Medsurgery - [A] Fluid + Electrolyte Imbalances

Front 1

movement of fluid to maintain homeostasis , space between the cells in the tissues is called

Back 1

interstitual space

Front 2

fluid in cells (made of pottasium) is called

Back 2

intracellular fluid

Front 3

fluid outside of cells (plasma, i.f.) , these are NOT in cells

Back 3

extracellular fluid

Front 4

what gets rid of pottassium, secreted by adrenal cortex, stimulates renal (K) reabsorption.

Holds on to H20 and Sodium

Back 4

aldosterone

Front 5

what is secreted by the posterior pituatary gland, reabsorbs H20 in kidney and rids body of Pottasium

Back 5

ADH antidiuretic hormone

Front 6

the body wants to maintain what kind of state

Back 6

Isotonic/Homeostatic

Front 7

when you hold on to H20 and Sodium, what do you rid the body of

ex) ADH

Back 7

Pottasium

Front 8

a decrease in tissue perfusion and a decrease of fluid to the tissues is an example of

Back 8

HYPOvolemia (ECF volume deficit)

Front 9

EFC volume deficit is also known as

Back 9

HYPOVOLEMIA

Front 10

same concentration as normal body fluids is known as (saline)

Back 10

isotonic

Front 11

measurement of number of solutes per concentration is called

Back 11

osmolarity

Front 12

higher concentration (MORE solutes to number of fluids) is known as

Back 12

hypertonic

(shrinks)

Front 13

less concentration (LESS solutes to number of fluid) is known as

Back 13

HYPO tonic
(bursts)

Front 14

loss of H20 alone describes

Back 14

dehydration

Front 15

circulating volume increases and circulatory overload, including dehydration, this occurs with electrolyte imbalances

Back 15

ECF volume excess , HYPERVOLEMIA

Front 16

Major loss of all insensible fluids is through

Back 16

PERSPIRATION

Front 17

what is caused by insensible loss of fluids(H20) , draining wounds, diuretics, thirs space loss, decreased fluid intake

Back 17

HYPOVOLEMIA

Front 18

Supplemental O2 adds to

Back 18

fluid loss, fever, heat stroke

Front 19

a loss of blood sugar is what kind of loss?

Back 19

Isotonic

Front 20

thirst
dry mucous membranes
decreased turgor
are later signs of

Back 20

ECF decrease , hypovolemia

Front 21

hypovolemia comes with a _______ in urine output and weight loss

Back 21

decrease

Front 22

signs and symtoms of HYPOVOLEMIA are

Back 22

deceraed urine output
weight loss
postural orthostatic hypotension
increase pulse and RR
decreae cap refill
neckvein distention

Front 23

you must treat the ___________ w/ hypovolemia

Back 23

underlying cause

Front 24

with hypovolemia, explain what you do to loss of h20 and electrolytes and blood

Back 24

- use an ISOTONIC IV solution
to replace h20 and electrolytes

repalce blood if blood loss

Front 25

excessive IV fluids can cause heart failure or renal failure, this is known as

Back 25

hypervolemia (Excess fluid volume)

Front 26

drinking too much is known as

Back 26

polydipsia

Front 27

excessive steroids, corticosteroids is known as

Back 27

cushings syndrome

Front 28

inappropriate ADH secretion at wrong time is known as

Back 28

SIADH

Front 29

clinical manifestations of hypervolemia include distended abdomin, liverenlargement, seizure coma, increase BP, NVD, and what ....

Back 29

fluid in lungs backup causing dyspnea and oprhopnea cough

Front 30

name one way to treat underlying cause of hypervolemia

Back 30

remove f/e with diuretics, fluid restriction, NA restriction or finally with needle (paracentesis)

Front 31

if intake and output is INCREASED, urine is

Back 31

more concentrated, you want urine to be concentrated

Front 32

if intake and output is DECREASED urine is

Back 32

more dilute

Front 33

pulse rate, heart sound, bp changes , your heart is working too hard, flatteened neck veins, these are examples of

Back 33

cardiovascultar changes
(reflects sympathetic nervous system compensation)

Front 34

pulmonary congestion (fluid in alveoli) or decreased tissue perfusion, change in respiratory rate, SOB, dyspnea, cough, are exammples of what type of changes

Back 34

respiratory

Front 35

THE EASIEST AND MOST ACCURATE WAY TO JUDGE FLUID LOSS IS WITH

Back 35

DAILY WEIGHTS

Front 36

asess skin turgor and mobility, temp, mositure, edema, mucuous membrane and do what for implementation to patient?

Back 36

change position
elevate edemous extremties
use lotions and oils

Front 37

1 kg = 2.2 lb =

Back 37

1 LITER FLUID!

Front 38

PRIMARY determinant of ECF osmolarity

Back 38

SODIUM NA+

Front 39

SODIUM NORMAL LEVEL IS

Back 39

135-145

Front 40

sodium is important for the body for

Back 40

GENERATION AND TRANSMISSION OF NERVE IMPULSES AND

REGUALTE ACID=BASE BALANCE

Front 41

WHAT IS MOST SENSITIVE TO CHANGES IN NA+ LEVELS!?

Back 41

THE BRAIN

Front 42

sodium moves with what?

Back 42

water

Front 43

a change in K pottasium level affects what?

Back 43

the HEART

Front 44

the body gets most of it's NA+ from what?

Back 44

FOOD (GI absortption)

Front 45

how does the body lose NA+

Back 45

feces, urine, sweat

Front 46

what regulates the NA+ Balance?

Back 46

KIDNEYS

Front 47

Name examples of kidney regulation of NA+ balance

Back 47

ADH
aldosterone

Front 48

adh and aldosterone help lose sodium and where does sodium get excreted

Back 48

kidneys

Front 49

what reflects the ratio of NA+ to H20?

Back 49

serum NA+ level

Front 50

if isotonic imbalance NA + Level remains what?

Back 50

NORMAL, an isotonic loss

Front 51

where does NA+ come from primarily

Back 51

food such as processed food, canned goods

Front 52

what causes nerve impulses to move?

Back 52

sodium switching

Front 53

HYPERNATREMIA affects what?

Back 53

THE BRAIN

Front 54

a GAIN of na+ or a loss of H20 is called

Back 54

HYPERNATERMIA

Front 55

shifts from cells to ECF cuasing

Back 55

cell shrinkage (hyper)

Front 56

the body picks up increasing NA+ to maintain

Back 56

homeostasis

Front 57

H20 to ECF helps maintain what kind of state

Back 57

isontonic

Front 58

causes of hypernatermia are impaired thirst, dysphagia, watery diareah, polyuria

Back 58

excessive hypertonic solutions IV, edxcessive PO intake of NA+m, disease

Front 59

what kind of symptoms (restlessness, agitation, seizures, coma) would you see with HYPERNATREMIA?

Back 59

CNS symptoms, the BRAIN is affected

Front 60

you must treat underlying cause of hypernatremia, and use hypotomnic IV solutions slow or fast?

Back 60

slow, NA levels must be reduced SLOWLY

Front 61

A DECREASED ADH will

Back 61

RETAIN NA+ AND RID H20 (hypernatremia)

Front 62

gained too much H20 or too little NA+ is known as

Back 62

HYPONATERMIA

Front 63

IN hyponatermia , H20 shifts into cells causing

Back 63

cell swelling and bursts

Front 64

a condition commonly found in the hospital population, especially in patients being hospitalized for central nervous system (CNS) injury. This is a syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is hyponatremia, and sometimes fluid overload. It should be noted that vasopressin has other important functions, addressed in the appropriate articles.

Back 64

SIADH
syndrome of inappropriate ADH secretion

Front 65

SIADH result is

Back 65

hyponatermia

Front 66

hyponatremia occurs when there is a _______ of na+ containing fluids, example is a wound.

Back 66

LOSS

Front 67

h20 Excess / hypotonic IV fluids causes

Back 67

hyponatremia

Front 68

too little NA+ or too muc hH20 in ECF causes

Back 68

hyponatremia

Front 69

a Sodium level above 145(157) is

Back 69

hypernatremia

Front 70

a soidunm level below 134 (129) is known as

Back 70

hyponatremia

Front 71

hyponatermia retains H20 causing

Back 71

weight gain

Front 72

how do you care for a patient with HYPONATREMIA?

Back 72

treat underlying cause
HYPERTONIC IV - SLOWLYYYY
replace PO fluids with NA+
correct slow to prevent NEURO DAMAGE

Front 73

To fix HYPERNATREMIA you give what kind of IV SLOWLY

Back 73

HYPOTONIC IV

Front 74

to fix HYPONATERMIA you give what kind of IV slowly

Back 74

HYPERTONIC IV

Front 75

Primary determiant of ICF osmolarity is known as

Back 75

K POTASSIUM (IN THE CELLS)

Front 76

Pottassium is located

Back 76

IN THE CELLS

Front 77

Cardiac Cells are very sensitive to changes in

Back 77

K+ LEVELS

Front 78

K levels affect the

Back 78

HEART

Front 79

The body gets most it's K+ from

Back 79

Food such as fruits and vegetables
BANANAS
ORANGES
GREEN LEAFY
VEGS

Front 80

Potassium is important to the body for

Back 80

cell funciton
generation of nerve impulses
cell growth

Front 81

The body loses K in

Back 81

urine, stool, sweat, medication such as diuretics

Front 82

What excrete extra K -

Back 82

kidneys

Front 83

what kind of relationship occurs between K and NA

Back 83

INVERSE relationship

Front 84

Serfum K+ levels refelect the movement of K+ .........

Back 84

OUT OF CELLS INTO ECF

Front 85

Trauma to cells (medications) is known as

Back 85

acidosis

Front 86

cell building, stress, insulin is known as

Back 86

ALKALOSIS

Front 87

Kidneys hold NA+ and excrete

Back 87

POTASSIUM K

Front 88

what are some things that increase potassium levels

Back 88

surgery, accidents, tissue cell damage

Front 89

Potassium normal level is

Back 89

3.5-5

Front 90

a gain of K+ movement of fluid from ICF into ECF.

amn EXCESS K intake

Back 90

hyperkalemia

Front 91

you must look at what level to asess KIDNEY problem

Back 91

BUN/CREATINE level

Front 92

hydrogen moves INTO cell and potassium moves out causing hyperkalemia is known as

Back 92

ACIDOSIS

Front 93

a K + level greater than 5 = HYPERKALEMIA and sings are

Back 93

EKG CHANGE, Irregular pulse, cardiac arrest, LOWER EXTREMEITY WEAKNESS

Front 94

A sure sign of HYPERKALEMIA or excess K+ is

Back 94

LOWER EXTREMITY WEAKNESS

Front 95

RN interevention for hyperkalemia is to

Back 95

decrease K intake, increase elimiation of K+ with diuretics such as KAYEXALATE, dialysis

Front 96

What causes HYPERKALEMIA?

Back 96

METABOLIC ACIDOSIS

Front 97

THE MOST COMMON ELECTROLYTE IMBALANCE IN THE HOSPITAL IS KNOWN AS

Back 97

HYPOKALEMIA

Front 98

caused by a lack of intake, lack of potassium, shifts into cells

Back 98

hypokalemia

Front 99

K must be replentished in the body, a decrease in cellular exciteability causes changes in the

Back 99

HEART

Front 100

weakness, fatigue, cramps, decreased pulse ox, vital changes, orthostatic hypotension, are clinical manifestiations of

Back 100

Hypokalemia

Front 101

to care for hypkalemia , you must replace what

Back 101

K+ PO or IV and SLOWLY

Front 102

A PH level greater that 7.45 is

Back 102

ALKALOSIS

Front 103

A PH level less than 7.35 is

Back 103

ACIDOSIS

Front 104

kidnesy excrete what and retain what

Back 104

kidneys EXCRETE HYDROGEN IONS
and RETAIN BICARBONATE.

Front 105

Lungs exhale what?

Back 105

CO2

Front 106

An increase of HCO3 (Bicarbonate) =

Back 106

HIGH ALKALOSIS

Front 107

an increase of Hydrogen Ions =

Back 107

LOW ACIDOSIS

Front 108

ARTERIAL BLOOD GAS PROBLEMS

Back 108

LOOK AT PH TO FIND ACID./ALK
LOOK AT PACO2 AND HC03
to figure out respiratory or metabolic

Front 109

PH normal

Back 109

7.35-7.45 ACID/ALK

Front 110

PAC02 normal

Back 110

35-45 RESPIRATORY

Front 111

PAC03 Normal

Back 111

22-26 METABOLIC

Front 112

Respiratory is the lungs and metabolic is the

Back 112

kidneys

Front 113

excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is hyponatremia, and sometimes fluid overload.

Back 113

SIADH

Front 114

failure of respiratory system to remove CO2 from body fluids as fast as it is produced causing excess CARBONIC ACID (pac03) leads to

Back 114

RESPIRATORY ACIDOSIS

Front 115

RESPIRATORY ACIDOSIS =

Back 115

PACO2 > 45
PH < 7.35

Front 116

RESPIRATORY acidosis is caused by

Back 116

HYPOVENTILATION
EX) copd/ meds that depress resp.

Front 117

too much o2 decreases respiratory drive because it decreases

Back 117

stimuls to breathe and let off CO2

Front 118

a patient with cyanosis and rapid shallow respirations, disorientation and blurred vision and weakness is experiencing

Back 118

RESPIRATORY ACIDOSIS

Front 119

What compensates for respiratory acidosis?

Back 119

KIDNEYS reabsorb HC03 AND EXCRETE HYDROGEN IONS into the urine

this takes HOURS TO DAYS

Front 120

Another way to compensate for respiratory acidosis is to

Back 120

hyperventialtion to blow off CO2

Front 121

a loss of CO2 from lungs faster than produced by cells aka CARBONIC ACID DEFICIT is known as

Back 121

RESPIRATORY ALKALOSIS
(excessive CO2 exhalation)

Front 122

REspiratory Alkolosis is caused by

Back 122

HYPERVENTILATION

Front 123

respiratory alkolosis can also be triggered byt

Back 123

high altitude, anxiety, fever, excercise, stimulation of respiratory center, brain injury, septicemia

Front 124

a pt complains of ligheadednes, parasthesias, altered consciousness, cramps, spasms, these are signs of

Back 124

RESPIRATORY ALKOLOSIS

Front 125

RESPIRATORY ALKALOSIS =

Back 125

PACO2 < 35
PH > 7.45

Front 126

to compensate for RESP ALKALOSIS

Back 126

kidneys reabsorb H+ and excrete HC03 (Bicarbonate)

takes hours to days

Front 127

respiratory alkalosis patients can counteract it with

Back 127

CO2 rebreather
antianxiety agents

Front 128

Abnormal accumulation of acids or loss of bases from the body known as base bicarbonate deficit is called

Back 128

METABOLIC ACIDOSIS

Front 129

abnormal accumulation of acids or loss of bases from the body (base bicarbonate deficit)

Back 129

METABOLIC ACIDOSIS

Front 130

METABOLIC ACIDOSIS =

Back 130

PH < 7.35
HCO3 > 22

Front 131

metabolic acidosis is caused by

Back 131

DM acidosis, lactic acidosis, starvation, renal failure, breakdown of muscle

Front 132

a pt with deep rapid respirations (kussmaul resp) is a clinical manifestation of

Back 132

metabolic acidosis

Front 133

to compensate for metabolic acidosis ,patient is given

Back 133

IV bicarbonate, lungs try to blow off excess CO2, renal buffering

Front 134

loss of hydrogen ions or too much bicarobate is called

Back 134

METABOLIC ALKALOSIS

Front 135

METABOLIC ALKALOSIS =

Back 135

ph > 7.45
hc03 bicarb > 26

Front 136

DURING metabolic alkalosis, H and K compete in the

Back 136

kidneys

Front 137

Kidneys choose H + and remove K + , this is called

Back 137

hypokalemia

Front 138

meds that increase excretion of H and K , fluid loss from stomach, cushings disease, excessive adminstartion of alkali lead to

Back 138

metabolic alkalosis

Front 139

pt ocmplains of apathy, mental confusion, dizziness, weakness, shallow respirations, spastic muslces and cramping shows signs of

Back 139

metabolic alkalosis

Front 140

RESPIRATIONS SLOW AND SHALLOW WITH PERIODS OF APNEAAAAAAAAAA occur with

Back 140

METABOLIC ALKALOSIS

Front 141

To compenssate for metabolic alkalosis, the lungs

Back 141

retain CO2 by decreasing respirations (slow hypoventilation)

Front 142

what can you use to incrase HC03 (bicarb) excretion?

Back 142

Diuretics (diamox)

Front 143

who get dehyrdrated quicker and are at greater risk for kidney problems due to excess medication

Back 143

elderly

Front 144

major cause of elderly problem are

Back 144

diuretics

Front 145

most accuarte measurement of fluid loss is

Back 145

weight

Front 146

what value shows blood concentration level of red blood cells

Back 146

hematocrit HCT

Front 147

what value if increased shows a definite kidney problem

Back 147

CREATINine

Front 148

if hematocrit is off there is a decrease of

Back 148

fluid

Front 149

patient should learn to

Back 149

report signs and symptomsof imbalances such as weight gain or loss, edema, urine production changes, hygiene oral

Front 150

primary - for mild to moderate dehydration is

Back 150

oral replacement

Front 151

if patient has mild or chronic FVE Fluid volume excess or hypervolemia, you need to

Back 151

restrict fluids and sodium

Front 152

if given a diuretic, you must monitor

Back 152

Electrolytes

Front 153

if you have a kidney problem you cannot give a

Back 153

diuretic

Front 154

potassium given orally, tasetes bad , ggive with food because of GI upset , this is for

Back 154

electroltye replacement

Front 155

increase excretion of potassium, given rectally

Back 155

kayexalate

Front 156

MOST COMMON OCCURING ELECROTYEPROBLEM IN HOSPITAL

Back 156

HYPOKALEMIA

Front 157

NEVER GIVE POTASSIUM IV PUSH
OR IM OR SUBQ
T/F

Back 157

TRUE

Front 158

IF potasium mixed in IV you must give with a

Back 158

infusion pump

Front 159

patients shoudl learn to report

Back 159

weight gain or loss, edema, urine proudction changes.

Front 160

primary cure for dehydration is

Back 160

OREAL REPLACEMENT

Front 161

if fluid volume excess, you must

Back 161

restrict fluids and sodium, no caffeine or salt.

Front 162

must monitor what if you are taking diuretics, cant use with kidney problems

Back 162

ELECTROLYTE MONITORING

Front 163

most useful if renal failure is not cause of problem, potential to cause dehyrdation and elec imbaalnce

Back 163

diuretics

Front 164

A nurse understands isotonic solutions when the nurse states:

Back 164

It is helpful in the treatment of hypotension from the loss of fluid.

Front 165

Why is old blood and injuries like burns important to K monitoring?

Back 165

K is released from damaged blood cells.

Front 166

Nurse Lala is assessing her pt's IV site. She notices that is red and warm to the touch. What can Lala take away from this?

Back 166

phlebitis

Front 167

Which condition needs extra assessment when considering hypertonic solutions?

Back 167

heart

Front 168

Nick has had surgery and is having post op edema. Which solution would you expect, as the nurse, to see being used for Nick?

Back 168

hypertonic

Front 169

Oral K is not usually a problem unless a pt has this problem?

Back 169

kidney/renal failure

Front 170

Concentrations of electrolytes are similar in ICF and ECF.

Back 170

false

Front 171

A nurse understand hypokalermia when the nurse states:

Back 171

hypokalemia can decrease BP

Front 172

In pt teaching about hypokalemia, what is the most important education to be done?

Back 172

Bowel management care

Front 173

Hypernatremia can be caused by:

Back 173

high fever, sweating

Front 174

A nurse understand hypertonic solutions when the nurse states:

Back 174

It has a higher osmolality than plasma , pushes fluid into the cells

Front 175

k is important for

Back 175

muscle function

Front 176

A nurse understand K and IV infusion when the nurse states:

Back 176

K never be infused into a patient

Front 177

Why is insulin good for K regulation?

Back 177

keeps K from being pulled out of cells

Front 178

Mary Anne is a 86 year old woman. She has olguria and a swollen tongue. She does ask for water. She is confused and has muscle weakness. Her Na serum came back at 165. What could the problem be?

Back 178

she has hypernatremia

Front 179

A nurse understand the use of hypertonic solutions to be used in surgery when the nurse states:

Back 179

It is used when there is substantial loss of blood and BP needs to be raised.

Front 180

It replaces or maintains vascular fluid volume. (correct answer)

C. It is helpful in the treatment of hypotension from the loss of fluid. (correct answer)

Back 180

isotonic solutions

Front 181

Nancy is having a low output of urine. The doctor orders an hypotonic solution. Should you question the order?

Back 181

yes

Front 182

patienst with memory loss and concentration have

Back 182

hyperkalemia

Front 183

regulated by BP and kidney perfusion (correct answer)
B. regulated by hormones such as aldosterone and ADH (your answer)
C. reflects the blood osmolality (your answer)

Back 183

serum NA

Front 184

How often does a nurse want to assess a pt on IV fluids?

Back 184

q 2 hours

Front 185

A patient is hyperkalemic, which foods are best for this patient?

Back 185

beans and chicken

Front 186

Which condition needs extra assessment when considering hypertonic solutions?

Back 186

heart