Fluid and Electrolyte Flashcards
Intracellular Fluid ( Hypotonic )
2/3 of body fluid
Extracellular
1/3 of body fluid
Interstital
Intravascular
Transcellular
Fluid Intake
2,5000 mL a day
Fluid Output
1,4000-1,5000 mL
- Filtration
Is the movement of fluid through a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of membrane.
Ex: Blood Pressure
Higher —> lower
- Diffusion
Movement of solution from an area of high concentration to low concentration.
- Smaller substances diffuse more easily!
Molecules intermerge
Facilitated Diffusion / Active transport
The transport of substances across a biological membrane from an area of higher to lower concentration WITH the help of a transport molecule.
- Regulates what goes in/out of cell.
Ex: Sodium / P pump
- Osmosis
Movement of water across the cellular membrane from an area of lower concentration to higher.
- Helps regulate fluid balance.
Hypovolemia
Isotonic Loss
Risk Factors: GI loss, skin loss, burns, high intake of salt, hyperventilation, low water intake.
Cardio: Increased heart rate, low BP
Respiratory: Increased rate
Skin: Poor skin turgor
Neuro: Cognition changes
Kidney: Concentrated urine, strong odor, < 500 mL = Concerning!
Labs: Multiple labs + S/S
Third Spacing
From vascular space to other areas
Trapped fluid= volume loss
Causes: Burns, trauma, surgery, sepsis
Diagnostics Fluid Deficit
HcT increased
BUN increased
Elevated Urine Specific Gravity
Na+ elevated
Increased blood osmolarity
Interventions for Dehydration
-Oral Fluids if awake
-Pedialyte
- IV Fluids: 0.9% NS
- Monitor I&O
-DAILY WEIGHTS!!!!
- Meds: antiemetics, antipyretics, desmopressin ( diabetes insipidus )
Hypovolemic Shock
Cells no longer carry oxygen to the blood
- Administer Oxygen
- Monitor VS
- Fluid Replacements
- Vasoconstrictors
Hypervolemia
Causes: Heart failure, kidney failure, overdose of fluids, corticocosterioids
Cardio: Increased pulse, high bp, distended neck veins
Resp: Increased rate, crackles
Skin: Edema
Neuro: HA, weakness
GI: Increased motility, enlarged liver
*** increased CVP
Hypervolemia Diagnostics
Decreased HCT
Decreased blood osmolarity
Decreased urine specific gravity
Decreased BUN
Fixing Fluid Overload?
-Drug therapy: Removing Excess fluid; * Diuretics such as furosemide ( loop )
-Nutrition: Fluid restriction possible for chronic cases.
-Monitoring: I&O and daily weights!
What response does the nurse expect as a result of infusing 500 mL of a 3% NS solution over a 1 hr time period?
Plasma volume osmolarity increases; blood pressure increases
- Solutes going into blood = High BP
Which clinical indicators are most relevant for the nurse to monitor during IV fluid replacement for a client with dehydration?
BP
Pulse Rate
Urine output
Cations
NA-
K+
Mg+
CA+
Anions
Phosphate
Cl-
Sodium
Most abundant in ECF
Hyponatremia
Is when the serum sodium level is below 136 mEq/L
Sodium most abundant in electro in ECF
No Na+”
NA+ excretion increased with renal problems: Loss of sodium and water!
- NG suction, vomitting, over use of diuretics, sweating, diarrhea
Overload of fluid with CHF
- Water follows sodium
- Sodium decreasing because of dilution: renal failure, hypotonic fluid infusions
Hyponatremia manifestations
***Neuro: HA, Increased intracranial pressure, seizures, coma can occur
Musc: Muscle Weakness, DTR diminish
Intestinal: Increased motility causing N/V, diarrhea, hyperactive BS
Cardio: Rapid, weak, thready pulse, decreased BP
Hyponatremia Interventions
Always bring up Na+ SLOWLY! Never exceed 12 meQ in 24 hr time period
- Drug Therapy: Reduce diuretics bc of sodium loss, IV Saline, promote excretion of water rather than sodium when caused by fluid excess.
- Increase oral sodium
Hypernatremia Risk factors
Kidney failure, cushings, cortico, excessive oral sodium intake, fevers, sweating
-Above 145
Hypernatremia Manifestations`
Neuro: AMS, short attention span, agitated, confused
- *** hypernatremia and fluid overload can cause lethargy, stupor, coma
Skeletal Muscle: Muscle twitching, weak, deep tendon reflexes are absent, occurs bilaterally, no pattern
Cardio: Increased pulse rate, hypotension = hypernatremia and hypovolemia
Decreased pulse rate, distended neck veins, increased BP = hypernatremia and hypovolemia
Hypernatremia Interventions
Drug: Need diuretics that promote sodium loss
( furosemide, bumetanide )
Nutriton: Ensure adequate fluid intake
- Dietary sodium restriction
ALWAYS CONTINUE TO ASSESS THE PATIENT FOR INDICATIONS OF EXCESSIVE LOSSES OF FLUID, SODIUM, POTASSIUM
Potassium
Normal Range: 3.5-5.0
- Commonly altered by changes in K+ intake
- Essential in NA/K pump
-Foods high: Meat, fish, fruits, veggies
-Foods low in: Eggs,bread, grains
- Facilitates glycogen storage in lover and skeletal muscle cells
- Main ion in ICF 98%
Hypokalemia
Serum potassium level below 3.5
- Low K+ levels reduce exitability of cells, causing excitable tissues to respond to less stimuli
Excessive Fluid Loss: Vomiting, Diarrhea, NG suction
Diuretic Drugs
Kidney Disease
Cushings
Wound Drainage
Diuresis
Heart Failure
Rapid infusion of insulin… because drug increases the activity of Sodiumm- Potassium pump forcing more blood potassium levels are linked to magnesium
Stress reaction
S/S of Hypokalemia
Muscle: skeletal muscle weakness, DTR reflexes reduced = flaccid paralysis
*** Cardio: Thready, weak pulse. Orthostatic Hypotension.
- Perform an ECG. Can include ST- segment depression, flat T wave, increased U waves. Dysrhymias can lead to death.
Neuro: AMS, irrability, anxiety
Ints: N/V, constipation, abdominal distension
- Shallow respirations
How to fix Hypokalemia?
- Preventing K+ loss
- Potassium Sparing Diuretic
- Sprinlactone - Increasing K+ Levels
- Potassium Supplements: Potassium chloride, glucanate, citrate given oral or IV. - Resp Monitoring: Nail bed pallor or cyanosis.
Potassium Chloride Dosages
A concentration of ***10 meQ KCL/100 mL can be administered through a peripheral vein; You can run 20 mEq/100 mL though a central venous catheter or PICC.
Hyperkalemia
Level higher than 5.0 mEq / L
- Increase exitability of cells, causing excitable tissues to respond to less intense stimuli.
- Can lead to V-Fib
- Sudden potassium rises cause severe problems at serum levels betweem 6-7. When serum potassium rises slowly, problems may not occur until K+ levels reach 8+.
Examples of Hyperkalemia can occur..
- Over ingestion of potassium containing foods / meds.
- Rapid infusions
- Burns, MI ***
- Kidney failure
-Potassium sparing diuretics - ACE’S 1 **
-Acidosis ** - Diabetes ( uncontrolled )
Hyperkalemia Manifestations
***CV: Brady, hypotension, ECG changes of tail peaked T waves, aystole and V Fib
Neuro: Twitching, tingling, burning, numbness, muscle weakness and flaccid paralysis
Intest: Increased motility with diarrhea
Hyperkalemia 3 Solutions
- First Intervention: Insulin ( IVP 10-15 Units of regular insulin along with 50 mL of 50% dextrose to prevent hypoglycemia ) will lead to shift of potassium ions into the cell secondary to increased activity of the sodium - potassium pumps. Can be repeated.
- Biocarbonate ( e.g. 1 ampule ( 50 meQ ) infused over 5 mins ) is effective in shifting potassium into the cell. The biocarbonate ion will stimulate an exchange of cellular H+ ( moves it out cell ) for Na+ leading to stimulation of pumps.
- Albuterol ( beta 2 agonist; inhaled as neb ) : This drug lowers blood levels of K+ by promoting its movement into cells.
If client has ECG changes ( tall, peaked T waves )….
Calcium gluconate should be given before insulin / dextrose
- Stabilize cardiac muscle
Hyperkalemia Perm Fixes
- Loop Diuretics ( Furosemide ) - gets the client to urinate and potassium leaves the body completely again need a patient who makes urine.
- Sodium Polystyrene Sulfonate - Given PO or as enema. Potassium is exchanged for sodium in intestines and excreted in stool. Causes frequent stooling; dont give to someone with impaired bowel function —> intestinal necrosis
- Monitor s/s of fluid overload: crackles, edema, HTN, JVD distention, assess abdomen, monitor K+ lab - Dialysis usually hemodyalysis: If this is AKI patient might just have a few runs of hemo –> until kidney function improves.
Calcium
9.0-10.5
- Must be kept in narrow range ECF
-Absorbed through intestinal tract.
-Requires active form of VIT D
Hypocalcemia how it can occur…
- Common in renal failure
- Hypothyroidism
-Hypomagnsemia
- Hypothyroidism
- Vit D deficiency
-Pancreatis
-Alkalosis - Malabsorption syndrome
-Diarrhea
-Would drainage
- Malabsorption syndrome
Hypocalcemia Manifestations
NeuroM: Parathesia occurs first, with sensations of tingling and numbness. Frequent painful muscle spasms- thigh, foot, calf during sleep.
- Charli Horse
- Trousseau’s
- Chvstek’s
CV: HR could be slower or faster, weak, thready pulse. Severe hypotesnion. Prologned QT
Intest: Hyperactive BS
Skelt: osteoporosis, curv of spine
Hypocalcemia How to fix it?
Drug Therapy: Oral or IV calcium & Vit D to enhance absorption. Treating hypothy with Vit D
- *Phosphate: binding agents may be required to reduce serum phosphurus in patients w chronic renal failure.
- Take w meals ^
Nutrtion: Increase calcium rich foods
Hypercalcemia
Serum level above 10.5 mg/dl or 2.62 mmol/l
- Causes exitable tissues to be less sensitive to normal stimuli thus requiring stonger stimulus to function.
- Most affects heart, skeletal muscles, nerves, intestinal smooth muscles.
Causes of Hypercalcemia
- Excessive intake of calcium
-Excessive oral intake of vit D - Kidney Failure
- Thiazide diuretics ***
-Hyperthyroidism - Gluccocorticosteroids
Hypercalcemia S/S
Cardio: Most serious:
- 1. Causes increased heart rate and BP.
2. Severe depresses electrical conduction slowing heart rate.
- Short QT interval
- Monitor for blood clots
NeuroM: Muscle weakness, decreased deep tendon reflexes with paraesthesia. Confused, lethargic.
Intestinal: Constipation, abdominal pain
Hypercalcemia Treatment
- Fluid Volume Replacement: 0.9% NACL
- Drug Therapy:
- ** Thiazide diuretics are discontinued and replaced with diuretics that enhance discretion of calcium, such as furosemide. Calcium chelators help lower calcium levels.
-Drugs to prevent hypercalcemia include agents that inhibit calcium resorption ( movement out ) from bone such as ****phosphurs, calcitonin, bisphosphonates, and prostaglandin synthesis inhibitors ( NSAIDS, aspirin ) - Dialysis if severe
Magnesium is essential for
Skeletal Muscle Contraction
Carbo Metabolism
Generation of energy stores
Vit Activation
Blood Coag
Cell growth
Hypomagnesemia Risk Factors
*Malnutrition
Diarrhea
Celiac Disease
Crohns Disease
Drugs ( diuretics )
*Ethanol Ingestion ( alcohol abuse )
Hypomagnesemia Manifestations
Cardio: Can increase risk of hypertension, athersclerosis, hypertrophic left ventricle, dysrhymias
Neuro: Caused by increase nerve impulse transmission
- Hyperactive deep tendon reflexes, numbness, tingling, painful muscle contractions
- Positive Chvostek, Trosseau signs
Intestinal: Decreased peristalis, constipation, N/V, paralytic illeus
Hypomagnesemia How to fix it?
Hypomagnesemia and Hypocalcemia go hand in hand!
- Disc drugs that promote Mag loss…
- Loop diuretics, osmotic diuretics, aminoglycoside antibiotics, phosphurus
Mag is replaced with magnesium sulfate *
- IV replacement
Hypermagnesemia
Serum level above 2.6 meQ
- Increased intake of antiacids, too much IV, decreased kidney excretion = kidney disease
Hypermagnesemia Manifestions
**Cardio: Brady, cardiac arrest, peripheral vasodilation, hypotension, ECG changes
- Grave danger for cardiac arrest
CNS: Depressed nerve impulse, drowsiness, coma
NeuroM: Absent tendon relfexes, muscle contractions
Resp: Weak, shallow respirations
How do we fix Hypermagnesemia?
Discontinue drugs that increase Mag levels:
- All oral/ parenteral mag
- Administer mag free IV
- Loop diuretics can further reduce serum levels
- ***When cardiac problems are severe giving calcium may reverse the cardiac effects of hypermagensemia
With which client does the nurse remain alert for and. assess most frequently for s/s of hypokalemia?
22 yr old receiving an IV infusion of reg insulin to manage ep of ketoacidosis
Potassium level went from 4.6-6.1 which assessment first?
Pulse rate and rhythm
Which condition in the client with a serum sodium level at 149 indicates to the nurse that this electrolyte imbalance is caused by dehydration/
Hematocrit is 52%; HC is higher is definite sign
Which electrolytes are most affected by low mag levels
Calcium, Potassium
