Nursing 201, Fluid & Electrolyte Disturbances.

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  1. ECF is further divided into 3 categories. What are they?
    Intravascular, Interstitial, and transcellular.
  2. What does the intrvascular space contain?
    Contains plasma. Is the fluid within the blood vessels. 3 L -6 L.
  3. What does the interstitial fluid contain?
    Contains the fluid that surrounds the cell. 11 L- 12 L.
  4. Describe the transcellular division?
    The smallest division, contains about 1 L. Exs of this fluid include cerebrospinal, pericardial, intraocular, etc...
  5. Loss of ECF into a space that does not contribute to equilibrium between ECF & ICF. This is called?
    Third Spacing or Third-Space Fluid Shift.
  6. What is an early sign of Third Spacing?
    Decrease in urine output despite adequate fluid intake.
  7. Name a few other signs of Third Spacing?
    Decreased BP, Increased HR and body weight. Edema.
  8. Third Spacing normally occurs in patients with....
    hypocalcemia, decreased iron, liver disease, alcoholism, hypothyroidism, immobility.
  9. Name the Cations.
    Positive charge. Na, K, Ca, Mg, & hydrgen ions.
  10. Name the Anions.
    Negative charge. Cl, bicarbonate, phosphate, sulfate, proteinate ions.
  11. What exactly does MEQ measure?
    Measure of chemical activity. Equivalent to electrochemical activity of 1mg of hydrogen.
  12. Pressure exerted by the fluid on the walls of the blood vessels. This is called?
    Hydrostatic Pressure.
  13. The direction of fluid movement depends on the differences in these two opposing forces?
    hydrostatic pressure and osmostic pressure.
  14. When fluid shifts through the membrane from a region of low solute concentration to a region of high solute concentration until they are of equal concentration, this is called...
  15. The ability of all the solutes to cause an osmotic driving force that promotes water movement from one compartment to another. Concentration of small molecules held within the solution.
  16. Name some electrolytes that are capable of affecting water movement.
    Sodium, mannitol, glucose, and sorbitol.
  17. Define osmotic pressure.
    The amount of hydrostatic pressure neeeded to stop the flow of water by osmosis. Primarily determined by the concentration of solutes.
  18. Define oncotic pressure.
    The osmotic pressure exerted by protiens.
  19. Define osmotic diuresis.
    The increase in urine output caused by the excretion of substances such as glucose, mannitol, or contrast agents in urine.
  20. The natural tendency of a substance to move from an area of higher concentration to one of lower concentration. Occurs through random movement of ions and molecules. Ex: exachange of O2 and C02. This is called....
  21. Is the sodium concentration greater in ECF or ICF?
    ECF is where the concentration is greater.
  22. Define active transport.
    Energy must be expended for the movement to occur against a concentration gradient.
  23. Sodium tends to enter a cell by means of....
  24. What organs lose fluid?
    Kidneys, skin, lungs, and the GI tract.
  25. Define osmolality.
    The concentration of fluid that affects the movement of water between fluid compartments by osmosis. It measures the solute concentration per kilogram through blood and urine. It is also a measure of a solution's ability to create osmotic pressure and affect the movement of water.
  26. What determines serum osmolity versus urine osmolity?
    Serum: reflects the concentration of sodium, although BUN and glucose play a role in determining it as well. Urine: determined by urea, creatinine, and uric acid. Both are most reliable indicator of urine concentration.
  27. What is the normal serum osmolity and urine osmolity in healthy adults?
    Serum: 275-295 mOsm/kg. Urine: 200-800 mOsm/kg
  28. What is the normal range of urine specific gravity?
    1.010- 1.025. Can be measured with 20 mL or urine.
  29. What is the normal BUN range?
    10-20 mg/dl
  30. Name same factors that increase BUN and some that decrease it.
    Increase: decreased renal function, GI bleeding, dehydration, increased protein shake, fever, and sepsis. Decrease: end-stage liver disease, a low protien diet, starvation, and any condition that results in expanded fluid volume.
  31. Creatinine is the end product of what?
    muscle metabolism.
  32. What is the normal serum creatinine level?
    0.7-1.4 mg/dL
  33. What does hematocrit measure?
    The volume percentage of red blood cells in whole blood.
  34. What conditions increase hematocrit and what decreases it?
    Increase: dehydration, polycythemia. Decrease: overhydration, anemia
  35. What is the purpose of IV fluids?
    To provide/replace/correct water, electrolytes, and nutrients to meet daily requirements. To administer meds or blood products.
  36. How quickly after administration can reactions occur?
    15 mins.
  37. Describe crystalloids.
    Solutes that easily dissolve in solution. Flow easily across a semipermeable membrane allowing for transfer from the blood stream into the cells and body tissues. This may increase fluid volume in both the interstitial and intravascular spaces.
  38. What is the osmolality of isotonic solutions?
    250-375 mOsm/L
  39. Describe isotonic solution.
    Osmotic pressure the same inside & outside of cell. No fluid shift occurs. Cells neither shrink nor swell. Most similar to plasma.
  40. What is isotonic solution used to treat?
    Treats low extracellular fluid as in fluid volume deficit. Ex: hemorrhage, severe vomiting, diarrhea, fistulas, wounds.
  41. Name some isotonic solutions.
    0.9 Nacl, Lactate Ringer's, 5% dextrose in water, ringer solution.
  42. Name some conditions commonly treated with 0.9% NS (normal saline)
    Shock, mild hyponatremia, metabolic acidosis, hypercalcemia. Used most often to correct extracellular volume defecit.
  43. What can occur if you administer 0.9% NS too rapidly?
    Cerebral edema.
  44. Describe Lactate Ringer's solution.
    Contains Ka and Ca, along with NaCl. Used to correct dehydration and sodium depletion. Replace GI losses. Caution: fluid volume overload can quickly develop, potential. Listen to lungs for crackles.
  45. What are some symptoms of hypervolemia?
    HyperT, bounding pulse, lung crackles, dyspenia, edema, jugular vein distention, extra heart sounds such as s3.
  46. What are some signs of hypovolemia?
    Urine output < 0.5 mL/kg/hr, poor skin turgor, tachycardia, weak pulse, hypoT.
  47. Describe hypotonic solutions.
    Has lower concetration or tonicity of solutes. Has osmolality less than 250 mOsm/L. Infusion of this solution lowers the serum osmolity in the vascular space, causing fluids to shift frm intravascular to both interstitial and intracellular space. Does not contain electrolytes (except NaCl). This will hydrate cells but may deplete fluid within the circulation system.
  48. - This electrolyte is a major anion of ECF. It functions w/ sodium to regulate serum osmolality & blood volume. Major component of gastric juice & HCL. Acts as buffer in exchange of O2 and CO2 in RBC’s. What is this electrolyte?
  49. Your pt. displays the following symptoms: Acidosis, weakness, lethargy, dysrhythmia. This is overload of what electrolyte?
  50. BThis electrolyte is present in both ICF & ECF. Regulates acid-base balance. Kidney can regenerate & reabsorb its ions and it must be consumed in the diet. What is it?
  51. Describe the Active Transport System.
    2nd major type of transport system for F&E. Principle is that solutes can be moved from an area of lower concentration to higher area. Against concentration gradient. Also referred to as pumping, Keeps sodium outside of the cell and potassium inside of the cell.
  52. What determines the Resting Membrane Potential & what is this potential necessary for?
    The ratio between ECF potassium and ICF potassium determines this. & it is necessary for the transmission of nerve impulses.
  53. Describe the Sodium Potassium Pump.
    Most common ex of active transport. Located in cell membrane. Allows movement when needed of sodium out of the cell and potassium into the cell, creating the electrical charge innervating every nerve in the body. Energy is required for this process. Needs ATP.
  54. This electrolyte is a major cation in ICF. Important w/ cellular metabolism, especially in protein and glycogen synthesis. Critical in nerve impulse conduction, maintaining cardiac rhythm and skeletal/smooth muscle contraction. Must be consumed daily because the body cant store it. Food sources include lean meats, whole grain, green leaf, potatoes, & beans.
  55. What hormone acts on the distal tubules, triggering potassium excretion & reabsorption of sodium?
  56. A shift in what ion can change potassium serum levels?
  57. What are some causes of hypokalemia?
    Vomiting, diarrhea, heavy perspiration, poor Ka intake- on diuretics. A direct relationship exist with low magnesium level. Prolonged hypo- Ka impairs the kidney’s ability to concentrate urine, resulting in polyuria and urine w/ low specific gravity. Also depresses insulin release frm pancreas = glucose intolerance.
  58. How do you properly administer potassium packages? What’s important about potassium pills? What about potassium IV?
    Dilute in water or fruit juice, give w/ or before meals to decrease GI upset. DO NOT CRUSH potassium pills. IV: Give slowly, never give by IV push or IM injection. If given too fast, cardiac arrest may occur. Rate is 10-20 MeQ/L/ hour.
  59. How does potassium affect digoxin?
    Hypokalemia will increase the action of digitalis, therefor, a pt on digoxin must be monitored closely for toxicity.
  60. Describe hyperkalemia.
    Most often related to renal failure. Most dangerous electrolyte imbalance. Can cause cardiac arrest. Causes of hyperKa include force trauma (Ka moves frm inside cell to outside too fast), burns, crush injuries. Skeletal muscle & respiratory muscle weakness/paralysis, speech defecit, & diarrhea are all symptoms.
  61. Name some treatment options for Hyperkalemia.
    Cation-exchange resins, administration of an IV diuretic, IV regular insulin (D50)- causes Ka to move back into cells. Limit Ka source.
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Nursing 201, Fluid & Electrolyte Disturbances.

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