Assessment and Care of Patients with Fluid and Electrolyte Imbalances
Order by
95 terms
Terms | Definitions |
|---|---|
 solvent | water portion of fluids |
| solute | particles dissolved or suspended in water |
| hydrostatic pressure | the force that pushes water outward from a confined space through a membrane |
| viscous | "thickness" of a fluid |
| equilibrium | no pressure differences between the two spaces due to equal hydrostatic pressure |
| disequilibrium | occurs when a gradient of unequal pressures exist across a membrane |
| Average amount of urine per day | 1.5 L |
| Filtration | movement of fluid through a cell or blood vessel membrane due to hydrostatic pressure differences on both sides of the membrane |
| How is blood pressure an example of hydrostatic filtering force? | It moves whole blood from the heart to capillaries where filtration can occur to exchange water, nutrients, and waste products between the blood and tissues |
| Edema develops when... | increases in venous capillary pressure rise and force fluid into the interstitial tissues |
| Diffusion | free movement of particles across a permeable membrane from an area of high concentration to low concentration |
| Osmosis | -movement of water through a semi-permeable membrane -Water moves from low to high concentration to achieve homeostasis |
| What is the thirst mechanism? | The feeling of thirst is caused by the activation of cell in the brain that responds to changes in the ECF osmolarity |
| Normal Osmolarity | 270-300 mOsm/L |
| Lymph | -fluid left in interstitial tissue following a movement of fluids from the capillary at it's arterial end and back to venous capillary system -Lymph flow is slower than blood flow |
| What is lymph flow enhanced by? | -skeletal muscle contractions -breathing -lymphatic peristalsis |
| What is flood intake regulated by? | thirst drive |
| What triggers the thirst drive? | increased osmolarity decreased blood volume |
| Measurable fluid intake | oral fluids parenteral fluids enemas irrigation fluids |
| Non measurable intake | solid foods metabolism |
| Minimum amount of urine needed to excrete toxic waste products | 400-600 mL/day |
| Insensible water loss | fluid loss through skin, lungs, and stool cannot be controlled or measured |
| average water loss for healthy adult | 500-1000 mL/day |
| Aldosterone | secreted by adrenal cortex when sodium level in ECF in decreased prevents both water and sodium loss |
| Antidiuretic hormone (ADH) | stored in posterior pituitary gland acts on renal tubules in response to changes in blood osmolarity causing water retention |
| Natriuretic peptides | hormones secreted by special cells in the atria (ANP) and ventricles (BNP) of the heart in response to increased blood volume and pressure ***Opposite of aldosterone- increases urine output to reduce circulating blood volume |
| When does BNP increase? | CHF |
| Dehydration | Fluid intake is less than what is needed to meet the body's fluid needs, resulting in fluid volume deficit |
| Actual dehydration | decrease in total body water |
| Relative Dehydration | intravascular water shifts out of circulating blood volume into the interstitial (extravascular) space |
| Where do you assess skin turgor in older adults? | skin over sternum or on forehead |
| Assessment for DEHYDRATION | I&O record fever sweating diarrhea diuretics laxatives vomiting |
| Physical assessment & clinical manifestations of DEHYDRATION | orthostatic hypotension flattened neck veins in supine position tachypnea decreased turgor decreased moisture dry mucous membranes change in mental status concentrated urine (increased spec. grav.) decreased urine output (<500 mL/day cause for concern) |
| Lab assessment for DEHYDRATION | INCREASED Hgb, Hct, Serum Osmolality, glucose, protein, BUN, and electrolytes (All increased because decreased extracellular volume) |
| Fluid overload | excess of body fluid -most common causes are related to fluid volume excess in the vascular space or to dilution of specific electrolytes and blood components |
| Assessment of FLUID OVERLOAD | pitting edema weight gain (EARLIEST INDICATOR) tachycardia bounding pulses hypertension distended neck veins tachypnea AMS hepatomegaly (Report >3 lb weight gain/week OR >1-2 lbs in 24 hrs. |
| Sodium normal range | 136-145 mmol/L |
| Nursing care priority for hyponatremia | monitor pts. response to therapy and prevent hypernatremia and fluid overload |
| Normal potassium range | 3.5-5.0 mEq/L |
| ECG changes in HYPOkalemia | flattened T wave, appearance of U wave |
| Nursing care for HYPOkalemia | ensures adequate oxygenation, patient safety for falls prevention, prevent injury from potassium administration, monitor pts. response to therapy |
| Most severe problems from HYPERkalemia | Cardiovascular changes due to ECG changes Major cause of death in hyperkalemia (ventricular ectopy, heart block, systole, or ventricular fibrillation) |
| Normal CALCIUM range | 9.0-10.5 mg/dL |
| Trousseau's sign | palmar spasm with arterial occlusion with BP cuff for 1-4 min. |
| Chvostek's sign | tap the face in front and below ear to assess for twitching |
| Musculoskeletal weakness in HYPOphospatemia may progress to... | rhabdomyolosis |
| Normal Phosphorus levels | 3.0-4.5 mg/dL |
| What does it mean when CALCIUM and PHOSPHORUS are in a balanced reciprocal relationship? | If Calcium increases, Phosphorus decreases If Calcium decreases, Phosphorus increases |
| Normal Magnesium levels | 1.3-2.1 mg/dL |
| What is a major nursing intervention for HYPERmagnesemia? | Discontinue all oral and parenteral magnesium |
| Normal Chloride levels | 98-106 mEq/L |
| Most common reasons for Infusion Therapy | -maintain or correct fluid balance -maintain or correct electrolyte or acid-base balance -Administer medications -Replace blood or blood products |
| Normal serum osmolarity for adults | 270-300 mOsm/L |
| Parenteral solutions within normal range are... | Isotonic |
| Fluids greater than 300 mOsm/L are... | hypertonic |
| Fluids less than 270 mOsm/L are... | hypotonic |
| Patient's receiving ISOTONIC solutions are at risk for... WHY? | fluid overload -when isotonic infusions are used, water does not move into or out of the body's cells |
| 3-5% NS | HYPERTONIC |
| D5NS | HYPERTONIC |
| D5LR | HYPERTONIC |
| How do HYPERTONIC infusions work? | move water out of the body's cells (ICF) by osmosis and into the bloodstream (ECF) LESS WATER, MORE SALT |
| Complications with HYPERTONIC infusions | vascular overload (increased ECF) pulmonary edema cellular dehydration (decreased ICF) |
| 1/4 NS | HYPOTONIC |
| 0.45% NS | HYPOTONIC |
| Complications with HYPOTONIC infusions | causes cells to burst or lyse (increased ICF) serum (decreased ECF) dehydration increased serum electrolytes due to hemoconcentration |
| Vascular Access Device (VAD) -Where are they used? -How long can they dwell in a vein? | superficial veins of the hand and forearm dwell for 72 to 96 hours and then require removal |
| How do you remove a PICC line? | 1-2" at a time, over 1-2 minutes (relaxes, prevents vasospasm, breakage) MEASURE CATHETER*** make sure you take as much as you gave |
| Tunneled Central Catheter | portion of catheter lying in a subcutaneous tunnel separates the point at which the catheter enters the vein from where it exits the skin used for infusion therapy that is frequent and long-term |
| Implanted Ports | A subcutaneous pocket is surgically created to house the port body Port is usually placed in the upper chest or the upper extremity Port needs to be flushed after each use and at least once a month between courses of therapy (Most facilities require a heparin-lock flush upon discontinuing infusions |
| Dialysis Catheters | Lumens are very large to accommodate the hemodialysis procedure or a pheresis procedure that harvests specific blood cells Should not be used for administration of other fluids or medications, except in an emergency |
| What type of administration set is used when no primary line is present? Ex: Antibiotic without continuous infusion line | Intermittent |
| Needleless connection devices | Used to minimize risk for needle sticks |
| Slip-lock add-on system | Memorial has them, male and female end |
| Luer-lock add-on system | threaded end that screw together |
| Circulatory overload | homeostasis disruption due to excess fluid |
| Speed shock | rapid infusion of drugs or bolus infusion that causes shock or cardiac arrest due to introduction of a foreign substance |
| Allergic reaction | may be to tape, cleansing agent, solution, or IV device |
| Catheter embolism | Piece of catheter breaks off causing it to freely float in the blood vessel |
| Arterial therapy | Used for pressure monitoring, repeated blood gases, & to infuse some chemotherapy agents |
| Intraperitoneal infusion | placement of chemotherapy agents into the peritoneal cavity |
| Suncutaneous infusion HYPODERMOCLYSIS | slow infusion of isotonic fluids into the subcutaneous tissue, short term fluid replacement torso preferred site |
| Intraspinal infusion | Administration of opioids and anesthetics for regional pain relief, also steroids and antispasmodics Ex: Epidural, Subarachnoid injection |
| Intraosseous therapy | Easy access in the proximal tibia or sternum Used mostly in pediatric population Now used for trauma, burn, or cardiac arrest victims Short duration (24 hours), but as effective as peripheral or central IVs for large volume infusions |
| What does a "pins and needles" sensation indicate? | nerve puncture |
| aldosterone | adrenal gland hormone that causes kidneys to reabsorb sodium into the blood, causing more water to be reabsorbed by osmosis |
| hemodilution | condition in which that plasma is more dilute than normal |
| hypovolemia | a state of fluid volume excess or overload in the blood stream |
| Osmolality | concentration of solute per kilogram of water, which creates the pulling power of that solution for water |
| Osmolarity | concentration of solute per liter of solution, which creates the pulling power of that solution for water |
| vascular space | space within the blood vessels |
| euvolemia | normal fluid volume in the body |
| relative hyperkalemia | movement of potassium from the intercellular fluid to the extracellular fluid, leading to elevated serum potassium levels without a true body increase of K+, such as occurs with acidosis |
| relative hypokalemia | movement of potassium fro the ECF to the ICF, leading to lowered K+ levels without a true decrease of K+ in the body, such as occurs with insulin therapy |
| ECG changes for hyperkalemia | wide QRS, tall tented T-wave, ST segment depression |
| ECG changes for hypokalemia | Flattened T wave, Normal QRS, ST segment depression |
First Time Here?
Welcome to Quizlet, a fun, free place to study. Try these flashcards, find others to study, or make your own.