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Med surg > Fluid and electrolytes > Flashcards

Fluid and electrolytes Flashcards

1
Q

signs of fluid overload

A
  • increased urine specific gravity
  • hyperactive bowel sounds (why?)
  • bounding pulses
  • increased RR
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2
Q

Transcellular fluid

A

Transcellular body uids: Secreted by epithelial cells
(cerebrospinal, pleural, peritoneal, and synovial uid

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3
Q

s/s respiratory acidosis

A

vasodilation

  • pale, dry skin
  • hyporeflexia
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4
Q

hyponatremia

A
  • altered mentation

- decreased respiratory effort

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5
Q

thizide drug

A
  • diuretics
  • monitor for hypomagnesemia
  • monitor for hypercalcemia
  • monitor for hypokalemia
  • monitor for hyponatremia
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6
Q

thizide drug

A
  • diuretics
  • monitor for hypomagnesemia
  • monitor for hypercalcemia
  • monitor for hypokalemia
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7
Q

s/s hypokalemia

A
  • hypotension with weak thready pulse
  • decreased respiration strength
  • decreased tendon reflexes
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8
Q

s/s hypokalemia

A
  • hypotension with weak thready pulse
  • decreased respiration strength
  • decreased tendon reflexes
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9
Q

s/s hyperkalemia

A
  • parasthesia
  • hypotension
  • bradycardia
  • increased gastric motility
  • muscle weakness
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10
Q

s/s hyperkalemia

A

-parasthesia

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11
Q

what is someone with hypocalcemia at high risk for and why

A

seizures b/c they have a low excitation threshold

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12
Q

what are the major concerns of insulin therapy

A

-hypoglycemia

hypokalemia

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13
Q

compression stocking teaching

A
  • put on in the morning and take off at night
  • never roll any part of the band as it can become a constrictive band
  • elevate legs for 20 mins per day
  • do not cross legs
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14
Q

what fluid is used to treat hypernatremia

A

hypotonic (with a little sodium) because you want to move water and sodium into the cell slowly to prevent cerebral edema.Glucose will enter the cell and remove more sodium.

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15
Q

hypomagnesemia

A

hyperactive tendon reflexes

  • muscle cramps, numbness, tingling
  • decreased bowel sounds
  • insomnia
  • vasoconstriction
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16
Q

hypocalcemia

A
  • hyperreflexia
  • parasthesia
  • increased gastric motility
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17
Q

hypophosphatemia

A

rhabdomyolysis

  • decreased Cardiac output
  • weak pulse
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18
Q

expected vital signs for hypovolemia

A
  1. hyperthermia
  2. tachycardia with thready pulse and hypotension
  3. decreased central venous pressure
  4. tachypnea (compensation)
  5. hypoxia
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19
Q

expected neruomusculoskeletal for hypovolemia

A

dizziness/syncope
weakness and confusion
fatigue

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20
Q

other key findings in hypovolemia

A
  1. furrowed tongue
  2. diminished cap refill
  3. cool clammy skin
  4. sunken eyeballs
  5. flat neck veins
  6. poor skin turgor and tenting
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21
Q

lab finding for hypovolemia

A
  1. high HCT (~35-47)
  2. High BUN (10-20)
  3. high urine specific gravity (1.005-1.030)
  4. hypernatremia(135-145)
  5. increased serum osmolality (275-295)
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22
Q

interventions for hypovolemia

A
  1. monitor I&O, mentation, and vitals
  2. instruct to stand up slowly
  3. monitor weight
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23
Q

complications of hypovolemia

A
  1. hypovolemic shock
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24
Q

what is hypovolemic shock and what do you do

A

the MAP gets to low therefore cells are not able to get enough oxygen. 1. give oxygen 2. must stay with patient 3.monitor vitals q15 4. replace fluids with colloids and crystalloids.
5. administer pressers 6. admin nitro to improve myocardial perfusion 7.administer positive inotropic medication 8. perform hemodynamic monitoring

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25
Q

examples of colloids

A

whole blood, packed RBCs, plasma, synthetic plasma expanders

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26
Q

examples of crystalloids

A

lactated ringers and normal saline

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27
Q

what does it mean when a drug is a positive inotropic. give some examples

A

it increases contraction strength of the heart. 1. dobutamine 2. milrinone

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28
Q

give some examples of pressor drugs

A

dopamine, norepinephrine, phenylephrine

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29
Q

what are clients with hypervolemia at risk for

A

pulmonary edema and congestive heart failure

30
Q

who is at risk for hypervolemia

A

HF, kidney disease, and cirrhosis, high salt intake, burns(fluid shift), people on corticosteroids, severe stress, and hyperaldosteronism

31
Q

expected vital signs in hypervolemia

A
  1. tachycardia 2. bounding pulse 3. hypertension, tachypnea, 4.increased central venous pressure
32
Q

expected neuromuscular signs in hypervolemia

A

weakness (retention depletes energy and increases workload) headache and altered LOC

33
Q

Other findings for hypervolemia

A

Ascities(GI), crackles, increased RR, cough peripheral, edema, distended neck veins,

34
Q

lab tests for hypervolemia

A

opposite of hypovolemia and also CXR may show pulmonary edema

35
Q

interventions for hypervolemia

A
  1. monitor I&O and weight 2.restrict fluids 3.check breath sounds and for peripheral edema 4. monitor NA and K levels 5. low sodium and fluid intake (may have to restrict fluids)
36
Q

complications for fluid volume excess (hypervolemia) and how to manage it

A

pulmonary edema. Put patient in high fowlers and give O2. Give morphine, nitrates, and diuretics

37
Q

assessment of pulmonary edema

A

frothy pink tinged sputum, JVD, tachycardia, change in LOC, crackles

38
Q 
expected ranges
sodium
calcium
potasium
magnesium
chloride
phosphorus
A 
136-145
9.0-10.5
3.5-5.0
1.3-2.1
98-106
3.0-4.5
39
Q

which hormones are involved in the regulation of salt levels

A

aldosterone, Antidiuretic hormone, and natriuretic peptide

40
Q

what does hyponatremia do to the body

A
  1. delays and slows the depolarization of membranes

2. blood becomes hypotonic leading to lysis of cells

41
Q

what does salt in the urine tell us

A

if there is salt in the urine that means the kidneys are wasting salt. If there isnt and there is still hyponatremia that means we have some non-kidney related fluid loss. (sweating, vomiting, diarrhea)

42
Q

what are some risk factors for hyponatremia

A
  1. hyperglycemia
  2. cerebral salt wasting syndrome
  3. nasogastric suctioning
  4. hyperlipidemia
  5. sweating and diuretics
  6. drinking/irrigation with hypotonic water
  7. psychogenic polydipsia
  8. anticonvulsants, SSRIs, or desmopressin
43
Q

s/s hyponatremia

A

vitals will vary based on weather the cause is hypo/hypervolemia.
Neuro: headache, muscle weakness(may lead to respiratory compromise) decreased deep tendon reflexes, seizures, lightheadedness
GI:increased motility, cramping, nausea

44
Q

Interventions for hyponatremia

A
  1. do not exceed 12 mEq/L in a 24 hour period as a rapid rise in sodium levels increases risk of neuro damage due to demyelination
  2. inform DR if there is a 1-2 lb gain in 24 hour or 3 Lbs in 1 week.
45
Q

what fluid would you use to decrease cerebreal edema

A

hypertonic sodium solution

46
Q

expected vitals for hypernatremia

A

hyperthermia, tachycardia, orthostatic hypotension

47
Q

expected neuro for hypernatremia

A

restless, irritability, muscle twiching leading to muscle weakness, decreased DTR, seizures

48
Q

expected GI for hypernatremia

A

thirst, dry mucous membranes, n/v, anorexia, occasional diarrhea

49
Q

interventions for hypernatremia

A
  1. encourage water intake
  2. administer diuretics if they have poor kidney excretion
  3. daily weights
  4. 5% dextrose in water to replace fluids
50
Q

risk factors for hypokalemia

A
  1. diuretics, digitalis, corticosteroids
  2. increased levels of aldosterone
  3. cushings syndrome
  4. vomiting, diarrhea, prolonged nasogastric suctioning
51
Q

expected vitals for hypokalemia

A

hypotension, thready weak pulse, orthostatic hypotension

52
Q

expected neuro and ECG for hypokalemia

A

altered mental status, anxiety, lethargy.
flat T waves, U waves, ST depression, prolonged PR interval, V tach, premature ventricular contractions, inverted T waves,

53
Q

other expected findings in hypokalemia

A

hypoactive bowel sounds, n/v, constipation, abdominal distention, paralytic ileus, weakness, shallow breathing

54
Q

interventions for hypokalemia

A

hypokalemia increases risk for digoxin toxicity

  • monitor LOC, GI
  • check hand grip for muscle weakness and DTR
55
Q

foods high in potassium

A

avocados, broccoli, dairy, dried fruit, cantaloupe, juices, melon, lean meats, whole grains, citrus fruits

56
Q

maximum rate for potassium

A

10 mEq/hr

57
Q

complications of hypokalemia

A

respiratory failure and cardiac arrest

58
Q

risk factors for hyperkalemia

A
  1. older adults tend to have decreased renin and aldosterone
  2. salt substitutes
  3. ACE inhibitors,
  4. extracellular shift caused from decreased insulin(DKA), tissue damage(sepsis, trauma, surgery, fever, MI), hyperuricemia
59
Q

vital signs for hyperkalemia

A

slow irregular pulse with hypotension

60
Q

other findings in hyperkalemia

A

same neuro as hypo, premature ventricular contractions, V fib, peaked T waves, widened QRS, increased GI motility (diarrhea), oliguria

61
Q

lab findings for hyperkalemia

A

HCT and HGB will be increased with dehydration or decreased with kidney failure

  • BUN and creatinine will be increased with kidney failure
  • ABGs = metabolic acidosis with kidney failure
62
Q

interventions for hyperkalemia

A

priority is to prevent falls and cardiac complications

  • avoid administering “aged” blood product to people with kidney failure because some cells lyse and release potassium.
  • monitor I&O and for weakness
  • glucose + insulin to lower potassium levels
  • kayexalate (sodium polystyrene sulfonate)
63
Q

risk factors for hypocalcemia

A
  1. lactose intolerance or any malabsorption syndrome such as Crohns
  2. thyroidectomy
  3. hypoparathyroidism
    - pancreatitis, ESKD
  4. Hyperphosphatemia
  5. aluminum, caffeine, cisplatin, steroids, mithramycin, phosphates, and loop diuretics.
64
Q

Expeted findings in hypocalcemia

A

Tetany (intermittent muscle spasms) is the hallmark due to decreased threshold for excitability.

  • parasthesia of the fingers and lips (early manifestation)
  • painful muscle spasms at rest in the foot or calf (Charleys horses)
  • Positive Chvosteks signs (faical twitch)
  • Positive Trousseaus (hand/finger spasm with blood pressure cuff inflation)
65
Q

ECG changes with hypocalcemia

A

Prolonged QT and ST interval

66
Q

interventions for hypocalcemia

A
  1. seziure precautions

2. dilute IV calcium with 5% dextrose and water and give as bolus.

67
Q

Risk factors for hypomagnesemia

A
  1. celiac or crohns disease
  2. ethanol ingestion causes magnesium excretion
  3. diarrhea
  4. steatorrhea
68
Q

Expected findings in hypomagnesemia

A
  1. dpressed mood/apathy
  2. hyperactive DTR, parasthesia, tetany, seizures, positive Chvosteks and Trousseaus signs,
  3. Hypoactive bowels, abdominal distention, paralytic ileus
69
Q

interventions for hypomagnesemia

A
  1. stop magnesium depleting meds (loop diuretics, osmotic diuretics, aminoglycoside antibiotics, and meds containing phosphorus)
  2. monitor DTR hourly when administering magnesium sulfate
  3. low magnesium increases chances at digoxin toxicity
70
Q

foods high in magnesium

A

dark green veggies, nuts, whole grains, seafood, cocoa

Med surg (35 decks)

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