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Nursing Agency 1 > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

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1
Q

What are the hypotonic solutions? (2)

A

D5W

0.45% NS

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2
Q

What are the isotonic solutions? (4)

A

0.9% NS

lactated ringer solution

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3
Q

This solution is considered isotonic but becomes free water after dextrose is metabolized; then it acts as a hypotonic solution:

A

D5W

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4
Q

When administering D5W what are two things you should watch out for?

A

hyponatremia and hyperglycemia

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5
Q

What isotonic solution replaces losses without altering fluid concentrations?

A

0.9% NS

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6
Q

Continued fluid replacement with 0.9% NS can lead to what?

A

hypernatremia and hyperchloremia

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7
Q

If a patient has heart failure, edema, or hypernatremia, what kind of solution should they NOT be given?

A

0.9% NS

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8
Q

What type of IV solution most closely resembles blood plasma?

A

lactated ringer solution

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9
Q

What IV solution is commonly used to treat hypovolemia and maintain normal fluid balance, especially in the postoperative period?

A

D5 0.45% NS

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10
Q

Why shouldn’t you administer IV potassium as a push or bolus medication?

A

It can cause severe cardiac arrhythmias and death

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11
Q

What are two herbs that act as diuretics?

A

celery and dandelion

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12
Q

What herb can lead to sodium retention and hypokalemia?

A

licorice

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13
Q

What are the clinical manifestations of respiratory acidosis?

A

headache, altered level of consciousness, dyspnea (hypoventilation), tachycardia, muscle twitching

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14
Q

What are the clinical manifestations of respiratory alkalosis?

A

Hyperventilation, tachypnea (rapid and shallow)

numbness, tingling of fingers, muscle cramping, palpitations, anxiety, ECG changes

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15
Q

What are the clinical manifestations of metabolic acidosis?

A

Kussmaul respirations, hypotension, headache, decreased LOC, weakness, nausea, vomiting

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16
Q

What are the clinical signs of metabolic alkalosis?

A

hypotension, vomiting, mental confusion, tetany, increased deep tendon reflexes, tingling fingers/toes, seizures, polyuria

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17
Q

Respiratory alkalosis is a result of _____ and excess exhalation of ______________.

A

hyperventilation; carbon dioxide

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18
Q

Respiratory acidosis occurs when gas exchange is decreased due to abnormal ventilation, perfusion, or diffusion. This leads to ________ in the blood.

A

hypercapnia

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19
Q

Why are the elderly more prone to hypokalemia?

A

Increased use of potassium-wasting diuretics

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20
Q

What electrolyte disorder can enhance the effect of digitalis and lead to digitalis toxicity and cardiac arrest?

A

hypokalemia

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21
Q

Patient teaching when prescribed digitalis and a potassium-wasting diuretic:

A

eat food high in potassium, take prescribed potassium supplements, learns signs of hypokalemia

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22
Q

Clinical manifestations of hyponatremia:

A

lethargy, confusion, weakness, muscle cramping, seizures, nausea, vomiting

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23
Q

What kind of IV solution will be administered for hyponatremia?

A

Hypertonic IV saline solutions as ordered

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24
Q

Underlying causes of hyponatremia…

A

Diuretics, GI fluid loss, profuse diaphoresis, water intoxication

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25
Q

Symptoms of hypernatremia:

A

Thirst, dry mucus membranes, weakness, elevated temperatures; severe hypernatremia can cause confusion, decreased levels of consciousness, seizures

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26
Q

Interventions for hypernatremia:

A

Monitor LOC, I/O, limit salt intake, increase water intake, administer hypotonic IV solutions as ordered

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27
Q

Causes of hypernatremia:

A

Excess sodium intake, excessive loss of water, excessive hypertonic IV solutions

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28
Q

Normal sodium

A

136-145 mEq/L

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29
Q

Symptoms of hypokalemia:

A 
Weak, irregular pulse
Decreased blood pressure
Lethargy
Muscle weakness/cramping
Hypoactive bowel sounds
Cardiac dysrhythmias 
Increased risk of digitalis toxicity
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30
Q

Interventions for hypokalemia:

A

Monitor heart rate and rhythm, ECG, assess for digitalis toxicity, encourage foods high in potassium, administer potassium supplements as ordered/IV potassium

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31
Q

Normal potassium

A

3.5-5.0 mEq/L

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32
Q

Hyperkalemia signs and symptoms

A

Anxiety, confusion, dysrhythmias (bradycardia), muscle weakness, flaccid paralysis, paresthesia, abdominal cramping

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33
Q

Causes of hypokalemia:

A

Vomiting, gastric suctioning, laxative abuse, potassium-wasting diuretics, alcoholism

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34
Q

Causes of hyperkalemia:

A

Renal failure, massive trauma, hemolysis, IV potassium, potassium-sparing diuretics, acidosis: especially diabetic ketoacidosis

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35
Q

Interventions for hyperkalemia:

A

EKG, limit potassium-rich foods, administer Kayexalate as ordered, administer glucose and insulin as ordered (potassium moves back in cell)

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36
Q

Symptoms of Hypocalcemia:

A

Confusion, numbness and tingling in extremities, tetany, seizures, hyperactive reflexes, cardiac dysrhythmias, positive Trousseau and Chvostek signs

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37
Q

Interventions for hypocalcemia:

A

ECG, institute fall and seizure precautions, encourage calcium rich foods, administer supplements as ordered

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38
Q

normal calcium

A

9-10.5 mg/dL

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39
Q

Causes of hypocalcemia:

A

Hypoparathyroidism, pancreatitis, vitamin D deficiency, HYPERphosphatemia, chronic alcoholism

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40
Q

Symptoms of hypercalcemia:

A 
Lethargy
Coma
Decreased muscle strength
Constipation 
Dysrhythmias 
Renal calculi
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41
Q

Hypercalcemia Interventions:

A

EKG, increased fluid intake, increased active ROM

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42
Q

Causes of Hypercalcemia:

A

Prolonged bed rest, hyperparathyroidism, bone cancer, osteoporosis

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43
Q

In cases of hypokalemia, what other electrolyte should be checked and replaced first in order for the the body to hold onto potassium?

A

magnesium

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44
Q

Metabolic alkalosis causes the shift of what electrolyte into cells?

A

potassium (hypokalemia)

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45
Q

What electrolyte imbalance causes tingling around the mouth?

A

hyperkalemia and hypocalcemia

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46
Q

Signs and symptoms of hyperkalemia:

A

low BP, hyperactive deep tendon reflexes, low HR, hyperactive bowel sounds, muscle twitching, water diarrhea, paresthesia (hands, feet, mouth), EKG changes

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47
Q

Causes of respiratory acidosis:

A

DEPRESS: drugs, edema, pneumonia, respiratory center of brain is damaged, emboli, Spasms of bronchial tubes, Sac (alveolar) elasticity damaged (COPD/emphysema)

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48
Q

Respiratory acidosis causes a buildup of _____ .

A

CO2

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49
Q

Nursing interventions for respiratory acidosis:

A 
administer O2
encourage coughing and deep breathing
hold any resp. depressants
watch potassium levels - can cause hyperkalemia
assess for EKG changes
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50
Q

Respiratory alkalosis is the result of expelling too much ___ due to _______.

A

CO2; tachypnea

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51
Q

Causes of respiratory alkalosis:

A 
TACHYPNEA
temperature increase
aspirin toxicity
controlled mechanical ventilation 
hyperventilation/anxiety
pain
neurological injury
embolism/edema in lungs
asthma due to hyperventilation
52
Q

Signs and symptoms of respiratory alkalosis:

A 
very fast respiratory rate
confusion
increased HR
tetany, muscle cramps
\+ Chvostek
EKG changes
decreases in potassium and calcium
53
Q

What causes metabolic alkalosis?

A 
"ALKALI"
aldosterone production is excessive
loop diuretics or thiazides
alKali ingestion - too many antacids
anticoagulant citrate
loss of fluids - vomiting, NG suction 
increases sodium bicarb. administration (over-correcting)
54
Q

Signs and symptoms of metabolic alkalosis:

A

bradypnea

symptoms of hypokalemia

55
Q

Nursing interventions for metabolic alkalosis:

A

if vomiting, give antiemetic
stop NG suctioning
stop diuretics and watch potassium and chloride levels
dr. may order diamox

56
Q

What are some causes of metabolic acidosis?

A

DKA
renal failure
diarrhea (loss of bicarb)
salicylate toxicity

57
Q

Signs and symptoms of metabolic acidosis:

A

kussmaul respirations
confusion, weakness, decreased BP
nausea, vomiting
cardiac changes due to hyperkalemia

58
Q

Nursing interventions for metabolic acidosis:

A

watch for respiratory distress
watch for signs of hyperkalemia
monitor BUN, creatinine, glucose (DKA)

59
Q

Clinical manifestations of respiratory acidosis:

A 
Headache
Altered LOC
Dyspnea
Tachycardia
Muscle twitching
60
Q

Clinical manifestations of respiratory alkalosis:

A 
Tachypnea
Numbness, tingling of fingers
Muscle cramping
Palpitations
Anxiety, restlessness
61
Q

Clinical manifestations of metabolic acidosis:

A 
Kussmaul respirations
Hypotension
Headache
Decreased LOC
Weakness
Nausea, vomiting
62
Q

Clinical manifestations of metabolic alkalosis:

A 
Hypotension
Mental confusion
Muscle twitching, tetany
Increased deep tendon reflexes
Numbness, tingling of fingers and toes
Seizures
Polyuria
Nausea, vomiting
63
Q

Cause of metabolic alkalosis:

A 
Vomiting
NG suction
Overuse of antacids
Hypokalemia
Loop and thiazide diuretics
64
Q

Causes of metabolic acidosis:

A 
Shock
Trauma
Cardiac arrest
DKA
Salicylate overdose
Chronic diarrhea
65
Q

Causes of respiratory alkalosis:

A

HYPERVENTILATION
Salicylate overdose
Pain
Nicotine overdose

66
Q

Causes of respiratory acidosis:

A

HYPOVENTILATION

  • asthma
  • pulmonary edema
  • opioids/CNS depressants
67
Q

What acid base imbalance causes Kussmaul respirations?

A

Metabolic acidosis

68
Q

What acid base imbalance can be caused by NG suctioning or overuse of antacids?

A

Metabolic alkalosis

69
Q

For which acid base imbalance will you initiate seizure precautions?

A

Metabolic acidosis

70
Q

For which acid base imbalance might you need to treat hypokalemia?

A

Metabolic alkalosis

71
Q

For which acid base imbalance will you encourage deep breathing and coughing?

A

Respiratory acidosis

72
Q

For which acid base imbalance might you administer sodium bicarbonate if ordered?

A

Metabolic acidosis

73
Q

What electrolyte imbalance cause positive Chvostek and Trousseau signs?

A

Hypocalcemia

74
Q

Normal magnesium:

A

1.3-2.1

75
Q

Causes of hypomagnesemia:

A 
malabsorption
loop and thiazide diuretics
laxative abuse
prolonged diarrhea
ulcerative colitis
76
Q

What is the loss of water without the corresponding loss of sodium?

A

dehydration

77
Q

What are the best ways to remove fluid volume excess without changing electrolyte composition or osmolality of ECF?

A

diuretics
fluid restriction
restriction of sodium intake

78
Q

Nursing management of fluid volume imbalances:

A 
daily weights
I/O
lab findings
cardiovascular care
respiratory care
patient safety
skin care
79
Q

What is the body’s primary protective mechanism against hypernatremia?

A

thirst

80
Q

If a patient is experiencing severe hyponatremia (seizures) what IV solution would you expect to give?

A

small amount of hypertonic saline solution (3% NaCl)

81
Q

If the cause of hyponatremia is abnormal fluid loss, what type of IV solution would you expect?

A

isotonic sodium-containing

82
Q

In a case of hyperkalemia, what is an order you would expect to force K+ from ECF to ICF?

A

insulin with dextrose

83
Q

In a case of hyperkalemia, what would be administered to stabilize cardiac cell membrane?

A

calcium gluconate IV

84
Q

What should you always expect to monitor with hyperkalemia?

A

continuous ECG monitoring

85
Q

What are two main causes of hypercalcemia?

A

hyperparathyroidism

cancer

86
Q

Nursing Management of hypercalcemia:

A 
low calcium diet
increased weight-bearing activity
increased fluid intake
isotonic saline infusion
bisphosphonates
calcitonin
87
Q

What electrolyte deficit causes positive Chvostek and Trousseau signs?

A

hypocalcemia

88
Q

What electrolyte deficit causes laryngeal stridor?

A

hypocalcemia

89
Q

Numbness and tingling around mouth and/or extremities is caused by:

A

hypocalcemia

90
Q

Nursing Management of hypocalcemia:

A

calcium and vitamin D supplements
IV calcium gluconate
rebreathe into paper bag
treat pain and anxiety to prevent hyperventilation and respiratory alkalosis

91
Q

Serum levels o phosphate are controlled by:

A

parathyroid hormone

92
Q

Phosphate has an inverse relationship with _____.

A

calcium

93
Q

If you have hyperphosphatemia, it is likely your calcium level is _____.

A

low

94
Q

A loop diuretic such as furosemide might be ordered for which electrolyte imbalance?

A

hypermagnesemia

95
Q

Symptoms of hypermagnesemia resemble those of:

A

hypocalcemia

96
Q

Primary food sources of potassium:

A 
fish (NOT shellfish), whole grains, nuts
broccoli, cabbage, carrots, celery, 
cucumbers, potatoes with skins
spinach, tomatoes
apricots, bananas, cantaloupe, nectarines, oranges, tangerines
97
Q

Primary food sources of calcium:

A

cheese, ice cream, milk, yogurt, rhubarb, spinach, tofu

98
Q

Primary food sources of magnesium:

A

cashews, halibut, swiss chard and other leafy greens, tofu, wheat germ, dried fruit

99
Q

Primary food sources of phosphate:

A

milk, meat, nuts, legumes, grains

100
Q

Clinical manifestations of hypomagnesemia:

A 
irritable nerves and muscles
hyperactive deep tendon reflexes (think restless leg syndrome)
dysrhythmias
ECG changes
dysphasia
101
Q

Clinical manifestations of hypermagnesemia:

A 
warm, flushed appearance
decreased muscle strength
decreased deep tendon reflexes
hypotension
slow, shallow respirations; respiratory arrest
102
Q

rapid onset of hypernatremia is caused by:

A

severe vomiting
hypertonic IV fluids
excessive sweating

103
Q

slow onset of hypernatremia may be caused by:

A

heart failure
renal failure
increased sodium intake

104
Q

What herb acts has a cathartic/laxative and can lead to hypokalemia?

A

aloe

105
Q

prolonged use of normal saline can lead to ____ and ______

A

hypernatremia; circulatory overload

106
Q

hydrochlorothiazide causes losses of:

A

sodium, potassium, magnesium

107
Q

What is a thiazide diuretic that promotes calcium reabsorption?

A

hydrochlorothiazide

108
Q

What kind of diuretic is spironolactone?

A

potassium-sparing

109
Q

patient teaching for spironolactone:

A

avoid direct sunlight (photosensitivity)

avoid foods rich in potassium

110
Q

What should you assess (history) before administering spironolactone?

A

is the patient taking potassium supplements or using a salt substitute

111
Q

What type of diuretic is furosemide?

A

loop diuretic

112
Q

What is the concern if your patient is taking furosemide and an aminoglycoside?

A

ototoxicity

113
Q

What should you observe for if your patient is taking furosemide?

A

hypokalemia and digoxin toxicity

also: monitor BP and weigh pt daily

114
Q

What diuretic is given to decrease IOP in pt with narrow angle glaucoma?

A

acetazolamide (carbonic anhydrase inhibitor)

115
Q

The osmotic diuretic _____ is potassium ______.

A

mannitol; wasting

116
Q

lisinopril is an ______

A

ACE inhibitor

117
Q

What pt history should you gather before administering lisinopril?

A

are they taking K+ supplements, potassium-sparing diuretics, or using salt substitutes?

118
Q

What are side effects of lisinopril?

A

hyperkalemia and angioedema

119
Q

normal phosphate

A

3-4.5

120
Q

normal BUN

A

7-20

121
Q

normal creatinine

A

0.7-1.3

122
Q

normal urine specific gravity

A

1.010-1.030

123
Q

Hgb

A

12-18

124
Q

Hct

A

36-54%

125
Q

2.2lbs is the equivalent of how much body fluid?

A

1L

126
Q

therapeutic digoxin level

A

0.8-2

Nursing Agency 1 (3 decks)

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