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Chapter 52 Fluid, electrolyte, and acid-base balance
Nursing Fundamentals (Kozier)
69
Nursing
Undergraduate 1
03/31/2014

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Term
Fluid/electrolyte imbalance in infants and young children
Definition
-faster respiratory rate
-higher % ECF (40% ECF, 35% ICF-infants...20% ECF in adults
-immature renal function
-immature esophageal sphincter
-higher rate of peristalsis
Term
ICF Intracellular Fluid
Definition
fluid found within the cells of the body
-2/3 of the total body fluid in adults
Term
ECF Extracellular Fluid
Definition
fluid found outside cells
-intravascular fluid (plasma)
-interstitial fluid
-transcellular fluid
Term
Intravascular Fluid (Plasma)
Definition
found in the vasculature (blood vessels)
-20% of ECF
Term
Interstitial Fluid
Definition
fluid that surrounds the cells
-75% of ECF
Term
Transcellular Fluid
Definition
Cerebrospinal, pericardial, pancreatic, pleural, intraocular, bilary, peritoneal, and synovial fluids
Term
Body Fluids
1 pound = ______ml
Definition
1 pound = 500 ml
Term
the most abundant cation in the ECF
Definition
Sodium
Term
Na+
Definition
Sodium
Term
functions largely in controlling and regulating water balance
Definition
Sodium
Term
found in bacon, ham, processed cheese, and table salt
Definition
Sodium
Term
K+
Definition
Potassium
Term
major cation in ICF
Definition
Potassium
Term
needed for skeletal, cardiac, and smooth muscle activity
Definition
Potassium
Term
found in many fruit and vegetables
Definition
Potassium
Term
Ca++
Definition
Calcium
Term
mainly found in the skeletal system
Definition
Calcium
Term
regulates muscle contraction and relaxation, neuromuscular function, and cardiac function
Definition
Calcium
Term
found in milk and milk products
Definition
Calcium
Term
Cl-
Definition
Chloride
Term
the major anion of the ECF
Definition
Chloride
Term
regulates water balance along with Na+
Definition
Chloride
Term
found in the same foods as Na+
Definition
Chloride
Term
Factors affecting Body Fluid and electrolyte balance
Definition
age
sex
body size
environmental temperature
lifestyle (stress, alcohol, exercise)
Term
FVD
Definition
Fluid Volume Deficit
Term
FVD
Clients at risk
Definition
excessive sweating
clients on diuretics
vomiting
diarrhea
NG suction
anorexia
impaired swallowing
active participant sports (marathon)
fever
Term
FVD
clinical manifestations
Definition
weight loss
dry tongue and mucus membranes
low blood pressure
decreased urine output
poor skin turgor
confusion
weak rapid pulse
low temperature
Term
hypovolemia
Definition
decreased blood volume
Term
hypervolemia
Definition
increased blood volume
Term
FVE
Definition
Fluid Volume Excess
Term
FVE
clients at risk
Definition
clients on high Na+ IV solutions at a fast rate or high Na+ diets
clients with heart failure, renal failure, or cirrhosis of liver
Term
FVE
clinical manifestations
Definition
weight gain
full bounding pulse
high BP
moist crackles (rales) in lungs
edema lower extremities
ascites- accumulation of fluid in abdomen
distended neck veins
mental confusion
Term
low serum sodium
Na+<135 mEq/L
Definition
hyponatremia
Term
Hyponatrenia
causes
Definition
-excess perspiration
-excess use of diuretics
-excess water replacement with drinking large amounts of water or IV D5W (water intoxiacation)
Term
Hyponatrenia
treatment
Definition
-monitor I and O and serum Na+ level
-assess clinical signs and vital signs
-administer Na+ IV solutions as ordered
-encourage high Na+ foods
Term
Hyponatrenia
clinical manifestations
Definition
-lethargy, confusion, apprehension
-muscle twitching
-abdominal cramps
-anorexia, nausea, vomiting
-headache
-seizures, coma
-malaise, general discomfort

<115-120 seizure activity
Term
high serum sodium
>145 mEq/L
Definition
Hypernatremia
Term
Hypernatremia
causes
Definition
-decreased water intake
-heatstroke
-fever
-excess intake of salt
-overuse of salt tablets or sodium bicarb
-saline IV solutions
-diarrhea
Term
Hypernatremia
treatment
Definition
-monitor I and O and serum Na+ level
-encourage fluids and IV solutions as ordered
-sodium restricted diet as ordered
Term
Hypernatremia
clinical manifestations
Definition
-thirst
-dry, sticky mucous membranes
-reddened tongue (dry and swollen)
-weakness
-postural hypotension, dyspnea
-severe disorientation, convulsions
Term
low serum potassium
<3.5 mEq/L
Definition
Hypokalemia
Term
Hypokalemia
causes
Definition
-vomiting
-NG suction
-diarrhea
-use of diuretics
-K+ free IV solutions
-poor intake of K+ rich foods
-alcoholics
-anorexics
-starvation
Term
Hypokalemia
clinical manifestations
Definition
-muscle weakness, leg cramps
-fatigue, lethargy
-anorexia, vomiting, nausea
-decreased bowel motility
-cardiac dysrhythmias
-depressed deep-tendon reflexes
Term
Potassium rich foods
Definition
avocado, raw carrot, baked potato, raw tomato, spinach, beef , cod, pork, veal, dried fruits, banana, apricot, cantaloupe, orange, milk, OJ, apricot nectar
Term
high serum potassium
>5.0 mEq/L
Definition
Hyperkalemia
Term
Hyperkalemia
causes
Definition
-excess K+ replacement from IV or oral K+
-excess K+ containing salt substitutes
-renal failure
-massive crushing injuries, burns, trauma, infection (K+ spills out into plasma)
Term
Hyperkalemia
treatment
Definition
-closely monitor cardiac status
-avoid K+ rich foods
-hold K+ supplements
Term
Hyperkalemia
clinical manifestations
Definition
-diarrhea
-irritability, confusion
-cardiac dysrhythmias or arrest
-muscle weakness, areflexia
-paresthesis
Term
Normal Electrolyte Values for Adults
Sodium
Potassium
Chloride
Calcium (total)
Calcium (ionized)
Magnesium
Phosphate
Serum osmolality
Definition
Sodium 135-145 mEq/L
Potassium 3.5-5.0 mEq/L
Chloride 95-108 mEq/L
Calcium (total) 4.5-5.5 mEq/L or 8.5-10.5 mg/dL
Calcium (ionized) 56% of total calcium (2.5 mEq/L or 4.0-5.0 mg/dL)
Magnesium 1.5-2.5mEq/L or 1.6-2.5 mg/dL
Phosphate 1.8-2.6 mEq/L ot 2.5-4.5 mg/dL
Serum osmolality 280-300 mOsm/kg water
Term
low serum Ca++ < 4.5 mEq/L or 8.5 mg/dL
Definition
Hypocalcemia
Term
Hypocalcemia
causes
Definition
-surgical removal of parathyroid gland,
-vitamin D deficiency
-acute pancreatitis
-thyroid cancer
Term
Hypocalcemia
treatment
Definition
-closely monitor respiratory and cardiac status
-administer oral or IV Ca++ as ordered
-teach about osteoporosis prevention
Term
Hypocalcemia
clinical manifestations
Definition
-muscle tremors, cramps
-cardiac dysrhythmias
-numbness/tingling of extremities and around mouth
-positive Trousseau's and Chvostek's signs
-confusion, anxiety
Term
Chvtoskek's sign
Definition
contraction of the facial muscles in response to tapping the facial nerve in front of the ear
Term
Trousseau's sign
Definition
carpal spasm in response to inflating a blood pressure cuff on the upper arm to 20 mmHg greater than the systolic pressure for 2-5 minutes
Term
high serum Ca++ level
> 5.5 mEq/L or 10.5 mg/dL
Definition
Hypercalcemia
Term
Hypercalcemia
causes
Definition
-prolonged immobilization
-parathyroid tumor
-bone malignancy
-excess intake of calcium containing antacids or supplements
Term
Hypercalcemia
treatment
Definition
-increase activity as ordered
-encourage oral fluids
-limit foods high in calcium or calcium supplements
Term
Hypercalcemia
clinical manifestations
Definition
-lethargy, weakness
-depressed deep-tendon reflexes
-anorexia, nausea, vomiting
-constipation
-polyuria
-hypercalcuria
Term
Intake and Output
Definition
when individuals are in a healthy state, their fluid output should be approximately the same as their fluid intake
Term
Intake
Definition
oral fluids
ice chips
liquid foods
tube feedings
parenteral fluids
intravenous meds
catheter or tube irrigants
Term
Output
Definition
urinary output
vomitus
liquid feces
tube drainage
wound drainage
Term
Intravenous Solutions
Lactated Ringer's
Definition
isotonic
Term
Intravenous Solutions
Normal Saline (0.9% NaCl)
Definition
isotonic
Term
Intravenous Solutions
D5W
Definition
isotonic
Term
Intravenous Solutions
0.45 Sodium Chloride
Definition
hypotonic
Term
Intravenous Solutions
D5 in 0.45% Sodium Chloride
Definition
hypertonic
Term
Intravenous Solutions
D5 in 0.9% Sodium Chloride
Definition
hypertonic
Term
Intravenous Solutions
3% Nacl
Definition
hypertonic
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