Fluid And Electrolytes Flashcards
Hypervolemia = FVE
Definition and causes
Define: too much fluid in space
Causes:
1) HF (heart weak, ⬇️ CO, ⬇️ perfusion ⬇️ UO) 2) IVF w/NA , fleet enema, Alia-seltzer 3) Renal Failure 4) alka seltzer ( sodium bicard therapy)
what 3 hormones regulate fluid volume?
Aldosterone
ANP
ADH
how does aldosterone regulate fluid volume?
found in adrenals above kidney.
1) decrease blood volume (vomit, hemmorrhage, etc) =
2) aldoserone secretion increases
3) retain Na and water
4) blood volume incease
what if we have too much aldosterone?
What if we have too little aldosterone?
Cushings disease ( too many steriods, FVE) Conns syndrome
Addisons (FVD)
how does ANP (atrial natriuretic peptide) regualte fluid volume?
found in atria of heart
when fluid pressure builds aroung heart, ANP is released which causes excretion of NA and water
gets rid of fluid
How does ADH regualte fluid volume?
makes you retain WATER ONLY
What happens is we have too much ADH?
SIADH
retain water (FVE)
decreased Urine output because holding onto fluid
concentrated urine because putting out very little urine
diluted blood because of excess fluid in body
what happens if we have too little ADH
DI
lose water (FVD)
watch for SHOCK
increased urine output because losing fluid
diluted urine
concentrated blood
concentrated makes number go?
dilute makes numbers go?
concentrated = up dilute= down
urine specific gravity
sodium
hematocrit
Where is ADH found and why is this important?
ADH found in pituitary (head)
key words for ADH problems
1) craniotomy
2) head injury
3) sinus surgery
4) transphenoidal hypophysectomy
5) any condition that can lead to an increased ICP
what is another name for ADH?
vasopressin (pitressin) desmopressin acetate (DDAVP) -nasal spray
used as ADH replacement in DI
Signs and symptoms of FVE
Cardiovascular
1) increased pulse (bounding)
2)distended neck veins
3)increased CVP
4)increased BP
more volume more pressure
Respiratory
1) increased respirations (shallow)
2) wet moist crackles
3) SOB, dyspna
Integumentary
1) peripheral edema, third spacing (vessels start to leak)
2) skin pale and cool to touch
Polyuria Increased weight (acute gain or lose is not fat, its fluid)
if patient is retaining fluid think what first?
Heart Problems
Treatment for FVE
Low sodium diet
Restrict fluids
I and O and daily weights
Diuretics
Furosemide, bumetanide (loop)
Hydrochlorothiazide
Aldactone (watch K+ levels)
Bed rest (induce diuresis by releasing ANP)
watch for electrolyte imbalances
What causes FVD?
1) Loss of fluid anywhere (suction, vomit, diarhea, paracentesis)
2) Third spacing (Burns, Ascites)
3) Diseases with polyuria (DI)
What are the signs of FVD?
⬇️ weight ⬇️ skin turgor Dry mucous membranes, dry skin, dry mouth ⬇️ UO ⬇️BP (less volume less pressure) ⬆️ pulse weak and thready because heart trying to push around what little fluidis left ⬆️ resp bc body thinks it is hypoxic ⬇️ CVP peripheral veins vasocontrict Cool extremeties ⬆️ USG ( if putting out any urine will be VERY concentrated) decreased weight thirst
what is the treatment of FVD?
Prevent further loss
Replace volume
Mild PO
Severe IV
safety precautions
Higher risk for falls
Monitor for overload
causes of Hypermagnesemia
renal failure
antacids
Signs and Symptoms of Hypermagnesemia
ACTS LIKE A SEDATIVE (SLEEPY)
Flushing and warmth decrease DTR weak flaccid muscles arrythmias (PROLONG PR AND WIDE QRS) decrease LOC decrease pulse decrease respirations
Treatment of Hypermagnnesemia
ventilator
dialysis
give calcium gluconate bc reverse depression and arrythmias
safety precautions
causes of hypercalcemia
hyperparathyroidism (too much PTH)-pulls calcium from bone to blood
thiazides retain Ca
immobilization
signs and symptoms of hypercalcemia
brittle bones
kidney stones
WIDE T
decreased DTR
decrease LOC respirations pulse
weak muscle tone
treatment of hypercalemia
MOVE! BEAR WT! give fluids to prevent kidney stones phospho soda and fleet enema bc have phosporus steroids add phos to diet safety precautions must have vit d to use calcium give calcitonin
phos foods is anything with protein
causes of hypernatremia
hypertension heat stoke DI vomit diarrhea
signs and symtoms of hypernatremia
dry mouth
thirsty
swollen tongue
neuro changes
treatment of hypernatremia
restrict Na
dilute client with fluds
fluid problem- daily wts, i and o, lab work
causes of hyponatemia
drinking water for fluid replacement (vomitting, sweating)
pyschogenic polydipisia
d5w
SIADH
signs and symtoms
headache
seizure
coma
treatment of hyponatremia
client needs Na not water
if having neuro probles give hypertonic saline (3% or 5%)
monitor for FVE when giving hypertonic fluids
causes of hyperkalemia
kidney trouble ( increases k) aldactone
signs and symptoms of hyperkalemia
PROLONG PR/ life threatening arrhythmias
muscle twitch then
muscle weakeness
and finally flaccid paralysis
ECG changes for hyperkalemia
bradycardia tall adn peaked t waves prolong PR interval flat or absent p waves wide QRS conduction blocks v fib
treatment for hyperkalemia
dialysis calcium gluconate glu and insulin (watch for increase k kayexalate push fluids
sodium and k are inverse
causes of hypokalemia
vomitting
NG suction
diuretics
not eating
signs and symtoms of hypokalemia
muscle cramps
weakness
arrythmias
ECG changes for hypokalemaia
U waves
PVCs
V tach
treatment of hypokalemia
give k
aldactone makes retain k
eat more k
causes of hypomagnesmia
diarrhea
ETOH bc suppress ADH adn make u diureses
ETOH is hypertonic
signs and symtoms og hypomagnesmia
ekg
Tall T
depressed ST
tight rigid muscles seizure precautions stidor/laryngospasm \+ chov adn trouss increased DTR neuro changes swallowing problems arrythmias
treatment of hypomagnesmia
give mg
check kidney function
seiure precautions
eat mg
casues of hypocalcemia
hypoparathyroidism
radical neck
thyroidectomy
signs and symtoms of hypocalcemia
same as MG
not enough sedative
treatment of hypocalemia
vit d phosphate binders (sevelamer hydrocholride//renagel) phoslo
iv Ca slowly and on heart monitor
oscal
micellanous info on potassium
assess UO before iv K po K watch for GI upset IV k on a pump always mix well never give IV k push (dilute in somthing) burns during infusion
