Fluid & Electrolytes Flashcards
Covers Nursing Concepts related to care of patients with conditions related to fluid and electrolyte balances: -Acute Kidney Injury -Hypo/hypernatremia -Hypo/hyperkalemia -Hypo/hypermagnesemia -Hypo/hypercalcemia
Normal Range of Serum Potassium (K)
3.5 - 5.0 mEq/L
Normal Range of Serum Sodium (Na)
135 - 145 mEq/L
Normal Range of Serum Magnesium (Mg)
1.8 - 2.6 mEq/L
Normal Range of Serum Calcium (Ca)
9.0- 10.5 mEq/L
Signs and Symptoms of Hyperkalemia (>5.0 mEq/L)
-palpitations
-skipped beats
-cardiac irregularities
-muscle twitching
-leg weakness
-unusual tingling, numbness in face, hands and feet
-diarrhea
-increased motility
Signs and Symptoms of Hypokalemia (<3.5 mEq/L)
-skeletal muscle weakness
-hand grasps weakened
-deep tendon reflexes reduced
-constipation
-pulses thready and weak
-orthostatic hypotension
-pulse rate erratic and irregular
-altered mental status
-lethargy progressing to confusion, coma
Signs and Symptoms of Hypernatremia (>145 mEq/L)
-altered cerebral function
-agitation
-confusion
-with fluid overload, lethargic, stupurous, comatose
-muscle twitching
-irregular muscle contractions
-progressive muscle weakness
-if severe, DTRs absent
-decreased contractility
Signs and Symptoms of Hyponatremia (<134 mEq/L)
-cerebral changes
-level of consciousness
-general muscle weakness
-deep tendon reflexes (DTRs) diminished
-nausea, diarrhea, cramping
-rapid, weak, thready pulse
-periph pulses weak
-severe orthostatic hypotension
-if fluid overload, bounding pulse
Signs and Symptoms of Hypermagnesemia (>2.6 mEq/L)
-bradycardia
-periph vasodilation
-hypotension
-prolonged PR
-widened QRS
-cardiac arrest can occur if severe
-drowsy
-lethargic
-reduced or absent DTRs
-weak voluntary skeletal muscle contractions
-respiratory insufficiency
Signs and Symptoms of Hypomagnesemia (<1.8 mEq/L)
-dysrhythmias
-shortening ST segment
-prolonging PR and QRS
-triggering ectopic beats
-hyperactive DTRs
-numbness
-tingling
-painful muscle contractions
-positive Chvostek and Trousseau signs
-tetany
-seizures
-decreased motility
-anorexia
-nausea
-ABD distension
Signs and Symptoms of Hypercalcemia (>10.5 mEq/L)
-tachycardia
-HTN
-progresses to bradycardia if prolonged
-cyanosis
-pallor
-shortened QT
-dysrhythmias
-lower extremity thrombosis
-severe muscle weakness
-decreased DTRS w/o parasthesia
-confusion
-lethargy
-decreased motility
-constipation
-anorexia
-nausea /vomiting
Signs and Symptoms of Hypocalcemia (<9.0 mEq/L)
-painful muscle spasms (thigh, calf, foot)
-parasthesia
-tingling (lips, nose, ears)
-numbness
-tetany
-positive Chvostek and Trousseau signs
-weak, thready pulses
-if severe, prolonged ST and prolonged QT, arrhythmias, hypotension
-increased motility
-painful cramping
-diarrhea
-brittle bones
-spinal compression
-height changes
-bone pain
Nursing Priorities for Hyperkalemia
-cardiac monitor
-avoid foods high in potassium
-avoid salt substitutes
-loop diuretic
-patiromer binds K and prevents reabsorption
-insulin cocktail
Nursing Priorities for Hypokalemia
-K IV infusion (NOT push) (no more than 20 mEq/hr or 1mEq/10mL)
-cardiac monitor
-fall prevention
-spironolactone if on diuretics
-assess IV site hourly
-respiratory monitoring
-watch ABG values
Nursing Priorities for Hypernatremia
-monitor response to therapy
-restore fluid balance with iso saline/ D5
-lasix to promote Na loss with diuresis
-teach pt about salt in diet
Nursing Priorities for Hyponatremia
-fall prevention
-infusions of Hypertonic saline
-fluid restriction may be needed
-skin protection
Nursing Priorities for Hypermagnesemia
-cardiac monitor
-diuretics lasix
-Ca helps with severe cardiac effects
-semi fowlers
Nursing Priorities for Hypomagnesemia
-cardiac monitor
-magnesium sulfate IV
Nursing Priorities for Hypercalcemia
-assess girth
-cardiac monitor
-dialysis if severe
-stop Ca containing Rxs
-fluid replacement, NS
-thiazide diuretics discontinued, use lasix instead
-calcium chelator
-phosphorus, aspirin, NSAIDs, bisphosphonates, calcitonin
Nursing Priorities for Hypocalcemia
-cardiac monitor
-patient safety
-Ca and Vit D
-Rxs to decrease nerve and muscle responses
-environment precautions: reduce stimuli, quiet, limit visitors
Chvostek Sign
Tap face just below and in front of Ear
Causes one-sided twitching of mouth, nose and cheek
Trousseau Sign
Place BP cuff around arm and inflate >Pt’s systolic BP, keep cuff inflated for 1-4 minutes
Causes hand and fingers to go into spasm of palmar flexion
Acute Kidney Injury (AKI) Risk Factors
-heart attack
-atherosclerosis
-renal artery stenosis
-blood pressure medications
-heart disease
-scleroderma
-thrombotic thrombocytopenic purpura (TTP)
-cervical cancer
-colon cancer
-prostate cancer
-kidney stones
-Autoimmune disorders
Acute Kidney Injury (AKI) Prerenal Causes
affects perfusion to kidney
-burns
-dehydration
-blood or fluid loss
-sepsis or septic shock
-liver failure
-use of aspirin, NSAIDs
-allergic reaction
-bleeding or clotting in renal blood vessels
Acute Kidney Injury (AKI) Diagnostics
-BUN (up)
-Creatinine (increase of 1-2mg/dL in 24-48hrs)
-Na
-K (up)
-Phos (up)
-Ca (down)
-Mg
-ABGs
-pH (down)
-H and H (down)
-Urinalysis
-Blood Osmolality (up)
-eGFR (down)
-Renal US
-CT scan w/o contrast
-biopsy if cause is uncertain
Acute Kidney Injury (AKI) Nursing Priorities
-Fluid overload
-Respiratory assessment
-cardiac monitor
-reduce nephrotoxins
-strict I’s and O’s
-IV sites
Acute Kidney Injury (AKI) Treatments
-If K is excessively high, insulin cocktail
-Flush, fluids and diuretics, K wasting
-TPN possible
-hemodialysis or peritoneal dialysis possible
Acute Kidney Injury (AKI) Stages
Initial
Oliguric
Diaphoresis
Recovery
Acute Kidney Injury (AKI) Signs and Symptoms
-decreased urine output
-azotemia
-fluid overload
-pulmonary crackles
-dependent and generalized edema
-decreased oxygenation
-confusion
-tachypnea
-dyspnea
-MAP <65
-tachycardia
-thready periph pulses
-decreased cognition
-SpO2 <88%
Acute Kidney Injury (AKI) Intrarenal Causes
direct damage to kidney
-nephrotoxins
-chemotherapy
-contrast media
-Lupus
-blood clots
-antibiotics
-glomerulonephritis
-hemolytic uremic syndrome
-local infection
-NSAIDs
Acute Kidney Injury (AKI) Postrenal causes
urine flow obstruction
-constriction of ureters or urinary tract
-damage to nerves that control bladder
-blood clots in urinary tract
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