Fluid, Electrolytes, and Nutrition Practice Flashcards

Composition and Movement of Body Fluids

• Total Body Water (TBW):     * Intracellular Fluid (ICF): Fluid located within the cells.     * Extracellular Fluid (ECF): Fluid outside the cells, categorized as:         * Interstitial fluid.         * Intravascular fluid.         * Transcellular fluid.
• Solutes:     * Crystalloids: Small particles that can pass through semi-permeable membranes.     * Colloids: Large particles (like proteins) that do not cross membranes easily.     * Electrolytes: Solutes with an electrical charge.     * Nonelectrolytes: Solutes without an electrical charge.
• Movement of Body Fluids:     * Osmosis: The movement of fluids through cell walls and vessel walls to maintain homeostasis. It is specifically the movement of $H_2O$.     * Diffusion: The movement of solutes from an area of higher concentration to an area of lower concentration.     * Filtration: The simultaneous occurrence of osmosis and diffusion.
• Solution Dynamics:     * Hypotonic: Solutions with fewer particles than the cell. Fluid moves into the cell, causing it to swell.     * Isotonic: Solutions with equal fluid to particles. There is no net movement of $H_2O$, and the cell stays the same size.     * Hypertonic: Solutions with more particles than the cell. $H_2O$ leaves the cell, causing it to shrink.     * Hypervolemic: A state of having more fluid relative to particles.     * Hypovolemic: A state of having less fluid relative to particles.

Osmotic Pressure and Tonicity

• Osmotic Pressure: The force needed to stop $H_2O$ from moving across a membrane by osmosis.
• Osmolarity: The concentration of all dissolved particles (solutes) in a solution, measured per Liter.
• Tonicity: How a solution affects the size of a cell, which depends on solutes that cannot cross the membrane.
• Oncotic Pressure (Colloid Osmotic Pressure): The part of osmotic pressure caused specifically by proteins, such as albumin. Albumin acts as a "magnet" that pulls $H_2O$ into blood vessels and keeps fluid in the intravascular space.     * Implication: Low osmotic pressure (e.g., in cirrhosis) leads to edema; plasma protein replacement may be necessary.

Regulation and Types of Electrolytes

• Active Transport: The movement of solutes from an area of lower concentration to an area of higher concentration.
• Major Cations (With Charge):     * Sodium ($Na^+$)     * Magnesium ($Mg^{2+}$)     * Potassium ($K^+$)     * Calcium ($Ca^{2+}$)     * Hydrogen ($H^+$)
• Major Anions (Without specified positive charge):     * Chloride ($Cl^-$)     * Bicarbonate ($HCO_3^-$)     * Phosphate ($PO_4^{3-}$)
• Hormonal Regulation:     * Aldosterone: Released from the adrenal cortex; manages blood pressure by managing $Na^+$ and $K^+$ in the blood. When blood potassium rises or sodium falls, aldosterone targets the kidneys to reabsorb $Na^+$ and decrease $K^+$ release.     * Antidiuretic Hormone (ADH/Vasopressin): Formed in the hypothalamus; regulates $H_2O$ balance by controlling kidney $H_2O$ absorption and blood pressure.

Electrolyte Imbalances: Sodium ($Na^+$)

• Normal Levels: $135$ to $145\,mEq/L$.
• Clinical Concept: "Sodium Swells" / "Sodium think BRAIN." Imbalances primarily manifest as neurological changes.
• Hyponatremia ($< 135\,mEq/L$):     * Types: Hypovolemic and Hypervolemic.     * Signs/Symptoms: Confusion, lethargy, weakness, muscle cramping, seizures, anorexia, nausea, vomiting, and serum osmolality < 290\,mOsm/kg.     * Interventions: Administer IV fluids with $Na$, encourage foods with $Na$, monitor vitals, intake/output (I&O), and labs ($Na$ serum osmolality). Administer hypertonic IV saline solution if ordered.     * Sources: Bread, cheese, chips, processed meats (lunch meat, hot dogs, bacon, ham), canned foods, table salt.
• Hypernatremia ($> 145\,mEq/L$):     * Signs/Symptoms: Thirst, dry sticky mucous membranes, weakness, increased temperature, confusion, irritability, hallucinations, seizures, and serum osmolality > 290\,mOsm/kg.     * Interventions: Monitor vitals, Level of Consciousness (LOC), and labs. Increase $H_2O$ intake, implement sodium-restricted diets, and administer hypotonic IV solutions as ordered.

Electrolyte Imbalances: Potassium ($K^+$)

• Normal Levels: $3.5$ to $5.0\,mEq/L$.
• Clinical Concept: "Potassium Pump" / "Potassium think HEART." It helps muscles pump blood to the body; imbalance causes cardiac dysrhythmias.
• Hypokalemia ($< 3.5\,mEq/L$):     * Signs/Symptoms: Weakness, irregular heart rate (pulse), fatigue, lethargy, anorexia, nausea, vomiting, muscle weakness/cramping, decreased peristalsis, hypoactive bowel, paresthesia, and cardiac dysrhythmias.     * Interventions: Monitor vitals (ESPECIALLY HR and rhythm), labs ($K^+$), use a cardiac monitor, and administer $K^+$ supplements or IV fluids with $K^+$ as ordered.     * Warning: NEVER IV BOLUS OR PUSH IV Potassium ($K^+$).     * Sources: Fish (not shellfish), whole grains, nuts, broccoli, cabbage, carrots, potatoes with skin, bananas, cantaloupe, oranges, nectarines.
• Hyperkalemia ($> 5.0\,mEq/L$):     * Context: Often associated with renal failure.     * Signs/Symptoms: Anxiety, irritability, confusion, muscle weakness, flaccid paralysis, paresthesia, GI hyperactivity, diarrhea, abdominal cramping, cardiac arrest, bradycardia, heart block, and irregular pulses.     * Interventions: Monitor vitals (HR and rhythm), labs ($K^+$), cardiac monitor, limit high-potassium foods. Administer Kayexalate, glucose and insulin (to move potassium back into cells), or dialysis as ordered.

Electrolyte Imbalances: Magnesium ($Mg^{2+}$)

• Normal Levels: $1.5$ to $2.5\,mEq/L$.
• Clinical Concept: "Magnesium Manages Muscles" / "Think Calm and Sedated."
• Hypomagnesemia ($< 1.5\,mEq/L$):     * Signs/Symptoms: Neuromuscular irritability with tremors, disorientation, vertigo, confusion, increased reflexes, convulsions, positive Trousseau's and Chvostek's signs, tachycardia, elevated blood pressure, anorexia, and dysphagia.     * Interventions: Assess vitals, HR, and rhythm, cardiac monitor, assess mental status and LOC, give magnesium supplements, assess swallowing before providing oral items, use seizure precautions, and avoid alcohol.     * Sources: Cereal grains, nuts, dried fruit, legumes, leafy greens, dairy, meat, fish, chocolate.
• Hypermagnesemia ($> 2.5\,mEq/L$):     * Signs/Symptoms: Warm flushed appearance, peripheral vasodilation, nausea/vomiting, drowsiness, lethargy, generalized weakness, decreased deep tendon reflexes, hypotension, bradycardia, heart block, and respiratory depression/arrest.     * Interventions: Monitor vitals, heart rhythm, cardiac monitor, mental status/LOC, and neuromuscular status. Encourage increased oral intake and IV fluids, dialysis, loop diuretics as ordered, respiratory support PRN, and a low magnesium diet.

Electrolyte Imbalances: Calcium ($Ca^{2+}$)

• Normal Levels: $9$ to $10.5\,mg/dL$.
• Clinical Concept: "Calcium Creating Bone." Imbalance poses a risk for pathological fractures.
• Hypocalcemia ($< 9\,mg/dL$):     * Context: Associated with hypoparathyroidism.     * Signs/Symptoms: Confusion, anxiety, hyperactive reflexes, cardiac dysrhythmias, muscle cramps progressing to tetany, seizures, numbness/tingling of extremities, and positive Trousseau's/Chvostek's signs.     * Interventions: Monitor HR and rhythm, cardiac monitor, fall and seizure precautions, administer Calcium and Vitamin D as ordered, and encourage calcium-rich foods.     * Sources: Dark leafy vegetables, canned salmon, soy products, and milk.
• Hypercalcemia ($> 10.5\,mg/dL$):     * Context: Associated with prolonged bed rest.     * Signs/Symptoms: Lethargy, stupor, coma, depressed deep muscle strength/tone, dysrhythmias, anorexia, nausea, vomiting, constipation, pathological fractures, and kidney stones.     * Interventions: Monitor HR and rhythm, cardiac monitor, encourage increased fluids, increase activity and active ROM, and restrict calcium-rich foods.

Miscellaneous Electrolytes and Fluid Trends

• Phosphorus: "Think Perfect teeth." Helps the body use vitamins and maintains tooth/bone health. (Note: Not tested this quarter).
• Chloride: "Think carrying fluids" / "Chloride to Cellular." Maintains healthy fluid volume. (Note: Not tested this quarter).
• Fluid Volume Excess (Gain by TBW):     * $2\%$ gain: Mild.     * $5\%$ gain: Moderate.     * $8\%$ gain: Severe.

Nursing Process: Assessment, Diagnosis, and Implementation

• Assessment Factors:     * Age: Infants and elderly are more susceptible to imbalances.     * Stress: Causes fluid retention and decreased renal excretion.     * Weight: Total body fluid is disproportionate in obese individuals. A change of $1\,kg$ is equivalent to $1\,L$ ($1000\,mL$) of fluid.     * Surgery: Preoperative NPO, blood loss, stress, drainage, and postoperative vomiting affect balance.     * Medical Conditions: Cardiac, hepatic, renal, and respiratory disorders.
• Diagnostic Indicators:     * Fluid Imbalance: Nausea, vomiting, output > intake, dry mucous membranes, urine specific gravity $1.041$, urine osmolarity $1080\,mOsm/kg$.     * Fluid Retention: Bounding pulse ($116$), labored respirations ($32$), $3+$ pitting edema in feet, crackles in lungs, weight gain.     * Dehydration: Fluid volume loss, weak pulse, tachycardia, thirst.
• Intake and Output (I&O):     * Oral Intake: Includes all fluids and foods that become liquid at room temperature.     * Output: All measurable body fluids and drainage.     * Documentation: Record each shift and tally for a $24$-hour balance; monitor trends over days.
• Physical Assessment:     * Edema: Graded as pitting edema ($1+$ to $4+$).     * Turgor/Mucous Membranes: Check for hydration status.
• IV Site Monitoring (Infiltration Scale):     * Symptoms: Swelling, tenderness, coolness, firmness, blanching.     * Scale:         * $0$: No symptoms.         * $1$: Skin blanched, edema $< 1\,inch$, cool to touch, possible pain.         * $2$: All of above + edema $1$ to $6\,inches$.         * $3$: All of above + translucent extremity, edema $> 6\,inches$, mild to moderate pain, possible numbness.         * $4$: All of above + tight leaking skin, deep pitting edema, circulatory impairment, moderate to severe pain (considered extravasation).     * Implementation for Infiltration: Stop infusion immediately, remove catheter, assess vitals, check for extravasation, apply thermal applications, elevate extremity, outline damage with a skin marker, and cover with a sterile dressing if leaking.

Nutrition: Metabolism and Nutrient Types

• Definitions:     * Nutrition: Body's intake and use of nutrients for tissue growth and production.     * Nutrients: Substances from food that supply energy, build/maintain tissues, and aid body systems.     * Malnutrition: An imbalance between nutrient intake and body needs.     * Basal Metabolic Rate (BMR): Minimum energy required to maintain body functions in a resting, awake state.
• Biochemical Processes:     * Anabolism: Building complex molecules using energy.     * Catabolism: Breaking down molecules to release energy (destructive process using enzymes).
• Macronutrients:     * Carbohydrates ($4\,kcal/g$):         * Simple: Breaks down fast.         * Complex: Slower, more steady (e.g., sweet potatoes).         * Fiber: Soluble or insoluble; affects stool consistency.     * Fats ($1\,kcal/g$ per transcript): Includes lipids and triglycerides (most abundant in food). Saturated and trans fatty acids increase cholesterol and risk of heart attack/stroke. Monounsaturated and Polyunsaturated are healthier. Essential fatty acids: Omega-3 and Omega-6.     * Protein ($4\,kcal/g$): Amino acids are the building blocks. Complete proteins contain all amino acids; incomplete do not.     * Water ($H_2O$): Component of ICF and ECF. Imbalance leads to thirst/dehydration or intoxication/fluid overload.
• Micronutrients:     * Fat-Soluble Vitamins (Stored in liver/fat):         * Vitamin A: Vision health.         * Vitamin D: Bone strength/collagen.         * Vitamin E: Antioxidant (free radical protection), cancer/disease prevention.         * Vitamin K: Blood clotting.     * Water-Soluble Vitamins (Excreted in urine):         * Vitamin C: Antioxidant, teeth strength.         * Vitamin B Complex: Energy, nervous system, brain, RBC formation, infection prevention, immune system.         * B1 (Thiamine), B2 (Riboflavin), B3 (Niacin), B5 (Pantothenic Acid), B6 (Pyridoxine), B7 (Biotin).         * B9 (Folic Acid): Very important for DNA and RBC formation during pregnancy.         * B12 (Cyanocobalamin): Found in meats, eggs, dairy; aids RBC formation.

Nutritional Assessment and Labs

• Laboratory Tests:     * Prealbumin: $1/2$-life of $2$ days. Normal: $16$ to $30\,mg/dL$. Mild: $10$ to $15$. Moderate: $5$ to $10$. Severe: < 5.     * Albumin: $1/2$-life of $21$ days. Normal: $3.5$ to $5.0\,g/dL$. Mild: $2.8$ to $3.5$. Moderate: $2.1$ to $2.7$. Severe: < 2.1.     * Transferrin: $1/2$-life of $8$ to $9$ days. Normal: $200$ to $400\,mg/dL$. Mild: $150$ to $200$. Moderate: $100$ to $150$. Severe: < 100.     * Others: Hemoglobin, hematocrit, Blood Urea Nitrogen (BUN), and Creatinine.
• Anthropometric Measures:     * Body Mass Index (BMI):         * Underweight: $< 18.5\,kg/m^2$.         * Normal: $18.5$ to $24.9\,kg/m^2$.         * Overweight: $25.0$ to $29.9\,kg/m^2$.         * Obese (Class 1): $30.0$ to $34.9\,kg/m^2$.         * Obese (Class 2): $35.0$ to $39.9\,kg/m^2$.         * Extreme Obesity (Class 3): $> 39.9\,kg/m^2$.     * Morphology, height, weight, waist-to-hip ratio, and skinfold measurements.
• Physical Signs of Malnutrition:     * Hair: Thinning, dry, stiff, lack of shine, loss of pigment.     * Skin: Dry, rough, pallor, easy bruising, poor turgor.     * Dentition: Loss of natural teeth affects nutrient consumption.
• DETERMINE Screen for Older Adults: Used to identify risk factors (Disease, Eating poorly, Tooth/mouth pain, Economic hardship, Reduced social contact, Multiple medications, Involuntary weight loss/gain, Needs assistance, Elderly > 80 yrs).

Specialized Diets and Feeding

• Diets: Clear liquid, full liquid, pureed, mechanical soft, thickened, regular, diabetic, cardiac, renal.
• Enteral Feeding Tubes: For those with functioning GI tracts who cannot swallow or refuse to eat.     * Nasogastric (NG): Short-term therapy, bowel decompression.     * Percutaneous Endoscopic Gastrostomy (PEG): Long-term therapy for neurologically impaired clients.     * Medication Rule: Medications are NEVER added directly into a tube feeding formula.
• Total Parenteral Nutrition (TPN): Given via Peripherally Inserted Central Catheter (PICC) or Central Venous Catheter (CVC).     * For clients without a functioning GI tract who cannot ingest or absorb nutrients.     * TPN formulas are individualized and carry risks of potential complications.
• Psychological Eating Disorders:     * Anorexia Nervosa: Limited caloric intake, obsession with healthy food omission, excessive exercise.     * Bulimia Nervosa: Binging (excessive intake) followed by purging (vomiting).

Priority Foods by Nutrient

• Iron: Green leafy vegetables and animal meat.
• Calcium: Milk, dairy, tofu, soy products, and green leafy vegetables.
• Phosphorus: Dairy, beans, and meats.
• Vitamin C: Citrus fruits, broccoli, Brussel sprouts, tomatoes.
• Potassium: Bananas, avocado, sweet potatoes, white beans.
• Proteins: Lean meats, eggs, dairy, seeds, nuts, beans, legumes, and soy.
• Vitamin A: Carrots, green leafy vegetables.