Fluid & Electrolytes Flashcards
3 causes of hypervolemia
HF
RF
things with a lot of sodium
what are three things high in sodium
effervescent medications - (alka seltzer, fleet enema, IVF w Na)
Canned/processed food
IVF with sodium
what 3 hormones regulate fluid volume
aldosterone
atrial natriuretic peptide (ANP)
ADH
where is aldosterone found
adrenal glands
what is the role of aldosterone
retain sodium and water
increase blood volume
what diseases invovle too much aldosterone
cushing’s
hyperaldosteronism or Conn’s
(fluid overload)
what disease has too little aldosterone
addisons (losing sodium and water)
where is ANP found
atrium of heart (atrial natriuretic peptide)
How does ANP work
causes excretion of sodium and water
when is ANP released
when the heart stretches
how does Anti-diuretic hormone work (ADH)
retain water
what is the disease associated with too much ADH
Syndrome of Inappropriate ADH secretion (SIADH)
- retain H2O
What happens in SIADH
too many letters too much H2O
decreased urine output
increased blood volume
What disease is associated with not enough ADH
Diabetes Insipidus (DI)
what happens in DI
Diuresis!
fluid volume depletion
urine is dilute
blood concentrated
where is ADH found
pituitary gland between the eyes
when should you consider potential ADH problem
anytime there is a head injury or any condition that leads to increased ICP
when you see sphenoid think
sinus
when you see hypophysis
pituitary
what is another name for ADH (drug name)
vasopressin
what are signs and symptoms of ADH problems (8)
distended veins peripheral edema/third spacing CVP goes up lungs sound wet polyuria increased pulse pulmonary edema increased BP weight increase
Where is CVP measured?
normal values
right atrium
2-6 mmHg
what is the treatment for hypervolemia or fluid excess
low NA diet/fluid restriction I & O daily weights diuretics bed rest fluid replacement
whne you see fluid retention what problems should you think first
heart problems
causes of fluid volume deficit or hypovolemia
shock anything that causes fluid loss third spacing burns acites polyruia diseases - RF or diabetes
what happens with CVP when a person is experiencing fluid volume deficit
decreases
what happens to urine specific gravity during hypovolemia
goes up - very concentrated
treatment of hypovolemia
prevent further losses
replace volume
falls precautions
monitor for overload
what do isotonic solutions do
stay where I put it
what do hypotonic solutions do
go Out of vessel
what do hypertonic solutions do
Enter the vessel
examples of isotonic solutions )4)
NS
lactated ringers
D5W
D5 1/2 NS
examples of hypotonic soltions (3)
D (2.5)W
0.5NS
.33NS
examples of hypertonic solutions
D10W 3%NS 5%NS D5LR D51/2NS, D5NS TPN Albumin
magnesium and calcium act like
sedatives
normal Mg levels
0.65-1.02
normal calcium levles
2.25-2.62
causes of hypermangesemia
RF
antacids
symptoms of too much Mg
flushing
warmth
(makes you dilate)
treatment for too much MG
ventilator
dialysis
calcium gluconate (IV slow adminster)
what element has an inverse relationship with Ca
phosphorus
what are the causes of hypercalcemia
hyperparathyroidism - too much PTH
thiazides - retain Ca
immobilization - have to bear weight to keep Ca in bones
what regulates calcium
parathyormone (PTH) - kicks in when Ca gest low and pulls Ca from the bone
what are signs and symptoms of too much calcium
brittle bones
kidney stones
what are signs and symptoms common in clinets with too much calcium or mag
decreased deep tendon reflex weak and flacid or low muscle tone arrhytmias decreased LOC decreased pulse decreased respirations
treatment for too much calcium
move fluids to prevent kidney stones add phosphorus to diet (inverse relationship) steroids (decrease serum ca) medications - biphosphates or calcitonin
what are causes of hypomagnesmia
diarreha - lots of Mg in intestines
alcoholism - hypertonic, suppreses ADH and not eating or drinking
signs and symptoms of too little Ca or Mg
rigid and tight muscles seizures stridor (airway is smooth muscle_ \+'ve Chcosteks- "C" for cheek Trousseaus - pump up BP cuff - hand tremors arrythmias - heart is a muscle increase in reflexes mind changes swallowing problems - esophagus is a smooth muscle
treatment for too little Mg
give Mg (check kidney function first) seizure precations
what do you do if your client starts sweating and flushing when you start IV Mg
stop it
what are foods high in MG
green leafy foods
seeds
peppermint
squash
what are causes of hypocalcemia
hypoparathyroidsim
neck surgery - low PTH decrases serum calcium
what is the treatment for too little calcium
give calcium (po or slow IV - heart monitor if IV)
vitamin D 0 help utilize Ca
phosphate binding medications
what are you looking for in an ECG when giving IV calcium
wide QRS complexes
what should you think of first with calcium and mag
MUSCLES
what should you think of first with sodium changes
NEURO changes
what is normal sodium lab voalues
135-145 mmol/L
what is the level of sodium in your blood totally dependent on
how much water you have in your blood
what is hypernatremia eqivalent to
dehydration - too much Na not enough H20
causes of hypernatremia
hyperventilation - you exhale H2O heat stroke DI vomiting diarrhea
what are the S&S of hypernatremia
dry mouth
thirsty
swollen tongue
what is the treatment for hypernatremia
restrict Na dilute client with fluids daily weights I& O lab work
what is hyponatremia
dilution; too much water not enough Na
what is the causes of too little Na
drinking H2O for fluid replacement (vomiting, sweating)
psychogenic polydipsia - love to drink too much water
D5W (sugar and water)
SIADH
signs and symptoms of hyponatremia
headache
seizure
coma
treatment for hyponatremia
need sodium
no water
if having neuro problems need hypertonic saline 4%NS or 5%NS
normal potassium levels
3.5-5
what happens to potassium if the kidneys aren’t working well
potassium goes up
what are the causes for too much K
kidney trouble
spironolactone
S & S of too much potassium
muscle twitching –> muscle weakness –> flaccid paralysis
life threatening arrhytmias
what are ECG changes with hyperkalemia
brady tall and peaked T waves proloinged PR flat or absent P waves widened QRS conduction blocks Vfib
what are ECG changes for hypokalemia
U waves
PVC’s
Vtach
what is the treatment for too much potassium
dialysis (kidneys aren't working) calcium gluconate decreases arrythmias glucose and insulin - inulin carries glucose and K into cell; give glucose to prevent hypoglycemia sodium polystyrene (kayexalate)
potassium has an inverse realtionship with which element
sodium
what are causes of hypokalemia
vomiting
suction (lot of potassium in stomach)
diuretics
not eating
signs and symptoms of too little K
muscle cramps
muscle weakness
life threatening arrhythmias
treatment for too little K
give K
spironolactone
eat more K
what is the major problem with giving oral K
GI upset
always run IV K through waht
pump
should you ever give K IV push
NEVER
does IV K burn during infusion
yes - eats up peripheral vessels
