Fluid and Electrolytes Flashcards
Too much fluid in the vascular space
Fluid volume excess/hypervolemia
Causes of FVE
Heart failure
Renal failure
Too much sodium
How does heart failure cause FVE?
Heart is weak, cardiac output down, kidney perfusion down, urinary output down. (volume stays in vascular space)
Where is aldosterone found?
Adrenal glands
What is the normal action of aldosterone?
When blood volume gets low, aldosterone is secreted and causes sodium and water retention and causes the blood volume to increase
What are diseases with too much aldosterone?
Cushing’s and hyperaldosteronism
What are diseases with too little aldosterone?
Addison’s
What does anti-diuretic hormone (ADH) normally do?
causes water retention
What is the disease related to too much ADH?
SIADH
What does too much ADH cause?
FVE
What disease is related to not enough ADH?
Diabetes Insipidus
What does not enough ADH cause?
FVD
Is urine concentrated or diluted with too much ADH?
Concentrated because kidneys are retaining water
Is blood concentrated or diluted with too much ADH?
Diluted (fluid is being held in the vascular space)
Where is ADH found?
Pituitary
What kind of injury can cause ADH problems?
Head injuries
What labs are measured with ADH?
Urine specific gravity, sodium, hematocrit
What is another name for ADH?
Vasopressin (Pitressin)
What drug can be used as an ADH replacement in diabetes insipidus?
vasopressin (Pitressin) or desmopressin acetate (DDAVP)
What is a normal CVP?
2-6 mmHg
What are signs and symptoms of FVE?
Distended neck veins/peripheral veins: vessels are full
Peripheral edema/third spacing
increased CVP
Lung sounds: wet
Polyuria: Kidneys are trying to help remove fluid
increased pulse: trying to keep fluid moving forward
increased BP: more volume=more pressure
increased weight
Where is CVP measured?
Right Atrium
What should you think of first when someone has fluid retention?
Heart Problems
What type of diet is a treatment for FVE?
Low sodium and restricted fluids
What type of drugs are given as a treatment for FVE?
Diuretics
Why is someone with FVE on bedrest?
to induce diuresis by the release of ANP and decreased production of ADH
What causes FVD/hypovolemia?
Loss of fluid from anywhere
Third spacing
Diseases with polyuria
What should you think of first when someone has polyuria?
Shock
Examples of third spacing
Burns: fluid goes into tissues
Ascites: fluid goes into abdomen
What should you worry about with third spacing?
hypotension
Signs and symptoms of FVD
Weight decreased Decreased skin turgor dry mucous membranes decreased urine output decreased BP: less volume=less pressure increased pulse: trying to pump little fluid left increased respirations decreased CVP constricted neck/peripheral veins cool extremities increased urine specific gravity
How do you replace fluids with a mild fluid deficit?
with PO fluids
How do you replace fluids with a severe fluid deficit?
with IV fluids
Where do isotonic solutions go?
into the vascular space and stay there
Where do hypotonic solutions go?
into the vascular space and then shifts out into the cells
What can isotonic solutions cause?
FVE, hypertension, hypernatremia
Examples of isotonic solutions
Normal saline
LR
D5W
D5 1/4 NS
Uses for isotonic solutions
to replace fluids lost through nausea, vomiting, burns, sweating, and trauma
Examples of hypotonic solutions
D2.5W
1/2 NS
0.33% NS
Uses for hypotonic solutions
for a client with hypertension, renal, or cardiac disease and needs fluid replaced because of nausea, vomiting, burns, hemorrhage, etc.
what should be monitored for with hypotonic solutions?
Cellular edema, FVD, and hypotension due to fluid shifting out of vascular space and into cells
Where do hypertonic solutions go?
into the vascular space and draw fluids from cells into the vascular space to expand fluid volume
Uses for hypertonic solutions?
client with hyponatremia, a client who has shifted large amounts of fluid with third spacing, or has severe edema, burns, or ascites
What should be monitored for with hypertonic solutions?
FVE
What kind of medication is a hypertonic solution?
high alert
How does renal failure cause hypermagnesemia?
Kidneys cannot excrete magnesium (builds up in blood)
How do antacids cause hypermagnesemia?
Antacids contain magnesium. Taking too many can cause magnesium to build up in the blood
Why is flushing and warmth a symptom of hypermagesemia?
magnesium causes vasodilation
What should you think of first when you think of magnesium or calcium?
Muscles
Why is a ventilator a treatment for hypermagnesemia?
muscles are flaccid and weak and respirations are decreased
why is dialysis a treatment for hypermagnesemia?
This can help filter magnesium out of the blood if kidney failure is the cause
Why is calcium gluconate a treatment for hypermagnesemia?
it is the antidote for mag toxicity
What rate is calcium gluconate administered?
1.5-2 mL/min
What is the normal lab value for magnesium?
1.3-2.1 mEq/L
Signs and symptoms of hypermagnesemia
decreased DTR weak/flaccid muscle tone arrhythmias decreased LOC decreased pulse decreased respirations
What does too much magnesium act like?
sedative
Why is hyperparathyroidism a cause for hypercalceimia?
too much PTH: PTH pulls Ca from the bones and puts it in the blood, causing the blood calcium levels to increase
Why are thiazides a cause of hypercalcemia?
thiazides retain calcium
why is immobilization a cause for hypercalcemia?
you have to bear weight to keep calcium in the bones
Why are kidney stones a symptom of hypercalcemia?
kidney stones are made up of calcium
Why are brittle bones a sign of hypercalcemia?
Calcium is being pulled from the bones and put into the blood stream
Why is movement a treatment for hypercalcemia?
movement keeps calcium in the bones
Why are fluids a treatment for hypercalcemia?
fluids help prevent kidney stones
Why is increased phosphorus in the diet a treatment for hypercalcemia?
Calcium has an inverse relationship with phosphorus
What medications decrease serum calcium?
bisphosphates (etidronate)
Calcitonin
Signs and symptoms of hypercalcemia?
decreased DTR weak/flaccid muscle tone arrhythmias decreased LOC Decreased pulse decreased respirations
What does too much calcium act like?
sedative
Why is diarrhea a cause of hypomagnesemia?
this causes magnesium to be lost out of the intestinal tract (lots of magnesium in the intestines)
Why is alcoholism a cause of hypomagnesemia?
alcohol suppresses ADH (causes FVD) and it is hypertonic (dilutes blood)
signs and symptoms of hypomagnesemia
rigid and tight muscles seizures stridor/laryngospasm (smooth muscle) \+ Chvostek's (tap cheek, twitch) \+Trousseasu's (pump up BP cuff, hand tremor) arrhythmias (heart is a muscle) increased DTR mind changes swallowing problems (esophagus is smooth muscle)
Treatment for hypomagnesemia
give IV Mg (increase Mg in blood)
Check kidney function before administration (Mg is excreted through the kidneys)
Seizure precautions (can be a symptom)
Eat magnesium (increase level in blood)
Stop the Mg infusion if patient reports flushing and sweating
Causes of hypocalcemia?
Hypoparathyroidism
radical neck
thyroidectomy
(not enough PTH in all of these situations)
signs and symptoms of hypocalcemia?
rigid and tight muscles seizures stridor/laryngospasm (smooth muscle) \+ Chvostek's (tap cheek, twitch) \+Trousseasu's (pump up BP cuff, hand tremor) arrhythmias (heart is a muscle) increased DTR mind changes swallowing problems (esophagus is smooth muscle)
treatment for hypocalcemia
PO calcium (increase level in blood) IV calcium (increase level in blood; give slowly; make sure they are on heart monitor) Vitamin D (helps with calcium absorption)
What kind of medications are given to treat hypocalcemia?
Phosphate binders: (reducing phosphate increases calcium) sevelamer hydrochloride (Renagel) calcium acetate (PhosLo)
what is the normal lab value for sodium?
135-145 mEq/L
What should you think of when you think about a sodium problem?
neuro changes
Why are hyperventilation, diabetes insipidus, and heat stroke a cause of hypernatremia?
causes water loss which concentrates the sodium level in the blood
Why are dry mouth and thirst a symptom of hypernatremia?
dehydration (too much fluid lost)
why are neuro changes a symptom of hypernatremia?
The brain shrinks when too much fluid is lost
Treatment for hypernatremia
restrict sodium dilute client with fluids (makes sodium go down) daily weights I&O Lab work
Why is drinking water for fluid replacement a cause of hyponatremia?
This only replaces water and not the other electrolytes that were also lost, such as sodium
Why is SIADH a cause of hyponatremia?
This causes water to be retained (dilute the blood)
Signs and symptoms of hyponatremia
headache
seizure
coma
treatment of hyponatremia
client needs sodium
doesn’t need water
hypertonic saline if having neuro problems
Normal lab value for potassium?
3.5-5 mEq/L
Why is kidney trouble a cause of hyperkalemia?
kidneys excrete potassium and potassium is retained if the kidneys don’t work
Why is spironolactone a cause of hyperkalemia?
This is a potassium sparing diuretic
Signs and symptoms of hyperkalemia?
starts with muscle twitching
then muscle weakness
the flaccid paralysis
life threatening arrhythmias (v fib)
Why is dialysis a treatment for hyperkalemia?
Helps filter the blood in place of the kidneys to remove excess potassium
Why are glucose and insulin a treatment for hyperkalemia?
insulin carries glucose and potassium into the cells
What do you have to worry about any time you give IV insulin?
Hypokalemia and hypoglycemia
What does calcium gluconate do as a treatment for hyperkalemia?
decreases arrhythmias
what medication is given for hyperkalemia?
sodium polystyrene sulfonate (Kayexalate) (sodium and potassium have an inverse relationship)
Why are vomiting and NG suction causes for hypokalemia?
This causes a loss of potassium from the stomach (lots of potassium in the stomach)
why are diuretics a cause for hypokalemia?
diuretics can remove potassium
Why is not eating a cause for hypokalemia?
potassium is not being taken into the body
signs and symptoms of hypokalemia?
muscle cramps
muscle weakness
life threatening arrhythmias (v tach)
treatment for hypokalemia?
give potassium
spironolactone (potassium sparing diuretic)
eat more potassium
