Nur 324 Fluid And Electrolytes

Front 1

Extracellular fluid

Back 1

divided into smaller compartments and makes up 20% of body weight
-compartments:
1) Interstitial
2) Intravascular
3) Transcellular

Front 2

Interstitial fluid

Back 2

fluid betwen the cells and outside blood vessels

Front 3

Intravascular fluid

Back 3

blood plasma

Front 4

Transcellular fluid

Back 4

Ex. cerebrospinal, pleural peritoneal, synovial fluids

Front 5

Electrolytes (mineral salts)are ingested as ______

Back 5

compounds

Front 6

Electrolytes (mineral salts)
are broken down into _____

Back 6

ions

Front 7

Electrolytes (mineral salts)are mportant to physiologic professes such as ____, ____,and ______

Back 7

nerve impulse

muscle contraction

metabolism of nutrients in food

Front 8

Sodium level

Back 8

135-145

Front 9

Potassium Level

Back 9

3.5-5.0

Front 10

Calcium level

Back 10

4.5 to 5.5 ionized

8.5 to 10.5

Front 11

Bicarbonate level

Back 11

22-26 arterial

24-30 venous

Front 12

Chloride level

Back 12

90-100

Front 13

Magnesium level

Back 13

1.5- 2.5

Front 14

Phosphate level

Back 14

1.7 to 4.6

Front 15

osmosis

Back 15

movement of a pure solvent through a membrane from a lesser to a greater solute concentration in order to equalize

Front 16

osmotic pressure

Back 16

drawing power from water, dependes on the number of molecules in solution

Front 17

osmolarity

Back 17

measure sed to evaluate serum and urine in the clinical setting

Front 18

hypertonic solution

Back 18

a solution higher in osmotic pressure than blood, pulls fluid from cells causing them to shrink

Front 19

isotonic solution

Back 19

same osmotic pressure as blood

Front 20

hypotonic solutionn

Back 20

a solution lower in osmotic pressure than blood, fluid moves into cells causing them to swell

Front 21

What regulates body fluid?

Back 21

1. Fluid intake

2. Hormonal controls

3. Fluid output

*The balance is called homeostasis

Front 22

who is at risk for dehydration?

Back 22

1. infants
2. people with altered LOC/psyche problems
3. older adults

Front 23

the average oral intake is:

Back 23

2200-2700 ml per day

Front 24

This hormone released in response to changes in blood osmolarity causes water to return to the systemic circulation, which dilutes the blood and decreases its osmolarity

Back 24

Antidiuretic Hormone

Front 25

This hormoneis released in response to increased plasma potassium levels to counteract hypovolemia. It increases the reabsorption of sodium and secretes/excretes potassium and hydrogen

Back 25

Aldosterone

Front 26

A hormone secreted by the kidney due to decreased renal perfusion acts to produce angiotensin 1 which turnis into angiotensin 2 which causes vasoconstriction to relocate and increased blood flow to the kidney.

Back 26

Renin

Front 27

What 4 organs does urine output occur through?

Back 27

kidneys
skin
lungs
GI tract

Front 28

Lungs insensible loss:

Back 28

400 ml/day

Front 29

GI insensible loss:

Back 29

100-200 ml/day

Front 30

sensible loss

Back 30

occurs through sweating and urine output. Can be perceived/measured

Front 31

Insensible loss

Back 31

continuous, is not perceived by the person

(can increase significantly with fever or burns)

Front 32

Who is at risk of dehydration from fluid output?

Back 32

fever
burns
diarrhea
NG tube
O2 therapy

Front 33

sodium

Back 33

-regulated by dietary intake and aldosterone secretion
- major in ECF
- maintain water balance through effect on serum osmolality, nerve impulse transmission, acid-base balance, and cellular chem. rxns

Front 34

potassium

Back 34

-regulated through dietary intake and renal excretion
- major in ICF
- is necessary for glycogen deposits, transmission of nerve impulses, normal cardiac conduction, and skeletal smooth muscle contraction

Front 35

any condition that increases UOP ____________ potassium concentration

Back 35

decreases


* potassium is conserved poorly

Front 36

calcium

Back 36

- regulated by dietary intake and hormonal control
-stored in bones, plasma, and body cells.
- is necessary for blood clotting, transmission of nerve impulses, muscle contraction
- bone/teeth formation
-membrane integrity
-cardiac conduction

Front 37

magnesium

Back 37

-regulated by dietary intake, renal function, and PTH (parathyroid hormone)
-essential for enzyme activities, neurochemical activities, and cardiac/skeletal muscle excitability

Front 38

Chloride

Back 38

-regulated by dietary intake and kidneys

Front 39

phosphorus

Back 39

- regulated by dietary intake, renal secretion, intestinal absorption, PTH
-inversely proportional to calcium
-phosphate is a buffer ion.

Front 40

bicarbonate

Back 40

-HCO3
-not an electrolyte, but important in acid/base balance
- regulated by the kidneys
- major chemical base buffer within the body. Essential component of the carbonic acid-bicarbonate buffering system

Front 41

What is the largest chemical buffer system?

Back 41

carbonic acid-bicarbonate

Front 42

Excretion of CO2 is controlled by the _____, and excretion of H+ and bicarbonate is controlled by the _________

Back 42

lungs

kidneys

Front 43

what is the main biological buffer system in the body?

Back 43

hydrogen buffer system

Front 44

what are the main phsyiological buffers?

Back 44

lungs (increase or decrease RR to blow off CO2, reacts quickly-ex. Kussmal's)

kidneys (reansprn pr excrete bicarb, takes several hours to days)

Front 45

What are some causes of hyponatremia?

Back 45

- kidney disease
- adrenal insufficiency
-GI losses
-sweating
-diuretics
-SIADH
-pschogenic polydipsia

Front 46

What are s/s of hyponatremia?

Back 46

- mental status changes
- postural hypotension
- N/V/D
- abdominal pain
- sternal edema
-seizures
-coma

Front 47

What lab values associate with hyponatremia?

Back 47

- serum sodium <135
- urine specific gravity <0.010

Front 48

what are some causes of hypernatremia?

Back 48

- dietary
- hypertonic IV solutions
- excess aldosterone secretion
- diabetes insipidus
- increased water losses
- water deprivation

Front 49

whate are s/s of hypernatremia?

Back 49

- dry/flushed skin
- sticky mucus membranes
- fever
- agitation
- restlessness
- seizures

Front 50

What lab values indicate hypernatremia?

Back 50

- serum sodium > 145
- urine specific gravity >1.030

Front 51

What are some causes of hypokalemia?

Back 51

- K+ wasing
- diuretics
- GI losses
- alkalosis
- excess aldosterone secretion
- polyuria
- sweating
- K+ free IV soln
- Tx of DKA with IV insulin

Front 52

What are s/s of hypokalemia?

Back 52

- weakness
- fatigue
- loss of muscle tone
- decreased bowel sounds
- paresthesias
- dysrhythmias ****
- weak/irregular pulse

Front 53

What labs indicate hypokalemia?

Back 53

- serum K+ <3.5
-ventricular EKG dysrrhythmias

Front 54

What are some causes of hyperkalemia?

Back 54

- renal failure
- FVD
- burns
- trauma
- IV K+ soln
- adrenal insufficiency
- rapid infusion of blood
- K+ sparing diuretics

Front 55

what are s/s of hyperkalemia?

Back 55

- serum K+ >5.0
- EKG abnormalities (bradycardia, heart block)
- eventually QRS complex widens and cardiac arrest occurs

Front 56

What are some causes of hypocalcemia?

Back 56

- rapid blood transfusions with citrate
- hypoalbuminemia
- hypoparathyroidism
- vitamin D deficiency
- pancreatitis
- alkalosis

Front 57

What are s/s of hypocalcemia?

Back 57

- finger tingling
- hyperactive reflexes
- positive Trousseau's sign
- positive Chvosteck's sign
- tetany
- muscle cramps
- pathological fractures

Front 58

What labs indicate hypocalcemia?

Back 58

- serum calcium <4.5
- EKG abnormalities

Front 59

Trousseau's sign

Back 59

- assessment for hypocalcemia and hypomaganesemia
- a blood pressure cuff is placed on the arm and inflated above patient's systolic BP for 3 minutes
- in a healthy adult, the response will be a sudden muscle contraction in the prospective muscle
- in hypocalcemia and hypomaganesemia, the response is the development of a carpopedal spasm

Front 60

Chvostek's sign

Back 60

- assessment for hypocalcemia or hypomagnesemia
- percuss the facial nerve about 2 cm anterior to the earlobe
- in a healthy person, there is no response
- in hypocalcemia or hypomagnesemia, positive response is a unilateral twitching of the facial muscles, eyelid, and lips.

Front 61

What are some causes of hypercalcemia?

Back 61

- hyperparathyroidism
- bone cancer
- paget's disease
- osteoporosis
- bedrest
- acidosis

Front 62

What are s/s of hypercalcemia?

Back 62

- anorexia
- N/V
- weakness
- lethargy
- low back pain (kidney stones)
- decreased LOC
- personality changes
- cardiac arrest

Front 63

What labs indicate hypercalcemia?

Back 63

- serum calcium >5.5
- elevated BUN and creatinine
- x-ray: bone loss
- kidney stones
- EKG abnormalities

Front 64

What are some causes of hypomagnesemia?

Back 64

- malnutrition
- ETOH abuse
- N/V/D
- diseases of small intestine
- thiazide diuretics
- aldosterone excess
- polyuria

Front 65

What are s/s of hypomagnesemia?

Back 65

- muscle tremors
- hyperactive DTRs
- confusion
- disorientation
- dysrhythmias
- + cvosteck's sign
- + Trousseau's sign

Front 66

What labs indicate hypomagnesemia?

Back 66

- serum Mg <1.5

Front 67

What are the causes of hypermagnesemia?

Back 67

- renal failure
- excessive intake

Front 68

What are s/s of hypermagnesemia?

Back 68

- hypoactive DTR's
- decreased rate and depth of respirations
- hypotension
- flushing

Front 69

What lab values indicate hypermagnesemia?

Back 69

- serum Mg >2.5

Front 70

What are some causes of hypochloremia?

Back 70

- GI losses
- diuretics

Front 71

What are s/s of hypochloremia?

Back 71

-same as sodium:

- mental status changes
- postural hypotension
- N/V/D
- abd pain
- sternal edema
- seizures and coma

Front 72

What labs indicate hypochloremia?

Back 72

serum chloride <90

compensatory rise in bicarb

Front 73

What are some causes of hyperchloremia?

Back 73

-same as sodium:

- dietary
- hypertonic IV solns
- excess aldosterone secretion
- diabetes insipidus
- increased water losses
- water deprivation

Front 74

What are s/s of hyperchloremia?

Back 74

-same as sodium:

-dry/flushed skin
- sticky mucous membranes
- fever
- agitation
- restlessness
- seizures

Front 75

What labs indicate hyperchloremia?

Back 75

- serum chloride > 110

Front 76

Hypochloremia or hyperchloremia usually occur along with imbalances in:

Back 76

sodium

Front 77

What are the 2 isotonic imbalances in fluids:

Back 77

- fluid volume deficit
- fluid volume excess

Front 78

What are some causes of fluid volume deficit

Back 78

- GI losses
- loss of plasma or whole blood
- sweating
- fever
- decreased intake
- use of diuretics

Front 79

What are s/s of physical exam?

Back 79

- postural hypotension
- tachycardia
- dry mucous membranes
- poor skin turgor
- wt loss
- thirst
- confusion
- lethargy
- oliguria
- weak pulse

Front 80

What labs indicate fluid volume deficit?

Back 80

- increases in urine specific gravity
- incrase in hematocrite
- increase in BUN (hemo-concentration)

Front 81

What are some causes of fluid volume excess?

Back 81

- CHF
- renal failure
- hepatic cirrhosis (decreased albumin, fluid in interspaces, malnutrition)
- increased serum aldosterone and steroid levels
- excess sodium

Front 82

What are s/s of fluid volume excess?

Back 82

- wt gain
- edema
- HTN
- polyuria
- JVD
- increased venous pressure
- crackles in lungs

Front 83

What labs indicate fluid volume excess?

Back 83

- decreased urine specific gravity
- decreased hematocrite and BUN due to hemodilation

Front 84

What are the two kinds of osmolar imbalances in fluids?

Back 84

- hyperosmolar imbalances (dehydration)
- hypo-osmolar imbalances (water excess)

Front 85

What are some causes of hyperosmolar imbalances (dehydration)?

Back 85

- diabetes insipidus
- disruption in the thirst drive
- DKA
- osmotic diuresis
- use of hypertonic IV solns or tube feedings

Front 86

What are s/s of hyperosmolar imbalances (dehydration)?

Back 86

- dry mucous membranes
- flushed, dry skin
- thirst
- increased body temp
- irritability
- seizures
- coma

Front 87

What labs indicate hyperosmolar imbalances (dehydration)?

Back 87

- serum sodium above 145

Front 88

What are some causes of hypo-osmolar imbalances (water retention)?

Back 88

- SIADH
- excess water intake
- use of hypotonic IV solutions

Front 89

What are s/s of hypo-osmolar imbalances (water retention)?

Back 89

-decreased LOC
- convulsions
-coma

Front 90

What labs indicate hypo-osmolar imbalances (water retention)?

Back 90

sodium below 135

Front 91

What are some risk factors for Fluid/Electrolyte and acid base imbalances?

Back 91

- Age (very old or very young)
- Chronic diseases (cancer, CVD, CHF, endocrine disease, malnutrition, COPD, renal disease, altered LOC)
- Trauma (crush injuries, head injuries, burns)
- GI losses (acute gastroenteritis, NG suctioning, fistulas with drainage)

Front 92

what fluid imbalance can a weight loss of 2-5% create?

Back 92

mild FVD

Front 93

what fluid imbalance can a weight loss of 5-10% create?

Back 93

moderate FVD

Front 94

what fluid imbalance can a weight loss of 10-15% create?

Back 94

severe FVD

Front 95

what fluid imbalance can a weight gain of 8% create?

Back 95

Severe FVE

Front 96

What fluid imbalance can a weight loss of 15-20% create?

Back 96

Death

Front 97

What fluid and electrolyte imbalances can Diuretics cause?

Back 97

metabolic alkalosis, Hyperkalemia, Hypokalemia

Front 98

What fluid and electrolyte imbalances can Steroids cause?

Back 98

metabolic alkalosis, fluid retention

Front 99

What fluid and electrolyte imbalances can Opioids cause?

Back 99

decreased RR, respiratory alkalosis

Front 100

What fluid and electrolyte imbalances can Antibiotics cause?

Back 100

nephrotoxicity, Hyperkalemia, hypernatremia

Front 101

What fluid and electrolyte imbalances can Calcium carbonate (TUMS) cause?

Back 101

mild metabolic acidosis

Front 102

What fluid and electrolyte imbalances can Magnesium hydroxide (milk of mag) cause?

Back 102

Hypokalemia