F/E 2 Flashcards
Isotonic Fluid
NS, LR, D5W, D5 1/4 NS
Do not use isotonic fluids with these 3 things
Renal disease, Heart Disease, HTN
Hypotonic solutions
D 2.5W, 0.45% NS, 0.3% NS
Hypotonic acts how?
Shifts fluid out of the vascular space
What kind of fluid to give to heart disease/renal disease/HTN
hypotonic
Hypertonic solutions
D10W, 3-5% NS, D5LR, D5 ½ NS, D5 NS, TPN, Albumin
Monitor in ICU setting with what kind of fluids?
Hypertonic
What 2 electrolytes act like sedatives with increased amounts?
Mg, Ca - Think muscles first
Causes of Hypermagnesemia
Renal failure - Excreted there (can be lost through GI too)
Antacids - Contain Mg
S/S ^Mg
DECREASE: DTR, P, R
Muscle weakness
Mg does what to the blood vessels?
Causes vasodilation, resulting in flushing and warmth
Tx of ^Mg
Calcium Gluconate - Antidote that must by given slowly!
Dialysis
MV
Causes of Hypercalcemia
Hyperparathyroidism
Immobilization
How does PTH affect Ca?
When serum Ca is low, PTH pulls Ca from the bones and into the blood stream, causing bones to be brittle and kidney stones to develop
What kind of diuretic retains Ca
Thiazide
Treatment of ^Ca
MOVE to keep Ca in the bones FLUID to prevent stones Phosphate binders - P inverse to Ca Vitamin D so the body can utilize Ca Foods high in P - Organ meats, nuts, seeds
Causes of LOW Magnesium
Diarrhea - Lots of Mg in our stomach
Alcohol
* We get most of our Mg through food, so if we have diarrhea, we lose it; If we drink alcohol, we aren’t hungry so we aren’t getting it from food; also alcohol causes diuresis
S/S of LOW Mg and LOW Ca in muscles
NOT ENOUGH SEDATIVE Muscle tone: rigid and tight Smooth muscle-airway: Stridor/larygngospasm Sm muscle-esophagus: Swallowing problems Cardiac muscle: Arrhythmias
Other S/S LOW Mg and LOW Ca
SEIZURE Chevostek's - Cheek twitch Trousseaus - BP cough w/ tremor Increase in DTR Mind changes
Treatment of LOW Mg
Give Mg - give slowly
Seizure precautions
Eat Mg - Greens and seeds
Precaution of giving Mg
Check kidney function before and during infusion and stop if kidney function appears to be declining or a reaction appears
Even if there are MINOR changes, you need dos top the Mg
Causes of Hypocalcemia
Hypoparathyroidism
Radical neck, Thyroidectomy - These may cause the doctor to accidentally clip part of the parathyroid gland, thus causing a decrease in PTH secretion
S/S LOW Ca
NOT ENOUGH SEDATIVE
Rigid muscles with swallowing, breathing, arrhythmias, Chevosteks, Trousseau’s, mind changes
Treatment of LOW Ca
Vitamin D so we can use the Ca
Phosphate binders - Ca Acetate, sevelamer: Make P^ so Ca goes down
IV Ca - Need to give slowly and with a heart monitor
When taking about Na changes, think of what changes
NEURO
Sodium leves depend on what
Amount of water
With high Na, think _______
Dehydration and low K
Causes of ^Na
Hyperventilation (insensible fluid low) Heat Stroke - sweating DI (diurese a lot) Vomiting and diarrhea Feeding tube pt - May need to call MD to increase water intake after feeding
S/S of LOW Na
Dry mouth
Thirsty (already dehydrated)
SWOLLEN TONGUE
Neuro changes
Tx of LOW Na
Restrict Na and dilute pt with fluids
Daily wt, I/O
Labs
With low Na, think ______
Dilution
Causes of Hyponatremia
Replacing fluid by drinking water
Psychogenic polydipsia
SIADH - retain water
D5W - Sugar and water
S/S LOW Na
HA, seizure, coma
Tx of LOW Na - pt needs Na but not water
Hypertonic saline (3-5% NS)
K is secreted by the _____
Kidneys
____ K : _____ Na
Low K : High Na
We have lots of K where?
Our stomach
Causes of ^K
Decrease renal function
Spironolactone
ACEI
S/S ^K
Muscle twitching –> weakness –> paralysis
Peak T wave, longer PR, wide QRS
Arrythmias
Treatment of ^K
Dialysis
Ca Gluconate - decreases arrhythmia
Na polystyrene sulfonate (Kayexelate) exchanges K for Na in Gi tract
Insulin & glucose - bring K out of vast space
Anytime you give IV insulin, worry about _____ and _______
Low glucose and Low K
Insulin carries glucose and K into the cells s when giving insulin, we worry about LOW K and LOW GLUCOSE
Causes of LOW K
Vomiting, suction (Remember that there is a lot of K in our stomach)
Diuretics
Not eating
S/S of LOW K
Muscle cramps –> weakness
Arrhythmias
Tx of LOW K
Give K
Spironolactone
Eat more K - greens, veggies, fruit
SE of oral K? How to relieve?
GI upset
Take with food
SE of IV K?
Burning –> Will “eat” at peripheral veins
What to check before/during IV potassium? How do we give it IV?
UO
On a PUMP and MIXED WELL - NEVER IVP
Watch IV sites
Need to check what when giving IV K
Kidney function
