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N271-01: Class #2
Fluid & Electrolyte Imbalances
| Question | Answer |
|---|---|
| ______, _______, and _____ work together to maintain the fluid and electrolyte balance. | skin, lungs, kidneys |
| T or F: input should equal output. | T |
| _______ is the type of fluid loss that can be measured. (i.e. urine and stool) | sensible loss |
| _______ is the type of fluid loss that can't be measured. (i.e. respiratory tract and sweat) | insensible loss |
| Sites involved in fluid loss are _______, ________ (interstitial, intravascular, plasma), and _______ (cerebrospinal and pleural fluid). | intracellular (75%), extracellular (25%), transcellular |
| The body loses approximately ______mL/day. | 2,500 |
| Kidneys lose approximately _____mL/day depending on the input. | 1,500 |
| Skin loses approximately _____mL/day. | 600 |
| Lungs lose approximately _____mL/day | 400 |
| Intestines lose approximately ______mL/day. | 100 |
| T or F: infants are more at risk during fluid loss b/c they have 80% water in their body while adults only have 60%. | T |
| _______ also known as vasopressin is the water retaining hormone. | anti-diuretic hormone (ADH) |
| T or F: elevated serum osmolality + low blood volume = increased concentration outside the cell -> osmoreceptors senses the balance is off so ADH is released. | T |
| ______ is the concentration of particles in the blood. | serum osmolality |
| ______ is what "dilutes" the particles in the blood. | blood volume |
| _______ are located in the hypothalamus and are sensitive to blood concentration changes. | osmoreceptors |
| Osmoreceptors sense an __ serum osmolarity and __ urine output, -> signals the __ of ADH from the __-> which __ to the kidney tubules making it more permeable for -> __ that will -> __ the blood volume until it's normal, then ->_ SO -> _ ADH -> _ output | increased; decreased; release; posterior pituitary; binds; water reabsorption; increase; decreased; inhibits; increased |
| When blood volume is ____ and sodium/concentration is ____, ADH is released. | low; high |
| When blood volume is _____, the osmoreceptors detect this causing ADH inhibition. | high/normalized |
| Body fluids aren't in pure forms, they can be administered as IV solutions: ______, _______, and _____. | isotonic, hypotonic, hypertonic |
| ______ is an IV solution that has the same concentration as our blood; there's no net movement. | isotonic |
| Examples of isotonic solutions are ______ and _____. With an exception of ____ that starts as isotonic until the body absorbs dextrose/glucose, then it becomes ______. These are given to hypovolemic pts. | 0.9NS, lactated ringers; D5W; hypotonic |
| ______ is an IV solution that has a lower concentration so one solution (the blood) has to have more sodium whenever this is administered. | hypotonic |
| T or F: in a hypotonic solution, water will enter the cell causing it to swell and then burst (lysis). | T |
| Examples of hypotonic solutions are _____ and ____ (maintenance IV). | 0.45NS; D5W |
| ______ is an IV solution with a higher concentration than the the other solution (the blood). | hypertonic |
| T or F: in a hypertonic solution, water will leave the cell causing it to shrink (crenation). | T |
| Examples of hypertonic solutions are _____, _____, and _____ (given to hyponatremic pts (sodium >135). | D5.45NS, D5NS, 2-3%NS |
| The _____ regulates fluid volume whenever there's poor kidney perfusion. End result = increased blood volume and increased blood pressure/normal. (check slide 6 for better understanding) | RASS |
| RASS is the compensatory system for ______ but is short term. So we need to address the root cause which is very likely to be ______. Then we administer ______. | blood pressure; fluid imbalance; isotonic IV |
| ______ is the major extracellular electrolyte. It makes up 90% of the extracellular fluid. | sodium |
| T or F: sodium DOES NOT attract fluid and DOES NOT preserve fluid volume and distribution. | F |
| T or F: sodium helps regulate acid-base balance, transmit impulses in nerve and muscle fibers. | T |
| The normal serum/sodium levels are _______. | 135-145 mEq/L |
| Hyponatremia means ____ sodium levels. | low |
| Diuretics (excess excretion of fluid), wound drainage (esp. GI), and hyperglycemia (increased glucose/exceeding threshold causes tubules to not absorb so we excrete more and lose water + electrolytes) are causes of ______. | hyponatremia |
| T or F: we DON'T have to check sodium levels if pt is to receive diuretics b/c it DOES NOT promote further loss of electrolytes. | F |
| The following s/s and changes occur during hyponatremia: ______, ______, ________, and ______. | neurological, neuromuscular, intestinal, and cardiovascular |
| T or F: when pt is hyponatremic, they become irritable, confused and disoriented. It's commonly seen in older adults. (always know their baseline!) + Which change is this? | T; neurological |
| T or F: when pt is HYPERNATREMIC, deep tendon reflexes and muscle strengths are decreased b/c we need electrical impulse for these to function. + Which change is this? | F; neuromuscular |
| T or F: when pt is hyponatremic, there will be an increase in GI motility (hyperactive bowel sounds, diarrhea, cramping) + Which change is this? | T; intestinal |
| T or F: when pt is HYPERNATREMIC, their cardiac output, HR, and BP will decrease making it hard to palpate peripherals. + Which change is this? | F; cardiovascular |
| T or F: to treat HYPERNATREMIA, we need to reduce/hold off drugs that promote sodium excretion. + Give examples | F; HCTZ (thiazide), Ferosimide (loop) |
| Administer ______ to treat hyponatremia but only in small amounts b/c it can cause cerebral edema. | 2-3%NS (hypertonic) |
| Administer osmotic diuretic such as ______ to treat hyponatremia. It increases fluid excretion but retains sodium. | mannitol OR Osmitrol |
| To treat hyponatremia, we can use nutrition therapy by _______ and _____ (due to renal/cardiac issue). | increasing sodium intake, restricting oral fluid |
| Hypernatremia means _____ sodium levels. It's less common than hyponatremia. | high |
| T or F: hypernatremia becomes a problem to those who can't voluntarily drink. | T |
| Renal failure (increased BUN and creatinine, <15 GFR), corticosteroids (Prednisone will increase sodium long term on a high dose), excessive sodium intake, excessive administration of sodium containing fluids will cause ______. | hyponatremia |
| The following s/s and system changes occur during hypernatremia: ______, ______, and ________. | nervous, skeletal, cardiovascular |
| T or F: hypernatremia causes the pt to be lethargic & dizzy due to osmotic shift, agitated, confused, disoriented, and will even experience seizures. + What system change is this? | T; nervous |
| T or F: during HYPONATREMIA, pt will experience twitching/contractions due to excitability. + Which system change is this? | F; skeletal |
| T or F: a hypernatremic pt experiences myocardial contractions b/c sodium disrupts potassium. + Which system change is this? | T; cardiovascular |
| Hypernatremia causes ____ pulses and fluid ____ resulting in ____ BP. | bounding; overload; high |
| To treat hypernatremia, we need to _____ serum sodium levels, administer ______ solution, diuretics such as _______ and ______. | decrease; 0.9NS isotonic; Furosemide (lasix), Bumetanide (bumex) |
| ______ is an artificial glomerulus wherein it filters the blood and decreases sodium levels. This is the last resort for treatment. | hemodialysis |
| ______ is the major intracellular electrolyte. The normal range is _______. | potassium; 3.5-5 mmol/L |
| _______ is a condition wherein potassium levels are low. This is seen more frequently than high levels. | hypokalemia |
| Diuretics, vomiting, diarrhea, wound drainage (esp. GI), copious NG suction/output, and excessive diaphoresis can cause ______. | hypokalemia |
| T or F: increased fluid loss = increased electrolyte imbalance. | T |
| The following s/s and changes occur during hypokalemia: _______, _______, _______, and _______. | respiratory, cardiac, neurological, intestinal |
| T or F: during hypokalemia, the RR is shallow b/c breathing muscles are weak, leading to respiratory ALKALOSIS. | F |
| T or F: during hypokalemia, peripherals and can occlude easily. Pt might also experience cardiac dysrhythmia (v-fib) that's life threatening. | T |
| T or F: hypokalemic pts could be disoriented. | T |
| T or F: hypokalemia causes decreased GI motility/peristalsis = unable to move contents. | T |
| To treat hypokalemia, we need to replace the lost potassium through administering _____ K+ medication b/c it's an irritant so it shouldn't be IV. | PO |
| To treat hypokalemia, we need to use K+ sparing diuretics such as _________ to increase fluid excretion but retain potassium. | spironolactone OR Aldactone |
| T or F: we should always dilute potassium and never administer through IV push b/c it could cause cardiac arrest. | T |
| T or F: there's only A FEW options for nutrition therapy to treat hypokalemia. | F |
| ______ is a condition wherein there's an excessive amount of potassium in the body. | hyperkalemia |
| Over-supplement, excessive IV K+, whole blood/packed RBC transfusion (not monitored well), K+ sparing diuretics, renal failure (no excretion = electrolytes retained), dehydration (less volume = relative hyperkalemia - normalize before treating) cause _. | hyperkalemia |
| The following s/s and changes can occur during hyperkalemia: ______, _______, and ______. | cardiovascular, neuromuscular, intestinal |
| During hyperkalemia, pt may experience cardiovascular changes such as symptomatic _____ and ______ with prolonged PRN interval. | bradycardia, heart block |
| T or F: during hyperkalemia, the pt will experience neuromuscular weakness and increased GI motility. | T |
| To treat hyperkalemia, we should ____ K+ infusions/supplements, eliminate K+ through enhancing ______, and _____ monitoring. | stop; excretion; cardiac |
| To enhance K+ excretions for treatment of hyperkalemia, we can use _____ (non-K+ sparing), _____ (exchange resins), _____ + _____ (decreased glucose will push potassium into cell), and/or ______ (last resort). | Lasix, Kayexalate, 50% dextrose + insulin, hemodialysis |
| _______ plays a role in cell permeability and impulse transmission. It also maintains cell structure. The normal range is _______. | calcium; 8.5-10.5 mg/dL |
| Calcium is stored in _____ and ____ increases serum calcium levels. | bones; parathyroid hormone (PTH) |
| ______ promotes kidney reabsorption of calcium. If calcium is low, PTH is _____. If calcium is high, PTH is ______. | PTH; released; inhibited |
| Inadequate intake of calcium, poor calcium absorption (due to alcoholism and post-menopause), low serum albumin (due to malnutrition, severe burns (where calcium ions are trapped in wounds), and infection can cause ______. | hypocalcemia |
| The following s/s and changes can occur during hypocalcemia: _____, _____, and ______. | neuromuscular, neurological, cardiovascular |
| During hypocalcemia, pt will exhibit ______ (wrist flexion when bp cuff is inflated above 20mmHg) and ______ (upward movement of facial nerves when tapped). | trousseau sign; chvostek sign |
| T or F: during HYPERCALCEMIA, pt might experience seizures and cardiac arrhythmias. | F |
| To treat hypocalcemia, we should administer ______, ______, (IV but not too much b/c it can make bones fragile) or _______ (b/c it enhances calcium absorption). We can also give them a diet high in calcium (cheese, milk, etc). | calcium gluconate, calcium chloride, aluminum hydroxide and vitamin D |
| _______ is a condition of elevated calcium. | hypercalcemia |
| Excessive intake, hyperparathyroidism (most common: secretion of PTH even when levels are high), thiazide diuretics (decreases excretion), and cancer can cause ________. | hypercalcemia |
| The following s/s and changes occur during hypercalcemia: _____, _____, and ______. | cardiovascular, neuromuscular, intestinal |
| T or F: when a pt is hypercalcemic, they can experience tachycardia, hypertension, cardiac arrhythmias, and blood clotting. Along with confusion and lethargy. | T |
| To treat hypercalcemia, we should _____ (to lead to diuresis), use _____ solution (sodium will inhibit tubules from reabsorption of calcium), ____ diuretics, and _____ (last resort). | rehydrate, NS, loop, hemodialysis |
Created by:
yortiz
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