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From Flashcardlet > Core Concepts - Fluid & Electrolytes > Flashcards

Core Concepts - Fluid & Electrolytes Flashcards

0
Q

_______ are substances that are charged particles (ions) when they are placed in water

A

Electrolytes

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1
Q

_______ is water plus the substances dissolved in suspended in it

A

Fluid

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2
Q

What are the four primary examples of electrolytes story here

A 
Sodium ions (Na+),
Potassium ions (K+),
Calcium ions (Ca++),
Magnesium ions (Mg++)
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3
Q

This is the process of moving fluid and electrolytes between the various body fluid compartments

A

Fluid and electrolyte distribution

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4
Q

Which fluid compartments something that are part of fluid and electrolyte distribution

A

Inside the cells (intracellular),
Outside the cell (extracellular),
Between the cells (interstitial),
Inside blood vessels (vascular)

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5
Q

This is the removal of fluid and electrolytes from the body, through normal or abnormal routes.

A

Fluid and electrolyte output

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6
Q

What are the two aspects of fluid balance

A

Extracellular volume and Osmolality

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7
Q

What are the three aspects of Electrolyte balance

A

Extracellular fluid volume,
Body fluid osmolality,
Plasma electrolyte concentrations

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8
Q

What are the characteristics necessary for optimal fluid and electrolyte balance

A
  • fluid electrolyte intake and absorption match the fluid and electrolyte output
  • volume, osmolality, and electrolyte concentrations of fluid in the various body fluid compartments are within their normal range
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9
Q

ECV = ____

A

Extracellular fluid volume

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10
Q

Extracellular fluid volume and balances are abnormal amounts of _______ in the _______

A 
Fluid,
Extracellular compartment (vascular plus interstitial)
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11
Q

When fluid has the same effective concentration as normal body fluid it is called ______ fluid

A

Isotonic

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12
Q

(ECF)= ______

A

Extracellular fluid

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13
Q

Normal _______ is isotonic sodium ion containing fluid

A

Extracellular fluid

The sodium ion is necessary to hold the water in the extracellular compartment

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14
Q

What are the two types of extracellular fluid volume imbalances

A
  • low Na+ containing isotonic fluid in the extracellular compartment
  • excess Na+ containing isotonic extracellular fluid
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15
Q

For optimal osmolality the normal range of sodium = _______

A

135-145 mEq/L

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16
Q

For optimal osmolality the normal range of osmolality = _______

A

280-300 mosmo/kg

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17
Q

Optimal potassium concentration = _______

A

3.5-5.0 mEq/L

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18
Q

The normal range for urine specific gravity = 1.002 to 1.030

A number above 1.001 can indicate mild dehydration. The higher the number the my dehydrated a person may be.

A

1.002 to 1.030

A number above 1.001 can indicate mild dehydration. The higher the number the my dehydrated a person may be.

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19
Q

_______ reflects the osmolality of the blood

A

Serum Na+

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20
Q

What is the normal range for Serum Na+ (Sodium)

A

135-145 mEq/L

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21
Q

What is the Serum Na+ during hypernatremia

A

> 145 mEq/L

  • Serum osmolality presents at >300 mOsm/kg
  • Urine specific gravity presents greater than 1.030
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22
Q

What is the Serum Na+ level during hyponatremia

A

<135 mEq/L

  • Serum osmolality presents less than 280 mOsm/kg
  • Urine specific gravity presents less than 1.010
  • Elevated hematocrit and plasma protein levels
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23
Q

What causes hypernatremia

A
  • Increased water loss (diabetes insipidus, renal concentrating disorders, watery diarrhea, Profuse diaphoresis without fluid replacement)
  • decrease water intake or increased sodium intake (inability to respond to thirst mechanism, difficulty swallowing fluids, hypertonic tube feedings without adequate water supplements, excessive administration of hypertonic sodium chloride or sodium hydrochloride, Adrenal hyperfunction)
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24
Q

What are the signs and symptoms of hypernatremia

A

Confusion, lethargy, stupor, coma, extreme thirst, muscle weakness, dry or stinky mucous membranes

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25
Q

What is the appropriate nursing care to PREVENT hypernatremia

A
  • administer water between hypertonic tube feedings
  • teach elderly patients to drink fluids regularly
  • offer fluids frequently to patients at risk
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26
Q

What is the appropriate nursing care to CORRECT hypernatremia

A
  • monitor replacement of water loss as prescribed
  • diuretics to remove excess sodium may also be prescribed
  • Monitor specific gravity of urine
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27
Q

What causes hyponatremia

A
  • Increased water gain (excess of administration of sodium free IV fluids – DW5, excessive use of tapwater enemas, stimulation of antidiuretic hormone – ADH, psychogenic polydipsia)
  • increased loss of sodium (use of hypotonic irrigating solutions – distilled water, excessive use of thiazide or Loop diuretics, sodium – losing renal disease, adrenal insufficiency, replacement of water but not electrolytes from Burns, diaphoresis, vomiting, diarrhea, NG suction
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28
Q

What are the signs and symptoms of hyponatremia

A

Confusion, lethargy, convulsions, coma, muscle weakness, nausea and abdominal cramps, postural hypotension

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29
Q

What is the appropriate nursing care to PREVENT hyponatremia

A
  • use normal saline instead of distilled water for irrigation
  • avoid tap water enemas in bowel management
  • teach patients to replace body fluid losses with fruit juice or bouillon rather than water
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30
Q

What is the appropriate nursing care to CORRECT hypernatremia

A
  • Help patient comply with prescribed fluid restriction

- Administer hypertonic IV solutions when prescribed, with great caution

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31
Q

Potassium is primarily 98% ________

A

Intracellular

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32
Q

What is the normal range for Serum K+ (Potassium)

A

3.5-5 mEq/L

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33
Q

What is the Serum K+ level during hyperkalemia

A

> 5 mEq/L

-decreased arterial pH, indicating acidosis

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34
Q

What is the Serum K+ level during hypokalemia

A

<3.5 mEq/L

  • slightly elevated serum glucose level
  • Elevated pH of bicarbonate levels
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35
Q

What causes hyperkalemia

A
  • increased K+ intake (IV administration of K+, administration of aged blood, excessive use of salt substitutes)
  • decreased renal excretion of K+ (acute and chronic renal failure, decreased production of aldosterone, adrenal insufficiency – Adkins disease, excessive use of potassium sparing diuretics; Spironolactone (Aldactone), Amiloride (Moduretic)
  • movement of K+ into extracellular fluid (tissue injury, acidosis, insulin deficiency)
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36
Q

What are the signs and symptoms of hyperkalemia

A

Mental confusion,
G.I. hyperactivity,
cardiotoxicity,
EKG changes

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37
Q

What is the appropriate nursing care to PREVENT hyperkalemia

A
  • Monitor IV infusions of K+
  • evaluate renal function before administering potassium intravenously
  • avoid use of salt substitutes for patients with renal problems
  • teach patients about fluid/foods that are high in potassium
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38
Q

What is the appropriate nursing care to CORRECT hyperkalemia

A
  • Give fluids to increase urinary output
  • administer potassium depleting diuretics as ordered
  • withhold drugs that contain large amounts of potassium
  • decrease dietary sources of potassium
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39
Q

What causes hypokalemia

A
  • decrease potassium intake
  • anorexia nervosa
  • gastrointestinal potassium loss (vomiting, gastric suction, diarrhea, laxative abuse)
  • large sweat lost without potassium replacement
  • increased renal excretion of potassium (use of potassium losing diuretics such as furosemide and bumetanide)
  • entry potassium into cells (alkalosis, hypersecretion of insulin)
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40
Q

What are the signs and symptoms of hypokalemia

A
  • muscle weakness/paralysis
  • decreased bowel motility
  • polyuria
  • EKG changes
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41
Q

What is the appropriate nursing care to PREVENT hypokalemia

A
  • teach patients which foods have high potassium content

- patients about their diuretics

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42
Q

What is the appropriate nursing care to CORRECT hypokalemia

A
  • Watch for signs of digitalis toxicity
  • administer potassium supplements as ordered
  • administer IV potassium and eluded concentration (never by IV push)
43
Q

What is the normal range for Serum Ca++ (Calcium)

A

9-11 mg/dL

44
Q

What is the Serum Ca++ level during hypocalcemia

A

<9 mg/dL

45
Q

What causes hypercalcemia

A
  • calcium released from bone
  • hyperparathyroidism
  • prolonged immobilization
  • excessive indigestion of vitamin D
46
Q

What are the signs and symptoms of hypercalcemia

A
  • nausea and vomiting
  • constipation
  • muscle weakness
  • confusion
  • lethargy
  • coma
  • polyuria
  • pathological fractures
  • chronic renal calculi
47
Q

What are the causes of hypocalcemia

A
  • decreased intake or decreased G.I. absorption of calcium
  • decrease in physiologically available calcium (hypoparathyroidism)
  • increased urinary excretion of calcium (chronic renal failure)
48
Q

What are the signs and symptoms of hypocalcemia

A 
Muscle cramps, 
confusion, 
irritability, 
anxiety, 
neuromuscular irritability, 
hyperactive deep tendon reflexes, 
convulsions
49
Q

What is the appropriate nursing care to PREVENT hypercalcemia

A
  • increase client motility

- teach patient to avoid excess vitamin D supplements

50
Q

What is the appropriate nursing care to CORRECT hypercalcemia

A
  • administer Loop diuretics as ordered

- administer IV normal saline has ordered

51
Q

What is the appropriate nursing care to PREVENT COMPLICATIONS of hypercalcemia

A
  • ensure adequate hydration to decrease possibility of renal calculi formation
  • handle patient gently when transferring or repositioning to prevent pathological fractures
52
Q

What is the appropriate nursing care to PREVENT hypocalcemia

A
  • teach patients careful management of antacids and laxatives
  • teach patients dietary sources of calcium and vitamin D
53
Q

What is the appropriate nursing care to PREVENT COMPLICATIONS of hypocalcemia

A
  • administer oral calcium supplements is ordered
  • keep an IV solution of calcium gluconate available for emergency use after thyroid surgery (administration not to exceed 2 ml/min)
54
Q

What is the normal range for Serum Mg++ (Magnesium)

A

1.6-2.6 m3q/L

55
Q

Magnesium is absorbed primarily through the _______

A

Small intestine

56
Q

What is the Serum Mg++ level during hypermagnesemia

A

> 2.6 mEq/L

57
Q

What is the Serum Mg++ level during hypomagnesemia

A

<1.6 mEq/L

58
Q

What are the causes of hypermagnesemia

A
  • Excessive intake or absorption of magnesium,
  • Overuse of antacids containing magnesium (Maalox, Gelusil Riopan)
  • overuse of laxatives containing magnesium (milk of magnesia)
  • impaired magnesium excretion
  • Advanced renal failure
  • adrenal insufficiency (Addison’s disease)
59
Q

What are the causes of hypomagnesemia

A
  • decrease magnesium intake or absorption
  • chronic diarrhea
  • chronic malnutrition
  • chronic alcoholism
  • Small bowel resection
  • prolonged IV administration without magnesium supplementation
  • prolonged diarrhea or nasogastric suction
  • prolonged excessive diuretic therapy
60
Q

What are the signs and symptoms of hypermagnesemia

A
  • hypoactive deep tendon reflexes
  • drowsiness
  • lethargy
  • nausea and vomiting
  • mild hypotension
  • cardiac arrhythmias
  • cardiac arrest
61
Q

What are the signs and symptoms of hypomagnesemia

A
  • hyperactive deep tendon reflexes
  • course tremors
  • intense confusion
  • convulsions
  • coma
62
Q

What is the appropriate nursing care to PREVENT hypermagnesemia

A
  • teach careful management of magnesium containing antacids and laxatives
  • give fluids to increase urinary output
  • withhold preparations containing large amounts of magnesium
  • keep 10% calcium gluconate available for emergency use
63
Q

What is the appropriate nursing care to PREVENT hypomagnesemia

A
  • provide diet counseling for patients at risk
  • evaluate renal function before administering magnesium replacement
  • administer magnesium replacement as ordered
64
Q

What is the normal range for Serum PO4+ (Phosphate)

A

2.8-4.5 mEq/L

65
Q

A reciprocal relationship exists between the phosphate and _____

A

Calcium

66
Q

What is the Serum PO4+ level during Hyperphosphatemia

A

> 4.5 mEq/L

67
Q

What is the Serum PO4+ level during Hypophosphatemia

A

<2.8 mEq/L

68
Q

What causes hyperphosphatemia

A
  • acute or chronic renal failure
  • chemotherapy
  • excessive ingestion of milk or phosphate containing laxatives
  • large intake of vitamin D
69
Q

What causes hypophosphatemia

A
  • Malnourishment
  • malabsorption syndrome
  • alcohol withdrawal
  • use of phosphate binding antacids
  • parenteral nutrition with inadequate phospate replacement
70
Q

What are the signs and symptoms of hyperphosphatemia

A
  • increased phosphate with calcium precipitate readily causing calcified deposits in the joints, arteries, skin, kidneys, corneas
  • neuromuscular irritability
  • tetany
71
Q

What are the signs and symptoms of hypophosphatemia

A
  • mild to moderate muscle weakness
  • pain
  • dysrhythmias and cardiomyopathy
  • severe central nervous system depression and confusion
72
Q

What is the appropriate nursing care to PREVENT hyperphosphatemia

A
  • restrict dairy products
  • adequate hydration to enhance renal excretion of phosphate
  • calcium supplement
  • phosphate binding gels
  • dietary phosphate restrictions
73
Q

What is the appropriate nursing care to PREVENT hypophosphatemia

A
  • oral supplementation with medications
  • increased dairy products
  • IV administration of sodium phosphate for potassium phosphate
74
Q

What populations are at the greatest risk for fluid and electrolyte imbalance

A

Very young

very old

75
Q

What information is important to collect in a medical history when determining fluid and electrolyte status

A

Recent surgery,
gastrointestinal output,
acute illness or trauma (respiratory disorders, burns, trauma),
chronic illness (cancer, heart failure, oliguric renal disease)

76
Q

____ can be an indicator of fluid status

A

Daily weights

77
Q

When the solute concentration is less than that of the serum it is a _____ solution

A

Hypotonic

78
Q

When the solute concentration is equal to that of the serum it is a _____ solution

A

Isotonic

79
Q

When a solute concentration is higher than that of serum it is a ______ solution

A

Hypertonic

80
Q

During ______ solutes move from areas of higher concentration to areas of lower concentration until the concentration is equal in both areas

A

Diffusion

81
Q

During ______ solutes move from an area of lower concentration to an area of higher concentration which requires energy

A

Active transport

82
Q

During _____ fluids move passively from an area with more fluid and fewer solutes to an area with less fluid and more solutes

A

Osmosis

83
Q

What are the extracellular electrolytes

A

Sodium,
chloride,
calcium,
bicarbonate

84
Q

What are the intracellular electrolytes

A

Potassium,
phosphate,
magnesium

85
Q

What is the Serum Ca+ level during hypercalcemia

A

> 10.2 mg/dL

86
Q

What causes hyponatremia

A 
Fever, 
heat stroke, 
pulmonary infections, 
burns, 
severe diarrhea, 
diabetes insipidus, 
excess sodium intake, 
use of certain drugs
87
Q

Signs and symptoms of hypernatremia

A 
Agitation, 
confusion, 
flushed skin, 
intense thirst, 
lethargy, 
low-grade fever
88
Q

Drugs that cause hypernatremia

A

Antacids with sodium bicarbonate,
antibiotics,
salt tablets,
IV sodium chloride preps

89
Q

With hypernatremia, osmolality is ____

A

> 300

90
Q

What causes hyponatremia

A 
Adrenal insufficiency, 
diuretics, 
vomiting, 
diarrhea, 
metabolic alkalosis, 
cystic fibrosis, 
burns, 
wound drainage, 
heart or liver failure, 
renal failure
91
Q

Signs and symptoms of hyponatremia

A 
Abdominal cramps, 
altered consciousness, 
confusion, 
headache, 
muscle twitching and weakness, 
nausea, 
seizures
92
Q

During hyponatremia serum osmolality the levels are _____

A

<280

93
Q

What are the causes of hyperkalemia

A 
Excess potassium intake, 
excess of salt substitutes, 
medications, 
renal failure, 
kidney disorders, 
Addison disease, 
burns, 
infection, 
trauma, 
metabolic acidosis
94
Q

Drugs that cause hyperkalemia

A 
NSAIDs,
Antibiotics, 
beta blockers, 
chemotherapy drugs, 
potassium supplements, 
ACE inhibitors
95
Q

What causes hypokalemia

A 
Low intake of potassium rich foods, 
Vomiting, 
diarrhea, 
magnesium deficiency, 
stress, 
diuretics, 
insulin, 
laxatives
96
Q

Signs and symptoms of hypokalemia

A 
Constipation, 
muscle cramps and weakness, 
nausea and vomiting, 
orthostatic hypotension, 
polyuria
97
Q

What causes hypermagnesemia

A 
Renal dysfunction, 
age, 
Addison's disease, 
diabetic ketoacidosis, 
antacids, 
laxatives, 
magnesium supplements
98
Q

Signs and symptoms of hypermagnesemia

A 
Bradycardia, 
decreased level of consciousness,
Decreased muscle and nerve activity, 
flushed skin, 
hyperactive deep tendon reflexes,
 hypotension, 
nausea and vomiting, 
shallow respirations
99
Q

What causes hypomagnesemia

A 
Alcoholism, 
IV therapy, 
ulcerative colitis, 
prolonged diarrhea, 
laxative abuse, 
hyperparathyroidism, 
renal disorders
100
Q

Signs and symptoms of hypomagnesemia

A 
Confusion, 
seizures, 
dysphasia, 
arrhythmias, 
hypertension, 
leg and foot cramps, 
muscle weakness, 
nausea and vomiting, 
respiratory difficulties
101
Q

What causes hypercalcemia

A 
Hyperparathyroidism, 
cancer, 
fractures, 
immobility, 
hypophosphatemia, 
acidosis,
Thiazide diuretics, 
vitamin A & D
102
Q

Signs and symptoms of hypercalcemia

A 
Abdominal pain and constipation, 
confusion, 
bone pain, 
hypertension, 
muscle weakness, 
nausea and vomiting
103
Q

What causes hypocalcemia

A 
Alcoholism, 
diarrhea, 
laxative abuse, insufficient vitamin D, 
hypoparathyroidism, 
severe burns, 
loop diuretics
104
Q

Signs and symptoms of hypocalcemia

A

Anxiety, confusion, irritability, arrhythmias, diarrhea

From Flashcardlet (23 decks)

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