Fluid and Electrolyte Flashcards
What is the treatment for hypovolemia?
replace water and electrolytes with lactated ringers or 0.9% NaCl
What is the treatment for hypervolemia?
diuretics and fluid restriction
What is the range for sodium?
135-145
What is the range for potassium?
3.5-5.0
4 Nursing implications for admin of K+
- Always dilute IV potassium
- never give KCL via IV push or as bolus
- should not exceed 10-20mEq/hr
- IV potassium can be irritating to veins
What occurs with the QRS complex during hyperkalemia?
widens
What is a positive Trousseau’s sign?
- place BP cuff around arm
- keep inflated for 1-4min
positive: hand and fingers go into spasm in flexion
What is a positive Chvostek’s sign?
- tap the face just below and in front of the ear
positive: facial twitching of one side of the mouth, nose, and cheek
What are the manifestations for hypocalcemia?
- positive Trousseau’s sign
- positive Chvostek’s sign
- Laryngeal stridor
- dysphagia
- tingling around mouth/extremities
In a patient with prolonged vomiting, the nurse monitors for fluid volume deficit because vomiting results in…
fluid movement from the cells into the interstitial space and blood vessels
The nurse is administering 3.0% NaCl to a patient with severe hyponatremia. It is most important for the nurse to observe for what?
Shortness of breath and increased RR
A patient is admitted with renal failure and an arterial blood pH level of 7.29. Which lab result would the nurse expect?
serum potassium of 5.9mEq/L
What lab value is the best indicator of kidney function?
creatine
What is azotemia?
accumulation of nitrogenous waste products
What 2 lab values elevate with loss of kidney function?
BUN and K+
Nephrotoxic antibiotics
amphotericin, rifampin, sulfonamides, tetracycline, vancomycin, gentamicin
Nephrotoxic chemotherapy agents
cisplatin, methotrexate
Nephrotoxic NSAIDS
celecoxib, ibuprofen, meloxicam, acetaminophen
What are phenols?
byproduct of antioxidants
What is the most serious electrolyte disorder in kidney disease?
hyperkalemia
Drug therapy for hyperkalemia?
IV glucose and insulin
Kayexalate
3 Calcium channel blockers
Norvasc
Cardizem
Procardia
4 ACE inhibitors
Lotensin
Captopril
Vasotec
Altec
3 ARB agents
Avapro
Teveten
Benicar
What 5 components are restricted in the AKI patient’s diet?
- protein
- fluid
- sodium
- potassium
- phosphate
Identify individuals at risk for CKD
- hypertension
- diabetes mellitus
- repeated UTIs
Cardiovascular findings for dehydration
- thready, increased PR
- decreased BP
- dysrhythmias
Respiratory findings for dehydration
- increased RR
- dyspnea
Neuromuscular findings for dehydration
- lethargy to coma
- fever
- muscle weakness
What lab values increase due to dehydration?
serum osmolality
hct and hgb (false reads)
BUN
serum sodium
urine specific gravity
What is the nutritional status for severe dehydration?
NPO status allows gut to rest
What is the relationship between sodium and calcium?
high sodium levels slow the movement of calcium into the heart cells which causes decreased contractility
What are the potential complications for the patient whose serum sodium drops too low?
confusion
irritability
headache
seizures
coma
At what value should a nurse notify the provider of I & O?
if output is 200mL less than intake
Why would the patient with renal failure be given Epoetin?
when someone’s kidneys don’t work, the kidneys produce less EPO and so the person becomes anemic
What treatments can be used to lower K+ level?
- cation exchange resin or diuretics
- insulin
- B2 agonists
- Sodium bicarbonate
- Lasix
Clinical manifestations for patient with hyperkalemia
impair renal excretion, renal failure
leg cramps
weak
paralysis
abdominal cramping
diarrhea
cardiac dysrhythmias = widen QRS, depresses ST, elevates P
Clinical manifestations for patient with hypokalemia
metabolic alkalosis
muscle weakness
weak respiratory muscles
decreased GI
hyperglycemia
