal specific gravity

Back 45

1.005 - 1.030

Front 46

If sg is >1.030 what might be the cause

Back 46

dehydration

Front 47

Fluid replacement ND

Back 47

r4 fv excess r/t excess volume infused, rapidly infused IV fluids or volume infused too great for client's physical size or condition.
R4 deficient fluid volume r/t inadequate fuid intake
Ineffective tissue perfusion (vascular) r/t decreased blood circulation or inadequate fluid replacement.

Front 48

Elevated BUN, creatinine and hct can indicate what

Back 48

dehydration

Front 49

When IV fluids are prescribed for 24 hours, the total amount ordered is usually what

Back 49

2000 to 3000 ml.

Front 50

hyperosmolality does what to the cells

Back 50

pulls fluid from cells and promotes fluid excretion.

Front 51

K+ range

Back 51

3.5 - 5.5 mEq/L

Front 52

K+ <2.5 mEq/L or > 7.0 mEq/L
could lead to what

Back 52

cardiac arrest

Front 53

K+ RDA

Back 53

40-60 mEq daily

Front 54

Major sources of K+

Back 54

bananas and dried fruits

Front 55

K+ serves to do what

Back 55

transmission and conduction of nerve impulses and for the contraction of skeletal, cardiac and smooth muscles.

Front 56

How can K+ be administered

Back 56

oral (liquid, powder or tablet) or IV.
Is combined with chloride or bicarb.
***MUST BE GIVEN WITH HALF GLASS OR FULL GLASS OF WATER to prevent gastric irritaion.

Front 57

How must K+ be administered when doing so IV

Back 57

must be diluted and CANNOT be given as a bolus.

Front 58

S/S hypokalemia

Back 58

nausea
vomitting
dysrhythmias
ab. distention
soft, flabby muscles

Front 59

If K+ is a LOW normal - which foods should be suggested

Back 59

fruit juices,
citrus fruits
dried fruits
bananas
nuts (peanut butter)
some sodas and tea
veges such as potatoes, broccoli and green leafy veges.

Front 60

Which drugs promote K+ loss

Back 60

Hydrochlorothiazide (HydroDiuril)
Furosemide
ethacrynic acid (Edecin)
cortisone preparations

Front 61

Onset or oral K+

Back 61

30 minutes (within)

Front 62

What normally causes hyperkalemia

Back 62

renal insufficiency or administration of large doses of K+ over time.

Front 63

To immediately correct hyperkalemia what might be given

Back 63

bicarb
calcium gluconate
insulin or glucose

Front 64

For SEVER hyperkalemia give

Back 64

Kayexalate (Sodium polystyrene sulfonate.

Front 65

S/S hyperkalemia are

Back 65

nausea
ab. cramps
oliguria (decreased urine output)
tachycardia and later bradycardi
weakness
numbness or tingling in the extremities.

Front 66

Potassium-wasting durectics are a majoy cause of what

Back 66

hypokalemia (low K+)

Front 67

What are the two categories of diuretics

Back 67

potassium-wasting
potassium-sparing

Front 68

Which major drug groups can cause hypokalemia

Back 68

laxatives
corticosteroids
antibiotics
K+ sparing diuretics

Front 69

The drug groups that may cause hyperkalemia include

Back 69

oral and IV K+ salts
CNS agents
K+ sparing diuretics

Front 70

Normal sodium level

Back 70

135-145 mEq/L

Front 71

S/S hyponatremia

Back 71

muscular weakness
headaches
ab.cramps
nausea
vomiting

Front 72

For serum sodium level between 125-135 mEq/L give

Back 72

normal saline (0.9% sodium chloride) which may increase the sodium content in the vascular fluid.

Front 73

For serum sodium level 115 mEq/L what do you give

Back 73

Hypertonic, 3% saline solution

Front 74

S/S hypernatremia

Back 74

>145mEq/L restrict sodium.

Flushed skin
elevated body tem and blood pressure
rough dry tongue

Front 75

Calcium range

Back 75

4.5 - 5.5 mEq/L
or
8.5 - 10.5 mEq/L (9 to 11) mg/dl

Front 76

Function of calcium

Back 76

Promotes normal nerve and muscle activity. It increases contraction of the heart muscle (myocardium). Also, promotes blood clotting by converting prothrombin into thrombin. In addition, calcium is needed for the formation of bones and teeth.

Front 77

What does Vit. D. do in relation to calcium

Back 77

It is needed for calcium absorption from the GI tract.

Front 78

Which meds. alter calcium absorption

Back 78

Aspirin
anticonvulsants

Front 79

Which meds promote calcium loss

Back 79

furosemide (Lasix)
steroids (Cortisone)
magnesium preparations
phosphate preparations

Front 80

Which meds increase serum calcium levels

Back 80

Thiazide diuretics (hydrochlorothiazide ((HydroDiuril)).

Front 81

What are the causes of hypocalcemia

Back 81

Hypoparathyroidism
blood transfusions

Front 82

S/S of hypocalcemia

Back 82

anxiety
irritability
tetany (twitching around the mouth, tingling and numbness of fingers, carpopedal spasm, spasmodic contractions, laryngeal spasm, and convulsions.

Front 83

What are calcium preparations combined with

Back 83

various salts, such as chloride, carbonate, gluconate, gluceptate and lactate.

Front 84

How should calcium for IV use be mixed

Back 84

with D5W. *** DO NOT MIX WITH SALINE SOLUTION *****

Front 85

In emergency situations, how can calcium be given

Back 85

undiluted

Front 86

Hypercalcemia may be caused by what

Back 86

hyperparathyroidism
hypophosphatemia
tumors of the bone
prolonged immobilization
multiple fractures
drugs such as thiazide diuretics.

Front 87

S/S hypercalcemia

Back 87

flabby muscles
pain over bony areas
kidney stones

Front 88

Which groups of drugs can lower serum calcium level.

Back 88

Phosphate preparations
corticosteroids
loop diuretics
aspirin
anticonvulsants
magnesium sulfate
mithramycin

Front 89

What is the clinical management of hypocalcemia

Back 89

oral supplements and IV calcium diluted in D5W. ***CALCIUM SHOULD NOT BE DILUTED IN A NORMAL SALINE SOLUTION (0.9%) because sodium promotes calcium loss.

Front 90

When should oral calcium be given

Back 90

30 minutes before meals.

Front 91

How should hypercalcemia be managed.

Back 91

Tx the underlying cause. Drugs such as CALCITONIN or IV SALINE SOLUTION administered rapidly and followed by a loop diuretic can be used to promote rapid urinary excretion of calcium.

Front 92

Where is magnesium the most abundant

Back 92

ICF

Front 93

Decreased K+ =

Back 93

decreased magnesium

Front 94

Normal magnesium level

Back 94

1.5 to 2.5 mEq/L
or
1.8 to 3.0 mg/dl

Front 95

RDA magnesium

Back 95

8 to 20 mEq

Front 96

Functions of magnesium

Back 96

promotes the transmission of neuromuscular activity
Contraction of myocardium
Activates many enzymes for the metabolism of carbs and protein
Is responsible for the transportation of sodium and potassium across cell membranes

Front 97

Hypomagnesemia can result in what with regards to the heart

Back 97

cardiac (ventricular) dysrhythmias

Front 98

Hypermagnesemia can result in

Back 98

heart block and hypotension

Front 99

Hypomagnesemia is asymptomatic and hard to detect until the mag. level approaches

Back 99

1.0 mEq/L

Front 100

To correct severe hypomagnesemia give

Back 100

IV magnesium sulfate (MgSO4)

Front 101

For hypermagnesemia tx with

Back 101

calcium gluconate.

Front 102

Digitalis toxicity can be enhanced by hypo or hypermagnesemia

Back 102

hypomagnesemia

Front 103

Which drug groups could cause hypermagnesemia

Back 103

laxatives (magnesium sulfate, milk of magnesia, magnesium citrate
antacids (Maalox, Mylanta, Di-Gel)

Front 104

What is the average range of osmolality of body fluids.

Back 104

290 mOsm/kg

Front 105

If your client's serum sodium is 140 mEq/L, BUN is 12 mg/dl and glucose is 100 mg/dl, what is your client's serum osmolality.

Back 105

Double the serum sodium:
140 x 2 = 280 mOsm/kg

Can only do this if the SERUM SODIUM level is known along with BUN,or GLUCOSE

Front 106

The client is receiving 1000 ml of D5W/0.9% NaCl (5% dextrose in normal saline solution). What is the osmolality of this IV solution? Explain?

Back 106

Help******

Front 107

What is the difference between crystalloids and colloids.

Back 107

Crystalloids include dextrose, saline and lactated Ringer's solutions. This group of solutions is used from replacement therapy.
Colloids are volume expanders that include dextran solutions, amino acids, hetastarch and Plasmanate.

Front 108

Your client gained 15 pounds in 2 days. It is determined that the weight gain is caused by body fluid retention. The weight gain could be quivalent to how many liters of fluid (water).

Back 108

15lb x 15ml per 1lb body weight = 225 ml

***CLARE DOUBLE CHECK THIS ***

Front 109

What is normal serum K+ range

Back 109

3.5 - 5.3 mEq/L

Front 110

Your pt has been vomiting and has weak, flabby muscles. The cliennt's pulse is irregular. Whate type of K+ imbalance would you suspect?

Back 110

hypokalemia

Front 111

What are the nursing implications of giving oral K+ supplements and for giving IV KCL.

Back 111

oral - give with at least 6-8 oz of water or at mealtime. K+ is extremely irritating to gastric mucosa.
Dilute IV K+ in the IV bag. NEVER give as a bolus or IV push.

Front 112

What drugs are used to tx severe hyperkalemia

Back 112

Sodium Polystyrene sulfonate (Kayexalte) with sorbital.

Front 113

How is Sodium Polystyren sulfonate (Kayexalate administered

Back 113

Orally or rectally.

Front 114

What drugs may cause an elevated serum sodium level? What health problem may result?

Back 114

x

Front 115

Hypocalcemia range

S/S of hypocalcemia

Back 115

4.5 to 5.5 mEq/L or 8.5 to 105 mg/dl

Anxiety, irritability and tentany (twitching around mouth, tingline and numbness of fingers, carpopedal spasm, spasmodic contractions, laryngeal spasm and cunvulsions).

Front 116

Why are clients with hypocalcemia and hypercalcemia at high risk of having fractures

Back 116

With hypocalcemia, inadequate calcium intake causes calcium to leave the bone to maintain a normal serum calcium level. Fractures may occur if calcium deficit persists because of calcium loss from the bones (bone demineralization).

With hypercalcemia, pathologic fractures might occur because of thinning of the bone resulting from calcium loss from the bony structure.

Front 117

What are the functions of magnesium?

Back 117

Promotes the transmission of neuromuscular activity; it is an important mediator of neural transmission in the CNS. It pomotes contraction of the myocardium. It activates many enzymes for the metabolism of carbohydrates and protein. It is responsible for the transportation of sodium and potassium across cell membranes.

Front 118

Describe specific client teaching for clients with hypomagnesemia or hypermagnesemia.

Back 118

Hypomagnesemia ~ eat food rich in magnesium (green veges. fruits, fish and seafood, grains, nuts and peanut butter)
Hypermagnesemia ~ Avoid routine use of laxatives and antacids that contain magnesium. Suggest the client check drug labels.