Fluid and Electrolyte Balance: Part 2

Question 1

Potassium sparing diuretics

Answer 1

Increase urine production and decrease K+ excretion

Question 2

Potassium sparing diuretics block…

Answer 2

Aldosterone action in distal nephron to increase K+ retention and excretion of Na+

Question 3

What is the only approved potassium-sparing diuretic in the US?

Answer 3

Spironolactone (Aldactone)

Question 4

Spironolactone onset of action

Answer 4

May take up to 48 hours to produce effects

Question 5

Potassium-sparing diuretics therapeutic uses

Answer 5

In combination with loop or thiazide diuretics for hypertension and edema for heart failure
Hyperaldosteronism

Question 6

PSDs are rarely given IV because…

Answer 6

They do not work fast enough

Question 7

What is one way you would know a person is hypokalemic?

Answer 7

Cramps

Question 8

Adverse effects of PSDs

Answer 8

Hyperkalemia
N/V
Leg cramps

Question 9

Drug interactions with PSDs

Answer 9

Never give with drugs that increase K+ (ACE inhibitors)

Question 10

Osmotic diuretics main medication

Answer 10

Mannitol (Osmitrol)

Question 11

Mannitol IV action in..

Answer 11

30-80 min; lasts 8 hours

Question 12

Mannitol therapeutic doses

Answer 12

Renal failure prophylaxis
Reduction of intracranial pressure
Reduction of intraocular pressure

Question 13

Adverse effects of osmotic diuretics

Answer 13

Can leave vascular system except in brain

Caution with heart disease, HA, N/V, F/E imbalance

Question 14

Osmotic diuretics are only used…

Answer 14

In critical care setting, short term, usually only a couple days

Question 15

How do osmotic diuretics work?

Answer 15

Create an osmotic gradient > makes blood hyperosmolar > pulls fluid into the blood

Question 16

What happens if too much osmotic is given?

Answer 16

Will pull from the brain and start 3rd spacing everywhere (lungs, ascites)

Question 17

Osmotic dose based on..

Answer 17

ICP

Question 18

Osmotic diuretics reduction of intraocular pressure

Answer 18

When patient gets strongly hit in head, it can change angle of aqueous humor

Question 19

Angle closure glaucoma

Answer 19

Needs to be treated immediately in order to avoid blindness, needs surgery

Question 20

Renal failure prophylaxis

Answer 20

Emergency situation, continues to force kidneys to make a small amount of urine because of osmotic shifts - last stitch effort to keep kidneys going a little longer

Question 21

IV fluids are ordered based on…

Answer 21

Fluid & Electrolyte balance
FLuid requirements
Fluid volume deficit

Question 22

Type of IV solutions

Answer 22

Crystalloids
Colloids
Blood & Blood products

Question 23

Crystalloids

Answer 23

Clear solutions that contain fluid & electrolytes

Feely cross capillary walls

Question 24

Crystalloids treat…

Answer 24

Dehydration
Electrolyte imbalances
Short-term maintenance fluids
Early plasma expansion (shorter duration of action)

Question 25

What type of crystalloid solution would be given for edema?

Answer 25

Hypertonic to decrease fluid in tissues

Question 26

Examples of isotonic fluids

Answer 26

LR- lactated ringers 0.9% NaCl D5W 5% dextrose in water

Question 27

If you add anything to isotonic fluids, you make them _______ and if you take anything away you make them _________

Answer 27

Hypertonic | Hypotonic

Question 28

If a person is hemorrhaging, can you give them crystalloids?

Answer 28

Yes for a short time to keep them perfusing and oxygenated until you can get blood and colloids (keep them from going into hypovolemic shock)

Question 29

Hypertonic solution

Answer 29

>300 Decreases ICP and severe hyponatremia Can cause fluid overload Not for CHF patients

Question 30

Isotonic

Answer 30

280-300mOsm Corrects dehydration and sodium depletion Caution with cardiac / renal disease Do NOT use in patients with increased ICP

Question 31

Hypotonic

Answer 31

<280 Replaces cellular fluid (Diabetes ketoacidosis) Do not use with shock patients, trauma, burns (risk of depleting vascular volume)

Question 32

Colloids

Answer 32

Solutions that contain proteins or other large molecules

Question 33

What do colloids do?

Answer 33

Increase osmolarity without dissolving in solution

Question 34

Colloids are plasma ______

Answer 34

Expanders (Pull fluids from the interstitial space into the plasma)

Question 35

Color of colloids

Answer 35

Pale yellow or brownish

Question 36

When giving IV solutions, what order do you go in?

Answer 36

Crystalloids, colloids then blood products