Fluid & Electrolytes Flashcards
FVE, FVD, IV fluids, hyper/hypomagnesemia, hyper/hypocalcemia, hyper/hyponatremia, hyper/hypokalemia,
1
Q
Fluid Volume Excess = ____
Too much ____ in the ____ ____
A
Hypervolemia
fluid, vascular space
2
Q
Causes of FVE
• Heart Failure
• Renal Failure
• Things w/ lots of sodium
A
• 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
3
Q
Aldosterone
A
- found in adrenal gland
- normal action: when blood volume gets low (vomiting, hemorrhage) -> aldosterone secretion increases -> retain SODIUM and WATER -> blood volume ↑
4
Q
Diseases with too much aldosterone
A
Cushing’s disease (too much of ALL steroids)
Hyperaldosteronism (Conn’s syndrome)
5
Q
Diseases with too little aldosterone
A
Addison’s disease
6
Q
Anti-diuretic hormone (ADH)
A
retain water
7
Q
Three Letters/Three Characters
A
ADH and H2O
ADH = think WATER
8
Q
Too much ADH
TOO MANY ____, TOO MUCH ____
A
SIADH - Syndrome of Inappropriate Anti-Diuretic Hormone
TOO MANY letters, TOO MUCH water
• Retain water
• FVE
• Urine concentrated - ↑ specific gravity, ↑ Na
• Blood diluted - ↓ Hct
9
Q
Not enough ADH
DI = di____
A
DI - Diabetes Insipidus DI = diurese • Lose (diurese) water • FVD • concerned w/ SHOCK • Urine diluted - ↓ specific gravity, ↓ Na • Blood concentrated - ↑ Hct
10
Q
CONCENTRATED makes #’s go ______
DILUTE makes #’s go _______
A
CONCENTRATED = #’s go UP
DILUTE = #’s go DOWN
• Urine specific gravity, Sodium, Hematocrit (Hct)
11
Q
ADH is found in the ____
A
pituitary gland (behind sinus)
12
Q
Conditions associated w/ ADH problem
A
- craniotomy
- head injury
- sinus surgery
- transsphenoidal hypophysectomy
- any condition that can lead to ↑ ICP = ADH problem
13
Q
increased ICP can lead to a ________ problem
A
ADH (SIADH or DI)
14
Q
transsphenoidal hypophysectomy
A
going thru sinus in the pituitary to take something out
15
Q
Drugs utilized in DI
A
desmopressin (DDAVP) or vasopressin (Pitressin)–ADH replacement in DI
16
Q
S/SX of FVE
Veins? Edema? CVP? lung sounds? UOP? Pulse? BP? Weight?
A
- 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)
17
Q
Central Venous Pressure (CVP) is measured where?
A
right atrium
18
Q
HEART only wants fluid to go _____
A
FORWARD
19
Q
If the fluid doesn’t go forward, it’s going to ____
Can lead to ____
A
go back into the lungs
HF and pulmonary edema
20
Q
Fluid retention: Think ____ ____ first
A
Heart Problems
21
Q
FVE Treatment
• diet? fluids?
• measure?
• meds?
- bed rest to induce?
- precaution about IVFs
A
- 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
22
Q
Fluid Volume Deficit
Loss of fluid from ____
A
Hypovolemia
anywhere
23
Q
Causes of FVD
• Loss of ____ from anywhere (like?)
• ____ spacing – what is it? examples?
• Diseases with ____
A
• 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
24
Q
Polyuria: Think ____ first
A
SHOCK
25
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)
26
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
27
Safety precautions for FVD
Falls and Overload w/ IV fluids
28
Isotonic
goes into the vascular space and stays there
"stay where I put it!"
Normal Saline (NS), Lactated Ringers (LR), D5W, D5¼
29
Isotonic USES
N/V, burns, sweating, trauma
30
Normal Saine (NS) is used when administering ____
blood
31
Isotonic ALERT
Do not use w/ hypertension, cardiac disease or renal disease (can cause FVE, HTN, hypernatremia)
32
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
33
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
34
Hypotonic ALERT
Watch for cellular edema b/c fluid is moving out of to the cells = lead to FVD and low BP
35
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
36
Hypertonic USES
hyponatremia, client with 3rd spacing, severe edema, burns, ascites
37
Hypertonic ALERT
Watch for FVE. Monitor BP, pulse, CVP (esp with 3% or 5% NS)
38
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%
39
TOO MUCH MAGNESIUM AND CALCIUM = THINK ____
SEDATION
40
If you want to get Mg and Ca questions right, think ____ first
MUSCLES
41
Hypermagnesemia Causes
* Renal failure (Mg is normally excreted by kidneys)
| * Antacids
42
Hypermagnesemia S/SX
* Flushing and warmth
| * Mg causes vasodilation
43
Hypermagnesemia Treatment
* Ventilator (if <12 = TOXICITY!!!)
* Dialysis
* Calcium gluconate: Antidote for Magnesium toxicity
44
Magnesium toxicity S/SX and Treatment
* ↓ UOP, RR <12, loss DTR
| * Calcium gluconate
45
Magnesium Sulfate use for?
decrease seizures
46
S/SX common in a client w/ HYPERMAGNESEMIA and HYPERCALCEMIA
1. DTRs ↓
2. Muscle tone WEAK and FLACCID
3. Arrhythmias YES
4. LOC ↓
5. Pulse ↓
6. RR ↓
47
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)
48
Hypercalcemia S/SX
* Bones are BRITTLE
| * Kidney stones
49
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
```
50
Calcium has an inverse relationship with ____
Phosphorus
51
Hypomagnesemia Causes
```
• Diarrhea - lots of Mg in intestines
• Alcoholism
• Alcohol suppresses ADH and it's hypertonic
- not eating
-drinking = diuresing
```
52
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
53
What do you do if your client reports flushing and sweating when you start IV Mg?
Stop infusion
54
Hypocalcemia Causes
```
• Hypoparathyroidism
• Radical neck
• Thyroidectomy
*All these = Not Enough PTH
- Serum Ca ↓
```
55
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)
56
Safety precautions w/ IV Calcium
GIVE SLOWLY and always make sure the client is on a HEART MONITOR
57
IV Ca may cause
widen QRS, asystole
58
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
59
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)
60
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
61
Hypernatremia = ____
| Too much sodium; not enough ____
Dehydration
| water
62
Hypernatremia Causes
* Hyperventilation (exhale = lose water)
* Heat stroke
* Diabetes Insipidus
63
Hypernatremia S/SX
* dry mouth
* thirsty - already dehydrated by the time you're thirsty
* swollen tongue
* NEURO CHANGES
64
Hypernatremia Treatment
* Restrict SODIUM
* Dilute client w/ hypotonic fluids = diluting makes sodium ↓
* Daily weights
* I & O
* lab work
65
Feeding tube clients tend to become ____
dehydrated!
66
Hyponatremia = ____
| Too much water; not enough ____
Dilution
| sodium
67
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
68
Hyponatremia S/SX
* Headache
* Seizure
* Coma
69
Hyponatremia Treatment
* Client needs SODIUM, not WATER
| * if having NEURO problems: need HYPERTONIC SALINE -- 3% NS or 5% NS (monitor/worry FVE)
70
Potassium
Excreted by the ____
If the ____ are not working well, the serum Potassium will go ____
kidneys
| up
71
Hyperkalemia Causes
* Kidney trouble
| * spironolactone (Aldactone) - retains K
72
Hyperkalemia S/SX
Muscle twitching → muscle weakness → flaccid paralysis
| • life-threatening arrhythmias
73
EKG changes w/ HYPERKALEMIA
bradycardia, TALL PEAKED T WAVES, prolonged PR intervals, flat/absent P waves, widened QRS, conduction blocks, V-fib
74
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
75
Any time you give IV insulin, worry about ____ and ____
hypoglycemia, hypokalemia
76
Hypokalemia Causes
* Vomiting
* NG suction (d/t lots of K in stomach)
* Diuretics
* Not eating
77
Hypokalemia S/SX
* muscle cramps
| * muscle weakness
78
EKG changes w/ HYPOKALEMIA
U WAVES, PVCs, V-tach
79
Hypokalemia Treatment
* Potassium; Mix well!
* spironolactone (Aldactone) to retain K
* Eat more Potassium
80
Sodium and Potassium have an ____ relationship
inverse
81
Major problem with oral potassium
GI upset
| - give w/ food
82
Assess ____ before/during IV potassium
```
urinary output (UO)
if UOP ↓ = retaining K
```
83
Always put IV Potassium on a ____
pump
84
NEVER give potassium IV ____
push
85
(Potassium)
| Burns during infusion?
YES
86
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
```
87
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!
88
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
89
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
90
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
91
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
