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331 Quiz 2 > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

what concentration do isotonic solutions have

A
  • same solute concentration as blood plasma
  • no fluid shifts
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2
Q

isotonic solution examples

A
  • NS 0.9%, D5W, or lactate ringers solutions
  • expect no shifts in fluids when giving to patients
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3
Q

what are isotonic fluids used for

A
  • increase intravascular fluid volume (conditions with loss of volume)
  • blood loss, dehydration (vomitting, diarrhea)
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4
Q

what would isotonic solution DSW used for

A
  • fluid replacement when dehydrated
  • used as keep-open or flush
  • rehydrate when Na and Cl are concentrated
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5
Q

disadvantage of using DSW isotonic solutions

A
  • electrolyte imbalance, interstitial and cellular edema
  • do not use with head injuries
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6
Q

Normal saline uses

A
  • replace loss of body fluid (bowel obstructions)
  • increases plasma volume without changing Na concentration or serum osmolality
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7
Q

disadvantage using NS solutions

A
  • dilutes RBC and plasma proteins
  • lowers osmotic pressure (pulmonary edema)
  • causes hypernatremia, hyperchloremic metabolic acidosis
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8
Q

ringers lactate is used for

A
  • early stages of hemmoragic shock
  • cheap
  • balanced electrolytes to interstitial fluids
  • does not increase serum Na or Cl
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9
Q

disadvantages with ringers lactate

A
  • dilutes RBC and plasma proteins
  • lowers osmotic pressure (pulmonary edema)
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10
Q

hypotonic solution

A
  • have lower solute concentration than blood
  • shifts into more concentrated solutions
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11
Q

hypotonic solution example

A
  • 0.45% NS
  • concentration of sodium in the solution is less than blood
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12
Q

who would you give a hypotonic

A
  • cellular dehydration
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13
Q

in what situation would you have cellular dehydration

A
  • loose fluid but not Na (hypernatremia)
  • diabetes insipidus
  • NG tube feeds - not getting enough fluids
  • vommiting and diarrhea
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14
Q

negative effects using a hypotonic solution

A
  • cerebral edema
  • hypovolemia and hypotention
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15
Q

hypertonic solutions

A
  • have higher solute concentration than the plasma
  • fluid shifts from intracellular space into intravascular space
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16
Q

examples of hypertonic solutions

A
  • 3% NS, 5% NS, 10% dextrose water
  • have more solute concentrations than the plasma
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17
Q

what shifts occur when giving hypertonic solutions to patients

A
  • fluid shifts from intracellular space to intravascular space
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18
Q

when would giving hypertonic solutions be helpful?

A
  • hyponatremia
  • brain injuries when you want to decrease swelling in the brain
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19
Q

what is hyponatremia

A
  • low levels of sodium (less than 135)
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20
Q

main causes of low sodium imbalances (hyponatremia)

A
  • excessive sodium loss
  • excessive fluid input
  • inadequate sodium intake
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21
Q

signs and symptoms of hyponatremia (115-120 sodium levels)

A
  • sodium levels of 115-120 you will see: nausea, vomiting, headache, irritability, muscle twitching, tremors, weakness, lethargic
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22
Q

signs and symptoms of hyponatremia (less than 110 sodium levels)

A
  • sodium levels less than 110: delirium, psychosis, seizures, coma
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23
Q

What happens when sodium levels are low? what major impact the body can this have? (hyponatremia)

A
  • decreased extracellular osmolity
  • fluid moves form intravascular space to intracellular space (cells swell)
  • the brain is most affected
  • seizures, coma, brain damage
24
Q

hyponatremia can be classified into 3 categories

A
  • hypovolemic hyponatremia
  • hypervolemic hyponatremia
  • isovolemic hypomatremia
25
Q

what is the cause of hypovolemic hyponatremia

A
  • sodium and water levels in intravascular space are low, sodium levels are lower
  • vomiting, diarrhea, sweating, diuretic use
26
Q

what is the cause of hypervolemic hyponatremia

A
  • water in intravascular space dilutes sodium
  • HF, liver failure, excessive administration of hypotonic solutions
27
Q

what is the cause of isovolemic hyponatremia

A
  • sodium levels appear to be low due to too much fluid in the body
  • renal failure
  • excessive release of ADH (water retention)
28
Q

what will you manage mild hyponatremia (115-120)

A
  • restrict fluid intake
  • oral sodium supplements
  • high sodium foods
  • isotonic IV fluids secondary to hypovolemia
29
Q

management for critical hyponatremia

A
  • infusion of hypertonic solutions (3%, 5% saline)
  • shift fluids out of extracellular spaces
  • prevent fluid overload while on hypertonic solutions give lasix (close monitoring
30
Q

what is hypernatremia and what can it lead to?

A
  • sodium is high
  • can cause seizures, coma, permanent brain damage
  • fluid exists extracellular space
31
Q

what causes hypernatremia?

A

water deficit:
- reduced water intake
- heatstroke
- athletes
- burns
- vomiting, diarrhea
- diabetes insipidus
- excessive diuresis
excessive sodium intake

32
Q

what are 2 most significant clinical manifestations of hypernatremia?

A
  • brain cells shrink (brain very sensitive to fluid changes)
  • vascular rupture (fluid shift into intravascular space)
33
Q

early signs of hypernatremia (7)

A
  • restlessness
  • agitation
  • nausea
  • vomiting
  • low grade fever
  • flushed skin
  • intense thirst
34
Q

later signs and symptoms of hypernatremia (7)

A
  • weakness,
  • lethargy
  • confusion
  • seizures
  • twitching
  • trmors
  • coma
35
Q

what would be present if hypernatremia is due to excessive sodium?

A
  • hypervolemic
  • elevated BP, bounding pulse, dyspnea
36
Q

what would be present if hypernatremia is due to water deficit

A
  • appear hypovolemic
  • dry mucus membranes, oliguria, orthodox HTN
37
Q

how will water deficit be managed to help relieve hypernatremia

A
  • water intake increase gradually (dont want to overswell cells - water moves from high to low)
  • if Pt can’t do oral intake then IV 5% dextrose (isotonic solution) to help return sodium levels then 0.45% hypotonic (low sodium - helps move water into cells)
38
Q

how would we help decrease the chance with fluid overload when managing water deficit

A
  • loop diuretics (lasix)
39
Q

if the cause for hypernatremia is diabetes insidious how would this be managed?

A
  • help ADH levels
  • give vasopressin
  • give IV fluids
  • give thiazide diuretics
40
Q

what is hypokalemia

A
  • severe levels is less that 2.5
  • can cause dysrhythmias, cardiac arrest, respiratory arrest
41
Q

hypokalemia caused by not enough K in:

A
  • inadequate K intake
  • potassium deficient iv fluids
42
Q

hypokalemia caused by too much K out:

A
  • loss of GI fluids (vomiting, diarrhea, laxative use, diaphoresis)
  • diuretic therapy
  • cushing syndrome - increase diuresis
43
Q

hypokalemia affecting skeletal muscles signs

A
  • skeletal muscle weakness
  • leg cramps
  • decreased tendon reflexes
  • respiratory muscles
44
Q

GI/GU muscles affected signs during hypokalmeia

A
  • nausea
  • vomiting
  • decreased bowel motility
  • constipation
45
Q

what happens to the heart during hypokalemia

A
  • irregular HR
  • palpitation
  • ortho HTN
  • inverted T waves, depressed ST segment
  • ventricular dysrhythmias, bradycardia, tachycardia, cardiac arrest
46
Q

how to manage hypokalemia

A
  • high potassium diet and low sodium diet
  • oral potassium supplements (KCl)
  • IV potassium
  • spironolactone diuretic
47
Q

what is hyperkalemia

A
  • greater than 5-7
  • can cause dysrhythmias, cardiac arrest, respiratory arrest
48
Q

how can you become hyperkalemic (9)

A
  • increased K intake
  • blood donations
  • potassium sparing diuretic
  • antibiotic
  • chemo
  • ace inhibitors and ARBs
  • renal failure
  • additions disease
  • infection
49
Q

signs and symptoms of hyperkalemia (8)

A
  • muscle weakness
  • decreased deep tendon reflexes
  • nausea
  • abd. cramping
  • peaked T waves
  • irregular HR
  • ventricular fib.
  • hypotension
50
Q

how to manage hyperkalemia

A
  • loop diuretics (lasix)
  • K restrictions
  • put on kayexalate
  • IV insulin infusion with 10% dextrose solution -> glucose infusion as well
51
Q

what is hypocloremia

A
  • less than 98
  • extracellular space low in Cl
  • impacts levels of Na, K, and calcium
  • bicarbonate increases when Cl is low = hypochloremic alkalosis
52
Q

how does hypochloremic occur

A
  • intake and output
  • salt restricted diets
  • GI disorders
  • chloride follows sodium
  • vomiting, diarrhea, burns, Addisons disease, NG suctioning, HF
53
Q

signs and symptoms of hypochloremia

A
  • same as hyponatremia and hypokalemia
54
Q

how to manage hypochloremia

A
  • salty foods
  • NS IV
  • give KCl
  • treat diaphoresis
  • treat vomiting
  • treat GI issues
55
Q

what is hyperchloremia

A
  • greater than 108
  • increased Cl in the extracellular space
  • cause metabolic acidosis (decrease bicarbonate)
  • associated with hypernatremia
56
Q

signs and symptoms of hyperchloremia

A
  • metabolic acidosis
  • lethargy
  • thirst
  • weakness
  • dehydration
  • hypotension
  • coma, decreased LOC, arrhythmia
57
Q

manage hyperchloremia:

A
  • give fluids
  • IV sodium bicarbonate
    all help decrease chloride levels

331 Quiz 2 (8 decks)

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