Fluids and Electrolytes

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  1. Calcium good for? NV?
    • bone formation-
    • coagulation of blood-
    • excitation of cardiac and skeletal muscle- maintenance of muscle tone -
    • conduction of neuromuscular impulses-
    • synthesis and regulation of the endocrine and exocrine glands-
    • NV: 8 to 10mg/dl
  2. Sodium
    • maintain osmotic pressure and acid base balance- transmit nerve impulse-
    • NV: 135-145
  3. Magnesium
    • concentrated in bone cartilage and w/in cell itself
    • rqd for use of ATP as source of energy
    • nec for action of carb metabolism, protein and nucleic acid synthesis, contraction of muscle tissue-
    • NV: 1.6 - 2.6
  4. Phosphorus
    • - inverse relationship w/ calcium - when one is inc, the other one dec-
    • needed for generation of bone tissue - maintenace of acid base,
    • tranfer of energy from one site in the body to the other.-
    • functions in metabolism of glucose and lipids- NV: 2.7-4.5
  5. Potassium
    • needed for nerve conduction-
    • muscle function, -
    • acid base balance-
    • osmotic pressure - with calcium and mg,
    • control the rate and force of contraction of the heart → CO-
    • NV: 3.5 - 5.1
  6. Intra and Extracellular fluids
    • Intracellular = inside cells
    • Extra = interstitial ( fluid in between cells - also called 3rd spacing) and intravascular ( fluid in blood vessels)
  7. 3rd spacing?
    trapped extracellular fluid in a actual or potential body space as a result of disease or injury.
  8. Isotonic dehydration?
    equal amount of water and electrolytes are lost = hypovolemia  --> dec circulating blood volume and inadequte tissue perfusion
  9. Hypertonic Dehydration
    • More water loss than electrolytes → fluid move from inside the cell into the plasma and the intracellular space causing cells to dehydrate and shrink.
    • Causes: excessive perspiration, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early-stage renal failure, and diabetes insipidus
  10. Hypotonic Dehydration
    • More electrolyte loss than water → fluid move from plasma and interstitial fluid spaces into the cells, causing cell to swell while causing a plasma volume deficit.
    • Causes: chronic illnesses, excessive water replacement (hypotonic), renal failure, chronic malnutrition.
  11. Lab finding and fluid imbalances
    Fluid Volume deficit --> ↑ ht, BUN, serum osmolality, serum sodium, urinary specific gravity

    Fluid Volume Excess -->↓ht, BUN, serum osmolality, serum sodium, urinary specific gravity
  12. What is Isotonic overhydration and its causes?
    • hypervolemia --> excessive fluid in extracellular 
    • fluid compartment
    • can cause CHF or Pulm edema
    • Causes: inadequate control of IV therapy, renal failure, LT steroids therapy
  13. Hypertonic overhydration? causes?
    • Excessive sodium intake
    • fluid drawn from intracell fluid compartment - more extracellular fluid, intracellular fluid contract.

    Causes: rapid infusion of hypertonic saline, excessive sodium bicarbonate therapy.
  14. Hypotonic overhydration? Causes?
    - water intoxication --> excessive fluid moves into the intracellular space, and all body fluid compartments expand.  => electrolyte imbalance as a result of dilution

    Causes: early renal failure, CHF, SIADH, inadequately controlled IV therapy, replacement of isotonic fluid with hypotonic fluid, irrigation of wounds with hypotonic fluid
  15. Hyponatremia - Causes
    Causes: excessive diaphoresis, diuretics, v,d, wound drainage, renal disease, low aldosterone ( increasing reabsorption of ions and water in the kidney, to cause the conservation of sodium, secretion of potassium, increased water retention, and increased blood pressure) , ingestion of hypotonic fluid, fresh water drowning, SIADH, hyperglycemia, CHF
  16. Hyponatremia - SS?
    • CV: depends on volume of fluid 
    • Resp: shallow resp - late sign of resp muscle weakness
    • Neuro: gen skeletal muscle weakness worse in ext, low DTR
    • CNS: HA, pers change, confusion, seizures, coma
    • GI: inc motility and BS, n,d, abdo cramps
    • Renal: Inc urinaty output, dec urinary sp. grav.
    • Skin: dry - muc memb too
  17. Hypernatremia - causes?
    • Steroids use
    • Cushing Syndrome
    • Renal failure
    • Hyperaldosteroidism
    • dec water intake- h20 loss - fever, DI, d,v, diaphoresis, hyperventilation
  18. Hypernatremia SS?
    • CV: depending on vasc volume status
    • Resp: pulm edema if hypervolemic
    • Neuro: Early --> muscle twitches, irregular muscle contraction. Late -->skeletal muscle weakness, dtr low or absent
    • CNS: hypervolemic --> lethargy, stupor, coma
    • Hypovolemic --> agitation, confusion, seizures
    • GI: thrist
    • Renal: dec UO, inc usg
    • Skin: dry eurrthing
  19. Hypokalemia - cause
    ex use of diuretics, steroids, high aldosterone ( Cuching syndrome), v, d, diaph

    others: when K move from outside cell to in --> alkalosis, hyperinsulinism. 

    water intoxication
  20. Hypokalemia SS?
    • CV: weak and thready pulse, irregular, ortho BP
    • Resp: shallow, abs of BS
    • Neuro: anxiety, lethargy, confusion, coma, paresthesia, dtr hyporeflexia
    • GI: dec motility, hypoactive or absent BS, n,v, const, abdo distention, paralytic ileus
    • EKG changes: st depression, inverted t wave and prominent u wave
  21. How to take K? PO and liquid
    How to administer K?
    • PO: do not take on empty stomach
    • Liquid - ( KCL) nasty taste, give w/ juice

    • Never given IV push, IM or subcu.
    • IV K always diluted NEVER w/ dextrose but normal saline and admin using an infusion device!!!!
    • Dilution of no more 1mEq/ml
    • Make sure that K is well distributed in bag
    • Max: 5-10 mEq/hr 
    • > 10 mEQ --> put pt on ht monitor
    • Risk for phlebitis/infiltration: inspection of IV site fq
    • Before admin: assess renal function - and monitor intake and output.
  22. Hyperkalemia- cause?
    • Addison's disease - low aldosterone
    • mvt of K in cell out of cell --> tissue damage, acidosis, hyperuricemia, hypercatabolism
  23. Hyperkalemia - SS?
    • CV: bradycardia, low BP
    • Resp: weakness of resp muscle - resp failure
    • Neuro: Early --> muscle twitches, paresthesia, cramps. Late --> profound weakness, flaccid arms, etc ...
    • GI: inc motility, high BS, d
    • EKG changes: tall T waves, flat p waves, widened QRS complexes, prolonged PR intervals
  24. Hypocalcemia - causeS?
    • Malabsorption syndrome --> Celiac sprue, Crohns's disease 
    • end stage renal failure 
    • alkalosis /  acute pancreatitis
    • hyperphosphatemia
    • No parathyroid gland
  25. Aministration of calcium? 
    Other meds that help w/ hypocalcemia
    • warm solution to room temp, admin slowly.
    • aluminum hydroxide - dec phos
    • 10% calcium gluconate - for acute calcium deficiency
  26. SS hypocalcemia?
    • CV: low HR, BP, per pulses
    • Resp: muscle tetany or seizures can cause resp arrest
    • Neuro: tetany, seizures, muscle cramps, + Trousseau ( carpal spasm induced by inflating a BP cuff) and Chovstek (contraction of facial muscle when tap in front of ear on facial nerve -cheek area-) SIGNS, hyperactive DTR, anxiety, irritability
    • GI: cramping fiarrhea, high BS, inc motility
    • EKG changes: prolonged ST and QT interval
  27. Causes of hypercalcemia
    • Use of thiazide diuretics 
    • Inc bone resorption of Ca --> hyperparathyroidism, hyperthyroidism
  28. SS of hypercalcemia
    - and what to monitor for?
    • CV: inc hr, bp, pulses
    • Resp: muscle weakness - low resp
    • Neuro: profound muscle weakness, low/no dtr, disorientation, lethargy, coma
    • EKG changes: shortened ST segment, widened T wave

    • Monitor for signs of pathologic fractures - move pt slowly, carefully, assist w/ ambulation
    • Monitor for abdo cramp or pain, flank pain
    • Check urine for presence of urinary stones
  29. Meds to treat hypercalcemia
    • phosphorus
    • calcitonin
    • prostaglandin synthesis inhibitor ( aspirin, NSAIDS)
  30. Causes - hypomagnesemia
    • Celiac and Crohns --> malabsorption
    • sepsis
    • mg going into cell
    • insulin admin
    • hypocalcemia
  31. Hypomagnesia solution?
    IV magnesium sulfate - IM injection causes pain and tissue damage
  32. SS hypomagnesia
    • CV: tachycardia, htn
    • Resp: shallow
    • Neuro: same for hypocalcemia
    • CNS: confusion, irritability
    • EKG changes: tall T waves, depressed ST segments
  33. Hpermg - causes and treatment
    • Cause: excessive laxatives and antacids
    • Treatment: calcium gluconate or calcium chloride

    CG: antidote for mg toxicity
  34. SS hypermg
    • CV: low HR, dysrhythmia, low bp
    • Resp: low
    • Neuro: low DTR, skeletal msucle weakness
    • CNS: drowsiness, lethargy, confusion
    • EHG chnages: prolonged pr interval, widened qrs complex
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Fluids and Electrolytes
2014-02-27 15:54:07
Fluids and Electrolytes
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