Fluid & Electrolytes Flashcards
3 causes of fluid volume excess (hypervolemia):
Heart Failure
Renal Failure
Too much sodium
3 things with excess sodium:
Effervescent soluble meds (Alka-Seltzer)
Canned, processed foods
IVF with Na
What 3 hormones can regulate fluid volume and where are they released from?
1) Aldosterone - adrenal glands when vol too low
2) Atrial Natriuretic Peptide (ANP) - Atria of heart when vol too high
3) ADH - pituitary gland when vol too low
Aldosterone retains ___ and ___
ANP excretes ___ and ___
ADH retains ___ ___
Aldosterone: Sodium and water
ANP: Sodium and water
ADH: water ONLY
ADH excess leads to ____
ADH insufficiency leads to ____
Excess - SIADH (Syndrome of “INCREASED” ADH)
Insufficiency - DI (DI-uresis)
Concentrated makes the #’s go ___
Dilute makes the #’s go ___
What are these 3 values effected here?
Concentrated --> Up Dilute --> Down (remember the D's) 3 values: - Urine specific gravity - Sodium - Hct
Central venous pressure (CVP) is measured in the ___ ___
Right atrium
For fluid excess in the lungs, listen where?
Lower posterior area (due to gravity pooling it there)
Fluid excess, the heart will beat faster or slower? Why?
Faster…Heart is trying to move fluid forward
When getting daily weight, remember what?
Same:
- time
- clothes
- scale
- void 1st!!!
If fluid retention…think ____ problems 1st.
Heart
Diuretics:
Furosemide, bumetanide (K+ ____)
HCTZ (K+ ____)
Spironolactone (K+ ____)
Furosemide, bumetanide –> K+ losing
HCTZ –> K+ losing
Spironolactone –> K+ SPARING
Bed rest good or bad for volume excess pts? Why?
Good
Induces diuresis by the release of ANP and, decrease production of ADH
What does PID stand for regarding fluid volume?
Particle Induced Diuresis
HYPOvolemia…heart beats faster or slower? Why?
Faster…Heart trying to pump what little fluid is left around
(Tachycardia for both hypo- and hypervolemia)
HYPOvolemia…RR faster or slower? Why?
Faster…body perceives hypovolemia as HYPOXIA
HYPOvolemia…CVP increase or decrease? Why?
Decrease…less volume, less pressure
HYPOvolemia…urine specific gravity goes up or down? Why?
UP…concentrated makes it go up
More, less, or same as cells?
Isotonic solution
Hypotonic solution
Hypertonic solution
Isotonic –> Same
Hypotonic –> Less
Hypertonic –> More
Isotonic solution goes into the vascular space and ____ ____.
stays there
Examples of isotonic solutions:
NS, LR, D5W, D5 1/4 NS
What is unique about the isotonic solution D5W?
Only isotonic for a moment, then body uses up the dextrose
Used to keep lines open
Who should NOT get isotonic fluids?
HTN
Cardiac dz
Renal dz
Hypotonic solution goes into the vascular space then…
shifts out into the cells to replace cellular fluid
Rehydration w/o HTN
Examples of hypotonic solution:
D2.5W, 0.45% NS (1/2 NS), 0.33% NS
Hypertonic solutions are ___ ___ that will draw fluid ___ the vascular space from the cells.
volume expanders
into
Examples of hypertonic solutions:
D10W, 3% NS, 5% NS, D5LR, D51/2 NS, D5 NS, TPN, Albumin
Just think, anything packed with particles is HYPERtonic. Any NS higher than 0.9%
Magnesium and calcium act like ___
Think ___ first
sedatives
muscles
Lab values for:
Mg
Ca
Mg –> 1.3 - 2.1
Ca –> 9 - 11
Causes of hypermagnesemia:
Renal failure
Antacids
Increased Mg can lead to ___
seizures
S/S of hypermagnesemia:
flushing
warmth
(because vasodilation)
S/S of too much Mg or Ca:
(Remember…low Mg and Ca act like sedatives)
1) Decreased DTR
2) Arrhythmias
3) Bradycardia
4) Muscle tone weak & flaccid
5) LOC decreased
6) Decreased RR
Treatment for hypermagnesemia
Vent –> manage low RR
Dialysis –> clean the blood
Calcium gluconate –> antidote
Causes of hypercalcemia:
- Too much PTH
- Thiazides…retain Ca
- Immobilization…you have to bear weight to keep Ca in the bones
S/S of hypercalcemia
Brittle bones
Kidney stones
Treatement of hypercalcemia:
Weight bearing movement Fluids...to prevent kidney stones Add phosphorus to diet (inverse r'ship with Ca) Steroids (Remember CUSHINGOID) Vit D
Meds that decrease serum Ca:
Biphosphonates (-dronate)
Prostaglandin synthesis inhibitors
Calcitonin (for osteoporosis…takes Ca from blood to bones)
Causes of HYPOmagnesemia
- Diarrhea…lots of Mg in intestines
- Alcoholism
- Alcohol suppresses ADH and it’s hypertonic
S/S of not enough Mg and Ca
(Remember…NOT ENOUGH sedation here)
1) Muscles rigid and tight
2) Seizures
3) Stridor/laryngospasm –> airway is smooth muscle
4) + Chvostek’s (C for Cheek)
5) + Trousseau’s
6) Arrhythmias –> heart is a muscle
7) DTR are increased
8) Mind changes –> psychotic, wild, depressed
9) Swallowing probs –> esophagus is smooth muscle
Treatment for hypomagnesemia
- give Mg
- check kidney function before and during IV Mg
- Seizure precautions
- Eat Mg (greens and seeds)
What should you do if pt c/o flushing and sweating during IV Mg infusion?
STOP the infusion
Causes of HYPOcalcemia
- hypoparathyroidism
- radical neck surgery (may have taken parathyroids)
- thyroidectomy (may have take parathyroids)
Treatment for HYPOcalcemia
- Vit D
- Phosphate binders…decreasing phosphate will increase Ca (inverted r’ship)
- IV Ca
Must be on a ___ ___ when administering Ca
cardiac monitor
Na imbalance…think ___ changes
neuro
Sodium is the only electrolyte that cares about ___
water
The Na level in the blood is totally dependent on how much ___ is in the blood.
- hypernatremia = ___
- hyponatremia = ___
water
Hypernatremia = dehydration
Hyponatremia = dilution
Causes of hypernatremia
- hyperventilation (insensible fluid loss)
- heat stroke
- DI
S/S of hypernatremia
Neuro changes
Dry mouth
Thirsty
Swollen tongue
Treatment of hypernatremia
Restrict Na Dilute client with fluids, diluting makes Na go down Daily weights I and O's Lab work
Feeding tube clients tend to get ___
dehydrated
Normal lab values for Na
135 - 145
Causes of hyponatremia
- Drinking water for fluid replacement (dilutes the blood w/o replacing electrolytes)
- Psychogenic polydipsia
- D5W
- SIADH (retain water)
S/S of hyponatremia
(All brain issues)
HA
Seizure
Coma
Treatment of hyponatremia
Admin Na
Water restriction
If having neuro probs, need HYPERtonic saline
Normal values for Potassium
3.5 - 5
K is mostly excreted by the ____
Kidneys
think K for Kidneys
Causes of hyperkalemia
Kidney probs
Spironolactone (K sparing diuretic)
S/S of hyperkalemia
First…muscle twitching
Then…muscle weakness
Then…flaccid paralysis
ECG changes with hyperkalemia
bradycardia tall, peaked T-waves prolonged PR intervals flat or absent P-waves widened QRS Conduction blocks V-fib
ECG changes with hypokalemia
U waves
PVCs
V-tach
Treatment for hyperkalemia
Dialysis...kidneys aren't working Calcium gluconate...decreases arrythmia Glucose and insulin Kayexcelate (sodium polystyrene, exchanges Na for K) - Na and K have an inverse r'ship
Causes of hypokalemia
Vomiting
NG suction (we have lots of K in our stomach)
K losing diuretics (Lasix and HCTZ)
Not eating
S/S of hypokalemia
Muscle cramps
Muscle weakness
Treatment for hypokalemia
Give K
Spironolactone (K sparing diuretic)
Eat more K rich foods
Never give potassium IV ___
push
Always on a pump
