F+E Flashcards
fluid overview
fluid processes -> diffusion and osmosis
colloidal osmotic P (oncotic P) -> albumin = pulling power (fluid in IV, 3rd space if not)
hydrostatic P -> pushing -> HF (IV -> interstitum)
FVE: cm
HA, confusion, lethargy, peripheral edema, JVD (IVF), S3, bounding pulse (IVF), htn, centravenous P - F in RA (ICU), polyuria (w normal function), dyspnea, pulm edema, muscle spasms, weight gain (water), seizures and coma (hypoNa)
pulm edema, peripheral edema, 3rd spacing
FVE: causes
excess isotonic or hypotonic -> older (HF)
HF, RF (not peeing), primary polydipsia (drink lots of water), endocrine (SIADH, cushing S, long term corticosteroids - also fluid retention)
FVD: causes
high insensible water loss or perspiration (high fever, heatstroke) -> insensible means cannot be measured in cylinder - breathing/fever/sweat)
SM insipidous -> endocrine
osmotic diuresis -> mannitol
hemorrhage
low intake -> no thirst, obtunded, older (most common issue)
GI loss: v, ng, d, fistula drainage
overuse of diuretics
3rd spacing: burns bc increase in cap perm, pancreatitis
FVD: cm
restless, drowsy, lethargy, confusion
thirst dry mucus (elderly!)
cold clammy
decreased turgor, decreased cap refill
postural hypoT, increased pulse (tachy bc CO = Hr x SV, so it is to maintain CO), decreased CVP
urine output, [] urine
increased RR
weak, dizzy, weight loss (water), seizure, coma
fluid status nc
daily weight (same scale, clothes, time)
I+O but unreliable
labs: BUN, Na, hct but can all be false high/low; urine and serum osmolality -> particles/solution -> [] specifically
FVD: nc
mild: oral rehyd
severe: replaces with blood (esp if d/t blood loss) or balances IV solutions (NS, LR)
FVE: nc
HF, CKD, liver
restrict
fluid status nc: CV
monitor VS
FVE = bounding
FVD = tachy to keep BP wnl, weak/thready, orthostatic hypoT
fluid status nc: resp
FVE = risk for pulm edema
fluid status nc: pt safety
Na
change in LOC, orthostatic
fluid status nc: skin care
dry v pitting edema
fluid status nc: fluid therapy
rate, hc, needed?
delegate
RN interprets assessment findings
daily weights and VS
other freq oral care
I+O, skin care and position change, encourage oral fluids as appropriate, elevate edematous extremities (FVE)
Na
major ecf cation, sucks and governs osmolality (most particles in body are Na), activate muscle/nerve cells (AP)
135 - 145
hyperNa: causes
> 145
excessive intake: hypertonic IVF, tube feed without h2o supplements - free water usually added
inadequate h2o intake: elderly, anorexia, v/d, depressed
excessive loss of h2o (Na retained): insensible water loss, d, diuretics
diseases: diabetes insipidous and cushings S are endocrine, uncontrolled DM like ketoacidosis
hypoNa: causes
< 135
excess loss: GI, renal, diuretics, skin (burns, wounds)
inadequate intake
excessive h2o gain (low Na dilution): hypotonic IVF
diseases: SIADH (counterpart to DI), HF and KF = fluid retention, cirrhosis
hyperNa: cm
cellular shrink: mental change -> HA, irritable, difficulty [], confusion, seizure, coma
if also ECF v deficit: postural hypoT, tachy, weak
hyperNa: nc
depends on cause
water loss = add h2o
Na excess = remove
monitor serum Na/osmolality
gradually over 48hr for cerebral edema
hypoNa: cm
cellular shrinking: mental change -> drowsy, restless, confused, lethargy, seizures, coma
if also ecf V excess: weight gain and htn
hypoNa: nc
mild: restrict F (HF, KF, liver disease), loop diuretic
acute: small IV hypertonic NS (3%)
avoid rapid correction (24-46hr)
safe env precaution prn
K
intracellular cation, helps regulate cell excitability and electrical status
hyperK: causes
excess intake: parenteral admin (40meq KCl), renal insufficiency (not clearing well)
shift out of cell: acidosis (pH), tissue catabolism, intense exercise
fail to eliminate: renal disease (oliguria), adrenal insuff
hypoK: causes
excess loss: G (v/d), kidney, skin (diaphoresis), dialysis (CKD), loop and thiazide diuretics (question k sparing or need for supplement
shift into cells: high insulin release (IV dextrose), insulin therapy (w/ dka), alkalosis
lack of K intake: starvation or low diet with k, no K in IVF if NPO
hyperK: cm
ekg change -> cardiac dysrhythmias (put pt in tele)
fatigue, irritable, muscle weak
loss of tone
paresthesia
confusion
hyperK: nc
stop intake
increase excretion: loop and thiazide diuretics, dialysis, patiromer or Na polystyrene sulfonate (take hrs - days to work)
K into cell: insulin and dextrose, NaCO2 if acidotic (temporary fixes, keep pt safe long enough to address cause)
hypoK: cm
ekg change
fatigue, muscle weak, cramps
paresthesia
hypoK: nc
increase med intake (oral or IV)
increase PO intake (food)
IV KCl -> safety alert: always dilute, never push, should not exceed 10meq/hr unless in ICU setting and has CVAD, infiltration can cause necrosis
hypoK precipitates digitoxicity (digoxin for HF) - narrow therapeutic index
K foods
fruits: apricot, avocado, banana, cantaloupe, dried fruits, grapefruit juice, honeydew, oranges, prunes, raisins
veggies: baked/refried/black beans, butternut squash, cooked broccoli, raw carrots, greens (x kale), canned mushrooms, potatoes (white and sweet), cooked spinach, tomatoes or products, veggie juices
other: bran or bran products, choc, granola, all milk, nutritional supplements, nuts and seeds, PB, salt substitutes, salt free broth, yogurt
Ca
effects membrane potentials and nerve excitability
most Ca inside bone, provide bone strength
1% in cells (1/2 p bound, other 1/2 ionized/avail)
hyperCa: causes
hyperparaT
hematologic: cancer -> perineoplastic disorders, cancers secrete things with no purpose (lung cancer!)
others less common
hypoCa: causes
renal fail
paraT deficiency or removed
multiple blood transF (citrate used in blood binds with Ca)
hyperCa: cm
excess is like sedative -> decrease excitability of muscles and nerves
confusion, psychosis
seizures, coma
hyperCa: nc
mild: stop Ca meds, decrease Ca diet, increase weight bearing and maintain adequate hydration
severe: IV isotonic saline, bisphosphonate (pamidronate if cancer) and calcistronin injections (increase renal excretion but short term)
hypoCa: cm
tetany (nerve excitability and sustains muscle contraction): chvostek (face), trousseau (carpal)
ekg changes
hypoCa: nc
mild: diet high in Ca rich foods, Ca supplements + vit D
S: IV Ca gluconate
Mg
stabilize heart and smooth muscle
hyperMg: causes
renal rail and high Mg: CKD with Maalox
IV Mg (preg)
hypoMg: causes
GI loss and malN (low intake): d, v, NG suction, chronic OH, prolonged malN
hyperMg: cm
nerves and muscles slowed down
lethargy, drowsy, muscle weak, decreased DTRs
hyperMg: nc
avoid drugs and limit intake (green veggies, nuts, bananas, oranges, PB, choc)
dialysis if CKD
FF if kidneys okay -> urinary excretion
IV Ca gluconate if S (oppose excess Mg on cardiac muscle)
hypoMg: cm
nerves and muscles reved up
like hypoCa: confusion, muscle cramp, tremors, seizure, vertigo, hypoactive DTRs, chvosteks/trousseaus, increased P/BP/dysrhythmias
hypoMg: nc
treat cause and S
oral: mylanta, MgSO4
IV MgSO4: several days, IVP if needed (rapid can cause hypoT)
P
inverse to Ca
hyperP: causes
renal fial, lax/enemas w/ P, hypoparaT
hypoP: causes
malN, vit D def, chronic OH, severe d
hyperP: cm
usually asymp
typically only S of hyperCa = muscle spasms, paresthesia, tetany
hypoP: cm
CNS depress (confusion, coma)
muscle weak (resp muscles)
hyperP: nc
treat cause
Ca based P binders (CaCO3)
hemodialysis if severe
hypoP: nc
IV (long time) v oral replace (dairy, P supplement)
resolve CKD or hyperCa
