Fluid and Electrolyte Management in Nursing
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Questions and Answers

What is primarily responsible for maintaining fluid and electrolyte balance in the body?

  • Reproductive hormones
  • Dynamic processes (correct)
  • Digestive enzymes
  • Immune system responses

    • Which of the following would be considered a complication of intravenous (I.V.) therapy?

  • Fluid overload (correct)
  • Hypotension
  • Electrolyte imbalance
  • Vascular hypertension

    • Which factor is least likely to affect fluid and electrolyte balance in the body?

  • Dietary intake
  • Age
  • Breathing rate (correct)
  • Body composition

    • In the context of fluid imbalance, what does F.V.E stand for?

    <p>Fluid Volume Excess (A)</p> Signup and view all the answers

    Which nursing intervention is critical when managing electrolyte abnormalities?

    <p>Monitoring patient's vital signs (C)</p> Signup and view all the answers

    What is NOT a clinical manifestation of dehydration?

    <p>Increased blood pressure (A)</p> Signup and view all the answers

    Which intravenous fluid type is commonly used for volume expansion in a patient with hypovolemia?

    <p>Isotonic saline (D)</p> Signup and view all the answers

    Which of the following is a true statement regarding edema?

    <p>It can occur due to increased hydrostatic pressure. (A)</p> Signup and view all the answers

    Which nursing intervention is essential for managing a patient with edema?

    <p>Elevate the edematous limb (C)</p> Signup and view all the answers

    What is the purpose of using hypotonic fluids in intravenous therapy?

    <p>To replace cellular fluid (C)</p> Signup and view all the answers

    What complication arises when IV fluid leaks into surrounding tissue?

    <p>Infiltration (B)</p> Signup and view all the answers

    When administering parenteral fluids, what is a primary consideration a nurse should monitor?

    <p>Patient's response to fluid volume (A)</p> Signup and view all the answers

    What is a primary goal of administering intravenous fluids?

    <p>To provide nutrients and correct electrolyte deficits (A)</p> Signup and view all the answers

    What should be avoided to prevent complications in patients receiving intravenous therapy?

    <p>Keeping the patient in a single position for prolonged periods (D)</p> Signup and view all the answers

    Which type of intravenous solution is best for preventing dehydration in cells?

    <p>Hypotonic fluids (B)</p> Signup and view all the answers

    What characterizes fluid volume deficit (hypovolemia)?

    <p>Proportionate loss of water and electrolytes (B)</p> Signup and view all the answers

    Which condition specifically leads to increased serum sodium levels without a change in electrolytes?

    <p>Dehydration (B)</p> Signup and view all the answers

    What is the primary consequence of decreased plasma protein concentration?

    <p>Decreased capillary oncotic pressure (C)</p> Signup and view all the answers

    What is a common sign of fluid volume deficit?

    <p>Oliguria in severe cases (A)</p> Signup and view all the answers

    What condition can lead to an increase in interstitial oncotic pressure?

    <p>Inflammatory conditions (B)</p> Signup and view all the answers

    Which factor does NOT contribute to fluid volume deficit?

    <p>Excessive fluid consumption (B)</p> Signup and view all the answers

    Which physiological response is NOT typically associated with fluid volume deficit?

    <p>Increased urine output (B)</p> Signup and view all the answers

    Localized edema typically results from which of the following factors?

    <p>Local factors affecting fluid balance (A)</p> Signup and view all the answers

    The correction of fluid loss should primarily occur via which route in mild cases?

    <p>Oral route (C)</p> Signup and view all the answers

    Which condition is characterized by widespread swelling of the skin and subcutaneous tissues?

    <p>Anasarca (D)</p> Signup and view all the answers

    Which of the following symptoms is indicative of fluid volume deficit?

    <p>Muscle cramps (B)</p> Signup and view all the answers

    In which scenario would ascites most likely occur?

    <p>Cirrhosis (B)</p> Signup and view all the answers

    What is a possible clinical manifestation of ascites?

    <p>Abdominal distension (C)</p> Signup and view all the answers

    What laboratory finding is typically seen in patients with fluid volume deficit?

    <p>Increased serum osmolality (B)</p> Signup and view all the answers

    Mental status changes in patients with fluid volume deficit can potentially lead to which of the following?

    <p>Coma (A)</p> Signup and view all the answers

    What can be a direct result of increased vascular permeability in localized edema?

    <p>Fluid leakage into interstitial spaces (C)</p> Signup and view all the answers

    Which mechanism primarily affects fluid volume and cardiovascular function through sodium excretion?

    <p>Natriuretic peptides (A)</p> Signup and view all the answers

    What typically characterizes generalized edema?

    <p>Multiple body areas affected simultaneously (C)</p> Signup and view all the answers

    In cases of decreased capillary oncotic pressure, which condition is unlikely to be related?

    <p>Chronic hypertension (C)</p> Signup and view all the answers

    Which of the following is a common cause of localized edema?

    <p>Infection or injury (A)</p> Signup and view all the answers

    What is the role of homeostasis in fluid and electrolyte balance?

    <p>It maintains a constant internal equilibrium. (B)</p> Signup and view all the answers

    Which compartment of body fluids is described as constituting 25% of total body fluid?

    <p>Intravascular fluid (C)</p> Signup and view all the answers

    Which process involves solutes moving from an area of lower concentration to an area of higher concentration?

    <p>Active transport (A)</p> Signup and view all the answers

    What primarily drives the process of osmosis?

    <p>Concentration of solutes (A)</p> Signup and view all the answers

    What is the approximate size of intracellular fluid (ICF) compared to the total body fluid in a 70-kg adult?

    <p>75% (D)</p> Signup and view all the answers

    In the context of fluid balance, which is a consequence of inadequate intake of fluid and electrolytes?

    <p>Potential electrolyte imbalance (A)</p> Signup and view all the answers

    What is the primary effect of strenuous exercise on fluid and electrolyte balance?

    <p>Increased fluid and sodium loss (B)</p> Signup and view all the answers

    What is the primary characteristic of diffusion in fluid processes?

    <p>It is governed by solute concentration gradients. (A)</p> Signup and view all the answers

    What occurs if the distribution of fluids between intracellular and extracellular compartments becomes unbalanced?

    <p>Disorders of fluid and electrolyte balance may arise. (C)</p> Signup and view all the answers

    What happens to fluid movement during osmosis in relation to solute concentration?

    <p>Fluid moves toward areas of higher solute concentration. (B)</p> Signup and view all the answers

    Flashcards

    Fluid and Electrolyte Balance

    Dynamic processes vital for life and maintaining a stable internal environment (homeostasis).

    Body Fluid Distribution

    The way fluids are spread throughout the body.

    Fluid Imbalance

    Disruption in the body's fluid balance.

    Fluid Volume Deficit

    A condition of having too little fluid in the body.

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    Fluid Volume Excess

    A condition of having too much fluid in the body.

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    Electrolyte Imbalance

    Disruption in the balance of electrolytes in the body.

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    Homeostasis

    Maintaining a stable internal environment.

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    Electrolytes

    Minerals that carry electrical charges in the body and are crucial for many functions.

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    Fluid compartments

    Different areas in the body where fluids are stored (intracellular and extracellular).

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    Intracellular fluid (ICF)

    Fluid inside the cells.

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    Extracellular fluid (ECF)

    Fluid outside the cells.

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    Diffusion

    Movement of solutes from high to low concentration.

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    Active transport

    Movement of solutes from low to high concentration, requiring energy.

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    Osmosis

    Movement of water from high to low water concentration.

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    Fluid Imbalance Causes

    Disorders, strenuous exercise, or inadequate fluid/electrolyte intake.

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    Fluid Distribution

    ICF and ECF percentages. Maintaining proper balance is critical for health.

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    Body Fluid Compartments

    Intravascular, interstitial, and intracellular.

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    Hypovolemia

    A fluid volume deficit (FVD) where ECF volume loss exceeds fluid intake, with electrolytes and water lost proportionally.

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    Decreased Capillary Oncotic Pressure

    Lower oncotic pressure in blood capillaries, often due to low albumin levels.

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    Dehydration

    A fluid volume deficit where only water is lost, leading to increased serum sodium levels.

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    Increased Interstitial Oncotic Pressure

    Higher oncotic pressure in the space between cells, usually caused by inflammation or blocked lymph.

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    Localized Edema

    Swelling confined to a specific body part, like an ankle or injured area.

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    Causes of FVD (Fluid Volume Deficit)

    Abnormal fluid losses (vomiting, diarrhea, etc.), decreased intake (nausea), third-space fluid shifts (burns), diabetes insipidus, adrenal insufficiency, osmotic diuresis, hemorrhage, coma.

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    Signs of FVD (Fluid Volume Deficit)

    Acute weight loss, decreased skin turgor, increased hematocrit and hemoglobin, concentrated urine/oliguria, increased serum/urine osmolality/specific gravity, increased BUN/creatinine, low CVP, flattened neck veins, tachycardia, hypotension, dry skin, cracked lips, sunken eyes, muscle cramps, nausea, cold extremities, dizziness, weakness, thirst, decreased salivation, mental status changes (potentially coma).

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    Generalized Edema

    Swelling affecting multiple body areas at once.

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    Treatment of FVD

    Correcting fluid loss. Oral route is preferred if the patient can drink; otherwise, intravenous fluids are necessary.

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    Anasarca

    Severe generalized edema, affecting the skin and subcutaneous tissues.

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    Ascites

    Fluid build-up in the abdominal cavity.

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    ECF

    Extracellular Fluid

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    BUN

    Blood Urea Nitrogen

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    Causes of Ascites

    Conditions like cirrhosis, nephrotic syndrome, and certain cancers can cause fluid buildup in the abdomen.

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    Clinical Manifestations of Ascites

    Symptoms include abdominal swelling, shortness of breath, and pressure sensations.

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    CVP

    Central Venous Pressure

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    Osmolality

    Measure of solute concentration in a solution, such as blood.

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    Causes of Edema

    Conditions that affect fluid balance, including local factors, inflammation, kidney damage, and heart failure.

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    Third-space fluid shift

    Movement of fluid from the vascular system to other body spaces.

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    Systemic Issues

    Problems that affect the whole body, sometimes linked to widespread edema.

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    Isotonic Fluids

    Fluids with osmolality close to the ECF, not causing red blood cells to shrink or swell.

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    Hypotonic Fluids

    Fluids with lower osmolality than plasma, causing water to move into cells and swell them.

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    Hypertonic Fluids

    Fluids with higher osmolality than plasma, drawing water out of cells and causing them to shrink.

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    Infiltration

    Fluid leaking from a vein into surrounding tissue, often due to dislodged IV access.

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    IV Infection

    Infection occurring due to contamination of the IV line or site.

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    Venipuncture Technique

    The method of inserting a needle into a vein, usually for IV therapy.

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    Infusion Therapy

    Administering medications, fluids, or blood products via IV.

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    Study Notes

    Fluid and Electrolyte Balance and Disturbances

    • Fluid and electrolyte balance is crucial for homeostasis
    • Fluid and electrolyte balance depends on dynamic processes
    • Fluid and electrolyte disorders occur in various settings and affect healthy and ill individuals
    • Homeostasis, maintenance of a constant internal equilibrium, involves feedback mechanisms

    Fluid Distribution/Compartments

    • Total body water accounts for 60% of body weight
    • Intracellular fluid (ICF) accounts for 2/3 of body water
    • Extracellular fluid (ECF) accounts for 1/3 of body water, further divided into intravascular (25%) and interstitial (75%)
    • Maintaining proper fluid balance requires constant fluid distribution between compartments

    Systemic Routes of Gains and Losses

    • Healthy individuals gain and lose fluids at approximately equal rates daily (2500 mL)
    • Intake includes oral intake, intake from food, and water of oxidation
    • Output includes urine, stool, insensible loss from lungs, and skin

    Systemic Routes of Gains and Losses (continued)

    • Kidneys are responsible for urine production (1-2L daily)
    • Skin and lungs contribute to insensible water loss
    • Gastrointestinal tract loses approximately 100-200 mL daily

    Laboratory Tests for Evaluating Fluid Status

    • Osmolality measures fluid concentration affecting water movement
    • Normal serum osmolality ranges from 275 to 290 mOsm/kg
    • Urine-specific gravity measures kidney ability to excrete or conserve water (1.010-1.025)
    • BUN (Blood Urea Nitrogen) measures urea (liver protein metabolism byproduct) (10-20 mg/dL)
    • Creatinine measures muscle metabolism (0.7-1.4 mg/dL)
    • Hematocrit measures red blood cells (42%-52% for men, 35%-47% for women)

    Homeostatic Mechanisms

    • Kidneys filter 180L of plasma daily; output is 1-2L urine
    • Heart pumps blood through the kidneys for urine formation
    • Lungs expel approximately 300 mL water daily
    • Pituitary gland produces ADH for water conservation
    • Adrenal glands secrete aldosterone for sodium retention and water retention
    • Parathyroid hormone influences bone reabsorption, calcium absorption, and renal calcium reabsorption

    Other Homeostatic Mechanisms

    • Baroreceptors in the atrium, carotid, and aortic arches respond to blood volume changes
    • Renin-angiotensin-aldosterone system regulates fluid and electrolyte balance
    • Antidiuretic hormone and thirst center regulate fluid intake
    • Osmoreceptors detect changes in sodium concentration

    Fluid Volume Deficit (FVD)

    • FVD occurs when ECF volume loss exceeds intake
    • Ratio of serum electrolytes to water remains the same
    • Dehydration is loss of water only; serum sodium increases
    • Causes include fluid losses (vomiting, diarrhea, sweating), decreased intake, third-space shifts (burns, edema)
    • Diabetes insipidus, adrenal insufficiency, and hemorrhage are additional causes

    Signs and Symptoms of FVD

    • Weight loss, reduced skin turgor, concentrated urine, prolonged capillary refill time
    • Low central venous pressure, tachycardia, low blood pressure, dry skin, sunken eyes
    • Muscle cramps, nausea, cold extremities, dizziness, and weakness
    • Mental status changes, which may lead to coma

    Medical Management of FVD

    • Oral fluids are preferred if the patient can tolerate them.
    • In severe cases, intravenous (IV) fluids are necessary
    • Common IV solutions include isotonic solutions (e.g., lactated Ringer's solution, 0.9% sodium chloride)
    • Hypotonic solutions (e.g., 0.45% sodium chloride) may be used as the patient improves
    • Metabolic waste excretion is aided by administering fluids

    Nursing Care of Patients with FVD

    • Monitor vital signs and fluid intake/output
    • Assess patient's ability to ambulate and fluid balance
    • Encourage oral fluids and offer small volumes of oral rehydration solutions
    • Improve oral hygiene for patients who are not able to take oral fluids

    Hypervolemia (Fluid Volume Excess [FVE])

    • FVE is an isotonic expansion of the ECF due to abnormal water and sodium retention.
    • Causes include increased intake of IV fluids, kidney/liver disorders, heart failure, cirrhosis, and excessive sodium intake
    • Causes of FVE may include fluid excess, decreased urine output, excessive sodium intake, physical disorders or stress

    Signs and Symptoms of FVE

    • Weight gain, edema, elevated central venous pressure, distended neck veins
    • Shortness of breath, hypertension, tachycardia, and increased urine output

    Medical Management of FVE

    • Addressing the underlying cause is the primary goal.
    • Discontinuing unnecessary IV fluids may be sufficient in certain situations.
    • Administer diuretics as needed.
    • Sodium and fluid restriction are commonly implemented.
    • Dialysis for severe or persistent FVE.

    Nutritional Therapy for FVE

    • Restricting sodium intake (250 mg/day)
    • Educate patients on food labels and proper fluid measurement
    • Consider using potassium-containing substitutes with caution
    • Choose distilled water or avoid water softeners, if necessary

    Parenteral Fluid Therapy

    • IV fluids are used when oral intake is unavailable
    • Isotonic solutions help with fluid management.
    • Hypotonic fluids help with cellular fluid replacement
    • Hypertonic fluids are used when cellular fluid needs to be reduced

    Complications of IV Therapy

    • Infiltration is fluid leakage into surrounding tissue
    • Infection at the IV site is a potential complication
    • Phlebitis is inflammation of the vein
    • Air embolism can occur resulting in decreased blood pressure, increased pulse rate, respiratory distress, and possible loss of consciousness

    Electrolytes Imbalances

    • Electrolytes are essential for numerous bodily functions including nerve impulse transmission, muscle contraction, and acid-base balance.
    • Major electrolytes include sodium, potassium, calcium, and magnesium.
    • A variety of conditions cause electrolyte imbalances. These may include but are not limited to, diuretics, vomiting, and/or diarrhea.

    Roles of Major Electrolytes

    • Electrolytes, essential chemicals, regulate water distribution, nerve impulse transmission, and muscular function
    • They assist with acid-base homeostasis and blood clotting.

    Concentrations of Extracellular and Intracellular Electrolytes in Adults

    • Electrolytes concentrations are measured in milliequivalents (mEq) per liter or millimoles (mmol) per liter
    • Sodium and potassium are the primary extracellular and intracellular electrolytes

    Sodium Imbalances

    • Sodium is the most abundant electrolyte in the extracellular fluid (ECF).
    • Sodium deficit (hyponatremia) is defined as a serum sodium level lower than 135 mEq/L (or 135 mmol/L).
    • Hyponatremia is caused by imbalances of water and sodium.
    • Signs and symptoms include anorexia, nausea/vomiting, headache, confusion, lethargy, and seizures, muscle weakness/cramps, and/or dry skin.
    • Medical management includes fluid restriction, hypertonic solution administration, and possible sodium replacement.

    Sodium Excessive (Hypernatremia)

    • Hypernatremia is defined as a serum sodium level higher than 145 mEq/L (or 145 mmol/L).
    • Excess sodium intake, water loss, or both cause hypernatremia.
    • Signs and symptoms include thirst, fever, tachycardia, swollen/dry tongue, and dry skin. Also include hallucinations, lethargy, irritability, and/or restlessness.

    Potassium Imbalances

    • Potassium is a major intracellular electrolyte. Hypokalemia is a potassium deficiency.
    • Causes of hypokalemia include diuretics, vomiting, diarrhea, and/or an inadequate intake of potassium.
    • Symptoms of hypokalemia can include muscle weakness, fatigue, anorexia, nausea, vomiting, and/or parasthesias
    • Medical management commonly includes potassium replacement, either oral or intravenous.
    • Hyperkalemia, excess potassium, arises from renal failure, adrenal insufficiency or acidosis. Symptoms of this are muscle twitching, decreased heart rate, and arrhythmias.

    Calcium Imbalances

    • Calcium plays a crucial role in nerve impulse transmission, muscle contraction, and blood clotting.

    • Calcium deficit (hypocalcemia) can result from hypoparathyroidism, malabsorption (Vitamin D deficiency), pancreatitis, or prolonged immobility.

    • Signs of hypocalcemia include hyperactive deep tendon reflexes, numbness/tingling in the fingers/toes, impaired clotting time, and seizures.

    • Treating hypocalcemia may require vitamin D supplementation and/or calcium supplements.

    • Calcium excess (hypercalcemia), can stem from prolonged immobility, hyperparathyroidism, or cancer.

    • Associated symptoms are often anorexia, nausea/vomiting, constipation, excessive urination (polyuria) and/or thirst (polydipsia).

    • Medical management often includes hydration therapy and/or medications to control calcium levels

    Edema

    • Edema is fluid accumulation in the interstitial space, causing soft tissue swelling.
    • Edema grading defines different degrees of swelling based on pitting depth and rebound time.
    • Pathophysiology of edema includes increased capillary fluid pressure, decreased capillary oncotic pressure, and increased interstitial oncotic pressure.
    • Localized edema can be due to specific factors, generalized edema may be caused by systemic issues, anasarca is extreme generalized edema.
    • Ascites is a form of generalized edema in the peritoneal cavity.

    Assessing and Monitoring Edema

    • Visual inspection and physical examination to identify the presence of edema
    • Pitting test to determine the degree of edema by applying firm pressure to an edematous area.
    • Circumference measurement that tracks changes in limb circumference.
    • Monitoring weight every day to assess fluid retention

    Nursing Management of patients with Edema

    • Dietary, fluid, and medication management to control underlying causes of edema
    • Patients are cautioned that swelling is an indication of fluid overload in severe cases
    • Medical intervention may be required for patients suffering from severe edema
    • Patients are advised to follow advice of medical and/or nursing professionals

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    Fluid and Electrolytes Balance and Disturbance PDF

    Description

    This quiz tests your knowledge on the principles of fluid and electrolyte balance in the human body. It covers topics such as the complications of intravenous therapy, nursing interventions, and clinical manifestations of dehydration. Perfect for nursing students and healthcare professionals!

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