#4 Flashcards
1
Q
FVD
A
the loss of extracellular fluid from the body > intake
2
Q
Causes of FVD
A
Abnormal fluid loss
Decreased intake
Third-space fluid shifts
3
Q
FVD S/S
A
Acute weight loss Concentrated urine Weakness Confusion Thirst Nausea
4
Q
FVD Labs
A
Increased H+H
Increased BUN + Cr
Decrease Na
Increased SG
5
Q
FVD Nursing Management
A
I+O Daily weight Vitals Skin turgor Mental status
6
Q
FVD Medical Management
A
Replace fluid PO if possible
Isotonic electrolytes
Hypotonic if normotensive
Rate of admin depends on severity
7
Q
0.9% Saline
A
Excess Na / Cl
Given w/ blood
Not maintenance
8
Q
LR
A
Multiple electrolytes
Not w/ CKD or AKI
9
Q
FVD Complications
A
Hypovolemic Shock - Insufficient blood volume to pumo
10
Q
Hypovolemic Shock Tx
A
O2
Fluid replacement
Admin vasoconstrictors, coronary vasodilators
11
Q
FVE
A
hypervolemia, refers to an isotonic expansion of the ECF due to an increase in total body sodium content and an increase in total body water
12
Q
Causes of FVE
A
Fluid overload
HF, Kidney Failure, Liver Cirrhosis
Excess Na
13
Q
FVE S/S
A
Acute weight gain Distended neck veins Crackles Peri edema SOB HTN
14
Q
FVE Labs
A
Decreased BUN
Decreased H+H
Increase Na
CXR
15
Q
FVE Meds
A
Diuretics or Dialysis
16
Q
FVE Nursing Management
A
I & O Daily weights Monitor response to medications Promote adherence to fluid restriction Avoid sources of excessive sodium Promote rest
17
Q
Hydrostatic Pressure
A
exerted on walls of blood vessels
18
Q
Osmotic Pressure
A
exerted by protein in plasma
19
Q
Osmosis
A
area of low solute concentration to area of high solute concentration
20
Q
Diffusion
A
solutes move from area of higher concentration to one of lower concentration
21
Q
Filtration
A
movement of water, solutes occurs from area of high hydrostatic pressure to area of low hydrostatic pressure
22
Q
Active Transport
A
Na/K Pump
Maintains gradient of high intra K, extra Na
23
Q
Sodium
A
Most abundant electrolyte in ECF
Controls H2O distribution through body
135-145mEq/L
Muscle contraction, nerves
24
Q
Hyponatremia
A
Na deficit <136
Low urine sodium occurs when kidneys retain sodium
High urine sodium is associated with diuretics
25
Hypernatremia
Na excess >145
26
Hypernatremia S/S
a. Edema
b. Warm, flushed skin
c. Oliguria
d. Tachycardia
e. Extreme thirst
f. Orthostatic hypotension
27
Potassium
Major intracellular electrolyte
| 3.5-50mEq/L
28
Hypokalemia Cause
Medications
Vomiting, diarrhea
Inadequate diet
29
Hypokalemia S/S
a. ECG changes
c. Dilute urine
d. Excessive thirst
e. Fatigue
f. Anorexia
30
Hypokalemia Nursing Management
a. Replace lost potassium
b. Monitor ECG for changes
c. Monitor adequate urine output
d. Monitor level of consciousness
e. Maintain safe environment
31
Hyperkalemia
a. Seldom occurs in patients with normal renal function
b. Increased risk in older population
c. Cardiac arrest is frequently associated
32
Hyperkalemia Causes
a. Decreased renal excretion of potassium
b. Rapid administration of potassium
c. Untreated kidney disease
d. Medications
33
Hyperkalemia S/S
a. Slow, irregular pulse
b. Cardiac changes
c. Muscle weakness
d. Anxiety
e. Nausea, vomiting, diarrhea
34
Calcium
Regulates muscle contractions and relaxation
| 8.6-10.2mg/dL
35
Hypocalcemia
Patients can have low body calcium level but a normal serum calcium level
36
Causes of Hypocalcemia
a. Hypoparathyroidism
b. End stage kidney disease (ESKD)
c. Pancreatitis
d. Renal failure
e. Medications
37
Hypocalcemia S/S
a. Tetany
b. Chvostek’s sign
c. Trousseau’s sign
d. Seizures
e. Osteoporosis
38
Hypocalcemia Management
a. Life threatening
b. IV of calcium gluconate
c. Seizure precautions
d. Oral calcium and vitamin D supplements
e. Exercises to decrease bone calcium loss
f. Patient teaching related to diet and medications
39
Hypercalcemia Characteristics
50% fatal
40
Hypercalcemia Causes
a. Malignancies
b. Hyperparathyroidism
c. Bone loss
d. Diuretics
41
Hypercalcemia S/S
a. Symptoms are proportioned to the degree of elevation
b. Severe thirst
c. Polyuria
d. Muscle weakness
e. Nausea
42
Hypercalcemia Management
a. IV 0.9% sodium chloride
b. IV phosphate
c. Furosemide
d. Calcitonin
e. Increase mobility
f. Encourage fluids
g. Dietary teaching
43
Magnesium
Plays a role in carbohydrate and protein metabolism
1.3-2.3
Important in neuromuscular function
Affects the cardiovascular system
44
Hypomagnesemia
Associated with hypokalemia and hypocalcemia
45
Hypomagnesemia Causes
a. Alcoholism
b. GI losses
c. Malnutrition
d. Medications
46
Hypomagnesemia S/S
a. Chvostek and Trousseau signs
b. Hypoactive bowel sounds
c. Depression
d. Constipation
e. Muscle weakness
f. Tremors
47
Hypermagnesemia
a. Rare electrolyte abnormality
| b. Risk of false positive serum magnesium level
48
Hypermagnesemia Causes
a. Kidney injury
b. Untreated DKA
c. Excessive administration of magnesium
d. Extensive soft tissue injury
49
Hypermagnesemia S/S
a. Hypotension
b. Muscle weakness
c. Hypoactive reflexes
d. Drowsiness
e. ECG changes
f. Depressed respirations
50
Hypermagnesemia Management
a. Avoid administration to patients with kidney injury
b. IV calcium gluconate
c. Hemodialysis
d. Loop diuretics (furosemide), sodium chloride, LR
e. Monitor vital signs
f. Observe deep tendon reflexes (DTR)
51
Phosphorus
Essential to function of muscles and RBC
| Helps with metabolism of carbohydrates, protein, and fat
52
Hypophosphatemia Lab
< 2.5mg/dL
53
Hypophosphatemia Causes
a. Alcoholism
b. Pain
c. Major burns
d. Use of diuretics and antacids
54
Hypophosphatemia S/S
a. Confusion
b. Muscle weakness
c. Seizures
d. Muscle and bone pain
e. Increased susceptibility to infection
55
Hypophosphatemia Tx
a. IV phosphorous replacement
1. limited for patients with phosphorous level less than
1mg/dL; GI tract not functioning
2. tetany from hypocalcemia and calcifications in tissues
b. Oral replacement can be given in less acute situations
56
Hyperphosphatemia
Serum > 4.5mg/dL
57
Hyperphosphatemia Causes
a. Kidney injury
b. Excess phosphorous
c. Excess vitamin D
d. Hypoparathyroidism
e. Chemotherapy
58
Hyperphosphatemia S/S
a. Tetany
b. Tachycardia
c. Anorexia
d. Muscle weakness
e. Soft-tissue calcifications
59
Hyperphosphatemia Medical Management
a. Treat underlying disorder
b. Vitamin D preparations
c. Calcium binding antacids
d. Loop diuretics
e. Normal saline IV
f. Dialysis
60
Chloride
Major anion of ECF
| Produced in stomach
61
Chloride Lab
97-107mEq/L
62
Hypochloremia
a. GI tube drainage
b. Gastric suctioning
c. Gastric surgery
d. Severe vomiting and diarrhea
e. Excessive sweating
f. Burns
63
Hypochloremia Medical Management
a. Replace chloride with either normal saline (0.9% sodium chloride or half-strength saline (o.45% sodium chloride)
b. Diuretics may be discontinued or changed to a different diuretic
64
Hypochloremia Nursing Management
a. I & O’s
b. Arterial blood gases
c. Electrolyte levels
d. LOC
e. Changes in muscle strength
f. Vital signs
g. Respiratory assessment
65
Hyperchloremia Causes
a. Excess sodium chloride infusions
b. Head injury
c. Hypernatremia
d. Dehydration
e. Severe diarrhea
66
Hyperchloremia Medical Management
a. Restore electrolyte and fluid balance
b. Lactated Ringer solution
c. Diuretics
d. Restriction of sodium, chloride, and fluids
67
Metabolic Acidosis Causes
Kidney failure, starvation, hypoxia, seizures, dehydration
68
Metabolic Acidosis S/S
a. Bradycardia, hypotension
b. Dysrhythmias
c. Confusion, muscle weakness
d. Warm, dry, flushed skin
69
Metabolic Alkalosis
Ingestion of antacids, blood transfusions, prolonged vomiting, potassium depletion (thiazide diuretics, laxatives)
70
Metabolic Alkalosis S/S
a. Hypotensive, tachycardia
b. Dysrhythmias
c. Numbness, tetany, confusion, convulsion, muscle weakness
d. Ineffective breathing
71
Respiratory Acidosis
Results in hypoventilation
| Poisons, anesthetics, hemothorax, asthma, pulmonary embolus
72
Respiratory Acidosis S/S
a. Tachycardia
b. Dysrhythmias
c. Anxiety, irritability, confusion
d. Shallow, rapid breathing
e. Pale or cyanotic skin
73
Respiratory Alkalosis
Results in hyperventilation
| Fear, anxiety, shock, early-stage asthma or pneumonia
74
Respiratory Alkalosis S/S
a. Tachypnea
b. Tingling, numbness
c. Palpitations, chest pain
d. Rapid, deep respirations
75
ABG Labs
```
pH 7.35-7.45
PaCO2 35-45 mm Hg
HCO3 22-26 mEq/L
PaO2 80-100 mm Hg
Oxygen saturation > 94%
Base Excess/deficit (+) or (-) 2 mEq/L
```
76
pH
a. If pH less than 7.35, diagnosis is acidosis
| b. If pH greater than 7.35, diagnosis is alkalosis
77
CO2 / HCO3
c. Less than 35 or greater than 45 PaCO2, respiratory
| d. Less than 22 or greater than 26 HCO3, metabolic
78
Third Spacing
Movement of blood from intravascular space into interstitial “third space”
