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z Here you go, Alexis! > f & e > Flashcards

f & e Flashcards

1
Q

hypervolemia is

A

fluid volume excess

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2
Q

hypovolemia is

A

fluid volume deficit

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3
Q

fluid volume excess: definition

A

too much fluid in the vascular space

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4
Q

how does heart failure lead to fluid volume excess?

A 
heart is WEAK
cardiac output DECREASES
kidney perfusion DECREASES
urine output DECREASES
volume stays in VASCULAR SPACE
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5
Q

3 meds that can lead to fluid volume excess and why

A

alka-seltzer
fleet’s enema
IVF with Na

all 3 have a lot of Na

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6
Q

hormones that regulate fluid volume

A

aldosterone
atrial natriuretic peptide
anti-diuretic hormone

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7
Q

aldosterone: what and where

A

steroid (mineralocorticoid) made by the adrenal glands

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8
Q

aldosterone: normal action

A

in response to LOW blood volume (d/t vomiting, hemorrhage, etc) –>aldosterone secretion increases

  • -> Na + H2O retained
  • -> blood volume goes up
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9
Q

diseases with too much aldosterone x2

A

Cushing’s Syndrome (too much of all electrolytes)

hyperaldosteronism aka Conn’s Syndrome

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10
Q

disease with too little aldosterone

A

Addison’s Syndrome

lose Na + H2O = fluid volume deficit

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11
Q

atrial natriuretic peptide: where & action

A

secreted by atria (in response to stretch due to increased volume)
causes excretion of Na and H2O

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12
Q

opposite action from aldosterone

A

atrial natriuretic peptide –>

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13
Q

anti-diuretic hormone: where and action

A

secreted by pituitary gland

causes retention of H2O (and therefore Na)

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14
Q

too much ADH / not enough ADH: diseases x2

A

too much ADH: SIADH

not enough ADH: diabetes insipidus

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15
Q

siadh

A

syndrome of inappropriate anti-diuretic hormone
TOO MANY LETTERS TOO MUCH H2O

retain H2O –> fluid volume excess

blood: dilute
urine: concentrated

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16
Q

diabetes insipidus

A

DI = DIuresis

lose (diurese) H2O –> fluid volume deficit

blood: concentrated
urine: dilute

THINK: SHOCK

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17
Q

see diabetes insipidus, think…

A

DIuresis

shock!

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18
Q

key words to make you think potential ADH problem

A

craniotomy, head injury, sinus injury, transphenoidal hypophysectomy, any condition leading to ICP

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19
Q

other names for ADH

A

vasopressin
DDAVP

  • may be utilized as ADH replacement in DI -
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20
Q

hypervolemia s/s: vessels full therefore…

A

distended neck and peripheral veins

leak –> peripheral edema, third spacing

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21
Q

hypervolemia s/s: CVP…

A

increased

MORE VOLUME MORE PRESSURE

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22
Q

hypervolemia s/s: lung sounds

A

wet

- down low, listen posteriorly at bases

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23
Q

hypervolemia s/s: polyuria

A

kidneys trying to help you diurese

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24
Q

hypervolemia s/s: pulse

A

full and bounding

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25
Q

hypervolemia s/s: BP

A

increases

MORE VOLUME MORE PRESSURE

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26
Q

hypervolemia s/s: weight

A

increases

fluid not fat

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27
Q

fluid retention think…

A

heart problems first!

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28
Q

hypervolemia: treatments x5

A
  • low Na diet
  • restrict fluids
  • daily i/o and weights
  • diuretics
  • bed rest
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29
Q

with all diuretics watch…

A

lab work - potential dehydration and electrolyte problems

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30
Q

how does bedrest induce diuresis?

A

through the release of ANP and decreased production of ADH

- fluid returns to core, heart stretches, ANP produced and pituitary signaled to decrease ADH production

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31
Q

why give IVF slowly to the elderly?

A

this age group goes into fluid volume excess easier

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32
Q

why are IVF given during bedrest?

A

prevent DVT, PE, pneumonia

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33
Q

major fluid deficit results in

A

shock

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34
Q

hypovolemia: causes + why

A

loss of fluids
- thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage

third spacing
- burns, ascites

diseases with polyuria
- polyuria becomes oliguria becomes anuria

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35
Q

hypovolemia s/s: weight

A

decreases

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36
Q

hypovolemia s/s: skin turgor

A

decreased

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37
Q

hypovolemia s/s: mucus membranes

A

dry

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38
Q

hypovolemia s/s: urine output + why

A

decreased

- kidneys aren’t being perfused or are trying to retain fluid to compensate

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39
Q

hypovolemia s/s: BP

A

decreased

LESS VOLUME, LESS PRESSURE

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40
Q

hypovolemia s/s: pulse

A

increased and weak and thready - heart is trying to pump what little fluid is left

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41
Q

hypovolemia s/s: respirations + why

A

increased because body perceives decrease in circulating blood volume as hypoxia

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42
Q

hypovolemia s/s: CVP

A

decreased

LESS VOLUME, LESS PRESSURE

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43
Q

hypovolemia s/s: peripheral/neck veins

A

vasoconstrict, very tiny!

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44
Q

hypovolemia s/s: extremities + why

A

cool d/t peripheral vasoconstriction in an effort to shunt blood to vital organs

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45
Q

hypovolemia s/s: urine specific gravity

A

increased - very concentrated

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46
Q

hypovolemia treatment x3

A

prevent further losses
replace volume
safety precautions

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47
Q

how do you replace volume with mild hypovolemia?

A

PO

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48
Q

how do you replace volume with severe hypovolemia?

A

IVF

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49
Q

what safety precautions should be taken for hypovolemic patient? x2

A

fall risk: r/t changes in vitals and mental staus

monitor for fluid overload

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50
Q

isotonic solutions: action

A

goes into vascular space and stays there

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51
Q

isotonic solutions: examples

A

NS, LR, D5W, D5 1/4 NS

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52
Q

isotonic solutions: uses x2

A

for client that needs blood volume
- fluids lost via n/v, burns, sweating, trauma

also, NS is basic solution when administering blood

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53
Q

isotonic solutions: in excess can cause x3

A

fluid volume excess, hypertension, hypernatremia

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54
Q

never give isotonic solutions to x3

A

patients with hypertension, renal disease, cardiac disease

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55
Q

hypernatremia is an alert only when administering isotonic solutions…

A

that contain sodium

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56
Q

hypotonic solutions: action

A

go into vascular space, hang out, shift out into the cells to replace cellular fluids

rehydrate but do not cause hypertension

57
Q

hypotonic solutions: examples

A

D 2.5 W, 1/2 NS (0.45%), 0.33% NS

58
Q

hypotonic solutions: uses x3

A

for client who has hypertension, renal, or cardiac disease and needs fluid replacement because of nausea, vomiting, burns, hemorrhage, etc.

also used for dilution when client has hypernatremia and for cellular dehydration

59
Q

hypotonic solutions: alert

A

watch for cellular edema because this fluid is moving out to the cells which could lead to fluid volume deficit and decrease blood pressure (when used to the extreme)

60
Q

hypertonic solutions: action

A

packed with particles! volume expanders that draw fluid into the vascular space from the cell

61
Q

hypertonic solutions: examples

A

D10W, 3% NS, 5% NS, D5LR, D5 1/2NS, D5 NS, TPN, albumin

62
Q

hypertonic solutions: uses

A

client with hyponatremia or

who has shifted large amounts of vascular volume due to a third space, severe edema, burns, ascites

63
Q

hypertonic solutions: alert

A

watch for fluid volume excess

monitor in an ICU setting: hourly BP, HR, CVP – ESPECIALLY for 3% or 5% NS (Na = worry about rapid shifts of fluid)

64
Q

magnesium is excreted by

A

the kidneys, but can be lost other ways (such as via GI tract)

65
Q

Mg and Ca act like

A

sedatives

66
Q

see Mg and Ca think…

A

muscles first!

67
Q

hypermagnesemia: causes x2

A

renal failures

antacids (in ESRD)

68
Q

hypermagnesemia: s/s

A

flushing
warmth
vasodilation (decreased BP)

69
Q

hypermagnesemia, hypercalcemia: s/s in common

A

decreased: DTR, LOC, HR, RR
arrhythmias
weak, flaccid muscle tone

70
Q

hyper Mg or Ca s/s: DTR

A

decreased

71
Q

hyper Mg or Ca s/s: LOC

A

decreased

72
Q

hyper Mg or Ca s/s: HR

A

decreased

73
Q

hyper Mg or Ca s/s: RR

A

decreased

74
Q

hyper Mg or Ca s/s: heart & muscle

A

arrhythmias

weak, flaccid muscle tone

75
Q

hypermagnesemia: treatment & why x4

A

ventilator
- Mg toxic, RR less than 12

dialysis
- kidney excretion

calcium gluconate
- reverses decreased RR and potential arrhythmias

safety precautions

76
Q

Ca, phosphate relationship

A

inverse!

77
Q

hypercalcemia: causes x3

A

hyperparathyroidism
thiazides
immobilization

78
Q

PTH and calcium relationship

A

serum Ca low
PTH secreted and moves Ca from bones into the blood
serum Ca increases

79
Q

how do thiazides cause hypercalcemia?

A

retention of Ca+

80
Q

how does immobilization cause hypercalcemia?

A

weight-bearing necessary to keep Ca in bones

81
Q

hypercalcemia: s/s x2

A

brittle bones, kidney stones

82
Q

hypercalcemia: treatment

A
  • BOOM BOOM
  • fluids
  • sodium phosphate enema
  • steroids
  • add phosphorus to diet
  • vitamin D
  • calcitonin
83
Q

hypercalcemia treatment: fluids purpose

A

prevent kidney stones

84
Q

hypercalcemia treatment: sodium phosphate enema purpose

A

Ca and P have an inverse relationship

increase P, Ca goes down!

85
Q

hypercalcemia treatment: steroids purpose

A

decrease serum Ca

86
Q

hypercalcemia treatment: calcitonin purpose

A

decreases serum Ca by returning it to the bones

- typically given for osteoporosis

87
Q

hypercalcemia treatment: why safety precautions?

A

think: SEDATION!

88
Q

hypomagnesemia: causes

A

diarrhea (lots of Mg in intestines)
alcoholism
- alcohol suppresses ADH & it’s hypertonic

89
Q

hypomagnesemia and hypocalcemia s/s

A
  • rigid, tight muscle tone
  • seizures
  • stridor/laryngospasm
  • positive chvostek’s
  • positive trousseau’s
  • arrhythmias
  • increased DTRs
  • AMS (anything)
  • dysphagia
90
Q

hypomagnesemia and hypocalcemia s/s: muscle tone

A

rigid, tight

91
Q

hypomagnesemia and hypocalcemia s/s: stridor and laryngospasms why

A

smooth muscle

not enough sedative!

92
Q

hypomagnesemia and hypocalcemia s/s: arrhythmias why

A

heart muscle - not enough sedative

93
Q

hypomagnesemia and hypocalcemia s/s: dysphagia why

A

smooth muscle

not enough sedative!

94
Q

chvostek’s sign

A

tap cheek = twitch

sign of hypomagnesemia or hypocalcemia

95
Q

trousseau’s sign

A

inflate BP cuff = arm jerks

sign of hypomagnesemia or hypocalcemia

96
Q

hypomagnesemia: treatment

A
  • give Mg
  • check kidney function before and after IV Mg (excretion of Mg!)
  • seizure precautions
  • diet
97
Q

what do you do if client reports flushing and sweating when IV Mag started?

A

STOP INFUSION!!

98
Q

magnesium effect on vessels

A

vasodilation

99
Q

hypocalcemia: causes

A

hypoparathyroidism
radial neck
thyroidectomy

100
Q

not enough PTH =

A

reduced serum Ca

101
Q

hypocalcemia: treatment

A
  • vitamin D
  • phosphate binders
  • IV Ca
102
Q

nursing considerations for administration of IV Ca

A
  • give slowly

- telemetry

103
Q

hypocalcemia treatment: why Vitamin D

A

needed to utilize Ca

104
Q

hypocalcemia treatment: why phosphate binders

A

because of inverse relationship between Ca and P

- bind PO4 = increase in Ca

105
Q

sodium think…

A

neurological changes

106
Q

Na level in blood is totally dependent on

A

how much water you have in your body.

107
Q

hypernatremia

A

= dehydration; too much Na, not enough H2O

108
Q

hypernatremia: causes x4

A

hyperventilation
heat stroke
diabetes insipidus
vomiting, diarrhea, etc

109
Q

hypernatremia: s/s x3

A

dry mouth
thirst
swollen tongue

110
Q

significance of thirst and hypernatremia

A

you are already dehydrated by the time you are thirsty

111
Q

swollen tongue

A

sign that is very specific to hypernatremia

112
Q

hypernatremia: treatment

A
  • restrict Na
  • dilute client with fluids (DILUTION MAKES #s GO DOWN)
  • daily weight
  • i/o
  • lab work
113
Q

if you’ve got an Na problem…

A

you’ve got a fluid volume problem

114
Q

feeding tube clients to get ? + how to fix?

A

dehydrated; offset with free water

115
Q

hyponatremia

A

dilution; too much H2O, not enough Na

116
Q

hyponatremia: causes x4

A
  • drinking H2O for fluid replacement
  • psychogenic polydipsia
  • D5W
  • SIADH
117
Q

hyponatremia: s/s x3

A
  • headache
  • seizure
  • coma
118
Q

hyponatremia: treatment

A

CLIENT NEEDS Na CLIENT DOESN’T NEED H2O

neuro problems? need hypertonic saline
- 3% or 5% NS

119
Q

note about saline infusion for hyponatremia

A

pulling water in vascular space rapidly = beware fluid volume excess
- ICU to monitor HR, BP, CVP

brain cannot handle rapid shifts of volume quickly

120
Q

potassium is excreted by

A

kidneys

therefore if kidneys are not working well, serum K goes up

121
Q

hyperkalemia: causes

A

kidney issues

spironolactone

122
Q

hyperkalemia: s/s

A

in this order:
muscle twitching
weakness
flaccid paralysis

also, life-threatening arrhythmias

123
Q

hyperkalemia: treatment

A
  • dialysis
  • calcium gluconate
  • glucose and insulin
  • Kayexalate
124
Q

hyperkalemia treatment: why dialysis

A

kidneys aren’t functioning

125
Q

hyperkalemia treatment: why calcium gluconate

A

decreases arrhythmias

126
Q

hyperkalemia treatment: why glucose and insulin

A

insulin carries GLUCOSE and POTASSIUM into the cell

127
Q

any time you give IV insulin, worry about…

A

hypoglycemia and hypokalemia

128
Q

Kayexalate

A

sodium poylystyrene sulfonate

  • given for hyperkalemia
  • exchanges Na for K in GI tract = VOLUMINOUS DIARRHEA!
129
Q

hypokalemia: causes

A
  • vomiting
  • ng suction
  • diuretics
  • not eating
130
Q

why does ng suction contribute to hypokalemia?

A

we have a lot of K in our stomachs

131
Q

hypokalemia: s/s

A
  • muscle cramps
  • weakness
  • life threatening arrhythmias
132
Q

hypokalemia: treatment

A
  • give potassium (CHECK KIDNEY FUNCTION!)
  • spironolactone
  • diet
133
Q

if you give potassium for hypokalemia…

A

check kidney function!

134
Q

sodium and potassium relationship

A

INVERSE!

135
Q

major problem with PO K+?

A

GI upset, so give with food

136
Q

assess what before/during IV K+

A

UOP

137
Q

never give IV K+…

A

BOLUS. always administer ON A PUMP

138
Q

hyperkalemia EKG changes

A 
bradycardia
tall and peaked T waves
prolonged PR intervals
flat or absent P waves
widened QRS
conduction blocks
v fib
139
Q

hypokalemia EKG changes

A

U waves
PVC
v tach

z Here you go, Alexis! (23 decks)

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