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Hesi PN > fluid and electrolyte balance > Flashcards

fluid and electrolyte balance Flashcards

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1
Q

What is hypervolemia

A

Too much fluid in the vascular space

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2
Q

What causes Hypervolemia

A

Heart failure
Renal Failure
Sodium

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3
Q

How does Heart failure cause fluid volume excess

A

Heart is weak, cardiac output is down, Kidney profusion is down, urinary output is down, volume stays in vascular space

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4
Q

How does kidney failure cause fluid volume excess

A

Kidneys aren’t working

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5
Q

Three things with a lot of sodium

A

Effervescent soluble medications
canned/ processed foods
IVF with sodium

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6
Q

Where is aldosterone found

A

Adrenal glands on top of kidneys

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7
Q

What does aldosterone do

A

Secretion increases sodium water retention, causing blood volume to go up

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8
Q

What causes too much aldosterone

A

Cushings
Hyperaldosteronism (conns syndrome)

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9
Q

What causes too little aldosterone

A

Addisons

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10
Q

What is aldosterone

A

Steroid, mineralcorticoid

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11
Q

What does ADH do

A

Cause water retention

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12
Q

What happens with too much ADH

A

Retain water
fluid volume excess
SIADH
urine concentrated
blood diluted

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13
Q

What happens with not enough ADH

A

Lose water
fluid volume deficit
Diuresis
Diabetes insipidus
urine diluted
blood concentrated

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14
Q

What happens to urine specific gravity, sodium and hematocrit when concentrated? dilute?

A

Concentrated numbers go up
dilute numbers go down

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15
Q

Where is ADH found

A

Pituitary gland

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16
Q

What things should make you think ADH problem

A

Craniotomy
head injury
sinus surgery
transsphenoidal hypophysectomy
anything that can lead to increased ICP

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17
Q

What can be used as an ADH replacement

A

Vasopressin or Despompresin acetate

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18
Q

S&S of Fluid volume excess

A

Extended neck veins/peripheral veins
peripheral edema/ third spacing
wet lung sounds (low first)
polyuria
increased pulse
increased BP
increase weight

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19
Q

Why does pulse go up with fluid volume excess

A

To move fluid forward, if it doesn’t go forward it goes backward into the lungs, can lead to pulmonary edema

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20
Q

treatment of Fluid volume excess

A

Low sodium diet/ restrict fluid
I&O daily weights
diuretics
bed rest
give IVF slowly

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21
Q

what is furosemide

A

Loop diuretic

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22
Q

What is a potassium sparing diuretic

A

Spirolactone

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23
Q

How does bed rest induce diureses

A

The release of ANP and lower production of ADH

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24
Q

What causes fluid volume deficit

A

Loss of fluid
third spacing
diseases with polyuria

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25
Q

What causes third spacing

A

Burns
ascites

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26
Q

signs of fluid volume deficit

A

Weight down
decreased skin turgor
dry mucous membranes
decreased urine output
low BP
increased pulse
increased respirations
veins constrict
extremities cool
unrine specific gravity goes up

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27
Q

Treatment of fluid volume deficit

A

Prevent further losses
Replace volume
safety precautions

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28
Q

What do Isotonic solutions do

A

Goes into vascular space and stays there

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29
Q

Examples of isotonic solutions

A

NS
LR
D5W

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30
Q

uses for isotonic solutions

A

Fluid loss through nausea, vomiting, burns, sweating, trauma

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31
Q

When should you avoid hypotonic solutions

A

Clients with hypertension, cardiac disease or renal disease

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32
Q

What can isotonic solutions cause

A

FVE
hypertension
hypernatremia (if contains sodium)

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33
Q

What do hypotonic solutions do

A

Goes into the vascular space and shifts into cells to replace cellular fluid

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34
Q

What is a benefit of hypotonic solution over isotonic solution

A

Rehydrate but don’t cause hypertension

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35
Q

Examples of of hypotonic solutions

A

D2.5, 1/2 normal saline, 0.33 NS

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36
Q

uses of hypotonic solutions

A

Pt with hypertension, renal or cardiac disease that need fluid replacement
Dilution for hypernatremia

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37
Q

what should you watch for with hypotonic solutions

A

cellular edema because this fluid is moving out to the cells which could lead to FVD and decrease BP

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38
Q

What do hypertonic solutions do

A

Volume expanders that draw fluid into vascular space from cell

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39
Q

examples of hypertonic solutions

A

D5LR, D5 1/2 NS, D5NS, TPN, Albumin

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40
Q

uses of hypertonic solutions

A

client with hyponatremia
3rd spacing
burns
edema
ascites

brings fluid back into the vascular space

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41
Q

What do you watch for with hypertonic solutions

A

Monitor in an ICU, monitor BP, pulse, CVP,

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42
Q

what causes hypermagnesemia

A

Renal failure
antacids

43
Q

S&S of hypermagnesemia

A

Flushing and warmth
Vasodilation

44
Q

Causes of hypercalcemia

A

hyperparathyroidism
thiazides (retain calcium)
immobilization

45
Q

How Does hyperparathyroid cause hypercalcemia

A

hyperparathyroidism has too much PTH
When serum calcium is low PTH pulls CA from bone to blood causing serum calcium to go ip

46
Q

S&S of hypercalcemia

A

Bones are brittle
kidney stones

47
Q

Treatment of Hypermagnesemia

A

Ventilator if RR below 12
dialysis
calcium gluconate

48
Q

Treatment of hypercalcemia

A

Move
fluids
Steroids
Safety precautions
medications that decrease serum CA

49
Q

causes of hypomagnesemia

A

Diarrhea
alcoholism

50
Q

how does alcoholism contribute to hypomagnesemia

A

alcohol suppresses ADH and is hypertonic
not eating
not drinking

51
Q

signs and symptoms of hypomagnesemia and hypocalcemia

A

Rigid and tight muscles
seizures
stridor
+ Chvosteks
+ trousseaus
arrhythmias
DTR’s
Mind changes
Swallowing problems

52
Q

What is Chvosteks sign

A

contraction of facial muscle after percussion over facial nerve

53
Q

What is trousseaus sign

A

Hand spasm after wearing BP cuff two to three minutes

54
Q

treatment of hypo magnesium

A

Give MG
check renal function (before IV MG)
seizure precautions
eat magnesium

55
Q

Treatment of hypocalcemia

A

PO calcium
Vitamin D
phosphate binders

56
Q

Foods high in magnesium

A

Spinach
mustard greens
pumpkin seeds
peppermint
cucumber greens
green beans
celery
kale
sunflower seeds
sesame seeds
flax seeds

57
Q

symptoms common in hypermagnesemia and hypercalcemia

A

Weak muscle tone
arrhythmias
low LOC
low pulse
low respirations

58
Q

what is the relationship between calcium and phosphorus

A

Inverse

59
Q

Normal MG values

A

1.3-2.1

60
Q

Normal calcium values

A

9.0-10.5

61
Q

What should you think of for calcium and magnesium issues

A

muscles

62
Q

what is hyperntremia

A

too much sodium not enough water

63
Q

causes of hypernatremia

A

Hyperventilation
heat stroke
diabetes insipidus
insensible fluid loss

64
Q

normal sodium lab values

A

135-145

65
Q

signs and symptoms of hypernatremia

A

dry mouth
thirsty
swollen tongue
neuro changes

66
Q

treatment of hypernatremia

A

restrict sodium
dilute with fluids
weight
I&O
labs

67
Q

What is hyponatremia

A

too much water not enough sodium

68
Q

causes of hyponatremia

A

drinking H2O for fluid replacement
psychogenic polydipsia
d5W
SIADH: retaining water

69
Q

Signs and symptoms of hyponatremia

A

headache
seizure
coma

70
Q

treatment of hyponatremia

A

increase sodium
don’t need water

71
Q

what happens to potassium if kidneys aren’t working

A

serum potassium goes up

72
Q

what causes hyperkalemia

A

kidney problems
spironolactone (retain potassium)

73
Q

signs and symptoms of hyperkalemia

A

muscle twitching
muscle weakness
flaccid paralysis

74
Q

Treatment of hyperkalemia

A

dialysis
calcium glutinate (decrease arrhythmia)
sodium polystyrene sulfonate

75
Q

What is the relationship between sodium and potassium

A

inverse

76
Q

hypokalemia causes

A

Vomiting
NG suction
diuretics
not eating

77
Q

signs and symptoms of hypokalemia

A

muscle cramps
muscle weakness

78
Q

treatment of hypokalemia

A

give potassium
spironolactone
eat more potassium

79
Q

major problems with oral potassium

A

GI upset
burns during infusion
assess urinary out put before IV potassium1

80
Q

foods high in potassium

A

spinach, fennel, kale, mustard greens, brussel sprouts, broccoli, eggplant, cantaloupe tomatoes, parsley, cucumber, bell pepper, apricots, ginger root, strawberries, avocado, banana, tuna, halibut, cauliflower, kiwi, oranges, lima beans, potatoes, cabbage

81
Q

What are the 3 major acid base chemicals

A

Bicarb (base)
Hydrogen (Base)
CO2 (acid)

82
Q

major lung chemical

A

CO2

83
Q

Major kidney chemicals

A

Bicarb
hydrogen

84
Q

normal PH

A

7.35 to 7.45

85
Q

an acidotic person is

A

lethargic

86
Q

an alkalotic person is

A

excitable

87
Q

How do kidneys compensate

A

remove excess bicarb by excreting it through urine
or
retain hydrogen and bicarb and return to blood

88
Q

how to lungs compensate

A
89
Q

what causes respiratory acidosis

A

retaining Co2
mid-abdominal incision
narcotics
sleeping pills
pneumothorax
collapsed lung
pneumonia
impaired gas exchange
hypoventilation

90
Q

signs and symptoms of respiratory acidosis

A

headache, confused, sleepy
could lead to coma
hypoxia (restlessness, tachycardia)

91
Q

PaO2 levels

A

80-100

92
Q

PaCo2 levels

A

35-45

93
Q

HCO3 levels, Bicarb

A

22-26

94
Q

treatment for respiratory acidosis

A

fix breathing problem
turn cough deep breath

95
Q

how to fix pneumonia breathing problems

A

postural rainage
percussion
deep breathing
suctioning
fluids
elevate HOB
incentive spirometry

96
Q

causes of respiratory alkalosis

A

hyperventilation ( hysterical, Aspirin OD)

97
Q

signs and symptoms of respiratory alkalosis

A

Vaso constriction
lightheaded faint feeling
peri-oral numbness,
numbness and tingling in fingers and toes

98
Q

treatment of respiratory alkalosis

A

sedate
treat cause
monitor ABG

99
Q

What causes metabolic acidosis

A

DKA
Starvation
renal failure
severe diarrhea

100
Q

signs and symptoms of metabolic acidosis

A

depends on cause
hyperkalemia
increased respiratory rate
kussmaul respirations

101
Q

metabolic alkalosis causes

A

loss of upper GI contents
too many antacids (too much base)

102
Q

signs and symptoms of metabolic alkalosis

A

depends on cause
observe loc
serum potassium down
muscle cramps and arrhythmias

103
Q

treatment of metabolic alkalosis

A

fix problem
replace potassium

Hesi PN (24 decks)

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