Fluid & Electrolyte / Acid & Base Flashcards
Causes of Fluid Volume Excess
Heart failure
- CO down, kidney perfusion down, UOP down
- no fluid can leave
Renal failure
- kidneys aren’t filtering out excess water
Three things w a lot of sodium
effervescent soluble meds
canned / processed foods
IVF w sodium
What two hormones regulate fluid volume?
ADH & aldosterone
Aldosterone
- found in adrenal cortex
- causes body to retain sodium & water
- increases blood volume
- it’s a steroid (mineralocorticoid)
Diseases w too much aldosterone
Cushing’s Dz
Hyperaldosteronism / Conn’s Dz
Diseases with too little aldosterone
Addison’s Dz
- lose sodium & water –> fluid volume deficit
Does ADH make you retain or diurese?
retain water ONLY
Too much ADH:
retain water
fluid volume excess
SIADH (too much water)
urine concentrated
blood dilute
too little sodium (dilute)
Not enough ADH
lose (diurese) water
fluid volume deficit
DI (#1 concern is shock)
urine diluted
blood concentrated
increased sodium
Urine specific gravity, sodium, and hematocrit numbers go ___ when its concentrated?
up
What are some causes of ADH problems?
craniotomy, head injury, sinus surgery, transsphenoidal hypophysectomy, increased ICP
Another name for ADH
vasopression (Pitressin)
What two drugs can be utilized as an ADH replacement in DI?
Vasopressin or desmopressin acetate
S/sx of FVE
distended neck veins / peripheral veins
— vessels are full
peripheral edema / third spacing
— vessels start to leak
Central Venous Pressure (CVP) increases
Crackles and wetness in lungs
Polyuria
— kidneys trying to get out excess fluid
Increased pulse
— bounding and full
Increased blood pressure
increased weight
Treatment for FVE
low sodium diet / restrict fluids
I&O / Daily weights
Diuretics
—-Loop (furosemide) (bumetanide may be given when furosemide doesn’t work)
—-hydrochlorothiazide
—- potassium-sparing (spiralactone)
CVP normal ranges
2-6 mmHg
5-10 cmH2O
CVP info
measured in right atrium
number increases in FVE
more volume = more pressure
ANP (Atrial natriuretic peptide)
released when walls of heart are stretched / makes you lose water & sodium
decreases ADH
bed rest induces
diuresis by releasing ANP which decreases ADH production
- means you can easily become dehydrated, get DVTs, kidney stones, pneumonia, and constipation
Fluid Volume Deficit (hypovolemia) Causes:
Loss of fluid from anywhere (thoracentesis, paracentesis, V/D, hemorrhage)
Third spacing (burns, ascites)
Diseases with polyuria (Diabetes)
Ascites
makes it harder to breathe looks like FVE but is FVD since its third spacing measure abdominal girth daily worry hypotension --- decreased HR (wt may be the same)
Polyuria
think shock first!
losing fluids
polyuria –> oliguria –> anuria –> worry about renal failure
S/sx of FVD
decreased weight
decreased skin turgor
dry mucous membranes
decreased urine output (kidneys aren’t being perfused or are trying to retain fluids)
decreased BP
increased pulse (weak and thready / compensation)
increased RR (body can’t tell difference b/t decreased volume and O2)
decreased CVP
Peripheral veins / neck veins vasoconstrict (hard to get IV)
cool extremities
increased urine specifiic gravity (very concentrated urine)
Treatment for FVD:
prevent further losses replace volume (oral or IV) Safety precautions -- higher risk for falls (VS and mental changes) -- monitor for overload w IV replacement
Isotonic
balanced solutions
- goes into vascular space and stays there
- NS, LR, D5W, D5(1/4)NS
-client that has lost fluids through nausea, vomiting, burns, sweating, and trauma
- DO NOT use isotonic w HTN, cardiac or kidney dz
- can cause FVE, HTN, or hypernatremia
Hypotonic
Goes into vascular space then shifts out into the cells to replace cellular fluid
- rehydrate WITHOUT causing HTN
- D2.5W, 1/2 NS, 0.33% NS
- used for HTN, renal or cardiac dz, or dilution w hypernatremia and cellular dehydration
- nausea, vomiting, burns, hemorrhage
WATCH FOR cellular edema bc fluid is moving out to the cells which could lead to fluid volume deficit and decreased BP
Hypertonic
HIGH ALERT / packed w particles
- volume expanders that will draw fluid into the vascular space from the cells
- –hypertonic solution returns fluid to vasculature
- D10W, 3% NS, 5%NS, D5LR, D5(1/2)NS, D5N5, TPN, Albumin, Mag.Sulfate
- used w hyponatremia, third spacing (severe), severe edema, burns, ascites
- WATCH FOR FVE!!
- Monitor in ICU setting w frequent BP, pulse, CVP esp w NS 3 or 5%
Isotonic v. Hypotonic v. Hypertonic
Isotonic - stay where I put it
Hypotonic - go Out of the vessel
Hypertonic - Enter the vessel
Magnesium
1.3 - 2.1 mEq/L
excreted by kidneys or lost in GI tract (vomiting/ severe diarrhea)
Hypermagnesemia Causes
Renal failure
Antacids
Hypermagnesemia S/sx
flushing and warmth
vasodilation
hypermagnesemia and hypercalcemia s/sx:
- decreased DTRs
- weak / flaccid muscles
- increased arrhythmias
- decreased LOC
- decreased pulse
- decreased RR
Hypermagnesemia Treatment
ventilator (if RR less than 12)
dialysis
clacium gluconate (ANTIDOTE** for mag toxicity) (reverses resp. depression)
safety precautions
Calcium
9.0 - 10.5 mg/dL
Hypercalcemia Causes:
Hyperparathyroidism
Thiazides
Immobilization
Hyperparathyroidism
can cause hypercalcemia
- too much PTH
- when serum calcium gets low, PTH pulls Ca from the bones to put in the blood
Hypercalcemia S/sx:
bones are brittle / weak
kidney stones
Same as hypermagnesemia
- decreased DTRs
- weak / flaccid muscles
- increased arrhythmias
- decreased LOC
- decreased pulse
- decreased RR
Hypercalcemia Treatment
activity fluids prevent kidney stones phosphurous in diet (inverse relationship w ca) steroids (decrease ca) safety precautions
Meds that decrease serum Ca:
- Biphosphates (etidronate)
- Calcitonin
Calcitonin
treats hypercalcemia and osteoporosis?
Hypomagnesemia Causes
diarrhea
alcoholism (alcohol suppresses ADH / hypertonic)
not eating / drinking
Hypomagnesemia S/sx
- rigid / tight muscle tone
- seizures
- stridor / laryyngospasm
- +Chvostek’s
- +Trousseau’s
- arrhythmias
- DTRs increased
- mental changes
- dysphagia
Hypomagnesemia Treatment
- give / eat Mg
- check kidney function (before and during)
- seizure precautions
Foods 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
Causes of Hypocalcemia
hypoparathyroidism
radical neck
thyroidectomy
** not enough PTH which decreases serum Ca
Hypocalcemia S/sx:
- rigid / tight muscle tone
- seizures
- stridor / laryyngospasm
- +Chvostek’s
- +Trousseau’s
- arrhythmias
- DTRs increased
- mental changes
- dysphagia
Hypocalcemia Treatment
PO calcium
IV calcium (give slowly or heart arrythmia) (heart monitor)
Vitamin D
Phosphate binders (inverse relationship so decreasing phosphate will increase Ca)
– sevelamer hydrochloride
– calcium acetate
Sodium
Think Neuro Changes!!
Sodium is dependent on water levels
135-145 mEq/L
Hypernatremia vs. Hyponatremia
hyper = dehydration
hypo = dilution
Hypernatremia Causes:
hyperventilation
heat stroke
DI
Hypernatremia S/sx
dry mouth
thirst
swollen tongue
neurochanges
Hypernatremia Treatment
restrict sodium dilute w fluids daily weights I&Os Lab Work
Hyponatremia Causes
Drinking H2O for fluid replacement
psychogenic polydipsia
D5W
SIADH
Hyponatremia S/sx
headache
seizure
coma
Hyponatremia Treatment
client needs sodium / not a lot of water
neuro problems = they need to be on hypertonic saline
3% or 5% NS can cause…?
cerebral edema
Potassium
excreted by kidneys (poor kidney function = increased potassium)
3.5-5.0 mEq/L
Hyperkalemia Causes:
kidney trouble
spironolactone
Hyperkalemia S/sx
begins w muscle TWITCHING
then proceeds to muscle WEAKNESS
then FLACCID PARALYSIS
–> life-threatening arrhythmias
ECG changes w hyperkalemia
bradycardia tall and peaked T waves prolonged PR intervals flat or absent P waves widened QRS conduction blocks ventricular fibrillation
Hyperkalemia Treatment
dialysis (kidneys aren’t working)
calcium gluconate (decreases arrhythmias)
Glucose and insulin
Sodium polystyrene sulfonate (Kayexalate) (enema)
Potassium has an inverse relationship with …?
sodium
Any time you give IV insulin, worry about _________ and _________.
hypokalemia and hypoglycemia
Hypokalemia Causes
vomitting
NG suction
diuretics (other than spiralactone)
not eating
Hypokalemia S/sx
muscle crmaps
muscle weakeness –> flaccid paralysis –> life-threatening arrhythmias
Hypokalemia Treatment
Give potassium
spironolactone makes client retain potassium
eat more potassium
ECG Changes with hypokalemia
U waves, PVCs, ventricular tachycardia
How to fix GI upset with oral potassium
give w food
What do we need to assess with IV potassium
Urinary output before and during
IV potassium always needs to be on
a pump! never gravity
Foods high in potassium
spinach, fennel, kale, mustard greens, brussel sprouts, broccoli, eggplant, cantaloupe, tomatoes, parsley, cucumber, bell pepper, apricots, ginger root, strawberries, avocado, banana, tuna, halibut, cauliflower, kiwi, oranges, lima beans, potatoes, cabbage
Normal pH range
7.35 - 7.45
acidotic person
lethargic
alkalotic person
excitable
CNS is stimulated / sensitive
Hyperventilation
more CO2 getting out
hypoventilation
not eliminating CO2
Respiratory Acidosis
**ACUTE
Lungs have problem so kidneys compensate!
-CO2 is the problem. Too MUCH.
Caused by HYPOventilation.
Kidneys compensate with bicarb and hydrogen. It’ll excrete hydrogen and retain bicarb.
PaO2
80-100 mmHg
PaCO2
35-45 mmHg
HCO3
Bicarb
22-26 mEq/L
increased CO2 means?
decreased LOC
increased CO2 means?
decreased O2 (inverse relationship)
Causes of resp acidosis
retain CO2
- mid-abdominal incision, narcotics, sleeping pills, pneumothorax, collapsed lung, pneumonia
- anything that decreases RR or gas exchange
- anything that causes HYPOventilation (decreased RR)
Restlessness thing _____ first!
hypoxia
early signs of hypoxia are tachycardia and restlessness
S/sx of resp acidosis
headache / confusion / sleepy / coma
Hypoxic (give oxygen)
Resp acidosis treatment
fix the breathing problem!
- if pneumonia is cause… liqueefy and mobilize secretions
- percusion, deep breathing, suctioning, fluids, elevate HOB, IS
- pneumothorax = chest tubes
- post -op = turn, cough, deep breathe
respiratory alkalosis
too little CO2 = HYPERventilation
Kidneys will excrete bicarb and retain hydrogen
Causes of resp alkalosis
hyperventilation
= hysterical (client breathing too fast)
= acute aspirin OD (client breathing too fast)
S/sx of resp alkalosis
lightheaded or faint feeling
peri-oral numbness
numbless and tingling in fingers & toes
Treatment for resp alkalosis
may have to sedate to decrease RR
treat the cause
monitor ABGs
Metabolic Acidosis
lungs compensate with CO2 by increased RR to blow off acid (hyperventilate)
too little bicarb and too much hydrogen
Causes of metabolic acidosis
DKA
Starvation
Renal Failure
Severe diarrhea
*DKA and starvation due to breakdown of ketones
S/sx of metabolic acidosis
depend on cause
hyperkalemia (muscle twitching, muscle weakness, flaccid paralysis, arrhythmias)
increased RR (Kussmaul respirations for DKA)
Treatment for metabolic acidosis
Treat problem
Causes of Metabolic Alkalosis
loss of upper GI contents (vomiting, NG suctioning)
too many antacids
Upper GI tract think _____
Lower GI tract think _____
upper = acid lower = base
S/sx of Metabolic Alkalosis
depends on cause
observe LOC
serum potassium will decrease
monitor for mucle cramps and life threatening arrhythmias (Hypokalemia)
serum potassium will ______ in metabolic acidosis and _________ in metabolic alkalosis
increase
decrease
Treatment for metabolic alkalosis
fix problem
replace potassium
Phosphate binders
(inverse relationship so decreasing phosphate will increase Ca)
- sevelamer hydrochloride
- calcium acetate
