electrolytes Flashcards
*Greater osmolarity then plasma
*Water moves OUT of the cells & into the intravascular compartment
*Cells SHRINK
D5 NS (5% Dextrose in 0.9% saline)
D5 ½ NS (5% Dextrose in 0.45% saline)
D5 LR (5% Dextrose in Lactated Ringer’s)
*Provision of calories as part of parenteral nutrition.
*Do not administer to client at risk for fluid volume excess.
*Nursing Assessment - Risk for fluid volume excess: blood pressure, lung sounds, serum sodium levels
-Packed red blood cells and whole blood
hypertonic
*Less osmolarity than plasma
*Water moves INTO the cells & out of the intravascular space
*Cells SWELL & possibly burst
-0.45% Sodium Chloride (NaCl)
*“half normal saline”
*1/2 NS
*Maintenance solution
*Nursing Assessment: Mental Status Changes - may indicate cerebral edema
*D5W is isotonic until dextrose is metabolized in the body - becomes free water (hypotonic)
hypotonic
consists of fluid intake and absorption, fluid distribution, fluid output
fluid balance
Movement of fluid among its various compartments.
fluid distribution
*Drinking and foods
*Thirst and habit
fluid intake
*Normally via skin, lungs, GI tract, kidneys
*Abnormally via vomiting, wound drainage, hemorrhage
sensible is measurable like through urine and feces and insensible is not measurable like through the lungs
fluid output
Dextrose in Water 5%
*D5W
*Glucose is quickly used up
*After glucose is used up, it becomes free water (hypotonic)
*Common “KVO” fluid
*Often compatible with meds
*Usually isotonic only in the container.when the concentration of two solutions is the same
Normal Saline
0.9% NaCl
Compatible with most medications
The only fluid to be given with blood
Excessive administration can raise serum Na level
Lactated Ringer’s
Lactated Ringer’s, Ringer’s solution
Often used in surgery patients to expand circulating volume from blood loss
Used to treat loss from burns & lower GI
Rescue Fluids-given in emergency situations/trauma as vascular replacement for hypovolemic shock
Dextrose in Water 5%
*D5W
*Glucose is quickly used up
*After glucose is used up, it becomes free water (hypotonic)
*Common “KVO” fluid
*Often compatible with meds
*Usually isotonic only in the container.
isotonic
excess
*ECV deficit
*Hypovolemia means decreased
vascular volume and often is
used when discussing ECV
deficit.
extracellular fluid volume (ECV)
*Shift of fluid into transcellular compartment (interstitial space, peritoneal cavity-ascites, bowel, joint cavities, pleural space
*Fluid trapped
*Decreased body weight does not occur
*Fluid loss cannot be measured
third-spacing of fluid
*Full, bounding pulses
*Hypertension
*Distended neck veins (JVD)
*Rapid weight gain best indicator of fluid overload
*Shortness of breath
*Moist Crackles on auscultation (“wet lungs”)
*Peripheral Edema (may be pitting)
*DLC - seizure
- Restrict fluid & Na intake as ordered
- TED hose/compression stockings
- Encourage rest periods
- Assess skin breakdown/change position
- Monitor I/O
- Assess for worsening FVE
- Educate self-monitoring of weight & I/O
fluid volume excess
loss of both water and electrolytes from the extracellular fluid; also called hypovolemia
*Fluid replacement is key.
*Administer oral fluids as indicated.
*Administer IV fluids as ordered.
*I and O, hourly outputs
*Daily weights
*Monitor vital signs
*Assess skin turgor
*Assess labs (urine specific gravity)
*Monitor during rehydration: pulse , blood pressure, urine output
fluid volume deficit
-Weight
-Skin turgor
-Pitting edema
-Skin for moisture
-Venous filling
-Neck veins in supine position with head elevated 45 degrees
-Tongue
-Eyeball palpation
-Eye position
-Lung sounds
-Blood pressure
hydration assessment
*Maintain/correct fluid imbalance
*Maintain/correct electrolyte or acid-base imbalance
*Expand vascular space
*Provide nutrition
intravenous (IV)
*Blood component therapy = IV administration of whole blood or blood component
*-Ensure patient knows reason for transfusion
*-Informed consent
*-Pretransfusion assessment
*-Verify blood product
*-20 G or larger
*-NS !!!!
*Type and cross
*Use proper equipment
*2 Nurses Check!!
*Baseline Assessment
*Initiate slowly
*Continuous Monitoring
*If suspected adverse reaction, stop transfusion immediately
blood replacement
*Stop the transfusion
*Disconnect the Blood at the site near patient
*Change tubing and start infusion of NS only
*Notify provider
*Frequent Vital signs per protocol
*Prepare to administer Antihistamines, Corticosteroids, vasopressors
*Label all tubing and send to lab
transfusion reaction
normal BUN levels
10 - 20 mg/dL
fluid leaks into tissues
S&S
Pain - Tight
Swelling
Coolness
Infusion may be slow or stop
Nursing Action
Stop infusion
Elevate extremity
Warm Compress
The IV infiltration most commonly occurs when the IV catheter is dislodged from its normal place, leading to the fluids infiltrating in the nearby tissues
infiltration
inflammation of vein
phlebitis
*Cations (+)
*Anions (-)
*Balanced with each other on respective sides of cell membranes
*Most are maintained in a narrow therapeutic range in the ECF
*Imbalances can occur when homeostasis is disrupted
*Responsible for membrane excitability & the transmission of nerve impulses
electrolyte balance
Normal level 135-145
*Main ECF cation (Na+)
*Low concentration in ICF
*Primary determinant of ECF osmolarity
*If Na+ is “off”, then expect serum osmolarity to be “off”
*Plays a major role in
*Skeletal & cardiac muscle contractions
*Transmission of nerve impulses
*ECF volume and osmolarity
*How do we get it?
Bacon, butter, canned food, cheese, ketchup, lunch meat, table salt, soy sauce, beef broth, tomato juice, etc.
*How do we get rid of it?
Urine
*What is the main hormone that regulates it?
Aldosterone
sodium
Less than 136 mEq/L
*Sodium Loss
*Inadequate intake or loss of sodium-rich fluids via diaphoresis, diuretics, vomiting, NG tube suctioning
*Dilution of sodium with Excess water (gain water via hypotonic fluids, fluid overload with heart, liver, or renal failure)
s/s :Anorexia, N/V, Weakness, Lethargy, Confusion, Muscle cramps, Twitching, Seizures
hyponatremia
Na level over 145 mEq/L
*Excess water loss or Overall sodium excess:
*Increased Na intake: excessive oral ingestion of sodium or excessive IV intake
*Decreased Na excretion: excess aldosterone secretion, renal failure
*Decreased water intake: NPO/water deprivation
*Increased water loss: increased metabolic rate, fever, watery diarrhea, excessive sweating
*Older adult, clients with decreased LOC - at risk
s/s: Thirst, Hyperpyrexia, Sticky mucous membranes, Dry mouth, Hallucinations, Lethargy, Irritability, Seizures
hypernatremia
Normal Serum K = 3.5 - 5.0 mEq/L
*The major ICF cation
*98% of total body K+ is intracellular
*Low (only 2%) in ECF, so narrow therapeutic range
*Plays a role in:
*Cell metabolism
*Transmission & conduction nerve impulses
*Normal cardiac conduction
*Skeletal & smooth muscle contraction
*Acid-base balance
*Regulation of glucose use & storage
Get it from: avocados, cantaloupe, bananas, spinach, strawberries, mushrooms, etc. also in meds and stored in blood
excreted 80% w/ kidneys/urine
DANGEROUS
potassium
less than 3.5 mEq/L
*Decreased total body potassium:
*GI Loss - vomiting, diarrhea, NG suction
*Kidney loss - diuretics (furosemide)
*Skin loss - diaphoresis, wounds
*Insufficient K+ intake:
*Dietary intake - rare, not common
*Prolonged IV therapy with non-electrolyte containing solutions (5% dextrose in water)
*Movement of K+ from the ECF to ICF: metabolic alkalosis, after correction of acidosis, TPN
s/s: muscle weakness, fatigue, constipation, weak pulse, hypotension, cardiac arrhythmias, tenders muscles, increased sensitive to digoxin, polyuria, nocturia, etc
hypokalemia
*Increased risk for digoxin toxicity
*S/Sx of Digoxin Toxicity
*Anorexia
*Dysrhythmias
*Nausea/vomiting
*Yellow-tinted vision, seeing halos around lights
*Fatigue, weakness
*Confusion
*If patient taking digoxin, look at K+ level
*If patient hypokalemic, look at digoxin level (if taking digoxin)
digoxin w/ hyponatremia
Replacement of Potassium
*Oral (foods, oral medication supplement)
*IV potassium supplementation; No more than 5 -10 mEq/hr (max recommended rate)
*NEVER give IV bolus, SQ, or IM!
*Painful to peripheral veins - assess phlebitis
*NEVER give unless the patient is making urine
*Never give IM, IVP, or Subcutaneous
*Ensure IV bag containing KCl is properly labeled
*Assess IV site frequently for s/s phlebitis/infiltration
*Assess renal function before administration
*Monitor I/O (“No pee, No K”)
*If pt receiving more than 10 mEq/hr, they should be placed on cardiac monitor/telemetry
vitamin K+ (potassium therapy)
greater than 5.0 MEQ/L
*Excess K+ intake
*-PO potassium meds
*-Rapid infusion of K-containing IV solutions or stored blood
*Inadequate Renal excretion of K+
*-Renal failure
*-K-sparing diuretics
*Movement of K+ out of cell
*-Extracellular Shifts - diabetic ketoacidosis, decreased insulin
*-Hypertonic states - uncontrolled diabetes
s/s : *Paresthesia of face, tongue, feet, & hands
*Ascending Flaccid muscle paralysis
*GI: hyperactive bowel sounds, diarrhea, increased GI motility
*Oliguria
hyperkalemia
Normal serum Ca++ = 9 -11 mg/dl
*Exists in 2 forms in ECF:
*Bound Calcium attaches to serum proteins (albumin)
**Free, ionized calcium
*Narrow therapeutic range
*Functions of Calcium:
*Bone and tooth strength
*Skeletal and myocardial contractions
*Nerve impulse transmission
*Blood clotting
*How do we get it?
*Foods: cheese, collard greens, milk and soy milk, rhubarb, sardines, spinach, tofu, yogurt
*Vitamin D
*Released from bone
*How do we get rid of it?
*Urine
*Deposited into bone
calcium
Out of the bone and into serum
Ca level increases
parathyroid
Deposits it in bone, out of serum
Ca level decreases
thyrocalcitonin
Less than 9
Risk Factors:
*Lactose Intolerance
*Crohn’s Disease
*Hyperphosphatemia
*End-stage Kidney disease
*Inadequate calcium intake
*Pancreatitis
*Vitamin D deficiency
*Hypoparathyroidism
s/s:*Numbness & Tingling of fingers & lips (early symptom)
*Cramps in muscles of extremities/painful spasms
* Positive Trousseau’s & Chvostek’s signs
*Spasm of laryngeal muscles
hypocalcemia
more than 11
*Prolonged immobility, hyperparathyroidism, osteoporosis
*Frequently a symptom of an
*underlying disease resulting
*in excess bone reabsorption
*with release of calcium
*Thiazide diuretics,
*renal failure
s/s : muscle weakness, tiredness, lethargy, constipation, decreased memory and attention span, renal stones, neurotic behavior, anorexia and n/v
hypercalcemia
normal 1.5-2.5
*is one of the major intracellular cations.
*normal levels of magnesium are important for the maintenance of heart and nervous system function.
*A shift of potassium can cause a shift in magnesium levels.
*Magnesium can be excreted by your kidneys.
magnesium
Less than 1.5
*Caused by decreased intake or absorption
*Malnutrition
*Chronic alcoholism
*Chronic diarrhea
*Laxative Misuse
*Magnesium Shift
*Potassium shifts into cells Magnesium shifts
*Increased Mg2+ output
*Diarrhea, thiazide or loop diuretics
hypomagnesemia
greater than 2.5 mEq/L
*Increased intake or Absorption
*Overuse of Magnesium containing laxatives or antacids
*Parenteral overload
*Decreased output
*Oliguria (ESRD)
*Adrenal Insufficiency
hypermagnesemia
