Fluid and Electrolytes Flashcards
vascular space
fluid volume excess
any vessels- veins, arteries, capillaries
fluid volume excess
too much fluid in vascular space
build up of pressure-can leak into interstitial space
causes of FVE
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)
hormonal regulation of fluid volume
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
action of ADH
retain H2O
too much ADH
retain H20 FVE SIADH (too many letters too much water) urine concentrated blood dilute urine decreases
not enough ADH
lose (diurese) H2O FVD DI ***** can go into shock urine dilute blood concentrated
Concentrated vs Dilute for values
concentrated makes the #s go up
dilute makes the #s go down
urine specific gravity
sodium
hematocrit
Words that make you think ADH issue
found in pituitary gland
craniotomy head injury sinus injury transsphenoidal hypophysectomy (going through nose to remove pituitary) anything that can lead to increased ICP
S/S of FVE
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
CVP
measured in R atrium
normal 2-6mmHg
normal 5-10 cmH2O
FVE treatment/interventions
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
FVD causes
***** 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
S/S of FVD
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)
FVD treatment
prevent further loss
replace (PO or IV)
** safety r/t risk for falls, monitor for overload with IV
isotonic solutions
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
hypotonic solutions
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)
hypertonic solutions
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
other names for TPN
PN or TNA
***** HIGH ALERT
MEDS TO DOUBLE CHECK WITH A 2ND NURSE
insulin
opiates and narcotics
injectable K chloride or phosphate concentrate
IV anticoags
sodium chloride solutions about 0.9 percent
Mg and Ca
act like sedatives
** think muscles first
hypermagnesemia causes
renal failure
antacids
hypermagnesemia S/S
flushing and warmth
vasodilation
hypermagnesemia treatment
ventilator
dialysis
calcium gluconate (antidote for Mg toxicity)*** administered very slow
safety precautions
hypercalcemia causes
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
hypercalcemia s/s
brittle bones
kidney stones
hypercalcemia treatment
move
fluids to prevent stones
add protein (phosphorus) to diet*** inverse relationship
steroids
safety
biphosphates
calcitonin
Ca levels
9.0-10.5
Mg levels
1.3-2.1
common s/s for high Mg and Ca
DTRs decreases weak/flaccid muscle tone arrhythmia decreased LOC decreased pulse decreased respirations
hypomagnesemia causes
diarrhea
alcoholism
hypocalcemia causes
hypoparathyroidism
radical neck
thyroidectomy
*** not enough PTH so serum Ca decreases
s/s for low Ca and Mg
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)
hypomagnesemia treatment
Mg
assess kidney function during IV Mg
seizure precautions
stop IV Mg if they report flushing and sweating
foods high in Mg
greens (spinach, mustard greens, broccoli, cucumber, celery, green beans, kale) summer squash halibut turnip seeds (pumpkin, sunflower, sesame, flax) peppermint
hypocalcemia treatment
Ca
IV Ca give SLOW and always on a heart monitor
Vit D
sevelamer hydrochloride or calcium acetate (phosphate binders)
sodium
think neuro changes
depends on how much H2O you have in the blood
sodium levels
135-145
hypernatremia causes
dehydration
too much Na
not enough H2O
hyperventilation
heat stroke
DI
feeding tube clients
hypernatremia s/s
dry mouth
thirsty
swollen tongue
neuro changes
hypernatremia treatment
restrict Na dilute client with fluids daily weights i & O labs
hyponatremia causes
too much H2O not enough Na drinking H2O for fluid replacement psychogenic polydipsia (loves to drink H2O) D5W (sugar and water) SIADH
hyponatremia s/s
headache
seizure
coma
hyponatremia treatment
give Na
restrict H2O
3 or 5% NS if having neuro problems (hypertonic solution)
potassium levels/patho
3.5-5
excreted by kidneys
increased K if kidneys dont work
hyperkalemia causes
kidney issues
spironolactone (retains K)
hyperkalemia s/s
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
hyperkalemia treatment
dialysis calcium gluconate (decreases arrhythmia) glucose and insulin (carries K into the cell) sodium polystyrene sulfonate (exchange Na for K in GI tract)
Na and K
inverse relationship
hypokalemia causes
vomiting
NG suction
diuretics
not eating
hypokalemia s/s
muscle cramps/weakness arrhythmia U waves PVC vtach
hypokalemia treatment
give K
spironolactone (retains K)
what to do before/ during administering IV K
assess urinary output always put on pump mix well never give as a push can burn as infusion
foods high in K
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
