Fluids and Electrolytes Flashcards
1
Q
Isotonic dehydration
A
Water and electrolytes are lost in equal proportions.
Leads to decreased blood volume and tissue perfusion.
2
Q
Hypertonic dehydration
A
Water loss exceeds electrolyte loss
Fluid moves from the intracellular space into the plasma and interstitial fluid causing cellular dehydration and shrinkage.
3
Q
Hypotonic dehydration
A
Electrolyte loss exceeds water loss.
Fluid moves from the interstitial space and plasma into the intracellular space causing plasma fluid deficit and swelling in the cells.
4
Q
Causes of isotonic dehydration
A
- Inadequate intake of fluids and solutes
- Fluid shifts between compartments
- Excessive losses of isotonic body fluids
5
Q
Causes of hypertonic dehydration
A
Increase fluid loss:
- Excessive perspiration
- Hyperventilation
- Ketoacidosis
- Prolonged fevers
- Diarrhea
- Early stage kidney disease
6
Q
Causes of hypotonic dehydration
A
- Chronic illness
- Excessive hypotonic fluid replacement
- Kidney disease
- Chronic malnutrition
7
Q
Assessment of fluid volume deficit
A
- Thready fast pulse, diminished peripheral pulses
- Dysrhythmias
- Increased rate and depth of respirations
- Diminished CNS: lethargy to coma
- Decreased urine output
- Poor turgor, dry skin and mouth
- Decreased motility and BS, constipation
8
Q
Hypovolemia laboratory findings
A
- Increased serum osmolarity
- Increased hematoma
- Increased blood urea nitrogen (BUN)
- Increased serum sodium
- Increased urinary specific gravity
9
Q
Hypovolemia interventions
A
- Monitor patient assessment
- Prevent further fluid loss
- Provide oral hydration of possible, IV replacement if severe
- Monitor intake and output
- Depending on cause administer antidiarrheal, antimicrobial, antiemetic or antipyretic
10
Q
Causes Isotonic hypervolemia
A
- Inadequately controlled IV therapy
- Kidney disease
- Long term corticosteroid therapy
11
Q
Causes of hypertonic hypervolemia
A
- Excessive sodium ingestion
- Rapid infusion or hypertonic saline
- Excessive sodium bicarbonate therapy
12
Q
Causes of hypotonic hypervolemia
A
- Early kidney disease
- Heart failure
- Syndrome of inappropriate antidiuretic hormone secretion
- Inadequately controlled IV therapy
- Replacement of isotonic fluid loss with hypotonic fluids
- Irrigation of wounds and body cavities with hypotonic fluids
13
Q
Assessment of hypervolemia
A
- Bounding increased bounding pulse and hypertension
- Distention of veins, elevated CVP, dysrhythmias
- Increased RR, dyspnea, crackles on auscultation
- Altered level of consciousness
- Headache, visual disturbance, muscle weakness, paresthesia
- Increased urine output if kidneys can compensate
- Pitting edema
- Increased motility and BS diarrhea , liver enlargement, ascites
14
Q
Hypervolemia laboratory findings
A
- Decreased serum osmolarity
- Decreased hematocrit
Decreased BUN level - Decreased serum sodium level
- Decreased urine specific gravity
15
Q
Hypervolemia interventions
A
- Monitor assessment
- Prevent further overload and restore balance
- Administer diuretics, osmotic diuretics may be prescribed to prevent sever electrolyte imbalances
- Restrict fluid and sodium intake
- Monitor intake and output + weight
- Monitor electrolyte values
16
Q
Normal Serum Potassium levels
A
3.5-5.0 mEq/L (mmol/L)
17
Q
Causes of body potassium loss
A
- Medications such as diuretics (loop/thiazide), corticosteroids, bronchodilators
- Increased aldosterone (cushings)
- Vomiting, diarrhea, excessive diaphoresis
- GI wound drainage
- Prolonged NG succion
- Kidney disease
18
Q
Causes of hypokalemia
A
- Actual body K+ loss
- Inadequate potassium intake (NPO)
- Movement from extra to intracellular space (alkalosis, hyperinsulinism)
- Dilution or serum K+ (water intoxication, IV therapy)
19
Q
Assessment of a patient with hypokalemia
A
- Thready weak irregular pulse and orthostatic hypotension
- Shallow ineffective breathing with diminished breath sounds
- Anxiety, lethargy, confusion, coma
- Skeletal muscle weakness , legs cramps
- Loss of tactile discrimination, paresthesia, deep tendon hyporeflexia
- Decreased motility, hypoactive bowel sounds
- Nausea, vomiting, constipation, abdo distention
- Paralytic ileus
20
Q
ECG for hypokalemia
A
- ST depression
- Shallow flat or inverted T wave
- Prominent U wave
21
Q
Interventions of hypokalemia
A
- Monitor assessment + electrolytes
- PO K+: causes N/V not to be taken on an empty stomach, if vomiting give IV
- DC meds, prescribe K+ retaining diuretics
- Educate about foods high in K+
22
Q
Precautions of IV K+
A
- Never give push, never give more than 20 mEq/H (average 5-10 mmol/h)
- More than 10 mEq/h should be on a cardiac monitor
- Infusions can cause phlebitis or infiltration
23
Q
Causes of hyperkalemia
A
- Excessive K+ intake
- Decreased K+ excretion (Spironolactone, Addison’s (increased aldosterone), kidney disease)
- Movement of K+ from intra et extracellular space
24
Q
Assessment of a patient with hyperkalemia
A
- Slow, weak, irregular irregular hear rate, decreased blood pressure
- Respiratory failure (muscle weakness)
- Early: muscle twitches, paresthesia, cramps, numbness
Late: pronounced weakness, paralysis in arms and legs, - Increased motility, hyperactive bowel sounds, diarrhea
25
ECG for hyperkalemia
- Tall peaked T waves
- Flat P waves
- Widened QRS complexes
- Prolonged PR interval
26
Interventions hyperkalemia
- Monitor assessment and electrolyte values
- Initiate a K+ restricted diet
- K+ excreting diuretics if good kidney function
- If bad renal function give Kayexelate (eliminates in stool)
- Dialysis if critically high
- IV calcium to avoid myocardial excitability
- If blood transfusions use fresh blood, cell decay releases K+
27
Normal serum sodium levels
135 - 145 mEq/L (mmol/L)
28
Normal calcium values
9.0 - 10.5 mg/dL (2.25 - 2.75 mmol/L)
29
Normal magnesium values
1.3 - 2.1 mEq/L (0.65 - 1.05 mmol/L)
30
Normal phosphate values
3.0 - 4.5 mg/dL (0.97 - 1.45 mmol/L)
31
Hypocalcemia ECG changes
- Prolonged ST segment
| - Prolonged QT interval
32
Hypercalcemia ECG changes
- Shortened ST segments
| - Widened T waves
33
Hypomagnesemia ECG changes
- Tall T waves
| - Depressed ST segment
34
Hypermagnesemia ECG changes
- Prolonged PR interval
| - Widened QRS complexes
35
Causes of Hyponatremia
- Increased sodium excretion (sweating, diuretics, vomiting, diarrhea wound drainage, kidney disease, low aldosterone)
- Inadequate sodium intake
- Dilution of serum sodium (heart failure, fresh water drowning, syndrome of ADH secretion)
36
Causes of Hypernatremia
- Decreased sodium excretion: corticosteroids, cushings, kidney, hyperaldosteronism
- Increased sodium intake
- Decreased water intake
- Increased water loss: increased metabolic rate, fever, hyperventilation, diabetes insipidus
