Fluid and Electrolytes Flashcards
Sodium Range
135-145 mEq/L
Hyponatremia Causes
Active Losses or Dilution (Excessive Water Intake)
Hyponatremia S/S
- Lethargy and HA
- Decreased LOC
- Brain Herniation and Death
- Seizure and Coma (Cerebral Edema)
- Nausea and Malaise
Hyponatremia Nursing Interventions
SODIUM
- Sodium intake, Seizure Precautions
- Overload- Restrict Water Intake
- Daily Wts., Diuretics
- I&Os
- Monitor: BP, N/V, HR, Dry Mucous Membrane, LOC
Hypernatremia Causes
Gain of Na or Loss of Fluids
Hypernatremia Mortality
> 150 = 30-48% Mortality
Hypernatremia S/S
DRIED
- Decreased urine output, Dry mouth, Dehydrated -> Swollen tongue
- Restless, Irritable > Confusion > Delusions > Hallucinations
- Increases in HR, Temp -> Flushed Skin
- Edema (Peripheral and Pulmonary)
- Deep muscle reflexes increased
Hypernatremia Treatment
-Fluid replacement with hypotonic or isotonic electrolyte solutions
Hypernatremia Nursing Care
I&O’s, Daily Weights, Oral Hygiene, Monitor Na Intake, Neuro, Urine Output
Hypovolemia Definition and Causes
Fluid Volume Deficit
-Loss of ECF volume > intake of fluids
Hypovolemia Levels
Mild = 2% loss of BW Moderate = 5% loss of BW Severe = 8% loss of BW
Hypovolemia S/S
Acute Wt loss, Flat neck veins, Postural HypoTN, Weak/rapid HR, Increased temp, Decreased skin turgor, oliguria/[urine], Decreased central venous pressure
Hypovolemia Treatment
- Find Cause
- Replace Fluids
- Mild= use oral rt if possible
- Moderate or Severe = Isotonic or hypotonic IV solutions
Hypovolemia Nursing Considerations
I&O’s, Daily wt, VS, Skin turgor, LOC
Hypervolemia
- Fluid Volume Excess
- Abnormal Retention of water and Na
Hypervolemia Contributing Factors
CHF, Renal Failure, Cirrhosis of the liver, Excessive Na intake
Hypervolemia S/S
JVD, Increased pulse, Increased BP, Increased wt, Increased edema, Increased ascites, Increased crackles in lungs, Increased dyspnea, Increased confusion
Third Space
Fluid is trapped in a place where it cannot be used.
Hypervolemia Treatment
(Directed at causes)
- Limit Na intake
- Restrict fluids
- Use of diuretics
Hypervolemia Nursing Considerations
I&O’s, Daily wt, VS, Edema, LOC
Phosphorous Range
Powerpoint = 2.5-4.5 mg/dL
NCLEX Book = 2.7-4.5 mg/dL
Hypophosphatemia Causes
Malnutrition, Alcoholism, Anorexia, Hyperparathyroidism, malignancies, severe burns, Vit. D deficiency, Overuse of antacids (Mg based), Post organ transplant, Dehydrated
Hypophosphatemia S/S
Muscle weakness, numbness, fatigue, bone pain/facture, altered mental status (anxiety, irritability, confusion, seizures, coma), decreased platelet aggregation (increased brusing)
Hypophosphatemia Treatment
- Educate on Diet ->Grains!
- Oral supplementation -> Laxative
- IV replacement (SLOW)
- watch site
- monitor Ca and P levels
- watch for HTN, Tetany, and Necrosis
Hyperphosphatemia Causes
Renal failure, hypoparathyroidism, excessive intake and/or Vit. D toxicity, chemo, acidosis
Hyperphosphatemia S/S
RELATED TO HYPOCALCEMIA
Hyperphosphatemia Treatment
-Focus on underlying disorder
- Diet
Pt. education
Magnesium Ranges
Powerpoint: 1.3-2.3 mEq/L
NCLEX Book: 1.6-2.6 mg/dL
Hypomagnesemia Manifestations (S/S)
NM, Neuropsychotic, Cardiac
Hypomagnesemia Causes
- Chronic alcoholism
- Decreased intake (TPN, PPN, or Tube feeding)
- Lower GI Loss
- DKA
Hypomagnesemia Treatment
Mg replacement:
- diet
- PO supplememnt
- IV (severe…
Hypomagnesemia Nursing Considerations
Pt Education
- diet
- DKA
- Diabetic control
- Alcohol consumption
Hypermagnesemia Causes
Renal failure, Excessive intake, Lithium therapy, Untreated DKA
Hypermagnesemia S/S
- CNS Depression
- Muscle Weakness/Paralysis
- N/V, Flushed skin (d/t vasodilation)
- Cardiac: bradycardia, heart block, arrest
Hypermagnesemia Treatment
- IV fluids (w/ or w/o Ca) (NO IV PUSH)
- Hold Mg
- Dialysis
Calcium Ranges
Powerpoint: 8.5-10.5 mg/dL
NCLEX Book: 8.6-10 mg/dL
Hypocalcemia Causes
- Inadequate intake
- Increased loss
- Malabsorption
- Increased binding of calcium
Hypocalcemia S/S
- Tetany (increased neural excitability/ spasms)
- Arrhythmias
- Refractory HypoTN
- Paresthesia
- Seizures
Hypocalcemia Treatment
- Ca Replacement
- Seizure Precautions
- DON’T mix with PO4 or HCO3
- Give in divided doses
Hypercalcemia Causes
- Malignancy
- Hyperparathyroidism
Hypercalcemia effects
Increased Ca = decreased neuromuscular excitability
Hypercalcemia S/S
- Confusion, lethargy, coma
- Muscle weakness/uncoordinated
- Cardiac arrest
- Bone pain
- Anorexia, N/V, constipation
- Kidney stones, diuresis, thirst
Hypercalcemia Treatment
- Treat cause
- Increase fluids
- Restrict Ca intake
- Mobilize the pt.
- Monitor cardiac and neuro status
- Calcitonin
Potassium Range
3.5-5.0 mEq/L
Hypokalemia Causes
Active Losses or Insufficient Intake
- Urinary Loss
- GI loss
- Redistribution from extracellular to intracellular
Hypokalemia S/S
Cardiac, Respiratory, Muscular (Death through cardiac or respiratory arrest)
- Orthostatic HypoTN
- EKG: inverted T wave or U wave
- Skeletal muscle weakness/cramping
- Constipation, paralytic ileus, N/V, hypoactive bowel
- Numbness and tingling/Paresthesia
- Weak/thread pulse
- Toxicity of Digitalus glycosides
- Shallow/ineffective breaths
Hypokalemia Treatment
IV K must be administered using a PUMP.
- concentrations of 20 mEq/100mL or higher = through central line
Hyperkalemia Causes
- Decreased Renal excretion
- Increased intake
- Medication effects
- Cellular shift of K (acidosis or MS)
Hyperkalemia S/S
- Slow weak HR, decreased BP
- Respiratory failure (d/t muscle weakness)
- NM (early= twitches, cramps, tingling; late= profound weakness, ascending flaccid paralysis in arms and legs)
- Hyperactive bowel, diarrhea
- Tall peaked T waves
Hyperkalemia Treatment
- Mild= restrict K intake and K-sparring meds
- Severe = cation change resins (Kayexelate)
- Emergent = IV HCO3, Ca, and insulin together w/ D50W
Hyperkalemia Nursing Considerations
- Lab Values
- EKG changes
- Urine Output
Chloride Range
97-107 mEq/L
Hypochloremia Causes
Occurs with:
- other electrolyte imbalances
- NG tube
- Vomiting
Hypochloremia S/S
- Hyponatremia
- Hypokalemia
- Metabolic Acidosis
Chloride need
Makes HCl in stomach
Hypochloremia Treatment
- Correcting the Cause
- Treating electrolyte involved
Hyperchloremia Cause
Other metabolic conditions
Hyperchloremia S/S
Related to:
- Hypernatremia
- HCO3 loss
- Metabolic acidosis
- Hypervolemia
Respiratory Acidosis Ranges
pH 45 mmHg
Respiratory Acidosis Cause
Inadequate excretion of CO2 w/ inadequate ventilation
Respiratory Acidosis S/S
Vary, but:
- Neuro: drowsiness, HA, Coma
- CV: decreased BP, Vfib, flushed skin
- NM: Seizures
- Repiratory: Hypoventilation w/ hypoxia
Respiratory Acidosis Treatment
Directed at cause (admin O2, hydrate, etc)
Respiratory Alkalosis Ranges
pH > 7.45
PaCO2
Respiratory Alkalosis Causes
Always due to hyperventilation (cause of hyperventilation can vary i.e. fever, hysteria,, etc.)
Respiratory Alkalosis S/S
- Neuro: lethargy, lightheadedness, confusion
- CV: Tachy, Dysrhythmias
- GI: N/V, epigastric pain
- NM: tetany, numbness, tingling of extremities, hyperreflexia, seizures
- Resp. : hyperventilation
Respiratory Alkalosis Treatment
Treat the cause
Metabolic Acidosis Ranges
pH
Metabolic Acidosis Causes
- GI Loss of HCO3
- Accumulation of fixed acid (lactic acid, ketoacidosis, etc)
- Renal failure
- Starvation
Metabolic Acidosis S/S
- Tachy
- Confusion
- HypoTN
- Decreased cardiac output
Metabolic Acidosis Treatment
- Focus on underlying metabolic disorder
- Improve tissue perfusion
Metabolic Alkalosis Ranges
pH > 7.45
HCO3 > 27 mEq/L (NCLEX)
Metabolic Alkalosis Causes
Gain of bicarb or loss of H+
- vomiting or suction
Metabolic Alkalosis S/S
- Neuro: Drowsiness, Dizziness, Nervous, confusion
- CV: tachy, dysrhythmias
- GI: Anorexia, N/V
- NM: tremors, hypertonic muscles, muscle cramps, tetany, seizures, tingling in extremities
- Resp.: hypoventilation
Metabolic Alkalosis Treatment
- Address underlying disorder
- K replacement
- Fluid volume replacement
