F&E Imbalances Flashcards
1
Q
What is the best indicator of overall fluid loss or gain?
A
Weight
2
Q
What is an early indicator of a third-space shift?
A
A decrease in urine output despite adequate fluid intake
3
Q
Major cations (+)
A
Sodium, potassium, calcium, magnesium, H+ ions
4
Q
Major anions (-)
A
Chloride, bicarbonate, phosphate, sulfate, proteinate ions
5
Q
What is the most prevalent cation in ECF? Anion?
A
Na, Cl
6
Q
What is the most prevalent cation in ICF? Anion?
A
K, PO4
7
Q
Normal electrolyte levels
A
Na = 135-145 K = 3.5-5 Cl = 98-106 Ca = 8.5-10.5 PO4 = 2.5-4.5 Mg = 1.8-3
8
Q
What is normal urine output?
A
0.5 mL/kg/hr
9
Q
Fluid loss through…
A
- Kidney: high urine output (> 1 mL/kg/hr)
- Skin: sensible loss S/T sweating & insensible loss S/T fever, exercise, burns
- Lungs: 300 mL daily, greater w/increased RR
- GI: large losses due to diarrhea and fistulas
10
Q
What population is @ high risk of fluid imbalances?
A
Elderly
11
Q
Difference b/t FVD and dehydration
A
FVD = electrolytes & fluid lost
Dehydration = loss of water alone, increase in serum Na levels
12
Q
Causes of FVD
A
- Vomiting, diarrhea, sweating, GI suction
- Decreased intake S/T nausea, lack of access to fluid
- Third space shift S/T burns, ascites
- Diabetes insipidus, adrenal insufficiency, hemorrhage
13
Q
S/S of FVD
A
Acute weight loss, decreased skin turgor, oliguria, concentrated urine, prolonged cap refill, low CVP, decreased BP, flattened neck veins, dizziness, weakness, thirst & confusion, increased HR, cramps, sunken eyes, nausea, increased temp, cool/clammy/pale skin
14
Q
Lab findings in FVD
A
Increased H&H, serum & urine osmolality/specific gravity, BUN/creatinine
Decreased urine Na
15
Q
Nursing interventions FVD
A
- I&O Q8 hrs (at least)
- Daily weights
- VS, skin & tongue turgor, mucosa, output, mental status
- PO/IV fluids
16
Q
Causes of FVE
A
- Due to fluid overload, diminished homeostatic mechanisms
- HF, kidney injury, cirrhosis of liver
- Contributing factors: consumption of excessive amts of Na (table salt, sodium salts)
- Excess admin of Na containing fluids
17
Q
S/S of FVE
A
Acute weight gain, peripheral edema & ascites, JVD, crackles, elevated CVP, SOB, increased BP, bounding pulse, cough, increased RR, increased output
18
Q
Lab values FVE
A
Decreased H&H, serum/urine osmolality, urine Na & specific gravity
19
Q
Nursing interventions FVE
A
- I&O, daily weights
- Assess lung sounds, edema
- Monitor responses to RX’s —> diuretics, IVF
- Promote adherence to fluid restrictions
- Education R/T Na and fluid restrictions
- Monitor/avoid Na (including RX’s)
- Promote rest
20
Q
Hyponatremia
Causes
A
Imbalance of water, vomiting, diarrhea, sweating, diuretics, adrenal insufficiency, RX’s, SAIDH
21
Q
Hyponatremia
S/S
A
Poor skin turgor, dry mucosa, HA, decreased salivation, decreased BP, nausea, abdominal cramping, neuro changes
22
Q
Hyponatremia
Nursing interventions
A
- TX underlying condition
- Na replacement
- Water restriction
- Assessment: I&O, daily weight, labs, CNS changes
- Encourage dietary Na
- Monitor fluid intake, effects of RX’s
23
Q
Hypernatremia
Most affected
A
Very old, very young, cognitively impaired
24
Q
Hypernatremia
Causes
A
Fluid deprivation, excess Na admin, diabetes insipidus, heat stroke, hypertonic IV solutions
25
Hypernatremia
| S/S
Thirst
| Elevated temp
26
Hypernatremia
| Nursing interventions
- Decrease Na by slow infusion of hypotonic electrolyte solution
- Diuretics
- Assess: abnormal water losses, OTC sources of Na
- Monitor for CNS changes
27
Hypokalemia
| Causes
GI losses, RX’s, prolonged suctioning, recent ileostomy, tumor of intestine, alterations in acid-base balance, poor dietary intake, hyperaldosteronism
28
Hypokalemia
| S/S
ECG changes, dysrhythmias, dilute urine, excessive thirst, fatigue, anorexia, muscle weakness, decreased bowel motility, paresthesias
29
Hypokalemia
| Nursing interventions
- K replacement: PO or IV potassium, NEVER GIVEN AS IV PUSH/IM/SQ, GIVE SLOWLY, admin only after adequate urine output has been established
- Monitor for ECG changes, ABGs, digitalis toxicity
30
Hyperkalemia
| Causes
Impaired renal function, rapid admin of potassium, hypoaldosteronism, RX’s, tissue trauma, acidosis
31
Hyperkalemia
| S/S
Cardiac changes & dysrhythmias, muscle weakness, paresthesias, anxiety, GI manifestations
32
Hyperkalemia
| Nursing interventions
- Monitor ECG, labs, I&O, apical pulse
- Limit dietary potassium
- Admin of cation exchange resins (kayexalate)
- Emergent care: IV calcium gluconate, IV sodium bicarbonate, IV regular insulin & hypertonic D10W, beta-2 agonists, dialysis
33
Hypocalcemia
| What must serum level be considered in conjunction w/?
Serum albumin level
34
What controls calcium level?
PTH & calcitonin
35
Hypocalcemia
| Causes
Hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis, transfusion of citrated blood, kidney injury, RX’s
36
Hypocalcemia
| S/S
Tetany, circumoral numbness, paresthesias, hyperactive DTRs, trousseau’s sign, chvostek’s sign, seizures, dyspnea, laryngospasm, abnormal clotting, anxiety
37
Hypocalcemia
| Management
- IV calcium gluconate for emergency
- Seizure precautions
- PO calcium & vit D supplements
- Exercise to decrease bone calcium loss
- Patient teaching R/T diet & RX’s
38
What causes trousseaus sign?
Ischemia of the ulnar nerve
39
Hypercalcemia
| Causes
Malignancy, hyperparathyroidism, bone loss R/T immobility, diuretics
40
Hypercalcemia
| S/S
Polyuria, thirst, muscle weakness, intractable nausea, abdominal cramps, severe constipation, diarrhea, peptic ulcer, bone pain, ECG changes, dysrhythmias
41
Hypercalcemia
| Management
- TX underlying cause
- IVF, furosemide, phosphates, calcitonin, biphosphonates
- Increase mobility
- Encourage fluids
- Dietary teaching, fiber for constipation
- Ensure safety
42
Hypomagnesemia
| Causes
Alcoholism, GI losses, enteral or paraenteral feeding deficient in mag, RX’s, rapid admin of citrated blood
43
Hypomagnesemia
| S/S
Chvostek & Trousseau signs, apathy, depressed mood, psychosis, NM irritability, muscle weakness, tremors, ECG changes, dysrhytmias
44
Hypomagnesemia
| Management
- Mag sulfate IV —> monitor VS and output
- PO mag —> watch for diarrhea
- Monitor for dysphasia
- Seizure precautions
- Dietary teaching
45
Hypermagnesemia
| Causes
Kidney injury, DKA, excessive admin of mag, extensive soft tissue injury
46
Hypermagnesemia
| S/S
Hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias, cardiac arrest
47
Hypermagnesemia
| Management
- IV calcium gluconate
- Hemodialysis
- Admin of loop diuretics, sodium chloride, LR
- Avoid meds w/mag
- Education regarding OTC meds w/mag
- Observe for DTR & changes in LOC
48
Hypophospatemia
| Causes
Alcoholism, refeeding syndrome, pain, heat, stroke, respiratory alkalosis, hyperventilation, DKA, hepatic encephalopathy, major burns, hyperparathyroidism, low mag, low K, diarrhea, vit D deficiency, use of diuretics & antacids
49
Hypophosphatemia
| S/S
Confusion, muscle weakness, tissue hypoxia, muscle & bone pain, increased susceptibility to infections
50
Hypophosphatemia
| Management
- PO/IV phosphorus
- Encourage foods high in phosphorus
- Gradually introduce calories for malnourished patients receiving parenteral nutrition
51
Hyperphosphatemia
| Causes
Kidney injury, excessive phosphorus, excessive vit D, acidosis, hypoparathyroidism, chemotherapy
52
Hyperphoshatemia
| S/S
Few S/S
| Soft tissue calcifications, S/S of hypocalcemia
53
Hyperphosphatemia
| Management
- TX underlying condition
- Vit D, calcium-binding antacids, phosphate-binding gels/antacids, loop diuretics, NS IV, dialysis
- Avoid high phos foods
- S/S of hypocalcemia
54
Hypochloremia
| Causes
Addison’s disease, reduced intake, GI loss, DKA, excessive sweating, fever, burns, RX’s, metabolic acidosis
Occurs w/loss of other lytes : K, Na
55
Hypochloremia
| S/S
Agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma
56
Hypochloremia
| Management
- Replace chloride w/IV NS or 0.45% NS
| - Avoid free water, encourage high-chloride foods
57
Hyperchloremia
| Causes
Excessive NS infusion w/water loss, TBI, hypernatremia, dehydration, severe diarrhea, respiratory alkalosis, metabolic acidosis, hyperparathyroidism, RX’s
58
Hyperchloremia
| S/S
Tachypnea, lethargy, weakness, rapid/deep respirations, HTN, cognitive changes
59
Hyperchloremia
| Management
- Restore lytes & fluid balance w/LR, sodium bicarbonate, diuretics
- Diet & hydration teaching
60
Potassium rich foods
Potatoes, pork, oranges, tomatoes, avocado, strawberries, spinach, fish, mushrooms, musk melons (cantaloupe)
61
Sodium rich foods
Bacon, butter, cheese, hot dogs, lunch meat, processed foods, table salt, canned foods
62
Calcium rich foods
Yogurt, sardines, cheese, spinach, collard greens, tofu, rhubarb, milk
63
Phosphorus rich foods
Fish, organ meat, nuts, pork, chicken, whole grains, beef
64
Magnesium rich foods
Avocado, green/leafy veggies, peanut butter, pork, oatmeal, fish (canned tuna, mackerel), cauliflower, dark chocolate, legumes, nuts, oranges, milk
65
Chloride rich foods
Table salt/sea salt, seaweed, rye, tomatoes, lettuce, celery, olives
