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NCLEX > Fluid & Electrolytes > Flashcards

Fluid & Electrolytes Flashcards

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1
Q

3 causes of fluid volume excess (hypervolemia):

A

Heart Failure
Renal Failure
Too much sodium

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2
Q

3 things with excess sodium:

A

Effervescent soluble meds (Alka-Seltzer)
Canned, processed foods
IVF with Na

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3
Q

What 3 hormones can regulate fluid volume and where are they released from?

A

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

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4
Q

Aldosterone retains ___ and ___
ANP excretes ___ and ___
ADH retains ___ ___

A

Aldosterone: Sodium and water
ANP: Sodium and water
ADH: water ONLY

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5
Q

ADH excess leads to ____

ADH insufficiency leads to ____

A

Excess - SIADH (Syndrome of “INCREASED” ADH)

Insufficiency - DI (DI-uresis)

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6
Q

Concentrated makes the #’s go ___
Dilute makes the #’s go ___
What are these 3 values effected here?

A 
Concentrated --> Up
Dilute --> Down (remember the D's)
3 values: 
- Urine specific gravity
- Sodium
- Hct
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7
Q

Central venous pressure (CVP) is measured in the ___ ___

A

Right atrium

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8
Q

For fluid excess in the lungs, listen where?

A

Lower posterior area (due to gravity pooling it there)

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9
Q

Fluid excess, the heart will beat faster or slower? Why?

A

Faster…Heart is trying to move fluid forward

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10
Q

When getting daily weight, remember what?

A

Same:

  • time
  • clothes
  • scale
  • void 1st!!!
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11
Q

If fluid retention…think ____ problems 1st.

A

Heart

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12
Q

Diuretics:
Furosemide, bumetanide (K+ ____)
HCTZ (K+ ____)
Spironolactone (K+ ____)

A

Furosemide, bumetanide –> K+ losing
HCTZ –> K+ losing

Spironolactone –> K+ SPARING

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13
Q

Bed rest good or bad for volume excess pts? Why?

A

Good

Induces diuresis by the release of ANP and, decrease production of ADH

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14
Q

What does PID stand for regarding fluid volume?

A

Particle Induced Diuresis

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15
Q

HYPOvolemia…heart beats faster or slower? Why?

A

Faster…Heart trying to pump what little fluid is left around
(Tachycardia for both hypo- and hypervolemia)

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16
Q

HYPOvolemia…RR faster or slower? Why?

A

Faster…body perceives hypovolemia as HYPOXIA

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17
Q

HYPOvolemia…CVP increase or decrease? Why?

A

Decrease…less volume, less pressure

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18
Q

HYPOvolemia…urine specific gravity goes up or down? Why?

A

UP…concentrated makes it go up

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19
Q

More, less, or same as cells?
Isotonic solution
Hypotonic solution
Hypertonic solution

A

Isotonic –> Same
Hypotonic –> Less
Hypertonic –> More

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20
Q

Isotonic solution goes into the vascular space and ____ ____.

A

stays there

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21
Q

Examples of isotonic solutions:

A

NS, LR, D5W, D5 1/4 NS

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22
Q

What is unique about the isotonic solution D5W?

A

Only isotonic for a moment, then body uses up the dextrose

Used to keep lines open

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23
Q

Who should NOT get isotonic fluids?

A

HTN
Cardiac dz
Renal dz

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24
Q

Hypotonic solution goes into the vascular space then…

A

shifts out into the cells to replace cellular fluid

Rehydration w/o HTN

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25
Q

Examples of hypotonic solution:

A

D2.5W, 0.45% NS (1/2 NS), 0.33% NS

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26
Q

Hypertonic solutions are ___ ___ that will draw fluid ___ the vascular space from the cells.

A

volume expanders

into

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27
Q

Examples of hypertonic solutions:

A

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%

28
Q

Magnesium and calcium act like ___

Think ___ first

A

sedatives

muscles

29
Q

Lab values for:
Mg
Ca

A

Mg –> 1.3 - 2.1

Ca –> 9 - 11

30
Q

Causes of hypermagnesemia:

A

Renal failure

Antacids

31
Q

Increased Mg can lead to ___

A

seizures

32
Q

S/S of hypermagnesemia:

A

flushing
warmth
(because vasodilation)

33
Q

S/S of too much Mg or Ca:

A

(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

34
Q

Treatment for hypermagnesemia

A

Vent –> manage low RR
Dialysis –> clean the blood
Calcium gluconate –> antidote

35
Q

Causes of hypercalcemia:

A
  • Too much PTH
  • Thiazides…retain Ca
  • Immobilization…you have to bear weight to keep Ca in the bones
36
Q

S/S of hypercalcemia

A

Brittle bones

Kidney stones

37
Q

Treatement of hypercalcemia:

A 
Weight bearing movement
Fluids...to prevent kidney stones
Add phosphorus to diet (inverse r'ship with Ca)
Steroids (Remember CUSHINGOID)
Vit D
38
Q

Meds that decrease serum Ca:

A

Biphosphonates (-dronate)
Prostaglandin synthesis inhibitors
Calcitonin (for osteoporosis…takes Ca from blood to bones)

39
Q

Causes of HYPOmagnesemia

A
  • Diarrhea…lots of Mg in intestines
  • Alcoholism
  • Alcohol suppresses ADH and it’s hypertonic
40
Q

S/S of not enough Mg and Ca

A

(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

41
Q

Treatment for hypomagnesemia

A
  • give Mg
  • check kidney function before and during IV Mg
  • Seizure precautions
  • Eat Mg (greens and seeds)
42
Q

What should you do if pt c/o flushing and sweating during IV Mg infusion?

A

STOP the infusion

43
Q

Causes of HYPOcalcemia

A
  • hypoparathyroidism
  • radical neck surgery (may have taken parathyroids)
  • thyroidectomy (may have take parathyroids)
44
Q

Treatment for HYPOcalcemia

A
  • Vit D
  • Phosphate binders…decreasing phosphate will increase Ca (inverted r’ship)
  • IV Ca
45
Q

Must be on a ___ ___ when administering Ca

A

cardiac monitor

46
Q

Na imbalance…think ___ changes

A

neuro

47
Q

Sodium is the only electrolyte that cares about ___

A

water

48
Q

The Na level in the blood is totally dependent on how much ___ is in the blood.

  • hypernatremia = ___
  • hyponatremia = ___
A

water
Hypernatremia = dehydration
Hyponatremia = dilution

49
Q

Causes of hypernatremia

A
  • hyperventilation (insensible fluid loss)
  • heat stroke
  • DI
50
Q

S/S of hypernatremia

A

Neuro changes
Dry mouth
Thirsty
Swollen tongue

51
Q

Treatment of hypernatremia

A 
Restrict Na
Dilute client with fluids, diluting makes Na go down
Daily weights
I and O's
Lab work
52
Q

Feeding tube clients tend to get ___

A

dehydrated

53
Q

Normal lab values for Na

A

135 - 145

54
Q

Causes of hyponatremia

A
  • Drinking water for fluid replacement (dilutes the blood w/o replacing electrolytes)
  • Psychogenic polydipsia
  • D5W
  • SIADH (retain water)
55
Q

S/S of hyponatremia

A

(All brain issues)
HA
Seizure
Coma

56
Q

Treatment of hyponatremia

A

Admin Na
Water restriction
If having neuro probs, need HYPERtonic saline

57
Q

Normal values for Potassium

A

3.5 - 5

58
Q

K is mostly excreted by the ____

A

Kidneys

think K for Kidneys

59
Q

Causes of hyperkalemia

A

Kidney probs

Spironolactone (K sparing diuretic)

60
Q

S/S of hyperkalemia

A

First…muscle twitching
Then…muscle weakness
Then…flaccid paralysis

61
Q

ECG changes with hyperkalemia

A 
bradycardia
tall, peaked T-waves
prolonged PR intervals
flat or absent P-waves
widened QRS
Conduction blocks
V-fib
62
Q

ECG changes with hypokalemia

A

U waves
PVCs
V-tach

63
Q

Treatment for hyperkalemia

A 
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
64
Q

Causes of hypokalemia

A

Vomiting
NG suction (we have lots of K in our stomach)
K losing diuretics (Lasix and HCTZ)
Not eating

65
Q

S/S of hypokalemia

A

Muscle cramps

Muscle weakness

66
Q

Treatment for hypokalemia

A

Give K
Spironolactone (K sparing diuretic)
Eat more K rich foods

67
Q

Never give potassium IV ___

A

push

Always on a pump

NCLEX (13 decks)

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