fluid and electrolyte balance Flashcards
What is hypervolemia
Too much fluid in the vascular space
What causes Hypervolemia
Heart failure
Renal Failure
Sodium
How does Heart failure cause fluid volume excess
Heart is weak, cardiac output is down, Kidney profusion is down, urinary output is down, volume stays in vascular space
How does kidney failure cause fluid volume excess
Kidneys aren’t working
Three things with a lot of sodium
Effervescent soluble medications
canned/ processed foods
IVF with sodium
Where is aldosterone found
Adrenal glands on top of kidneys
What does aldosterone do
Secretion increases sodium water retention, causing blood volume to go up
What causes too much aldosterone
Cushings
Hyperaldosteronism (conns syndrome)
What causes too little aldosterone
Addisons
What is aldosterone
Steroid, mineralcorticoid
What does ADH do
Cause water retention
What happens with too much ADH
Retain water
fluid volume excess
SIADH
urine concentrated
blood diluted
What happens with not enough ADH
Lose water
fluid volume deficit
Diuresis
Diabetes insipidus
urine diluted
blood concentrated
What happens to urine specific gravity, sodium and hematocrit when concentrated? dilute?
Concentrated numbers go up
dilute numbers go down
Where is ADH found
Pituitary gland
What things should make you think ADH problem
Craniotomy
head injury
sinus surgery
transsphenoidal hypophysectomy
anything that can lead to increased ICP
What can be used as an ADH replacement
Vasopressin or Despompresin acetate
S&S of Fluid volume excess
Extended neck veins/peripheral veins
peripheral edema/ third spacing
wet lung sounds (low first)
polyuria
increased pulse
increased BP
increase weight
Why does pulse go up with fluid volume excess
To move fluid forward, if it doesn’t go forward it goes backward into the lungs, can lead to pulmonary edema
treatment of Fluid volume excess
Low sodium diet/ restrict fluid
I&O daily weights
diuretics
bed rest
give IVF slowly
what is furosemide
Loop diuretic
What is a potassium sparing diuretic
Spirolactone
How does bed rest induce diureses
The release of ANP and lower production of ADH
What causes fluid volume deficit
Loss of fluid
third spacing
diseases with polyuria
What causes third spacing
Burns
ascites
signs of fluid volume deficit
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
Treatment of fluid volume deficit
Prevent further losses
Replace volume
safety precautions
What do Isotonic solutions do
Goes into vascular space and stays there
Examples of isotonic solutions
NS
LR
D5W
uses for isotonic solutions
Fluid loss through nausea, vomiting, burns, sweating, trauma
When should you avoid hypotonic solutions
Clients with hypertension, cardiac disease or renal disease
What can isotonic solutions cause
FVE
hypertension
hypernatremia (if contains sodium)
What do hypotonic solutions do
Goes into the vascular space and shifts into cells to replace cellular fluid
What is a benefit of hypotonic solution over isotonic solution
Rehydrate but don’t cause hypertension
Examples of of hypotonic solutions
D2.5, 1/2 normal saline, 0.33 NS
uses of hypotonic solutions
Pt with hypertension, renal or cardiac disease that need fluid replacement
Dilution for hypernatremia
what should you watch for with hypotonic solutions
cellular edema because this fluid is moving out to the cells which could lead to FVD and decrease BP
What do hypertonic solutions do
Volume expanders that draw fluid into vascular space from cell
examples of hypertonic solutions
D5LR, D5 1/2 NS, D5NS, TPN, Albumin
uses of hypertonic solutions
client with hyponatremia
3rd spacing
burns
edema
ascites
brings fluid back into the vascular space
What do you watch for with hypertonic solutions
Monitor in an ICU, monitor BP, pulse, CVP,
what causes hypermagnesemia
Renal failure
antacids
S&S of hypermagnesemia
Flushing and warmth
Vasodilation
Causes of hypercalcemia
hyperparathyroidism
thiazides (retain calcium)
immobilization
How Does hyperparathyroid cause hypercalcemia
hyperparathyroidism has too much PTH
When serum calcium is low PTH pulls CA from bone to blood causing serum calcium to go ip
S&S of hypercalcemia
Bones are brittle
kidney stones
Treatment of Hypermagnesemia
Ventilator if RR below 12
dialysis
calcium gluconate
Treatment of hypercalcemia
Move
fluids
Steroids
Safety precautions
medications that decrease serum CA
causes of hypomagnesemia
Diarrhea
alcoholism
how does alcoholism contribute to hypomagnesemia
alcohol suppresses ADH and is hypertonic
not eating
not drinking
signs and symptoms of hypomagnesemia and hypocalcemia
Rigid and tight muscles
seizures
stridor
+ Chvosteks
+ trousseaus
arrhythmias
DTR’s
Mind changes
Swallowing problems
What is Chvosteks sign
contraction of facial muscle after percussion over facial nerve
What is trousseaus sign
Hand spasm after wearing BP cuff two to three minutes
treatment of hypo magnesium
Give MG
check renal function (before IV MG)
seizure precautions
eat magnesium
Treatment of hypocalcemia
PO calcium
Vitamin D
phosphate binders
Foods high in magnesium
Spinach
mustard greens
pumpkin seeds
peppermint
cucumber greens
green beans
celery
kale
sunflower seeds
sesame seeds
flax seeds
symptoms common in hypermagnesemia and hypercalcemia
Weak muscle tone
arrhythmias
low LOC
low pulse
low respirations
what is the relationship between calcium and phosphorus
Inverse
Normal MG values
1.3-2.1
Normal calcium values
9.0-10.5
What should you think of for calcium and magnesium issues
muscles
what is hyperntremia
too much sodium not enough water
causes of hypernatremia
Hyperventilation
heat stroke
diabetes insipidus
insensible fluid loss
normal sodium lab values
135-145
signs and symptoms of hypernatremia
dry mouth
thirsty
swollen tongue
neuro changes
treatment of hypernatremia
restrict sodium
dilute with fluids
weight
I&O
labs
What is hyponatremia
too much water not enough sodium
causes of hyponatremia
drinking H2O for fluid replacement
psychogenic polydipsia
d5W
SIADH: retaining water
Signs and symptoms of hyponatremia
headache
seizure
coma
treatment of hyponatremia
increase sodium
don’t need water
what happens to potassium if kidneys aren’t working
serum potassium goes up
what causes hyperkalemia
kidney problems
spironolactone (retain potassium)
signs and symptoms of hyperkalemia
muscle twitching
muscle weakness
flaccid paralysis
Treatment of hyperkalemia
dialysis
calcium glutinate (decrease arrhythmia)
sodium polystyrene sulfonate
What is the relationship between sodium and potassium
inverse
hypokalemia causes
Vomiting
NG suction
diuretics
not eating
signs and symptoms of hypokalemia
muscle cramps
muscle weakness
treatment of hypokalemia
give potassium
spironolactone
eat more potassium
major problems with oral potassium
GI upset
burns during infusion
assess urinary out put before IV potassium1
foods high in potassium
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
What are the 3 major acid base chemicals
Bicarb (base)
Hydrogen (Base)
CO2 (acid)
major lung chemical
CO2
Major kidney chemicals
Bicarb
hydrogen
normal PH
7.35 to 7.45
an acidotic person is
lethargic
an alkalotic person is
excitable
How do kidneys compensate
remove excess bicarb by excreting it through urine
or
retain hydrogen and bicarb and return to blood
how to lungs compensate
what causes respiratory acidosis
retaining Co2
mid-abdominal incision
narcotics
sleeping pills
pneumothorax
collapsed lung
pneumonia
impaired gas exchange
hypoventilation
signs and symptoms of respiratory acidosis
headache, confused, sleepy
could lead to coma
hypoxia (restlessness, tachycardia)
PaO2 levels
80-100
PaCo2 levels
35-45
HCO3 levels, Bicarb
22-26
treatment for respiratory acidosis
fix breathing problem
turn cough deep breath
how to fix pneumonia breathing problems
postural rainage
percussion
deep breathing
suctioning
fluids
elevate HOB
incentive spirometry
causes of respiratory alkalosis
hyperventilation ( hysterical, Aspirin OD)
signs and symptoms of respiratory alkalosis
Vaso constriction
lightheaded faint feeling
peri-oral numbness,
numbness and tingling in fingers and toes
treatment of respiratory alkalosis
sedate
treat cause
monitor ABG
What causes metabolic acidosis
DKA
Starvation
renal failure
severe diarrhea
signs and symptoms of metabolic acidosis
depends on cause
hyperkalemia
increased respiratory rate
kussmaul respirations
metabolic alkalosis causes
loss of upper GI contents
too many antacids (too much base)
signs and symptoms of metabolic alkalosis
depends on cause
observe loc
serum potassium down
muscle cramps and arrhythmias
treatment of metabolic alkalosis
fix problem
replace potassium
