Fluid & Electrolytes Flashcards
What happens to fluid volume in heart failure
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.
Alka-Seltzer has a lot of what?
Sodium, meaning it will make you retain water.
What is the normal action of aldosterone?
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
Name 2 diseases with too much aldosterone
Cushings (too much of all steroids), hyperaldosteronisms (Conn’s Syndrome). So they are retaining too much Na and Water
Name of disease they are not making enough aldosterone
Addisons disease. They are losing Na and water. Hypovolemia.
How does ANP work and where is it located in the body?
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
How does ADH work?
It makes you retain WATER!
What happens with SIADH
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
What happens with Diabetes Insipidus
Not enough ADH, DI-Diurese water; FVD (think shock), Urine is diluted, blood is concentrated; Serum sodium is high, Urine Sodium is low
Dilution makes what numbers go down? & Concentration makes what numbers go up?
Urine specific gravity, sodium and hematocrit.
Name some ways people get ADH problems
ADH located in pituitary so by craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy, or any condition that can lead to increased ICP
What drug is given for low ADH used for Diabetes Insipidus
Vasopressing (Pitressin) or Desmopressin Acetate (ddavp)
S/SX of FVE
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
Treatment for FVE-Diet, Meds
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)
S/sx of FVD
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
Treatment for FVD
Prevent further losses, for mild deficit do PO fluid and severe deficit do IV Fluids, Monitor for overload, high risk for falls
Think what with magnesium and calcium
They act like sedatives
Magnesium does what to blood pressure?
vasodilates so your blood pressure decreases
Causes of hypermagnesemia
renal failure, antacids
S/sx of hypermagnesemia
Flushing, warmth from vasodilation, muscle tone, DTR decreased, muscle tone weak, arrythmias, LOC decreased, pulse down, resp rate down
antidote for magnesium toxicity
calcium gluconate: Admin IVP very slowly (1.5-2ml/min). It reverses rep depression and potential arrythmias
Normal Mg level
1.2-2.1 mEq/L
Normal calcium level
9.0-10.5 mg/dL
Causes of hypercalcemia
Hyperparathyroidism, thiazides, immobilization (you have to bear weight to keep Ca in the bone).
S/sx of hypercalcemia
Brittle bones, kidney stones, DTR decreased, muscle tone weak, arrythmias, LOC decreased, pulse down, resp rate down
Tx for hypercalcemia
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)
Hypomagnesemia and hypocalcemia, think…
think not enough sedatives
Causes of hypomagnesemia
Diarrhea, alcoholism, not eating and drinking.
S/sx of hypermagnesemia & hypercalcemia
Muscle tone rigid and tight, seizures, stridor or laryngospasm, + chvosteks, + trousseaus, arrythmias, increased DTR, mind changes, swallowing problems-worry aspiration
Treatment for hypomagnesemia
Give magnesium and check renal function first!!! Seizure precautions and magnesium in diet (spinach, flax seed)
Causes of hypocalcemia
hypoparathyroidism, radical neck and thyroidectomy—not enough pth
Treatment for hypocalcemia
vitamin D to utilize calcium, renagel, PhosLo or calcium acetate, IV calcium….be sure to be on a heart monitor.
Foods high in magnesium
spinach, mustard greens, summer squash, broccoli, halibut, turbip greens, pumpkin seeds, peppermint, cucumber, green breans, celery, kale, sunflower seeds, sesame seeds and flax seeds
Normal sodium level
135-145meq/L
Causes of hypernatremia
hyperventilation, heat stroke, DI, dehydration, vomiting, diarrhea, hemorrhage
S/sx of hypernatremia
dry mouth, thirsty-already dehydrated, swollen tongue for severe cases, neuro changes
Treatment for hypernatremia
restrict Na, dilute client with fluids, daily weights, I&O, Lab workup
Causes of hyponatremia
Drinking H20 for fluid replacement, psychogenic polydipsia, D5W (sugar and water), SIADH
S/sx of hyponatremia
Headaches, seizure, coma
Treatment for hyponatremia
Give hypertonic solution like 3% NS or 5% NS
Hyperkalemia Causes
Kidney trouble, aldactone (retaining K)
Normal K Levels
3.5-5 meq/l
S/sx of hyperkalemia
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
Treament for hyperkalemia
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
Causes of hypokalemia
Vomiting, NG suction, loop diuretics, not eating enough potassium
S/sx of hypokalemia
muscle cramps, weakness and life threatening arrythmias, U waves, PVCs, and v tach
Treatment
Give potassium, give aldactone, eat more potassium
Foods high in potassium
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.
