Fluid & Electrolytes Flashcards
Too much fluid in the vascular space
hypervolemia
causes of hypervolemia
HF
RF
things with lots of sodium
in ___ ___ the heart is weak, decreased CO, decreased UO, decreased kidney perfusion,
volume stays in the vascular space
heart failure
3 things with lots of sodium
efferescent soluble meds (aklaseltzer)
canned foods
IVF with sodium
3 hormones that regulate fluid volume
adolsterone
ANP
ADH
where is aldosterone found?
adrenal glands
normal action of aldosterone
retain sodium AND water
aldosterone makes the blood volume go ____
up
diseases with too much aldosterone
cushing’s dx
hyperaldosteronism
dx with too little aldosterone
addison’s disease
where is Atrial Natriuretic Peptide (ANP) found
atria of the heart
how does ANP work?
opposite of aldosterone
ANP causes excretion of ??
water and sodium
ANP is released for ___ ___ patients
heart failure
anti-diuretic hormone (ADH) makes you ____ water
retain
too much ADH aka?
SIADH
with SIADH they are in fluid volume ____
excess
urine and blood with SIADH
concentrated urine
dilute blood
not enough ADH aka??
DI
DI patients are in fluid volume ____
deficit
urine and blood with DI
dilute urine
concentrated blood
PC with DI
SHOCK….DIE
Concentrated makes the #s go ____
up
dilute makes the #s go ____
down
which 3 things can go up or down with dilute vs. concentrated?
urine specific gravity
sodium
Hct
ADH is found where?
pituitary gland
key words to make you think potential ADH problems?
craniotomy head injury sinus surgery trassphenoidal hypophysectomy or any condition that can lead to increased ICP
another name for ADH =
vasopressin
with hypervolemia the vessels can’t hold anymore fluids so they start to
3rd space
central venous pressure is measured where?
right atrium
with hypervolemia….CVP goes ___
up
sx of hypervolemia
wet lung sounds
polyuria
increased BP
increased weight
hypervolemia can lead to
heart failure then pulmonary edema
normal CVP
2-6
or 5-10
fluid retention: think ____ problems first
HEART
treatment for hypervolemia
low Na+ diet fluid restriction I/Os and daily weights diuretics bed rest
loop diuretic
furosemide
thiazide diuretic
hydrochlorothiazide
potassium sparing diuretic
sprionolactone
bed rest induces ____ by the release of ___ and decreased production of ____
diuresis
ANP
ADH
fluid volume deficit AKA
hypovolemia
causes of hypovolemia
loss of fluid from anywhere
third spacing
diseases with polyuria
examples of fluid loss from anywhere
thoracentesis paracentesis vomiting diarrhea hemorrhage
when fluid is in a place that does you no good
3rd spacing
examples of 3rd spacing
burns
ascites
diseases with polyuria
polyuria
oliguria
anuria
sx of hypovolemia
decreased weight, decreased skin turgor dry MM decreased UO low BP increased HR increased RR decreased CVP increased urine specific gravity
treatment for hypovolemia
prevent further losses
replace volume
fluid that goes into the vascular space and stays there!
isotonic solution
exs of isotonic solution
NS
LR
D5W
D5 1/4 NS
uses for isotonic solutions
N/V
burns
sweating
trauma
when is isotonic solutions C/I
HTN
cardiac disease
renal dx
goes into the vascular space and then shifts out into the cells to replace cellular fluid
hypotonic solutions
hypotonic solutions rehydrate without causing ____
HTN
examples of hypotonic solutions
D2.5W
1/2 NS
0.33% NS
uses for hypotonic solutions
client who has HTN
renal or cardiac disease
watch for cellular edema with hypotonic solutions because this fluid is moving out to the cells, which could lead to fluid volume ____ and decreased BP
deficit
volume expanders that will draw fluid into the vascular from the cells
hypertonic solutions
examples of hypertonic solutions
D10W 3% NS 5% NS D5LR D5 1/2 D5 TPN Albumin
uses for hypertonic
hyponatremia
3rd spacing clients
clients with severe edema, burns, or ascites
watch for fluid volume ____with hypertonic solutions
excess
ISOTONIC
“stay where I put it”
HYPOTONIC
go Out of the vessel
HYPERTONIC
Enter the vessel
Mg and Ca act like
sedatives
Mg is excreted by the ____ or can be lost in the ___ ___
kidneys
GI tract
causes of hypermagnesemia
renal failure
antacids
sx of hypermagnesemia
flushing
warmth
vasodilation
treatment for hypermagesemia
ventilator
dialysis
CALCIUM GLUCONATE
causes of hypercalcemia
hyperparathyroidism
thiazides
immobilization
sx of hypercalcemia
bones are brittle
kidney stones
treatment for hypercalcemia
move!!!!! fluids add phosphorus to diet steroids vitamin D
sx common with hypermagnesemia and hypercalcemia
decreased DTRs weak muscle tone arrhythmias decreased LOC decreased pulse and RR
if you want to get Mg and Ca questions right, think ____ first
muscles
calcium has an inverse relationship with _____
phosphorus
Mg level
1.3-2.1
calcium level
9.0-10.5
causes of hypomamagnesemia
diarrhea
alcoholism
causes of hypocalcemia
hypoparathyroidism
radical neck
thyroidectomy
(not enough PTH)
sx of hypomagnesema and hypocalcemia
rigid muscle tone seizure risk stridor positive trousseau's sign and chovestek's sign arrhythmias increased DTRs swallowing problems mind changes
treatment of hypomamagnesemia
give some Mg
seizure precautions
eat Mg
what to checking before and during Mg infusion?
kidney function
what do you do if your client reports flushing and sweating when you start IV Mg?
STOP IT
treatment for hypocalcemia
vitamin D
phosphate binders
IV Ca
what to make sure to do before administering IV Ca
put patient on the heart monitor
foods high in Mg
spinach mustard greens summer squash broccoli halibut turnip greens pumpkin seeds peppermint cucumber green beans celery kale sunflower seeds sesame seeds flax seeds
sodium level in your blood is totally dependent on how much ____ you have in the blood
water
sodium level
135-145
Hypernatremia AKA
dehydration
hyponatremia AKA
dilution
causes of hypernatremia
hyperventilation
heat stroke
DI
V/D
sx of hypernatremia
dry mouth
swollen tongue
thirsty
treatment of hypernatremia
restrict Na+ dilute client with fluids daily weights I/Os lab work
causes of hyponatremia
drinking H20 for fluid replacement
psychogenic polydipsia
D5W
SIADH
psychogenic polydipsia
loves to drink water
sx of hyponatremia
HA
seizure
coma
treatment for hyponatremia
client needs Na+
client doesn’t need water
if having neuro problems with hypocalcemia they need ______ saline
hypertonic
K+ levels
3.5-5.0
K+ is excreted by the ____
kidneys
causes of hyperkalemia
kidney trouble
spironolactone
spironolactone makes you retain ____
K+
sx of hyperkalemia
muscle twitching
then muscle weakness
then flaccid paralysis
arrhythmias
treatment for hyperkalemia
dialysis
calcium gluconate
glucose and insulin
sodium polystyrene sulfonate (kayexelate)
calcium gluconate decreases _____
arrhythmias
insulin carries ____ and ___ into the cell.
glucose and K+
anytime you give IV insulin, worry about _____ and ____
hypoglycemia and hypokalemia
causes of hypokalemia
vomiting
NG suctioning
diuretics
not eating
sx of hypokalemia
muscle cramps
muscle weakness
arrhythmias
treatment for hypokalemia
give K+
Spironolactone
eat more K+
spironolactone makes you retain ____
K+
sodium and ___ have an inverse relationship
K+
major problem with oral potassium
GI upset
give with food
assess ___ ____ before and during IV potassium
urinary output
always put IV ____ on a pump
K+
