Fluid & Electrolyte Balance

Front 1

When the plasma sodium concentration is lower than normal or renal blood flow is reduced, the juxtaglomerular cells in the kidneys produce _______, which enters the circulation.

Back 1

Renin

Front 2

In the renin-angiotensin-aldosterone System ___ is excreted in exchange for ___?

Back 2

K for NA

Front 3

A hormone that is produced by the cardiac atrium in response to excess blood volume that stretches the atrial wall.

Promotes sodium wasting and acts as a potent diuretic. (exact opposite of angiotensin II)

Back 3

Atrial Natriuretic Factor (ANF)

Front 4

ANF acts on the nephrons as a potent ________ to ________ blood volume.

Back 4

diuretic

decrease

Front 5

Risk Factors Affecting Fluid Balance

Back 5

•ChronicDiseases

•AcuteConditions

•Medications

•Treatments

•Nutrition

•Age

Front 6

Lifespan Considerations

Infants and Children

Back 6

Immature Kidneys

Rapid Respiratory Rate = Greater Insensible Losses

Thirst Mechanism (cannot express or seek fluids)

Front 7

Lifespan Consideration

Older Adults

Back 7

•ThirstSensationdecreased

•Decreased Urine Concentrate

•DecreasedICF andTotal Body Fluid

•Increaseduse ofDiuretics

•DecreasedIntake of Food/Water

•ImpairedRenal Function

Front 8

Assessment Interview

Back 8

•Current and Past Medical History

•Medications and Treatments

•Food and Fluid Intake

•Fluid Output

•Imbalances

Front 9

Clinical Measurements

Back 9

•Daily Weights*

•Vital Signs

•Fluid Intake and Output

Front 10

Sodium (Na)

Back 10

135-145 mEq/L

Front 11

Magnesium (Mg)

Back 11

1.5-2.5 mEq/L

Front 12

Phosphate (PO3-)

Back 12

1.8-2.6 mEq/L

Front 13

Calcium (Ca)

Back 13

4.5-5.5 mEq/L

Front 14

Bicarbonate (HCO3-)

Back 14

22-26 mEq/L

Front 15

Chloride (Cl)

Back 15

95-108 mEq/L

Front 16

Potassium (k)

Back 16

3.5-5.3 mEq/L

Front 17

Hematocrit (HCT)

men-

women-

Back 17

40-54%

37-47%

Front 18

________ solution refers to two solutions having the same osmotic pressure across a semipermeable membrane

Back 18

isotonic

Front 19

Both fluid and electrolytes are lost in equal proportion. Commonly referred to as hypovolemia.

Back 19

fluid volume deficit (FVD)

Front 20

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Serum Osmolalitycan be estimated by doubling the serum ________ value

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Back 20

sodium

Front 21

Measures the amount of all chemical particles dissolved in serum (such as Na+, Cl-, bicarbonate, proteins, & glucose)

Back 21

Serum Osmolality

280-300 mOsm/kg

Front 22

when serum osmolality _________, ADH is released to retain fluid

Back 22

increases

Front 23

Occurs when the body retains both water and sodium in similar proportions to normal ECF, commonly referred to as hypervolemia.

Back 23

Fluid volume excess (FVE)

Front 24

when hydration decreases, serum osmolality ________

Back 24

increases

Front 25

Albumin (Alb)

Protein produced by the liver

(Has a sponge like effect)

Back 25

35-50 g/L

Front 26

Urine Osmolality

Back 26

500-800 mOsm/kg

Front 27

Urine Specific Gravity

Back 27

1.005-1.030 (usually 1.010-1.025)

Front 28

Urine pH

Back 28

Normal value is 6.0 but a range of 4.6-8.0 is considered normal

Front 29

Patient Teaching fluid balance

Back 29

Consume 6-8 glasses of water

Avoid high salt, sugar, and caffeine

Limit alcohol

Maintain normal body weight

Monitor medication side effects

Recognize risk factors (watery stool)

Front 30

Nursing Responsibilities During F & E Replacement

Back 30

•Safely administer the replacement

•Measuring fluid intake and output

•Monitoring for complications of therapy: weight/VS

•Teaching clients and families regarding the therapy

•Know the rationale behind why your client is receiving the replacement: A.Treating the underlying cause B. Increasing or decreasing the Fluid C. Shift electrolytes into their appropriate area to decrease plasma concentration

Front 31

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chief cation within the cell (ICF)

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Back 31

Potassium (k+)

Front 32

major cation+ within the cell (ICF)

major anion- within the cell (ICF)

Back 32

Magnesium (Mg+)

Phosphate (PO3-)

Front 33

major anions- in the ECF

Back 33

Bicarbonate (HCO3-)

Chloride (Cl-)

Front 34

*************************************

chief cation+ outside the cell

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Back 34

Sodium (Na+)

Front 35

Please let the Cat in (_________)

So the Cat wants to go outside (_______)

Back 35

Potassium

Sodium

Front 36

Is necessary for nerve impulse transmission, regulates cell excitability. Ratio must be maintainedVital for skeletal, cardiac, and smooth muscle activity. (Dysrhythmias, Muscle Cramps, Weakness, Confusion)

Needed for proper heart muscle activity!

Back 36

Postassium

Front 37

Foods high in K+

Back 37

Oranges, dried fruits, tomatoes, avocados, dried peas, meats, broccoli, bananas, dairy products, whole grains

Licorice in large amounts can cause hypokalemia.

Front 38

Most abundant electrolyte in ECF (90%)

Role in acid/base balance- buffer base

Kidneys main regulator of _______ reabsorption or excretion (Hormones)

Aids in the conduction of nerve impulses

Helps control muscle contractility

Obtained via GI intake

Back 38

Sodium

135-145 mEq/L

Front 39

Main determinant of serum osmolality

Back 39

Sodium

Front 40

Foods high in Na+

Back 40

Foods: Processed/Preserved foods Processed cheese and luncheon meat Snack foods (chips…)Canned foods (meats,soups and vegetables)Bacon, Ham, Sausage Most condiments (Ketchup)Seafood Table salt, etc.

Front 41

Maintains proper blood volume and pressure

Necessary for maintenance of acid-base via the kidneys

Mostly comes from the salt that you eat.

Back 41

Chloride (Cl)

95-108 mEq/L

Front 42

Forming bones/teethAids in the clotting of bloodTransmitting nerve impulsesRegulates cardiac, skeletal and smooth muscle contraction Decreases neuro-muscular irritabilityAbsorption requires active form of vitamin D

Back 42

Calcium

4.5-5.5 mEq/L

Front 43

Sources of Calcium

Back 43

•Dairy•Cheese•Yogurt•Broccoli•Kale•Grains•EggYolks

Front 44

•Importantforintracellular metabolism in producing and using ATP•Promotescarbohydrate, fat, and protein metabolism•PowersNa-K pump•Regulatescardiac function•Transmitnerve impulses•Relaxesmuscle contractions

Back 44

Magnesium(1.5-2.5mEq/L)

Front 45

Magnesium rich foods

Back 45

Whole grains, nuts, dried fruit, green leafy vegetables, dairy products, tuna fish, chocolate

Front 46

Deficient calcium

Back 46

Hypocalcemia

Front 47

Excessive potasssium

Back 47

hyperkalemia

Front 48

Deficient sodium

Back 48

hyponatremia

Front 49

Primary Nursing Diagnosis

Back 49

•Risk for Electrolyte Imbalance p. 348

•Risk for Imbalanced Fluid Volume p. 397 •Readiness for Enhanced Fluid Balance p.386•Deficient Fluid Volume p. 388 (Ackley) p. 1319 (Krozier)

•Excess Fluid Volume p. 393(Ackley) p. 1319 (Krozier)

Front 50

Additional Secondary Nursing Diagnosis

Back 50

•Decreased Cardiac Output (dysrhythmia)

•Activity Intolerance (hypovolemia)

•Ineffective Tissue Perfusion (cardiac output or edema)

•Risk for Injury (calcium shift out of bones)

•Impaired Oral Mucous Membrane (FVD)

•Impaired Memory/Acute Confusion

•Risk for Impaired Skin Integrity (dehydration/edema)

•Risk for Falls

Front 51

Diuretics

Back 51

Lasix (flurosemide) *Loop

Thiazide *Distal Convoluted tubule

Potassium-sparing *DCT

Front 52

is the most important base in the body.

Back 52

Bicarbonate (HCO3)

Front 53

A pH reflects the ________ ion concentration of a solution.

Back 53

hydrogen

Front 54

Lower pH is _______…higher pH is alkaline (base)

Acids release hydrogen ions and bases ________ hydrogen ions.

Back 54

acidic

absorb

Front 55

Normal blood pH level

Back 55

7.35-7.45

Front 56

A __________ solution is a particular type of solution that has a greater concentration of solutes on the outside of a cell when compared with the inside of a cell.

Back 56

hypertonic

Front 57

any solution that has a lower osmotic pressure than another solution. In the biological fields, this generally refers to a solution that has less solute and more water than another solution.

Back 57

Hypotonic

Front 58

Angiostensin II does what

Back 58

Causes sodium and water retention (by vasoconstriction, less filtration in kidney) and releases Aldosterone from Adrenal cortex

Front 59

What does aldosterone cause

Back 59

Sodium reabsorption and potassium secretion in the distal convoluted tubule

Front 60

If serum osmolality decreases, ADH is _________, the collecting ducts become less permeable to water, and urine output increases.

Back 60

suppressed

Front 61

Atrial Natriuretic Factor (ANF)

Back 61

Increases excretion of sodium and water

decreases thirst mechanism

increases the glomerular filtration rate (GFR)

Reduces aldosterone secretion

Relaxes arterioles and venules

Front 62

What percent of potassium is excreted by the kidneys?

Back 62

80%

Front 63

Regulates water excretion from the kidney, is synthesized in the anterior hypothalamus and acts on the collecting ducts of the nephrons?

Back 63

ADH

Front 64

Net result of the RAAS system

Back 64

Increased blood volume through sodium and water retention

Front 65

Insulin helps move ____ into cells?

Back 65

K+ (potassium)

Front 66

A person who is electrolyte depleted may experience?

Back 66

Fatigue, weakness, headache, and GI symptoms such as anorexia or nausea.

Front 67

Stress can release this which lowers urine production.

The overall result of stress is increased _____ _________.

Back 67

ADH

blood volume