Fluid & Electrlytes Flashcards
What is aldosterone?
A mineralcorticosteroid that is produced by the adrenal glands. Aldosterone makes you retain sodium and water and makes you lose potassium.
What is a diagnosis with too much aldosterone?
Cushing’s and Conn’s
What is a diagnosis with not enough aldosterone?
Addison’s
What is Cushing’s?
A disease with too many steroids. which makes you have too much aldosterone, which makes you retain too much sodium and water
What is Conn’s?
A disease that makes you have too much aldosterone. Which makes you retain too much sodium and water
What is Addison’s?
A disease with not enough aldosterone, which makes you lose sodium and water
What does ANP do?
Causes the excretion of sodium and water
What does ADH do?
Makes you retain water
What excretes ANP?
The atrium
What is the diagnosis with too much ADH?
SIADH
What is the diagnosis with not enough ADH?
Diabetes insipidus
What does SIADH do?
You have too much ADH, which makes you retain too much water with decreased urine output.
What does diabetes insipidus do?
You have not enough ADH which causes you to diuresis. Watch out for the patient from going into shock
What is vasopressin?
ADH used in diabetes insipidus as an ADH replacement
What is desmopressin acetate?
ADH used in diabetes insipidus as an ADH replacement
When you see a patient with a head issue, what should you initially think of?
Potential ADH problem
Where is CVP measured?
The right atrium
What is the CVP range?
2-6 mmHg
5-10 cmH2O
What does acute Weight gain mean?
Increased fluid volume
What should you initially think of when you see fluid retention?
Possible heart problems
What is bumetanide?
Loop diuretic that loses potassium
What is furosemide?
Loop diuretic that loses potassium
What is hydrochlorothiazide?
Diuretic that retains calcium
What is spironolactone?
Potassium sparing diuretics that causes hyperkalemia. Always limit patient dietary intake of potassium with this med.
What is ascites?
Fluid in the peritoneal cavity which causes fluid volume deficit. The patient will have a large abdomen, possible breathing problems, and sometimes have a liver diagnosis. Always check blood pressure and measure abdominal girth.
What should you initially think of when you see polyuria?
Shock
What are you worried about with anuria?
Renal failure
What are the changes in vital signs with fluid volume deficit?
Decrease blood pressure, increased heart rate, increased respirations
What is isotonic solution?
Fluid that goes into your vascular space and stays there.
It makes the blood pressure increase.
It’s used for fluid volume deficit.
DO NOT use isotonic solutions with hypertension patient, cardiac diagnosis, and renal diagnosis.
Can cause hypertension, fluid volume excess, or hypernatremia
What kind of solution is normal saline?
Isotonic solution
What kind of solution as lactated ringer’s?
Isotonic solution that is most widely used for the shock patient because it has the most electrolytes.
What kind of solution is D5W?
Isotonic solution that can cause hyponatremia
What kind of solution is D5 1/4NS?
Isotonic solution
What are some examples of isotonic solutions?
NS
LR
D5W
D5 1/4NS
What is the solution of choice for the shock patient?
Isotonic, LR because it has more electrolytes
What is hypotonic solution?
Fluid that goes into the vascular space and then shifts out into the cells to replace cellular fluid.
It rehydrates but doesn’t cause hypertension.
Used for the patient with hypertension, renal or cardiac disease, and has fluid volume deficit.
Watch out for cellular edema which can lead to fluid volume deficit and decrease blood pressure.
What kind of solution is D2.5W?
Hypotonic solution
What kind of solution is 1/2NS?
Hypotonic solution
What kind of solution is 0.33% NS?
Hypotonic solution
What are examples of hypotonic solution?
D2.5W
1/2NS
0.33% NS
What is hypertonic solution?
Volume expander that draws fluid into the vascular space from the cell.
Used for the patient with third spacing, edema, burns, or ascites.
Watch out for fluid volume excess and pulmonary edema.
Monitor blood pressure, pulse in central venous pressure closely. (especially with 3%NS and 5%NS)
What type of solution do you give to the patient who has fluid volume deficit and doesn’t have hypertension, cardiac problems, or renal problems?
Isotonic solution : NS LR D5W D5 1/4NS
What type of solution do you give to the patient who is in fluid volume deficit and has hypertension, renal and/or cardiac problems?
Hypotonic solution:
D2.5W
1/2NS
0.33% NS
What type of solution do you give to the patient with third spacing, edema, burns or ascites?
Hypertonic solution: D10W 3%NS 5%NS D5LR D5 1/2NS D5NS TPN Albumin
What kind of solution is D10W?
Hypertonic solution
What kind of solution is 3%NS?
Hypertonic solution. This solution is mostly only seen in the ICU for hyponatremia. Given SLOWLY while the blood pressure, pulse and CVP are closely monitored.
What kind of solution is 5%NS?
Hypertonic solution. This solution is mostly only seen in the ICU for hyponatremia. Given SLOWLY while the blood pressure, pulse and CVP are closely monitored.
What kind of solution is D5LR?
Hypertonic solution
What kind of solution is D5 1/2NS?
Hypertonic solution
What kind of solution is D5NS?
Hypertonic solution
What kind of solution is TPN?
Hypertonic solution
What kind of solution is albumin?
Hypertonic solution
What are examples of hypertonic solutions?
D10W 3%NS 5%NS D5LR D5 1/2NS D5NS TPN Albumin
Which electrolytes act like sedatives?
Magnesium and calcium
What are the normal lab values for magnesium?
1.3-2.1 mEq
What are the normal lab values for calcium?
9.0-10.5 mg/dl
What should you initially think of when you see magnesium and calcium questions?
Think muscle first
What does PIH mean?
Pregnancy induced hypertension
Which electrolyte is given to the PIH patient?
Magnesium because it makes you vasodialate which makes your blood pressure go down
What causes hypermagnesemia?
Renal failure, because kidney secrete magnesium and antacids
What are the signs and symptoms of hypermagnesemia?
Flushing, warmth, vasodilation, decreased deep tendon reflexes, weak/flaccid muscle tone, arrhythmias, decreased level of consciousness, decreased pulse, decreased respirations
What is the antidote for magnesium Toxicity?
Calcium gluconate
What is calcium gluconate?
The antidote for magnesium toxicity.
Must be administered slowly at A max rate of 1.5-2mL/min
What does the parathyroid hormone do?
Pulls calcium from the bones and puts it in the bloodstream.
What causes hypercalcemia?
Hyperparathyroidism, thiazides which retains calcium, immobilization because you have to bear weight to keep calcium in the bones
What are signs and symptoms of hypercalcemia?
Brittle bones, kidney stones, decreased deep tendon reflexes, weak/flaccid muscle tone, arrhythmias, decreased level of consciousness, decreased pulse, decreased respirations
What has an inverse relationship with calcium?
Phosphorus (protein)
What foods are high in phosphorus?
Protein
How do you treat hypercalcemia?
Movement, add phosphorus to diet, give steroids to decrease calcium, vitamin D to use calcium, give meds: biphosphates, prostaglandin synthesis inhibitors, and calcitonin
What is biphosphate?
Used to decrease serum calcium
What is prostaglandin synthesis inhibitor?
Used to decrease serum calcium
What is calcitonin?
Used to decrease serum calcium and given to osteoporosis patients a lot.
Where do you get your main source of vitamin D?
The sun
How do you treat hypermagnesemia?
Put on the ventilator for respirations less than 12, dialysis, calcium gluconate and safety precautions
What causes hypomagnesemia?
Diarrhea and alcoholism
What are signs and symptoms of hypomagnesemia?
Tight/rigid muscles, possible seizures, stridor/laryngospasms, positive chvostek’s, positive trousseau’s, arrhythmias, increase deep tendon reflexes, mind changes, problems with swallowing
How do you check for chvostek’s sign?
Tap cheek to check for hyper irritability. Positive sign will show the face twitching
How do you check for positive Trousseau’s?
Watch for hand twitching while blood pressure cuff is pumping up. This shows hyper irritability
What foods are high in magnesium?
Spinach, mustard greens, summer squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, celery, kale, sunflower seeds, sesame seeds, flax seeds
Spinach, mustard greens, summer squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, celery, kale, sunflower seeds, sesame seeds, flax seeds are high in what electrolyte?
Magnesium
Protein is high in what electrolyte?
Phosphorus
What causes hypocalcemia?
Not enough parathyroid hormone from: hypoparathyroidism, radical neck dissection, thyroidectomy
What are signs and symptoms of hypocalcemia?
Tight/rigid muscles, possible seizures, stridor/laryngospasms, positive chvostek’s, positive trousseau’s, arrhythmias, increase deep tendon reflexes, mind changes, problems with swallowing
What is vitamin D?
A vitamin used to help utilize calcium, given with hypocalcemia
What is calcium carbonate?
If phosphate binder that increases calcium
What is sevelamer hydrochloride?
If phosphate binder that increases calcium
What is calcium acetate?
If phosphate binder that increases calcium
What is IV calcium?
Used for hypocalcemia, only given SLOWLY to patients on heart monitors. Must watch for widening QRS complex.
What are the normal sodium lab values?
135-145 mEq/L
What is your serum sodium level dependent on?
Water in the blood
What causes hypernatremia?
Hyperventilation, heat stroke, diabetes insipidus
what are signs and symptoms of hypernatremia?
Dry mouth, thirsty, swollen tongue, neuro changes
What causes hyponatremia?
Too much water in the blood by drinking water as a fluid replacement, drinking way too much water, D5W (sugar and water), SIADH
What are signs and symptoms of hyponatremia?
Headache, seizure, coma
What is the normal lab value for potassium?
3.5-5.0 mEq/L
What causes hyperkalemia?
Kidney problems, spironolactone
What are signs and symptoms of hyperkalemia?
Muscle twitching which leads to arrhythmias, muscle weakness flaccid paralysis.
ECG changes: bradycardia, tall and Peaked T waves, prolonged PR interval, flat or absent P waves, widened QRS, conduction blocks, ventricular fibrillation
What is the treatment for hyperkalemia?
Emergency measures:
Dialysis, calcium gluconate to decrease arrhythmias, glucose and insulin because insulin carries potassium into the cell, sodium polystyrene sulfonate because it exchanges potassium for sodium in the GI tract.
What is calcium gluconate?
Used in an emergent situation, given for hyperkalemia to decrease arrhythmias
What is sodium polystyrene sulfonate?
Used in an emergent situation,
Given for hyperkalemia to exchange potassium for sodium in the GI tract,
Push fluids to offset dehydration
Which electrolytes have inverse relationships?
Sodium and potassium, calcium and phosphorus
What are signs and symptoms of hypokalemia?
Muscle cramps which leads to arrhythmias, muscle weakness
What are things to remember when giving oral potassium?
Oral potassium can cause gastrointestinal upset, always give with food
What is IV potassium?
Given for hypokalemia,
closely watching urine output before and during administration of this medicine,
If urine output decreases during IVK then patient is retaining potassium (which is a killer!),
This medicine must be put on a pump, mixed well,
NEVER give potassium IV push,
It’s normal to feel a burning sensation during infusion,
Watch the IV site closely,(IVK is damaging to peripheral lines)
Which foods are high in potassium?
Spinach, fennel, kale, mustard greens, brussels sprouts, broccoli, eggplant, cantaloupe, tomatoes, parsley, cucumber, bell pepper, apricot, ginger root, strawberries, avocado, banana, tuna, halibut, cauliflower, kiwi, oranges, lima beans, potatoes, sweet potatoes, cabbage
Spinach, fennel, kale, mustard greens, brussels sprouts, broccoli, eggplant, cantaloupe, tomatoes, parsley, cucumber, bell pepper, apricot, ginger root, strawberries, avocado, banana, tuna, halibut, cauliflower, kiwi, oranges, lima beans, potatoes, sweet potatoes, cabbage are high and what electrolyte?
Potassium
