F/E 2

Question 1

Isotonic Fluid

Answer 1

NS, LR, D5W, D5 1/4 NS

Question 2

Do not use isotonic fluids with these 3 things

Answer 2

Renal disease, Heart Disease, HTN

Question 3

Hypotonic solutions

Answer 3

D 2.5W, 0.45% NS, 0.3% NS

Question 4

Hypotonic acts how?

Answer 4

Shifts fluid out of the vascular space

Question 5

What kind of fluid to give to heart disease/renal disease/HTN

Answer 5

hypotonic

Question 6

Hypertonic solutions

Answer 6

D10W, 3-5% NS, D5LR, D5 ½ NS, D5 NS, TPN, Albumin

Question 7

Monitor in ICU setting with what kind of fluids?

Answer 7

Hypertonic

Question 8

What 2 electrolytes act like sedatives with increased amounts?

Answer 8

Mg, Ca - Think muscles first

Question 9

Causes of Hypermagnesemia

Answer 9

Renal failure - Excreted there (can be lost through GI too)

Antacids - Contain Mg

Question 10

S/S ^Mg

Answer 10

DECREASE: DTR, P, R

Muscle weakness

Question 11

Mg does what to the blood vessels?

Answer 11

Causes vasodilation, resulting in flushing and warmth

Question 12

Tx of ^Mg

Answer 12

Calcium Gluconate - Antidote that must by given slowly!
Dialysis
MV

Question 13

Causes of Hypercalcemia

Answer 13

Hyperparathyroidism

Immobilization

Question 14

How does PTH affect Ca?

Answer 14

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

Question 15

What kind of diuretic retains Ca

Answer 15

Thiazide

Question 16

Treatment of ^Ca

Answer 16

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

Question 17

Causes of LOW Magnesium

Answer 17

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

Question 18

S/S of LOW Mg and LOW Ca in muscles

Answer 18

NOT ENOUGH SEDATIVE
Muscle tone: rigid and tight
Smooth muscle-airway: Stridor/larygngospasm
Sm muscle-esophagus: Swallowing problems
Cardiac muscle: Arrhythmias

Question 19

Other S/S LOW Mg and LOW Ca

Answer 19

SEIZURE
Chevostek's - Cheek twitch
Trousseaus - BP cough w/ tremor
Increase in DTR
Mind changes

Question 20

Treatment of LOW Mg

Answer 20

Give Mg - give slowly
Seizure precautions
Eat Mg - Greens and seeds

Question 21

Precaution of giving Mg

Answer 21

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

Question 22

Causes of Hypocalcemia

Answer 22

Hypoparathyroidism
Radical neck, Thyroidectomy - These may cause the doctor to accidentally clip part of the parathyroid gland, thus causing a decrease in PTH secretion

Question 23

S/S LOW Ca

Answer 23

NOT ENOUGH SEDATIVE

Rigid muscles with swallowing, breathing, arrhythmias, Chevosteks, Trousseau’s, mind changes

Question 24

Treatment of LOW Ca

Answer 24

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

Question 25

When taking about Na changes, think of what changes

Answer 25

NEURO

Question 26

Sodium leves depend on what

Answer 26

Amount of water

Question 27

With high Na, think _______

Answer 27

Dehydration and low K

Question 28

Causes of ^Na

Answer 28

``` 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 ```

Question 29

S/S of LOW Na

Answer 29

Dry mouth Thirsty (already dehydrated) SWOLLEN TONGUE Neuro changes

Question 30

Tx of LOW Na

Answer 30

Restrict Na and dilute pt with fluids Daily wt, I/O Labs

Question 31

With low Na, think ______

Answer 31

Dilution

Question 32

Causes of Hyponatremia

Answer 32

Replacing fluid by drinking water Psychogenic polydipsia SIADH - retain water D5W - Sugar and water

Question 33

S/S LOW Na

Answer 33

HA, seizure, coma

Question 34

Tx of LOW Na - pt needs Na but not water

Answer 34

Hypertonic saline (3-5% NS)

Question 35

K is secreted by the _____

Answer 35

Kidneys

Question 36

____ K : _____ Na

Answer 36

Low K : High Na

Question 37

We have lots of K where?

Answer 37

Our stomach

Question 38

Causes of ^K

Answer 38

Decrease renal function Spironolactone ACEI

Question 39

S/S ^K

Answer 39

Muscle twitching --> weakness --> paralysis Peak T wave, longer PR, wide QRS Arrythmias

Question 40

Treatment of ^K

Answer 40

Dialysis Ca Gluconate - decreases arrhythmia Na polystyrene sulfonate (Kayexelate) exchanges K for Na in Gi tract Insulin & glucose - bring K out of vast space

Question 41

Anytime you give IV insulin, worry about _____ and _______

Answer 41

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

Question 42

Causes of LOW K

Answer 42

Vomiting, suction (Remember that there is a lot of K in our stomach) Diuretics Not eating

Question 43

S/S of LOW K

Answer 43

Muscle cramps --> weakness | Arrhythmias

Question 44

Tx of LOW K

Answer 44

Give K Spironolactone Eat more K - greens, veggies, fruit

Question 45

SE of oral K? How to relieve?

Answer 45

GI upset | Take with food

Question 46

SE of IV K?

Answer 46

Burning --> Will "eat" at peripheral veins

Question 47

What to check before/during IV potassium? How do we give it IV?

Answer 47

UO On a PUMP and MIXED WELL - NEVER IVP Watch IV sites

Question 48

Need to check what when giving IV K

Answer 48

Kidney function