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Fluid and electcro > F&E > Flashcards

F&E Flashcards

1
Q
A
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2
Q

What is the relationship between Ca, PO4, and Mg?

A

An ↑ in Ca lvls→ ↓ PO4 lvls

An↑ in Ca lvls → ↑ Mg lvls

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3
Q

What are the normal parameters for urine osmolality?

A

200-800 mOsm/kg/H2O

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4
Q

What can cause low osmolality?

A

hemodilution (fluid volume excess):

  • Syndrome of SIADH, excessive D5W
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5
Q

What are the manifestations of hypernatermia?

A

Cardiovascular:

  • Severe: Hypertension, tachycardia

Neruologic:

  • Moderate: confusion, thirst
  • Severe: Restlessness, coma

Gastrointestinal:

  • Nausea and vomiting

Neruomusclar:

  • Hyperreflexia, muscle twittching, seizures
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6
Q

What is the normal range of potassium?

A

3.5-5

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7
Q

What are the normal parameters for serum osmolality?

A

280-300 mOsm/kg

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8
Q

What are the manifestations of hyperkalemia?

A

Cardiovascular:

  • Progression from tachy to bradycardia to cardiac arrest is possible
  • Prolonged PR interval, flat or absent P wave, peaked T wave, ST segment depression

Musculoskeletal:

  • Muscle weakness or cramps

Gastrointestinal:

  • Nausea, vomiting, abdominal cramping, diarrhea

Acid-Base:

  • Metabloc acidosis
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9
Q

Whata are some nursing interventions for hypokalemia?

A

-PO or IV K administration

-

  • Decreased cardiac output
  • Monitor EKG’s
  • IV K through peripheral veins is painful
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10
Q

Indentations that disappear within 10 to 15 seconds would be considered what type of pitting edema?

A

+2

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11
Q

What are the manifestations of hypocalcemia?

A

Cardiovascular:

  • Hypotension, decreased myocardial contractility
  • EKG Changes: prolonged QT interval, long ST segment

Neruologic:

  • Irritability, reduced cognitive ability

Neuromusclar:

  • Cramps (abdominal and extremities), parathesias (tingling, tickling, prickling, pricking sensations)
  • Severe: positive Chvostek’s or Trousseau’s sign, tetany, seziures

Skeletal:

  • Bone fractures possible

Other:

  • Abdominal clotting
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12
Q

What is the function of phosphorus in the body?

A
  • Intracellular mineral
  • Essential for TEETH and BONE development
  • Normal NEUROMUSCULAR function
  • Required for ATP production
  • Protein, fat, and carb metabolism
  • pH balance maintenance
  • INVERSE relationship to Ca [PTH]
  • Kidneys regulate levels
    • Reabsorption & excretion
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13
Q

What is the normal range for central venous pressure?

A

2-6mmHg

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14
Q

What are the 3 main extracellular electrolytes?

A
  1. SODIUM (Na)
  2. CHLORIDE (Cl)
  3. CALCIUM (Ca)
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15
Q

What can cause hypocalemia or hypercalcemia?

A
  • HypoCa [ acute/chronic kidney dis, PTH def, low Mg/Vitamin D
  • HyperCa[>11]- immobilization, Vitamin A/D intoxic, lithium/thiazide
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16
Q

What are the manifestations of hypokalemia?

A

Cardiovascular:

  • Flat T wave, development of U waves, depressed ST segment

Pulmonary:

  • Respiratory muscle weakness
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17
Q

What can cause hypo or hypermagnesemia?

A
  • HypoMg [GI/Kidney loss, burn, sepsis, transfusions & drugs, acute pancreatitis, starvation, chron’s disease, ulcerative colitis
  • HyperMg [>3.0]- kidney disease & drugs (antacids, laxatives)
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18
Q

Indentations that disappear within 1 to 2 minutes would be considered what type of pitting edema?

A

+3

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19
Q

What is the normal range for Albumin?

A

3.5-5 g/dL

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20
Q

What causes hyponatremia (

A
  • Excessive Sodium Loss
    • Skin, GI tract, kidneys
  • Dilutional effect
    • DKA – shift of water from ICF to ECF to dilute the glucose
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21
Q

What are the nursing interventions for hyperkalemia?

A
  • Treat underlying cause
  • Correct acidosis
  • Regular insulin and D5W to move K back into cells
  • IV cal. gluconate
  • Sodium polystyrene sulfonate ( Kayexalate) Makes you poop out the K+
  • Dialysis
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22
Q

What are the manifestations of hypomagnesemia?

A

Cardiovascular:

  • ​EKG changes: **premature ventricular contractions, **ventricular tachycardia and or fibrillation, flat T wave, decreased ST segment

Neruomusclar:

  • ​Tremors, tetany, positive chovostek’s and trousseau’s signs
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23
Q

What are the manifestations ofr hypochloremia?

A
  • Irritability
  • Tetany

-Shallow, slow respirations

-weakness

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24
Q

What are the manifestations and treatment for malignant hypercalcemia?

A

Manifestations:

  • General (dehydration, polyuria, polydipsia),
  • Gastrointestinal (nausea, vomiting, constipation, anorexia),
  • Neurologic (fatigue, delirium, myopathy).
  • Very severe cases: Seizures, coma, or cardiovascular collapse

Treatment:

  • IVF, diuretics, bi-phosphate , calcitonin, Na/K-PO4, dialysis
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25
Q

How does the hypothalamus regulate fluid balance?

A
  • It regulates water intake
  • Detects:
    • Decreased fluid volume [BP dropped]
    • Increased serum OSMOLARITY
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26
Q

What are the nursing interventions for hypocalcemia?

A
  • Correct underlying cause
  • IV calcium administation (e.g. ca.gluconate/chloride
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27
Q

What are the manifestations of hyponatermia?

A

Cardiovascular:

  • Hypotension

Neruologic:

  • Confusion, headache, lethargy, possible coma

Gastrointestinal:

  • Anorexia, comiting, diarrhea, cramps

Neruomusclar:

  • seizures, muscle cramps or spasms

Fluid Balance:

  • Excess, Edema
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28
Q

What are some nursing interventions for hypercalcemia?

A
  • Correct underlying cause
  • Promote Ca elimination
  • IVF & diuretics
  • Monitor for cardiac dysrhythmias
29
Q

What is the diagnostic for hypervolemia (fluid volume excess)?

A

Decreased:

  • Hematocrit
  • Serum osmolality
  • Urine Specific gravity

These values are all decreased because there is so much water inside of the vasculature it is diluted.

30
Q

What two signs check for hypocalcemia?

A
  • Chvostek Sign = taps pt’s face =>twitch/spams (+)
  • Trousseau Sign = places pressure on bp cuff
  • =>fingers hyperextend w the
  • thumb flexing toward the palm (+)
31
Q

Indentations that disappear after 2 to 5 minutes would be considered what type of pitting edema?

A

+4

32
Q

What can cause high osmolality?

A

hemoconcentration (fluid volume deficit)

  • HyperNa, HyperGlycemia, Dehydration
  • Diabetes Insipidus, kidney Failure
33
Q

Where are the arterial baroreceptors and how do the they regulate fluid balance?

A
  • They are located in the Arch of the aorta, carotid sinus, pulmonary arteries.
  • They detect pressure changes and can lead to:\
    • ANS=> SNS: vasoconstriction, blood volume increased
34
Q

What is the function of mangesium in the body?

A
  • Intracellular electrolyte
  • Helps with Na & K transport across cell membrane
  • Needed for protein and carbohydrate metabolism
  • Biochemical reactions & nerve cell conduction
  • Excreted in FECES and KIDNEYS
  • Closely related to K and Ca balance
35
Q

What are the manifestations of hypercholoremia?

A

-Rapid, deep respirations

  • Decreased LOC
  • S/Sx of FVD
36
Q

What can cause hypokalemia or hyperkalemia?

A
  • HypoK-[GI loss (excessive nasogastric suction fluid loss), drug therapies (digoxin [vision, confusion, vomiting])
  • HyperK[>5.5] - kidney disease (MAJOR CAUSE), insulin deficiency, severe burns, metabolic acidosis & drugs (beta-adrenergic blocker)
37
Q

What hormones can regulate fluid balance?

A
  • Adrenocorticotropic Hormone (ACTH): aldosterone
  • Antidiuretic Hormone (ADH) : vasopressin
  • Renin-Angiotensin-Aldosterone System (RAAS)
38
Q

What are some nursing interventions for hypernatermia?

A
  • Water replacement
  • Hypotonic IVF
  • Diuretics

Rapid changes can cause cerebral edema, watch out for headaches, changes in LOC, blury vision, or N/V

39
Q

What are the nursing interventions for hyperphosphatemia?

A
  • Lower levels
  • Binding agents
  • IV NS promotes renal excretion
  • Aluminum-containing agents
40
Q

What is the normal range of magnesium?

A

1.3-2.1

41
Q

What is the normal range of phosphate?

A

1.7-2.6

42
Q

What are some physical assessment findings seen in a patient with a fluid volume deficit? (Hypovolemia)

A
  • Dry mucous membranes
  • Dec urine output, inc urine specific gravity (increased hematocrit & BUN)
  • AMS, anxiety, dec LOC
  • Dry skin, pale, dec skin turgor
  • Tachycardia, orthostatic hypotension, dec BP, dec cap refill
43
Q

Indentations that disappear rapidly would be considered what type of pitting edema?

A

+1

44
Q

What are the changes in vital signs seen with a fluid volume deficit? (Hypovolemia)

A
  • HYPOtension
  • Rapid, WEAK, thready pulse
  • Rapid, SHALLOW respirations
  • Dec body temp

These are all increased because the patient is not peeing because they are trying to reabsorb water.

45
Q

What are the nursing interventions for hypermagnesemia?

A
  • Identify cause
  • Give calcium to lower Mg levels
  • Antagonized (Ca. gluconate)
46
Q

What are the 3 main intracellular electrolytes?

A
  1. POTASSIUM (K)
  2. MAGNESIUM (Mg)
  3. PHOSPHORUS (PO4)
47
Q

What is the normal range of sodium?

A

135-145

48
Q

What are some nursing interventions for hypornatermia?

A
  • IV NS
  • Hypertonic Saline (3 or 5% NaCl)
  • Conivaptan hydrochloride (Vaprisol)
  • PO fluid restriction
  • Risk for imbalanced fluid volume
  • Monitor for pulmonary and cerebral edema
  • Neuro changes
49
Q

What are the manifestations for hypermagnesemia?

A

Cardiovascular:

  • ​Hypotension
  • EKG changes: Prolonged PR intervals, complete heart block, wide QRS complex, bradycardia, cardiac arrest

Respiratory:

  • Depression

Neruomusclar:

  • ​Absent deep tendon reflexes, lethargy, drowsiness
50
Q

What are the nursing interventions for hypomagnesemia?

A
  • Raise serum levels
  • IVF with Mg
  • Mg replacement – IV or PO
51
Q

What causes hypernatremia (>145)?

A
  • Excessive INTAKE
  • Excessive WATER LOSS
52
Q

What is the normal range of calcium?

A

8.5-10

53
Q

What are the manifestations of hypercalcemia?

A

Cardiovascular:

  • Hypertension, cardiovascular calcification
  • EKG Changes: Short QT interval, decreased ST segment, heart block, dysrhythmias

Neruologic:

  • Lethargy, depression, fatigue, impaired memory, emotional lability
  • Severe: confusion, stupor, and coma

Neuromusclar:

  • Muscle weakness

Gastrointestinal:

  • Anorexia, constipation, peptic ulcer disease, abdominal discomfort

Skeletal:

  • Pathologic bone fractures, bone thinning (osteopenia, osteoporosis)

Other:

  • Kidney stones, polyuria, polydipsia
54
Q

What are the manifestations of hyperphosphatemia?

A

Cardiovascular:

  • Hypotension, tachycardia
  • EKG changes: prolonged QT interval and ventricular dysrhythmias

Gastrointestinal:

  • Diarrhea, nausea, abdominal cramping

Neurologic:

  • Altered mental state, delirium, coma, positive chvostek’s and trousseau’s signs, paresthesias

Neuromusclar:

  • Muscle cramping, tetany, seizure

Hyperphosphatemia = PHO4 > 2.6mEq/L

55
Q

What can cause hypo or hyperphosphartemia?

A
  • HypoPO4[gram (-) sepsis, malnutrition, rep alkalosis, DKA, alcohol
  • HyperPO4 [>4.5] - chronic kidney
56
Q

What is the normal range for the anion gap?

A

10-17 mEq/L

IF HIGHER THAN 17 = Metabolic acidosis

57
Q

What is malignant hypercalcemia?

A
  • Occurs in 10-30 % of Cancer patients (breast/lung=>myelomas)
  • Oncologic emergency
  • Caused by cytokines, hormonal substances and growth factors from cancer cells
  • Ca levels >11 mg/dL
  • Life threatening symptoms r/t hypercalcemia
58
Q

How is Na+ regulated?

A

Regulated by two mechanisms:

  • Glomerular filtration rate
  • ADH (by hypothalamus) => Na reabsorption
  • Aldosterone (by the adrenal glands => Na reabsorption
  • Renin-angiotensin-aldosterone system => Na reabsorption

HypoNa [

                                    free water (16-20 L/day)

HyperNa [>160]: sodium bicarbonate (Tx acidosis), diuretics, vomit

59
Q

What are the nursing interventions for hypophosphatemia?

A
  • Treat cause
  • Replace levels
  • PO or IV supplements
  • IV for Na/K PO4
60
Q

What is the function of Na+?

A
  • Most abundant CATION (POSITIVELY charged) in ECF
  • Transmission of IMPULSES across MUSCLE and NERVE cells
  • Maintain acid/base balance
    • Combine with Cl or Bicarb to increase or decrease pH
61
Q

What is the normal range of chloride?

A

96-106

62
Q

What are the manifestations of hypophosphatemia?

A

Cardiovascular:

  • Diminished myocardial function
  • Severe: heart failure

Gastrointestinal:

  • Vomiting, nausea, anorexia

Neurologic:

  • Disorientation, irrtability, coma
  • Severe: neurologic dysfunction

Neuromusclar:

  • Pathologic fractures

Other:

  • Respirtatory failure or arrest, hemolysis, blood cell dysfunction
63
Q

What is the normal range for creatinine?

A
  1. 5-1.5mg/dL
    * *Affected by fewer conditions than BUN & THEREFORE, a BETTER INDICATOR of renal f(x) **
64
Q

What is the normal range for BUN?

A

5-25mg/dL

NOTE: If BUN lvls are high/low, but creatine levels are normal in a patient, think of fluid overload/deficit rather than ARF.

65
Q

When would BUN levels increase without there being any renal impariment?

A

With renal dysfunction there is a decrease in the GFR so there is decreased excretion of BUN and increased serum BUN levels. HOWEVER BUN can also be increased in the presence of normal kidney function such as with:

  • Hypovolemia
  • Hematoma reabsorption
  • GI Bleeding
66
Q

What is calcium regulated by?

A
  • PARATHYROID HORMONE [PTH]
  • Calcitonin (a hormone produced by the thyroid)
  • Calcitriol (active form of vitamin D)
67
Q

What is the function of potassium?

A
  • Intracellular CATION
  • Most common electrolyte abnormality in high-acuity
    • Intolerant of abnml K levels – potentially lethal
  • Close monitoring required
  • Maintains CARDIAC & NEUROMUSCULAR function
    • Affects muscle CONTRACTION
  • Influence nerve impulse CONDUCTION
  • Vital to CARBOHYDRATE metabolism for cell membrane function (hydrogen ions in vas exchange w K in ICF)
68
Q

What is the normal range for hemoglobin?

A

Adult males: 14 to 18 gm/dL
Adult women: 12 to 16 gm/dL

Fluid and electcro (1 decks)

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