FLUID VOLUME DISTURBANCES Flashcards
1
Q
loss of ECF volume exceeds the intake of fluid.
A
hypovolemia
2
Q
isotonic volume expansion of the ECF
A
hypervolemia
3
Q
Hyponatremia refers to a serum sodium level that is less than
A
135
4
Q
Hypernatremia is a serum sodium level higher than
A
145 mEq/L.
5
Q
sually indicates a deficit in total potassium stores.
A
hypokalemia
6
Q
Hyperkalemia refers to a potassium level greater than
A
5.0 mEq/L.
7
Q
Hypocalcemia are serum levels below
A
8.6 mg/di.
8
Q
Hypercalcemia is a calcium level greater than
A
10.2 mg/dl.
9
Q
refers to a below-normal serum magnesium concentration.
A
Hypomagnesemia
10
Q
Hypermagnesemia are serum levels over
A
2.3 mg/di.
11
Q
Hypophosphatemia is indicated by a value below
A
2.5
12
Q
Hyperphosphatemia is a serum phosphorus level
that exceeds
A
4.5
13
Q
SIADH
A
SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC
HORMONE
14
Q
DISORDER OF IMPAIRED WATER EXCRETION CAUSED BY THE
INABILITY TO SUPPRESS THE SECRETION OF ANTIDIURETIC HORMONE (ADH).
A
SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC
HORMONE
15
Q
Water is retained abnormally in
A
SIADH
16
Q
give 6 diagnostic exams
A
BUN
Hematocrit
Physical exam
Serum Electrolyte
ECG
ABG
17
Q
used to treat the hypotensive patient with FVD
A
Isotonic electrolyte solutions
18
Q
performed to remove nitrogenous wastes and control
potassium and acid-base balance
A
Hemodialysis
19
Q
treat hyponatremia by
stimulating free water excretion.
A
AVP receptor agonists
20
Q
decrease fluid volume in FVE, diuretics
are administered
A
Diuretics.
21
Q
serum potassium levels are
dangerously elevated, it may be necessary
A
IV Calcium gluconate
22
Q
used to lower the
serum calcium level and is particularly useful for
patients with heart disease
A
Calcitonin.
23
Q
enhance
conservation of water by increasing the
permeability of collecting ducts to wate
A
Avp/ Vasopressin is a vasopressin receptor
agonist.
24
Q
also a potent
vasoconstrictor and exerts a direct constrictive
action on specific smooth muscle receptors
A
Vasopressin
25
when loss of extracellular
fluid exceeds the intake of fluid
hypovolemia
26
predisposing factors of hypovolemia
DAOHCT
Diabetes Insipidus
● Adrenal insufficiency
● Osmotic diuresis
● Hemorrhage
● Coma
● Third-space fluid shifts
27
movement of fluid from
the vascular system to other body space
third-space fluid shifts
28
signs and symptoms of hypovolemia
LTDOC
Low BP (Postural hypotension)
● Tachycardia: rapid weak & thready pulse
● Decreased skin turgor
● Oliguria
● Concentrated urine
29
SIGNS AND SYMPTOMS (INFANT AND YOUNG CHILDREN)
Crying without tears
● No wet diapers for three hours or more
● Being unusually sleepy or drowsy
● Irritability Eyes that look sunken
● Sunken fontanel
30
CBC results of hypovolemic px
increase hematocrit
Elevated BUN
Decreased plasma volume
31
Urine test for hypovolemic px
Increased BUN
Na concentration
Urine pH
32
factors caused by:
Diarrhea
Fistula
Wounds
Diabetes insipidus
DKA
33
Level of Conciousness (5)
Alert
Lethargy
Obstundation
Stupor
Coma
34
Appearance of wakefulness, awareness of the self
and environment
Alert
35
mild reduction in alertness
Lethargy
36
moderate reduction in alertness. Increased response
time to stimuli
obtundation
37
Deep sleep, patient can be aroused only by vigorous
and repetitive stimulation. Returns to deep sleep
when not continually stimulated.
stupor
38
Sleep lice appearance and behaviorally unresponsive
to all external stimuli (Unarousable unresponsiveness,
eyes closed)
COMA (UNCONSCIOUS)
39
measure of pressure in the vena cava,
CENTRAL VENOUS PRESSURE
40
often used as an assessment of hemodynamic
status
CENTRAL VENOUS PRESSURE
41
stage 1 of hypovolemic shock
: 15% blood loss
(750 mL or about 25 ounces).
42
stage 2 of hypovolemic shock
15% to 30%
(750 mL to 1,500 mL or up to almost 51 ounces)
43
stage 2 of hypovolemic shock
30% to 40% of your blood (1,500 to 2,000 mL or up to 68 oz.)
44
isotonic volume
expansion of the extracellular fluid (ECF) caused by
the abnormal retention of water and sodium
● HYPERVOLEMIA r
45
SIGNS & SYMPTOMS (PULMONARY)
for hypervol
Pulmonary Congestion: crackles, rales
● Change in respiratory pattern
● Shortness of breath; orthopnea/dyspnea
● Orthopnea, Paroxysmal nocturnal dyspnea
● Cough
● X-ray shows pulmonary edema
46
SIGNS & SYMPTOMS (NEUROLOGIC)
for hypervol
Headache
● Restlessness, Anxiety
● Seizures
● Change in mental status (confusion), LOC
47
SIGNS & SYMPTOMS (EDEMA/ASCITES
hypervol
Dependent Pitting Edema
● Ascites
48
biochemical abnormality,
defined as elevation, or buildup of,
nitrogenous products
Azotemia
49
(BUN-usually ranging 7
to 21 mg/dL)
Azotemia
50
Normal urine specific gravity levels are
between
1.010 and 1.02
51
Urine Specific gr.
increases IF
if concentrated.
52
disorder that causes excess
excretion of protein in the urine
Nephrotic syndrome
53
swelling that occurs prior to
a woman's menstrual cycle
Premenstrual edema
54
CBC for hypercolemia
Low hematocrit
Serum Na
High Na
55
Urine test for hypervol
Increased BUN
56
Administer drugs to release water like
lasix,
hydrochlorothiazide or aldactone
57
OTHER TREATMENT OPTIONS FOR HYPERVOLEMIA INCLUDE:
Undergoing dialysis or paracentesis:
58
1kg weight gain is to
!L of water
59
Evidenced seen in hypervol
Ascites.
● Extra heart sounds S3
● Aphasia, muscle twitching, tremors, seizures
● Hypertension
● Productive cough.
● Bounding pulses.
● Shortness of breath.
● Changes in LOC (lethargy, disorientation, confusion to
coma)
● Sudden weight gain,
60
major extracellular fluid cation.
Sodium (Na)
61
facilitating impulse transmission in nerve
muscle fibers by participating in the
sodium-potassium pump.
Importance of NA
62
HYPERNATREMIA
↑ serum Na+ >145 mEq/L
urine specific gravity >1.025
63
s/s of hypernatremia
FRIED
● Fever-low grade , Flushed skin
● Restless (irritable)
● Increased fluid retention
● EDema ( peripheral and pitting)
● Decrease urine output, Dry mouth
64
SIGNS AND SYMPTOMS (TOO MUCH SALT)
SALT
Skin flushed
● Agitation
● Low grade fever
● Thirst
65
6mm deep pit for 10-12 secs grade of edema
3+
66
4 mm deep pit
2+
67
signs of circulatory overload
dyspnea, orthopnea, wheezing, tightness in
the chest, cough, cyanosis, tachypnea, rapid
increase in blood pressure, distended neck
veins..)
68
HYPONATREMIA
↓ serum Na+ <135 mEq/L
● Urine specific gravity <1.005
69
SIGNS AND SYMPTOMS of hyponat
SALT
Stupor/Coma
● Anorexia
● Lethargy
● Tendon reflexes ↓↓ - Depressed DTR
70
very brisk, hyperactive, with
clonus
4+
71
Average, expected response;
normal
2+
72
Brisker than average, slightly
hyperreflexic
3=
73
SIGNS AND SYMPTOMS (LOSS) for hyponat
Limp muscles
● Orthostatic hypotension
● Seizures
● Stomach crampingq
74
. EUVOLEMIC HYPONATREMIA
Caused by SIADH antidiuretic hormone problems:
fluid restriction
75
Euvolemia treated with antidiuretic hormone
antagonists called
Declomycin
76
major cation in the intracellular
fluid (ICF).
Potassium
77
K normal range
Normal Range: 3.5 - 5.0 mEq/L
78
ICF AND ECF of potassium
98% ICF and 2% ECF
79
5 functions of potassium
Aids in Heart & Muscle Contractility -Participates in Sodium - Potassium Pump
Maintains osmotic pressure in the intra and
extracellular environments -
80
Hyperkalemia
>5.0 meq/L
81
mild hyperkalemia
5.1-6.0
82
moderate hyperkalemia
6.1-7.0
83
severe hyperkalemia
above 7.0
84
S/S of hyperkal
MURDER
Muscle weakness/cramps
● Urine, oliguria, anuria
● Respiratory distress
● Decrease cardiac contractility
● EKG changes
● Reflexes ( hyper or areflexia)
85
Peaked T waves, Prolonged PR segment
Mild hyperkal
86
Loss of P wave, prolonged QRS. ST elevates
Moderate hyperkal
87
progressive widening of QRS comples, Sine wave, Ventricular fibri
Severe hyperkal
88
TREATMENT “C BIG K DROP”
Calcium gluconate (stabilizes cardiac membrane)
● Beta-2-agonist(albuterol neb q2-4hrs), Bicarb (shift
K+ to the cell)
● Insulin
● Glucose
● Kayexalate(Na polystyrene sulfonate)- to excrete K+
out
● Drop
89
to excrete K+
out
Kayexalate(Na polystyrene sulfonate)-
90
given to rapidly REVERSE
conduction abnormalities.
calcium infusion
91
HYPOKALEMIA
↓ serum K+ = <3.5 mEq/L
92
causes of hypokal
DITCH
DRUGS: loop diuretics, laxatives, glucocorticoids
(Hydrocortisone)
● INADEQUATE CONSUMPTION OF K+
● TOO MUCH WATER INTAKE
● CUSHING’S SYNDROME - causes kidneys to excrete
K+
● HEAVY FLUID LOSS - vomiting, diarrhea, wound
drainage, gastric lavage
93
SIGNS & SYMPTOMS (7L’S) of hypokal
Lethargy
● Low, shallow breathing
● Lethal cardiac arrest
● Loss of urine
● Leg cramps
● Limp muscles
● Low BP & HR
94
TREATMENT (STOP K+ LOSSES!)
no to lasix
Discontinue diuretics
Use potassium-sparing
95
potassium-sparing diuretics
/Aldactone,
Dyazide, Maxide, Triamterene
96
(for severe heart
failure
Triamterene
97
alkalosis potassium deficiency
use potassium chloride
98
acidosis potassium deficiency
use potassium acetate
99
IV Potassium for levels less than
2.5 mEq.
100
TREATMENT (NEVER EVER GIVE?
K+ VIA IV PUSH OR BY IM OR
SUBQ ROUTES!)
