Fluid and Electrolyte II Flashcards
Cause: Hypervolemia
Too much blood volume Too much/too fast IV fluid Organ issues (heart failure, kidney dysfunction, cirrhosis) Increase Na intake Hypertonic solution
Manifestations of Hypervolemia
CNS: lethargic, seizure, coma CVS: increase HR (bounding pulse), increase BP, JVD Resp: pulmonary edema GU: increase U/O (dilute urine) Skin: edema
Interventions for Hypervolemia
- diuretics
- low sodium diet
- daily in/out
- check lab value
- BIPAP
Cause: Hypovolemia
- Decreased blood volume
- Vomiting, diarrhea
- Severe dehydration
- Trauma, burn
- Medications (diuretics)
- Third spacing
Manifestations: Hypovolemia
- CNS: thirst, confusion, lethargic, seizure, coma
- CVS: increased HR (thready pulse), decreased BP, orthostatic hypotension
- Resp: Increased RR
- GU: decrease U/O (dark concentrated urine)
- Skin: decreased skin turgor
Interventions: Hypovolemia
- PO/IV rehydration
- Daily in/out
- Daily weight
- Check lab value
Cause Hypernatremia (MODEL)
M - meals
O - osmotic diuresis - increased urination
D - diabetic insipidus - imbalance of fluids. excessive urine
E - excessive water loss
L - low water intake
Manifestations Hypernatremia (FRIENDS)
F - flushed skin L - restlessness I - increased fluid retention E - Edema N - neuromuscular excitability D - decreased urine output S - sleepy, lethargy, coma
Interventions: Hypernatremia
- restrict diet sodium intake
- diuretic to promote sodium loss
- give free water
- daily weight
- IV infusion for fluid loss
- monitor for CVS, Resp, Neuro, cerebral, renal status
Cause: hyponatremia (SIADH)
S - syndrome of ineffective ADH (SIADH) I - intoxication of water A - adrenal insufficiency D - Diuretic, diarrhea, diaphoresis, drain (NG suction) H - Heat exhaustion or high fever
Manifestations: hyponatremia (SALT LOSS)
S - stupor (coma) A - anorexia (nausea & vomiting) L - lethargy T - tendon reflex decrease L - limb weakness O - orthostatic hypotension S - seizure S - stomach cramping
Interventions: Hyponatremia
- medication antagonize ADH
- osmotic diuretic
- increase oral sodium intake
- IV sodium chloride infusion
- Monitor for CVSm Resp, neuro, cerebral, renal status
Cause: hyperkalemia (MACHINE)
M - medication - ACE inhibitor, NSAIDS A - acidosis C - cellular destruction - burn, traumatic injury H - hypoaldosteronism I - intake (excessive) N - Nephrons (renal failure) E - Excretion impairment
Hyperkalemia manifestations (MURDER)
M - muscle weakness U - urine (oliguria, anuria) R - respiratory distress D - Decreased cardiac contractility E - EKG changes R - reflexes (hyper-reflex, areflexia)
Interventions: Hyperkalemia
- sodium bicarb
- limit intake of K+
- dialysis
- increased elimination (kayexalate, diuretic)
- Calcium gluconate
- Cardiac monitoring
- IV insulin (with glucose)
Cause: hypokalemia (MADOLD)
M - magnesium deficiency (aldosterone increase) A - alkalosis D - diuretic use O - overdose insulin L - laxatives D - diarrhea
Manifestations: hypokalemia (LLLLLL)
L - lethargy L - leg cramp L - limp muscles L - Lack of GI motility L - lethal cardiac dysrhythmia L - lot of urine
Interventions: hypokalemia
KCL IV/PO (10-20 mmol/hr)
Cause: hypercalcemia (HAM)
H - hyperparathyroidsim
A - antiacid
M - malignancy cancer
Manifestations: hypercalcemia (Groans, moans, bones, stones, overtones)
- Groans - constipation
- moans - joint pain
- bones - loss of calcium
- stones - kidney stones
- overtones - psychiatric overones (ie confusion, depression)
Intervention: hypercalcemia
- low calcium diet
- promote excretion of calcium (diuretics, N/S, increase water intake)
- use calcium reabsorption inhibitor (calcitonin, biphosphate)
- dialysis
Intervention: Hypocalcemia
- IV/PO caclium
- calcium-rich diet
- safety (risk fall and fracture)
Causes: hypocalcium (ABCDLOW)
A - alcoholism B - blood transfusion, multiple C - calcium & vitamin D low intake D - diarrhea, or Chron's disease L - low parathyroidism O - oral meds (laxatives, diuretics, steroids) W - wound drainage
Manifestations: hypocalcemia (CATTS)
C - convulsion (seizures) A - Arrythmia T - tetany ( numbness or tingling of muscle) T - Trousseaus or chvostek's sign S - spasm and stridor
Acidic
<7
Alkaline
> 7
Normal blood pH
7.35-7.45
Homeostasis
- fluid balance
- electrolyte imbalance
- acid-base inbalance
External Respiration
its what happens when you breathe oxygen into your lungs and breathe out CO2 and H2O (as vapour)
Internal Respiration
what happens at the tissue level when the arterial capillary beds allow diffusion of O2 into the cell and the venule capillary beds release CO2 into the plasma for return back to the lungs
Acid-Base Regulation
- buffer system (reacts immediately)
- respiratory system - responds in minutes; maximum effectiveness reached within hours
- renal system - takes 2-3 days to reach maximum response can maintain balance for a long period of time
Buffer system
- electrolyte exchange in the cells. K+ is exchanged with H+
- Alkalosis –> hypokalemia
- Acidosis –> hyperkalemia
(lungs - exhalation of CO2 decreases acidity) (kidneys - excretion and/or retention of acids and bicarbonate)
Lungs
- rapid respirations (exhalation of CO2 -> decreased acidity)
- slow respirations (retention of CO2 -> increased acidity)
Kidneys
- excretion of H+ and reabsorption of HCO3 -> decreased acidity
electrolyte exchanges - hypokalemia (alkalosis)
- hyperkalemia (acidosis)
the lungs …
“blow off” CO2 to increase pH in response to metabolic acidosis.
- kidneys excrete H+ and reabsorb HCO3 to increase pH in response to respiratory acidosis
Kidney ->
Respiratory ->
metabolic
respiratory component
Respiratory Acidosis: Causes
- anything that causes hypoventilation
- COPD
- Barbiturate or sedative overdose
- severe pneumonia
- atelectasis
- respiratory muscle weakness
- mechanical hypoventilation
- sleep apnea
- head trauma
- post op
- pneumonia
- asthma
Resp Acidosis: Lab values
- increased PCO2 and decreased pH if uncompensated
Resp acidosis: Manifestations
- drowsiness, disorientation, dizziness, headache coma
- decreased BP, ventricular fib, warm, flushed skin from peripheral vasodilation
- seizures
- dyspnea, hypoventilation with hypoxia
Resp acidosis: interventions
treat the underlying cause: give narcan for opioid antagonist during drug overdose
- oxygen therapy (low flow)
- respiratory therapy - BiPap
Respiratory alk: causes
- anything causing hyperventilaion
- 2nd degree to hypoxia, fear/anxiety, fever
- stimulated resp center - sepsis, brain injury, salicylate poisoning
- mechanical overventilation
Lab values: resp alk
- decrease PaCO2 and increased pH if uncompensated
Resp alk: manifestations
- lethargy, light-headedness, confusion
- increased HR, dysrhythmias
- nausea, vomiting, epigastric pain
- tetany, numbness, tingling, hyperreflexia, seizures
- rapid, shallow breathing (Kussmauls breathing)
- fast resps
Resp alk: Interventions
- treat the underlying cause
- rebreather mask
- assist client to slow respirations
- decrease anxiety
- oxygen therapy if hypoxia is the underlying cause
- monitor VS, ABGs and electrolyte imbalances
Metabolic acidosis: causes
accumulation of acid - diabetic ketoacidosis, septic shock (lactic acid accumulation), starvation
- loss of bicarbonate - diarrhea, renal failure
- DKA
Met Acidosis: lab values
- decrease HCO3 and decrease in pH if uncompensated. the resp system is going to try and compensate to blow off the CO2 and increase the pH - Kussmauls breathing happens
- urine pH is normally 6
Met Acidosis: manifestations
- drowsiness, confusion, headache, coma
- decreased BP, dysrhythmias, warm, flushed skin (vasodilation)
- nausea, vomiting, diarrhea, abdominal pain
- deep, rapid respirations (kussmauls resps)
Interventions: met acidosis
- treat underlying cause
- respiratory support
- administer sodium bicarbonate to neutralize acid
Metabolic alk: causes
- loss of acid - NG suctioning, prolonged vomiting, loss of K+ to diuretic therapy
- gain of bicarbonate - ingestion of baking soda
Met alk: lab values
- HCO3 increased and increased pH if uncompensated
Met alk: Manifestations
- dizziness, irritability, nervousness, confusion
- tachycardia, dysrhythmias
- anxorexia, nausea, vomiting
- tremors, hypertonic muscles, muscle cramps, tetany, tingling,
- hypoventilation
Met alk; interventions
- treat underlying cause
- replace lost fluids and electrolytes
- support renal function (dialysis)
- administer acetazolamide - promotes loss of bicarb in urine (diuretic)
Mixed
- two or more simple disorders present at the same time
- pH will depend on type, severity and acuity
- respiratory acidosis and metabolic alkalosis
- mixed acidosis
- mixed alkalosis
Normal ABG values
pH - 7.35-7.45
PaO2 - 80-100 mmHg
PaCO2 - 35-45 mmHg
HCO3 - 22-26 mEq/L
vomiting and diarrhea
vomiting will decrease acidity because of the stomach acid being lost
stool contains bicarbonate so when you have diarrhea- you will become acidic
Fully Compensated
- pH returned to normal despite the presence of abnormalities in both resp and/or metabolic systems
- acidosis because it is more leading towards acidosis
