Fluid And Electrolytes Flashcards
What is fluid volume excess?
What is the vascular space ?
Too much volume in the vascular space
The vascular space is arteries, veins and chambers of the heart
What is the first thing you should think of when you hear Fluid Retention?
Heart
Problems FIRST
What are some causes of fluid volume excess ?
- )CHF: The heart is weak, cardiac output decreases, decreased kindey perfusion, Decrease urinary output
- ) RF: kidneys aren’t perfusing
- ) Alka-Seltzer, Fleet enemas, IVF with Na!! (All three have a lot of sodium)
8 Signs and symptom of fluid volume excess
1.)Distended neck veins/peripheral veins: vessels are full
2.)Peripheral edema, third spacing: vessels can’t hold anymore so they start to
Leak.
3.)CVP: measured where right atrium; number goes up CVP Normal: 2-6 mmHg
More\_\_ volume More_ pressure
4.)BP: increases more volume….more pressure
5.)Pulse: up your heart only wants fluid to go forward
g. If the fluid doesn’t go forward it’s going to go backward into the lungs.
Can lead to heart failure then pulmonary edema.
6.) Lungs sound wet
d.
e Polyuria: kidneys trying to help you
4 FLE treatment
Tx:
a. Low Na diet/ restrict fluids
b. I and O’s and Daily weights
c. Diuretics:
• Loop: Example: Lasix
Bumetanide (Bumex®) may be given when Furosemide (Lasix®) doesn’t
work.
• Hydrochlorothiazide (Thiazide®) Watch lab work with all diuretics.
Dehydration and electrolyte problems
• K+ sparing: Example: Aldactone
d. Bed rest induces diuresis by release of ANP and, ↓ production of ADH.
e. Physical assessment Meaning signs and symptoms
f. Give IVFs slowly to elderly. Very young and patients with heart and kidney disease
With FLD u should think of what 1st?
Shock
FLD causes
1.Loss Of fluids was from anywhere
Examples : thoracentesis, paracentesis, vomiting diarrhea hemorrhage
- Third spacing( when fluid is it a place it does you no good)
. Burns
.Ascites - Diseases with polyuria
Example : DM
FLD 11 S and S
- Weight decrease
- Poor skin turgor
- Dry mucous membranes
- ) urine specific gravity goes up if they any urine all
- )decreased urinary output
- )Decrease BP (at risk for postural hypotension)
- ) Decrease CVP
- )Increase pulse but it’s weak and ; thready
- )Increased respiration
- )cool and calmly skin
- ) Peripheral veins/neck veins vasoconstriction
FLD TREATMENT
Prevent further fluid los
Tx: a. Prevent further \_\_\_\_\_\_\_\_\_\_. b. Replace volume • Mild Deficit: \_\_\_\_\_\_\_\_\_ • Severe Deficit: \_\_\_\_\_\_\_\_\_ c. SafetyPrecautions • Higher risk for \_\_\_\_\_\_\_\_ • Monitor for overload.
Normal action of aldosterone
When blood volume get low( vomiting, hemorrhage,etc)- aldosterone secretion increases- to help retain Na/water which increases the BP
Where is aldosterone found
Adrenal glands
Disease with to little aldosterone
Addison
Diseases with too much aldosterone
- Cushing
2. hyperaldosteronism
Where is atrial natriuretic peptide (ANP) found?
In the atrial of the heart
How does atrial natriuretic peptide (ANP) work?
It’s acts the opposite of aldosterone
So it’s excretes Na/water instead of retaining them
ADH helps u retain what?
Water
ADH is found in the
Pituitary
2 ADH problems are?
S I ADH
DI
the less the urine out; the higher the _________?
the more the urine out; the lower the ________?
the less the urine out; the higher the specific gravity…
the more the urine out; the lower the specific gravity
S I ADH is
What are they in ? And why ?
Describe the blood and urine ?
Fluid volume excess
Fluid is retained in the vascular space
The blood it is dilute urine is concentrated
SIADH finding
Specific gravity_____
Serum sodium_______
Serum osmolality______
Specific gravity_____high
Serum sodium_______low
Serum osmolality______low
DI is
What are they in ? And why ?
Describe the blood and urine ?
Fluid volume deficit
Because they diuresing
Urine is concentrated and the blood is dilute
DI Finding
Specific gravity_____
Serum sodium_______
Serum osmolality______
Specific gravity_____low
Serum sodium_______high
Serum osmolality______high
Cause of ADH problems
Things invoking the head
Things invoking the head Craniotomy Head injury sinus surgery Transsphenoidal hypophysectomy
4 examples of isotonic solutions
- ) 0.9% NS ( sodium chloride) ( normal saline ) (0.9%NS)
- ) LR (lactated ringers)
- ) D5W (dextrose in water 5%)
- ) D5W 1/4 NS ( 5% dextrose in 0.225% saline)
Isotonic solutions go where?
In the vascular space and stay there
When is normal saline use
The client that lost fluids through_______???.”
Normal saline is the basic solution with administrating ____?
Alert—do not use isotonic solutions in clients with ______, ____, or ______?? And why don’t we give to these client
The solutions can cause fluid volume excess, hypertension, and hypernatremia (Hypernatremia is an alert only when administrating isotonic solutions that contain sodium)
The client that lost fluids through nausea, vomiting, burns, sweating, trauma.
Normal saline is the basic solution with administrating blood
Alert—do not use isotonic solutions in clients with hypertension, cardiac disease, or renal disease
The solutions can cause fluid volume excess, hypertension, and hypernatremia (Hypernatremia is an alert only when administrating isotonic solutions that contain sodium)
Hypotonic solutions go where
Into the vascular space then shift out into the cells to replace cellular fluid
They rehydrate but do not cause hypertension
4 hypotonic solution examples
- ) 0.45% sodium chloride (normal saline) (1/2)
- ) 0.225% sodium chloride (normal saline) 1/4 NS
- ) 0.33% sodium chloride )normal saline ) 1/3 NS
- ) Tap water
Hypotonic s
The client who has ____, ___ or ___ disease and needs fluid
replacement because of ___, ___, ___, ____, etc.
• Also used for dilution when a client has ____, and for ___ dehydration.
Alert:Watch for cellular edema because this fluid is moving out to the cells which could lead to fluid volume __________ and ______ blood pressure.
The client who has hypertension, renal or cardiac disease and needs fluid replacement because of nausea, vomiting, burns, hemorrhage Etc
Also used for dilution when a client has hypernatremia and for cellular dehydration
ALERT—–watch for cellular edema because this fluid is moving out to the cells which can lead to fluid volume deficit and decreased blood pressure
Hypertonic solutions is a
Volume expanders that will draw fluid into the vascular space from the cell
Hypertonic solutions 8 examples
- )TPN
- ) ALBUMIN
- .) 3% NS
- .)5% NS
- ) 10% dextrose in water (D10W)
- ) 5% dextrose in 0.9% sodium chloride (normal saline) D5W/NS
- .) 5% dextrose in lactated readers ( D5LR)
- 5% dextrose in 0.45% sodium chloride (normal saline) D5W/1/2 NS)
- )TPN
- ) ALBUMIN
- .) 3% NS
- .)5% NS
- ) 10% dextrose in water (D10W)
- ) 5% dextrose in 0.9% sodium chloride (normal saline) D5W/NS
- .) 5% dextrose in 0.45% sodium chloride (normal saline) D5W/1/2 NS)
- 5% dextrose in lactated readers ( D5LR)
Hypertonic solutions uses
What is use for ?
The client with hyponatremia or a client who has shift large amounts of vascular volume to a 3rd space or has severe edema, burns or ascites
A hypertonic solution will return the fluid to the vascular space
ALERT—watch for fluid volume excess. Monitor in an ICU with frequent monitoring of blood pressure, CVP , and, pulse especially if they are receiving 3% NS or 5%NS
Quick tips for IV solution
Isotonic solutions equal=stay where I put it
Hypotonic solutions = go out of the vessel
Hypertonic solution = Entered the vessel
Mg and ; Ca act as
Magnesiums And calcium do what?
A sedative
Magnesium’s and Calcium do the OPPOSITE AS the prefix…
How is magnesium &potassium excreted?
The kidneys and it can be lost in other ways to like the G.I. tract
causes of Hypermagnesium
- ) renal failure
2. ) antaacids—because it contains magnesium
Hypermagnesium 6
signs and ; symptoms
brain lungs: heart: urine: bowel: muscles: reflexes:
*S/S* DTRs, decrease Muscle Tone weak & flaccid Arrhythmias ( u could have 1) LOC down Pulse down Respirations down
b. Warm & flush
brain: lethergy
lungs: bradypnea
heart: bradycardia
urine: oliguria
bowel: constipation
muscles: flaccidity
reflexes: 1/2
Hypermagnesium 4
treatment
- ) ventilator—if the respirations go below 12 which indicate mg toxicity
- ) dialysis - Renal failure is present
- ) calcium gluconate-anytime you have a client who has something to do with magnesium keep calcium gluconate available!!! Because magnesium is the antidote for magnesium Toxicity
Calcium Gluconate reverses respiratory depression and potential arrhythmias
4.) safety precautions because they are sedated
How is calcium Gluconate given
It is administered IVP very slowly max rate is 1.5 to 2 mL per minute
Hypercalcemia signs and symptoms
brain:
lungs:
heart:
urine:
bowel:
muscles:
reflexes:
*S/S* DTRs, decrease Muscle Tone weak & flaccid Arrhythmias ( u could have 1) LOC down Pulse down Respirations do
- )Bones are brittle and weak
- )kidney stones majority made of calcium
brain: lethergy
lungs: bradypnea
heart: bradycardia
urine: oliguria
bowel: constipation
muscles: flaccidity
reflexes: 1/2
3 casues of Hypercalcemia
1.)Hyperparathyroidism—meaning is too much PTH
When your some calcium is low PTH kicks in pulls calcium from the bones and puts in the blood therefore the serum calcium goes up
2.) Thiazides help you retain
Calcium
3.) immobilization–because you have to bear weight to keep calcium in the bone
Hypercalcemia treatment 7 things
- )Move
- ) fluids to prevent kidney stone
- ) Phospho-Soda and Fleet enema because they both contain phosphorus
Phosphorus has an inverse relationship with calcium
When phosphorus is up calcium is low
- ) steroids
- ) protein to the day
- )must have vitamin D to use Calcium
- ) calcitonin because a drive Calcium back into the bone
Nomal lab values for mg and ; calcium
Mg:1.2—2.1 mEq/L
Calcium: 9.0–10.5 mg/dl
If you want to get Mg & Ca questions right, think ____ 1st.
Muscles
Causes of have hyomagnesemia
1.) diarrhea-lots of mg intestines
2.) Alcoholism
Alcohol suppresses ADH & it’s hypertonic = Because it causes u to diurese
….. Not eating
…… Drinking
Hypomagnesemia 9 S&S
- ) DTRs increases
- ) Muscle tone- rigid and ; tight
- )Seizure can occur
4.) Arrhythmia heart is a muscle - )stridor/laryngospasm airway is a smooth muscle
- ). Mind changes
- )Swallowing problems - esophagus is a smooth muscle
- )Positive Chvostek’s -Tap cheek (“C is for cheek)
- .) Positive trousseau’s / pump up BP cuff
Hypomagnesemia 3 treatment
- )Seizure precaution
2.)Give some IV mg
Check kidney function ( b4 and during IV MG)
3.) Eat magnesium
Causes of Hypocalcemia
- Hypoparathyroidism
- Radical neck
- Thyroidectomy
Because there isn’t enough PTH
9 S&;;S of hypocalcemia
- ) DTRs increases
- ) Muscle tone- rigid and ; tight
- )Seizure can occur
4.) Arrhythmia heart is a muscle - )stridor/laryngospasm airway is a smooth muscle
- ). Mind changes
- )Swallowing problems - esophagus is a smooth muscle
- )Positive Chvostek’s -Tao cheek (“C is for cheek)
- .) Positive trousseau’s / pump up BP cuff
Hypocalcemia treatment
1.) Vit D–to help utilize the Calcium
- )Phosphorus binding drugs
- –Sevelamar hydrochloride (Renagel)
- – Calcium Acetate( PhosLo)
- —-Calcium Carbonate (Os-Cal)
3.) IV Ca ( give it slowly) because given it fast could cause a heart arrhythmia. Before you give IV calcium make sure they’re on a heart monitor. IV Ca will slow this person down because Ca acts as a seditive. This could cause a widening if the QRS complex
Your sodium level in your blood is totally dependent on what
How much water you have in your body
Normal Lab Values
Sodium:
Sodium: 135-145 mEq/L
4 Causes of Hypernatremia
- DI
- Heat stroke m
- ) hyperventilation: every time you exhale you’re losing water aka insensible fluid loss
- )VOMITING & diarrhea
Hypernatremia s/s
. S/S: a. Dry mouth b. Thirsty-already dehydrated by the time you’re thirsty c. Swollen tongue ( only in severe cases)
TESTING STRATEGY
Neuro changes: The brain doesn’t like it when the Na’s messed up.
this sign and symptom is common in a client with hypernatremia or hyponatremia
Hypernatremia treatment
Tx: a. Restrict Na b. Dilute client with IV fluids. Diluting makes serum Na go down
(If you’ve got a Na problem you have a fluid problem
c. Daily weights
d. I & O
e. Lab work (every day for potassium and sodium)
Case in Point: Feeding tube clients tend to get up
Hyponatremia causes
Causes:
1.)SIADH Retaining water
2.) D5W
(sugar & water)
3..)a. Drinking H2O for fluid replacement (vomiting, sweating) • This only replaces water and dilutesDroplet the blood.
4.)Psychogenic polydipsia:
loves to drink water
Hyponatremia signs and symptoms
S/S:
a. Headache
b. Seizure
c. Coma
TESTING STRATEGY
Neuro changes: The brain doesn’t like it when the Na’s messed up.
this sign and symptom is common in a client with hypernatremia or hyponatremia
Hyponatremia treatment
Tx: a. Client needs Na. b. Client doesn’t need Water c. If having neuro problems: needs hypertonic saline • Means “packed with particles” • 3% NS or 5% NS
Normal Lab Values
Potassium:
Potassium: 3.5-5.0 mEq/L
Potassium And manganese Is Excreted by the
the kidneys
If the kidneys are not working well, the serum potassium will go
Up
Hyperkalemia
Causes:
Hyperkalemia 1. Causes: a. Kidney trouble b. Aldactone- makes you retain Potassium.
Hyperkalemia S/S
brain:
lungs:
heart:
urine:
bowel:,
muscles:
reflexes:
S/S:
a. Begins with muscle twitching
b. Then proceeds to weakness
c. Then flaccid paralysis
brain: irritability, restlessness, agitation…
lungs: tachypnea
heart: Bradycardia
urine: oliguria
bowel: diarhhea, borborygmi
muscles: spasticity
reflexes: +3/+4
What do Kalemias do? Except for what ?
Kalemias do the SAME AS the prefix, except for heart rate and ; urine output!!
Hyperkalemia 4 thing for treatment
- ) dialysis
- ) calcium gluconate
- )glucose and insulin
4.) Sodium Polystyrene
Sulfonate (Kayexalate®
Hyperkalemia treatment
- )why would the patient be on dialysis?
- ) why would the patient need calcium gluconate?
- ) why would a patient need insulin and glucose?
- ) Why would The patient need Kayexalate?
- ) Whats fastest way to lower potassium?!?!
Dialysis- Kidneys aren’t working b. Calcium gluconate decreases Arrhythmias_. c. Glucose and insulin Insulin carries glucose&; Potassium into the cell. So Serum potassium will drop Any time you give IV insulin worry about hypokalemia & hypoglycemia. d) . Sodium Polystyrene Sulfonate (Kayexalate®-only give mean when someone already has hyperkalemia. It exchanges potassium for sodium in the G.I. tract
“K exits late
Give D5W with REGULAR insulin (drive potassium
into the cell & out of the blood) temporary/fast!!! “enters early
Sodium and potassium have what kind of relationship
Inverse
Hypokalemia 4causes
a. Vomiting
b. NG suction because We have lots of K+ in our
stomach
c. Diuretics
d. Not eating
Hypokalemia S/S
brain:
lungs:
heart:
urine:
bowel:
muscles:
Reflexes
S/S:
a. Muscle cramps
b. Weakness
brain: lethergy
lungs: bradypnea
heart: tachycardia
urine: polyuria
bowel: constipation
muscles: flaccidity
Reflexes : Hyporeflexia
Hypokalemia treatment
Tx: a. Give IV potassium. b.Eat more potassium. C. Aldactone makes them retain Some potassium.
6 has Miscellaneous Information about potassium
Major problem with PO K+?
- ) Mix well
- ) Give it with food can cause GI upset
- ) Always put IV K+ on a pump
- ) Never give IV K+ push!
- ) Assess UO before/during IV K+.
- ) Burns during infusion
7.) -NEVER more than 40 of K per liter of IV fluid.. If more than 40, question & clarify with
DOC first!
7 ECG changes with hyperkalemia
- )bradycardia,
- ) tall and peaked T waves,
- )prolonged PR intervals,
- )flat or absent P waves,
- )widened QRS,
- ) conduction blocks,
- )ventricular fibrillation.
ECG changes with hypokalemia:
U waves,
PVCs,
ventricular tachycardia
Hypernatremia equals
Dehydration too much sodium not enough watering
earliest sign of any electrolyte disorder
NUMBNESS & TINGLING (paresthesia)
(paresthesia) =
NUMBNESS &; TINGLING (paresthesia)
“circumoral” =
“circumoral” = numb & tingling lips
(paresis)=
MUSCLE weakness
UNIVERSAL sign of any electrolyte disorder =
UNIVERSAL sign of any electrolyte disorder = MUSCLE weakness (paresis
