Fluid & Electrolytes

Question 1

What happens to fluid volume in heart failure

Answer 1

The heart is weak, therefore the cardiac output is weak so the kidney are not being perfused well. The urinary output is decreased and the fluid stays in the vascular space. Hypervolemia.

Question 2

Alka-Seltzer has a lot of what?

Answer 2

Sodium, meaning it will make you retain water.

Question 3

What is the normal action of aldosterone?

Answer 3

When blood volume gets low (vomiting, hemorrhage, etc), then aldosterone is secreted and it causes retention of Na and Water, making the blood volume go back up

Question 4

Name 2 diseases with too much aldosterone

Answer 4

Cushings (too much of all steroids), hyperaldosteronisms (Conn’s Syndrome). So they are retaining too much Na and Water

Question 5

Name of disease they are not making enough aldosterone

Answer 5

Addisons disease. They are losing Na and water. Hypovolemia.

Question 6

How does ANP work and where is it located in the body?

Answer 6

Atria of heart; Works the opposite of aldosterone- It causes excretion of Na and water. As the heart is stretched with FVE, the heart releases ANP and it causes excretion of Na and Water

Question 7

How does ADH work?

Answer 7

It makes you retain WATER!

Question 8

What happens with SIADH

Answer 8

Too much ADH; Retaining too much water, FVE; Too many letters, too much water. Urine output decreases, Blood is diluted; Serum sodium is low and urine sodium is high

Question 9

What happens with Diabetes Insipidus

Answer 9

Not enough ADH, DI-Diurese water; FVD (think shock), Urine is diluted, blood is concentrated; Serum sodium is high, Urine Sodium is low

Question 10

Dilution makes what numbers go down? & Concentration makes what numbers go up?

Answer 10

Urine specific gravity, sodium and hematocrit.

Question 11

Name some ways people get ADH problems

Answer 11

ADH located in pituitary so by craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy, or any condition that can lead to increased ICP

Question 12

What drug is given for low ADH used for Diabetes Insipidus

Answer 12

Vasopressing (Pitressin) or Desmopressin Acetate (ddavp)

Question 13

S/SX of FVE

Answer 13

Distended neck veins, peripheral edema, CVP elevated, (norm 2-6mmHg), crackles and wet lungs, polyuria, increased pulse full and bounding, pulmonary edema, BP increased, weight increased, SOB, hear wet lungs low and posterior

Question 14

Treatment for FVE-Diet, Meds

Answer 14

Low Na+ Diet and restrict fluids; I&O, Daily weights; Loop Diuretics like Lasix (furosemide) or bumetanide (Bumex); Hydrochlorothiazide (Thiazide), K+ sparing diuretics including aldactone (spironolactone); bed rest which induces diuresis (Release ANP & decrease ADH prod)

Question 15

S/sx of FVD

Answer 15

Decreased weight, decreased skin turgor, decreased U/O, Dry mucous membranes, Low BP, increased pulse, increased respiration, CVP down, tiny veins, cool extremities, urine sp gravity increases

Question 16

Treatment for FVD

Answer 16

Prevent further losses, for mild deficit do PO fluid and severe deficit do IV Fluids, Monitor for overload, high risk for falls

Question 17

Think what with magnesium and calcium

Answer 17

They act like sedatives

Question 18

Magnesium does what to blood pressure?

Answer 18

vasodilates so your blood pressure decreases

Question 19

Causes of hypermagnesemia

Answer 19

renal failure, antacids

Question 20

S/sx of hypermagnesemia

Answer 20

Flushing, warmth from vasodilation, muscle tone, DTR decreased, muscle tone weak, arrythmias, LOC decreased, pulse down, resp rate down

Question 21

antidote for magnesium toxicity

Answer 21

calcium gluconate: Admin IVP very slowly (1.5-2ml/min). It reverses rep depression and potential arrythmias

Question 22

Normal Mg level

Answer 22

1.2-2.1 mEq/L

Question 23

Normal calcium level

Answer 23

9.0-10.5 mg/dL

Question 24

Causes of hypercalcemia

Answer 24

Hyperparathyroidism, thiazides, immobilization (you have to bear weight to keep Ca in the bone).

Question 25

S/sx of hypercalcemia

Answer 25

Brittle bones, kidney stones, DTR decreased, muscle tone weak, arrythmias, LOC decreased, pulse down, resp rate down

Question 26

Tx for hypercalcemia

Answer 26

Get them up and moving, give fluids to prevent kidney stone, Phospho soda and fleet enema that have alot of phosphorus, steroids, add phosphorus to diet—anything with protein, safety precautions “sedated”, must have vitamin D to use calcium, calcitonin decreases serum calcium (treating osteoporosis)

Question 27

Hypomagnesemia and hypocalcemia, think…

Answer 27

think not enough sedatives

Question 28

Causes of hypomagnesemia

Answer 28

Diarrhea, alcoholism, not eating and drinking.

Question 29

S/sx of hypermagnesemia & hypercalcemia

Answer 29

Muscle tone rigid and tight, seizures, stridor or laryngospasm, + chvosteks, + trousseaus, arrythmias, increased DTR, mind changes, swallowing problems-worry aspiration

Question 30

Treatment for hypomagnesemia

Answer 30

Give magnesium and check renal function first!!! Seizure precautions and magnesium in diet (spinach, flax seed)

Question 31

Causes of hypocalcemia

Answer 31

hypoparathyroidism, radical neck and thyroidectomy—not enough pth

Question 32

Treatment for hypocalcemia

Answer 32

vitamin D to utilize calcium, renagel, PhosLo or calcium acetate, IV calcium….be sure to be on a heart monitor.

Question 33

Foods high in magnesium

Answer 33

spinach, mustard greens, summer squash, broccoli, halibut, turbip greens, pumpkin seeds, peppermint, cucumber, green breans, celery, kale, sunflower seeds, sesame seeds and flax seeds

Question 34

Normal sodium level

Answer 34

135-145meq/L

Question 35

Causes of hypernatremia

Answer 35

hyperventilation, heat stroke, DI, dehydration, vomiting, diarrhea, hemorrhage

Question 36

S/sx of hypernatremia

Answer 36

dry mouth, thirsty-already dehydrated, swollen tongue for severe cases, neuro changes

Question 37

Treatment for hypernatremia

Answer 37

restrict Na, dilute client with fluids, daily weights, I&O, Lab workup

Question 38

Causes of hyponatremia

Answer 38

Drinking H20 for fluid replacement, psychogenic polydipsia, D5W (sugar and water), SIADH

Question 39

S/sx of hyponatremia

Answer 39

Headaches, seizure, coma

Question 40

Treatment for hyponatremia

Answer 40

Give hypertonic solution like 3% NS or 5% NS

Question 41

Hyperkalemia Causes

Answer 41

Kidney trouble, aldactone (retaining K)

Question 42

Normal K Levels

Answer 42

3.5-5 meq/l

Question 43

S/sx of hyperkalemia

Answer 43

Begins with muscle twitching, weakness, then flaccid paralysis, life threatening arrythmias, bradycardia, tall and peaked T waves, prolonged PR intervals, flat or absetn P waves, widened QRS, conduction block ,v fib

Question 44

Treament for hyperkalemia

Answer 44

Dialysis, calcium gluconate to decrease arrythmias, glucose and insulin carries glucose and potassium out of serum and into cell. Sodium polystyrene sulfonate (kayexalate) which exchanges Na for K in the Gi tract

Question 45

Causes of hypokalemia

Answer 45

Vomiting, NG suction, loop diuretics, not eating enough potassium

Question 46

S/sx of hypokalemia

Answer 46

muscle cramps, weakness and life threatening arrythmias, U waves, PVCs, and v tach

Question 47

Treatment

Answer 47

Give potassium, give aldactone, eat more potassium

Question 48

Foods high in potassium

Answer 48

spinach, fennel, kale, mustard greens, brussel sprouts, broccoli, eggplants, cantaloupe, tomatoes, parsley, cucumber, bell pepper, apricots, ginger roots, strawberries, avocado, banana, tuna, halibut, cauliflower, kiwi, oranges, lima beans, potatoes, and cabbage.