Fluid & Electrolytes Flashcards
FVE, FVD, IV fluids, hyper/hypomagnesemia, hyper/hypocalcemia, hyper/hyponatremia, hyper/hypokalemia,
Fluid Volume Excess = ____
Too much ____ in the ____ ____
Hypervolemia
fluid, vascular space
Causes of FVE
• Heart Failure
• Renal Failure
• Things w/ lots of sodium
• Heart Failure
Heart is weak = cardiac output ↓ = kidney perfusion ↓ = UOP ↓ = volume stays in vascular space
• Renal Failure
Kidneys are NOT perfusing
• Things w/ lots of sodium
- effervescent/fizzy meds
- canned foods
- IVF w/ sodium
Aldosterone
- found in adrenal gland
- normal action: when blood volume gets low (vomiting, hemorrhage) -> aldosterone secretion increases -> retain SODIUM and WATER -> blood volume ↑
Diseases with too much aldosterone
Cushing’s disease (too much of ALL steroids)
Hyperaldosteronism (Conn’s syndrome)
Diseases with too little aldosterone
Addison’s disease
Anti-diuretic hormone (ADH)
retain water
Three Letters/Three Characters
ADH and H2O
ADH = think WATER
Too much ADH
TOO MANY ____, TOO MUCH ____
SIADH - Syndrome of Inappropriate Anti-Diuretic Hormone
TOO MANY letters, TOO MUCH water
• Retain water
• FVE
• Urine concentrated - ↑ specific gravity, ↑ Na
• Blood diluted - ↓ Hct
Not enough ADH
DI = di____
DI - Diabetes Insipidus DI = diurese • Lose (diurese) water • FVD • concerned w/ SHOCK • Urine diluted - ↓ specific gravity, ↓ Na • Blood concentrated - ↑ Hct
CONCENTRATED makes #’s go ______
DILUTE makes #’s go _______
CONCENTRATED = #’s go UP
DILUTE = #’s go DOWN
• Urine specific gravity, Sodium, Hematocrit (Hct)
ADH is found in the ____
pituitary gland (behind sinus)
Conditions associated w/ ADH problem
- craniotomy
- head injury
- sinus surgery
- transsphenoidal hypophysectomy
- any condition that can lead to ↑ ICP = ADH problem
increased ICP can lead to a ________ problem
ADH (SIADH or DI)
transsphenoidal hypophysectomy
going thru sinus in the pituitary to take something out
Drugs utilized in DI
desmopressin (DDAVP) or vasopressin (Pitressin)–ADH replacement in DI
S/SX of FVE
Veins? Edema? CVP? lung sounds? UOP? Pulse? BP? Weight?
- distended neck veins/peripheral veins (full of fluid)
- peripheral edema/3rd spacing: Vessels can’t hold any more, so they start to LEAK
- CVP ↑ (more VOLUME, more PRESSURE)
- Lung sounds: WET CRACKLES
- Polyuria: kidney are trying to help you diurese
- Pulse ↑; palpate ARTERY; full and bounding
- BP ↑ (more VOLUME, more PRESSURE)
- Weight ↑ (not fat, acute gain/loss is FLUID)
Central Venous Pressure (CVP) is measured where?
right atrium
HEART only wants fluid to go _____
FORWARD
If the fluid doesn’t go forward, it’s going to ____
Can lead to ____
go back into the lungs
HF and pulmonary edema
Fluid retention: Think ____ ____ first
Heart Problems
FVE Treatment
• diet? fluids?
• measure?
• meds?
- bed rest to induce?
- precaution about IVFs
- Low sodium diet/Restrict fluids
- I and O and Daily weights (same time of day/scale/clothing, before 1st meal and 1st void)
• Diuretics
- Loop - 1st choice furosemide (Lasix); bumetanide (Bumex) given if furosemide doesn’t work
- hydrochlorothiazide (Thiazide) – watch for dehydration/electrolyte problems
- Potassium-sparing: spironolactone
- Bed rest induces DIURESIS by the release of ANP and ↓ production of ADH
- Physical assessment
- Give IVFs SLOWLY to the elderly and very young, and clients w/ history of cardiac/renal problems
Fluid Volume Deficit
Loss of fluid from ____
Hypovolemia
anywhere
Causes of FVD
• Loss of ____ from anywhere (like?)
• ____ spacing – what is it? examples?
• Diseases with ____
• Loss of fluid from anywhere
thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage
• 3rd spacing
when fluid is in a place that does you no good
- BURNS
- ASCITES - measure abdominal girth daily and worry about HYPOTENSION
• Diseases w/ polyuria
Diabetes Mellitus
- Polyuria: think SHOCK first
- Polyuria → Oliguria → Anuria = RENAL FAILURE
Polyuria: Think ____ first
SHOCK
S/SX of FVD
Weight? Skin turgor? Mucous membranes? UOP? BP? Pulse? Respirations? CVP? Veins? Temp of extremities? Urine specific gravity?
- Weight ↓
- Skin turgor ↓
- Mucous membranes DRY
- UOP ↓ - kidneys aren’t being perfused or they’re trying to hold on to fluid (compensate)
- BP ↓ (less VOLUME, less PRESSURE)
- Pulse ↑, weak and thready
- RR ↑, tachypnea
- CVP ↓ (less VOLUME, less PRESSURE)
- Vasoconstriction of peripheral veins/neck veins (very tiny)
- Cool extremities (vasoconstriction–blood shunt blood to vital organs)
- Urine specific gravity ↑ (very CONCENTRATED if putting out any urine)
FVD Treatment
• Prevent further losses
• Replace volume - Mild (PO fluids), Severe (IV fluids)
• Safety precautions
- higher risk for FALLS
- monitor for OVERLOAD w/ IVF replacement
Safety precautions for FVD
Falls and Overload w/ IV fluids
Isotonic
goes into the vascular space and stays there
“stay where I put it!”
Normal Saline (NS), Lactated Ringers (LR), D5W, D5¼
Isotonic USES
N/V, burns, sweating, trauma
Normal Saine (NS) is used when administering ____
blood
Isotonic ALERT
Do not use w/ hypertension, cardiac disease or renal disease (can cause FVE, HTN, hypernatremia)
Hypotonic
Goes into the vascular space and then shifts out into the cells to replace cellular fluid
“go Out of the vessel”
D2.5%, 0.45% NS, 0.33% NS
Hypotonic USES
Used w/ HTN, renal, or cardiac disease and needs fluid replacement b/c of N/V, burns, hemorrhage, etc. Also used for dilution for clients w/ hypernatremia and cellular dehydration
Hypotonic ALERT
Watch for cellular edema b/c fluid is moving out of to the cells = lead to FVD and low BP
Hypertonic
Volume expanders that will draw fluid into the vascular space from the cells; packed w/ particles
“Enter the vessel”
D10W, 3% NS, 5% NS, D5LR, D5½ NS, D5NS, TPN, Albumin
Hypertonic USES
hyponatremia, client with 3rd spacing, severe edema, burns, ascites
Hypertonic ALERT
Watch for FVE. Monitor BP, pulse, CVP (esp with 3% or 5% NS)
What HIGH ALERT MEDICATIONS need DOUBLE CHECK with a 2nd Licensed Nurse?
- Insulin
- Opiates and Narcotics
- Injectable KCl or Phosphate Concentrate
- IV Anticoagulants (Heparin)
- NaCl Solutions above 0.9%
TOO MUCH MAGNESIUM AND CALCIUM = THINK ____
SEDATION
If you want to get Mg and Ca questions right, think ____ first
MUSCLES
Hypermagnesemia Causes
- Renal failure (Mg is normally excreted by kidneys)
* Antacids
Hypermagnesemia S/SX
- Flushing and warmth
* Mg causes vasodilation
Hypermagnesemia Treatment
- Ventilator (if <12 = TOXICITY!!!)
- Dialysis
- Calcium gluconate: Antidote for Magnesium toxicity
Magnesium toxicity S/SX and Treatment
- ↓ UOP, RR <12, loss DTR
* Calcium gluconate
Magnesium Sulfate use for?
decrease seizures
S/SX common in a client w/ HYPERMAGNESEMIA and HYPERCALCEMIA
- DTRs ↓
- Muscle tone WEAK and FLACCID
- Arrhythmias YES
- LOC ↓
- Pulse ↓
- RR ↓
Hypercalcemia Causes
• Hyperparathyroidism: too much PTH
When serum calcium gets low, PTH kicks in and pulls Ca from bone and puts it in blood = ↑ serum Calcium
• Thiazide (retain Calcium) – good for client w/ osteoporosis
• Immobilization (you have to bear weight to keep Ca in bones)
Hypercalcemia S/SX
- Bones are BRITTLE
* Kidney stones
Hypercalcemia Treatment
• Move! • Fluids prevent KIDNEY STONES • Add phosphorus to diet (FONG- fish, organ meats, nuts, grains) • Steroids (to ↓ serum Ca) • Safety Precautions (bc sedated) • Medications - Biphosphates (etidronate) - Calcitonin: promotes renal excretion; puts back Ca into bone
Calcium has an inverse relationship with ____
Phosphorus
Hypomagnesemia Causes
• Diarrhea - lots of Mg in intestines • Alcoholism • Alcohol suppresses ADH and it's hypertonic - not eating -drinking = diuresing
Hypomagnesemia Treatment
- Give some Mg
- check kidney function (before and during IV Mg)
- Seizure precautions
- eat Magnesium
- STOP INFUSION if client reports flushing and sweating when you start IV Mg
What do you do if your client reports flushing and sweating when you start IV Mg?
Stop infusion
Hypocalcemia Causes
• Hypoparathyroidism • Radical neck • Thyroidectomy *All these = Not Enough PTH - Serum Ca ↓
Hypocalcemia Treatment
- PO Calcium
- IV Ca (GIVE SLOWLY) and always make sure the client is on a HEART MONITOR
- Vitamin D (utilize Ca)
- Phosphate binders: sevelamer hydrochloride (Renagel), calcium acetate (PhosLo)
Safety precautions w/ IV Calcium
GIVE SLOWLY and always make sure the client is on a HEART MONITOR
IV Ca may cause
widen QRS, asystole
Foods HIGH in Magnesium
GREENS AND SEEDS– spinach, mustard greens, summer squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, celery, kale, sunflower seeds, sesame seeds, and flax seeds
S/SX common in a client w/ HYPOMAGNESEMIA and HYPOCALCEMIA
- Muscle tone TIGHT and RIGID
- Client could have a SEIZURE
- Stridor/laryngospasm - airway is a smooth muscle
- (+) Chvostek’s - tap cheek (“C” for Cheek)
- (+) Trousseau’s - pump up BP cuff
- Arrhythmias - heart is a muscle
- DTRs ↑
- Mind changes
- Swallowing problems - esophagus is a smooth muscle (worry about ASPIRATION)
SODIUM: Think ____ ____
neuro changes
• Sodium level in your blood is totally dependent on how much water you have in the blood
• The brain does NOT like it when the sodium is messed up
Hypernatremia = ____
Too much sodium; not enough ____
Dehydration
water
Hypernatremia Causes
- Hyperventilation (exhale = lose water)
- Heat stroke
- Diabetes Insipidus
Hypernatremia S/SX
- dry mouth
- thirsty - already dehydrated by the time you’re thirsty
- swollen tongue
- NEURO CHANGES
Hypernatremia Treatment
- Restrict SODIUM
- Dilute client w/ hypotonic fluids = diluting makes sodium ↓
- Daily weights
- I & O
- lab work
Feeding tube clients tend to become ____
dehydrated!
Hyponatremia = ____
Too much water; not enough ____
Dilution
sodium
Hyponatremia Causes
- Drinking H2O for fluid replacement (vomiting, sweating) - this only replaces water and dilutes blood
- Psychogenic polydipsia - loves to drink water
- D5W (sugar and water)
- SIADH: Retaining water
Hyponatremia S/SX
- Headache
- Seizure
- Coma
Hyponatremia Treatment
- Client needs SODIUM, not WATER
* if having NEURO problems: need HYPERTONIC SALINE – 3% NS or 5% NS (monitor/worry FVE)
Potassium
Excreted by the ____
If the ____ are not working well, the serum Potassium will go ____
kidneys
up
Hyperkalemia Causes
- Kidney trouble
* spironolactone (Aldactone) - retains K
Hyperkalemia S/SX
Muscle twitching → muscle weakness → flaccid paralysis
• life-threatening arrhythmias
EKG changes w/ HYPERKALEMIA
bradycardia, TALL PEAKED T WAVES, prolonged PR intervals, flat/absent P waves, widened QRS, conduction blocks, V-fib
Hyperkalemia Treatment
- Dialysis - kidneys aren’t working
- Calcium gluconate - ↓ arrhythmias
- Glucose and insulin - insulin carries glucose and potassium into the cell
- Sodium polystyrene sulfonate (Kayexalate) - lose K thru diarrhea and replaces w/ sodium; push fluids to avoid dehydration
Any time you give IV insulin, worry about ____ and ____
hypoglycemia, hypokalemia
Hypokalemia Causes
- Vomiting
- NG suction (d/t lots of K in stomach)
- Diuretics
- Not eating
Hypokalemia S/SX
- muscle cramps
* muscle weakness
EKG changes w/ HYPOKALEMIA
U WAVES, PVCs, V-tach
Hypokalemia Treatment
- Potassium; Mix well!
- spironolactone (Aldactone) to retain K
- Eat more Potassium
Sodium and Potassium have an ____ relationship
inverse
Major problem with oral potassium
GI upset
- give w/ food
Assess ____ before/during IV potassium
urinary output (UO) if UOP ↓ = retaining K
Always put IV Potassium on a ____
pump
NEVER give potassium IV ____
push
(Potassium)
Burns during infusion?
YES
Foods high in potassium
spinach, fennel, kale, mustard greens, brussels sprouts, broccoli, eggplant, cantaloupe, tomatoes, parsley, cucumber, bell pepper, apricots, ginger root, strawberries, avocado, banana, tuna, halibut, cauliflower, kiwi, oranges, potatoes (white/sweet), cabbage
think of rainbow colors Red - strawberry, tomato (but not apple!!) Orange - oranges, cantaloupe, carrots, apricot Yellow - banana, potato Green - avocado, kiwi Blue from blue sea - fish I/V Indigo/Violet - raisins \+ salt substitutes
Anaphylactic shock
• description?
• cause?
• treatment?
• an extreme, often life-threatening allergic reaction to an antigen to which the body has become hypersensitive
• IV contrast, drugs (ASA), insect bites/stings, anesthetic agents, vaccines, foods, materials (latex)
• histamine H2 blockers (Tagamet), EPINEPHRINE (Drug of Choice), Benadryl, Volume expanders, Solumedrol, bronchodilators
***Ensure patent airway, O2!
Hypovolemic shock
• description?
• cause?
• treatment?
• loss of intravascular volume, ↓ stroke volume, ↓ cardiac output
• 3rd spacing, diuresis, HEMORRHAGE (#1 cause), burns, GI (V/D, NG tube drainage), DI, DKA, Addison’s disease
• Levophed, Neo-Synephrine, Intropin, Pitressin;
***Rapid volume replacement (blood, isotonic solutions), control bleeding, O2, hemodynamic monitoring
Cardiogenic shock
• description?
• cause?
• treatment?
• inability of heart to pump blood out effectively (pump failure) = ↓ cardiac output
• MI, ventricular arrhythmias, end-stage HF
• Dobutamine, Dopamine, Epinephrine, Primacor, Nitroglycerin, Nipride, Morphine;
*** intra-aortic balloon pump (IABP), correct arrhythmias, O2, intubation and mechanical ventilation may be necessary
Septic shock
• description?
• cause?
• treatment?
- Massive vasodilation by inflammatory response of body d/t overwhelming INFECTION
- sepsis
- antimicrobial therapy, volume replacement, cultures, vasopressors, hemodynamic monitoring
Neurogenic shock
• description?
• cause?
• treatment?
- pooling of blood = ↓ venous return, ↓ cardiac output, ↓ BP, ↓ HR
- Massive vasodilation, suppression of sympathetic n.s., injury/disease to spinal cord at T6, spinal anesthesia
- treat cause, vasopressors, airway and ventilation support
