Fluid and Electrolytes Flashcards by Ericka Merriweather

decrease in intravascular, interstitial, and/or intracellular fluid

Deficit Fluid Volume, Dehydration, Hypovalemia

How well did you know this?

Not at all

Perfectly

What is the pathophysiology of Deficit Fluid Volume, Dehydration, Hypovalemia?

can develop slowly or rapidly; includes Isotonic dehydration, hypotonic dehydration, Hypertonic dehydration, and third spacing (often occurs in interstitial tissues. Assessing the extent is difficult if no change in weight.

How well did you know this?

Not at all

Perfectly

Fluid loss not balanced by intake. Isotonic fluid volume deficit will result in a loss of electrolytes along with fluid.

Isotonic dehydration

How well did you know this?

Not at all

Perfectly

greater loss of sodium than water

Hypotonic Dehydration

How well did you know this?

Not at all

Perfectly

sodium loss less than water loss

Hypertonic Dehydration

How well did you know this?

Not at all

Perfectly

fluid shifts from vascular space to area where it is not available to support normal physiologic processes

Third Spacing

How well did you know this?

Not at all

Perfectly

Etiology/related to Deficit fluid volume/dehydration/hypovalemia

inadequate fluid intake (lack of fluid access, oral trauma, swallowing difficulty, altered thirst mechanism) excessive fluid loss (hemorrhage, GI suctioning, intestinal fistulas, vomiting, diarrhea), failure of regulatory mechanisms (burns, kidney failure); pediatric differences (imbalances due to exercise, heat stress, increased RR, fever); older adult (fewer intracellular reserves in rapid dehydration.

How well did you know this?

Not at all

Perfectly

changes in skin turgor, hypovalemia, tachycardia, weak pulse, postural hypotension, and confusion. also watch for extreme thirst, dry skin, sticky or dry mucous membranes, weight loss, and concentrated urine, jugular veins are flat. In CHILDREN there is irritability, lethargy/sleepy, decreased skin turgor, increased pulse, decreased blood pressure. In OLDER ADULTS there is altered mental status, decreased memory, lack of attention, and itchy skin.

Clinical Manifestations of Deficient fluid volume/dehydration/hypovalemia

How well did you know this?

Not at all

Perfectly

what lab values are used to diagnose deficient fluid volume/hypovalemia/dehydration

Increased BUN, HCT, Urine Specific Gravity

How well did you know this?

Not at all

Perfectly

what is the nursing diagnosis/outcome of deficient fluid volume ?

Increase fluid intake to at least 1500 ml daily.

How well did you know this?

Not at all

Perfectly

What is the nursing diagnosis/outcome of ineffective peripheral tissue perfusion?

moist mucous membranes

How well did you know this?

Not at all

Perfectly

What is the nursing diagnosis/outcome of activity intolerance?

absence of orthostatic hypotension

How well did you know this?

Not at all

Perfectly

What is the nursing diagnosis/outcome of confusion/risk for injury?

above and increased urinary output

How well did you know this?

Not at all

Perfectly

Planning and Interventions for deficient fluid volume/dehydration/hypovalemia?

accurate intake and output, weigh daily, vital signs, administer fluids as ordered, monitor lab values, monitor LOC, reposition every 2 hours, institute fall precautions, teach prevention of orthostatic hypo-tension, maintaining fluid intake, prevention of fluid deficit. Force up to 3000 mL daily if needed. Oral rehydration, safest gradual 30 - 50 % of deficit in first 24 hours. Hypo-tonic: 0.45 NS with cellular dehydration pulls fluid into cells. Isotonic: may be administered if they have electrolytes in them.

How well did you know this?

Not at all

Perfectly

What do you evaluate for deficient fluid volume/dehydration/hypovalemia?

patient has water and electrolytes that are balanced, urinary output is within normal limits, adequate fluid intake, vital signs are within normal limits.

How well did you know this?

Not at all

Perfectly

result of abnormal retention of water and Na in approximately the same proportions in which they normally exist in the ECF; always secondary to an increase in the total body Na content, which leads to excess fluid in tissues; excess fluid interferes with exchange of nutrients and waste.

Excess fluid volume/hypervolemia/overhydration

How well did you know this?

Not at all

Perfectly

compromised regulatory mechanisms,renal failure, CHF, cirrhoois of liver, Cushing syndrome, overzealous administration of Na containing fluids, low protein (related to malnutrition or burns); excessive ingestion of Na containing substances in diet of Na containing medicines.

Etiology of Excess Fluid Volume/Hypervolemia/Overhydration

How well did you know this?

Not at all

Perfectly

What are the clinical manifestations of Excess Fluid Volume/Hypervolemia/Overhydration

changes in LOC, confusion, headache, seizures, pulmonary congestion, bounding pulse, increase BP, JVD, presence of S3, tachycardia, anorexia, nausea, dependent pitting edema, ascities, weight gain > 5% of body weight, crackles, increased respiration rate, orthopnea, pulmonary edema (frothy sputum, dyspnea, cough, gargling sound on respiration), decreased urine output

How well did you know this?

Not at all

Perfectly

What lab values are looked at for Excess fluid volume/overhydration/hypervalemia

decreased serum osmolality, BUN, HCT, Albumin, increased urine specific gravity. Chest x-ray may show pulmonary congestion

How well did you know this?

Not at all

Perfectly

Nursing diagnosis associated with excess fluid volume, overhydration, and hypervalemia?

Excess Fluid volume
Activity Intolerance
Risk for impaired skin integrity 
risk for impaired gas exchange
ineffective health maintenance

How well did you know this?

Not at all

Perfectly

What are the expected outcomes of Excess Fluid volume/overhydration/hypervalemia?

decrease in peripheral edema from +3 to +2, weight loss of a pound a day, RR <24 and non-labored, decreased fatigue and weakness

How well did you know this?

Not at all

Perfectly

Name some interventions for Excess fluid volume/overhydration/hypervalemia

If dyspnea and orthopnea are present place in semi-fowler’s. Turn patient frequently (edematous tissue more prone to skin breakdown), reduce skin shearing, provide alterative mattress, foot cradle, heel protectors. Elevate edema areas, encourage rest periods (lying down favors diuresis of edematous fluid). Restrict foods high in fluid (soups, watermelon, citrus) Low sodium diet. 10-12 g of NaCl a day prevent! Depends on situation, patient may need as little as 100 mL per day.

How well did you know this?

Not at all

Perfectly

A high concentration of sodium in the blood >145 mEq/L

Hypernatremia

How well did you know this?

Not at all

Perfectly

mediations and meals (too much salt intake), osmotic diuretics (mannitol), diabetes insipidus and other diseases such as renal failure, long-term use of corticosteroids and uncontrolled DM, excessive water loss, lower water intake leading to dehydration. INcreased risk for infants, immobile and comatose patents. Must be corrected slowly to prevent rapid shift of water back into cells which would cause cerebral edema.

etiology of Hypernatremia

How well did you know this?

Not at all

Perfectly

Signs and symptoms : fever (low grade), flushed skin, restless, irritable, increased fluid retention, increased BP, edema (peripheral and pitting), decreased urine output, dry mouth, thirst, weakness, lethargy, confusion, stupor seizures, twitching, abdominal cramping, coma. WITH WEIGHT GAIN hypervolemia, dyspnea, bounding pulse, hypertension. WITH WATER LOSS hypervolemia, dry mucous membranes, olguria, orthostatic hypotension

Clinical Manifestations of Hypernatremia

What are some of the nursing diagnosis of hypernatremia

deficient fluid volume related to abnormal water loss, inadequate intake; risk for falls related to skeletal muscle weakness; readiness for enhanced nutrition related to the need of dietary sodium restrictions

What are the interventions/outcomes that a nurse should do?

refer to dietician to evaluate dietary intake for hidden sodium sources. Salt restricted diet can range from a severe restriction (500 mg) to a mild restriction (3000-4000 mg). Teach patient to read food labels, to not routinely add salt to foods prior to tasting, limit or avoid use of bottled or canned sauce products, sue herbs, lemon juice, spices, vinegar instead of salt or alternative substitutes to season. When eating in restaurants have food items prepared without salt, eat freshly prepared bakery produce (commercially prepared and frozen produce contain more sodium. Be aware of artificial sweeteners used in soft drinks and other products can contain extra sodium, learn to read and interpret nutrition labels to make better decisions.

what do you monitor in regards to hypernatremia?

Vital signs, tachycardia, high BP (fluid overload), low BP (fluid deficit), increased temperature greater than 101, intake and output, daily weights, oral hygiene, monitor for CNS and neurological changes such as agitation and seizures, maintain safe environment

a condition that ocurrs when the level of sodium in the blood is low. <135 mEq/L

Hyponatremia

GI losses through vomiting, diarrhea, suctioning, tap water enemas, GI surgery, and bulimia, skin losses through perspiration, environmental conditions, burns, wound drainage, ascities, low salt diet, diuretics, excessive fluid intake (IV or PO), dilution states (any condition that increases fluid volume) CHF, hyperglycemia

Etiology of Hyponatremia

signs and symptoms: irritability, apprehension, altered LOC, confusion, lethargy, headache, postural hypotension, tachycardia, weight loss, poor skin turgor, dry mucous membranes, muscle twitching, tremors, weakness, fatigue, seizures, coma, increased GI motility, abdominal cramping, nausea.

clinical manifestations of hyponatremia

what are some of the nursing diagnosis of hyponatremia?

disturbed though process related to electrolyte imbalance; excess fluid volume related to excessive intake of hypotonic fluids; risk for injury related to seizures, confusion, decreased blood pressure

what are the nursing interventions for hyponatremia?

encourage inclusion of high sodium foods in diet (processed food, ham, bacon, pork products, dill pickles, corned beef, products that are pickled in brine, potato chips, anchovies, mackerel, and other saltwater fish)

What needs to be monitored for hyponatremia?

intake and output and weight, confusion, change of LOC, and seizures. Protect patient from injury and maintain a safe environment. Assess for intravascular overload during infusion of sodium solutions - tachypnea, tachycardia SOB.

potassium level in your blood that's higher than normal ; > 5mEq/L

hyperkalemia

Signs and symptoms: muscle cramps in lower extremities followed by weakness, numbness and tingling in extremities, oliguria, anuria, respiratory distress, decreased cardiac contractility (cardiac arrhythmias, bradycardia, hypotension), EKG changes, hyperreflexia, areflexia, abdominal cramping, diarrhea, nausea and vomiting, lethargy and fatigue

Clinical manifestations of Hyperkalemia

what are some nursing diagnoses of hyperkalemia?

Ineffective breathing patter, activity intolerance, diarrhea, decreased cardiac output

given to antagonize effect of of K+ on myocardium and decrease myocardial irritability. Calcium administration does not promote K+ loss; carefully monitor clients who are taking digoxin (lanoxin) because calcium administration can promote digitalis toxicity. (used to treat hyperkalemia)

Calcium gluconate

combination therapy used to shift K+ from ECF to ICF; not long term treatment to reduce K levels (used to treat hyperkalemia)

Regular Insulin and Dextrose (usually 50%) solution

used to make cells more alkaline (elevating pH), should only be used with documented acidosis unresponsive to other treatment such as proper ventilation, shifts K back into cells (causes transcellular shifting). used to treat hyperkalemia

Sodium Bicarbonate

K+ wasting diuretics (loop diuretics and thiazide and thiazide-like diuretics) will promote excretion of K+ from renal tubules. K restricted diet. Dialysis may be performed for intractable conditions if hyperkalemia cannot be controlled in timely manner to prevent development of potentially lethal problems. (used to treat hyperkalemia)

Diuretic Therapy

Sodium polystyrene sulfate (kayexalate) given either PO with an osmotic agent to decrease possible constipation or as an enema; works to exchange sodium with K+ in GI tract and excrete resin and is available in both oral and rectal forms.

Exchange Resins

potassium level in your blood that is lower than normal . <3.5 mEq/L

hypokalemia

GI losses (diarrhea, vomiting, gastric suctioning, ostomy fluids), skin loss (diaphoresis, wound loss), diuretics (loop diuretics), diet low in K, laxatives, diabetic ketoacidosis, metabolic alkalosis, pernicious anemia

Etiology of hypokalemia

Signs and symptoms: | fatigue, weakness, leg cramps, constipation, anorexia, EKG changes, dysrhythmias

Clinical manifestations of hypokalemia

what are some nursing diagnosis related to hypokalemia ?

ineffective breathing pattern, fatigue, constipation, decreased cardic output

For patients at risk, provide diet containing adequate K+ about 50 - 100 mE daily; administer K supplements as ordered; initiate referral to dietician for assistance with meal planning to ensure adequate sources of potassium in diet. Monitor therapeutic serum drug levels for patients taking cardiac glycosides and serum K levels taking loop and thiazide diuretics . Protect patient from injury and maintain a safe environment due to weakness.

Interventions for those with hypokalemia

what are some vegetables high in potassium?

spinach, broccoli, carrots, green beans, tomato juice, acorn squash, potatoes

What are some fruits high in potassium?

bananas, cantaloupe, watermelon, grapefruit, strawberries, raisins, apricots, oranges

What are some other foods/beverages high in potassium?

milk, yogurt, meat, legumes, nuts, seeds, avocados, and other dried fruit, whole grains, all-bran cereal, dried beef jerky.

Too much calcium in the blood. > 10.5 mg/dL

hypercalcemia

increased loss of bone due to immobilization, cancer, multiple fractures, hyperparathyroidism, acidosis, decreased loss from thiazide diuretics, excessive dietary intake of calcium rich foods, excessive intake of antacids for gastric distress.

etiology of hypercalcemia

``` signs and symptoms: wont appear until > 12 mg/dL anorexia nausea fatigue pain constipation polyuria dehydration dysrhythmias (EKG) bradycardia urinary stones ```

Clincial manifestations of hypercalcemia

nursing diagnoses associated with hyerpcalcemia

``` activity intolerance constipation decreased cardiac output pain fatigue risk for injury impaired physical mobility ```

limit milk and dairy products, eliminate use of calcium carbonate antacids until calcium levels return to normal limits

Decrease calcium intake (intervention)

use loop diuretics, such as furosemide (Lasix) to promote increased urine output, thus more calcium will be excreted. Maintain hydration of 3000-4000 mL of fluid/day, oral fluids should be high in acid-ash (cranberry or prune juice); give NS infusion of 300 - 400 mL/hour to 6 liters as ordered until volume status is restored then 0.45% NS may be used, watch for fluid overload as a consequence of therapy. Corticosteroids to decrease GI absorption of calcium; predisone 20 - 50 mg PO BID is usual. Take 5 - 10 days for calcium to fall. Chronic management of hypercalcemia is only effective with parathroidectomy,

Promote Calcium Excretion (intervention)

what are things that things that need to be monitored in reference to hypercalcemia?

calcium and phosphorus level, EKG monitoring to detect cardiac arrhythmias, strict intake and output, daily weight, monitor patient for side effects of corticosteroids such as hyperglycemia, weight gain, and mood changes

too little calcium in the blood. < 8.5 mg/dL

hypocalcemia

condition caused by insufficient or lack of secretion of PTH by parathyroid glands - ex removal of parathyroid gland

Hypoarathyroidism

citrate is a preservative added to units of red blood cells that act as an anticoagulant, in massive rapid transfusions, citrate can combine with ionized calcium and render this inactive, leading to a transient hypocalcemia (due to citrate toxicity)

massive blood transfusions

signs and symptoms: convulsions, confusion, parethesias, and tingling in hands, lips and feet; arrhythmia, tetany, spasms, positive Trousseau's sign, positive Chvostek's sign, possible bone fractures due to demineralization, increased bleeding, development of cataracts, intestinal cramps, diarrhea, dry, brittle nails and dry hair, complaints of bone pains, painful muscle spasms

Clincial manifestations of hypocalcemia

muscle twitching/hyperactive deep tendon reflexes

tetany

Inflation of blood pressure cuff to upper arm to 20mm above systolic BP for about three minutes results in carpal spasm of hand

Positive Trousseau's Sign

Tapping over facial nerve just anterior to ear results in twitching of the cheek

Chvostek's sign

What are some nursing diagnosis related to hypocalcemia?

pain diarrhea risk for injury altered nutrition: less than body requirements

What do you monitor in relation to hypocalcemia?

monitor patients receiving calcium replacement who are also on digitalis for enhanced effect, check pulse, seizure precautions

Increase intake of foods high in calcium (dairy products and dark greens), IV calcium gluconate or calcium chloride SLOW, administer with Ds W or NS, Calcium carbonate PO with vitamin D to help absorption, continuous ECG monitoring, continually reassess neurologic, respiratory and cardiac status

Interventions associated with hypocalcemia

What test is often done to check kidney function?

BUN (6-20mg/dL)

This test is done to see how well your kidneys work. Creatinine is removed fro the body entirely by the kidneys. If kidney function is not normal, Creatinine level increases in your blood. This is because less Creatinine is released through your urine

Creatinine (0.7-1.3 mg/dL)

Pharmacologic Therapy agent that dissociates to provide bicarbonate ion. Neutralizes hydrogen ion concentration, raises blood, urinary pH.Alkalinizing agent, antacid electrolyte, urinary/systemic alkalinizer. (Side effects: abdominal distention, flatulence, belching)

Sodium Bicarbonate

is a metabolic condition in which the pH of tissue is elevated beyond the normal range (7.35–7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations.

Metabolic Alkalosis

signs and symptoms: restlessness, lethargy, dysrhythmias, tachycardia, compensatory hypo-ventilation, confusion, decreased LOC, dizzy, irritable, nausea, vomiting, diarrhea, tremors, muscle cramps, tingling of fingers and toes, hypokalemia, tetany.

Clinical Manifestations of metabolic alkalosis

is a condition that occurs when the body produces excessive quantities of acid or when the kidneys are not removing enough acid from the body. (DKA, severe diarrhea, renal failure, shock, salicylate OD, sepsis, shock)

Metabolic Acidosis

signs and symptoms: headache, decreased BP, hyperkalemia, muscle twitching, warm flushed skin, nausea, vomiting, diarrhea, changes in LOC, kussmaul respirations

clinical manifestations of metabolic acidosis

is a medical condition in which increased respiration elevates the blood pH beyond the normal range (7.35–7.45) with a concurrent reduction in arterial levels of carbon dioxide. This condition is one of the four basic categories of disruption of acid–base homeostasis. (Hyperventilation, initial stages of pulmonary emboli, hypoxia, fever, pregnancy, high altitude , anxiety, mechanical ventilation

Respiratory Alkalosis

signs and symptoms: seizures, deep and rapid breathing, hyperventilation, tachycardia, decreased or normal BP, hypokalemia, numbness and tingling of extremities, lethargy, confusion, light headedness, nausea, vomiting

clinical manifestations of respiratory alkalosis

is a condition that occurs when the lungs can't remove enough of the carbon dioxide (CO2) produced by the body. Excess CO2 causes the pH of blood and other bodily fluids to decrease, making them too acidic. ... This is also called respiratory failure or ventilatory failure. (Hypoventilation, drug overdose, pulmonary edema, chest traua, neuromuscular disease, airway obstruction, COPD, loss of too much base respiratory depression.

Respiratory acidosis (decreased pH, increase PaCO2 , HCO3 normal)

signs and symptoms: rapid and shallow respirations, hypoxia, decreased BP, skin/mucosa pal to cyanotic, headache, hyperkalemia, dysrhthmias, drowsiness, dizziness, disorientation, muscle weakness, hyperreflexia

clinical manifestations of respiratory acidosis

increase of hydrogen increases acidity. chemical and protein buffers are first to respond to the increase or decrease in hydrogen. Respiratory system responds next by controlling CO2 levels in the blood. Finally, the renal system is the last to respond, but is most effective. Releases HCO3. Expected in all well individuals, requires normal physiologic functioning. Imbalances develop as a complication of another underlying condition.

Acid-Base Balance

what are the risk associated with acid-base balance ?

``` COPD diabetes renal failure dehydration liver failure pancreatitis ```

retention of too much acid of loss of too much acid (a) CO2 retention = respiratory (b) HCO3 loss of H+ retention = metabolic

acidosis

retention of too much base or loss of too much base (a) CO2 loss = respiratory (b) HCO3 excess of H+ loss = metabolic

alkalosis

what is the normal range for pH?

7.35 - 7.45

what is the normal range for PaCO2 ?

35 - 45

what is the normal range for HCO3?

22 - 26

pharmacologic therapy that is focused on decreasing the SBP >140 mmHg, and to decrease edema. This is done by increasing urine flow (diuresis), natriuresis (sodium loss in urine), loss of other electrolytes (K+, Mg, cl, HCO3 Phosphate)

Diuretics

loop diuretic, that is more potent that thiazide that enhances excretion of sodium, chloride, potassium by direct action at ascending limb of loop of Henle. Produces diuresis, lowers BP

Furosemide (Lasix)

What are some of the side effects of Furosemide (lasix)?

increased urinary frequency/volue, nausea, dyspepsia, abdominal cramps, diarrhea, constipations, electrolyte disturbances, dizziness, light-headedness, headache, blurred vision, paresthesia, photosensitivity, rash, fatigue, bladder spasm, restlessness, and diaphoresis

What are some considerations to keep in mind when giving Furosemide (Lasix)?

Can be given if patient has renal disease, decreases potassium. NEVER give IV push (can cause permanent ototicity (hearing loss)). Increase potassium in diet. Has immediate effect. Check BP and pulse, assess baseline electrolytes, assess skin turgor, mucous membranes, observe edema, muscle strength, mental status, monitor intake and output, and obtain baseline weight

Blocks reabsportion of water, sodium, potassim at cortical diluting segment of distal tubule. Reduces plasma, extracellular fluid volue, and peripheral vascular resistance by direct effect on blood vessels. Promotes diuresis, reduces BP.

Hydrochlorothiazide (HydroDiuril)

side effects: increased urinary frequency, urine volume, potassium depletion, orthostatic hypotension, headache, GI disturbances, photosensitivity

Side Effect of HydroDiuril

interferes with sodium re-absorption by competitively inhibiting action of aldosterone in distal tubule, promoting sodium and water excretion, increasing potassium retention. Produces diuresis, lowers BP

Sprionolactone (Aldactone)