Fluid and Electrolytes Flashcards
Fluid Volume Deficit
Contributing Factors:
1.Excess GI and/or renal loss
2.Diaphoresis
3.Fever
4.Long-term NPO
5.Hemorrhage
6.Insufficient intake
7.Burns
8.Diuretic therapy
9.Aging: Older adults have less body water and decreased thirst sensation.
Manifestations:
1.Weight loss
2.Dry mucous membranes
3.Increased heart rate and respirations
4.Thready pulse
5.Capillary refill less than 3 seconds
6.Weakness, fatigue
7.Orthostatic hypotension
8.Poor skin turgor
9.LATE SIGNS: Oliguria, decreased CVP, flattened neck veins
Diagnostic Procedures:
1.Serum electrolytes, BUN, creatinine, Hct (Hct may be high due to hemoconcentration.)
2.Urine: specific gravity and osmolarity
Interventions:
1.Monitor vital signs, pulse quality, and amplitude.
2.Monitor skin turgor. In older adults, check skin over sternum or forehead.
3.Maintain strict I&O. Output should be at least 0.5 mL/kg/hr.
4.Weigh client daily.
5.Monitor laboratory data.
6.Correct underlying cause.
Fluid replacement: Increase oral fluid intake; initiate oral rehydration solution; IV fluids for severe dehydration/maintain as prescribed;Monitor response to therapy.
7. Initiate fall precautions.
Medications
1.Electrolyte replacement
2.Intravenous fluids
Isotonic Fluids
-Treatment of vascular system fluid deficit
Normal saline (0.9% NS)
Lactated Ringer’s (LR)
5% dextrose in water (D 5W)
Hypotonic Fluids
-Treatment of intracellular dehydration
-0.45% normal saline (0.45% NS)
-2.5% dextrose in 0.45% saline (D 2.5 45% NS)
Hypertonic Fluids
-Used only when serum osmolality is critically low
10% dextrose in water (D 10W)
50% dextrose in water (D 50W)
5% dextrose in 0.9% saline (D 5NS)
5% dextrose in 0.45% saline (D 5W in 0.45% NaCl)
5% dextrose in lactated Ringer’s (D 5LR)
Fluid Volume Excess
Fluid intake or retention is greater than the body’s needs.
Contributing Factors:
1.Kidney failure (late phase)
2.Heart failure
3.Cirrhosis
4.Interstitial to plasma fluid shifts (e.g., hypertonic fluids, burns)
5.Excessive water intake
6.Long-term corticosteroid therapy
7.Manifestations
8.Cough, dyspnea, crackles
9.Increased blood pressure
10.Tachypnea and tachycardia
11.Bounding pulse
12.Weight gain (1 L water = 1 kg of weight)
13.Jugular vein distention
14.Increased central venous pressure
Pitting edema
Diagnostic Procedures (may be decreased due to hemodilution):
Serum: electrolytes, BUN, creatinine, Hct
Urine: specific gravity and osmolarity
Chest x-ray if respiratory complications present
Nursing Interventions:
1.Monitor respiratory rate, symmetry, and effort.
2.Monitor breath sounds for signs of pulmonary edema.
3.Monitor for edema; measure pitting edema on scale of 1+ (minimal) to 4+ (severe); monitor dependent edema by measuring circumference of extremities.
4.Monitor for ascites, and measure abdominal girth.
5.Weigh the client daily.
6.Maintain strict I&O.
7.Monitor vital signs.
8.Administer diuretics (osmotic, loop) as prescribed.
9.Limit fluid intake.
10.Maintain skin integrity.
11.Use semi-Fowler’s position; reposition every 2 hr.
12.Restrict sodium intake.
Hypokalemia: Risk Factors, Manifestations, Interventions
Risk Factors:
1. Adverse effects of medications–
-Corticosteroids, Diuretics, Digitalis, Laxatives (abuse of)
2. Body fluid loss–
-Vomiting, Diarrhea, Wound drainage, NG suction
3. Excessive diaphoresis–
-Kidney disease, Dietary deficiency, Alkalosis
Manifestations:
1.Muscle weakness, cramping
2.Fatigue
3.Nausea, vomiting
4.Irritability, confusion
5.Decreased bowel motility
6.Paresthesia
7.Dysrhythmias
8.Flat and/or inverted T waves (ECG)
Interventions:
1.Monitor respiratory status.
2.Initiate fall precautions.
3.Initiate and monitor potassium replacement (oral, IV).
4.Monitor ECG.
5.Monitor I&O.
6.Monitor arterial HCO3 and pH.
7.Provide client education.
8.Dietary sources
9.Medications
Note:
NEVER give K + IV bolus; MUST dilute.
“No P = No K.” If the client is not urinating, do NOT administer potassium.
Hyperkalemia:Risk Factors, Manifestations, Interventions
Risk Factors:
1. Renal failure
-Adrenal insufficiency
2. Acidosis
-Excessive potassium intake
3. Medications
a.)Potassium-sparing diuretics
b.)ACE inhibitors
Manifestations:
1. Peaked T-waves (ECG)
2. Ventricular dysrhythmias
3. Muscle twitching and paresthesia (early)
4. Ascending muscle weakness (late)
5. Increased bowel motility
Interventions:
1.Monitor ECG.
2.Monitor bowel sounds.
3.Initiate dialysis.
4.Dietary restriction and teaching.
5.Administer medications.
a. Kayexalate (monitor bowel sounds)
b.50% glucose with insulin
c. Calcium gluconate
d. Bicarbonate
e. Loop diuretics
Hyponatremia: Risk Factors, Manifestations, Interventions
Risk Factors:
1.GI loss
-SIADH
-Adrenal insufficiency
-NPO status
2.Restricted sodium diet
-Water intoxication
-Excessive diaphoresis
3. Medications
-Diuretics
-Anticonvulsants
-SSRIs
-Lithium
-Demeclocycline
Manifestations:
1.Weakness
2.Lethargy
3.Confusion
4.Seizures
5.Headache
6.Anorexia, nausea, vomiting
7.Muscle cramps, twitching
8.Hypotension
9.Tachycardia
10.Weight gain, edema
Interventions:
1.Sodium replacement (oral, GI tube, IV)
2.Restrict oral fluid intake.
3.Daily weight
4.I&O
5.Medication: conivaptan hydrochloride
NOTE: Risk with hypertonic solutions—cerebral edema
Hypernatremia: Risk Factors, Manifestations, Interventions
Risk Factors:
1.Dehydration
2.GI loss
3.Hyperaldosteronism
4.Hypertonic tube feedings
5.Diabetes insipidus
6.Kidney failure
7.Burns
8.Heatstroke
9.Corticosteroids
Manifestations:
1.Fever
2.Swollen, dry tongue
3.Sticky mucous membranes
4.Hallucinations
5.Lethargy, restlessness, irritability
6.Seizures
7.Tachycardia
8.Hypertension
9.Hyperreflexia, twitching
10.Pulmonary edema
Hypocalcemia: Risk Factors, Manifestations, Interventions
Risk Factors:
1.Hypoparathyroidism
2.Hypomagnesemia
3.Kidney failure
4.Vitamin D deficiency
5.Inadequate intake
6.GI loss (wound drainage, diarrhea)
7.Disease process
a.)Celiac disease
b.)Lactose intolerance
c.)Crohn’s disease
d.)Alcohol use disorder
Manifestations:
1.Tetany, cramps
2.Paresthesia
3.Dysrhythmias
4.Trousseau’s sign
5.Chvostek’s sign
6.Seizures
7.Hyperreflexia
8.Impaired clotting time
Interventions:
1.Seizure precautions
2.IV calcium replacement
3.Daily calcium supplements
4.Vitamin D therapy
5.Monitor for orthostatic hypotension.
6.Dietary increase and education
NOTE: IV calcium must be administered slowly and the site monitored for extravasation. It is diluted in D 5 W, NEVER in NS
-Calcium has an inverse relationship with phosphorus.
Hypercalcemia:Risk Factors, Manifestations, Interventions
Risk Factors:
1.Hyperparathyroidism
2.Malignant disease
3.Prolonged immobilization
4.Dehydration
5.Vitamin D excess
6.Thiazide diuretics
7.Lithium
8.Glucocorticoids
9.Digoxin toxicity
10.Overuse of calcium supplements
11.Hyperthyroidism
Manifestations
1.Muscle weakness
2Hypercalciuria/kidney stones
3. Dysrhythmias
4.Lethargy/coma
5.Hyporeflexia
6.Pathologic fractures
7.Flank pain
8.Deep bone pain
9.Polyuria, polydipsia, dehydration
10.Hypertension
11.Nausea, vomiting
Interventions:
1.Increase mobility
2.Isotonic IVF
3.Dialysis
4.Cardiac monitoring
5. Medications:
a.)Furosemide
b.) Calcitonin
c.) Glucocorticoids
d.) Bisphosphonates
e.) Calcium chelators
-Ca has an inverse r/s with phosphorous
Hypomagnesemia: Risk Factors, Manifestations, Interventions
Risk Factors:
1.GI loss
2.Alcoholism
3.Hypocalcemia
4.Hypokalemia
5.DKA
6.Hyperparathyroidism
7.Malabsorption
8.TPN
9.Laxative abuse
10.Acute MI
11.Medications:
a. Cisplatin
b. Cyclosporine
c. Aminoglycoside antibiotics
d. Diuretics
e. Amphotericin B
Manifestations:
1. Paresthesias
2. Dysrhythmias
3. Trousseau’s sign
4. Chvostek’s sign
5. Agitation, confusion
6. Hyperreflexia
7. Hypertension
8. Insomnia, irritability
9. Anorexia, nausea, vomiting
10. Dysphagia
Interventions:
1. Seizure precautions
2. Monitor swallowing.
3. Dietary measures and education
4. Administer medications:
a.)IV magnesium sulfate
b.)PO magnesium salts
5. Monitor urine output.
6. Monitor respirations.
NOTE: Monitor for signs of magnesium toxicity with IV replacement, and treat with calcium gluconate.
Hypermagnesmia: Risk Factors, Manifestations, Interventions
Risk Factors:
1.Renal failure
2.Excessive Mg ++ therapy
3.Adrenal insufficiency
4.Laxative overuse
5.Lithium toxicity
6.Extensive soft tissue injury or necrosis
Manifestations:
1.Hypotension
2.Drowsiness
3.Bradycardia
4.Bradypnea
5.Coma
6.Cardiac arrest
7.Hyporeflexia
8.Nausea, vomiting
9.Facial flushing
Interventions:
1.Mechanical ventilation
2.IV fluids: lactated Ringer’s or NS
3.Administer medications.
a.)IV calcium gluconate
b.)Loop diuretics
4.Monitor respirations and blood pressure.
5.Monitor deep-tendon reflexes.
NOTE: Magnesium should not be administered to clients in renal failure.
Hypophosphatemia: Risk Factors, Manifestations, Interventions
Risk Factors:
1.Vitamin D deficiency
2.Refeeding after starvation
3.Alcohol use disorder
4.DKA
5.Alkalosis
6.Hypomagnesemia
7.Hypokalemia
8.Excessive loss of body fluids: sweat, diarrhea, vomiting, hyperventilation
9.Burns
10.TPN
11.Overuse of antacids
Manifestations:
1.Paresthesia
2.Muscle weakness
3.Bone pain and deformities
4.Chest pain
5.Confusion
6.Seizures
7.Nystagmus
Interventions:
1.Oral phosphate replacement
2.Careful IV administration of phosphorus (for severe cases)
3.Gradual introduction of solution for clients on TPN
4.Protect from infection.
5.Dietary management and education
6.Seizure precautions
Phosphorus has an inverse relationship with calcium.
Hyperphosphatemia: Risk Factors, Manifestations, Interventions
Risk Factors:
1.Renal failure
2.Chemotherapy
3.Acute pancreatitis
4.High vitamin D
5.High phosphorus intake
6.Hypoparathyroidism
7.Excessive enema use
8.Acidosis
Manifestations:
1.Tetany, cramps
2.Paresthesias
3.Dysrhythmias
4.Trousseau’s sign
5.Chvostek’s sign
6.Hyperreflexia
7.Anorexia, nausea, vomiting
8.Soft tissue calcifications
Interventions:
1.Medications
a.)Vitamin D
b.)Aluminum hydroxide
c.)Diuretics
2. IV NS
3.Dialysis
4.Dietary management and education
Phosphorus has an inverse relationship with calcium.
