Fluids, Electrolytes, Acid-Base Balance, and Intravenous Therapy

Flashcards covering key concepts from the lecture.

List four main functions of body fluids.

Transportation of substances, heat regulation, maintenance of hydrogen balance, and medium for enzymatic action of digestion.

What are the three fluid compartments in the body?

Intracellular, Extracellular (Intravascular, Interstitial, and Transcellular)

What electrolyte is high in the intracellular fluid?

Potassium

What electrolyte is high in the extracellular fluid?

Sodium

What is the function of osmoreceptors?

Sense internal environment and promote intake of fluids.

What is the function of baroreceptors?

Sense pressure and stimulate the nervous system to correct fluid balance.

What is the function of antidiuretic hormone (ADH)?

Influences how much fluid leaves the body and causes reabsorption of water from the kidneys.

What is the function of aldosterone?

Regulates water and sodium reabsorption in the kidneys.

What is the function of brain natriuretic peptide (BNP)/atrial natriuretic peptide (ANP)?

Promote loss of water and sodium and cause vasodilation.

What does the renin-angiotensin-aldosterone system regulate?

Release of aldosterone

What is the effect of sodium on water in the body?

Where sodium goes, water follows.

What is osmolality?

Concentration of a solution based on the number of solutes.

What type of transport requires energy (ATP) and moves from lower to higher concentration?

Active transport

What is filtration?

Movement of water and solutes

What is diffusion?

Substances move across a membrane to reach equal distribution, moving from high to low concentration.

What is osmosis?

Movement of water across a membrane, moving from low concentration to high concentration.

What is an isotonic solution?

Concentration of water and solute is equal.

What is a hypertonic solution?

Greater concentration of solute, causing fluid to move out of cells and cells to shrink.

What is a hypotonic solution?

Lower concentration of solute, causing fluid to move into cells and cells to swell.

What is insensible fluid loss?

Fluid loss people are unaware of, such as perspiration and respiration.

What is the most accurate way to measure fluid balance?

Weight change

Is thirst an early or late sign of dehydration in older adults?

Late sign

What are the symptoms of nausea and vomiting?

Pallor, diaphoresis, salivation, cold/clammy skin

What are the signs and symptoms of excess fluid volume?

Weight gain, bounding pulse, hypertension, edema, crackles in lungs, jugular venous distention, decreased sodium, decreased hematocrit, high volume of urine output, hypervolemia

What are the signs and symptoms of edema?

Puffy eyelids, swollen hands/feet, ascites, increased cranial pressure

What are the levels of edema?

1+ Mild pitting, 2+ Moderate pitting, 3+ Deep pitting, 4+ Very deep pitting

What are electrolytes?

Electrically charged ions that conduct an electrical current.

What are cations?

Positively charged ions.

What are anions?

Negatively charged ions.

What is the normal range for sodium?

135-145 mEq/L

What is the normal range for potassium?

3.5-5 mEq/L

What is the normal range for calcium?

8.4-10.6 mg/dL

What is the normal range for magnesium?

1.3-2.1 mg/dL

What are the causes of hyponatremia?

Sodium loss, inadequate intake, excess intake of water, heart failure, liver disease, chronic renal failure, burns

What are the signs and symptoms of hyponatremia?

Fatigue, lethargy, headache, confusion/altered LOC, coma, anxiety, anorexia, nausea/vomiting, muscle cramps, seizures, hypotension

What are the causes of hypernatremia?

Water loss from fever, respiratory infection, watery diarrhea, impaired thirst/restricted access to water, cellular dehydration, high sodium diet, excessive sweating

What are the signs and symptoms of hypernatremia?

Dry mucous membranes, taut skin turgor, intense thirst, flushed skin, oliguria, weakness, lethargy, irritability, twitching, seizures, low-grade fever, intracranial bleeding

What are the causes of hypokalemia?

Inadequate intake, loss of potassium in urine, diarrhea/vomiting, GI suction, diuretics

What are the signs and symptoms of hypokalemia?

Abdominal pain, paralytic ileus, cardiac dysrhythmias, muscle weakness, decreased reflexes, paralysis, urinary retention, lethargy, confusion, EKG changes

What are the causes of hyperkalemia?

Decreased excretion by kidneys due to renal insufficiency or drug effects, burns, crush injuries, renal failure, uncontrolled diabetes, insulin deficit, overuse of potassium salt substitute, potassium sparing diuretics

What are the signs and symptoms of hyperkalemia?

Muscle weakness, fatigue, hypotension, nausea, paralysis, EKG changes, cardiac dysrhythmias

What are the rules for administering IV Potassium?

NEVER give IV potassium as a push, must ALWAYS be diluted

What are the causes of hypocalcemia?

Calcium shifts into the bone, disorders/injury of parathyroid, alkalosis, renal failure, metastatic cancer, inadequate dietary intake of calcium/vitamin D, overuse of laxatives, chronic renal failure

What are the signs and symptoms of hypocalcemia?

Abnormalities in nerve conduction and muscle contractions, Trousseau sign, Chvostek sign, tetany, laryngospasm, paresthesia, abdominal cramps, weak pulse, hypotension, seizures, muscle spasms, dyspnea, cardiac failure

What are the causes of hypercalcemia?

Immobilization, excessive intake of calcium or vitamin D, excessive use of antacids, lung/stomach/kidney/bone tumors, multiple fractures, osteoporosis, parathyroid disorder

What are the signs and symptoms of hypercalcemia?

Anorexia, nausea, abdominal pain, constipation, muscle weakness, oliguria, confusion, pathologic fractures, renal calculi, dysrhythmias, cardiac arrest

What are the causes of hypomagnesemia?

Hypocalcemia, hypokalemia, chronic malnutrition, diarrhea, bowel resection, chronic alcoholism, diuretics, pancreatitis, GI suction, diabetic ketoacidosis (DKA)

What are the signs and symptoms of hypomagnesemia?

Insomnia, hyperactive reflexes, leg/foot cramps, twitching, tremors, seizures, cardiac dysrhythmias, Chvostek/Trousseau signs, vertigo, hypocalcemia, hypokalemia

What are the causes of hypermagnesemia?

Renal failure, overuse of antacids/cathartics, aspiration of sea water (as in near- drowning), chronic renal failure

What are the signs and symptoms of hypermagnesemia?

Hypotension, sweating, flushing, nausea and vomiting, muscle weakness, paralysis, respiratory depression, cardiac dysrhythmias

What is the mnemonic for remembering electrolyte imbalances?

Sodium-Same, Potassium-Pals, Calcium-Contradicts, Magnesium-More contradiction

What is the normal range for chloride?

95-103 mEq/L

What is hypochloremia associated with?

Hyponatremia

What is hyperchloremia associated with?

Hypernatremia

What is the normal range for phosphate?

3-4.5 mg/dL

What are the three mechanisms that control/rebalance pH?

Buffers, Respiratory system, Kidneys

What is the normal range for pH?

7.35 to 7.45

What is alkalosis?

pH above normal range (above 7.45)

What is acidosis?

pH below normal range (below 7.35)

What range does PaO2 normally fall under?

80-100

What range does PaCO2 normally fall under?

35-45

What range does SaO2 normally fall under?

94% to 100%

What range does HCO3 normally fall under?

22 to 28

What are the four acid-base imbalances?

Respiratory acidosis, metabolic acidosis, respiratory alkalosis, metabolic alkalosis

What are the causes of respiratory acidosis?

Airway obstruction, pneumonia, asthma, chest injuries, pulmonary edema, chronic obstructive pulmonary disease (COPD), opiate use/overdose

What are the causes of metabolic acidosis?

Excessive loss of bicarb from diarrhea, renal failure, DKA, hyperkalemia, sepsis, renal failure, excess lactic acid (periods of heavy exercise)

What are the causes of respiratory alkalosis?

Anxiety, high fever, aspirin overdose, hypoxemia, pain, head injuries, improper mechanical ventilation, high altitudes

What are the causes of metabolic alkalosis?

Vomiting, excessive GI suction, hypokalemia, excessive use of antacids, diuresis, steroid therapy

What does ROME stand for?

Respiratory Opposite Metabolic Equal

What fluid is the ONLY fluid that can hang with blood?

Normal Saline

List three isotonic fluids?

0.9% normal saline, 5% dextrose in water, lactated Ringer (LR)

List one hypotonic fluid.

0.45% saline

List two hypertonic fluids.

10% dextrose in water, 3% saline

List four goals of IV care?

Prevent infection, minimize injury to veins/tissues, administer correct fluid at the correct time with the correct flow rate, monitor/observe patient’s reaction to fluid/medications

What are the signs of infiltration?

Swelling, tenderness, skin COOL to touch

What are the signs of extravasation?

Pain at insertion site, tenderness skin COOL to touch, edema, visible tissue damage

What are the signs of phlebitis?

Vein is hard, tenderness, skin is WARM to touch

What are the signs of circulatory (fluid) overload?

Shortness of breath, tachypnea, hypertension, crackles, edema