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nursing > fluid and electrolytes > Flashcards

fluid and electrolytes Flashcards

1
Q

dehydration: cardiovascular changes

A 
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
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2
Q

dehydration: respiration changes

A 
shallow depth
rate speeds up d/t compensation
working harder to breath
cannot talk
O2 sat low
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3
Q

dehydration: neuro and renal changes

A

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

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4
Q

dehydration: lab findings

A

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

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5
Q

dehydration: nursing intervention PO

A

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

replace with isotonic fluid ie pedialyte which contains electrolytes and glucose

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6
Q

dehydration: nursing intervention IV

A

isotonic best unless severe dehydration then something with more electrolytes

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7
Q

dehydration: nursing intervention - back to normal

A

pulse - down
BP - up
urine output - increased

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8
Q

dehydration: nursing intervention - fluid overload

A

BIGGEST CONCERN IS GOING INTO FLUID OVERLOAD

wt and edema good indicator of fluid overload

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9
Q

dehydration: nursing intervention - meds

A

antimicrobial
antiemetics - reduce vomiting
antipyretics - reduce fever

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10
Q

IV fluids - isotonic

A

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

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11
Q

IV fluids - hypotonic

A

0.45% normal saline

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12
Q

IV fluids - hypertonic

A

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

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13
Q

fluid overload: definition and cause

A

definition - excess of extracellular fluid

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

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14
Q

hypervolemia: cardiovascular change

A 
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
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15
Q

hypervolemia: respiratory changes

A

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

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16
Q

hypervolemia: neurological change

A

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

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17
Q

hypervolemia: organs

A

enlarged liver and spleen

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18
Q

hypervolemia: lab findings

A

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

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19
Q

hypervolemia: nursing intervention

A 
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
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20
Q

hypervolemia: nursing intervention - meds

A

diuretics

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21
Q

sodium - range

A

135-145

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22
Q

potassium - range

A

3.5-4.5

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23
Q

chloride - range

A

98-106

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24
Q

calcium - range

A

9.0-10.5

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25
Q

magnesium - range

A

1.3-2.1

26
Q

phosphorus - range

A

3.0-4.5

27
Q

BUN - range

A

10-20

28
Q

creatinine - range

A

0.5-1.5

29
Q

Hgb - females - range

A

12-16

30
Q

Hgb - males - range

A

14-18

31
Q

Hct - females - range

A

37-47%

32
Q

Hct - males - range

A

42-52%

33
Q

Sodium - function

A 
musculoskeletal contraction
cardiac muscle contraction
nerve impulse transmission
maintenance of serum osmolarity
cerebral fx
34
Q

hyponatremia

A

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

35
Q

hypernatremia

A

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

36
Q

Hyponatremia interventions

A

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

37
Q

hypernatremia intervention

A

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

38
Q

Potassium - fx

A

responsible for maintaining resting membrane potential

essential for proper musculoskeletal and myocardial fx

39
Q

hypokalemia

A

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

40
Q

hyperkalemia

A

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

41
Q

hypokalemia interventions

A 
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
42
Q

hyperkalemia interventions

A 
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
43
Q

causes of hypokalemia

A 
excessive use if K depleting diuretics
hyperaldosteronism
cushings syndrome
diarrhea
vomiting
44
Q

causes of hyperkalemia

A 
excessive use of K sparing diuretics
hypoaldosteronism
addison's disease
renal failure
excessive dietary K consumption
45
Q

Calcium: fx

A

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

46
Q

hypocalcemia imbalance

A 
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
47
Q

hypercalcemia imbalance

A

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

48
Q

hypocalcemia interventions

A

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

49
Q

hypercalcemia interventions

A 
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
50
Q

causes hypocalcemia

A 
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
51
Q

causes of hypercalcemia

A 
excessive intake of Ca, Vit D or both
malignancy, metastasis to bones
dehydration
use of thiazide diuretics
cortocosteroid use
hyperparathyroidism
52
Q

phosphorus: fx

A

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

53
Q

hypophosphatemia imbalance

A

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

54
Q

hyperphosphotemia imbalance

A

few problems but affected patients my have hypocalcemia

55
Q

hypophosphatemia intervention

A

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

56
Q

hyperphosphatemia intervention

A 
admin Ca with Vit D
Magnesium sulfate, skeletal muscle relaxants
quiet environment
seizure precautions
gentle handling
57
Q

Magnesium fx

A 
stored in bones
muscle contraction
metabolism of carbs
manufacturing of ATP
DIRECTLY RELATED TO CA
58
Q

hypomagnesemia imbalance

A

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

59
Q

hypermagnesemia imbalance

A

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

60
Q

hypomagnesemia intervention

A

oral or IV replacement of Mg

may also need correct hypocalcemia

61
Q

hypermagnesemia intervention

A

admin Mg depleting diuretics

judicious Ca admin

nursing (9 decks)

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