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Questions and Answers
What is a primary use of carbonic anhydrase inhibitors?
What is a primary use of carbonic anhydrase inhibitors?
What action do loop diuretics have in the body?
What action do loop diuretics have in the body?
Which condition is a contraindication for the use of osmotic diuretics?
Which condition is a contraindication for the use of osmotic diuretics?
What is a common adverse effect of potassium-sparing diuretics?
What is a common adverse effect of potassium-sparing diuretics?
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What is the primary mechanism of action of osmotic diuretics like mannitol?
What is the primary mechanism of action of osmotic diuretics like mannitol?
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What is a primary intervention for managing edema?
What is a primary intervention for managing edema?
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Which of the following is an objective assessment finding of fluid volume deficit?
Which of the following is an objective assessment finding of fluid volume deficit?
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What change in lab values typically indicates fluid volume excess?
What change in lab values typically indicates fluid volume excess?
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Which electrolyte is primarily responsible for regulating the volume of body fluids?
Which electrolyte is primarily responsible for regulating the volume of body fluids?
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During an assessment for fluid volume deficit, which finding would indicate a critical intervention is needed?
During an assessment for fluid volume deficit, which finding would indicate a critical intervention is needed?
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How does chloride contribute to bodily functions?
How does chloride contribute to bodily functions?
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Which symptom is commonly associated with fluid volume excess?
Which symptom is commonly associated with fluid volume excess?
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What is the expected nursing intervention when a patient shows signs of electrolyte imbalance?
What is the expected nursing intervention when a patient shows signs of electrolyte imbalance?
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What is the primary function of water in the body?
What is the primary function of water in the body?
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Which of the following compartments contains 70% of total body fluid?
Which of the following compartments contains 70% of total body fluid?
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What factor most affects body water content?
What factor most affects body water content?
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Which method is NOT a source of fluid intake for the body?
Which method is NOT a source of fluid intake for the body?
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Which vital sign is most indicative of fluid balance?
Which vital sign is most indicative of fluid balance?
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What could indicate poor hydration status during a skin assessment?
What could indicate poor hydration status during a skin assessment?
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Which part of the nursing process involves assessing fluid intake and output?
Which part of the nursing process involves assessing fluid intake and output?
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Approximately what percentage of body weight is represented by total body fluid in a healthy adult?
Approximately what percentage of body weight is represented by total body fluid in a healthy adult?
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What is a common cause of hypernatremia?
What is a common cause of hypernatremia?
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Which of the following symptoms is associated with hypokalemia?
Which of the following symptoms is associated with hypokalemia?
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What condition can result from excessive calcium loss leading to hypocalcemia?
What condition can result from excessive calcium loss leading to hypocalcemia?
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Which condition is characterized by increased levels of potassium in the body?
Which condition is characterized by increased levels of potassium in the body?
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Which of the following is a likely cause of hypomagnesemia?
Which of the following is a likely cause of hypomagnesemia?
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What are common symptoms of hypermagnesemia?
What are common symptoms of hypermagnesemia?
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Inadequate sodium intake primarily leads to which condition?
Inadequate sodium intake primarily leads to which condition?
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Which electrolyte imbalance can cause confusion and muscle cramps?
Which electrolyte imbalance can cause confusion and muscle cramps?
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What is the primary function of osmosis in the context of fluid balance?
What is the primary function of osmosis in the context of fluid balance?
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Which type of solution causes cellular fluid volume to increase while decreasing circulating fluid volume?
Which type of solution causes cellular fluid volume to increase while decreasing circulating fluid volume?
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Which condition is characterized by excessive accumulation of fluid in the interstitial space?
Which condition is characterized by excessive accumulation of fluid in the interstitial space?
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What is a common risk factor for fluid and electrolyte imbalances?
What is a common risk factor for fluid and electrolyte imbalances?
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Hypertonic solutions are known to affect body fluids in what manner?
Hypertonic solutions are known to affect body fluids in what manner?
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What indicates fluid volume excess in a patient?
What indicates fluid volume excess in a patient?
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For which of the following conditions might impaired kidney function lead to fluid volume excess?
For which of the following conditions might impaired kidney function lead to fluid volume excess?
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In managing intake and output (I&O), what should be recorded?
In managing intake and output (I&O), what should be recorded?
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Study Notes
Transporting Functions of Body Fluids
- Transports nutrients to cells.
- Transports waste products from cells.
- Transports hormones, enzymes, and blood cells.
- Facilitates cellular metabolism and proper cellular chemical functioning.
- Acts as a solvent for electrolytes and non-electrolytes.
- Helps maintain normal body temperature.
- Facilitates digestion and promotes elimination.
- Acts as a tissue lubricant.
Fluid Compartments
- Intracellular Fluid (ICF): Fluid within cells, making up 70% of total body fluid.
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Extracellular Fluid (ECF): Fluid outside cells, making up 30% of total body fluid.
- Includes intravascular fluid (blood plasma) and interstitial fluid (fluid surrounding the cells).
Total Body Fluid
- Represents 50-60% of body weight in a normal adult.
Variations in Fluid Content
- Infants have more body fluid and ECF than adults.
- Women and obese people have less body water than men.
- Fat cells contain less water than muscle cells.
Sources of Fluids
- Ingested liquids: drinking water, juices, and other beverages.
- Food: fruits, vegetables, and soups.
- Byproduct of metabolism: oxidation of carbohydrates, fats, and proteins.
Fluid Losses
- Kidneys: urine.
- Intestinal tract: feces.
- Skin: perspiration (insensible water loss).
- Lungs: exhaled air.
Fluid Intake and Losses in Healthy Individuals
- Fluid intake and losses are generally equal in healthy individuals.
Nursing Process: Assessment of Fluid Balance
- Current/Past Medical History: Previous history of fluid and electrolyte imbalances.
- Vitals: Temperature, pulse, respirations, blood pressure.
- Intake and Output (I&O): Total fluids consumed and excreted.
- Urine Concentration: Checks for dehydration or electrolyte imbalances.
- Body Weight: Significant changes in weight can indicate fluid changes.
- Facial Appearance and Eye Appearance: Observe for signs of dehydration or edema.
- Skin Turgor: Assesses skin elasticity and hydration.
- Edema: Swelling in different areas of body indicates fluid accumulation.
- Mouth and Tongue: Dryness may suggest dehydration.
- Lab Values: Electrolyte levels, creatinine, blood urea nitrogen (BUN).
Guidelines for Measuring I&O
- Instruct the patient and family regarding the rationale for I&O monitoring.
- Document I&O measurements on the patient's plan of care.
- Measure I&O accurately; do not estimate.
- Total I&O for each shift and for 24 hours.
- Intake includes all liquids and foods that are liquid at room temperature.
Fluid Balance and Imbalance
- Fluid Imbalances: Can involve either volume or distribution of water or electrolytes.
Risk Factors for Fluid Imbalance
- Pathophysiology underlying acute and chronic illnesses.
- Abnormal losses of body fluids, such as from:
- Burns
- Trauma
- Surgery
- Therapies that disrupt fluid and electrolyte balance, such as:
- Diuretics
- IV fluid administration
Fluid Volume Excess (Hypervolemia)
- Excessive retention of water and sodium in the extracellular fluid (ECF).
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Causes:
- Excessive water and sodium intake.
- Impaired kidney function.
- Heart failure.
- Hypervolemia: Excessive ECF accumulation in the intravascular compartment.
- Edema: Excessive accumulation of fluid in the interstitial space.
Assessment Findings of Fluid Volume Excess
- Edema
- Weight gain
- Shortness of breath (SOB)
- Adventitious lung sounds (crackles, wheezes)
- Increased blood pressure
- Increased pulse rate
- Weakness and fatigue
- Lab value changes (e.g., decreased hematocrit)
Interventions for Fluid Volume Excess
- Prevent or correct underlying cause.
- Dietary modifications, limiting sodium intake.
- Fluid intake modifications, restricting or limiting fluid intake.
- Monitor labs, assessing electrolyte levels, hematocrit, and urine output.
- Medication administration, such as diuretics.
- Decrease anxieties, helping patients manage stress.
- Patient and family teaching, regarding fluid management and lifestyle changes.
Fluid Volume Deficit (Hypovolemia)
- Deficiency of water and solutes (electrolytes).
- Third-space fluid shift: Distribution of body fluids into potential body spaces.
Assessment Findings of Fluid Volume Deficit
- Change in mental status (confusion, lethargy)
- Increased temperature
- Increased pulse rate (tachycardia)
- Decreased blood pressure
- Lab value changes (e.g., increased hematocrit)
- Dry mucous membranes, cracked lips, furrowed tongue
- Decreased skin turgor
- Scant, dark urine output
- Sudden weight loss (5 lbs or more)
Interventions for Fluid Volume Deficit
- Prevent or correct underlying cause.
- Dietary modifications, increasing fluid and electrolyte intake.
- Fluid intake modifications, encouraging oral fluids or administering IV fluids.
- Monitor output, tracking urine output and other fluid losses.
- Monitor labs, assessing electrolyte levels and hematocrit.
- Medication administration, such as IV fluids or electrolyte replacement therapy.
- Patient and family teaching, regarding fluid management and lifestyle changes.
- Assess for electrolyte imbalances, monitoring for symptoms and managing accordingly.
Functions of Electrolytes
- Maintain fluid balance.
- Contribute to acid-base regulation.
- Facilitate enzyme reactions.
- Transmit neuromuscular reactions.
Chief Electrolytes and Their Functions
- Sodium (Na+): Chief electrolyte of ECF; controls and regulates the volume of body fluids.
- Potassium (K+): Major cation of ICF; chief regulator of cellular enzyme activity and water content.
- Calcium (Ca2+): Nerve impulse transmission, blood clotting, muscle contraction, vitamin B12 absorption.
- Magnesium (Mg2+): Metabolism of carbohydrates and proteins; vital actions involving enzymes.
- Phosphate (PO43-): Energy storage; bone and teeth formation.
- Chloride (Cl-): Maintains osmotic pressure in blood; produces hydrochloric acid.
Electrolyte Imbalances
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Hyponatremia: Low sodium levels.
- Causes: Increased water intake, excessive sodium loss (e.g., vomiting, diarrhea, diuretics, sweating).
- Symptoms: Confusion, muscle cramps, weakness.
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Hypernatremia: High sodium levels.
- Causes: Water loss, excessive sodium intake (e.g., burns, fluid deprivation, diarrhea, excess salt consumption).
- ** Symptoms:** Restlessness, increased thirst, dry tongue.
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Hypokalemia: Low potassium levels.
- Causes: Loss through vomiting, gastric suctioning, use of diuretics.
- Symptoms: Muscle weakness, leg cramps, dysrhythmias, anorexia, paresthesia.
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Hypekalemia: High potassium levels.
- Causes: Renal failure, potassium-sparing diuretics, NSAIDs.
- Symptoms: Cardiac arrest, gastrointestinal issues.
-
Hypocalcemia: Low calcium levels.
- Causes: Inadequate calcium intake, impaired calcium absorption, excessive calcium loss.
- Symptoms: Numbness/tingling of fingers, mouth, or feet; tetany.
-
Hypercalcemia: High calcium levels.
- Causes: Cancer, hyperparathyroidism.
- Symptoms: Constipation, kidney stones, bone pain.
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Hypomagnesemia: Low magnesium levels.
- Causes: ETOH withdrawal, diarrhea, NG tube suction, tube feedings, burns.
- Symptoms: Seizures, altered mental status, hyperactive deep tendon reflexes.
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Hypermagnesemia: High magnesium levels.
- Causes: Renal failure, excess consumption of magnesium-containing antacids.
- Symptoms: Loss of deep tendon reflexes, respiratory depression, coma, cardiac arrest.
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Hypophosphatemia: Low phosphate levels.
- Causes: Alcohol withdrawal.
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Hyperphosphatemia: High phosphate levels.
Carbonic Anhydrase Inhibitors
- Uses: Treatment of glaucoma, edema, and high-altitude sickness.
- Contraindications: Low sodium or potassium levels, renal failure.
- Adverse effects:
- Interactions: Digoxin, corticosteroids.
Loop Diuretics
- Examples: furosemide (Lasix), torsemide (Demadex), bumetanide (Bumex).
- Action: Potent diuretics that block chloride and sodium reabsorption in the loop of Henle.
- Uses: Edema (heart failure), hypertension, renal failure, hypercalcemia, pulmonary edema.
- Contraindications:
- Adverse effects: Dizziness, tinnitus, nausea, vomiting, diarrhea, hypokalemia, hyperglycemia.
- Interactions: Vancomycin, digoxin, NSAIDs.
Osmotic Diuretics
- Example: Mannitol (Osmitrol).
- Action: Increases osmotic pressure to pull fluid into the renal tubules, reducing cerebral edema.
- Uses: Renal failure, excretion of toxic substances, cerebral edema.
- Contraindications: Severe renal disease, pulmonary edema (use loop diuretics instead), intracranial bleed.
- Adverse effects:
- Interactions:
Potassium-Sparing Diuretics
- Examples: spironolactone (Aldactone), amiloride (Midamor), triamterene (Dyrenium).
- Action: Block aldosterone receptors, causing sodium and water excretion (weak diuretic effect).
- Uses: Hypertension, heart failure (in conjunction with loop diuretics to prevent potassium loss).
- Contraindications:
- Adverse effects: Dizziness, headache, cramps, nausea, vomiting, diarrhea, hyperkalemia.
- Interactions: Lithium, ACE inhibitors, or potassium supplements can cause significant hyperkalemia!!
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