F&E Flashcards
What are ways you can lose water?
urine
stool
insensible -lungs, skin
Fluid Volume Deficit is also known as?
hypovolemia, isotonic dehydration
Hemorrhage
____________
Diarrhea
Burns
________ therapy
Fever
Impaired _______
What are causes of Fluid Volume Deficit ?
Hemorrhage
Vomiting
Diarrhea
Burns
Diuretic therapy
Fever
Impaired thirst
This is an equal loss of sodium and water and results in __________.
isotonic dehydration hypovolemia or Fluid Volume Deficit
Weight ________
Thirst
____________ changes in pulse rate and bp
Weak, ________ pulse
__________ urine output
Dry _________ membranes
Poor ________ _________
dry __________
Signs/Symptoms of isotonic
dehydration
Weight loss
Thirst
Orthostatic changes in pulse rate and bp
Weak, rapid pulse
Decreased urine output
Dry mucous membranes
Poor skin turgor
dry tongue
Signs/Symptoms of isotonic dehydration
Weight loss
Thirst
Orthostatic changes in pulse rate and bp
Weak, rapid pulse
Decreased urine output
Dry mucous membranes
Poor skin turgor
dry tongue
Blood pressure drop over 20 mm Hg systolic or 10 mg Hg diastolic or both
Orthostatic Hypotension
Orthostatic Hypotension is defined as?
Blood pressure drop over 20 mm Hg systolic or 10 mg Hg diastolic or both
for dehydration, Labs show ?
Increased hgb and hct (is artificial, not true elevation, a constant amount of solute diluted in less solvent)
Increased urine specific gravity
Increased BUN and creatinine
Increased hgb and hct (is artificial, not true elevation, a constant amount of solute diluted in less solvent)
Increased urine specific gravity
Increased BUN and creatinine
lab results with dehydration
normal Hemoglobin Men ?
Men 13.5 to 17.5 grams per deciliter
normal hemoglobin for women?
12.0 to 15.5 grams per deciliter
What is the normal hematocrit for men?
Men 45% to 52%
What is the normal hematocrit for women?
Women 37% to 48%
: a red protein responsible for transporting oxygen in the blood of vertebrates.
HGB
–carries oxygen through the bloodstream
hemoglobin
what labs are falsely elevated when someone is dehydrated?
hemoglobin and hematocrit
is a measure of the RBCs with plasma separated out.
hematocrit
What are treatments/interventions for isotonic dehydration
for FVD:
Fluid Management
Diet therapy – Correct with oral fluid replacement.
Oral rehydration therapy – Solutions containing glucose and electrolytes. E.g., Pedialyte
IV therapy – Type of fluid ordered depends on the type of dehydration and the client’s cardiovascular status.
if the patient doesnt have low sodium, low potassium, or high potassium, what type of solution will they receive for their dehydration?
NS or LR, an isotonic fluid
What are assessments for isotonic dehydration?
Daily weights should be ______ thing in the am. If they are weighed on a bed scale, you need to make sure the same things are on the bed each time (such as 1 pillow 1 blanket). Patients who end up with multiple blankets and pillows on the bed can weigh significantly different from day to day. Also should make sure that the patient is weighed on the same ____ if at all possible.
first, scale
t/f: you cant measure sweat or fluid loss from breath
true
make sure that they’re getting good ______ ______ : prevents nasty fissures and blisters
oral care
Monitor postural heart rate and bp when getting patients out of bed
nursing implications for isotonic dehydration
What are common causes of fluid volume excess?
CHF
early renal failure
IV therapy
excessive sodium ingestion
corticosteroids
all pumps should have a safety mechanism when you pull tubing out it locks it: anytime you pull pump off IV pump it is ______.
locked
t/f: Techs should not be taking IV off pump to run it through a shirt or anything
true
CHF
early renal failure
IV therapy
excessive sodium ingestion
corticosteroids
common causes of fluid volume excess
Increased BP
Edema
Weight gain
Bounding pulse
Venous distention
Pulmonary edema
Dyspnea
Orthopnea (diff. breathing when supine)
crackles
Signs/Symptoms of fluid volume excess
what are signs/symptoms of fluid volume excess?
Increased BP
Edema
Weight gain
Bounding pulse
Venous distention
Pulmonary edema
Dyspnea
Orthopnea (diff. breathing when supine)
crackles
What happens to the HGB and HCT when someone has fluid volume excess ?
decreased HGB and HCT
What happens to urine specific gravity with FVE?
decreased urine specific gravity
What is the urine specific gravity normal range?
Normal range 1.002 and 1.030
A high specific gravity (over 1.030) is seen in ____________________
dehydration (fluid volume deficit)
A low specific gravity (over 1.002) is suggestive of _______________________________
the kidneys inability to concentrate urine/fluid volume excess
What are treatments/interventions for fluid volume excess?
Drug therapy
Diuretics may be ordered if renal failure is not the cause.
Restriction of sodium and saline intake
I/O
Weight
So this patient will not have IV fluids and will be on a low sodium (often 2 gm sodium diet)
they wont have IV fluids, they’ll have a saline lock
generally going to have restricted sodium (normal is 2 grams per day)
patient with FVE
What are s/s of fluid volume excess?
Which systems are predominately affected by the FVE?
not so much neurologic, mostly resp cardio and gi
can affect neruo though
_______and_______ don’t tolerate large shifts of fluid as well as others.. Become dehydrated easier as well as have fluid volume excess easier.
infants and children
buretrol
is used with infants and it goes under the IV bag about the pump and you only put enough fluid in there for a short time
buretrol:
Prior medical history
Acute illness
Chronic illness
Environmental factors
Diet
Lifestyle
Medications
factors that can cause FVE
Body systems
I/O
Weight
Labs
assessments for FVO
Elderly are more sensitive to changes in fluid volume
Skin turgor is not very reliable on elderly
May deliberately restrict fluid intake to prevent incontinence
Fluid loss needs to be replaced more slowly and cautiously in the elderly
Gerontological hydration considerations
What is the normal level of potassium
3.5 to 5 mmol/L
______ in K+ causes decreased excitability of cells, therefore cells are less responsive to normal stimuli
Decrease
What are contributing factors for hypokalemia?
Diuretics
Shift into cells
Digoxin
Water intoxication
Corticosteroids
Diarrhea
Vomiting
Shallow respirations
___________
confusion
___________
arrhythmias
lethargy
_________ pulse
decreased __________ motility
s/s: hypokalemia
Shallow respirations
irritability
confusion
weakness
arrhythmias
lethargy
thready pulse
decreased intestinal motility
s/s of hypokalemia
Shallow respirations
irritability
confusion
weakness
arrhythmias
lethargy
thready pulse
decreased intestinal motility
hypokalemia interventions
Assess and identify those at risk
Encourage potassium-rich foods: bananas, avocados
K+ replacement (IV or PO)
Monitor lab values
D/c potassium-wasting diuretics
Treat underlying cause
Potassium is never given by IV push or intramuscularly- given slowly in IV fluids
_______ is never given by IV push or intramuscularly- given slowly in IV fluids
Potassium
If _______ is given through an IV it is either part of a primary bag of solution or is premixed in a potassium cocktail that is given at a slow rate prescribed concentration. IV push could cause cardiac arrest or cardiac dysrhythmias and should never be done. Potassium that isn’t already mixed in primary IV bags should be kept in the pharmacy only.
potassium
An ______ in K+ causes increased excitability of cells.
increase
contributing factors to hyperkalemia
Increase in K+ intake
Renal failure
K+ sparing diuretics
Shift of K+ out of the cells
Increase in K+ intake
Renal failure
K+ sparing diuretics
Shift of K+ out of the cells
contributing factors to hyperkalemia
muscle cramps
weakness
paralysis
drowsiness
decreased bp
ekg changes
dysrhythmias
abdominal cramping
diarrhea
oliguria
s/s of hyperkalemia
s/s of hyperkalemia
muscle cramps
weakness
paralysis
drowsiness
decreased bp
ekg changes
dysrhythmias
abdominal cramping
diarrhea
oliguria
what are nursing interventions for hyperkalemia ?
Need to restore normal K+ balance:
Eliminate K+ administration
Inc. K+ excretion
Lasix
Kayexalate (Polystyrene sulfonate)
Infuse glucose and insulin
Cardiac Monitoring
What medications are given for an emergent need to decreased K+?
insulin and glucose -intracellular shift of potassium
What is given for a nonemergent need to decrease potassium?
kayexalate
Causes loss of K + through the bowel
______ binds with K+ in the bowel
Kayexalate
hyperkalemia:
Shouldn’t be used if emergent high level as it isn’t immediate
is not used for an emergent situation, ________ and ________ is used in an emergency
insulin and glucose
What are normal sodium blood levels?
135 to 145 mEq/L
What are contributing factors to hyponatremia?
Excessive diaphoresis
Wound Drainage
NPO
CHF
Low salt diet
Renal Disease
Diuretics
May occur due to fluid overload in a surgical patient
Excessive diaphoresis
Wound Drainage
NPO
CHF
Low salt diet
Renal Disease
Diuretics
May occur due to fluid overload in a surgical patient
contributing factors to hyponatremia
What are assessment finding for hyponatremia?
Neuro - Generalized skeletal muscle weakness. Headache / personality changes.
Resp.- Shallow respirations
CV - Cardiac changes depend on fluid volume
GI – Increased GI motility, Nausea, Diarrhea (explosive)
GU - Increased urine output
Neuro - Generalized skeletal muscle weakness. Headache / personality changes.
Resp.- Shallow respirations
CV - Cardiac changes depend on fluid volume
GI – Increased GI motility, Nausea, Diarrhea (explosive)
GU - Increased urine output
assessment findings for hyponatremia
significant ______: extreme diarrhea, possible loss of consciousness
hyponatremia
Restore Na levels to normal and prevent further decreases in Na.
Increase oral sodium intake and restrict oral fluid intake.
Don’t want to correct too quickly (12 meq in 24 hours)
If the person also has excess fluid they may restrict fluids.
interventions/treatments for hyponatremia
interventions/treatments for hyponatremia?
Restore Na levels to normal and prevent further decreases in Na.
Increase oral sodium intake and restrict oral fluid intake.
Don’t want to correct too quickly (12 meq in 24 hours)
If the person also has excess fluid they may restrict fluids.
An ______ diuretic is a type of diuretic that inhibits reabsorption of water and sodium (Na)
osmotic
What are causes of increased serium sodium?
medications, meals
osmotic diuretics
diabetes insipidus
excessive H2O loss
low H2O intake
medications, meals
_________diuretics
diabetes ______
___________H2O loss
low H2O _________
cases of increased serum sodium
medications, meals
osmotic diuretics
diabetes insipidus
excessive H2O loss
low H2O intake
Hyperaldosteronism
_______ failure
_________________________
Increase in oral Na intake
Na containing IV fluids
_____________ urine output with increased urine concentration
Diarrhea
________________
Fever
__________________
Contributing Factors to hypernatremia
Hyperaldosteronism
Renal failure
Corticosteroids
Increase in oral Na intake
Na containing IV fluids
Decreased urine output with increased urine concentration
Diarrhea
Dehydration
Fever
Hyperventilation
contributing factors to hypernatremia?
Hyperaldosteronism
Renal failure
Corticosteroids
Increase in oral Na intake
Na containing IV fluids
Decreased urine output with increased urine concentration
Diarrhea
Dehydration
Fever
Hyperventilation
Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle wkness. Diminished deep tendon reflexes
Resp. – Pulmonary edema
CV – HR and BP depend on vascular volume.
GU – Dec. urine output. Inc. specific gravity
Skin – Dry, flaky skin. Edema r/t fluid volume changes.
Assessment findings: hypernatremia
Assessment findings: hypernatremia
Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle wkness. Diminished deep tendon reflexes
Resp. – Pulmonary edema
CV – HR and BP depend on vascular volume
GU – Dec. urine output. Inc. specific gravity
Skin – Dry, flaky skin. Edema r/t fluid volume changes.
What are interventions/treatments for a patient with hypernatremia with FVD
(FVD) .45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics.
Interventions/treatment for hypernatremia
Interventions/Treatment
Drug therapy
(FVD) .45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics.
Diet therapy
Mild – Ensure water intake
decrease sodium intake
Contributing factors to hypocalcemia ?
Dec. oral intake
Lactose intolerance
Dec. Vitamin D intake
End stage renal disease
Diarrhea
Acute pancreatitis
Hyperphosphatemia
Immobility
Removal or destruction of parathyroid gland
Dec. oral intake
Lactose intolerance
Dec. Vitamin D intake
End stage renal disease
Diarrhea
Acute pancreatitis
Hyperphosphatemia
Immobility
Removal or destruction of parathyroid gland
contributing factors to hypocalcemia
___________ is required for proper absorption of calcium (often a patient can get enough through diet especially if the person gets outside in the sun)
Vitamin D
assessment findings with hypocalcemia?
irritable muscle twitches
Positive Trousseau’s sign.
Positive Chvostek’s sign
– involuntary contraction of muscles related to low calcium
Tetany
what are treatments for hypocalcemia?
NEED FOODS HIGH IN CALCIUM AND VITAMIN D
What does this picture indicate and what is the clinical meaning?
Positive Trousseau’s sign, indicates low calcium levels
What does this image depict and what is the clinical meaning?
Chvostek’s sign, hypocalcemia
Twitching of the facial muscles in response to gentle tapping of the facial nerve just anterior to the ear indicates what clinical finding which means the patient is a risk for ?
Chvostek’s sign, hypocalcemia
What are interventions/treatments for hypocalcemia?
Drug Therapy
Calcium supplements
Vitamin D
Diet Therapy
High calcium diet
Prevention of Injury
Seizure precautions
Excessive calcium intake
Excessive vitamin D intake
Renal failure
Hyperparathyroidism
Malignancy
Hyperthyroidism
contributing factors to hypercalcemia
Renal failure
Hyperparathyroidism
Malignancy
Hyperthyroidism
contributing factors to hypercalcemia minus excessive calcium intake and excessive vitamin D intake bc theyre kind of dead giveaways
what are contributing factors to hypercalcemia ?
Excessive calcium intake
Excessive vitamin D intake
Renal failure
Hyperparathyroidism
Malignancy
Hyperthyroidism
What are assessment findings associated with hypercalcemia?
Neuro – Disorientation, lethargy, coma, profound muscle weakness
Resp. – Ineffective resp. movement
CV - Inc. HR, Inc. BP. , Bounding peripheral pulses, Positive Homan’s sign.
Late Phase – Bradycardia, Cardiac arrest
GI – Dec. motility. Dec. BS. Constipation
GU – Inc. urine output. Formation of renal calculi
Neuro – Disorientation, lethargy, coma, profound muscle weakness
Resp. – Ineffective resp. movement
CV - Inc. HR, Inc. BP. , Bounding peripheral pulses, Positive Homan’s sign.
Late Phase – Bradycardia, Cardiac arrest
GI – Dec. motility. Dec. BS. Constipation
GU – Inc. urine output. Formation of renal calculi
assessment findings associated with hypercalcemia
muscle weakness, not twitches
slow, shallow breaths
can form renal calculi or kidney stones
findings associated with hypercalcemia
confusion
muscle weakness
bone pain
kidney stone
excessive urination
cardiac arrest
arrhythmias
s/s of hypercalcemia
s/s of hypercalcemia
confusion
muscle weakness
bone pain
kidney stone
excessive urination
cardiac arrest
arrhythmias
What are interventions/treatments for hypercalcemia?
Eliminate calcium administration
Drug Therapy
Isotonic NaCL (Inc. the excretion of Ca)
Diuretics
Calcium reabsorption inhibitors (Phosphorus)
Cardiac Monitoring
Eliminate calcium administration
Drug Therapy
Isotonic NaCL (Inc. the excretion of Ca)
Diuretics
Calcium reabsorption inhibitors (Phosphorus)
Cardiac Monitoring
interventions/treatments for hypercalcemia
Twitching of the facial muscles in response to gentle tapping of the facial nerve just anterior to the ear indicates what clinical finding which means the patient is a risk for ?
Chvostek’s sign, hypocalcemia
levels for Hypocalcemia
<9.0mg/dL
levels for Hypercalcemia
> 10.5mg/dL
