Fluid & Electrolytes Flashcards
HypOnatremia - Nursing Interventions
- GI suctioning, burns, wound drainage, 3rd space fluid shift
- Monitor fluid volume therapy (water intoxication)
- I&O, weight, skin care
- VS BP best indicator
- Safety & seizure precautions
HypOnatremia - Treatment
- Pharmacological: diuretics
- hypertonic IV if severe 3%NS given slowly to increase 1-2 mEq/hr
- monitor fluid volume during therapy, restrict fluid intake & provide high sodium foods
HypERnatremia - Nursing Interventions
- Monitor VS w/fluid replacement, esp for cerebral edema/ICP
- Monitor fluid volume replacement or removal
- I&O, weight, skin care
- Vascular profusion, blood clots, DVT & clot care
HypERnatremia - Treatment
- undiluted formula for babies
- limit salt intake
- drink plenty of fluids in hot weather
HypOkalemia - Nursing Interventions
- Monitor VS & EKG changes
- Assess ab & bowel sounds
- Replacement therapy (IV,PO) * All K+ via IV SHOULD GO ON A PUMP; never more than 20mEq/hr for K+ runs
HypOkalemia - Treatment
* MEDICATIONS: Diuretics (loop - Lasix, Bumex), Thiazide (HCTZ), Steroids (retain Na+, loose K+) Digoxin Toxicity (dependent on K+ to work correctly DO NOT give if K+ is too ↑or↓) monitor GI for ANVD, irregular heartbeat, halos/blurred vision * Diet: oranges, strawberries, peaches, cherries, prunes, apricots, dates, figs, potatoes, cantaloupe
HypERkalemia - Nursing Intervention
- monitor bowel movements
- GI, CV, and MS
- Eliminate K+ via meds & diet
HypERkalemia - Treatment
- MEDICATIONS: Kayexalate, K+ sparing diuretics (Spironolactone), ace inhibitors (PRILS)
- ER: D5W & insulin drip (pulls K+ into cell)
Calcium Gluconate (quiets cardiac irritability)
Na+HCO3 (alkalosis > K+ into cell) - Dialysis – short or long term
- Low K+ diet
HypOcalcemia - Nursing Interventions
- AIRWAY – tracheotomy tray at bedside; decreased DTR
- total protein & albumin
- provide a diet that’s rich in calcium, Vitamin D, & protein
- Monitor VS, peripheral profusion,
& cardiac status - monitor for infiltration – vesicant
- safety convulsions prevention
HypOcalcemia - Treatment
- MEDICATIONS: calcium gluconate or calcium chloride, never administer rapidly via IV
- TUMS, 750mg/dose with meals
- Diet: milk, cheese, yogurt, pudding, egg yolks, grains, chicken, salmon-canned with bones, nuts, legumes, tofu
- Vitamin D – green leafys
HypERcalcemia - Nursing Interventions
- assess for S&S of renal calculi
- decreased DTR, muscle weakness
- hydrate with NS to promote urinating & Ca+ excretion
- administer loop diuretic
- monitor cardiac status
HypERcalcemia - Treatment
*MEDICATIONS: *diuretics
-calcitonin (brings Ca+↓ alternate nostrils)
-biophosphates (pushes Ca+ back into the bone)
Aredia (pamidronate)
-IV phosphorus-if emergency
* Limit Ca+ intake in diet
HypOmagnesimia - Nursing Interventions
- increased DTR
- monitor BP, RR &urinary output
- give foods high in Mg2+
- monitor HR & rhythm
- patient safety
HypOmagnesimia - Treatment
- MEDICATIONS: MgSO4 (mag run)
- give Mg2+ first, then K+
- Diet: dark green veggies, peanut butter, almonds, bananas, egg yolks, soy, whole-grain cereal
HypERmagnesimia - Nursing Interventions
- decreased DTR “deep tendon reflex”, generalized weakness
- identify underlying cause & treat
- monitor cardiac & resp status
- decreases muscle & nerve activity
HypERmagnesimia - Treatment
- hold all meds with Mg2+
* low Mg2+ diet”
HypOvolemia (FVD) - Treatment
*3% NS with close monitoring, usually ICU patients
HypERvolemia (FVE) - Nursing Interventions
- elevate HOB, TCDB, ambulate, & float heels
- monitor VS & lung sounds
- I&O, edema
- assess for S&S of hypovolemia, can result from over correction
SAFETY: “RESTRICT” Reduce IV flow rate Evaluate breath sounds and ABGs Semi-Fowler’s position Treat with oxygen and diuretics as ordered Reduce fluid and sodium intake I & O and weight Circulation, color, and presence of edema Turn and position at least every 2 hrs
HypERvolemia - Treatment
- administer loop diuretics (K+ is flushed out)
- K+ sparing diuretics – aldactone –(pull H2O & not K+)
- Thiazide diuretics (loose K+)
- restrict Na+ & fluid intake
HypOtonic solutions
If we want to move fluids INTO the cell we give HYPOtonic solutions; can’t give water cause that’ll move too fast and explode the cell
Provide salt and water to replace cellular fluid.
Examples:
½ NS (0.45% normal saline)
1/3 NS (0.33%) - rarely see
¼ NS (0.225%)
HypERtonic solutions
We give this to draw fluid OUT of cells
we give this if we’re quickly trying to increase their intravascular volume; we give to replace sodium and to get fluids into the intravascular space but it results in interstitial dehydration
D51/4NS D51/2NS D5NS - this starts out as hypertonic but then body changes it to hypotonic, because dextrose adsorbs quickly so don’t use this at much D5LR D10LR D50W D10W
Isotonic solutions
these tend not to alter the cell because they’re closest the osmolality of blood; we use this a lot to give medications; and use lactated ringers for burns and trauma; but watch in pts with high blood pressure
NEVER use lactated ringers in pts with liver disease and alkalosis
- 0.9% NaCl (NS- normal saline
- Lactated Ringers solution - this contains small amounts of K+, Cl, Na
- 5% dextrose in water (D5W
Metabolic Acidosis
*Low pH (increased H+ concentration) and a low plasma bicarbonate concentration (
Metabolic Alkalosis
- High pH (decreased H+ concentration) and a high plasma bicarbonate concentration
- Can be produced by a gain of bicarbonate or a loss of H+ (usually by vomiting or suction)
- Often accompanies hypokalemia; manifestations are similar to hypokalemia and hypocalcemia
- Treatment addresses underlying disorder as well as K+ replacement and fluid volume replacement
