Fluid and Electrolytes Flashcards
What is the major fluid in the body?
Water
How much body weight is water?
50-60%
What is the most important nutrient to sustain life?
Water
What is fluid intake and fluid loss in a patient like?
It is equal
Intracellular fluid
-Fluid that is in the cells
-70% of water in the body
Extracellular fluid
-Fluid that is outside of the cells
-Approximately 30% of water in the body
Where does potassium stays the most?
Intracellular fluid
What are electrolytes?
substances that are capable of breaking into particles called ions
What are the major electrolyte in the ECF
sodium
chloride
calcium
bicarbonate
What are the major electrolytes in the ICF
potassium
phosphorus
magnesium
What foods are low in fluid
Cereal
Dried fruits
Waft are some things to keep in mind for fluid intake and output
-Fluid intake and output should be the same
-Always record I&O
How can we measure I&O for incontinent patients?
-Measure the diapers
- Measure urine from pure wick
What is sensible measurable
Urine
Stool
Wound
Insensible
Not measurable
Respiration
Vapor
Chicken etc
Sodium normal range
135-145
Potassium normal range
3.5-5.0
Calcium normal range
8.9-10.5
Normal range for magnesium
1.3-2.3
Chloride normal range
97-107
What causes fluid volume deficit: hypovolemia
Anything that causes us to lose fluids
Vomiting
Diarrhea
Taking lasix
Not drinking enough fluids
Bleeding
Burns
Sweating without replacing fluids
Nasogastric suction
Fever
What might cause a patient to have issues with intake leading to hypovolemia
Nausea
Impaired swallowing
Confusion
NPO
patient loses sense of taste
What are the S/S for hypovolemia
Dizziness
Confusion
Nausea
Vomiting
Fatigue
Seizures
Cool and clammy skin
Thirst
Dry mucous membrane
Decreased skin turgor
Tachycardia
Decreased urine output
Who is at risk for hypovolemia
Children
Older adults
Patients who are ill
Interventions for hypovolemia
Patient to intake fluids
Monitor patient weight
Safety precaution because the patient will be dehydrated
Hypervolemia causes
- when there is an increase in the intake of sodium in dehydrates the cells causing the water to move out of the cell causing edema
- too fluid fluid intake
- malfunction of the kidney: when the kidney is unable to excrete the excess fluid
- heart failure: accumulation of fluid in the lungs
Hypervolemia S/S
Bounding pulse
Edema
High blood pressure
Crackles
Distended neck vein
Weight gain
Wet cough
Skin is cool to touch
Dyspnea
What is a sign of Hypervolemia
Distend neck vein
Who is at risk for Hypervolemia
Patients with heart failure
Kidney disease
Certain meds
Interventions for Hypervolemia
Restrict sodium intake
Observe respiratory
Monitor for SOB
Check for edema
Monitor I&O
Administer diuretics
Monitor patient weight
Place patient in a semi Fowler position
What position do you put patients with Hypervolemia in
Semi fowlers
Hypernatremia
Sodium level higher than 145
Hypernatremia causes: anything that causes you to lose water
Dehydration or water deprivation
Heat stroke
Excess fluid loss
Too much sodium intake
Diarrhea
Vomiting
Burns
Patient is unable to communicate that they are thirsty
Sodium retention: kidney failure or Cushing disease
Hypernatremia S/S
FRIED
Fatigue
Restlessness
Increased flexes
Extreme thirst
Decreased urine and dry mouth
Seizures
Delusion
Hallucination
Disorientation
Interventions for Hypernatremia
Monitor the patients level of consciousness
Provide oral care
Monitor I&O
Low sodium diet
Encourage I oral fluid
Hyponatremia
Sodium level less than 135
Hyponatremia causes
Too much water intake
Congestive heart failure: dilute the sodium
Low salt due
NPO status
Kidney disease
Sodium wasting
What are examples of sodium wasting for Hyponatremia
Vomiting
Diarrhea
Sweating
Diuretics usage
Hyponatremia S/S
SALT LOSS
Seizures
Abdominal cramps
Lethargic
Tendon reflex diminished
Loss of urine and appetite
Orthostatic hypotension
Shallow respiration
Spasm of muscle
Muscle cramps
Weakness
Dry skin
What are the severe signs of Hyponatremia
Lethargy
Muscle twitching
Hyperflexia
Seizure
Coma
Intervention for Hyponatremia
ADD SALT
Monitor I&O
Vitals and level of consciousness
Monitor respiratory status if muscle weakness is present
Encourage intake of high sodium foods
Restrict water intake
Administer iv saline solution
Diuretic
Daily weight check
Safety
Airway precautions
Limit water intake
Teach high salt diet
What foods are source of sodium
Milk
Cheese
Processed meat
Canned foods
Hypokalemia
Potassium less than 3.5
With potassium everything is
Slow and low
Hypokalemia common causes: anything that causes you to lose electrolytes
Remember we “DITCH”potassium
Drugs: laxative or diuretic
Inadequate consumption of potassium
Too much water intake
Cushing syndrome
Heavy fluid loss: vomit, diarrhea, suction, sweat, wound drainage
Alkalosis
Hypokalemia S/S
Everything is slow and low
Decrease HR
Muscle weakness
Leg cramps
Fatigue
Parenthesis
Dysthymia
Weak irregular pulse
Respiratory distress
Decrease muscle tone
Hypoactive reflex
Bradycardia is for
Tachycardia is for
Bradycardia is for Hypokalemia
Tachycardia is for hyperkalemia
Interventions for Hypokalemia
Treat the underlying cause
Potassium intake
Potassium administration
Monitor for slow respiration
Monitor cardiac rhythm
What foods are high in potassium
Banana
Avocado
Leafy greens
Tomato
Strawberry
Mushroom
Fish
Hyperkalemia
Potassium higher than 5.0
Common causes of hyperkalemia
Excess potassium intake
Renal failure
Hyperaldosteeroism
Medications
What drugs might cause hyperkalemia
Potassium chloride
Heparin
Ace inhibitors
Potassium sparing diuretics
S/S Hyperkalemia
Tachycardia
Muscle weakness: the heart is working too much
Paralysis
Paresthesia
Interventions for hyperkalemia
ECG monitoring
Decrease potassium intake
Monitor serum potassium
Hypocalcemia
Less than 8.9
Common causes of Hypokalemia
Not enough calcium intake
Impaired calcium uptake
Excessive calcium loss
Low vitamin d
Low parathyroid hormone
Wound drainage
Kidney disease
S/S of hypocalcemia
Positive Chvostek
Numbness and tingling
Muscle spasms
Positive trousseau signs
Tetany or muscle twitching
Muscle cramps,os
Hyperactive reflex
What is trousseau
Hand and finger spasm
Interventions for Hypocalcemia
administer calcium
Vitamin d supplements
Seizure precautions
Safety precaution
High diet calcium
What foods are high in calcium
Milk
Yoghurt
Cheese
Spinach
Collard Greens
Almonds
Hypercalcemia
Higher than 10.5
Common cause of hypercalcemia
Hyperthyroidism : too much calcium released in blood
Cancer
Increased calcium intake
Signs and symptoms of hypercalcemia
Muscle pain
Bone pain
Nausea
Vomiting
Excessive urination
Thirst
Slurred speech
Lethargy
Thirst
Intervention for hypercalcemia
Restrict calcium intake
Increase fluid intake to dilute the calcium
Monitor from cal, injures
Assess for abdominal or flank pain
Strain urine for kidney stone
Hypomagnesia
Less than 1.3
Common cause of hypomagnesmia
Nasogastric suction
Diarrhea
Sepsis
Burns
Chronic alcoholism
Vomiting
Signs and symptoms for hypomagnesemia
Remember that the muscle will be experiencing excitement which causes ?
Muscle weakness
Tremors
Tetany
Seisures
Cardiac arrhythmia
Change in mental
Respiratory paralysis
Hyperactive deep tendon reflex
Interventions for hypomagnesmia
Disscontinue medication that might be causing losing magnesium
Magnesium administration
Encourage foods high in magnesium
What foods are high in magnesium
Whole grain
Dark vegetables
What is the precaution when giving oral magnesium
It can cause diarrhea further increasing magnesium depletion
Hypermagnesemia
Greater than 2.1
Common causes of hypermagnesemia
Renal failure
Excessive intake of magnesium
Signs and symptoms of hypermagnesemia
Everything is lethargic
Nausea
Vomiting
Weakness
Flushing
Lethargic
Hypoactive reflex
Respiratory depression
Coma
Cardiac arrest
Interventions for hypermagnesemia
Perform focused assessment of level of consciousness and reflex
Administer loop diuretics and magnesium iv free if kidney function adequate
Administer calcium glucinate
Withhold foods high in magnesium
What nursing assessment questions should you be asking
Acute and chronic illness
Any abnormal loss of body fluids
Burns
Trauma
Surgery
Treatment may disrupt fluid and electrolytes balance
Physical assessment should include
Skin
Muscous membrane
Vital signs
Neuro exam
Look for relative signs and symptoms
What are so,e relative signs and symptoms of fluid and electrolytes altercation
Nausea
Vomiting
Diarrhea
Wounds
Daily weights
Weighing the patient at the same time each day with them wearing the same clothes
what laboratory studies can you complete
CBC
Serum electrolyte
Blood urea nitrogen
Creatinine
What is a normal specific gravity
1.005 to 1.030
What increased urine specific gravity occur with
Dehydration
Vomiting
Diarrhea
Heart failure
Decreased urine specific gravity indicates
Renal damage
What would be some planned outcome for a patient with altercation in fluid and electrolytes
- patient will maintain fluid balance between fluid intake and fluid output
- patient will maintain a urine specific gravity of 1.005-1.030
Implementations
Dietary change
Change of fluid intake
Medication administration
Iv therapy
Blood and blood products replacement
Patient and family/ caregiver teaching
What can you teach the patient
The importance of accurately recording all of input and output
Provide instructions and explanations to help patient keep the measurements of when care instructions and for how the patient can keep measurements accurate
Use the patient plan of care to communicate to other nursing personal the need to measure fluid intake and output
Nursing care
Place a sign in the room the door to measure intake and output
Measure do not estimate
Record I&O for each 8 hour shift
What counts as patients fluid intake
All foods and fluid at room temperature
Use the faculty designation if specific volume for common food containers
All parental fluid
Sips of water
Subcutaneous fluid
Gastrointestinal fluid
Iv flush
Are sips of water included
Yes
Fluid output include
Urine
Diarrhea
Drainage from fistula, wounds and ulcers
Drainage from other
Heavy perspiration should be noted
Hyperventilation
Urine or liquid feces in diapers.
Vomiting on clothes or bed
Wound drainage saturated dressings
