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Nursing G140 Exam #1 (MS) > Fluid And Electrolytes > Flashcards

Fluid And Electrolytes Flashcards

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1
Q

Sodium Ranges

A

135-145 mEq/L

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2
Q

Chloride ranges

A

95-105 mEq/L

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3
Q

Potassium ranges

A

3.5-5 mEq/L

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4
Q

Calcium ranges

A

8.5-10.5 mEq/L

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5
Q

Magnesium Ranges

A

1.8-2.7 mEq/L

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6
Q

Phosphate ranges

A

2.5-4.5 mEq/L

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7
Q

Examples of isotonic fluids

A

0.9% NS, LR, D5W (isotonic in bag)

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8
Q

Hypotonic fluids

A

0.45% NS, D5W (in body after glucose is metabolized)

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9
Q

Hypertonic IV fluids

A

3% NS

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10
Q

Plasma Expanders

A

Albumin, PRBCs

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11
Q

Crystalloids are ____ soluble mineral solutions

A

Water

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12
Q

Colloids contain _____ molecules

A

Insoluble

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13
Q

Colloid solutions ____ plasma volume. They ___ peripheral edema. ____volumes are used for resuscitation. They have an IV half life of. ___ to ___ hours.

A

Increase, decrease, small, 3-6.

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14
Q

Crystalloid IV solutions are _____ (money wise). They are used as ___ fluid. They store ___ space loss. They have an IV half life of ___ to ____ mins.

A

Inexpensive, maintenance, 3rd, 20-30 mins.

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15
Q

Hypotonic solutions are ___ concentrated than cells.

A

Less

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16
Q

Hypotonic solutions may cause _____, _____, and _____. How do you assess for these changes?

A

cell swelling, fluid overload and hyponatremia. Assess for Neuro changes (cell swelling), BP and crackles (FVE), and DO NOT ADMINISTER TO LOW SODIUM PATIENTS.

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17
Q

What are isotonic solutions ideal for?

A

Bleeding patients, hemoconcentration and dehydration

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18
Q

What is the only IV solution given with blood?

A

0.9% NaCl

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19
Q

Lactated ringer has multiple ____. When should it not be given?

A
  • multiple electrolytes

- should not be given for electrolyte imbalances, acid-base imbalance or kidney injury patients

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20
Q

D5W is a ____ isotonic. How many cal/L does it supply?

A

Fake; 170 cal/L

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21
Q

Why can’t D5W be the only source of fluid?

A

It may dilute plasma electrolytes

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22
Q

All isotonics may cause ____, ____, and ____.

A

Fluid overload, H&H dilution, and electrolyte imbalances (high serum chloride)

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23
Q

What are hypertonic solutions used for?

A

Symptomatic hypovolemia and hyponatremia

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24
Q

Besides NaCl, what are other hypertonic? What must they be balanced by?

A

TPN, enteral feedings —> must be balanced by hypotonic

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25
Q

What risk comes with hypertonic solutions? How to monitor?

A

Fluid overload —> monitor for pulmonary edema (BP, crackles, serum sodium)

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26
Q

What volume are hypertonics run at?

A

200-250mL

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27
Q

How does albumin work?

A

Increases plasma oncotic pressure —> intravascular volume

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28
Q

What risk does whole blood run?

A

Fluid overload

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29
Q

What must happen for blood product administration?

A

-2 RNs must compare product w/ lab paper and patient chart

30
Q

Acute hemolytic reaction

A

Fever, chills, increased HR and RR,hypotension, flushing, low back pain

31
Q

Anaphylaxis

A

restlessness, wheezing, shock

32
Q

Circulatory overload

A

SOB, crackles, hypertension

33
Q

Febrile non hemolytic reaction

A

Fever, chills, flushing, HA, respiratory distress

34
Q

What does Na+ do in the body?

A
  • determines ECF
  • nerve impulses and muscle contractility
  • Connect with CNS concerns*
35
Q

Etiology of Hyponatremia (9)

A
  • Diuretics
  • Excessive GI suction
  • V/D
  • NG tube flushing w/ no H2O replacement
  • Hf, RF, SIADH, liver cirrhosis
  • excessive hypotonic administration
  • burns/wound exudate
  • tap water enema
  • sweating
36
Q

Hyponatremia clinical manifestation (8)

A
  • muscle cramping
  • HA, lethargy
  • fatigue, weakness
  • convulsions, coma
  • death
  • personality changes
  • decreased LOC
  • N/V/D
37
Q

Clinical management of hyponatremia (6)

A
  • isotonic IV fluids
  • diuretics
  • captivan (vasopril)
  • increased Na+ intake
  • fluid restriction
  • treat cause
38
Q

Nursing management for hyponatremia (5)

A
  • assess neuro fxn (increased ICP=decreased LOC)
  • monitor fluid overload
  • monitor I/O, serum electrolytes, daily weight
  • isotonic IV fluids
  • hypertonic IV fluids for severe imbalance
39
Q

Hypernatremia etiology (9)

A
  • altered thirst
  • inability to respond to thirst
  • heat stroke
  • hypertonic IV solutions
  • hypertonic electrolyte solutions
  • diabetes insipidus
  • profuse sweating
  • watery diarrhea
  • fever, burns
40
Q

Hypernatremia clinical manifestations (10)

A
  • cellular dehydration (brain shrink)
  • thirst, dry mucus membranes
  • seizures
  • coma, death
  • increased BP and FR
  • decreased UO
  • increased temp
  • ALOC
  • postural hypotension
  • restlessness, weakness
41
Q

Clinical management of hypernatremia (2)

A
  • hypotonic IV fluids (D5W or 0.3%)
  • diuretics

CORRECT SLOWLY TO AVOID CEREBRAL EDEMA

42
Q

Nursing management of hypernatremia (8)

A
  • monitor serum electrolytes
  • I/O
  • monitor for fluid overload (breath sounds)
  • monitor neurological function
  • institute seizure precautions
  • low Na+ diet
  • educate on diuretics
  • assess use of OTC sodium (Alkaseltzer or soft drinks)
43
Q

What does K+ do in the body?

A

-effects skeletal and cardiac muscles

CONNECT WITH ARRHYTHMIAS AND MUSCLE WEAKNESS

44
Q

Hypokalemia etiology (11)

A
  • K+ wasting diuretics
  • corticosteroids
  • sodium penicillin
  • excess insulin
  • long term TPN
  • inadequate intake
  • alkalosis
  • DKA
  • Rapid Tissue Repair
  • sever V/D, gastric suction
  • alcoholism in the elderly
45
Q

Hypokalemia clinical manifestations (9) REMEMBER LOW AND SLOW

A
  • dysrhythmias, ECG changes
  • thready pulse
  • postural hypotension
  • shallow respiration’s
  • Anorexia, decreased bowel sounds, ileus
  • polyuria
  • fatigue, generalized weakness, leg cramps
  • flabby muscles
  • digitalis toxicity
46
Q

Clinical management of hypokalemia (8)

A
  • serum K, Ca, Na
  • 12 lead-ECG
  • ABG
  • Renal function tests
  • dig level
  • myoglobin level
  • creatinine kinase
  • replace K+ oral/IV
47
Q

Nursing management hypokalemia (6)

A
  • place heart monitor
  • monitor muscle strength
  • monitor bowel sounds/distention
  • monitor digitalis toxicity and VS
  • administer K+ riders slowly (10mEq/hr)
  • educate on K+ replacement (bananas, potatoes, dark leafy greens)
48
Q

How should K+ riders be administered?

A

Preferably through a central line, but may use peripheral lines

49
Q

What is the usual dose of K+ riders?

A

40-80mEq —> maximum 10mEq/hr

50
Q

Digitalis toxicity symptoms (6)

A
  • vision changes
  • tachycardia
  • loss of appetite
  • N/V/D
  • irregular pulse
  • confusion
51
Q

Hyperkalemia etiology (10)

A
  • renal failure
  • adrenal insufficiency
  • tumor lysis syndrome
  • sever tissue trauma (burns)
  • excess Na+ substitutes
  • NSAIDs
  • ACE inhibitors
  • acidosis
  • aged stored blood
  • psuedohyperkalemia (hemolyzed RBC giving false result)
52
Q

Hyperkalemia clinical manifestations (7) REMEMBER TIGHT AND CONTRACTED

A
  • irritability/anxiety
  • dysrhythmias/ECG changes/ cardiac arrest
  • low BP
  • N/V/D, abdominal cramping
  • muscle twitching
  • lower extremity weakness
  • paresthesias
53
Q

Hyperkalemia clinical management (8)

A
  • insulin and glucose (helps drive K back into the cells)
  • kayexelate (GI excretion of K+)
  • calcium gluconate (decreases excitability of the heart)
  • B2-agonist nebulizer (drives potassium into cells)
  • Na Bicarbonate (if acidosis)
  • diuretics
  • dialysis
  • decrease K+ intake
54
Q

Nursing management of hyperkalemia (6)

A
  • cardiac monitor
  • assess numbness, muscle strength
  • I/O, daily weight, FVE
  • monitor GI if pt is on kayexelate
  • educate on K+ in the diet
  • if on spirinolactone have patient drink apple juice not orange juice
55
Q

What does calcium effect in the body?

A

-skeletal/cardiac muscle

56
Q

Etiology of hypocalcemia (9)

A
  • postoperative thyroidectomy with damage to the parathyroid
  • acute pancreatitis
  • renal failure
  • metastatic cancer
  • massive transfusion of citrated blood
  • malabsorption; GI Resection; diarrhea
  • elderly;post menopausal
  • low calcium, vitamin d, albumin and magnesium
  • loop diuretics, calcitonin,anticonvulsants, phosphates, aluminum containing antacids
57
Q

Hypocalcemia clinical manifestations (8)

A
  • decreased CO, hypotension, dysrhythmias
  • increased bowel sounds, and cramping
  • tetany, muscle spasms, laryngospasms
  • paresthesias
  • (+) Trousseau and Chvostek signs
  • easily fatigued
  • low mg
  • seizure precautions
58
Q

Clinical management of hypocalemia (5)

A
  • serum Ca, P, Mg, albumin
  • low PTH
  • ECG
  • bone density scan
  • IV calcium gluconate (monitor dig tox) DO NOT MIX W/ NS
59
Q

Nursing management of hypocalcemia (6)

A
  • assess paresthesias, SOB
  • identify risks (elderly, post menopausal, immobile, neck or thyroid surgery)
  • assess Trousseau and Chvostek, VS, Resp depth
  • infuse Ca slowly w/ heart monitor
  • maintain quiet room
  • pt education (Ca+ rich foods)
60
Q

Etiology of hypercalcemia (6)

A
  • overuse Ca+ based antacids;excess vit D
  • tumors/malignancies
  • prolonged immobilization
  • thiazides diuretics, lithium
  • hyperparathyroidism
  • decreased muscle tone and constipation
61
Q

Clinical manifestations of hypercalcemia (8)

A
  • fatigue, resp weakness
  • bradycardia, CNS changes
  • dehydration, polyuria
  • kidney stones
  • decreased GI motility
  • pancreatitis
  • coma, death
  • increased gastric secretions —> peptic ulcers
62
Q

Clinical management of hypercalcemia (4)

A
  • isotonic IV fluids (NS and furosemide dilute Ca and promote renal excretion)
  • loop diuretics
  • calcitonin, biophosphates
  • cortisone (inhibits calcium reabsorption and increases excretion)
63
Q

Nursing management of hypercalcemia (6)

A
  • initiate safety precautions
  • assess digitalis toxicity
  • promote mobility
  • promote fluid intake (increases urine acidity, decreases kidney stones)
  • decrease Ca+ intake
  • calcitonin (if pt cannot handle large amounts of fluid; assess for salmon allergy)
64
Q

What does Mg do in the body?

A

Affects neuromuscular junction (Na-K pump)

-Mg, ca, K all closely related

65
Q

Etiology of hypomagnesemia (9)

A
  • alcoholism
  • loss of GI fluids
  • malabsorption/malnutrition
  • DKA
  • loop or thiazides diuretics, aminoglycoside antibiotics, amphoterin B, cyclosporine
  • rapid administration of citrated blood
  • kidney disease
  • hypokalemia/hypocalcemia
  • prolonged TPN
66
Q

Hypomagnesemia clinical manifestations (8)

A
  • weakness, confusion
  • depression
  • tetany, paresthesias
  • increased DTR
  • (+) Trousseau, Chvostek
  • dysrhythmias
  • N/V/D
  • decreased BP, HR, RR
67
Q

Clinical management of hypomagnesemia (5)

A
  • Mg (oral or IV)
  • Monitor UO
  • treat hypocalcemia
  • monitor dig. Tox
  • seizure precautions for severe imbalances
68
Q

Nursing management for hypomagnesemia (3)

A
  • foods rich in Mg —> green leafy vegetables, nuts, whole grains
  • identify risk factories (alcohol/malnutrition)
  • maintain quiet, dark environment
69
Q

Etiology hypermagnesemia (6)

A
  • renal failure
  • abuse of MG antacids (MOM)
  • renal dysfunction
  • adrenal insufficiency
  • eclampsia tx
  • tumor lysis syndrome
70
Q

Clinical manifestations of hypermagnesemia (5)

A
  • weakness, somnolence
  • N/V
  • decreased HR, BP, RR
  • decreased DTR
  • lethargy
71
Q

Clinical management of hypermagnesemia (5)

A
  • administer Ca gluconate and diuretics
  • withhold all Mg meds
  • dialysis
  • mechanical ventilation
  • pacemaker
72
Q

Hypermagnesemia nursing management (4)

A
  • monitor renal pt
  • monitor VS, ECG, I/O, serum lutes
  • assess DTR
  • assess mental status

Nursing G140 Exam #1 (MS) (5 decks)

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