Block #1 / Exam #4: Fluid & Electrolyte

Front 1

ICF

Back 1

Intracellular Fluid

Front 2

ECF

Back 2

Extracellular Fluid

Front 3

ISF

Back 3

Interstitial Fluid

Front 4

Intracellular Fluid:

Back 4

maintains cell size and function

Front 5

Intravascular fluid:

Back 5

inside blood (plasma)

Front 6

Interstitial fluid:

Back 6

-between cells
-outside vascular space

Front 7

transcellular splace

Back 7

small amount of fluid in GI tract, cerebrospinal fluid, pleural, synovial, & peritoneal fluids

Front 8

Electrolytes:

Back 8

-substance which splits into ions when dissolved in water
-able to carry eletrical current

Front 9

Primary Electrolytes in body

Back 9

Na+ (sodium)
K+ (potassium)
Ca2+ (calcium)

Front 10

What needs to be in correct balance for cells to function properly?

Back 10

electrolytes

Front 11

Fluids & electrolytes (solutes) constantly shift between compartments by 4 processes:

Back 11

Osmosis
Diffusion
Filtration
Active Transport

Front 12

Osmosis:

Back 12

movement of solvent (water) across semi-permeable membrane from area of lower concentration to higher

Front 13

What is albumin important for?

Back 13

to keep fluid from shifting out of intravascular space

Front 14

colloid osmotic pressure (OR) oncotic pressure

Back 14

Keeps fluid from leaking out of vascular space

Front 15

Diffusion

Back 15

movement of solutes from higher concentration to lower

Front 16

Active transport

Back 16

molecules move from area of lower to higher concentration, requires energy

Front 17

Filtration

Back 17

-transfer of water & dissolved substances thru membrane from region of high pressure to region of lower pressure
-Occurs in kidney glomerular capillaries & in blood capillaries

Front 18

What is generally higher on arterial side & lower on venous side of capillaries?

Back 18

Hydrostatic Pressure

Front 19

Hydrostatic Pressure

Back 19

-Force within a fluid compartment
-Vascular space or tissues

Front 20

Oncotic Pressure

Back 20

-Osmotic pressure exerted by proteins, especially albumin)
-Large molecules hold fluid in vascular space

Front 21

Osmolality

Back 21

-Osmotic force of solute per unit of wt. of solvent mOsm/kg or mmol/kg
-Describes fluids inside the body

Front 22

Osmolarity

Back 22

-Total milliosmoles of solute per unit of volume of solution mOsm/L
-Describes fluids outside the body

Front 23

Isotonic

Back 23

-same concentration of particles as plasma
-just increase fluids
-stays were it is

Front 24

Hypertonic

Back 24

-greater concentration of particles than plasma
-post op, fluid into space outside vascular,
-pulls fluid out

Front 25

Hypotonic

Back 25

-lesser concentration of particles than plasma
-hydrate cells and interstitial space
-pulls fluid in

Front 26

What are the 2 primary body fluid compartments?

Back 26

Intracellular Fluid
Extracellular Fluid

Front 27

Subcompartments?

Back 27

Intravascular fluid
Interstitial fluid

Front 28

Fluid & electrolytes shift between compartments via which 4 processes?

Back 28

Osmosis
Diffusion
Filtration
Active Transport

Front 29

If someone is malnourished, what type of fluid shift may occur?

Back 29

Shifts to the interstitial space

Front 30

Edema

Back 30

– fluid shift from vascular space to interstitial space

Front 31

Third Spacing

Back 31

Major fluid shift from intravascular to interstitial space

Front 32

Elastic hose (TEDs) or ace wrap helps to decrease edema. HOW?

Back 32

Fluid shift into intravascular space because hydrostatic pressure in interstitial space in increased. Fluid moves from area of greater pressure to lesser pressure.

Front 33

How much fluid input does your body need?

Back 33

2200-2700ml per day

Front 34

What conditions may increase skin’s insensible loss?

Back 34

exercise
pain
fever

Front 35

What GI conditions cause increased fluid loss?

Back 35

vomiting
diarrhea

Front 36

What factors may cause an increase in plasma osmolality (solute concentration)?

Back 36

eating salty foods

Front 37

On I & O, should urine output always be exactly equal to oral & IV intake?

Back 37

no

Front 38

Dehydration

Back 38

is the loss of pure water alone without losing Na

Front 39

Fluid Volume Deficit (FVD)

Back 39

includes the loss of body fluids and electrolytes

Front 40

Fluid Volume Excess FVE

Back 40

due to fluid retention

Front 41

Assessment for Fluid Balance

Back 41

History
Vital signs
I&O balance
Weight
Skin turgor/moisture
Mucous membranes
Lung sounds
JVD
Edema
LOC
Labs

Front 42

1 Liter of Water =

Back 42

2.2 lb or 1kg

Front 43

Urine specific gravity

Back 43

concentrated (>1.025)
dilute (<1.01)

Front 44

Goals for treating F& E imbalance:

Back 44

-underlying cause
-correct the underlying cause
-stabilize pH
-replace deficient F & E or remove excess

Front 45

Hypervolemia

Back 45

over-hydration

Front 46

Fluid volume Excess Etiology:

Back 46

-excessive Na intake
-compromised regulatory systems (renal insufficiency, CHF, Cirrhosis, endocrine disorders)

Front 47

S/SX of fluid volume excess

Back 47

-weight gain
-VS- increased BP, HR, RR
-dyspnea, orthopnea
-pitting edema w/tight shiny skin
-JVD
-moist crackles
-cough
-headache
-agitation
-confusion
-Labs

Front 48

FVE Interventions:

Back 48

-daily weights
-elevate head of bed
-elevate affected extremities
-skin care to protect areas of edema
-meds
-monitor I & O
-restrict fluid if ordrered
-TEDs hose

Front 49

FVE fluid restriction

Back 49

-explain to pt
-teach ice chips, icre cream, gelatin are fluids
-teach client how to divide fluid throughout day

Front 50

Hypovolemia

Back 50

dehydration

Front 51

S/SX of FVD

Back 51

-Negative balance of intake/output
-Concentrated urine, specific gravity
-Weight loss
-Dry skin/mucous membranes
-Poor skin turgor, tenting >20-30sec
-*Weakness, restlessness, confusion
-Concentrated Hct. & electrolytes
-Severe FVD → dec. cardiac output, possible shock

Front 52

FVD Interventions

Back 52

I & O
daily weight
VS
labs
neurological status
respiratory status
cardiac function
renal function

Front 53

FVD Interventions Actions:

Back 53

encourage fluids
IV
Oral care
skin care
cover wounds to minimise loss
manage V&D with meds
pt. education

Front 54

FV Excess

Back 54

increase weight
increased BP
Bounding Pulse
increased RR
Urine diluted
Skin turgor-edema
eye bulging
JVD

Front 55

FV Deficit

Back 55

decreased weight
decreased BP
Weak pulse
increased RR
Urine Darker
skin-tenting
Mucous membranes-dry
Eye-sunken
flat veins

Front 56

Sodium

Back 56

aids in generation & transmission of nerve impulses

Front 57

What is the normal range for sodium?

Back 57

Range 135-145 mEq/L

Front 58

How does kidneys regulate sodium?

Back 58

by excreting/retaining water

Front 59

What effects osmolality & water distribution between ECF & ICF?

Back 59

Sodium

Front 60

Abnormal Na levels may indicate?

Back 60

water imbalance or sodium imbalance or both

Front 61

Water Excess (sodium levels)

Back 61

<135 mEq/L
Hyponatremia

Front 62

Water Deficit (sodium levels)

Back 62

>145mEq/L
Hypernatremia

Front 63

Hyponatremia

Back 63

Sodium & fluid Loss

Front 64

S/SX Hyponatremia:

Back 64

-Na<135mEq/L
-HA, lethargy, irritability, apprehension, confusion, seizures, coma
-s/sx dehydration
-hypotension, dizziness
-N, V, D, cramping
-muscle weakness

Front 65

CNS-
Muscle-

Back 65

CNS-Sodium
Muscle-Potassium

Front 66

If hyponatremia due to FVE, what s/sx would also be present?

Back 66

crackles in lungs
edema
bounding pulse

Front 67

Normal labs for potassium

Back 67

3.5-5.0

Front 68

Potassium is needed for:

Back 68

conduction of nerve impulses, normal cardiac rhythm, & muscle contraction

Front 69

Hypokalemia

Back 69

decreased potassium

Front 70

S/SX hypokalemia:

Back 70

fatigue
muscle weakness
leg cramps
N & V
ileus
paresthesia
plyuria
hyperglycemia
EKG changes
weak & irregular pulse
ventricular arrhythmias

Front 71

dietary sources of K+

Back 71

-Chocolate, dried fruit, nuts, seeds
-Fresh fruits – oranges, bananas, apricots, cantaloupe, tomatoes
-Meats & vegetables esp. beans, potatoes, mushrooms, carrots

Front 72

Hyperkalemia is caused by:

Back 72

excess intake in IVs, salt substitutes, or meds with K+, hypovolemia, blood transfusions

Front 73

Calcium aids in

Back 73

transmission of nerve impulses, myocardial contractions, blood clotting, formation of teeth & bone, muscle contractions

Front 74

Serum Ca levels usually show total of 3 types

Back 74

-Ionized (free)
-bound w/protein (albumin)
-complexed w/ phosphate, citrate, or carbonate

Front 75

Calcium balance controlled by:

Back 75

Parathyroid hormone (PTH)

Front 76

Parathyroid hormone (PTH)

Back 76

Stimulated by low serum Ca levels to move Ca out of bone, increased GI absorption, & renal tubule reabsorption

Front 77

Calcitonin

Back 77

Produced by thyroid gland. Responds to Ca. Opposite effects of PTH listed above.

Front 78

Vitamin D

Back 78

stimulates absorption of Ca from GI tract

Front 79

Hypercalcemia Signs & Symptoms:

Back 79

-“Warm milk makes you sleepy”
-Lethargy, weakness, depressed reflexes
-Decreased memory, confusion psychosis
-Anorexia, N, V, polyuria, dehydration
-Bone pain, fractures
-Ventricular arrhythmias, digitalis effect

Front 80

Hypercalcemia rates

Back 80

-2/3 caused by hyperparathyroidism
-1/3 caused by malignancy breast, lung, multiple myeloma

Front 81

Prolonged immobilization

Back 81

results in increased Ca from bone mineral loss

Front 82

Hypocalcemia is caused by:

Back 82

-Anything that decreased production of -PTH such as trauma or surgery to parathyroid gland, neck
-CRF, acute pancreatitis, loop diuretics
-Alcoholism, diarrhea, laxative abuse, decreased albumin

Front 83

decreased ionized Ca

Back 83

-Alkalosis
-Multiple blood transfusions of citrated blood

Front 84

Chvostek’s sign for hypocalcemia

Back 84

tap on facial nerve in front of ear – muscle contraction occurs

Front 85

Trousseau’s sign for hypocalcemia

Back 85

-apply BP cuff above systolic pressure for a few min.
-causes carpal spasm

Front 86

Hypocalcemia

Back 86

-decreased Ca allows Na to move into cells
-increased nerve excitability & sustained muscle contraction

Front 87

Hypocalcemia S/Sx

Back 87

-Fatigue, depression, anxiety, confusion
-Numbness & tingling in extremities & around mouth (early sign)
-Dysphagia, Hyperreflexia, muscle cramps

Front 88

Calcium levels are controlled by what 3 things?

Back 88

Parathyroid hormone (PTH)
Calcitonin
Vitamin D

Front 89

Hypercalcemia is usually caused by

Back 89

hyperparathyroidism
cancer

Front 90

High calcium makes the reflexes faster or slower?

Back 90

Slower

Front 91

Why are fractures more common with high serum Ca levels?

Back 91

calcium moves out of the bone

Front 92

Chvostek’s & Trousseau’s signs indicate?

Back 92

Hypocalcemia

Front 93

Hypocalcemia allows ____ to move into cells causing ____ in nerve excitability?

Back 93

sodium
increased

Front 94

Protein increases

Back 94

oncotic pressure and pulls fluid inward into vascular space

Front 95

Albumin indicates

Back 95

Plasma proteins (esp. albumin) are indicative of plasma volume

Front 96

Protein Imbalances s/sx

Back 96

edema from decreased oncotic pressure, slow healing, anorexia, fatigue, anemia, muscle loss

Front 97

acid-base balance

Back 97

Hydrogen ion concentration in the cellular environment is regulated within extremely narrow limits.

Front 98

Acid:

Back 98

any substance that can donate H+ ions to other molecules pH<7

Front 99

Base (Alkaline):

Back 99

any substance that can accept H+ molecules pH>7

Front 100

pH scale

Back 100

describes the degree of acidity or alkalinity of solutions

Front 101

pH of arterial blood should be

Back 101

7.35-7.45

Front 102

What is the MOST important buffer system in the body ?

Back 102

The bicarbonate-carbonic acid buffer system

Front 103

Lungs and kidneys regulate

Back 103

acid-base balance, but if these organs are diseased won’t respond right

Front 104

Lungs

Back 104

-react within seconds if a change in pH
-Regulate depth and rate of respiration to retain or excrete CO2
-Compensate for metabolic acidosis or alkalosis

Front 105

Kidneys

Back 105

-respond more slowly (Takes hours to days for kidneys to compensate)
-Regulate through excretion or reabsorption of bicarbonate

Front 106

Normal pH levels

Back 106

7.35-7.45

Front 107

Acidosis

Back 107

<7.35

Front 108

Alkalosis

Back 108

>7.45

Front 109

Too much CO2 causes

Back 109

Respiratory Acidosis

Front 110

Too little CO2 causes

Back 110

Respiratory Alkalosis

Front 111

Too much bicarb causes

Back 111

Metabolic alkalosis

Front 112

Too little bicarb causes

Back 112

metabolic acidosis

Front 113

In arterial blood, which factors cause respiratory acidosis?

Back 113

COPD
Drug over dose
severe pneumonia

Front 114

In arterial blood, which factors cause respiratory alkalosis?

Back 114

Panic attack
pain

Front 115

In arterial blood, which factors cause metabolic acidosis?

Back 115

Diabetic ketoacidosis
starvation

Front 116

In arterial blood, which factors cause metabolic alkalosis?

Back 116

NG suction
intractable vomiting

Front 117

Respiratory Acidosis

Back 117

-anything that causes hypoventilation which leads to increased CO2

Front 118

Respiratory Alkalosis

Back 118

-anything that causes hyperventilation or blowing off too much CO2

Front 119

Hyperventilation

Back 119

blows off more CO2 and increases pH to compensate for metabolic acidosis

Front 120

Hypoventilation

Back 120

retains CO2, decreases pH to compensate for metabolic alkalosis

Front 121

Renal Compensation:

Back 121

The kidneys influence maintenance of normal acid-base balance by changing rate of excretion or retention of hydrogen and HCO3 ions.

Front 122

Kidneys handle increase in blood acids by:

Back 122

-Increasing excretion of H+ ions into the urine and returning HCO3 ions to the blood
-Additional serum bicarbonate is made available to absorb more free H+ ions, and normal pH can be reestablished

Front 123

PaCO2

Back 123

-partial pressure of CO2
-reflects depth & rate of ventilation
-compensates for metabolic acidosis or alkalosis

Front 124

HCO3

Back 124

-Bicarb is major renal component of acid-base balance & principle buffer of ECF

Front 125

PCO2 normal

Back 125

35-45 mm Hg

Front 126

HCO3 normal

Back 126

22-26mEq/L arterial

Front 127

What is the primary collaborative goal if the patient has a fluid and electrolyte imbalance?

Back 127

Look for the underline cause
Labs
Pt symptoms
Look at condition

Front 128

What are major body spaces that contain fluid?

Back 128

ICF
ECF

Front 129

Major imbalances in fluid & electrolytes may cause brain cells to shrink or swell which leads to what type of symptoms?

Back 129

Neuro symptoms

Front 130

What are physiological changes in the elderly that may lead to F&E imbalance?

Back 130

Impaired thirst sensation, remind them to drink

Front 131

What is the best indication of fluid volume status & changes?

Back 131

Weight-take weight at the same time everyday

Front 132

With fluid volume deficit (FVD) will electrolyte values appear higher or lower than normal?

Back 132

Higher

Front 133

Hemoglobin

Back 133

will not change dramaticly

Front 134

Hematocrit

Back 134

will change more dramatic

Front 135

How would hypovolemia (dehydration) affect cardiac output?

Back 135

lower cardiac output

Front 136

How might crushing trauma (cell injury) or burns effect serum K+ levels?

Back 136

Increase K+ levels

Front 137

How would immobility or malignant tumors affect Ca levels?

Back 137

Increase calcium levels