Fluid & Electrolytes Flashcards
Fluid Volume Excess/Hypervolemia
too much fluid in the vascular space (vessels in the body & the chambers of the heart)
Causes of FVE
Heart failure
Renal failure
Things with a lot of Sodium: Effervescent soluble medications, Canned/processed foods, IVF with sodium
Role of Aldosterone
blood volume gets low (vomiting, hemorrhage) aldosterone secretion increases retaining sodium and water
leads to an increase in blood volume
Diseases with too much aldosterone
Cushing’s
Hyperaldosteronism (Conn’s)
too little aldosterone
Addison’s disease
antidiuretic hormone (ADH)
Retains water
Syndrome of Inappropriate Antidiuretic Hormone
“soaked inside”
-too much ADH
-retain water
-FVE
-urine = concentrated
-blood = dilute
Diabetes Insipidus
“dry inside”
-not enough ADH
-diuresis
-FVD
-urine = dilute
-blood = concentrated
dilute makes the numbers go down
specific gravity, hemoglobin, sodium
concentrated makes the numbers go up
specific gravity, hemoglobin, sodium
Meds used as ADH replacement
Vasopressin, Desmopressin
Signs and symptoms of FVE
-distended neck veins (vessels are full)
-peripheral edema/third spacing
-increase in CVP (more volume= more pressure)
-crackles & SOB
-polyuria
-increased bounding, full pulses
-increased BP
-quick increase in weight
Treatment of FVE
-low sodium diet/restrict fluids
-I&O
-daily weights
-diuretics:
loop (furosemide or bumentanide)
hydrochlorothiazide
potassium sparing: spironolactone
-bed rest
-give IVFs slowly to elderly and very young & in clients with heart/kidney problems
bed rest for FVE
supine –> BV shifts from extremities to thorax which increases volume of blood returning to the heart
Atria stretches and releases ANP
(bed rest induces diuresis by the release of ANP and the decreased production of ADH)
Fluid volume deficit/hypovolemia
big time deficit= shock
causes of FVD
-thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage (loss of fluid from vascular space)
-third spacing (burns, ascites)
-Diabetes Mellitus (polyuria)
Signs and symptoms of FVD
-weight decreased
-decreased skin turgor
-dry mucous membranes
-decreased urine output
-decreased BP
-increased weak, thready pulse
-increased respirations
-decreased CVP
-peripheral veins/neck veins vasoconstrict
-cool extremities
-increase in urine specific gravity
treatment of FVD
-prevent further loss
-mild deficit: PO fluids
-severe deficit: IV fluids
-safety precautions: higher risk for falls, monitor for overload with IV fluid replacement
isotonic solutions
“Stay where I put it”
-go into the vascular space and stay there
-0.9% NS, lactated ringers, D5W, D51/4 NS (pediatric)
uses for isotonic solutions
fluid loss through nausea, vomiting, sweating, burns, and trauma
Alert for isotonic solutions
Do not use in clients with HTN, cardiac disease or renal disease
-can cause FVE, HTN or hypernatremia
Hypotonic solutions
“Go Out of the vessel”
-go into the vascular space and then shift out into the cells to replace cellular fluid
-rehydrate but do not cause HTN
-D2.5W, 0.45% NS, 0.33% NS
Uses for hypotonic solutions
-for clients with HTN, renal or cardiac disease that need fluid replacement because of nausea, vomiting, burns, hemorrhage
-used for dilution in pts with hypernatremia & cellular dehydration
Hypertonic solutions
“Enter the vessel”
-packed with particles
-volume expanders that draw fluid into the vascular space from the cell
-D10W, 3% NS, 5% NS, D5LR, D5 1/2 NS, D5NS, TPN, albumin
Uses for hypertonic solutions
-clients with hyponatremia
-clients with third spacing
-clients with severe edema, burns, or ascites
Alert for hypertonic solutions
-Watch for FVE
-monitor BP, pulse, and CVP
high alert medications
-insulin
-opiates & narcotics
-injectable potassium chloride or phosphate concentrate
-IV anticoagulants (heparin)
-NaCl solutions >0.9%
causes of hypermagnesemia
-renal failure
-antacids
*Mg is excreted by the kidneys can be lost in other ways
signs and symptoms of hypermagnesemia
acts like a sedative!!
-flushing & warmth
-vasodilation
-decreased DTR
-weak, flaccid muscle tone
-arrhythmias
-decreased LOC
-decreased pulse
-decreased respirations
treatment for hypermagnesemia
-ventilator (if in toxicity-RR <12)
- Dialysis (kidneys not working)
-Calcium gluconate (antidote for Mg toxicity)
Causes of Hypercalcemia
-hyperparathyroidism (too much PTH- pulls Ca from bones into blood)
-thiazides (retain Ca)
-immobilization (Ca leaves the bones)
Signs and symptoms of Hypercalcemia
acts like a sedative!!
-brittle bones
-kidney stones
-decreased DTR
-flaccid and weak muscle tone
-arrhythmias
-decreased LOC
-decreased pulse
-decreased respirations
treatment for hypercalcemia
-move!! Ca will go from the blood to the bones
-fluids to prevent kidney stones
-add phosphorus to the diet to decrease Ca
-steroids
-medications: biphosphonates (etidronate), calcitonin
causes of hypomagnesemia
-diarrhea
-alcoholism (alcohol suppresses ADH and its hypertonic) –> not eating, drinking (diurese more= more Mg leaving the body)
signs and symptoms of hypomagnesemia
-rigid and tight muscles
-seizures
-stridor/laryngospasm (airway is a smooth muscle)
-+Chvostek’s (tap cheek)
-+Trousseau’s (BP cuff)
-arrhythmias
-increase in DTR
-mind changes (psychotic, depression)
-swallowing problems (esophagus is a smooth muscle)
treatment for hypomagnesemia
-give Mg
-check kidney function before & during IV Mg
-seizure precautions
-eat Mg
-if client reports flushing & sweating with Mg admin–> STOP INFUSION
causes of Hypocalcemia
-hypoparathyroidism
-radical neck
-thyroidectomy
(all of these = not enough PTH = decreased Ca)
signs and symptoms of hypocalcemia
-rigid and tight muscles
-seizures
-stridor/laryngospasm
-+Chvostek’s
-+Trousseau’s
-Arrhythmia
-increased DTR
-psychotic, depression
-swallowing problems
Treatment for Hypocalcemia
-PO calcium
-IV Ca (give slowly) + heart monitor
-Vitamin D to help utilize Ca
-Phosphate binders: sevelamer hydrochloride, calcium acetate
Causes of Hypernatremia
“too much sodium, not enough water”
-hyperventilation
-heat stroke
-diabetes insipidus
signs and symptoms of hypernatremia
-dry mouth
-thirsty
-swollen tongue
-neuro changes
treatment for hypernatremia
-restrict sodium
-dilute client with fluids
-daily weights
-I&Os
-lab work
Causes of hyponatremia
“too much water; not enough sodium”
-drinking water for fluid replacement (vomiting, sweating)
-psychogenic polydipsia
-D5W
-SIADH
signs and symptoms of hyponatremia
-headache
-seizure
-coma
treatment of hyponatremia
-sodium
-no water
- hypertonic saline for neuro problems (3% NS or 5% NS)
Causes of hyperkalemia
-kidney troubles
-spironolactone
signs and symptoms of hyperkalemia
-muscle twitching first
-then muscle weakness
-then flaccid paralysis
-life-threatening arrhythmias
ECG changes in hyperkalemia
-bradycardia
-tall & peaked T waves
-prolonged PR intervals
-flat or absent P waves
-widened QRS
-conduction blocks
-V fib
ECG changes in hypokalemia
-U waves
-PVCs
-ventricular tachycardia
treatment for hyperkalemia
-dialysis
-calcium gluconate to decrease arrythmias
-glucose and insulin (insulin carries glucose & potassium into the cell) (worry about hypoglycemia & hypokalemia)
-Sodium polystyrene sulfonate (Kayexalate)- exchanges Na for K in the GI tract
causes of hypokalemia
-vomiting
-NG suction
-Diuretics
-not eating
signs and symptoms of hypokalemia
-muscle cramps
-muscle weakness
-life-threatening arrythmias
treatment for hypokalemia
-give potassium
-spironolactone
-eat more potassium
administration instructions for PO potassium
-take with food, may cause GI upset
-asses urinary output before/during IV potassium admin
