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Fluid & Electrolytes
| Question | Answer |
|---|---|
| Fluid and Electrolyte Balance | The regulation of body fluid, fluid osmolality, and electrolytes by processes such as filtration, diffusion, and osmosis |
| Fluid and Electrolyte Imbalance Risk Factors | -Advanced age adults -Newborns, infants, and young children (d/t having less water) -Undernourished individuals -Acute illness -Severe burns -Serious injury/trauma -Chronic kidney disease -Surgery |
| Potassium | 3.5-5.0 mEq/L -Main intracellular ion -Involved in cardiac rhythm, nerve transmission -regulates glucose use and storage -Na/K/ATPase pump transports Na out of cells and K into cells -Direct effect on excitability of nerves and muscles |
| Hypokalemia | <3.5 mEq/L -ECG changes: ST depression, flat or inverted T waves, increased U waves |
| Hypokalemia Causes | -Vomiting -Gastric suctioning -Prolonged diarrhea -Diuretics -Steroids -Alkalosis -Inadequate intake -Hyperaldosteronism |
| Hypokalemia Symptoms | -anorexia -n/v -weak peripheral pulses -muscle weakness -decreased deep tendon reflexes -impaired urine concentration -ventricular dysrhythmias/thachycardia -shallow respirations |
| Hypokalemia Interventions | -Increased dietary potassium (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery) -Potassium replacement (IV for severe deficit) *never IV push -Assess EKG and ABG -Mg replacement -Tele monitor |
| Hyperkalemia | >5 mEq/L -ECG changes: tall peaked T waves, flat P waves, widened QRS complexes, prolonged PR intervals |
| Hyperkalemia Causes | -Hypoaldosteronism -Tissue trauma -Acidosis -Renal failure -Crushing injuries -Potassium-sparing diuretics -ACE inhibitors |
| Hyperkalemia Symptoms | -Dysrhythmias -Ventricular fibrillation -Muscle twitching/muscle weakness -Decreased urine output -Weak pulse/low HR -Respiratory failure |
| Hyperkalemia Interventions | -Kayexalate -Restrict dietary potassium (limit green leafy veggies and avacado) -Insulin + Dextrose -IV sodium bicarbonate -IV calcium gluconate -Diuretics -Monitor EKG -Blood transfusions -Dialysis |
| Sodium | 135-145 mEq/L -Main extracellular ion -Responsible for water balance -Regulates fluid transport and balance across wall membranes of ECF and cells -Provides chemical gradient vital to membrane polarization and subsequent action potentials |
| Hyponatremia | <135 mEq/L -Decreased urinary specific gravity |
| Hyponatremia Causes | -Vomiting -Diuretics -Adrenal insufficiency -Hypovolemic hyponatremia (fluid loss) -SIADH -Early stage kidney failure -Burns, wound drainage |
| Hyponatremia Symptoms | -Stupor/coma -Anorexia (n/v) -Lethargy -Tendon reflexes decreased -Limp muscles (weakness) -Orthostatic hypotension -Seizures/headache -Stomach cramping -Cerebral main concern (brain swelling) |
| Hyponatremia Interventions | -Fluid restriction with FVE -Fluid and Na replacement with FVD -IV lactated ringers or NS 0.9% -Daily weights -Monitor I & O -Seizure precautions -Thiazide diuretics -Lithium -Monitor kidney function |
| Hypernatremia | >145 mEq/L -Increased urinary specific gravity |
| Hypernatremia Causes | -Hyperaldosteronism -Increased sodium intake -Insufficient secretion of ADH -Hyperventilation -Diabetes insipidus -Inadequate water intake/dehydration -Excess IV hypertonic solution |
| Hypernatremia Symptoms | -Fever/flushed skin -Weakness -Disoriented/confusion -Irritability -Increased BP -Fluid retention -Edema -Decreased urine output -Thirst -Hyperactive bowel sounds |
| Hypernatremia Interventions | -Monitor sodium intake -Alka-seltzer, asprin, and cough preps shouldn't be admin -Monitor gravity of urine -Monitor I & O -Cardiac monitoring |
| Calcium | 8.6-10.2 mg/dL -Bone strength and density -Activating enzymes -Needed for blood clotting -Skeletal muscle contraction -Regulated by parathyroid hormone (PTH) |
| Hypocalcemia | <8.6 mg/dL -ECG changes: prolonged ST interval, prolonged QT interval |
| Hypocalcemia Causes | -Hypoparathyroidism -Pancreatitis -Renal failure -Corticosteroids -Antibiotics -Loop diuretics -Inadequate intake -Post-thyroid surgery |
| Hypocalcemia Symptoms | -Hypotension -Bradycardia -Tetany -Laryngospasm/stridor -Increased deep tendon reflexes -Increased blood sugar -positive Trousseau's sign -positive Chvostek's sign -Seizures |
| Hypocalcemia Interventions | -IV of calcium gluconate -Calcium and vitamin D supplements -Seizure precautions -Regular exercise -Administer phosphate-binding antacids |
| Hypercalcemia | >10.2 mg/dL -ECG changes: shortened ST segment, widened T wave |
| Hypercalcemia Causes | -Hyperparathyroidism -Antacids -Malignant neoplastic diseases -Prolonged immobilization |
| Hypercalcemia Symptoms | -Dysrhythmias -Pallor -HTN -Lack of coordination -Disorientation -Decrease deep tendon reflexes -Decrease blood sugar |
| Hypercalcemia Interventions | -Sodium containing fluids -IV phosphate -Furosemide -Calcitonin (decreases calcium levels) -Dietary calcium restriction -Monitor labs and I&O -Monitor for kidney stones -Encourage fluids (to minimize risk for calculi) -Fall risk precautions |
| Magnesium | 1.3-2.3 mg/dL -Interdependent with calcium Found mostly in muscle mass -Vital to normal heart function -Co-factor to various enzymes and involved in processes of proteins -Primarily regulated by the kidneys |
| Hypomagnesemia | <1.3 mg/dL -ECG changes: tall T waves, depressed ST segements |
| Hypomagnesemia Causes | -Renal failure -Rapid admin of citrated blood -DKA -Alcoholism -GI loss -Polyuria -Poorly managed diabetes -Metabolic alkalosis |
| Hypomagnesemia Symptoms | -Seizures -Tetany -Anorexia -Tachycardia -HTN -Mood changes -Generalized weakness |
| Hypomagnesemia Interventions | -IV magnesium sulfate -Assess reflexes for early signs of tetany -Monitor level of consciousness -Monitor labs and reflexes -Monitor for digitalis toxicity |
| Hypermagnesemia | >2.3 mg/dL -ECG changes: prolonged PR interval, widened QRS complexes |
| Hypermagnesemia Causes | -DKA -Overuse of antacids -Renal failure -Hypocalcemia -Hyperkalemia |
| Hypermagnesemia Symptoms | -Diminished deep tendon reflexes -Hypotension -Bradycardia -Respiratory distress |
| Hypermagnesemia Interventions | -Hemodialysis -IV calcium gluconate -Monitor labs and deep tendon reflexes -Loop diuretics -IV NS of RL |
| Hypovolemia | Low blood volume |
| Hypovolemia Causes | -Dehydration -Hemorrhage -Insensible water loss -N/V/D |
| Hypovolemia Symptoms | -Thready pulse -Increased rate and depth of respirations -Decreased BP -Orthostatic hypotension -Decreased urine output -Dry skin, poor tugor, tenting, dry mouth -Decreased motility and diminished bowel sounds |
| Hypervolemia | High blood volume |
| Hypervolemia Causes | -SIADH -Water intoxication -Too much bolus -Increased sodium intake -Renal insufficiency -CHF -Stops production of ADH and aldosterone |
| Hypervolemia Symptoms | -Bounding pulse -Increased heart rate -Elevated BP -Distended neck veins -Increased urine output -Pitting edema -Increased motility in GI, diarrhea |
| Isotonic Solutions | -When the solutions on both sides of a selectively permeable membrane have established equilibrium or are equal in concentration -Increase extracellular fluid volume -Does not enter the cells because no osmotic force exists/ no change in cell size -NS |
| Hypotonic Solutions | -When a solution contains a lower concentration of solute than another more concentrated solution -Lower osmolality that body fluids -Cause the movement of water into cells by osmosis -Cell swells -1/2 NS |
| Hypertonic Solutions | -A solution that has higher concentration of solutes than another less concentrated solution -Higher osmolality than body fluids -Cause movement of water from cells into ECF by osmosis -Cell shrinks -3% NS |
| Intracellular Fluid (ICF) | -Fluid inside the cell -K+ -Mg2+ |
| Extracellular Fluid (ECF) | -Fluid outside the cell (interstitial space, 3rd space, intravascular space) -Na+ -Ca2+ |
| Fluid and Electrolyte Assessment | -Ask about current episodes of n/v/d -Inquire about medications (prescribed/OTC) -Monitor vital signs -Weight changes -Laboratory tests -Skin/mucous membrane assessment |
| Fluid and Electrolyte Health Promotion | -Drink adequate fluids (8 glasses) to prevent dehydration -Educate on well balanced diet (certain foods contain high concentrations of essential vitamins, minerals, and electrolytes |
Created by:
NikkiLeigh83
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