fluid and electrolytes

Question 1

dehydration: cardiovascular changes

Answer 1

increased pulse b/c try compensate
weak and thready pulse
decreased BP b/c try keep up but can't
orthostatic hypotension
pale skin b/c not being oxygenated
poor skin turgor, tenting
stronger central pulse than peripheral pulse

Question 2

dehydration: respiration changes

Answer 2

shallow depth
rate speeds up d/t compensation
working harder to breath
cannot talk
O2 sat low

Question 3

dehydration: neuro and renal changes

Answer 3

neuro: confusion d/t shunting blood to brain, usually slow progression
renal: low urine output if any, darker, more concentrated than water (specific gravity)

Question 4

dehydration: lab findings

Answer 4

electrolytes - close to normal/slight increase
Hct & Hbg - increased, more concentrated
BUN and Creatinine - change in lab value
**if no kidney damage, BUN change, creatinine same
**BAD SIGN IF CREATININE INCREASES
serum osmolarity - concentrated urine
hemorrhage = loss of fluid and electrolyte

Question 5

dehydration: nursing intervention PO

Answer 5

PO better if not severe d/t less risk of inf

replace with isotonic fluid ie pedialyte which contains electrolytes and glucose

Question 6

dehydration: nursing intervention IV

Answer 6

isotonic best unless severe dehydration then something with more electrolytes

Question 7

dehydration: nursing intervention - back to normal

Answer 7

pulse - down
BP - up
urine output - increased

Question 8

dehydration: nursing intervention - fluid overload

Answer 8

BIGGEST CONCERN IS GOING INTO FLUID OVERLOAD

wt and edema good indicator of fluid overload

Question 9

dehydration: nursing intervention - meds

Answer 9

antimicrobial
antiemetics - reduce vomiting
antipyretics - reduce fever

Question 10

IV fluids - isotonic

Answer 10

0.9% normal saline
5% dextrose in water (D5W)
D5 0.225% normal saline
Lactated Ringers

Question 11

IV fluids - hypotonic

Answer 11

0.45% normal saline

Question 12

IV fluids - hypertonic

Answer 12

10% dextrose in water (D10W)
D5 0.9% normal saline
D5 0.45% normal saline

Question 13

fluid overload: definition and cause

Answer 13

definition - excess of extracellular fluid

cause - cardiovascular and/or renal dysfunction, pituitary adenoma leading to SIADH

Question 14

hypervolemia: cardiovascular change

Answer 14

pulse increase b/c have work harder
quality of pulse bounding both central and peripheral
BP - up
pitting edema
pale, cool skin
distended neck vein

Question 15

hypervolemia: respiratory changes

Answer 15

fast breathing b/c feel not getting enough O, fluid builds in lungs
crackles

Question 16

hypervolemia: neurological change

Answer 16

extreme headache
change in level of consciousness b/c not getting enough O to brain
vision change d/t increased pressure on cranial nerve
pronounced muscle weakness

Question 17

hypervolemia: organs

Answer 17

enlarged liver and spleen

Question 18

hypervolemia: lab findings

Answer 18

electrolytes - looks normal but will eventually shift
renal fx - BUN and creatinine will increase if prolonged, will do damage to kidney
Hgb and Hct - diluted
serum osmolarity - decreased concentration

Question 19

hypervolemia: nursing intervention

Answer 19

restrict fluid intake or as low as possible
increased output
weigh daily - call doc of lose more than 2 lbs/day or 3 lbs/wk
assess BP and pulse
fluid and sodium restriction
assess skin breakdown
O therapy prn d/t fluid in lungs
pt in high fowlers

Question 20

hypervolemia: nursing intervention - meds

Answer 20

diuretics

Question 21

sodium - range

Answer 21

135-145

Question 22

potassium - range

Answer 22

3.5-4.5

Question 23

chloride - range

Answer 23

98-106

Question 24

calcium - range

Answer 24

9.0-10.5

Question 25

magnesium - range

Answer 25

1.3-2.1

Question 26

phosphorus - range

Answer 26

3.0-4.5

Question 27

BUN - range

Answer 27

10-20

Question 28

creatinine - range

Answer 28

0.5-1.5

Question 29

Hgb - females - range

Answer 29

12-16

Question 30

Hgb - males - range

Answer 30

14-18

Question 31

Hct - females - range

Answer 31

37-47%

Question 32

Hct - males - range

Answer 32

42-52%

Question 33

Sodium - function

Answer 33

``` musculoskeletal contraction cardiac muscle contraction nerve impulse transmission maintenance of serum osmolarity cerebral fx ```

Question 34

hyponatremia

Answer 34

altered LOC and mental status generalized muscle weakness and diminished DTR n/d, cramping, hyperactive bowel sounds rapid, weak, thready pulse, hypotension

Question 35

hypernatremia

Answer 35

agitation, confusion, seizures, lethargy, coma twitching, involuntary muscle contraction, hyperreflexia progress to decreased muscle fx and hyporeflexia nausea, decreased peristalsis, hypoactive bowel sounds elevated Na levels block calcium influx, lead to myocardial conduction defect

Question 36

Hyponatremia interventions

Answer 36

2-3# sodium concentration for short time then change to isotonic ran at slow rate increase Na measure daily weight, I&O, serum Na levels q4hr, restoration of neuromuscular fx, check muscle strength

Question 37

hypernatremia intervention

Answer 37

hypotonic solution - 0.22% concentration specific diuretic ie loop diuretic instead of K sparing diuretic increase fluid restrict Na measure daily wt, I&O, serum Na levels, restoration neuromuscular fx

Question 38

Potassium - fx

Answer 38

responsible for maintaining resting membrane potential | essential for proper musculoskeletal and myocardial fx

Question 39

hypokalemia

Answer 39

respiratory muscle contraction impaired, shallow respirations profound muscle weakness, hyporeflexia leading to paralysis weak, thready pulse, irregular HR anxiety, irritability --> altered mental status --> coma diminished peristalsis -->hypoactive bowel sounds

Question 40

hyperkalemia

Answer 40

unaffected respiratory status until reach lethal level twitching and paresthesias --> flaccid paralysis as K increases life threatening ventricular dysrhythmia twitching --> tingling, burning, numbness spasticity of colon, increased peristalsis, hyperactive bowel sounds, watery diarrhea

Question 41

hypokalemia interventions

Answer 41

``` oral supplement if can tolerate IV at 5-10 mEq/hr - no faster PHARMACIST MUST DILUTE use ECG to monitor heart, respiratory rate, work of breathing, oximetry meds - K sparing diuretics eat green leafy vegetables ```

Question 42

hyperkalemia interventions

Answer 42

``` restrict food with K d/c meds with K K depleting diuretics kayexalate - cause constipation when given with laxative, have diarrhea and excrete K if K high, give insulin and dextrose **Insulin binds and pulls K off Calcium Chloride can block K in cardiac cells monitor ECG **wide QRS, tall peaked T waves bradycardia ```

Question 43

causes of hypokalemia

Answer 43

``` excessive use if K depleting diuretics hyperaldosteronism cushings syndrome diarrhea vomiting ```

Question 44

causes of hyperkalemia

Answer 44

``` excessive use of K sparing diuretics hypoaldosteronism addison's disease renal failure excessive dietary K consumption ```

Question 45

Calcium: fx

Answer 45

essential for strong bones and teeth muscle contraction proper blood clotting nerve impulse transmission

Question 46

hypocalcemia imbalance

Answer 46

``` muscle spasms paresthesia, muscle contraction chvostek and trosseau signs ECG changes tachy/bradycardia dysrhythmia weak,thready pulse increased peristalsis hyperactive bowel sounds, watery diarrhea decreased bone density, osteoporosis ```

Question 47

hypercalcemia imbalance

Answer 47

profound weakness, diminished DTR, lethargy --->coma electrical conduction disturbance decreased tissue perfusion, hypercoagulable decreased peristalsis w/ hypoactive bowel sounds increased bone mineralization

Question 48

hypocalcemia interventions

Answer 48

admin vit c with vit d for better absorption supplement with milk, OJ with Ca directly related to Mg so admin magnesium sulfate quiet environment to reduce change of excitability seizure precautions need suction and O in room brittle bones so be careful

Question 49

hypercalcemia interventions

Answer 49

``` d/c Ca containing meds rehydrate dilute serum Ca and promote renal excretion of Ca Ca depleting diuretics admin calcitonin and NSAIDS dialysis vigilant cardiac monitoring ```

Question 50

causes hypocalcemia

Answer 50

``` inadequate intake of Ca, Vit D or both chronic renal failure GI disturbance w/ poor absorption of vitamins and minerals excessive citrate administration pancreatitis low PTH ```

Question 51

causes of hypercalcemia

Answer 51

``` excessive intake of Ca, Vit D or both malignancy, metastasis to bones dehydration use of thiazide diuretics cortocosteroid use hyperparathyroidism ```

Question 52

phosphorus: fx

Answer 52

primarily in bones INVERSELY RELATED TO CA required to manufacture ATP levels influenced by action of PTH

Question 53

hypophosphatemia imbalance

Answer 53

decrease cardiac output weak, thready pulse poor tissue perfusion weakness, muscle breakdown -->rhabdomyolysis ineffective secondary to muscle weakness decreased bone density, osteoporosis CNS irritability --> seizure activity --> coma - only when severe

Question 54

hyperphosphotemia imbalance

Answer 54

few problems but affected patients my have hypocalcemia

Question 55

hypophosphatemia intervention

Answer 55

d/c meds that reduce P ie tums, give zantac give oral P w/ Vit D IV P if severe eat foods high in P ie fish, organ meats, nuts, whole grains, dairy

Question 56

hyperphosphatemia intervention

Answer 56

``` admin Ca with Vit D Magnesium sulfate, skeletal muscle relaxants quiet environment seizure precautions gentle handling ```

Question 57

Magnesium fx

Answer 57

``` stored in bones muscle contraction metabolism of carbs manufacturing of ATP DIRECTLY RELATED TO CA ```

Question 58

hypomagnesemia imbalance

Answer 58

hyperreflexia (DTR), parasthesias, + trosseau's and chvostek's tetany, seizure agitation, anxiety, paranoia, hallucination, confusion letal ventricular rhythm decreased motility, nausea constipation, abd distention, paralytic ileius

Question 59

hypermagnesemia imbalance

Answer 59

hyporeflexia, progressively weak skeletal muscle contraction drowsiness, lethargy, coma bardycardia and hypotension --> decreased perfusion, serious risk of cardiac arrest

Question 60

hypomagnesemia intervention

Answer 60

oral or IV replacement of Mg | may also need correct hypocalcemia

Question 61

hypermagnesemia intervention

Answer 61

admin Mg depleting diuretics | judicious Ca admin