Fluid And Electrolytes Flashcards
Electrolyte found in extracellular fluid
Sodium
Functions of sodium
Acid-base balance, fluid balance, active and passive transport, irritability and conduction of nerve muscle tissue
Normal sodium range
135-145 mEq/L
S/S of hypernatremia (>145 mEq/L)
FRIED SALT: Flushed skin, Restless/anxious/confused/irritable, Increased BP and fluid retention, Edema (pitting), Decreased UOP, Skin flushed and dry, Agitation, Low-grade fever, Thirst (dry mucous membranes)
S/S of hyponatremia (<135 mEq/L)
SALT LOSS: Stupor/coma, Anorexia (n/v), Lethargy, Tachycardia (thready pulse), Limp muscles, Orthostatic hypotension, Seizures/headache, Stomach cramping (hyperactive bowel sounds)
Hypernatremia risk factors
Increased sodium intake (oral, hypertonic fluids), loss of fluids (fever, v/d, DI, diaphoresis, infection), decreased sodium excretion (kidney problems)
Hyponatremia risk factors
4 D’s: diaphoresis, diarrhea/vomiting, drains (NGT suction), diuretics (loop & thiazide)
Other: SIADH, inadequate intake, kidney disease, HF
Hypernatremia management
IV infusions NS 0.9% (if d/t fluid loss), diuretics that promote sodium loss (loop and thiazide), restrict sodium and fluid as prescribed
Hyponatremia management
ADD SALT: Administer IV sodium chloride infusions (if d/t hypovolemia), 3% NS, Diuretics (if d/t hypervolemia), Daily weights, Safety (OHTN = risk for falls), Airway protection, Limit water intake, Teach about foods high in sodium (canned foods, packaged/processed meats)
Potassium and sodium are _________
Opposites; if Na is high K+ will be low (vice versa)
Role of potassium
Cellular metabolism and transition of nerve impulses, cardiac, lung, and muscle tissue function, acid-base balance
Normal potassium range
3.5-5 mEq/L
S/S of hyperkalemia (> 5 mEq/L)
MURDER: Muscle cramps and weakness, Urine abnormalities, Respiratory distress, Decreased cardiac contractility (low HR and BP), ECG changes, Reflexes (increased DTRs)
ECG changes related to hyperkalemia
Tall peaked T-waves, flat P waves, widened QRS, prolonged QT interval
S/S of hypokalemia
Thready/weak/irregular pulse, OHTN, shallow respirations, anxiety/lethargy/confusion/coma, paresthesias, hyporeflexia, constipation, N/V/abdominal distention, ECG changes
ECG changes related to hypokalemia
ST depression, shallow or inverted T-wave, prominent U wave
Potassium imbalance can cause
Cardiac dysrhythmias (can be life threatening!)
Hyperkalemia management
Monitor ECG, potassium-restricted diet, potassium excreting diuretics, IV calcium gluconate and IV sodium bicarb, avoid salt-substitutes
Hypokalemia management
Oral potassium supplements, spironolactone, liquid potassium chloride
Potassium is NEVER administered by
IV push, IM, or subq
How to administer IV potassium
Diluted and administered using an infusion device
Where is calcium found?
Cells, bones, and teeth
Electrolyte needed for proper functioning of the cardiovascular, neuromuscular, endocrine systems, blood clotting, and teeth formation
Calcium
Normal calcium range
9-11 mg/dL
S/S of hypercalcemia (> 11 mg/dL)
BACKME: Bone pain, Arrythmias, Cardiac arrest (bounding pulses), Kidney stones, Muscle weakness (decreased DTRs), Excessive urination, seizures
S/S of hypocalcemia
CATS GO NUMB: convulsions, arrythmias, tetany, spasms and stridor, numbness in fingers, face, and limbs
Carpal spasm caused by inflating a BP cuff; related to hypocalcemia
Positive Trousseau’s
Contraction of facial muscles with light tap over the facial muscle; related to hypocalcemia
Chvostek’s sign
A client with a calcium imbalance is at risk for
Pathological fracture (move them carefully and slowly!)
Hypercalcemia management
Administration of phosphorus, calcitonin, bisphosphonates, and prostaglandin synthesis inhibitors (NSAIDs), avoid foods high in calcium
Hypocalcemia management
Calcium PO or IV, aluminum chloride and vitamin D, seizure precautions, consume foods high in calcium
Calcium and phosphate are
Inverse; if Ca is high, PO4 is low (vice versa)
Most of the magnesium found in the body is found in the
Bones
Electrolyte that regulates BP, blood sugar, muscle contraction and nerve function
Magnesium
Normal magnesium range
1.5-2.5 mg/dL
S/S of hypermagnesemia (>2.5 mg/dL)
Low everything: energy, HR/BP/RR, bowel sound, DTRs
S/S of hypomagnesemia
High everything: HR/BP/DTRs, shallow respirations, twitches/paresthesias, tetany, seizures, irritability and confusion (may also see positive trousseau’s and Chvostek sign)
Hypermagnesemia management
Diuretics, IV calcium chloride or calcium gluconate, avoid laxatives and antacids containing mg
Hypomagnesemia management
IV or PO mag.sulfate, seizure precautions, increase magnesium-containing foods
Magnesium and calcium are
The same; if one is increased/decreased, so is the other
What electrolyte would you monitor for in a patient with thyroid disease?
Calcium
Describe what the blood is like when the serum osmolarity is >300
Concentrated
Most common electrolyte disorder
Hyponatremia
Tachycardia, flat neck veins, tachypnea, poor turgor, and decreased UOP are signs of
Dehydration
What is the most common route of potassium loss?
GI
Absorption of calcium requires
Vitamin D
What precautions would you place a patient with hypernatremia?
Seizure
In a patient with hypercalcemia, the blood will clot faster or slower?
Faster
What should you assess first with hypokalemia if the patient has a normal ECG?
Respiratory status
Example of potassium-sparing diuretic
Spironolactone
If a patient has hypophosphatemia, they will most likely have what other electrolyte imbalance?
Hypercalcemia
What should be the first assessment completed on a patient with hyperkalemia?
Cardiac
A nurse would expect an increased or decreased UOP with hypernatremia?
Decreased
Full and bounding pulse, HTN, JVD, dyspnea, crackles, pale and cool skin are S/S of
Over hydration or fluid overload
Which electrolyte maintains extracellular fluid?
Sodium
Which electrolytes maintain intracellular fluid?
Potassium and magnesium
Water goes with…
Sodium (were sodium goes, water flows)
What kind of fluid is normal saline?
Isotonic
Normal pH range
7.35-7.45
Low pH (<7.35)
Acidosis
High pH (>7.45)
Alkalosis
PaCO2 normal range
35-45
PaCO2 > 45
Acidosis
PaCO2 < 35
Alkalosis
HCO3 normal range
22-26
HCO3 < 22
Acidosis
HCO3 >26
Alkalosis
ROME method for ABGs
Respiratory Opposite Metabolic Equal
CO2 binds to H2O to form
Carbonic acid (H2HCO3); H2 (hydrogen ion — acidic), CO3 (bicarbonate — weak)
High hydrogen ions mean ___ blood pH
Low (acidic)
Low hydrogen ions mean ___ blood pH
High (alkaline)
What can cause alkalosis?
NGT suctioning, vomiting, diarrhea
What can cause respiratory alkalosis?
Hyperventilation, tachypnea, fever, NSAID/salicylate toxicity (Aspirin), high altitude (d/t decreased O2), pneumothorax, anxiety, pain
If patient has excessive diarrhea, the main electrolyte loss is
Potassium
Loop diuretics result in a loss of
Potassium
Kidney patients should not be given _________ because it is hard for them to excrete
Potassium
Hypotonic fluids _____ the cell
Swells
Hypotonic fluids are given for
Dehydration
Examples of hypotonic fluids
1/2 NS (0.45%), 0.33% NS, 2.5%DW
Hypertonic fluids _____ the cell
Shrinks (pulls water from cells)
Hypertonic fluids are given for
TBI (d/t swelling and increased ICP)
Examples of hypertonic fluids
3% saline (TBI/ICP), 5% saline, D51/2NS, D5LR, D5NS
_________ fluids do not change the volume of cell and are the go-to fluids for VOLUME
Isotonic
Isotonic fluids are given for
Hypovolemia
Examples of isotonic fluids
0.9% NS, LR, D5W
Best isotonic fluid option for fluid volume deficit
0.9% NS
Best isotonic fluid option for burns
LR
Fluid option for treatment of metabolic acidosis
Isotonic fluids
Priority assessment for patients with hypophosphatemia and hypercalcemia
Neuro status
IJ line is an example of
Central line (“intra”)
EJ is an example of
Peripheral line (“extra”)
PICC lines touch the
Heart
Why are PICC lines the most convenient central lines?
Nurses can insert it, patient can be sent home with PICC line if on long-term antibiotics (single-lumen), milrinone, and remodulin
PICC line patient education
How to care for PICC lines, come back to hospital or clinic for dressing changes, S/S of infection (pain, redness, fever, swelling)
Cardiac drip that can be administered via PICC line given for EF less than 20%
Milrinone
Drip that can be administered via PICC line used for pulmonary HTN
Remodulin
PICC line dressings should be changed every
7 days
___ should be used to wipe PICC lines every shift
CHG
Flushing a triple lumen PICC line
Scrub the hub — new alcohol wipe for each line, flush each line individually, scrub the hubs again, change cap each time you flush
What should the nurse do if resistance is felt when flushing PICC line?
STOP (could dislodge a clot); alteplase if line is blocked (clot buster; administered by PICC nurse)
What should the nurse do if PICC line infection is suspected?
Inform the physician (order will be given to removed PICC line); cut the tip of PICC line and send it to lab for culture
S/S of sepsis
Tachycardia (early sign) and hypotension (late sign)
Intervention for sepsis
Fluid resuscitation
Subclavian lines are for
Dialysis access
Chest access ports are for
Cancer patients
S/S of central line infection
Redness, drainage, blood around access site (especially in subclavian)
If bleeding from central line…
Apply pressure and call the physician (DO NOT remove the line)
Femoral line priority assessment
Infection
Key difference between infiltration and infection is
Skin temperature (cool to touch with infiltration and warm to touch with infection)
Interventions for infiltration
Removal is priority (can lead to infection)! Start a new IV site in a different area, cool compress for comfort
What are hypertonic solutions used for?
Cerebral edema, hyponatremia, metabolic alkalosis, maintenance fluid, hypovolemia
Monitor for __________ with hypertonic fluids
Fluid volume overload
Explain hypertonic solutions
More salt than water in solution. The vessel becomes more concentrated than the cell, causing water to leave the cell and the cell shrinks
Fluids used to expand intravascular fluid volume and replace fluid loss
Isotonic fluids
Isotonic fluids are used for
Blood loss (hemorrhage, burns, surgery), dehydration (V/D), fluid maintenance
What is the only solution compatible to use with blood or blood products?
Normal saline
Hypotonic fluids are used for
DKA, hypernatremia, helping kidneys excrete excess fluids
Hypotonic solutions should not be given with
Increased ICP, burns, trauma
Describe hypotonic solutions
More water than salt in solution. The vessel becomes less concentrated than the cell, causing water to enter the cells which swell the cells
Fluid inside the cell
Intracellular fluid
Fluid outside the cell
Extracellular fluid
Two categories of extracellular fluid
Interstitial fluid and intravascular fluid
Fluid that surrounds the cell (in the tissues)
Interstitial fluid
Plasma/fluid in the blood vessels
Intravascular fluid
Mixtures that have large molecules making it more efficient at increasing fluid volume in the blood (plasma expanders!)
Colloids
Examples of colloids
Albumin, fresh frozen plasma
Mixtures that have small molecules and provide immediate fluid resuscitation
Crystalloids
Examples of crystalloids
Hypertonic, isotonic, and hypotonic solutions
Colloids are used for
Shock, pancreatitis, burns, excessive bleeding
IV complication by which air enters the vein through the IV tubing
Air embolism
S/S of air embolism
Tachycardia, chest pain, hypotension, decreased LOC, cyanosis
Air embolism treatment
Clamp tubing, turn client on side and place in trendelenburg, notify HCP
IV complication in which IV fluid leaks into surrounding tissue
Infiltration
S/S of infiltration
Pain, swelling, coolness, and numbness at the site; no blood return
Infiltration treatment
Remove IV, elevate extremity, apply warm/cool compress, DO NOT rub the area
Entry of microorganism into the body via IV
Infection
Administration of fluids too rapidly
Circulatory overload (fluid volume overload)
S/S of fluid volume overload
HTN, distended neck veins, dyspnea, wet cough and crackles
Fluid overload treatment
Decrease IV flow rate, elevate HOB, keep client warm, notify HCP
Inflammation of the vein that can lead to a clot
Phlebitis
S/S of phlebitis
Heat, redness, tenderness at the site; decreased flow of IV
Phlebitis treatment
Remove the IV, notify HCP, restart IV on the opposite side
Collection of blood in the tissues
Hematoma
S/S of hematoma
Blood, hard and painful lump at the site; ecchymosis
Hematoma treatment
Elevate extremity, apply pressure and ice
Respiratory alkalosis
pH high, CO2 low
Respiratory acidosis
PH low, CO2 high
Metabolic alkalosis
PH high, HCO3 high
Metabolic acidosis
PH low, HCO3 low
How do kidneys compensate?
By excreting excess acid and bicarb (HCO3) OR retaining hydrogen and bicarb
How do the lungs compensate?
Through hyper or hypoventilation
Hyperventilation causes…
Decreased CO2 (alkalosis)
Hypoventilation causes…
Increased CO2 (acidosis)
PH is out of range and CO2 or HCO3 is in range
Uncompensated
CO2, HCO3 and pH are ALL out of range
Partially compensated
PH is in range
Fully compensated
causes of respiratory acidosis
Drugs (opioids and sedatives), edema (fluid in lungs), pneumonia, pulmonary emboli, asthma, COPD
Causes of respiratory alkalosis
Losing CO2 (tachypnea): fever, aspirin toxicity, hyperventilation
S/S of respiratory acidosis
Increased BP, RR, and HR, restlessness, confusion, headache, sleepy/coma
S/S of respiratory alkalosis
Increased HR, confused and tired, tetany, EKG changes, (+) chvostek
Causes of metabolic acidosis
DKA, AKI/CKD, malnutrition, severe diarrhea
Causes of metabolic alkalosis
Excess antacids, diuretics, excess vomiting, hyperaldosteronism
S/S of metabolic acidosis
Increased RR, hyperkalemia, decreased BP, confusion
S/S of metabolic alkalosis
Decreased RR, hypokalemia
Kidney problem in which there is too much hydrogen and too little bicarb; lungs compensate by blowing off CO2
Metabolic acidosis
Kidney problem in which there is too much bicarb and too little oxygen. Lungs compensated by retaining CO2
Metabolic alkalosis
Lung problem in which the lungs are retaining too much CO2. Kidneys compensate by excreting excess hydrogen and retaining bicarb
Respiratory acidosis
Lung problem in which the lungs are losing too much CO2. Kidneys compensate by excreting excess bicarb and retaining hydrogen
Respiratory alkalosis
For which acid base imbalance would you want the patient to rebreathe into a paper bag?
Respiratory alkalosis
