Fluid and electrolytes Flashcards
signs of fluid overload
- increased urine specific gravity
- hyperactive bowel sounds (why?)
- bounding pulses
- increased RR
Transcellular fluid
Transcellular body uids: Secreted by epithelial cells
(cerebrospinal, pleural, peritoneal, and synovial uid
s/s respiratory acidosis
vasodilation
- pale, dry skin
- hyporeflexia
hyponatremia
- altered mentation
- decreased respiratory effort
thizide drug
- diuretics
- monitor for hypomagnesemia
- monitor for hypercalcemia
- monitor for hypokalemia
- monitor for hyponatremia
thizide drug
- diuretics
- monitor for hypomagnesemia
- monitor for hypercalcemia
- monitor for hypokalemia
s/s hypokalemia
- hypotension with weak thready pulse
- decreased respiration strength
- decreased tendon reflexes
s/s hypokalemia
- hypotension with weak thready pulse
- decreased respiration strength
- decreased tendon reflexes
s/s hyperkalemia
- parasthesia
- hypotension
- bradycardia
- increased gastric motility
- muscle weakness
s/s hyperkalemia
-parasthesia
what is someone with hypocalcemia at high risk for and why
seizures b/c they have a low excitation threshold
what are the major concerns of insulin therapy
-hypoglycemia
hypokalemia
compression stocking teaching
- 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
what fluid is used to treat hypernatremia
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.
hypomagnesemia
hyperactive tendon reflexes
- muscle cramps, numbness, tingling
- decreased bowel sounds
- insomnia
- vasoconstriction
hypocalcemia
- hyperreflexia
- parasthesia
- increased gastric motility
hypophosphatemia
rhabdomyolysis
- decreased Cardiac output
- weak pulse
expected vital signs for hypovolemia
- hyperthermia
- tachycardia with thready pulse and hypotension
- decreased central venous pressure
- tachypnea (compensation)
- hypoxia
expected neruomusculoskeletal for hypovolemia
dizziness/syncope
weakness and confusion
fatigue
other key findings in hypovolemia
- furrowed tongue
- diminished cap refill
- cool clammy skin
- sunken eyeballs
- flat neck veins
- poor skin turgor and tenting
lab finding for hypovolemia
- high HCT (~35-47)
- High BUN (10-20)
- high urine specific gravity (1.005-1.030)
- hypernatremia(135-145)
- increased serum osmolality (275-295)
interventions for hypovolemia
- monitor I&O, mentation, and vitals
- instruct to stand up slowly
- monitor weight
complications of hypovolemia
- hypovolemic shock
what is hypovolemic shock and what do you do
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
examples of colloids
whole blood, packed RBCs, plasma, synthetic plasma expanders
examples of crystalloids
lactated ringers and normal saline
what does it mean when a drug is a positive inotropic. give some examples
it increases contraction strength of the heart. 1. dobutamine 2. milrinone
give some examples of pressor drugs
dopamine, norepinephrine, phenylephrine
what are clients with hypervolemia at risk for
pulmonary edema and congestive heart failure
who is at risk for hypervolemia
HF, kidney disease, and cirrhosis, high salt intake, burns(fluid shift), people on corticosteroids, severe stress, and hyperaldosteronism
expected vital signs in hypervolemia
- tachycardia 2. bounding pulse 3. hypertension, tachypnea, 4.increased central venous pressure
expected neuromuscular signs in hypervolemia
weakness (retention depletes energy and increases workload) headache and altered LOC
Other findings for hypervolemia
Ascities(GI), crackles, increased RR, cough peripheral, edema, distended neck veins,
lab tests for hypervolemia
opposite of hypovolemia and also CXR may show pulmonary edema
interventions for hypervolemia
- 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)
complications for fluid volume excess (hypervolemia) and how to manage it
pulmonary edema. Put patient in high fowlers and give O2. Give morphine, nitrates, and diuretics
assessment of pulmonary edema
frothy pink tinged sputum, JVD, tachycardia, change in LOC, crackles
expected ranges sodium calcium potasium magnesium chloride phosphorus
136-145 9.0-10.5 3.5-5.0 1.3-2.1 98-106 3.0-4.5
which hormones are involved in the regulation of salt levels
aldosterone, Antidiuretic hormone, and natriuretic peptide
what does hyponatremia do to the body
- delays and slows the depolarization of membranes
2. blood becomes hypotonic leading to lysis of cells
what does salt in the urine tell us
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)
what are some risk factors for hyponatremia
- hyperglycemia
- cerebral salt wasting syndrome
- nasogastric suctioning
- hyperlipidemia
- sweating and diuretics
- drinking/irrigation with hypotonic water
- psychogenic polydipsia
- anticonvulsants, SSRIs, or desmopressin
s/s hyponatremia
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
Interventions for hyponatremia
- 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
- inform DR if there is a 1-2 lb gain in 24 hour or 3 Lbs in 1 week.
what fluid would you use to decrease cerebreal edema
hypertonic sodium solution
expected vitals for hypernatremia
hyperthermia, tachycardia, orthostatic hypotension
expected neuro for hypernatremia
restless, irritability, muscle twiching leading to muscle weakness, decreased DTR, seizures
expected GI for hypernatremia
thirst, dry mucous membranes, n/v, anorexia, occasional diarrhea
interventions for hypernatremia
- encourage water intake
- administer diuretics if they have poor kidney excretion
- daily weights
- 5% dextrose in water to replace fluids
risk factors for hypokalemia
- diuretics, digitalis, corticosteroids
- increased levels of aldosterone
- cushings syndrome
- vomiting, diarrhea, prolonged nasogastric suctioning
expected vitals for hypokalemia
hypotension, thready weak pulse, orthostatic hypotension
expected neuro and ECG for hypokalemia
altered mental status, anxiety, lethargy.
flat T waves, U waves, ST depression, prolonged PR interval, V tach, premature ventricular contractions, inverted T waves,
other expected findings in hypokalemia
hypoactive bowel sounds, n/v, constipation, abdominal distention, paralytic ileus, weakness, shallow breathing
interventions for hypokalemia
hypokalemia increases risk for digoxin toxicity
- monitor LOC, GI
- check hand grip for muscle weakness and DTR
foods high in potassium
avocados, broccoli, dairy, dried fruit, cantaloupe, juices, melon, lean meats, whole grains, citrus fruits
maximum rate for potassium
10 mEq/hr
complications of hypokalemia
respiratory failure and cardiac arrest
risk factors for hyperkalemia
- older adults tend to have decreased renin and aldosterone
- salt substitutes
- ACE inhibitors,
- extracellular shift caused from decreased insulin(DKA), tissue damage(sepsis, trauma, surgery, fever, MI), hyperuricemia
vital signs for hyperkalemia
slow irregular pulse with hypotension
other findings in hyperkalemia
same neuro as hypo, premature ventricular contractions, V fib, peaked T waves, widened QRS, increased GI motility (diarrhea), oliguria
lab findings for hyperkalemia
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
interventions for hyperkalemia
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)
risk factors for hypocalcemia
- lactose intolerance or any malabsorption syndrome such as Crohns
- thyroidectomy
- hypoparathyroidism
- pancreatitis, ESKD - Hyperphosphatemia
- aluminum, caffeine, cisplatin, steroids, mithramycin, phosphates, and loop diuretics.
Expeted findings in hypocalcemia
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)
ECG changes with hypocalcemia
Prolonged QT and ST interval
interventions for hypocalcemia
- seziure precautions
2. dilute IV calcium with 5% dextrose and water and give as bolus.
Risk factors for hypomagnesemia
- celiac or crohns disease
- ethanol ingestion causes magnesium excretion
- diarrhea
- steatorrhea
Expected findings in hypomagnesemia
- dpressed mood/apathy
- hyperactive DTR, parasthesia, tetany, seizures, positive Chvosteks and Trousseaus signs,
- Hypoactive bowels, abdominal distention, paralytic ileus
interventions for hypomagnesemia
- stop magnesium depleting meds (loop diuretics, osmotic diuretics, aminoglycoside antibiotics, and meds containing phosphorus)
- monitor DTR hourly when administering magnesium sulfate
- low magnesium increases chances at digoxin toxicity
foods high in magnesium
dark green veggies, nuts, whole grains, seafood, cocoa
