NURM-102 Fluids & Electrolytes Exam Review

Ascites

Excess, trapped fluid in peritoneal cavity

Flank

Lateral portion of the body, kidney area

Oliguria

Below 30mL/hr

Extracellular Compartments

1. Interstitial

2. Intravascular

3. Transcellular

Osmosis

Movement of fluid down concentration gradient

Plasma osmolarity

275-300 mosm/L

Filtration

Blood goes to capillary bed into tissue with waste products filtering through osmotic pressure

Hydrostatic pressure

Blood pressure against capillary walls

Osmotic pressure

Draws water back in from venues as hydrostatic pressure drops

Albumins

Controls osmotic pressure, made by the liver

How does liver disease cause fluid buildup?

Lack of albumins made by liver means no fluid is being pulled out

RAAS

1. Low sodium/fluids detected by kidney releases renin into liver

2. Renin activates angiotensin I (vasoconstriction)

3. Angiotensin I enters lungs with ACE to become angiotensin II (stronger vasoconstriction)

Aldosterone

Retains sodium and releases potassium

• Released from renal CORTEX due to angiotensin II

Cortisol

Natural steroid that does the same thing as aldosterone

• Released by adrenal GLAND

ADH

Released by the PITUITARY GLAND

Hypothalamus

Thirst control center triggered when plasma osmolarity increases

• Detected by baroreceptors triggered by increased BV

PTH

Regulated calcium by keeping it in blood

How much fluid does an adult need in a day?

30mL/kg/day

How should wt be measured?

Same time, same amount of clothes, same scale

Isotonic solution effect

Same osmolarity —> Doesn’t affect cells + increases blood volume and pressure

• Builds back up vascular space

Isotonic EXAMPLES

• NS

• D5W

• RL

RL

Ringer’s Lactate

• NOT given for liver failure pt

HYPERtonic solution effect

Higher osmolarity —> Draws fluid out of cells and shrinks them

• Reduces blood pressure

• Given to REDUCE CEREBRAL EDEMA

Contra-indicators for HYPERtonic solutions

Impaired heart/kidney function

Examples of HYPERtonic solution

• D10W

• D5LR

• D5NaCl

HYPOtonic solution effect

Draws water into cell and reduces blood pressure

• Causes cells to swell and burst

HYPOtonic solution should be given to…

Normal bp but DEHYDRATED

HYPOtonic solution EXAMPLES

• ½ NS

• 1/3 NS

Contra-indicators for HYPOtonic solution

• Increased intracranial pressure (IICP)

• Burns

• Low albumin

• Liver disease —> 3rd spacing

Oral intake sources also include…

• Broth

• Ice cream

• Jello

Jackson-Pratt Drain

Takes drainage from post-surgical sites

I&O should be…

Roughly equal, with slightly higher intake

Shortness of breath comes from…

HYPERvolemia

Lack of electrolytes causes

• Muscle weakness

• Cardiac arrhythmias

• Seizures

Why are Hct and Hg considered pseudo?

• Hg can increase with fluid loss despite no cell loss

• Hct can also increase with fluid loss

BUN

6-20mg/dL

• TRUE indicator, INCREASES with dehydration

Urine specific gravity

1.005-1.025

HYPERvolemic lung sounds

Crackles

HYPOvolemic lung sounds

Clear (less fluid)

Wt loss to be considered hypovolemic

• 5% in adults

• 10% in infants

Severe weight loss

• 8+% in adults

• 15+% in children

Salt makes you want…

Water!

Third spacing

Fluid becomes trapped in transcellular compartment

• Due to loss of albumins returning fluids into capillaries

Transcellular compartment

Locked off areas with minimal osmosis

• Synovial joints, pericardium, peritoneum, eye humors, CSF

What differs third spacing from regular hypovolemia?

NO WEIGHT CHANGE

Primary intervention for third spacing

IV albumin

Fluid DEFICIT VITALS

• Increased temp

• Rapid weak pulse

• Rapid shallow respirations

Fluid OVERLOAD VITALS

• Temp unaffected

• Full and bounding pulse

• Moist and labored respirations

Other s/s of fluid DEFICIT

• Warm, dry flushed skin

• Sunken eyes

• Flat veins with fatigue

• Weak/sleepy/disoriented

Other s/s of fluid OVERLOAD

• Cool, moist and pallor skin

• Edema in eyes

• Distended veins

• Tense, worried, insomnia

Cations

POSITIVE

• Na+, K+, Ca+, Mg+

Na+

Regulates nervous and muscle cell activity, maintains fluid volume

• 135-145 mEq/L

• Convulsions occur with too much or little

Where is most Na+ present?

90% in ECF

-natremia

Relating to sodium

HYPOnatremia causes

• Kidney/adrenal disease

• GI loss

• Diaphoresis

• Diuretics

• Excess wataa

How can adrenal disease cause hyponatremia?

Not secreting aldosterone —> Nothing holding onto sodium

HYPOnatremia s/s

• Personality change

• Hypotension

• Abd cramping

• N/V

• Muscle weakness

Precautions with IV Na

Seizures and giving NS

HYPERnatremia causes

Increased sodium or burns

K+

Maintains cell activities and transmits impulses

• 3.5-5 mEq/L

What can reduced/excess K+ affect?

Cardiac impulses

Where is most K+ found?

ICF and GI secretions

• Primary electrolyte of the GI system

HYPOkalemia and causes

Below 3.5 mEq

• K+ wasting diuretics, GI loss, aldosterone

HYPOkalemia S/S

• Ventricular dysrhythmias

• Weakness, fatigue, paresthesia, hypotonicity

• LEG cramps

Can K+ be pushed IV?

NO —> Must be very diluted

HYPERkalemia and causes

> 5 mEq

• Renal failure, fluid deficit

HYPERkalemia s/s

• Heart block/cardiac arrest ← EKG dysrhythmia

• ABD cramp, paresthesia

Why do abdominal cramps happen in hyperkalemia?

Body trying to rid itself of K+ in GI

Kayexalate

Laxative that pulls off K+ from GI

• For SLIGHTLY elevated

Insulin

Much quicker fix that pushes potassium into cells

• TEMPORARY

Ca+

Bone/teeth framework, but also NERVE IMPULSES AND CLOTTING

• 8.5-10.5 mEq/L

• In milk and beans

HYPOcalcemia causes

• Fast blood transfusion

• HYPOparathyroid

• Vit D deficiency

HYPOcalcemia s/s

• Paresthesia

• Hyperactive reflexes

• Positive Trousseau and Chvostek

• Tetany

• Seizures

• Bleeding

Trousseau’s Sign

BP cuff inflation causes arm to contract

Chvostek’s Sign

Facial stimulation causes facial twitching

Tetany

Spasms from overexcited PNS nerves

HYPERcalcemia causes

• HYPERparathyroid

• Prolonged immobility

• Osteoporosis

HYPERcalcemia s/s

• Low back pain from renal calculi

• Bone pain

• Anorexia

Why does ambulating help with HYPERcalcemia?

Deposits calcium into bones because you’re using them

Mg+

Enzyme activities and exciting cardiac + skeletal muscle

• 1.8-2.6 mEq/L

• Green leafy veggies, nuts, whole grains, dark choc

HYPOmagnesemia causes

• No oral fluids, diarrhea

• Alcoholism

• N/V

• NG tubes

• Small intestine or renal disease

• Burns

HYPOmagnesemia s/s

• Muscle tremors

• Increased DEEP TENDON reflexes

• Confusion/disorientation

• Positive Chvostek and Trousseau

HYPERmagnesemia causes

• Renal failure

• Increased oral intake of antacids

• HYPERthyroidism

HYPERmagnesemia s/s

• REDUCED deep tendon reflexes

• DECREASED RESP DEPTH

• Hypotension

• Flushing

Ca Gluconate

Antidote to Mg+

• For HYPERmagnesemia

Why does hypermagnesemia cause decreased respiratory depth?

The diaphragm is one of the muscles relaxed