Fluid And Electrolytes Flashcards
Sodium Ranges
135-145 mEq/L
Chloride ranges
95-105 mEq/L
Potassium ranges
3.5-5 mEq/L
Calcium ranges
8.5-10.5 mEq/L
Magnesium Ranges
1.8-2.7 mEq/L
Phosphate ranges
2.5-4.5 mEq/L
Examples of isotonic fluids
0.9% NS, LR, D5W (isotonic in bag)
Hypotonic fluids
0.45% NS, D5W (in body after glucose is metabolized)
Hypertonic IV fluids
3% NS
Plasma Expanders
Albumin, PRBCs
Crystalloids are ____ soluble mineral solutions
Water
Colloids contain _____ molecules
Insoluble
Colloid solutions ____ plasma volume. They ___ peripheral edema. ____volumes are used for resuscitation. They have an IV half life of. ___ to ___ hours.
Increase, decrease, small, 3-6.
Crystalloid IV solutions are _____ (money wise). They are used as ___ fluid. They store ___ space loss. They have an IV half life of ___ to ____ mins.
Inexpensive, maintenance, 3rd, 20-30 mins.
Hypotonic solutions are ___ concentrated than cells.
Less
Hypotonic solutions may cause _____, _____, and _____. How do you assess for these changes?
cell swelling, fluid overload and hyponatremia. Assess for Neuro changes (cell swelling), BP and crackles (FVE), and DO NOT ADMINISTER TO LOW SODIUM PATIENTS.
What are isotonic solutions ideal for?
Bleeding patients, hemoconcentration and dehydration
What is the only IV solution given with blood?
0.9% NaCl
Lactated ringer has multiple ____. When should it not be given?
- multiple electrolytes
- should not be given for electrolyte imbalances, acid-base imbalance or kidney injury patients
D5W is a ____ isotonic. How many cal/L does it supply?
Fake; 170 cal/L
Why can’t D5W be the only source of fluid?
It may dilute plasma electrolytes
All isotonics may cause ____, ____, and ____.
Fluid overload, H&H dilution, and electrolyte imbalances (high serum chloride)
What are hypertonic solutions used for?
Symptomatic hypovolemia and hyponatremia
Besides NaCl, what are other hypertonic? What must they be balanced by?
TPN, enteral feedings —> must be balanced by hypotonic
What risk comes with hypertonic solutions? How to monitor?
Fluid overload —> monitor for pulmonary edema (BP, crackles, serum sodium)
What volume are hypertonics run at?
200-250mL
How does albumin work?
Increases plasma oncotic pressure —> intravascular volume
What risk does whole blood run?
Fluid overload
What must happen for blood product administration?
-2 RNs must compare product w/ lab paper and patient chart
Acute hemolytic reaction
Fever, chills, increased HR and RR,hypotension, flushing, low back pain
Anaphylaxis
restlessness, wheezing, shock
Circulatory overload
SOB, crackles, hypertension
Febrile non hemolytic reaction
Fever, chills, flushing, HA, respiratory distress
What does Na+ do in the body?
- determines ECF
- nerve impulses and muscle contractility
- Connect with CNS concerns*
Etiology of Hyponatremia (9)
- 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
Hyponatremia clinical manifestation (8)
- muscle cramping
- HA, lethargy
- fatigue, weakness
- convulsions, coma
- death
- personality changes
- decreased LOC
- N/V/D
Clinical management of hyponatremia (6)
- isotonic IV fluids
- diuretics
- captivan (vasopril)
- increased Na+ intake
- fluid restriction
- treat cause
Nursing management for hyponatremia (5)
- 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
Hypernatremia etiology (9)
- altered thirst
- inability to respond to thirst
- heat stroke
- hypertonic IV solutions
- hypertonic electrolyte solutions
- diabetes insipidus
- profuse sweating
- watery diarrhea
- fever, burns
Hypernatremia clinical manifestations (10)
- cellular dehydration (brain shrink)
- thirst, dry mucus membranes
- seizures
- coma, death
- increased BP and FR
- decreased UO
- increased temp
- ALOC
- postural hypotension
- restlessness, weakness
Clinical management of hypernatremia (2)
- hypotonic IV fluids (D5W or 0.3%)
- diuretics
CORRECT SLOWLY TO AVOID CEREBRAL EDEMA
Nursing management of hypernatremia (8)
- 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)
What does K+ do in the body?
-effects skeletal and cardiac muscles
CONNECT WITH ARRHYTHMIAS AND MUSCLE WEAKNESS
Hypokalemia etiology (11)
- 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
Hypokalemia clinical manifestations (9) REMEMBER LOW AND SLOW
- 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
Clinical management of hypokalemia (8)
- serum K, Ca, Na
- 12 lead-ECG
- ABG
- Renal function tests
- dig level
- myoglobin level
- creatinine kinase
- replace K+ oral/IV
Nursing management hypokalemia (6)
- 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)
How should K+ riders be administered?
Preferably through a central line, but may use peripheral lines
What is the usual dose of K+ riders?
40-80mEq —> maximum 10mEq/hr
Digitalis toxicity symptoms (6)
- vision changes
- tachycardia
- loss of appetite
- N/V/D
- irregular pulse
- confusion
Hyperkalemia etiology (10)
- 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)
Hyperkalemia clinical manifestations (7) REMEMBER TIGHT AND CONTRACTED
- irritability/anxiety
- dysrhythmias/ECG changes/ cardiac arrest
- low BP
- N/V/D, abdominal cramping
- muscle twitching
- lower extremity weakness
- paresthesias
Hyperkalemia clinical management (8)
- 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
Nursing management of hyperkalemia (6)
- 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
What does calcium effect in the body?
-skeletal/cardiac muscle
Etiology of hypocalcemia (9)
- 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
Hypocalcemia clinical manifestations (8)
- decreased CO, hypotension, dysrhythmias
- increased bowel sounds, and cramping
- tetany, muscle spasms, laryngospasms
- paresthesias
- (+) Trousseau and Chvostek signs
- easily fatigued
- low mg
- seizure precautions
Clinical management of hypocalemia (5)
- serum Ca, P, Mg, albumin
- low PTH
- ECG
- bone density scan
- IV calcium gluconate (monitor dig tox) DO NOT MIX W/ NS
Nursing management of hypocalcemia (6)
- 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)
Etiology of hypercalcemia (6)
- overuse Ca+ based antacids;excess vit D
- tumors/malignancies
- prolonged immobilization
- thiazides diuretics, lithium
- hyperparathyroidism
- decreased muscle tone and constipation
Clinical manifestations of hypercalcemia (8)
- fatigue, resp weakness
- bradycardia, CNS changes
- dehydration, polyuria
- kidney stones
- decreased GI motility
- pancreatitis
- coma, death
- increased gastric secretions —> peptic ulcers
Clinical management of hypercalcemia (4)
- isotonic IV fluids (NS and furosemide dilute Ca and promote renal excretion)
- loop diuretics
- calcitonin, biophosphates
- cortisone (inhibits calcium reabsorption and increases excretion)
Nursing management of hypercalcemia (6)
- 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)
What does Mg do in the body?
Affects neuromuscular junction (Na-K pump)
-Mg, ca, K all closely related
Etiology of hypomagnesemia (9)
- 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
Hypomagnesemia clinical manifestations (8)
- weakness, confusion
- depression
- tetany, paresthesias
- increased DTR
- (+) Trousseau, Chvostek
- dysrhythmias
- N/V/D
- decreased BP, HR, RR
Clinical management of hypomagnesemia (5)
- Mg (oral or IV)
- Monitor UO
- treat hypocalcemia
- monitor dig. Tox
- seizure precautions for severe imbalances
Nursing management for hypomagnesemia (3)
- foods rich in Mg —> green leafy vegetables, nuts, whole grains
- identify risk factories (alcohol/malnutrition)
- maintain quiet, dark environment
Etiology hypermagnesemia (6)
- renal failure
- abuse of MG antacids (MOM)
- renal dysfunction
- adrenal insufficiency
- eclampsia tx
- tumor lysis syndrome
Clinical manifestations of hypermagnesemia (5)
- weakness, somnolence
- N/V
- decreased HR, BP, RR
- decreased DTR
- lethargy
Clinical management of hypermagnesemia (5)
- administer Ca gluconate and diuretics
- withhold all Mg meds
- dialysis
- mechanical ventilation
- pacemaker
Hypermagnesemia nursing management (4)
- monitor renal pt
- monitor VS, ECG, I/O, serum lutes
- assess DTR
- assess mental status
