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MedSurg 1
Fluid & Electrolyte Imbalances
42
Nursing
Graduate
01/13/2011

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Cards

Term
Amount of water (% body weight)
Definition
70-80% in infants; 50-60% in adults; 45-55% in older adults
Term
Prevalent cation in the ICF
Definition
potassium
Term
Prevalent anion in the ICF
Definition
phosphate
Term
Prevalent cation in the ECF
Definition
sodium
Term
Prevalent anion in the ECF
Definition
chloride
Term
osmotic pressure
Definition
Amount of pressure required to stop osmotic flow of water; Determined by the concentration of solutes in the solution.
Term
Hydrostatic pressure
Definition
Force within the fluid compartment; force that pushes water out of the vascular system.
Term
Oncotic pressure
Definition
Osmotic pressure exerted by colloids in solution (such as protein).
Term
Causes of plasma-to-interstitial fluid shift.
Definition
(1) Elevation of hydrostatic pressure.
(2) Decrease in plasma oncotic pressure.
(3) Elevation of interstitial oncotic pressure.
Term
Causes of interstitial-to-plasma fluid shift.
Definition
Increased plasma osmotic or oncotic pressure.
Term
"First Spacing"
Definition
Normal distribution of fluid in ICF and ECF
Term
"Second Spacing"
Definition
Abnormal accumulation of interstitial fluid (edema).
Term
"Third Spacing"
Definition
Fluid accumulation in part of body where it is not easily exchanged with ECF.
Term
Hypothalamic regulation of water balance.
Definition
Osmoreceptors in hypothalamus sense fluid deficit; stimulate thirst and ADH release; result in increased free water and decreased plasma osmolarity.
Term
Pituitary regulation of water balance.
Definition
Posterior pituitary releases ADH; also induced by stress nausea, nicotine, and morphine.
Term
Adrenal cortical regulation of water balance.
Definition
Releases glucocorticoids (cortisol) and mineralocorticoids (aldosterone) when stimulated by ACTH or Ang II, respectively.
Term
Renal regulation of fluid balance.
Definition
Selective reabsorption of water/electrolytes; site of ADH and aldosterone action.
Term
Cardiac regulation of fluid balance.
Definition
Natriuretic peptides (ANP) produced by cardiomyocytes in response to increased atrial pressure. ANP antagonizes the RAAS pathway by suppressing secretion of aldosterone, renin, and ADH.
Term
GI regulation of fluid balance.
Definition
Elimination of small amounts of water by GI tract; diarrhea and vomiting can lead to significant losses.
Term
Insensible water loss
Definition
Invisible vaporization from lungs and skin; about 600-900mL/day.
Term
Gerontological considerations for fluid balance.
Definition
(1) Decreased ability to conserve water by kidneys.
(2) Decreased ADH and ANP.
(3) Loss of subcutaneous tissue and moisture.
(4) Reduced thirst mechanisms.
Term
S/S of fluid volume excess
Definition
(1) headache, confusion, lethargy
(2) peripheral edema, JVD, bounding pulse, inc BP
(3) dyspnea, crackles, pulmonary edema
(4) polyuria
(5) seizures, coma
Term
Causes of fluid retention leading to fluid volume excess
Definition
heart failure, renal failure, SIADH, Cushings, etc.
Term
Treatment for fluid volume excess
Definition
(1) diuretics
(2) fluid restriction
(3) sodium restriction
(4) paracentisis (extreme)
Term
Causes of fluid volume deficit
Definition
(1) abnormal loss of body fluids (e.g. diarrhea, vomiting, hemorrhage, etc)
(2) inadequate fluid intake
(3) plasma-to-interstitial fluid shift ("3rd spacing")
Term
S/S of fluid volume deficit
Definition
(1) restless, drowsy, lethargic, confused
(2) thirst, dry mouth
(3) decreased skin turgor
(4) decreased capillary refill
(5) postural hypotension, inc pulse, dec CVP
(6) dec UOP, inc urine concentration
(7) inc respiratory rate
(8) weight loss
(9) seizure, coma
Term
Interventions for fluid volume deficit
Definition
- replace fluids and electrolytes with isotonic IV solution (e.g. LR, NS, blood, etc.)
Term
Sodium: Normal Lab Value
Definition
135-145 mEq/L
Term
Causes of hypernatremia
Definition
(1) water deficit
(2) inc sodium intake
(3) dec sodium excretion (aldosterone mechanism)
Term
Treatment for hypernatremia
Definition
(1) prevent continued water loss by replacing fluids
(2) dilute sodium with hypotonic saline (0.45%NaCl) or D5W
(3) promote excretion of excess sodium w/diuretics
Term
S/S of hypernatremia
Definition
(1) restless, agitated, twitching
(2) thirst
(3) flushed skin
(4) also may be symptoms of fluid excess or deficit
Term
Causes of hyponatremia
Definition
(1) loss of sodium-containing fluids (GI, sweat, urine)
(2) water excess (sodium dilution)
Term
S/S of hyponatremia
Definition
- first manifested in the CNS; similar to those of hypernatremia
Term
Interventions for hyponatremia
Definition
(1) fluid restriction
(2) hypertonic saline solution IV (3% NaCl)
Term
Potassium: Normal Lab Value
Definition
3.5-5.0 mEq/L
Term
Causes of hyperkalemia
Definition
(1) inc intake (e.g. potassium-containing salt substitute)
(2) impaired renal excretion of K+ (most common)
(3) shift of K+ from ICF to ECF (e.g. w/ burn or crush injury; inc tissue catabolism; also metabolic acidosis)
Term
S/S of hyperkalemia
Definition
(1) irritable, anxious
(2) weakness, paresthesias
(3) abdominal cramping, diarrhea
(4) irregular pulse, cardiac arrest
(5) ECG changes associated with increased excitability (Vfib, wide QRS, long PR, ST depression)
Term
Interventions for hyperkalemia
Definition
(1) dec intake
(2) inc elimination of K+ (kayexalate, dialysis, fluid intake)
(3) IV insulin to force ECF-->ICF movement of K+
Term
Causes of hypokalemia
Definition
(1) abnormal K+ loss (diuresis, esp via aldosterone mech)
(2) shift of K+ from ECF to ICF (e.g. in metabolic acidosis or new cell formation)
(3) rarely, deficient dietary intake of K+
Term
S/S of hypokalemia
Definition
(1) associate with decreased excitability of nerve/muscle cells
(2) ECG changes: increased P, flattened T, brady, enhanced digoxin toxicity, ventricular arrhythmias
(3) fatigue, weakness, leg cramps
(4) nausea, vomiting, paralytic ileus
(5) paresthesias, decreased reflexes
(6) polyuria, hyperglycemia
Term
Interventions for hypokalemia
Definition
- administer KCl supplements (if UOP is >0.5mL/kg)
- IV fluid should be less than 10-20mEq/hr to prevent cardiac arrest
Term
Calcium: Normal Lab Value
Definition
4.5-5.5 mEq/L
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