Fluid & Electrolytes Flashcards
Diuretics are commonly used to treat _____
FVE
FVE, Diuretics inhibit/action is to:
They inhibit sodium and water transport ion, increasing urine output.
What are the three major types of diuretics?
Loop
Thiazides
Potassium-Sparing
Furosemide (Lasix)
Loop Diuretic
Bumetadine (Bumex)
Loop Diuretics
Mannitol (Osmitrol)
Osmotic Diuretic
Hydrochlorothiazide (Microzide)
Thiazides Diuretic
Chlorothiazide (Diuril)
Thiazides Diuretic
Metalazone (Zarolxolyn)
Thiazides Diuretic
Sprinolactone (Aldactone)
Potassium-Sparing Diuretics
Captopril (Capoten)
ACE Inhibitors
Enalapril (Vasotec)
ACE Inhibitors
Lisinopril (Zestril)
ACE Inhibitors
Can Potassium be given via IV push
No. Overdose is lethal
Losartan (Cozaar)
ARB
Valsartan (Diovan)
ARB
Irbesartan (Avapro)
ARB
Hydralazine (Apresoline)
Vasodilators
Nitroglycerin
Vasodilators
Heparin
Thrombin Inhibitors
Low Molecular Weight Heparins (Enoxaparin/Lovenox)
Thrombin Inhibitors
Fodaparinux (Arixtra)
Thrombin Inhibitors
What is the most powerful diuretic
Loop
Symptoms of fluid overload
Increased pulse rate, increased blood pressure, increased respiratory rate
Signs and symptoms of early indications for fluid volume access
Edema
Normal urinary output
1400 to 1500 mL per day
What is third spacing
When fluid shifts from vascular space to other areas
Isotonic dehydration may result from What
Normal sodium level
What is hypovolemia
Loss of ECF
True or false SaltSubstitutes have high potassium levels
True
Normal range for specific gravity
1.010-1.030
Measures the kidneys ability to concentrate urine
Fatigue weakness nausea and vomiting or signs of which problem
Hypokalemia
How slow should blood run in an IV transfusion
Two To 5 mL per minute for the first 15 minutes
Where is potassium stored
Cells
Where is calcium stored
Bones
The body does not store which two electrolytes
Sodium and chloride
Anti-diuretic hormone
Regulates water excretion from the kidney
A client is admitted with an stage renal disease and has a K Level of 7.1. The nurse anticipates which medication to be used to treat this electrolyte in balance
Insulin and glucose
The nurse is preparing to administer 20 MEQ of potassium chloride to a client who has been vomiting. What should the nurse explained to the client about the purpose of this medication
It is needed to maintain skeletal, cardiac, and neuromuscular activity
True or false
Fluid volume excess was calm and due to the increased levels of ADH in response to stress of the surgery
True
Which condition is known to result in fluid loss that is characterized by a proportionately greater loss of sodium and water
Hypotonic dehydration
Which interventions and the nurse implement to decrease the clients possibility of developing hypercalcemia
Assist the client to ambulate around the room at least three times daily
A nurse is caring for a client who has lost a large percent of circulating body fluids as a result of excessive diuresis. Which medication with the nurse anticipate this client needing
Crystalloid
The nurse is monitoring the fluid and electrolyte status of a client receiving IV Colloids. For which in balance to the nurse assessed client’s
Fluid overload
Movement of fluid across cell membranes from an area of less concentration to an area of higher concentration
Osmosis
The healthcare provider prescribes calcium gluconate for a client. For Rich electrolyte in balance should the nurse assess this client for
Hypomagnesemia
A client is experiencing symptoms of severe gastroenteritis. Which IV fluid order should the nurse anticipate being prescribed for this client
Lactated ringer’s
A client is experiencing fatigue, headache, nausea, vomiting, and has a decrease in deep tendon reflexes. Which electrolyte in balance to the nurse suspect is causing this client symptoms
Hypercalcemia
Will hematocrit be increased or decreased with fluid volume deficit
Increased
A client is prescribed her as mine. Which information should the nurse provide about this medication
Check daily weight
Intake and output should be within how much of each other
200 to 300 mL
Which electrolyte in balance is most frequently associated with tetany
Hypocalcemia
Nasal gastric drainage, vomiting, diarrhea, and the use of diuretics likely cause which electrolyte in balance
Hypokalemia
Dyspnea indicates
Circulatory overload
Hypertonic dehydration may result from
Proportionately less sodium lost then water loss
Hypotonic dehydration may result from
Fortunately more sodium lost and water loss
A patient with fluid volume excess has hypokalemia which collaborative intervention therapy should the nurse nurse expect to implement for this patient
Diuretics
A patient is experiencing a fluid and balance caused by excessive blood loss. What fluid is expected to be prescribed
Colloid
Intracellular fluid
About 2/3 of the bodies water is located within the body cells which makes up approximately 40% of body weight. Located in the cells of the body
Extra Cellular Fluid
Consist of interstitial fluid and is composed of fluid in the interstitum. Between cells
Where is sodium located
ECF
Hyper nature is may develop as a result of
Dehydration
Excess intake
Signs and symptoms of hyper natremia
Irritability, restlessness, confusion, twitching, increased thirst, dry mucous membranes, decreased urinary output, pulmonary Adema, dyspnea, flush skin, and orthostatic hypotension
Mnemonic for hyper natremia signs and symptoms
Fried F: fever(low grade) flushed skin R: Restless (irritable) I: Increased fluid rentention and BP E: Edema D: Decrease urine output, dry mouth
Mnemonic for the causes of hyper natremia
Model Medication, Meals Osmotic diuretics Diabetes insipid is Excessive H2O loss Low H2O intake
Hyponatremia signs and symptoms
Lethargy, headache, confusion, apprehension, seizures, coma
When does hypo natremia occur
A decrease in sodium is caused by dilution as a result of excess water or increased sodium loss. There are some situations.
Gastro intestinal suctioning, diarrhea, in adequate salt intake, fluid shift from intracellular to extracellular by hypertonic solution’s, diuretics, and vomiting
Nursing management for hyponatremia
Intake and output record, urine specific gravity, pulses, blood pressure and respiratory changes, cerebral edema, compare daily weights, and check for pitting Adema with fluid access
Potassium is necessary to maintain
Cardiac rhythm
Potassium is lost through what
The Gastro intestinal system
True or false
Potassium and sodium are necessary for a nerve impulses in the smooth muscle
True
Hyperkalemia signs and symptoms Mnemonic
Murder Muscle weakness Urine, Oliguria, Anuria Reap Distress/failure Decrease cardiac contractility ECG changes Reflexes
Causes of increased serum potassium levels. Mnemonic
Machine Medications, ace inhibitors, NSAIDS Acidosis Cellular destruction-burns, traumatic injury Hypoaldosteronism Intake-excessive Nephrons, renal failure Excretion-impaired
True or false
Insulin forces Potassium from Extra Cellular Fluid to the intracellular fluid
True
What will help pull the access potassium from the blood
Kayexalate
Hypocalcemia mnemonic s/s
CATS Convulsions Arrhythmias Tetany Spasms and strider
Common causes of hypo kalemia
Diarrhea, vomiting, diuretic therapy, excessive sweating, refeeding syndrome
Common causes of hyperkalemia
Burns, renal failure, in response to injury
When a burn damages sells you would expect us selves to release the major electrolyte
Potassium. This puts a patient at risk for hyperkalemia
Diuretics affect the kidney by alternating the reabsorption and excretion of
Water and electrolytes. Diuretics generally affect how much water in sodium the body excretes. At the same time other electrolytes such as Potassium can also be excreted in the urine
The main Extra Cellular cation is
Sodium. It helps regulate fluid balance in the body
Potassium is essential for conducting electrical impulses because it causes ions to
Shift in and out of the sales to conduct a current
Older adults are at an increased risk for electrolyte in balance because, with age, the kidneys have
If you were functioning nephrons
What is hypovolemia
Isotonic fluid loss from the Extra Cellular space
One sign of hypervolemia is
A rapid, bounding pools
In addition to it’s responsibility for fluid balance, sodium is also responsible for:
Impulse Transmission
Signs and symptoms of hypo natremia include
Change in level of consciousness, abdominal cramps, and muscle twitching
The minimum daily requirement for sodium for an average adult is
2 g
Increase serum sodium levels cause Thursday in the release of what
ADH into the bloodstream
The sodium potassium pump transports sodium ions
Out of cells
Potassium is responsible for
Maintaining a heartbeat
When the hormone aldosterone is secreted, the kidneys reabsorb
Sodium, and excrete potassium when aldosterone is secreted
Neuromuscular signs and symptoms of hypo kalemia include
Deep tendon reflexes. They may be decreased or absent.
Medications to help treat severe hyperkalemia include
Calcium Gluconate and regular insulin
A hallmark ECG characteristic of hyperkalemia is the presence of
Tall, tented T waves
When administering IV potassium for severe hypokalemia, you should
Verify that the concentration of the solution does not exceed 40 MEQ per liter
Magnesium is an important electrolyte because it
Assists in neuromuscular transmission. It is vital to nerve and muscle activity
True or False
Does hypomagnesemia increase neuromuscular excitability
True.
Expect to see hyper active deep tendon reflexes
When teaching your patient with hypomagnesemia, about proper diet, you should recommend that he consume plenty of
Seafood
The doctor prescribes IV magnesium sulfate for your patient with hypomagnesemia. Before giving the magnesium preparation, you review the practitioners order to make sure it specifies the
Number of grams or milliliters to give
Your patient is diagnosed with hyper Magnis MIA. To treat this imbalance of practitioner is likely to order
Both oral and IV fluids. By causing diuresis, the fluids promote excretion of excess magnesium by the kidneys
Hypocalcemia involves a dysfunction of
PTH
If you’re patient is hypercalcemic, you would expect to
Hydrate the patient with oral or IV fluids increase the year and excretion of calcium and help lower serum calcium levels
Which signs are associated with hypocalcemia
Chvostek’s and Trousseau’s
Phosphate and which electrolyte have an inverse relationship
Calcium
Calcium in which electrolyte have an inverse relationship
Phosphate
Chloride is primarily produced by the
Stomach
If the levels of bicarbonate ions increase, the level of chloride ions
Decrease.
Sodium and what electrolyte move together throughout the body
Chloride
Chloride and which electrolyte move together Throughout the body
Sodium
Hypertonic solution’scause fluid to move from the
Intracellular space to the Extra Cellular space
Isotonic fluids should not be used for a patient with
Increased ICP
Isotonic solution examples
D5 W, normal saline, dextrose 5% of normal Saline solution
Hypotonic solution examples
Half normal saline
Hypertonic solution examples
Dextrose 5% and half normal saline, 3% sodium chloride, dexterose 10% in NS
Hypotonic crystalloids
Moves from the bloodstream into the cell and causes the cell to expand with fluid
Hypertonic solution should be used cautiously and patience with
Reno in cardiac disease. It draws fluid from the intracellular space into the bloodstream.
Dextrose 5% in NS is an example of
Hypertonic solution
Dehydration is a what kind of state
Hypertonic state
Hypokalemia ECG changes
Flattened or inverted T-wave, a depressed ST segment, and a characteristic U wave
Hypermagnesimia cause
Muscle weakness
True or false
Hypocalcemia may be treated with IV calcium gluconate
True
Serum phosphate levels will fall below normal range in patients who
Abuse alcohol
FVD at risk for
Hypovolemia
Loss of both water and electrolytes
Dehydration
Just the loss of water
No electrolytes lost
Cause of FVD
GI losses, vomiting, diarrhea Diuretics Hemorrhaging Diaphoresis Diabetes insipidus ( peeing a lot) Kidney disease DKA Hyperventilation
Symptoms for FVD
Don’t have a lot of volume
Hypotension
To compensate for this
Increase RR and HR
Weak pulses Fatigue Weakness Thirst Dry mucous membranes Possible GI upset Oligiuria (Amal amount of urine) Decreased skin turgor Decreased cap refill Diaphoresis Flattened neck veins
Labs for FVD
Increase in: Blood is more concentrated Increased Hct Increased blood osmolarity Serum sodium BUN (also with dehydration) Urine specific gravity (due to very little urine that is concentrated
Nursing Care
Fluid replacement Monitor patient weight daily I & O Notify if output falls below 30mL/hours Fall risk
Complications for FVD
Hypovolemic shock (legs elevated, pt flat, oxygen, replace volume, vasoconstrictors, colloids)
FVE causes:
HF (due to heart not pumping correctively) Steroids Kidney difunction Cirrhosis Burns Excess sodium intake
Symptoms of FVE
Hypertension due to too much fluid, makes heart work hard Tachycardia Tachpnea Weight gain Edema Ascites Bounding pulses Dyspnea Crackles Distended neck veins
Labs for be FVE
All decreased: due to dilution Hct Hgb Serum osmolarity BUN Diluted urine Urine osmolarity Urine specific gravity
Monitor what for FVE
High Fowler’s or semi Fowler’s position Monitor weight daily (1 to 2 lb in 24 hours, 3 lbs in a week) I&O Limit fluid and sodium intake as ordered Fluid restriction Diuretics Oxygen if difficulty breathing
Complications of FVE
Pulmonary edema dyspnea pink frothy sputum
High risk for skin breakdown
Skin care, caution with repositions
Calcium has an inverse relationship with
Phosphorus
If one is high other will be low
Calcium
Normal level
9-11
Calcium
Function
Bone and teeth formation
Clotting
Nerve and muscle functioning
Hypocalcemia
Causes
Vit. D deficiency (allows for absorption of Ca in the body)
Hypoparathyroidism
Too much phosphorus
Pancreatitis
Signs and symptoms of hypocalcemia
Positive chvosteck(taping on cheek and facing switching)and trousseau (inflat BP cuff and it causes finger spasming)
Muscle spasms (due to lots of action potentials)
Numbness and tingling in lips and fingers
GI upset
Hypotension
Decreased HR
Nursing Care for hypocalcemia
Increase intake of calcium
Supplements
Hypercalcemia cause
Long term steriod use
Bone cancer
Hyperparathyroidism
Symptoms of Hypercalcemia
Constipation Decreased deep tendon reflexes Weakness Lethargy Kidney stones
Magnesium function
Nerve and muscle
Bone formation
Heart function
Normal range for magnesium
1.3-2.1
Hypomagnesimia
Causes
GI losses
Alcohol abuse
Diuretics
Malnourtrition
Symptoms of hypomagnesmia
Hyperactive DTR
Tetany
Seizures
Constipation
Hypomagnesmia
Management
Increased intake of foods
Supplements (can cause diarrhea)
Hypermagnesmia
Causes
Kidney disease
Excessive intake of laxatives or antacids
Hypermagnesimia
Signs and symptoms
Muscle weakness
Lethargy
Hypotension
Respiratory or cardiac arrest
Diminished deep tendon reflex’s
Hyper or hyponatremia
Hyponatremia
Signs and symptoms of hyponatremia are often what in ____ in nature
Neurological
A patient with hyponatremia will typically have a increased or decreased level of consciousness
Decreased
Renal failure
Considered that sodium levels will be too high or too low
Too high with renal failure
What are the three classifications of hyponatremia
Hypovolemic
Hyper
Uvolemic
Cardiac output will be increased or decreased with hyperchloremia
Decreased
Hyperchloriemia
Peripheral vasodilation
Chloride level below what is considered hypo
95
High aerial chloride level
Brady or tachycardia
Hypo or hypertension
Brady
Hypo
What causes the muscle weakness in hypokalemia
Due to decreased impulse conduction
What GI symptoms will be seen in hyperkalmia
Diarrhea
Hyperactive bowel sounds
Nausea
GI symptoms with hypokalemia
Constipation
Ilieus
Nausea
Vomiting
Ekg with hypokalemia
St depression
Q wave enlarged
T wave fat or inverted
True or false
Confusion, restlessness and irritability are associated with hyperkalmia
True
Serum osmolarity
280-300
Calcium and what have an inverse relationship
Phosphorus
