chapter 10: fluid and electrolyte imbalances Flashcards
hyperkalemia
excessive potassium in the blood (ECF), more than 5
what are the signs and symptoms of hyperkalemia?
M: muscle cramps/weakness
U: urine low/absent
R: respiratory distress
D: decreased cardiac (HR, BP)
E: ECG changes (tall peaked T waves)
R: increased reflexes
* dysrhythmias
what are the cause/risk factors for hyperkalemia?
C: K movement to ECF
A: adrenal insufficiency (Addison disease)
R: renal failure (dialysis patients)
E: excessive intake
D: drugs (ACE inhibitors, NSAIDS, spironolactone)
others: acidosis, hyperuricemia, hypercatabolism, tissue damage
RF: arrhythmias
nursing interventions for hyperkalemia
monitor EKG, respiratory, neuromuscular, GI states
discontinue IV/PO potassium
initiate potassium restricted diet (POTASSIUM)
potassium excreting diuretics: kayexalate (PO/edema, GI sodium absorption= K excretion, hold if their hypokalemia), Lasix (K wasting), furosemide, dextrose (prevents hypoglycemia)
dialysis
administer IV hypertonic solution (glucose/insulin, pulls K into cells)
- calcium gluconate/sodium bicarb
avoid salt substitutes
sodium range
135-145
potassium range
3.5-5
phosphorus range
2.5-4.5
calcium range
9-11
magnesium range
1.5-2.5
chloride range
95-105
hemoglobin (Hgb) range
males: 13-18
female: 12-16
hematocrit range
female: 36-48%
male: 39-54%
BUN range
7-20 mgdl
creatinine range
0.6-1.2mg/dl
hypernatremia
excess sodium intake (higher than 145)
what are the risk factors/causes for hypernatremia?
increased sodium intake (oral ingestion, IV fluid administration with sodium, hypertonic IV fluids)
loss of fluids (fever, diarrhea, diabetes insipidus, excessive diaphoresis, infection)
decreased sodium excretion (kidney problems)
HIGH SALT
H-hypercortisolism (overproduction of aldosterone=retain Na, Cushing syndrome), hyperventilation
I: increased intake
G: GI feeding without adequate H20 intake
H: hypertonic solution (3% saline)
S:decreased Na excretion
A: aldosterone problem
L: loss of fluid
T: impaired thirst
T: loss of fluid
what are the signs/symptoms for hypernatremia?
BIG/BLOATED
FRIED SALTS
F: flushed
R: restless, anxious, confused, irritable
I: increased BP/fluid retention
E: edema pitting
D: decreased urine output
S: skin dry
A: agitation
L: low grade fever
T: thirt (dry mucous membrane)
what is the nursing management for hypernatremia?
if because of fluid loss–> administer hypotonic/isotonic solutions (0.45% NS slowly to avoid risk of cerebral edema)
if because of inadequate renal excretion –> give diuretics that promote sodium loss
restrict sodium and fluid intake
hyponatremia
sodium deficit, less than 135
hypovolemic hyponatremia
deficit in fluid and sodium
causes of hypovolemic hyponatremia
vomiting, diarrhea, NG sunction, burns, diuretic therapy, excessive therapy
hypervolemic hyponatremia
both water and sodium increase
sodium dilutes
causes of hypervolemic hyponatremia
CHF, kidney failure, saline infusion, liver failure
euvolemic hyponatremia
h20 increases and sodium levels stay the same –> sodium dilutes
C: STADH
S/S of hyponatremia
SALT LOSS
S: stupor/coma, shallow respirations
A: anorexia (nausea/vomiting)
L: lethargy (weakness/fatigue), loss of urine /appetite
T: tachycardia (thready pulse)
L: limp muscles, decreased DTR, spasms
O: orthostatic hypotension
S: seizures/headache
S: stomach bowels (hyperactive bowels)
causes of hyponatremia
increased sodium excretion (4 D’s)
1. diaphoresis
2, diarrhea/vomiting
3. drains (NG sunction)
4. diuretics (thiazide/loop diuretics)
SIADH
adrenal insufficiency
inadequate sodium intake (fasting, NPO, low-salt diet)
kidney diseases
heart failure (CHF)
NM for hyponatremia
ADD SALT
A: administer IV sodium chloride infusions (3% hypertonic solutions): only if due to hypovolemia
D: diuretics (if due to hypervolemia)/dialysis
-can cause hemodilution
D: daily weights
S: safety (orthostatic hypertension)
A: airway protection (NPO): don’t give food to a lethargic, confused patient= increased aspiration risk
L: limit water intake
T: teach about foods high in sodium (canned food, packaged/processed meats)
hypokalemia
potassium deficit, less than 3.5
what are the signs and symptoms of hypokalemia?
SLOW AND LOW
7 L: lethargic, low shallow rep, lethal cardiac, loss urine, leg cramps, low BP+HR
thready, weak, irregular pulse
orthostatic hypertension, shallow respirations
anxiety, lethargy, confusion, coma
parethesias, decreased DTR
hyporeflexia
hypoactive bowel sounds (constipation)
nausea, vomiting, abdominal distention
ECG changes: ST depression, shallow/inverted T waves, prominent U wave
what are the causes/risk factors of hypokalemia?
total body potassium loss
inadequate potassium intake: fasting, NPO , anorexia, nausea
movement of K from the ECF to ICF: alkalosis, hyperinsulinism (too much insulin)
dilution of serum K: water intoxication, IV therapy with potassium deficit solutions
DITCH
D: drugs (laxatives, diuretics, corticosteroids)
I: inadequate
T: too much water
C: Cushing syndrome (increased aldosterone)
H: heavy fluid loss (NG sunction. vomiting, diarrhea, sweating)
NM for hypokalemia
oral potassium supplements with food (2.5-3.5)
liquid potassium chloride
potassium-retaining diuretic: spinola, diazyde,maxide?
never administer via IV push, IM, subcut
always dilute and administered using an infusion device (no more than 20/hr, risk for phlebitis/infiltration)
hypercalcemia
excessive calcium in the body, more than 11
what are the signs/symptoms of hypercalcemia?
bone pain, arrythmias, cardiac arrest (bounding pulses, shortened QT interval), kidney stones, muscle weakness (lower DTR), excessive urination, abdominal distention, constipation
what are the risk factors/causes of hypercalcemia?
glucocorticoids: suppress Ca absorption
increased calcium absorption
decreased calcium excretion
thiazide diuretics:calcium excretion decreased
increased bone resorption of calcium
-hyperparathyroidism (releases too much Ca)/hyperthyroidism
-malignancy
hemoconcentration
lithium usage: causes Ca to increase
what are the NM for hypercalcemia?
hydration, safety, complaints for flank abdominal pain/strain urine
D/C IV/PO calcium
D/C thiazide diuretics
administer phosphorus, calcitonin, (inhibits reabsorption of calcium), biphosponates, prostagladins synthesis inhibitors (NSAID’s, decrease Ca)
avoid foods high in calcium
dialysis= if too severe
hypocalcemia
deficit in calcium, less than 9
what are the signs/symptoms of hypocalcemia?
convulsions, arrythmias, tetany, spasms/stridor, hyperactive DTR, numbness in fingers, face, limbs
positive trosseau’s” carpal spasm caused by inflating a BP cuff
positive chvostek’s signs: contraction of facial muscles w/light tap over 8th CN
what are the causes/risk factors for hypocalcemia?
inhibitoion of calcium absorption from the GI tract
increased calcium excretion
- kidney disease, diuretic
-diarrhea, steatorrhea
-wound drainage
conditions that decrease calcium
LOW CALCIUM
L: low PTH/thyroidectomy
O: oral intake inadequate
W: wound drainage
C: celiac/Crohns disease
A: acute pancreatitis
L: low vitamin D
C: CKO
I: increased potassium
U: using meds (mg supplements, loop diuretics)
M: mobility issues
what are the NM for hypocalcemia?
administer calcium PO/IV (10% calcium gluconate= risk for infiltration)
- for IV warm before and administer slowly
administer aluminum hydroxide/ vitamin D after meal
seizure precaustions
consume foods high in calcium: yogurt, sardines, cheese, spinach, tofu, milk
risk for pathological fracture
hypermagnesemia
magnesium excess, more than 2.5
what are ths signs/symptoms of hypermagnesemia?
LOW EVERYTHING
low energy (drownsiness/coma)
low HR
low BP (hypotension)
low RR (bradypnea)
low respirations (shallow)
low bowel sounds
low DTR (deep tendon reflexes)
EKG: prolonged PR+QT interval
what are the risk factors/causes for hypermagnesemia?
MAG
M: magnesium antacids/laxatives (ex: TUMS)
A: Addison diseases
G: glomerular filtration (<30ml/min), keeping too much
diabetic ketoacidosis
renal insufficency (no excretion= more in the blood)
what is the NM for hypermagnesemia?
diuretics
IV administration of calcium chloride/calcium gluconate: reverses Mg effects
restrict dietary intake of Mg containing foods
avoid the use of laxatives/antacids
hemodialysis
hypomagnesemia
magnesium deficit, less than 1.5
what are the signs/symptoms of hypomagnesemia?
HIGH EVERYTHING
high HR
high BP
hyperreflexia
shallow respirations
twitches, parathesia
tetany/seizures
irritability/confusion
Torsades depointes: abnormal heart rhythmn seen in alcohol abuse
EKG: tall T waves, depressed ST
positive Trousseaus’s/Chevstoke’s signs
what are the risk factors/causes for hypomagnesemia?
LOW MAG
L: limited intake
O: hypokalemia/hypocalcemia
W:wasting via kidneys, loop/thiazide diuretics, cyclosporines
M: malabsorption issues (Crohn, celiac, vomiting)
A: alcohol stimulates wasting
G: glycemic issues
sepsis
what are the NM for hypomkagnesemia?
oral Ca supplements/ w 10% calcium gluconate
oral K supplements
IV magnesium sulfate (can lead to hypermagnesemia, check DTR)/PO
seizure precauyions
increase magnesium contaning foods
do magnesium and calcium go up and down together?
yes
do calcium and phosphate go up/down together or inverse?
inverse
do potassium and sodium go up/down together or inverse?
inverse
hypovolemia/FVD
fluid output exceeds intake
what are the risk factors for hypovolemia?
GI losses (vomiting, diuretics)
hemorrhaging
diabetes insipidus
hyperventilation
what are the S/S for hypovolemia?
low BP, hypotension, high RR,HR, tachypnea, tachycardia, thirst, oliguria, flattened JV, weak/thready pulse
labs for hypovolemia
concentrated blood/urine
high hematocrit, serum osmolarity, BUN, USG, UO
what is the treatment for hypovolemia?
IV fluid replacement (isotonic)
what are the NI for hypovolemia?
monitor I/O, fall precautions, daily weights
if urine below 30ml= hypovolemic shock
hypervolemia/FVE
excessive intake of fluid/inadequate excretion
what are the risk factor/causes of hypervolemia?
kidney dysfunction, heart failure, corticosteroids, cirrhosis
what are the S/S of hypervolemia?
weight gain, edema, hypertension, bounding pulse, JVD, tachycardia, dyspnea, crackles, tachypnea
what are the labs for hypervolemia?
diluted, low hemoglobin, hematocrit, SO, USG
what is the treatment for hypervolemia?
diuretics & paracentesis
what are the NI for hypervolemia?
weigh on a daily basis, provide O2, skin care, restrict fluid/sodium intake
- gain weight 1/2 lbs in 24 hrs or 3lbs in a week= danger
what are complications for hypervolemia?
pulmonary edema: backup fluid in the lungs
CHF
