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Pathopharm I > Fluid > Flashcards

Fluid Flashcards

1
Q

Intracellular fluid

A

70%

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2
Q

Extracellular fluid

A

30%

Interstitial fluid + intravascular fluid (plasma)

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3
Q

Normal sodium

A

136-145 mEq/L

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4
Q

Normal potassium

A

3.5-5.0 mEq/L

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5
Q

Normal magnesium

A

1.7-2.2 mg/dL

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6
Q

Normal calcium

A

9-11 mg/dL

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7
Q

Normal phosphate

A

3.2-4.3 mg/dL

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8
Q

Sodium

A 
Main ECF cation
Governs osmolality
Influences water distribution 
Aids in acid-base balance
Activates muscle and nerve cells
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9
Q

Hyponatremia (<136) causes

A

GI loss: diarrhea, vomiting, fluid loss from fistula, excessive NG suction
Renal loss: diuretics, adrenal insufficiency
Skin loss: burns, wounds
Fasting
Drinking too much water
Excess hypotonic fluid

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10
Q

Hyponatremia signs/symptoms

A 
Confusion
Altered LOC
Anorexia
Muscle weakness
Seizures
Coma
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11
Q

Dilutional hyponatremia

A

Hypervolemic

Too much fluid lowers sodium concentration

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12
Q

Depletional hyponatremia

A

Hypovolemic

Absolute sodium loss

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13
Q

Dilutional hyponatremia symptoms

A 
Hypervolemia
High blood pressure
Weight gain
Bounding rapid pulse
Increased urine specific gravity
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14
Q

Depletional hyponatremia symptoms

A 
Hypovolemia
Decreased blood pressure
Tachycardia
Dry skin
Weight loss
Decreased urine specific gravity
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15
Q

Hyponatremia treatment

A

Sodium replacement (must do slowly)
Can replace IV or PO
NS
Fluid restriction for dilutional hyponatremia

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16
Q

Sodium bicarbonate MOA

A

Dissociates to sodium ion and bicarbonate ion—neutralizing ion concentration, raising pH, and increasing sodium plasma concentration

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17
Q

Sodium bicarbonate indication

A

Metabolic acidosis

Long-term hyponatremia

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18
Q

Sodium bicarbonate SE

A

Edema, cerebral hemorrhage, hypernatremia, electrolyte abnormalities, metabolic alkalosis, flatulence (with PO), tetany, pulmonary edema, heart failure exacerbation

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19
Q

Sodium bicarbonate nursing considerations

A

Do not give IV for hyponatremia (irritant/vesicant at high concentration)—only IVP through central line
If IV monitor IV patency
IVP for metabolic acidosis
Cardiac monitor
Monitor ABGs and electrolytes
Many drug interactions if drug is diluted in sodium solution
For PO give 1-3 after or before meals

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20
Q

Hypernatremia causes

A

IV fluids, tube feeds, near drowning in salt water, insufficient water intake, significant water loss (cognitively impaired, diarrhea, high fever, heatstroke), profound diuresis, cannot get from consuming salty foods

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21
Q

Hypernatremia signs/symptoms

A 
Altered LOC
Confusion
Seizure
Coma
Extreme thirst
Dry and sticky mucous membranes
Muscle cramps
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22
Q

Hypernatremia treatment

A

Add water or remove sodium
Fluid replacement must occur slowly to prevent cerebral edema
Gradually achieve normal sodium over 48 hours to avoid cerebral edema

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23
Q

Potassium

A

Main source: diet

Main source for loss: kidneys

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24
Q

Hypokalemia causes (<3.5)

A

Renal/GI losses: diuresis, diuretics, diarrhea, vomiting, ileostomy
Acid-base disorders

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25
Q

Hypokalemia signs/symptoms

A 
Cardiac rhythm disturbances
Muscle weakness
Cramps
Decreased bowel motility
Constipation
Nausea
Ileus
26
Q

Potassium chloride indication

A

Potassium depletion when dietary measures are inadequate

27
Q

Potassium chloride nursing indications

A

Given PO or IV
If given PO, dilute with smth to decrease GI distress as taste is bad
Must dilute IV potassium
Never give potassium IVP

28
Q

Potassium chloride SE

A

GI ulcers/bleeding

Nausea/vomiting

29
Q

IV potassium chloride nursing implications

A

Always dilute IV potassium and give slowly us. over an hour
Only give to patients with documented urine output
May cause phlebitis and pain
IV solutions should not contain more than 40 mEq/L and rate should not be greater than 10-20 mEq/hr
Patient must be placed on telemetry
Contraindicated for patients with renal failure
Never give IVP

30
Q

Undiluted IV potassium

A

Can cause v-fib
Must dilute IV potassium
Must never be given IVP

31
Q

Hyperkalemia causes

A

Renal failure and decreased urination causing decreased potassium output
Burns/crush injuries/sepsis causing cell bursting
Potassium-sparing diuretics, ACE inhibitors, ARBs, NSAIDs

32
Q

Hyperkalemia symptoms

A 
Cardiac rhythm disturbances
Muscle weakness
Cramps
Abdominal cramps
Diarrhea
Vomiting
33
Q

sodium polystyrene sulfonate

A

Trade name: Kayexalate
Class: cation exchange resin
Indication: hyperkalemia
MOA: binds to K and replaces K for sodium ions
Routes: PO, oral/rectal powder, oral/rectal suspension, rectal enema
Precaution: only use if bowel functions normal

34
Q

sodium polystyrene sulfonate SE

A 
Constipation
Diarrhea
Nausea
Vomiting
Hypokalemia
Intestinal obstruction 
Intestinal necrosis
35
Q

D50/insulin

A

Indication: hyperkalemia
MOA: insulin temporarily shifts potassium into the cell
Usually give 10 units regular insulin and 1 amp D50
Must check BS before/after

36
Q

Magnesium functions

A

Stabilizes cardiac muscle cells
Blocks/controls movement of K+ out of cardiac cells
Stabilizes smooth muscle
1.7-2.2

37
Q

Hypomagnesemia (<1.7)

A

Causes: GI/renal loss, limited dietary intake, alcohol abuse, pancreatitis, hyperglycemia

38
Q

Hypomagnesemia s/s

A 
Hyperactive reflexes
Cramps
Tremors
Confusion 
Seizures
Nystagmus
39
Q

Hypomagnesemia treatment

A

PO: Mylanta, magnesium sulfate
IV: magnesium sulfate

40
Q

Magnesium sulfate, magnesium oxide

A

Indication: hypomagnesemia, to prevent/treat seizures in preeclampsia, to treat cardiac rhythm disturbances, constipation (given PO), as an antacid

Magnesium oxide can be given for long-term hypomagnesemia

Route: IV (us. for hypomagnesemia) or PO (for GI symptoms)

Nursing: IV magnesium sulfate must be replaced over several days, IVP allowed if needed

41
Q

Magnesium sulfate, magnesium oxide SE

A

Hypermagnesemia, confusion, feeling sluggish, slow movements, SOB, nausea, dizziness (low calcium), abnormal heart rhythm, burning sensation when given IV

42
Q

Hypermagnesemia (>2.2)

A

Causes: increased intake with renal failure (I.e., chronic renal failure pt taking milk of magnesium), IV magnesium in OB patients to prevent seizures

Treatment: discontinue replacement, dialysis if chronic decreased intake

43
Q

Hypermagnesemia s/s

A 
Lethargy
Floppiness
Muscle weakness
Decreased reflexes
Flushed/warm skin
Decreased pulse
Decreased blood pressure
44
Q

Calcium functions

A

Enzyme reactions
Membrane potentials/nerve excitability
Skeletal/smooth/cardiac muscle contraction
Release of hormones, neurotransmitters, and chemical mediators
Influences cardiac contractility
Blood clotting

45
Q

Hypocalcemia causes

A 
Hypoparathyroidism
Hypomagnesemia 
Increased renal loss from renal failure
Increased binding to albumin (inactive form)
Decreased intake
Decreased vitamin D
Acute pancreatitis
Thyroid/parathyroid surgery
46
Q

Hypocalcemia symptoms

A 
Causes increased neuromuscular excitability
Parasthesias
Muscle cramps
Bone pain
Tetany (muscle spasms)
Laryngeal spasm
Hyperactive reflexes
Cardiac insufficiency
Prolonged QT interval
Positive Chvostek’s sign
Positive Trousseau’s sign
47
Q

Chvostek’s sign

A

Ipsilateral twitching of the circumoral muscles in response to gentle tapping of the facial nerve just anterior to the ear

48
Q

Trousseau’s sign

A

Carpal spasm upon inflation of BP cuff to 20 mmHg above systolic for 3 minutes

49
Q

Hypocalcemia treatment

A

IV calcium chloride (ionized form; preferred)
IV calcium gluconate: preferably through central line
PO calcium: elemental Ca, calcium carbonate
May also need vitamin D (active form of liver impaired and/or kidney dysfunction)

50
Q

Hypercalcemia causes

A

Hyperparathyroidism (PTH increases serum Ca2+), cancers, TUMS overdose

51
Q

Hypercalcemia s/s

A 
Calcium acts like a sedative
Fatigue
Lethargy
Confusion
Weakness
Seizures
COma
Kidney stones (chronic hypercalcemia)
52
Q

Hypercalcemia treatment

A 
Adequate hydration
Increased urine output
Diuretics
NaCl (sodium excretion accompanied by calcium excretion)
Dialysis in renal failure
53
Q

Phosphorous

A

Calcium and phosphate collaborate (low Ca-high P)
Found in bone, involved in bone formation
Essential for ATP formation
Part of DNA/RNA
Needed for enzymes in glucose/protein/fat metabolism
Involved in acid-base buffer
Needed for WBC and platelet function
Inorganic: circulating, measured
Organic: intracellular

54
Q

Hypophosphatemia (<3.2) Causes

A 
Decreased absorption
Antacid overdose
Severe diarrhea
Increased kidney elimination
Malnutrition 
Alcoholism
TPN
55
Q

Hypophosphatemia s/s

A 
Tremor
Paresthesia
Muscle weakness
Joint stiffness
Bone pain
Confusion
Coma
Hemolytic anemia
Platelet dysfunction
Impaired WBC function
Seizure
56
Q

Hyperphosphatemia (>4.3) causes

A

Kidney failure
Laxatives/enemas with phosphorous
Shift from intra- to extra cellular compartment due to massive trauma or heat stroke
Hypoparathyroidism

57
Q

Hypophosphatemia treatment

A

IV or PO replacement (give IV over long period), increase oral intake, manage CKD or hypercalcemia (increased risk of calcifications)

58
Q

Hyperphosphatemia treatment

A

Calcium-based phosphate binders, hemodialysis (for renal failure)

59
Q

Intracellular electrolytes

A

Potassium
Magnesium
Phosphorous

60
Q

Extracellular electrolytes

A

Sodium
Chloride
Bicarbonate

Pathopharm I (10 decks)

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