Fluid and electrolytes

Question 1

oncotic pressure

Answer 1

pulls fluid

Question 2

Hydrostatic pressure

Answer 2

pushes fluid

Question 3

First spacing

Answer 3

Normal distribution of fluids in ICF and ECF

Question 4

Second spacing

Answer 4

Abnormal interstitial fluid (edema)

Question 5

Third spacing

Answer 5

Fluid collection in a place difficult or impossible to move back to cells (Ascites, edema from burnsF)

Question 6

Fluid volume deficit vs dehdyration

Answer 6

Fluid volume deficit is water AND sodium loss

Dehydration is just water loss

Question 7

ECF volume deficit

Answer 7

Causes:

3rd space fluid shifts
Low fluid intake
Diuretic overuse
GI losses (NG suctioning, vomit, etc.)
DI
Fever/heatstroke

Manifestations:
Restless, drowsy, confused
Cold, clammy
Thirsty, dry mucous membranes
Inc. RR

Question 8

ECF volume excess

Answer 8

Causes

SIADH
Cushing/long term corticosteroid
Heart/renal failure
excess hypo/isotonic IV fluids

Manifestations

Headache
Peripheral edema
JVD
S3 sounds
Bounding pulse
Pulmonary edema

Question 9

Sodium range

Answer 9

135-145mEq/L

Question 10

Hypernatremia manifestations

Answer 10

> 145mEq/L

Manifestations
Dehydration of brain

Low ECF (wt loss, tachycardia, weakness, cramps post hypotension, LOW CVP)

High/normal ECF (Thirst, flushed skin, wt gain, edema, high BP, high CVP, seizures)

Question 11

Hyponatremia assessment and interventions

Answer 11

Assess for:
Seizure, LOC, mental status, Vitals, weight, CVP, strength, skin, mucous membranes, labs

Interventions:
Volume status, IVF (type), sodium restriction (dietary), monitor labs, meds (vasopressin), seizure precautions

Question 12

Hyponatremia manifestations

Answer 12

<135mEq/L

Low ECF: HA, irritability, confusion, tremors, seizures, dry membranes, tachycardia, cold/clammy

High ECF:
HA, confusion, seizures, N/V/D, Hypertension, HIGH CVP

Question 13

Hyponatremia assessment/interventions

Answer 13

Assess: HA, LOC, seizures, VS, CVP, mucous membranes, weight, nausea

Interventions:
NA+ isotonic solution, inc. PO intake, hold diuretics, free water restriction, vasopressor receptor antagonists

**Avoid rapid or overcorrection due to osmotic demyelination syndrome

Question 14

Hyperkalemia manifestations

Answer 14

> 5mEq/L

Overexcited nerve/muscle impulse (HIGH POTASSIUM=HIGH CONTRACTION)
Cardiac irregularity, weak muscle tone, cramping, D/V, d/t,

Question 15

Hyperkalemia assessment/interventions

Answer 15

Assess: ECG, muscle weakness, tetany, reflexes, respiratory effort, labs, pulses

Interventions:

Stop PO K+ intake/diuretics

Kayexalate or Patriomer

Shift potassium intracellular (insulin+dextrose+beta adrenergic- maybe bicarb/calcium gluconate)

Question 16

Hypokalemia manifestations

Answer 16

<3.5mEq/L

Impaired muscle contraction (LOW POTASSIUM=LOW CONTRACTION)

decreased reflexes, shallow respirations, constipation, hyperglycemia

Question 17

Hypokalemia assessment/interventions

Answer 17

Assess:
ECG, Muscle weakness, reflexes, resp. effort, bowel movements, blood glucose,

-On digoxin??

Interventions: K+ replacement IV or PO, telemetry, serial labs

Question 18

Hypercalcemia manifestations >10.5mg/dL

Answer 18

Acidosis, reduced muscle excitability/tone, fatigue, hallucination, N/V/anorexia, bone pain/fractures, polyuria, confusion

Question 19

Hypercalcemia assessments and intervention

Answer 19

Assess LOC, MS, Muscles, ECG, pain, seizures

Interventions:
Low Ca intake, inc. activity, hydrate IV meds (saline, bisphosphonates, calcitonin)

Question 20

Hypocalcemia manifestations

Answer 20

<9.0mg/dL

Cell membrane depolarization, sustained contraction/tetany, decreased cardiac contractions, tingling

Question 21

Hypocalcemia assessment and interventions

Answer 21

Assess: Swallowing, breathing, CHVOSTEK (face), TROSSEAU (carpal), ECG, sensation

Interventions: Diet/supplement, IV calcium gluconate, paper bag, adjust medications

Question 22

Hyperphosphatemia manifestations

Answer 22

> 4.5mg/dL

Can be asymptomatic until hypocalcemia, calciphylaxis

Question 23

Hyperphosphatemia assessment/interventions

Answer 23

Assess:
Labs, signs/symptom of hypocalcemia, wounds

Interventions: decrease PO intake, phosphate binders with meals, PTH

Question 24

Hypophospatemia manifestations

Answer 24

<3.0g/dL

Impaired cellular energy/O2 delivery, CNS depression

Weakness

Rhabdo

Soft bones

Question 25

Hypophospatemia assessement/interventions

Answer 25

Assess: LOC, MS, muscles, resp. status, urine output and color

Interventions:

Inc. PO intake, hydration, IV replacement (KPhos, NaPhos)

Question 26

Hypermagnesemia manifestations

Answer 26

> 2.1mEq/L

Impaired nerve/muscle function, bradycardia

Low BP

facial flushing, urinary retention, N/V

Loss of DTR, paralysis

Question 27

Hypermagesemia assessment/interventions

Answer 27

Assess LOC, muscles, N/V, reflexes, VS

Interventions:

Decrease PO intake/meds, IV calcium gluconate

If renal=ok then inc. fluid and diuretics

If renal not ok-dialysis

Question 28

Hypomagnesemia manifestations

Answer 28

<1.3mEq/L

Similar to hypocalcemia, cramps, tremors, hyperreflexia, vertigo, seizures, dysrhythmias

Question 29

Hypomagnesemia assessment/interventions

Answer 29

Assess muscle reflexes, VS, ECG, seizures, CHVOSTEK/TROSSEAU, LOC

Interventions:

Inc. PO intake, IV magnesium

Question 30

Sodium range

Answer 30

135-145mEq/L

Question 31

Potassium range

Answer 31

3.5-5mEq/L

Question 32

Calcium range

Answer 32

9-10.5mg/dL

Question 33

Phosphorus range

Answer 33

3-4.5mg/dL

Question 34

Magnesium range

Answer 34

1.3-2.1mEq/L

Question 35

Potassium interaction with digoxin

Answer 35

HYPOkalemia can cause digoxin toxicity

Question 36

Chvostek sign

Answer 36

Facial twitching upon stimulation

Question 37

Trosseau sign

Answer 37

When BP cuff placed on arm and inflated the hand makes a shape that looks like the thing you do for shadow puppets that looks like a duck