N320 -Med/Surg Drexel > Fluid/Electrolytes > Flashcards

Fluid/Electrolytes Flashcards

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1
Q

Intake

A

addition of Fluid and electrolytes into the body

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2
Q

Absorption

A

movement of fluid and electrolytes into the bloodstream

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3
Q

Distribution

A

process of moving fluid between compartments

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4
Q

output

A

removal of Fluid and Electrolytes from the body via normal or abnormal routes

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5
Q

Fluid Balance

A

extracellular volume and osmolarity

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6
Q

electrolyte balance

A

extracellular fluid volume, body fluid osmolarity and plasma electrolyte concentration on a continuum

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7
Q

Osmolarity

A

concentration of molecule per weight of water

  • number of dissolved particles per unit of water*
  1. When the amount of water decreases in relation to # particles, the osmolality increases and becomes concentrated
  2. When the amount of water increases relative to solutes the osmolality decreases and becomes more diluted
  3. The primary particle responsible for regulating osmolality is sodium
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8
Q

hyper-osmolarity

A

Cells shrinking

ex: dehydration

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9
Q

Hypo-osmolarity

A

cells swelling-water gain

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10
Q

Methods of Fluid intake

A 
Oral
IV
insertion into rectum
NG tubes
infusion into body cavities
bone marrow (intraosseous)
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11
Q

Mechanism for oral intake

A

Thirst- stimulated by increased osmolarity and receptors for hypovolemia

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12
Q

Electrolyte Intake ( except IV)

A

must be absorbed by the body

CA+( calcium) absorbed in intestine (duodenum); and requires vitamin D

MG++( magnesium) absorbed by the intestinal epithelium of ileum

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13
Q

Total body water Average for adult

A

60%

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14
Q

Intracellular fluid

A
  • 40% inside the cell,
  • mostly skeletal muscle cells
  • function- keep you hydrated
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15
Q

Extracellular fluid

A

20 %

  1. -Interstitial: outside the vessel and outside the cells (EDEMA) :contains little to no protein
  2. Intravascular: inside the vessel
  3. Transcellular: Outside the cell, outside the vessel – example intra-optic fluid synovial fluid
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16
Q

Hydrostatic Pressure

A
  • Influence by blood pressure and blood Volume

- Pushes fluid out of capillary

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17
Q

Colloidal Osmotic Pressure

A

(Constant unless problems w/ protein)

  • Exerted by plasma proteins
  • Draws fluid back into capillary
  • *Direction of fluid depends on the difference of the opposing forces**
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18
Q

Protein Dificiency

A

Think ~ LIVER

  • inadequate intake
  • protein loss
  • decreased protein synthesis
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19
Q

Signs of low protein

A
  1. Decrease muscle mass (measured by weight loss)
  2. slow wound healing
  3. edema
  4. lethargy/fatigue
  5. anemia
  6. low hemoglobin
  7. shortness of breath
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20
Q

EDEMA

A
  • Pitting
  • Dependent
  • Weeping
  • Anasarca
  • Other (ascites, plural effusion)
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21
Q

What do you do for Protein deficiency???

A
  • Diet high in carbs and protein (increase carbs so they don’t use the protein for energy)
  • IV or tube feedings with amino acids.
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22
Q

Distribution of Sodium

A

High extracellular pool concentration

-reflects osmolarity

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23
Q

Distribution of Potassium

A

high intracellular pool concentration

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24
Q

Distribution of Calclium

A

Bone pool

-parathyroid-intracellular and bone pool

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25
Distribution of Magnesium
Intracellular and bone pool
26
What factors influence Distribution
Hormones, diet, diseases/conditions
27
Sodium ( NA+)
135 - 145 mEq/L What it does: Water Retention, fluid volume regulation Manifestation: S/s hydration/dehydration
28
Chloride (Cl-)
97 - 107 mEq/L What it does: for Acid/Base balance, fluid, hydrocholric acid in stomach Manifestation: S/s Kidney problems
29
Potassium (K+)
3.5 - 5.0 mEq/L What it does: Na-K pump, cardiac**, role in muscle activity -Primarily inside the cell, high intracellular conc. Manifestation: lef cramps, arrhythmias
30
Calcium (Ca++)
8.2 - 10.2 mg/dL important to bones Coagulation; clotting factors, muscle contractions, slows peristalsis Manifestations: Muscle contractions, twitching Hyperkalemia= kidney stones, arrhythmias, *clotting factor
31
Phosphorus (PO4-)
2.5 - 4.5 mg/dL What it does: Acid/Base, ATP formation, *antagonist to calcium Manifestations: S/s Calcium Imbalance
32
Magnesium (Mg++)
1.6 - 2.6 mg/dL What it does: Neuromuscular excitability, reflexes, Nerve conduction to muscles (problems with muscles affect the diaphragm); THINK RESPIRATORY Manfestation: Change in respiratory status
33
Bicarbonate (HCO3-)
22 - 26 mEq/L Acid/Base; produced by kidneys
34
Normal Excretory Routes
1. Kidneys should produce - 30mL/HR ( this is an average if you know nothing about the patient) Ideal: 1-2ml/kg/hr (below 1 indicates kidney failure/disfunction) 2. Skin o Sensible Perspiration (sweat, can see it) o Insensible Perspiration (almost like evaporation, skin) 200-300/day (lose more with pyrexia) 3. Lungs ( increased respiration-more fluid loss) 4. gastrointestinal Tract - POOOOOOOOP
35
Abnormal excretory routes
Emesis Hemorrhage Drainage ( fistulas, tubes, etc.)
36
Renal Excretion
Antidiuretic hormone (ADH) - regulates excretion for water only (posterior pituitary) Aldosterone- retians NA+ and water and promotes renal excretion of K+ ( Adrenal Cortex)
37
Calculation of Fluid Loss
1L = 2.2 lbs = 1kg
38
Hemostasis is achieved by
- Renal System - Hormonal System - Respiratory System
39
Common Diagnostic Labs
1. CBC ( Complete Blood Count) 2. Electrolytes 3. Serum Creatinine 4. BUN 5. Plasma Proteins 6. Routine UA
40
CBC
``` o Red blood cells (oxygenation) o White blood cells (infection) o Hematocrit (concentration= reflection of hydration) o Plasma o Platelets ```
41
Serum Creaetinine
0.5 – 1.2 mg/dL Kidney Function High = Impaired /renal disease
42
BUN ( Blood, urea, Nitrogen)
waste products – Kidney Function, but because its mixed with blood- ratio; concentration, Reflection of hydration (increase= dehydration, high=fluid overload) o 8-21mg/dL
43
Plasma Protein
o Total Proteins: 6.4-8.3g/dL o Albumin: 3.5 – 5.0 g/dL low in pts. with edema
44
Routine UA
o Specific Gravity – 1.005-1.030 o PH o Ketones o Blood
45
Inside the cell
K+, MG++, PO4-
46
Outside the cell
NA+, HCO3, CA++
47
Respiratory Acidosis
Causes: ( increased HCO3 and Increased CO2 ) - Cardiac/Resp. Distress - overdose of sedatives - not coughing/deep breathing after surgery S/S: ``` Mental Changes headache restlessness dizziness Coma (SEVERE) ``` WDYD: improve ventilation ****DIS BREATHING HARDDDDDDD***
48
Respiratory Alkalosis
``` Causes: ( Decreased CO2, Decreased HCO3) hyperventilation aftermath of extreme exercise anxiety not enough CO2 ( High flow O2) ``` S/S: - hear palpatations - lightheadedness - sweating - drymouth - N/V - Epigastric pain WDYD: - Eliminate cause - control breathing - breath into a closed system ( paperbag) **BASIC BITCH BREATHING PROBLEM- ANXIETY AND HYPERVENTILATION****
49
Metabolic Acidosis
Causes: ( Decreased PH, Decrease in HCO3) too much acid - Chronic Renal Failure - ketoacidosis - diarrhea ( loosing bicarb) * KyperKalemia S/S: - headache - Increased RR ( excess of acid-lungs trying to excrete) - weakness WDYD: - IV bicarb - fix underlying problem - observe for Hyperkalemia
50
Metabolic Alkalosis
Causes: Increase in HCO3 and Increase in PH ( too much bicarb) - vomiting - gastric suctioning - antacids * kypokalemia S/S: - dizziness - irritability - tingling digits - Decreased RR ( not enough acid, RR decreases to build up CO2) WDYD: - Increase Cl to absorb NA resulting in HCO3 Excretion - Observe for hypokalemia - reverse underlying disorder
51
Hyponatremia
Causes: Loss of NA+ -Hypervolemia S/S: - mental status changes - headaches - lethergy WDYD: - isotonic IV - hypotonic IV - Restrict H2O intake - monitor for CNS changes
52
Hypernatremia
Causes: - too much sodium intake - Dehydration - hypovolemia S/S: - tachycardia - thirst - decreased urine output - hypoxia - decreased body weight WDYD: - limit NA intake - isotonic or hypotonic IV - Monitor for mental status changes
53
Hypochloremia ( Cl-) SAME AS - NA!!!!! ( SODIUM CHOLRIDE)
Causes: - Metabolic Alkalosis - loss of NA S/S: - mental status changes - headache - lethargy WDYD: - Isotonic IV - Hypertonic IV - Monitor CNS EAT FOODS HIGH IN CHLORIDE: - processed meats - canned veggies - bananas - tomatoes - foods high in salt
54
Hyperchloremia ( Cl-)
Causes: - similar to hypernatremia - metabolic acidosis - fluid volume excess S/S: - tachycardia - thirst - decrease urine output/weight - hypoxia WDYD: -increase bicarb Avoid FOODS HIGH IN CHLORIDE: - processed meats - canned veggies - bananas - tomatoes - foods high in salt
55
Hypomag ( MG++)
Causes: - alcoholism - malnutrition - diarrhea S/S: - hyperactive reflexes - tetany - increased HP and BP WDYD: - mag replacement ( same as IV K+ : SLOWWWWWW IV DRIP) - monitor cardiac sxs Increase foods high in Magnesium: - Chocolate - soybeans - spinach - almonds - avocado - oatmeal - flax seed
56
HyperMAG
Causes: - Renal Failure - Excessive MG++ intake ``` S/S: - Flush skin -sense of warmth -N/V -Decreased reflexes SEVERE: respiratory and Cardiac Depression ``` WDYD: - dialysis for kidney failure - calcium intake - monitor for cardiac sxs Decrease foods high in Magnesium: - Chocolate - soybeans - spinach - almonds - avocado - oatmeal - flax seed
57
Hypokalemia ( K+)
Causes: - N/V/D - Hyper-aldosteronism - too little potassium intake S/S: - HEART ISSUES - tachycardia WDYD: - give K+ ( SLOWW, IV DRIP) - increase intake - pt. education Eat foods high in K+: - banana - avocados - spinach - green leafy veggies - potatoes - squash - white beans - citrus FRUITS
58
Hyperkalemia (K+)
Causes: - excessive potassium intake (salt substitutes) - potassium sparing diuretics - renal failure - Metabolic Acidosis S/S: - dirrhea - cramping - cardia issues ( Peak T-waves) WDYD: - limit potassium intake - give calcium to alleviate heart issues - regular insulin and glucose - Kayexalate
59
Hypophosphatemia SEESAW WITH CALCIUM (hypercalcemia)
Causes: - Hyperparathyroidism - chronic Diarrhea S/S: - numbness - weakness ( from increase CA) - decreased cardiac output - mental status changes WDYD: - replace PO4- - assess calcium levels - diet Eat foods high in phosphate: - meat - poultry - fish - beans - nuts - dairy
60
HyperPhosphatemia | hypocalcemia
Causes: - renal failure - hypo-PTH - excessive intake S/S: - tingling fingers - muscle spasms WDYD: - IV Calcium ( FLUSH BEFORE and AFTER, NO IM injections) - Treat underlying disorder Avoid foods high in phosphate: - meat - poultry - fish - beans - nuts - dairy
61
HypoCalcemia Seesaw with PO4 (hyperphosphatemia)
Causes: - renal failure - hypoparathyroidism - too little Vitamin D ``` S/S: "CATS" -Confusion/Convulsions -Arrhythmias -Tetany/Trousseau's sign/ Chvosteks sign -Spasms/ Stridor (in the lungs) ``` WDYD: - increase vitamin D - IV Calcium ( FLUSH BEFORE and AFTER, NO IM injections) Increase foods high in Calcium: -milk, dairy, green leafy veggies, broccoli
62
Hypercalcemia BONES, STONES, GROANS
Causes: - hyperparathyroidism - immobility (leaching from bones) - over use of calcium products - malignancies S/S: - kidney stones - muscle weakness - bradycardia ( weak heart beats slow) - fatigue - constipation ( weak muscles= decreased peristalsis) WDYD: - IV phosphorus - IV fluids - GET THE PATIENT UPPPPP - Low calcium diet: decrease milk, dairy, leafy veggies and broccoli
63
What electrolytes are lost with vomiting
H+ NA+ K+ Cl- Think: upper GI looses hydrochloric acid from stomach
64
What electrolytes are lost with diarrhea
HCO3 NA+ K+ Cl- Think: Lower GI looses BICARB from instestines (bicarb out the butt)
65
What CAN'T a UAP do
can't take initial vitals no teaching no assessing nothing invasive
66
What Can't an LPN do
Can't do initial assessment can NOT initiate teaching can NO do things with IVs!!!
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5 Rights of delegation
1. Task 2. Circumstance.Concern 3. Person 4. Directions/Communication 5. Supervision ( reporting back to RN)
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Hypotonic IV solutions
lower osmolarity than cells -increases volume of cell, increases pressure - D5W - 45% NS - 25% NS
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Isotonic IV solutions
-Same osmolarity as blood and bodily fluids .9 NS Lactated Ringers
70
hypertonic IV Solutions
Higher osmolarity than cells - any saline higher than .9 - 25% dextrose in water -decreases volume of cell, decreases pressure
71
Renin-Angiotensin-Aldosterone system
Kicks in when blood pressure is low or if serum sodium. Purpose: Regulating blood pressure Renin releases into blood from kidneys and angiotensinogen from liver make angiotensin 1 which mixes with ACE enzymes in the lungs which makes angiotensin 2 (which is a potent vasoconstrictor) Angiotensin 2 does 4 things 1. hypothalamus kicks in thirst mechanism 2. adrenal cortex releases aldosterone (increases reabsorption of sodium, decrease potassium) 3. Blood vessels constrict 4. ADH secretion from pituitary all 4 things increases blood pressure
72
ADH
Is released from the posterior pituitary in response to increased osmolarity (high blood concentration and increased sodium), decreased BP or Decreased blood volume synthesized in hypothalamus and released by posterior pituitary - makes the kidnesy reabsorb water and puts this water back into the vascular system thus decreasing the concentration of the blood and increasing blood volume ( output of concentrated urine , peeing out more electrolytes than water) =HIGH specific gravity
73
Aldosterone
increases sodium | decreases potassium
74
Naturitic Peptide Hormone
in response to increased blood volume or increased blood pressure is released from specialized cells in the heart and DILATES the vasculature, thus decreasing blood pressure
N320 -Med/Surg Drexel
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