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NCLEX > Fluid and Electrolytes > Flashcards

Fluid and Electrolytes Flashcards

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1
Q

vascular space

A

fluid volume excess

any vessels- veins, arteries, capillaries

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2
Q

fluid volume excess

A

too much fluid in vascular space

build up of pressure-can leak into interstitial space

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3
Q

causes of FVE

A

heart failure (weak heart, decreased CO, decreased kidney perfusion, decreased urinary output, ** volume stays in vascular space

renal failure (kidneys don’t work *** stay in vascular space

excess Na (effervescent soluble meds, canned/processed foods, IVF with Na)

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4
Q

hormonal regulation of fluid volume

A

aldosterone

adrenal glands above kidneys

when blood volume gets low r/t vomiting, hemorrhage aldosterone secretion increases to retain sodium and water and blood volume goes up

too much aldosterone (too much Na and water): Cushings, hyperaldosteroism–Conn’s)

too little aldosterone: Addisons

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5
Q

action of ADH

A

retain H2O

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6
Q

too much ADH

A 
retain H20
FVE
SIADH (too many letters too much water)
urine concentrated
blood dilute
urine decreases
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7
Q

not enough ADH

A 
lose (diurese) H2O
FVD
DI ***** can go into shock
urine dilute
blood concentrated
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8
Q

Concentrated vs Dilute for values

A

concentrated makes the #s go up
dilute makes the #s go down

urine specific gravity
sodium
hematocrit

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9
Q

Words that make you think ADH issue

A

found in pituitary gland

craniotomy
head injury
sinus injury
transsphenoidal hypophysectomy (going through nose to remove pituitary) 
anything that can lead to increased ICP
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10
Q

S/S of FVE

A

distended neck veins/peripheral veins (vessels are full)
peripheral edema/third spacing (vessels can’t hold anymore and start to leak)
CVP increases (more volume = more pressure)
crackles in lungs (heard at bases first)
polyuria (kidneys are trying to help you diurese
increased pulse (palpate artery, full and bounding, fluid is moving back into the lungs–HF and pulmonary edema)
BP increases (more volume more pressure)
weight increases

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11
Q

CVP

A

measured in R atrium

normal 2-6mmHg
normal 5-10 cmH2O

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12
Q

FVE treatment/interventions

A 
low Na
restrict fluids
I and O 
daily weights
diuretics (furosemide or Bumetanide)-- Loop and will lose K+
hydrochlorothiazide
Spironolactone (retains K+)
bed rest 
**** if no hx give fluids fast
give IVF slow to elderly, young, or any heart or kidney issues 
**** watch lab values while on
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13
Q

FVD causes

A

***** SHOCK
loss of fluid (thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage)

third spacing (fluid in a place that does no good ** not in vascular space)– burns, ascites

diseases with polyuria (DI)

polyuria–> oliguria–> anuria

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14
Q

S/S of FVD

A

decreased weight
decreased skin turgor
dry mucous membranes
decreased urine output (kidneys not being perfused and hold on to urine to compensate)
BP decreases (less volume = less pressure)
pulse increases (weak and thready)
respirations increase
CVP decreases (less volume = less pressure)
peripheral veins/neck veins vasoconstrict (tiny)
cool extremities (peripheral vasoconstriction to shunt blood to vital organs)
urine specific gravity increases (concentrated)

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15
Q

FVD treatment

A

prevent further loss
replace (PO or IV)
** safety r/t risk for falls, monitor for overload with IV

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16
Q

isotonic solutions

A

stays in vascular space

NS
LR
D5W

Uses: lost fluids through N/V, burns, sweat, trauma

** don’t use with those who have HTN, cardiac or renal diseases

can cause FVE, HTN, or hypernatremia

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17
Q

hypotonic solutions

A

goes into vascular space and then shifts into the cells to replace cellular fluid

hydrate w/o causing HTN

D2.5W, 1/2 NS, 0.33% NS

Uses: HTN, renal, or cardiac diseases and needs fluid replacement

** watch for cellular edema r/t fluid moving to the ells and can cause FVD and decreased BP (leaving vascular space)

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18
Q

hypertonic solutions

A

leave cells to go into vascular space

D10W, 3% NS, 5%NS, D5LR, D5 1/2 NS, D5NS, TPN, Albumin

Uses: hyponatremia, 3rd spacing, severe edema, burns, or ascites

** watch for FVE, monitor in ICU if taking 3 or 5% NS

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19
Q

other names for TPN

A

PN or TNA

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20
Q

***** HIGH ALERT

MEDS TO DOUBLE CHECK WITH A 2ND NURSE

A

insulin
opiates and narcotics
injectable K chloride or phosphate concentrate
IV anticoags
sodium chloride solutions about 0.9 percent

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21
Q

Mg and Ca

A

act like sedatives

** think muscles first

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22
Q

hypermagnesemia causes

A

renal failure

antacids

23
Q

hypermagnesemia S/S

A

flushing and warmth

vasodilation

24
Q

hypermagnesemia treatment

A

ventilator
dialysis
calcium gluconate (antidote for Mg toxicity)*** administered very slow
safety precautions

25
Q

hypercalcemia causes

A

hyperparathryoidism (serum Ca gets low, PTH kicks in and pulls Ca from bone to go into blood so serum Ca goes up)

thiazides (retain Ca)

immobilization

26
Q

hypercalcemia s/s

A

brittle bones

kidney stones

27
Q

hypercalcemia treatment

A

move

fluids to prevent stones

add protein (phosphorus) to diet*** inverse relationship

steroids

safety

biphosphates
calcitonin

28
Q

Ca levels

A

9.0-10.5

29
Q

Mg levels

A

1.3-2.1

30
Q

common s/s for high Mg and Ca

A 
DTRs decreases
weak/flaccid muscle tone
arrhythmia
decreased LOC
decreased pulse
decreased respirations
31
Q

hypomagnesemia causes

A

diarrhea

alcoholism

32
Q

hypocalcemia causes

A

hypoparathyroidism
radical neck
thyroidectomy
*** not enough PTH so serum Ca decreases

33
Q

s/s for low Ca and Mg

A 
tight/rigid muscle tone
seizures
stridor/laryngospasms (airway is smooth muscle)
positive Chvostek's
positive Trousseaus 
arrhythmia (heart is a muscle)
DTRs increase
mind changes
swallowing issues (esophagus is a smooth muscle)
34
Q

hypomagnesemia treatment

A

Mg
assess kidney function during IV Mg
seizure precautions
stop IV Mg if they report flushing and sweating

35
Q

foods high in Mg

A 
greens (spinach, mustard greens, broccoli, cucumber, celery, green beans, kale)
summer squash
halibut 
turnip
seeds (pumpkin, sunflower, sesame, flax)
peppermint
36
Q

hypocalcemia treatment

A

Ca
IV Ca give SLOW and always on a heart monitor
Vit D
sevelamer hydrochloride or calcium acetate (phosphate binders)

37
Q

sodium

A

think neuro changes

depends on how much H2O you have in the blood

38
Q

sodium levels

A

135-145

39
Q

hypernatremia causes

A

dehydration
too much Na
not enough H2O

hyperventilation
heat stroke
DI
feeding tube clients

40
Q

hypernatremia s/s

A

dry mouth
thirsty
swollen tongue
neuro changes

41
Q

hypernatremia treatment

A 
restrict Na
dilute client with fluids
daily weights 
i & O
labs
42
Q

hyponatremia causes

A 
too much H2O
not enough Na
drinking H2O for fluid replacement 
psychogenic polydipsia (loves to drink H2O)
D5W (sugar and water)
SIADH
43
Q

hyponatremia s/s

A

headache
seizure
coma

44
Q

hyponatremia treatment

A

give Na
restrict H2O
3 or 5% NS if having neuro problems (hypertonic solution)

45
Q

potassium levels/patho

A

3.5-5
excreted by kidneys
increased K if kidneys dont work

46
Q

hyperkalemia causes

A

kidney issues

spironolactone (retains K)

47
Q

hyperkalemia s/s

A 
arrhythmia
muscle twitching/weakness
flaccid paralysis
bradycardia 
tall and peaked T waves
prolonged PR intervals
flat or absent P waves
widened QRS
vfib
conduction blocks
48
Q

hyperkalemia treatment

A 
dialysis
calcium gluconate (decreases arrhythmia)
glucose and insulin (carries K into the cell)
sodium polystyrene sulfonate (exchange Na for K in GI tract)
49
Q

Na and K

A

inverse relationship

50
Q

hypokalemia causes

A

vomiting
NG suction
diuretics
not eating

51
Q

hypokalemia s/s

A 
muscle cramps/weakness
arrhythmia 
U waves
PVC
vtach
52
Q

hypokalemia treatment

A

give K

spironolactone (retains K)

53
Q

what to do before/ during administering IV K

A 
assess urinary output
always put on pump 
mix well
never give as a push
can burn as infusion
54
Q

foods high in K

A 
greens (spinach, kale, mustard greens, brussel sprouts, broccoli, cucumber, bell pepper, cabbage, avocado)
fruits (cantaloupe, tomatoes, apricots, banana, strawberries, kiwi, oranges)
fennel
eggplant
parsley
ginger roots
tuna
halibut 
cauliflower
lima beans
potatoes

NCLEX (17 decks)

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