Concepts Unit 1 Fluid/Electrolyte

What are the main types of body fluid compartments?

Intracellular Fluid (ICF) and Extracellular Fluid (ECF)

What are the primary electrolytes found in Intracellular Fluid (ICF)?

Potassium (K+), Magnesium (Mg2+), Phosphorus (PO4^3-)

What are the primary electrolytes found in Extracellular Fluid (ECF)?

Sodium (Na+), Chloride (Cl-), Bicarbonate (HCO3-), Calcium (Ca2+)

How does water move between compartments in the body?

By osmosis, from low to high solute concentration

What pressure pushes fluid out of capillaries into tissues?

Hydrostatic pressure

What pressure pulls fluid back into the capillaries from tissues?

Oncotic pressure

What does serum osmolarity measure?

The number of solutes per liter of solution

What is the normal range for serum osmolarity?

270-300 mOsm/L

How is fluid moved from one body compartment to another?

By osmotic and hydrostatic pressures

What hormone is released in response to high serum osmolarity or low blood volume?

Anti-diuretic hormone (ADH)

What triggers the release of aldosterone from the adrenal glands?

Low blood pressure or low sodium levels

What is the role of renin in fluid and electrolyte balance?

Renin is released in response to low blood pressure or sodium, activating the RAAS

What is first spacing in fluid balance?

Fluid is in its normal compartments (ICF & ECF)

What is second spacing in fluid balance?

Accumulation of fluid in the interstitial space (e.g., edema)

What is third spacing in fluid balance?

Fluid trapped in areas that are not easily accessible, such as ascites or blisters

What is the function of potassium in the body?

Cell metabolism and resting potential of nerve and cardiac cells

What dietary sources are high in potassium?

Bananas, avocados, potatoes, spinach, broccoli

What is the function of magnesium in the body?

Skeletal muscle contraction, cardiac cell potential, metabolism, and coagulation

What are good dietary sources of magnesium?

Nuts, seeds, legumes, low-fat dairy, spinach

What is the function of phosphorus in the body?

Activates vitamins, enzymes, and is crucial for cell growth and energy supply

What foods are rich in phosphorus?

Beef, chicken, fish, lentils, cheese

What is the primary function of sodium in the body?

Muscle conduction, nerve impulse transmission, and acid/base balance

What foods are high in sodium?

Prepackaged foods, cold cuts, processed foods, cottage cheese

What is the function of calcium in the body?

Nerve impulse transmission, muscle conduction, clotting, and bone density

What dietary sources are high in calcium?

Dairy, cheese, orange juice, squash, almonds, salmon

What is the inverse relationship between chloride and bicarbonate in the body?

When chloride levels increase, bicarbonate levels decrease and vice versa

What electrolyte value is most concerning if out of normal range for a patient?

Sodium, as low levels increase the risk of seizures and neurological issues

What should be monitored in a patient receiving furosemide (Lasix)?

Potassium levels and signs of hypokalemia

What does Mean Arterial Pressure (MAP) indicate in fluid balance?

Total intravascular volume, cardiac output, and vascular bed size

What is the required MAP to maintain adequate organ perfusion?

At least 65 mmHg

What type of IV fluid should be administered for dehydration due to vomiting?

Isotonic solution, such as normal saline or lactated ringers

What type of fluid is 0.9% Normal Saline?

Isotonic solution

What is a potential risk when administering hypertonic saline (3% NaCl)?

Central line is needed; can cause fluid shifts and cerebral edema

What does albumin as an IV fluid do?

It acts as a plasma volume expander, pulling fluid into the intravascular space

What is osmolarity?

The number of solutes per liter of solution

What is osmolality?

The number of solutes per kilogram of water

What fluid intervention should be anticipated for a patient stabilized after significant blood loss?

Transition to a maintenance fluid such as 0.45% normal saline

What type of IV fluid is 0.45% Normal Saline?

Hypotonic solution

What type of IV fluid is Lactated Ringer's?

Isotonic solution

Why is Lactated Ringer's not compatible with blood products?

It contains calcium, which can cause clotting when mixed with blood

What does 5% Dextrose in Water (D5W) become after dextrose is metabolized?

Hypotonic solution

What is the main risk associated with administering colloids like albumin?

Pulmonary overload

What are the signs of fluid overload to monitor for when administering IV fluids?

Edema, hypertension, and respiratory distress

What hormone is primarily involved in water reabsorption in the kidneys?

Anti-diuretic hormone (ADH)

What stimulates the release of renin from the kidneys?

Low blood pressure and low sodium levels

How does aldosterone affect sodium levels in the body?

Increases sodium reabsorption in the kidneys

What is the function of the endocrine system in fluid and electrolyte balance?

Regulates fluid balance through hormones like ADH and aldosterone

What is the function of the renal system in fluid and electrolyte balance?

Regulates water excretion and blood pressure

What is a potential complication of high pulmonary artery pressure?

Pulmonary edema

What electrolyte imbalance can furosemide (Lasix) cause?

Hypokalemia (low potassium)

What should the nurse assess when administering diuretics like furosemide?

Electrolyte levels, particularly potassium

What fluid is used for volume resuscitation in trauma patients?

Isotonic solutions such as 0.9% Normal Saline or Lactated Ringer's

What fluid should be used for a patient with symptomatic hyponatremia?

Hypertonic saline (e.g., 3% NaCl)

What IV fluid type causes cells to swell and lyse?

Hypotonic solutions

How do kidneys contribute to maintaining fluid balance?

By filtering blood and regulating water and electrolyte excretion

What are the basal fluid requirements for a healthy adult?

Intake of 2300 mL/day; Output of 1500 mL/day

What fluid should be used cautiously in patients with renal disease?

Lactated Ringer's, due to potential for metabolic alkalosis

What is the minimum urine output to ensure adequate renal function?

0.5 mL/kg/hr

What is the osmolarity of 0.9% Normal Saline?

308 mOsm/L

What IV fluid expands plasma volume by pulling fluid from interstitial spaces?

Albumin

What electrolyte imbalance is most dangerous and requires immediate intervention?

Severe hyponatremia or hyperkalemia

What are signs of dehydration that a nurse should assess?

Dry mucous membranes, decreased skin turgor, hypotension, tachycardia

What is the role of bicarbonate in the body?

Helps maintain acid-base balance and assists in carbon dioxide transport

What electrolyte imbalance is associated with low magnesium levels?

Hypocalcemia and hypokalemia

Which electrolyte is the major determinant of serum osmolarity?

Sodium (Na+)

What is the clinical significance of third spacing?

Fluid is trapped and unavailable for normal physiological processes

What condition might require a central line for IV fluid administration?

Administration of hypertonic saline (3% NaCl)

What is the effect of hypertonic fluids on cellular hydration?

Causes cells to shrink by drawing water out

What condition is indicated by a low serum osmolarity during heart failure exacerbation?

Fluid volume overload

What is hydrostatic pressure, and where does it primarily occur?

The force of fluid against vessel walls; occurs in capillaries

What happens to fluid movement in cases of increased hydrostatic pressure?

Fluid is pushed from the capillaries into the interstitial space, causing edema

What is the primary effect of oncotic pressure?

Pulls fluid back into capillaries from the interstitial space

How does ADH affect the kidneys?

Increases water reabsorption, reducing urine output

What electrolyte is critical for nerve impulse transmission and muscle contraction?

Calcium (Ca2+)

What role does the hypothalamus play in fluid balance?

Detects changes in serum osmolarity and signals ADH release

What is the primary determinant of intravascular volume status?

Sodium (Na+)

What electrolyte imbalance is most common in patients with chronic kidney disease?

Hyperkalemia (high potassium)

What is the function of albumin in the intravascular space?

Maintains oncotic pressure, keeping fluid within blood vessels

How does aldosterone regulate potassium levels?

Promotes potassium excretion in the kidneys

What are the signs and symptoms of hypernatremia?

Thirst, confusion, seizures, muscle twitching

What dietary modifications might be needed for a patient with hyperkalemia?

Low potassium diet; avoid bananas, oranges, potatoes

What does a low MAP (Mean Arterial Pressure) indicate?

Inadequate perfusion to organs, risk of organ dysfunction

What IV fluid is contraindicated in patients with hyperkalemia?

Lactated Ringer's, due to potassium content

What are the clinical signs of hypocalcemia?

Muscle spasms, tetany, numbness, and tingling

What conditions could lead to third spacing of fluids?

Burns, sepsis, liver failure, and peritonitis

What is the expected change in serum osmolarity in a patient with dehydration?

Increased serum osmolarity due to higher solute concentration

What IV fluid should be avoided in a patient with cerebral edema?

Hypotonic solutions, as they can exacerbate brain swelling

What are the potential consequences of prolonged hypotension?

Reduced organ perfusion, potential organ damage or failure

What electrolyte is closely linked with water balance and is the major cation of the ECF?

Sodium (Na+)

What is the impact of hypertonic solutions on intracellular fluid?

They draw water out of cells, causing cell shrinkage

Why is 3% NaCl considered a high-risk IV fluid?

It is hypertonic and can cause rapid shifts in fluid and electrolytes

What lab value should be closely monitored in patients receiving IV fluids?

Serum electrolytes, especially sodium and potassium levels

What causes fluid shifts in second spacing?

Changes in hydrostatic and osmotic pressures

What hormone is released by the adrenal cortex to regulate sodium and potassium?

Aldosterone

What is the purpose of using isotonic IV solutions?

To expand the extracellular fluid volume without causing fluid shifts

What type of IV fluid would be used for a patient in shock?

Isotonic solutions, such as normal saline or lactated ringers

What electrolyte imbalance is associated with muscle weakness and cardiac arrhythmias?

Hypokalemia (low potassium)

What is the clinical concern with a sodium level of 118 mEq/L?

Severe hyponatremia, increased risk of seizures and neurological complications

What electrolyte should be monitored when administering digoxin?

Potassium, as low levels increase the risk of digoxin toxicity

What is the action of anti-diuretic hormone (ADH) in fluid regulation?

Promotes water reabsorption in the kidneys, increasing blood volume