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NCLEX > Fluid & Electrolytes > Flashcards

Fluid & Electrolytes Flashcards

FVE, FVD, IV fluids, hyper/hypomagnesemia, hyper/hypocalcemia, hyper/hyponatremia, hyper/hypokalemia,

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1
Q

Fluid Volume Excess = ____

Too much ____ in the ____ ____

A

Hypervolemia

fluid, vascular space

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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

  1. effervescent/fizzy meds
  2. canned foods
  3. IVF w/ sodium
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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 ↑
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4
Q

Diseases with too much aldosterone

A

Cushing’s disease (too much of ALL steroids)

Hyperaldosteronism (Conn’s syndrome)

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5
Q

Diseases with too little aldosterone

A

Addison’s disease

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6
Q

Anti-diuretic hormone (ADH)

A

retain water

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7
Q

Three Letters/Three Characters

A

ADH and H2O

ADH = think WATER

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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

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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
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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)

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11
Q

ADH is found in the ____

A

pituitary gland (behind sinus)

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12
Q

Conditions associated w/ ADH problem

A
  • craniotomy
  • head injury
  • sinus surgery
  • transsphenoidal hypophysectomy
  • any condition that can lead to ↑ ICP = ADH problem
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13
Q

increased ICP can lead to a ________ problem

A

ADH (SIADH or DI)

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14
Q

transsphenoidal hypophysectomy

A

going thru sinus in the pituitary to take something out

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15
Q

Drugs utilized in DI

A

desmopressin (DDAVP) or vasopressin (Pitressin)–ADH replacement in DI

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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)
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17
Q

Central Venous Pressure (CVP) is measured where?

A

right atrium

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18
Q

HEART only wants fluid to go _____

A

FORWARD

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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

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20
Q

Fluid retention: Think ____ ____ first

A

Heart Problems

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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

  1. Loop - 1st choice furosemide (Lasix); bumetanide (Bumex) given if furosemide doesn’t work
  2. hydrochlorothiazide (Thiazide) – watch for dehydration/electrolyte problems
  3. 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
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22
Q

Fluid Volume Deficit

Loss of fluid from ____

A

Hypovolemia

anywhere

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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

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24
Q

Polyuria: Think ____ first

A

SHOCK

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25
Q

S/SX of FVD
Weight? Skin turgor? Mucous membranes? UOP? BP? Pulse? Respirations? CVP? Veins? Temp of extremities? Urine specific gravity?

A
  • 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)
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26
Q

FVD Treatment

A

• Prevent further losses
• Replace volume - Mild (PO fluids), Severe (IV fluids)
• Safety precautions
- higher risk for FALLS
- monitor for OVERLOAD w/ IVF replacement

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27
Q

Safety precautions for FVD

A

Falls and Overload w/ IV fluids

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28
Q

Isotonic

A

goes into the vascular space and stays there

“stay where I put it!”

Normal Saline (NS), Lactated Ringers (LR), D5W, D5¼

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29
Q

Isotonic USES

A

N/V, burns, sweating, trauma

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30
Q

Normal Saine (NS) is used when administering ____

A

blood

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31
Q

Isotonic ALERT

A

Do not use w/ hypertension, cardiac disease or renal disease (can cause FVE, HTN, hypernatremia)

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32
Q

Hypotonic

A

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

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33
Q

Hypotonic USES

A

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

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34
Q

Hypotonic ALERT

A

Watch for cellular edema b/c fluid is moving out of to the cells = lead to FVD and low BP

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35
Q

Hypertonic

A

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

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36
Q

Hypertonic USES

A

hyponatremia, client with 3rd spacing, severe edema, burns, ascites

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37
Q

Hypertonic ALERT

A

Watch for FVE. Monitor BP, pulse, CVP (esp with 3% or 5% NS)

38
Q

What HIGH ALERT MEDICATIONS need DOUBLE CHECK with a 2nd Licensed Nurse?

A
  • Insulin
  • Opiates and Narcotics
  • Injectable KCl or Phosphate Concentrate
  • IV Anticoagulants (Heparin)
  • NaCl Solutions above 0.9%
39
Q

TOO MUCH MAGNESIUM AND CALCIUM = THINK ____

A

SEDATION

40
Q

If you want to get Mg and Ca questions right, think ____ first

A

MUSCLES

41
Q

Hypermagnesemia Causes

A
  • Renal failure (Mg is normally excreted by kidneys)

* Antacids

42
Q

Hypermagnesemia S/SX

A
  • Flushing and warmth

* Mg causes vasodilation

43
Q

Hypermagnesemia Treatment

A
  • Ventilator (if <12 = TOXICITY!!!)
  • Dialysis
  • Calcium gluconate: Antidote for Magnesium toxicity
44
Q

Magnesium toxicity S/SX and Treatment

A
  • ↓ UOP, RR <12, loss DTR

* Calcium gluconate

45
Q

Magnesium Sulfate use for?

A

decrease seizures

46
Q

S/SX common in a client w/ HYPERMAGNESEMIA and HYPERCALCEMIA

A
  1. DTRs ↓
  2. Muscle tone WEAK and FLACCID
  3. Arrhythmias YES
  4. LOC ↓
  5. Pulse ↓
  6. RR ↓
47
Q

Hypercalcemia Causes

A

• 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
Q

Hypercalcemia S/SX

A
  • Bones are BRITTLE

* Kidney stones

49
Q

Hypercalcemia Treatment

A 
• 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
Q

Calcium has an inverse relationship with ____

A

Phosphorus

51
Q

Hypomagnesemia Causes

A 
• Diarrhea - lots of Mg in intestines
• Alcoholism
• Alcohol suppresses ADH and it's hypertonic
- not eating
-drinking = diuresing
52
Q

Hypomagnesemia Treatment

A
  • 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
Q

What do you do if your client reports flushing and sweating when you start IV Mg?

A

Stop infusion

54
Q

Hypocalcemia Causes

A 
• Hypoparathyroidism
• Radical neck
• Thyroidectomy
*All these = Not Enough PTH
- Serum Ca ↓
55
Q

Hypocalcemia Treatment

A
  • 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
Q

Safety precautions w/ IV Calcium

A

GIVE SLOWLY and always make sure the client is on a HEART MONITOR

57
Q

IV Ca may cause

A

widen QRS, asystole

58
Q

Foods HIGH in Magnesium

A

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
Q

S/SX common in a client w/ HYPOMAGNESEMIA and HYPOCALCEMIA

A
  • 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
Q

SODIUM: Think ____ ____

A

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
Q

Hypernatremia = ____

Too much sodium; not enough ____

A

Dehydration

water

62
Q

Hypernatremia Causes

A
  • Hyperventilation (exhale = lose water)
  • Heat stroke
  • Diabetes Insipidus
63
Q

Hypernatremia S/SX

A
  • dry mouth
  • thirsty - already dehydrated by the time you’re thirsty
  • swollen tongue
  • NEURO CHANGES
64
Q

Hypernatremia Treatment

A
  • Restrict SODIUM
  • Dilute client w/ hypotonic fluids = diluting makes sodium ↓
  • Daily weights
  • I & O
  • lab work
65
Q

Feeding tube clients tend to become ____

A

dehydrated!

66
Q

Hyponatremia = ____

Too much water; not enough ____

A

Dilution

sodium

67
Q

Hyponatremia Causes

A
  • 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
Q

Hyponatremia S/SX

A
  • Headache
  • Seizure
  • Coma
69
Q

Hyponatremia Treatment

A
  • Client needs SODIUM, not WATER

* if having NEURO problems: need HYPERTONIC SALINE – 3% NS or 5% NS (monitor/worry FVE)

70
Q

Potassium
Excreted by the ____
If the ____ are not working well, the serum Potassium will go ____

A

kidneys

up

71
Q

Hyperkalemia Causes

A
  • Kidney trouble

* spironolactone (Aldactone) - retains K

72
Q

Hyperkalemia S/SX

A

Muscle twitching → muscle weakness → flaccid paralysis

• life-threatening arrhythmias

73
Q

EKG changes w/ HYPERKALEMIA

A

bradycardia, TALL PEAKED T WAVES, prolonged PR intervals, flat/absent P waves, widened QRS, conduction blocks, V-fib

74
Q

Hyperkalemia Treatment

A
  • 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
Q

Any time you give IV insulin, worry about ____ and ____

A

hypoglycemia, hypokalemia

76
Q

Hypokalemia Causes

A
  • Vomiting
  • NG suction (d/t lots of K in stomach)
  • Diuretics
  • Not eating
77
Q

Hypokalemia S/SX

A
  • muscle cramps

* muscle weakness

78
Q

EKG changes w/ HYPOKALEMIA

A

U WAVES, PVCs, V-tach

79
Q

Hypokalemia Treatment

A
  • Potassium; Mix well!
  • spironolactone (Aldactone) to retain K
  • Eat more Potassium
80
Q

Sodium and Potassium have an ____ relationship

A

inverse

81
Q

Major problem with oral potassium

A

GI upset

- give w/ food

82
Q

Assess ____ before/during IV potassium

A 
urinary output (UO)
if UOP ↓ = retaining K
83
Q

Always put IV Potassium on a ____

A

pump

84
Q

NEVER give potassium IV ____

A

push

85
Q

(Potassium)

Burns during infusion?

A

YES

86
Q

Foods high in potassium

A

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
Q

Anaphylactic shock
• description?
• cause?
• treatment?

A

• 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
Q

Hypovolemic shock
• description?
• cause?
• treatment?

A

• 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
Q

Cardiogenic shock
• description?
• cause?
• treatment?

A

• 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
Q

Septic shock
• description?
• cause?
• treatment?

A
  • Massive vasodilation by inflammatory response of body d/t overwhelming INFECTION
  • sepsis
  • antimicrobial therapy, volume replacement, cultures, vasopressors, hemodynamic monitoring
91
Q

Neurogenic shock
• description?
• cause?
• treatment?

A
  • 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

NCLEX (24 decks)

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