Ch 42: Electrolytes and Fluid Balance Flashcards
Purpose of Na
Maintains blood pressure and fluid balance; regulates water in/out of cells
Purpose of K
Cardiac and nerve function
Purpose of Mg
Muscle and nerve function
Purpose of Ca
Bone formation and muscle contraction
Purpose of Ph
Critical for cellular metabolism b/c it is a component of ATP
Purpose of Cl
Cellular fluid balance Assist in maintenance of blood volume, pressure and pH
Normal range: Na
135-145
Normal range: K
3.5-5.0
Normal range: Mg
1.5-2.5
Normal range: Ca
8.5-10.5
Normal range: Ph
1.8-2.6
Normal range: Cl
98-105
Fluid moves in and out of a cell through the process of…
Osmosis
Osmosis is the movement of fluid from _____ concentrated to _____ concentrated.
less, more
Describe the concentration relationship within an Isotonic solution.
Concentration is equal inside and out
Why is an Isotonic solution used?
To increase extracellular fluid volume
What are some reasons for the loss of extracellular volume?
- Blood loss - Dehydration (vomiting/diarrhea) - Surgery
Give four fluid types that are Isotonic solutions
- 0.9% NS
- 5% Dextrose in H2O (D5W)
- 5% Dextrose in 0.225% NS
- Lactated Ringers
Describe the concentration relationship within an Hypotonic solution.
Low concentration solution
What happens when you administer a hypotonic solution?
The water of the solution will be drawn to the higher concentration of sodium in the cell thus will move inside the cell causing cellular edema and eventually cytotysis
What is the biggest danger of administration of a hypotonic solution?
Brain tissue swelling and increased intercranial pressure, which can lead to brain damage or death.
What are the three types of Hypotonic solution?
- 0.45% NS (1/2 NS)
- 0.33% NS (1/3 NS)
- 0.225% NS (1/4 NS)
Describe the concentration relationship within an Hypertonic solution.
It is a high concentration solution
What happens when you administer a hypertonic solution?
The sodium in the solution will draw the water out of the cell and the cell will shrink.
Give two examples that a hypertonic solution is good for treating.
- Hyponatremia - because it adds sodium to extracellular fluid
- Cerebral edema - because it shrinks the cells
Would you administer a hypertonic solution quickly or slowly?
Why?
- Slowly
- The solution is hard on the veins and could cause phlebitus
What solution is good for diabetic maintenance?
What type of solution is it?
- D5W
- Isotonic
What type of solution is used for electrolyte maintenance and burn victims?
What type of solution is it?
- LR
- Isotonic
What type of solution has concentrations of halves, thirds and quarters?
Hypotonic
In terms of IV site prep, what does infiltration mean?
The needle has gone through the vein
What are some signs of IV infiltration?
- Blanching and skin coolness around insertion site
- Inflammation and pain at site
- Site should not hurt and is an indication something is wrong
IV infiltration intervention?
What do we need to keep in mind for this intervention?
- Remove and replace IV in a different location
- Don’t need an order to insert IV.
- Fluids/meds require MD order
What is phlebitus?
Inflammation of a vein
What are five signs of Phlibitis?
- Non-blanching
- Pain
- Erythema/redness
- Oozing
- Vein distention (bulging)
What are 5 risks/complications of Phlebitis?
- Local infection
- Abscess formation
- Clot formation
- DVT
- Pulmonary embolism
Phlebitis intervention?
Notify MD/HCP
What is the setup for a blood transfusion before getting blood?
- Get concent
- Set IV
- make sure its patent (clear)
- use #20 needle minimum
- Vitals
- taken before, during, after
- Check order
- Then get blood
After setup and blood is acquired, what should be done?
- Get a second nurse
- Double check medication, type, concents together
- One reads, other checks and repeats
When do blood transfusion reactions typically occur?
Within the first 15 minutes
What are 6 symptoms of a blood transfusion reaction?
- Chills
- Fever
- SOB
- Chest pain
- Hypotension
- Hemoglobinuria (red urine)
What is the only type of solution that should be given with a blood transfusion?
- Normal Saline (sodium/water) - LR can also be used, but doesn’t last as long as NS - both are isotonic
- Others contain additives that will destroy blood
What do you do if there is a Hemolytic Transfusion reaction?
- Stop transfusion immediately
- Replace blood with secondary bag of NS - free flow - to flush out system
- Double check blood type is correct/if not return blood and acquire correct
- Start transfusion with correct.
- MD will direct action
At the end of the blood transfusion, what do you do?
- Clamp blood
- Flush remaining in lines through with saline
- Run until lines are completely clear of blood
What is hyponatremia?
Give levels.
- Low blood Sodium, H2O excess
- Level is <135
Hyponatremia
Signs and Symptoms
- Nausea, vomiting, diarrhea
- Dizziness
- Abdominal cramping
- Tachycardia
- Convulsions, Siezures, Coma
Hypernatremia
Signs and Symptoms
- Extreme thirst
- Dry and flushed skin
- Dry and sticky tongue and mucous membranes
- Fever
- Agitation, Restlessness and irritability
Hypokalemia
Signs and Symptoms
“LOW AND SLOW”
- Tired/Weakness/fatigue
- Bradycardia
- Dysrhythmias
- Decreased bowel sounds w/ distention
- Nausea/vomiting
Hyperkalemia
Signs and Symptoms
- Anxiety
- Dysrhythmia
- Paresthesia - painless tingling or numbness, skin crawling, or itching of the extremities
- Weakness
- Abdominal cramps, Diarrhea
Hypocalcemia
Signs and Symptoms
- Positive Trousseau’s sign – carpopedal spasm with hypoxia
- Positive Chvostek’s sign – contraction of facial muscles when facial nerve tapped
- Tetany, Muscle cramps
- Pathological fractures (chronic hypocalcemia)
- Numbness and tingling fingers and circumoral (around mouth) region
Hypercalcemia
Signs and Symptoms
- Excessive thirst and frequent urination
- Stomach pain and digestive problems
- Bone pain and muscle weakness
- Confusion, lethargy, and fatigue
- High blood pressure and abnormal heart rhythms.
What is the treatment for HYPOKALEMIA?
- Potassium chloride
- Given slowly on pump
- Too much can result in cardiac arrest
- NEVER PUSH … IVP
What is the treatment for HYPERKALEMIA?
- Insulin - so Potassium shifts back into cells
- Glucose - to maintain glucose blood levels and avoid hypoglycemia
Also,
- Kayexalate (can be given orally or rectally)
- Orally preferred unless obstructed
Hypoglycemia
Signs and Symptoms
- Tremors
- Tachycardia
- Diaphoresis
- Dizzy
- Anxious/Irritable
- Hungry
- Blurry vision
- Weaknes/fatigue
- Headache
Hyperglycemia
Signs and Symptoms
- Extreme thirst
- Polyuria
- Dry skin
- Drowsy
- Slow-healing wounds
How do we assess Chvostek’s sign and what is it indicative of?
- Facial twitches when face (CNVII) is touched
- Indicative of
- hypocalcemia
- hypomagnesemia
- metabolic alkalosis
How do we assess Trousseau’s sign and what is it indicative of?
- Blood pressure cuff inflated to 20mmHg over systolic pressure
- Positive sign is indicated with finger and wrist contraction with some pronation
- Indicative of
- Hypocalcemia
- Hypomagnesemia
- Metabolic Alkalosis
What is tetany?
Involuntary muscle spasms, which may be caused by disorders that increase the action potential frequency of muscle cells or the nerves that innervate them
How long is an IV site and tubing good for?
72hrs (3 days)
