Fluid & Electrolytes Flashcards
causes of fluid imbalances
Vomiting, excessive wound drainage, hemorrhaging
Causes of dehydration
vomiting, diarrhea, hemorrhage, burns, GI suction, fever, difficulty swallowing, impaired motor function
Causes of fluid overload
kidney failure, HF, excess fluid replacements, over-secretion of ADH
Acidosis
pH below 7.35
Alkalosis
pH above 7.45
Normal sodium range
136-145
hyponatremia
sodium level below 136
Hypernatremia
sodium level above 145
Normal potassium range
3.5-5.0
Hypokalemia
potassium below 3.5
Hyperkalemia
potassium above 5.0
Calcium normal range
9-10.5
Foods high in calcium
milk, yogurt, ice cream, cheese, green leafy vegetables, whole grains
Hypocalcemia
Calcium below 9.0
Causes of hypocalcemia
- lactose intolerance
- end stage renal failure
- diarrhea
- immobility
- alcoholic
- elevated phosphorus
- malabsorption (ex. Crohn’s disease)
Signs & symptoms of hypocalcemia
- painful muscle spasms/cramps
- paresthesia
- easily fractured bones
- positive Trousseau’s and Chvostek’s test
- increased peristalsis
Interventions for hypocalcemia
- supplements (give vitamin D too)
- tums
- eat foods with calcium
- keep room quiet & dark
- safety precautions to prevent fractures
Hypercalcemia
calcium above 10.5
Causes of hypercalcemia
- renal failure
- immobility
- dehydration
- malignancy (bone cancer)
Signs & symptoms of hypercalcemia
- mild: increased HR and BP
- severe: slow HR
- poor perfusion, cyanosis, pallor
- DVT
- decreased peristalsis
Interventions for hypercalcemia
- no Ca/vitamin D intake
- IV fluids (so kidneys can filter Ca out)
- furosemide
- monitor calcium
Magnesium normal range
1.3-2.1
What happens when magnesium is too high or low?
cardiac dysrhythmias
Foods high in Mg
steak, nuts, green leafy vegetables, almonds, chocolate, dried beans
Hypomagnesemia
magnesium below 1.3
Causes of hypomagnesemia
- low intake
- diuretics (loop, furosemide, thiazide
- malabsorption
- diarrhea
- alcoholics - malnutrition
Signs & symptoms of hypomagnesemia
- dysrhythmias
- atherosclerosis
- severe paralytic ileus
Interventions for hypomagnesemia
give magnesium
Hypermagnesemia
magnesium above 2.1
Causes of hypermagnesemia
- increased intake
- excessive use of antacids & laxatives
- kidney disease
Signs & symptoms of hypermagnesemia
- bradycardia
- hypotension
- dysrhythmias
- lethargy
- weak muscle contraction
Interventions for hypermagnesemia
- loop diuretics (furosemide)
- reduce Mg intake
Furosemide (lasix)
- decreases K, Na, Cl, Mg
- decreases BP
- eat bananas, citrus, steak, sodium
- causes dehydration
- can mess up kidneys
Bumetanide (bumex)
- decreases Na, K, Mg, Ca
- controls edema
- decreases BP
Spironolactone (Aldactone)
- increases K
- decreases Na, Mg, Cl
- decreases BP
- give foods with sodium, steak, nuts
- NO salt substitutes
should you administer a diuretic to a patient whose Na is 137?
NO BITCH
how much does a liter of fluid weigh?
2.2 lbs
pts at risk for insensible water loss
high RR, continuous GI suction, severe diarrhea, fistula drainage, fever, burns, trauma
what should you assess for if a post op patient’s urine output is only 20mL for 2 consecutive hours?
s/s of blood loss
why are older adults more prone to dehydration
decreased thirst sensation, decreased mobility, often take diuretics and/or laxatives
how will the body react to hypovolemia?
vasoconstriction to maintain BP - decreased perfusion
how will dehydration affect vital signs
increased HR and RR, decreased BP, +1 pulses
how will dehydration affect the skin?
dry mucous membranes, can cause skin tenting
first indicator of dehydration in older adults
changes in mental status
how will dehydration affect labs?
increased H&H, BUN & electrolytes
how would fluid overload affect vital signs?
+4 pulse, increased BP, increased RR
how would fluid overload affect labs?
decreased protein & H&H
assessment findings w fluid overload
weight gain, SOB, crackles, pitting edema, altered LOC, headache, skeletal muscle weakness, increased GI motility
for fluid overload patients, what med should they recieve?
diuretics
fluid overload interventions - respiratory
monitor RR, auscultate lung sounds, position in semi-fowlers, administer oxygen if needed
why is it important to reposition fluid overload pts q2h?
increased risk of skin breakdown
fluid overload interventions
daily weight, I&Os, monitor for edema, restrict fluid & sodium intake
deadly pH levels
below 6.8
above 7.8
first line of defense for pH changes in the body
chemical buffers
second line of defense for pH changes in the body
lungs/respiratory system
last resort for pH changes in the body
kidneys
how does the respiratory system maintain pH in the body?
lungs are quick acting but have temporary effects
regulates CO2 levels
how do the kidneys regulate pH in the body?
long-term effects, but acts slowly
either excretes or retains bicarb
foods high in sodium
processed, preserved, canned, smoked, or pickled foods, snack foods, condiments
foods low in sodium
fresh fish, poultry, fresh or frozen fruits & vegetables,
what is dilutional hyponatremia?
from excess water in the plasma
causes of dilutional hyponatremia
HF
what is actual hyponatremia?
actual deficit of sodium
causes of actual hyponatremia
diuretic administration, wound drains, low sodium diet, being NPO
very very low sodium will cause…
seizures, coma, death
s/s of hyponatremia
generalized muscle weakness, decreased respiratory effectiveness, increased GI motility
for dilution hyponatremia, will the BP increase or decrease?
increase - overloaded w fluids
interventions for dilution hyponatremia
increase dietary sodium/supplements, fluid restriction, diuretic (only if electrolytes are high enough)
for actual hyponatremia, will the BP increase or decrease
decrease - low volume
interventions for actual hyponatremia
give IV fluids, do NOT give diuretic, monitor BP, orthostatic hypotension
causes of actual hypernatremia
renal failure, Cushing’s, excess oral intake
causes of relative hypernatremia
fever, infection, dehydration
how does hypernatremia affect skeletal muscle?
causes muscle twitching, as sodium continues to rise, the muscles will become weaker
how does hypernatremia affect the heart?
decreased contractility
how to treat hypernatremia from fluid loss
duh IV fluids (0.9% saline)
how to treat hyponatremia from renal failure
diuretic
foods high in potassium
fish, potatoes, tomatoes, fruit, bananas, citrus
how does renal failure affect level of potassium?
kidneys won’t excrete K, will need dialysis to get rid of excess
s/s of hyperkalemia
respiratory & skeletal muscle weakness, dysrhythmias, impaired perfusion, decreased peristalsis
one important thing to remember about IV K
DO NOT PUSH
interventions for hypokalemia
increase K - dietary or supplemental, potassium-sparing diuretics only, monitor RR & SpO2, assess ability to cough, place on fall risk precautions
causes of hyperkalemia
renal failure; high dietary K - salt substitutes contain K; potassium-sparing diuretics
most common s/s of hyperkalemia
palpitations, paresthesia around hands/mouth, muscle twitching, increased GI motility
kayexalate (sodium polystyrene sulfonate)
oral or rectal; draws K into GI tract, then causes diarrhea
kayexalate indications
hyperkalemia
hyperkalemia interventions
administer sodium polystyrene sulfonate; discontinue IVs with K, hold K supplements/ foods high in K, give insulin
how does insulin affect potassium?
pulls K into cells - serum is lowered
foods low in potassium
eggs, bread, cereal
high amounts of what electrolyte can cause DVTs?
calcium
what could low albumin mean?
liver failure; poor nutrition
dietary sources of calcium
milk, yogurt, cheese, green leafy vegetables, whole grains
