fluid and electrolytes Flashcards
dehydration: cardiovascular changes
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
dehydration: respiration changes
shallow depth rate speeds up d/t compensation working harder to breath cannot talk O2 sat low
dehydration: neuro and renal changes
neuro: confusion d/t shunting blood to brain, usually slow progression
renal: low urine output if any, darker, more concentrated than water (specific gravity)
dehydration: lab findings
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
dehydration: nursing intervention PO
PO better if not severe d/t less risk of inf
replace with isotonic fluid ie pedialyte which contains electrolytes and glucose
dehydration: nursing intervention IV
isotonic best unless severe dehydration then something with more electrolytes
dehydration: nursing intervention - back to normal
pulse - down
BP - up
urine output - increased
dehydration: nursing intervention - fluid overload
BIGGEST CONCERN IS GOING INTO FLUID OVERLOAD
wt and edema good indicator of fluid overload
dehydration: nursing intervention - meds
antimicrobial
antiemetics - reduce vomiting
antipyretics - reduce fever
IV fluids - isotonic
0.9% normal saline
5% dextrose in water (D5W)
D5 0.225% normal saline
Lactated Ringers
IV fluids - hypotonic
0.45% normal saline
IV fluids - hypertonic
10% dextrose in water (D10W)
D5 0.9% normal saline
D5 0.45% normal saline
fluid overload: definition and cause
definition - excess of extracellular fluid
cause - cardiovascular and/or renal dysfunction, pituitary adenoma leading to SIADH
hypervolemia: cardiovascular change
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
hypervolemia: respiratory changes
fast breathing b/c feel not getting enough O, fluid builds in lungs
crackles
hypervolemia: neurological change
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
hypervolemia: organs
enlarged liver and spleen
hypervolemia: lab findings
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
hypervolemia: nursing intervention
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
hypervolemia: nursing intervention - meds
diuretics
sodium - range
135-145
potassium - range
3.5-4.5
chloride - range
98-106
calcium - range
9.0-10.5
magnesium - range
1.3-2.1
phosphorus - range
3.0-4.5
BUN - range
10-20
creatinine - range
0.5-1.5
Hgb - females - range
12-16
Hgb - males - range
14-18
Hct - females - range
37-47%
Hct - males - range
42-52%
Sodium - function
musculoskeletal contraction cardiac muscle contraction nerve impulse transmission maintenance of serum osmolarity cerebral fx
hyponatremia
altered LOC and mental status
generalized muscle weakness and diminished DTR
n/d, cramping, hyperactive bowel sounds
rapid, weak, thready pulse, hypotension
hypernatremia
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
Hyponatremia interventions
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
hypernatremia intervention
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
Potassium - fx
responsible for maintaining resting membrane potential
essential for proper musculoskeletal and myocardial fx
hypokalemia
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
hyperkalemia
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
hypokalemia interventions
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
hyperkalemia interventions
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
causes of hypokalemia
excessive use if K depleting diuretics hyperaldosteronism cushings syndrome diarrhea vomiting
causes of hyperkalemia
excessive use of K sparing diuretics hypoaldosteronism addison's disease renal failure excessive dietary K consumption
Calcium: fx
essential for strong bones and teeth
muscle contraction
proper blood clotting
nerve impulse transmission
hypocalcemia imbalance
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
hypercalcemia imbalance
profound weakness, diminished DTR, lethargy —>coma
electrical conduction disturbance
decreased tissue perfusion, hypercoagulable
decreased peristalsis w/ hypoactive bowel sounds
increased bone mineralization
hypocalcemia interventions
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
hypercalcemia interventions
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
causes hypocalcemia
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
causes of hypercalcemia
excessive intake of Ca, Vit D or both malignancy, metastasis to bones dehydration use of thiazide diuretics cortocosteroid use hyperparathyroidism
phosphorus: fx
primarily in bones
INVERSELY RELATED TO CA
required to manufacture ATP
levels influenced by action of PTH
hypophosphatemia imbalance
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
hyperphosphotemia imbalance
few problems but affected patients my have hypocalcemia
hypophosphatemia intervention
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
hyperphosphatemia intervention
admin Ca with Vit D Magnesium sulfate, skeletal muscle relaxants quiet environment seizure precautions gentle handling
Magnesium fx
stored in bones muscle contraction metabolism of carbs manufacturing of ATP DIRECTLY RELATED TO CA
hypomagnesemia imbalance
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
hypermagnesemia imbalance
hyporeflexia, progressively weak skeletal muscle contraction
drowsiness, lethargy, coma
bardycardia and hypotension –> decreased perfusion, serious risk of cardiac arrest
hypomagnesemia intervention
oral or IV replacement of Mg
may also need correct hypocalcemia
hypermagnesemia intervention
admin Mg depleting diuretics
judicious Ca admin
