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Nursing 202 - Midterm > F&E Imbalances > Flashcards

F&E Imbalances Flashcards

1
Q

What is the best indicator of overall fluid loss or gain?

A

Weight

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2
Q

What is an early indicator of a third-space shift?

A

A decrease in urine output despite adequate fluid intake

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3
Q

Major cations (+)

A

Sodium, potassium, calcium, magnesium, H+ ions

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4
Q

Major anions (-)

A

Chloride, bicarbonate, phosphate, sulfate, proteinate ions

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5
Q

What is the most prevalent cation in ECF? Anion?

A

Na, Cl

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6
Q

What is the most prevalent cation in ICF? Anion?

A

K, PO4

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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
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8
Q

What is normal urine output?

A

0.5 mL/kg/hr

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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
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10
Q

What population is @ high risk of fluid imbalances?

A

Elderly

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11
Q

Difference b/t FVD and dehydration

A

FVD = electrolytes & fluid lost

Dehydration = loss of water alone, increase in serum Na levels

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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
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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

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14
Q

Lab findings in FVD

A

Increased H&H, serum & urine osmolality/specific gravity, BUN/creatinine

Decreased urine Na

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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
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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
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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

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18
Q

Lab values FVE

A

Decreased H&H, serum/urine osmolality, urine Na & specific gravity

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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
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20
Q

Hyponatremia

Causes

A

Imbalance of water, vomiting, diarrhea, sweating, diuretics, adrenal insufficiency, RX’s, SAIDH

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21
Q

Hyponatremia

S/S

A

Poor skin turgor, dry mucosa, HA, decreased salivation, decreased BP, nausea, abdominal cramping, neuro changes

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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
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23
Q

Hypernatremia

Most affected

A

Very old, very young, cognitively impaired

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24
Q

Hypernatremia

Causes

A

Fluid deprivation, excess Na admin, diabetes insipidus, heat stroke, hypertonic IV solutions

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25
Q

Hypernatremia

S/S

A

Thirst

Elevated temp

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26
Q

Hypernatremia

Nursing interventions

A
  • Decrease Na by slow infusion of hypotonic electrolyte solution
  • Diuretics
  • Assess: abnormal water losses, OTC sources of Na
  • Monitor for CNS changes
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27
Q

Hypokalemia

Causes

A

GI losses, RX’s, prolonged suctioning, recent ileostomy, tumor of intestine, alterations in acid-base balance, poor dietary intake, hyperaldosteronism

28
Q

Hypokalemia

S/S

A

ECG changes, dysrhythmias, dilute urine, excessive thirst, fatigue, anorexia, muscle weakness, decreased bowel motility, paresthesias

29
Q

Hypokalemia

Nursing interventions

A
  • 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
Q

Hyperkalemia

Causes

A

Impaired renal function, rapid admin of potassium, hypoaldosteronism, RX’s, tissue trauma, acidosis

31
Q

Hyperkalemia

S/S

A

Cardiac changes & dysrhythmias, muscle weakness, paresthesias, anxiety, GI manifestations

32
Q

Hyperkalemia

Nursing interventions

A
  • 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
Q

Hypocalcemia

What must serum level be considered in conjunction w/?

A

Serum albumin level

34
Q

What controls calcium level?

A

PTH & calcitonin

35
Q

Hypocalcemia

Causes

A

Hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis, transfusion of citrated blood, kidney injury, RX’s

36
Q

Hypocalcemia

S/S

A

Tetany, circumoral numbness, paresthesias, hyperactive DTRs, trousseau’s sign, chvostek’s sign, seizures, dyspnea, laryngospasm, abnormal clotting, anxiety

37
Q

Hypocalcemia

Management

A
  • 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
Q

What causes trousseaus sign?

A

Ischemia of the ulnar nerve

39
Q

Hypercalcemia

Causes

A

Malignancy, hyperparathyroidism, bone loss R/T immobility, diuretics

40
Q

Hypercalcemia

S/S

A

Polyuria, thirst, muscle weakness, intractable nausea, abdominal cramps, severe constipation, diarrhea, peptic ulcer, bone pain, ECG changes, dysrhythmias

41
Q

Hypercalcemia

Management

A
  • TX underlying cause
  • IVF, furosemide, phosphates, calcitonin, biphosphonates
  • Increase mobility
  • Encourage fluids
  • Dietary teaching, fiber for constipation
  • Ensure safety
42
Q

Hypomagnesemia

Causes

A

Alcoholism, GI losses, enteral or paraenteral feeding deficient in mag, RX’s, rapid admin of citrated blood

43
Q

Hypomagnesemia

S/S

A

Chvostek & Trousseau signs, apathy, depressed mood, psychosis, NM irritability, muscle weakness, tremors, ECG changes, dysrhytmias

44
Q

Hypomagnesemia

Management

A
  • Mag sulfate IV —> monitor VS and output
  • PO mag —> watch for diarrhea
  • Monitor for dysphasia
  • Seizure precautions
  • Dietary teaching
45
Q

Hypermagnesemia

Causes

A

Kidney injury, DKA, excessive admin of mag, extensive soft tissue injury

46
Q

Hypermagnesemia

S/S

A

Hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias, cardiac arrest

47
Q

Hypermagnesemia

Management

A
  • 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
Q

Hypophospatemia

Causes

A

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
Q

Hypophosphatemia

S/S

A

Confusion, muscle weakness, tissue hypoxia, muscle & bone pain, increased susceptibility to infections

50
Q

Hypophosphatemia

Management

A
  • PO/IV phosphorus
  • Encourage foods high in phosphorus
  • Gradually introduce calories for malnourished patients receiving parenteral nutrition
51
Q

Hyperphosphatemia

Causes

A

Kidney injury, excessive phosphorus, excessive vit D, acidosis, hypoparathyroidism, chemotherapy

52
Q

Hyperphoshatemia

S/S

A

Few S/S

Soft tissue calcifications, S/S of hypocalcemia

53
Q

Hyperphosphatemia

Management

A
  • 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
Q

Hypochloremia

Causes

A

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
Q

Hypochloremia

S/S

A

Agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma

56
Q

Hypochloremia

Management

A
  • Replace chloride w/IV NS or 0.45% NS

- Avoid free water, encourage high-chloride foods

57
Q

Hyperchloremia

Causes

A

Excessive NS infusion w/water loss, TBI, hypernatremia, dehydration, severe diarrhea, respiratory alkalosis, metabolic acidosis, hyperparathyroidism, RX’s

58
Q

Hyperchloremia

S/S

A

Tachypnea, lethargy, weakness, rapid/deep respirations, HTN, cognitive changes

59
Q

Hyperchloremia

Management

A
  • Restore lytes & fluid balance w/LR, sodium bicarbonate, diuretics
  • Diet & hydration teaching
60
Q

Potassium rich foods

A

Potatoes, pork, oranges, tomatoes, avocado, strawberries, spinach, fish, mushrooms, musk melons (cantaloupe)

61
Q

Sodium rich foods

A

Bacon, butter, cheese, hot dogs, lunch meat, processed foods, table salt, canned foods

62
Q

Calcium rich foods

A

Yogurt, sardines, cheese, spinach, collard greens, tofu, rhubarb, milk

63
Q

Phosphorus rich foods

A

Fish, organ meat, nuts, pork, chicken, whole grains, beef

64
Q

Magnesium rich foods

A

Avocado, green/leafy veggies, peanut butter, pork, oatmeal, fish (canned tuna, mackerel), cauliflower, dark chocolate, legumes, nuts, oranges, milk

65
Q

Chloride rich foods

A

Table salt/sea salt, seaweed, rye, tomatoes, lettuce, celery, olives

Nursing 202 - Midterm (12 decks)

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