Fluid Imbalances

Question 1

managment of hyponatremia from fluid loss

Answer 1

-oral intake of fluids and sodium containing foods
-IV isotonic solution
-if severe, IV hypertonic solution
xx NO diuretics xx

Question 2

management of hyponatremia from fluid excess

Answer 2

-fluid restriction
-loop diuretics
for severe hyponatremia: vasopressor antagonist medications such as Conivaptan (vasprisol) and Tolvaptan (Samsca)
these will block ADH release
-IV hypertonic solution

Question 3

nursing considerations with hypokalemia

Answer 3

hypokalemia can result from diuretic use, diarrhea, excessive laxative use
ECG can show an inverted T wave
-replace potassium, but never give IV potassium as a Push or bolus, always dilute
-place on a cardiac monitor

Question 4

nursing considerations with hyperkalemia

Answer 4

can result from potassium sparing diuretics, renal failure, adrenal insufficiency (addison’s disease)
ECG can show peaked T wave
-clinical manifestations also include GI stuff, and neuromuscular
-associated with metabolic acidosis
CARE: increase excretion of potassium with loop diuretics, Kayexalate-sodium polystyrene sulfonate PO or edema, Dialysis,
**Force K from ECF to ICF with IV insulin & glucose, B-adrenergic agonists, or sodium bicarbonate

Question 5

nursing considerations for hypocalcemia

Answer 5

risk factors: malabsoprtion, decreased prodution of PTH (post thyroidectomy), multiple blood transfusions, Alkalosis (high PH increases calcium binding to protein, decreasing free calcium)

manifestations: positive chvostek, trousseau, tetany, seizures, cardiac dysrhythmias

CARE: IV calcium gluconate, vitamin d replacement, treat pain and anxiety

Question 6

nursing considerations for hypercalcemia

Answer 6

risk factors: hyperparathyroidism, malignancy (release of calcium from tumor invasion of bones), prolonged immobilization, thiazide diuretics

manifestations: fatigue, lethargy, confusion, nausea, vomiting, cardiac, nephrolithiasis (kidney stones),

CARE: excretion of calcium with loop diuretic, fluids like isotonic, biophosphonates, IM or SC calcitonin (moves calcium into the bones and increases renal excretion)

Question 7

nursing considerations for hyperphosphotemia

Answer 7

causes: poor kidney function, hypoparathyroidism, excessive intake of laxatives, rhabdomyolysis

manifestations: hypocalcemia

CARE: correct hypocalcemia,

Question 8

nursing considerations for hypophosphatemia

Answer 8

causes: decreased absoprtion, diarrhea, respitaroty alkalosis, diuretics

manifestations: impaired cellular energy and oxygen delivery

CARE: IV administration of sodium or potassium phosphate,

Question 9

nursing considerations for hypermagnesemia

Answer 9

cause: renal failure

manifestations: deppressed reflexes, hypotension, urinary retention

treatment: calcium gluconate, IV furosemide

Question 10

nursing considerations for hypomagnesemia

Answer 10

cause: malnutrition, chronic alcoholism, uncontrolled diabetes with fluid loss

manifestations: seizure, muscle cramps, cardiac , hyperactive reflexes

treatment: magnesium intake increase,