fluids and electrolytes Flashcards
Fluid Volume Deficit
Fluid intake not sufficient to meet body’s fluid needs
Causes of Fluid Volume Deficit remember vomiting colostomy
- Vomiting/Diarrhea
- Fistulas, Burns, Wound Drainage
- ileostomy/colostomy drainage
- GI irrigations/ suctioning
- Increase urine output (diuretics) meaning increase specific gravity (dark, amber urine)
What to expect in a patient with fluid vol. deficit
- Increased specific gravity (Bernardo’s urine color) do to decrease in U/O
- Increase in HR (less fluid to circulate
heart pumps faster to bring O2 to body)
-weak pulse (Thready) - Increase hematocrit (dehydration)
- dyspnea
- dehydration ( poor skin turgor, dry mucous)
- flat neck veins
- Dizziness/weakness/confusion (neuro)
- Postural hypotension
Fluid Deficit Intervention ( what meds to treat with )
- Antidiarrheal
- Antiemetic (vomiting nausea)
- Antipyretic ( fever due to concentrated urine, can develop fever)
- Antimicrobial ( prevent bacterial growth)
- IV
- check for what is listed above
Normal Potassium level
3.5 - 5
Fluid Volume Excess Think of what kinds of diseases will cause fluid overload
- Overhydration (IV)
- Heart Failure and Kidney damage ( too much fluid in body)
- Long Term corticosteroids ( causes fluid retention )
- high intake of sodium
- SIADH ( No urine output )
- Hypotonic solutions hypotonic brings fluids in ( irrigating wounds body cavities )
What to expect in fluid volume excess Think of symptoms of each
- Crackles
- Edema (pitting)
- Decreased hematocrit ( overhydration; reason for HF and kidney damage)
- Weight gain
- Veins are distended
- Pt is confused
Interventions for fluid volume excess
- Neuro, respiratory, vital signs ( *think neuro- confusion; excess fluid vol. Resp- increase fluid/difficulty breathing )
- Hematocrit/electrolyte (monitor)
- restrict fluid
- diuretics
- low sodium
- weight
- edema
- O2
- semi fowlers
Hypokalemia ( Causes )
- potassium losing diuretics
- diarrhea
- vomiting
- gastric suctioning ( reason for GI monitoring)
- kidney disease (*think low potassium kidneys deplete)
- fistula drainage
- corticosteroid * long term use causes muscles to ache)
- laxatives
- uncontrolled diabetes
- alkalosis ( *think hyperventilation)
- parenteral nutrition
- uncontrolled diabetes
Signs/Symptoms ( Hypokalemia)
- Leg/Abd Cramping
- lethargy/weakness
- shallow respirations/weak pulse (Thready)
- bowel sounds are hypoactive
- ileus ( weak intestinal movement)
- Hypotension
Hypokalemia on EKG
P- wave peaked
T- wave flat
ST segments is depressed
U waves
Pt taking oral potassium ( nursing considerations before administering to Pt.) Think Pt reactions Pt complaints
- Not taken on empty stomach ( nausea/vomiting)
- Pt. complaining of abd pain, distention, nausea/vomiting, GI bleeding, diarrhea
(discontinue)
IV Phlebitis or infiltration (What should nurse do)
- Stop IV
- RN notified/ IV site changed and restart
Pt on IV potassium (What to monitor) Think heart
Kept on cardiac monitor
For Pt. taking potassium depleting medication what should be considered/safety measures
- will be stopped potassium retaining diuretic to be prescribed
- safety measures to be monitored for Pt. experiencing muscle weakness (falls)
Hyperkalemia (Causes)
- kidney failure
- intestinal obstruction
- cell damage
- Excess oral/parenteral potassium; potassium sparing diuretics
- Excess use of salt subs
- Blood transfusion or older red blood cells ; they release potassium (must be fresh)
- Addisons’s disease
Signs/Symptoms (Hyperkalemia)
- muscle weak
- paresthesias
- hypotension
- diarrhea
- hyperactive bowel sounds
Hyperkalemia on EKG
QRS complex prolonged
PR interval depressed
ST segment narrow
T waves peaked
What routes should IV potassium never be administered by ? Think about what can happen to Pt.
IV Push
Intramuscular
Sub Cut
How should IV potassium be administered ?
Diluted and using an infusion device
Interventions (Hyperkalemia) Think what to monitor for/initiate
- Cardiovascular ( placed on cardiac monitor)
- GI
- Renal
- Respiratory
- ALL potassium stopped IV/oral withheld (IV cath kept patent)
- Give potassium excreting diuretics if kidney is not impaired
What medication do you give if kidney function is impaired ? kay what does it do ?
kayexalate ( GI sodium absorption/ potassium excretion)
Calcium given in hyperkalemia ?
Helps to protect the heart and lower potassium levels if severely high
Why is hypertonic glucose and regular insulin administered in hyperkalemia ?
helps to move excess potassium into the cells
Normal sodium level
135-145 mEq/L
Hyponatremia ( causes )
- sodium intake is low
- GI suctioning/irrigation
- Excess water intake think that is washes away salt
- diuretics
- draining skin lesions
- burns
- nausea/vomiting
- DKA (look up )
- SIADH (fluid retention)
Signs/symptoms (Hyponatremia)
- Pulse is rapid/thready think excess water/retention pulse increase trying to compensate
- postural B/P changes
- Weakness think hypo is related to weakness
- poor skin turgor
- muscle twitching Hypo ( weak )
- Apprehension * when Hypo body is compensating for loss/ Rapid pulse*
Hyponatremia ( Interventions )
- GI
- Cardiac
- Respiratory
- Cerebral
- Renal
- Increase sodium
If hyponatremia accompanied with hypovolemia what is to be prescribed ? think loss of sodium
Sodium Chloride
If hyponatremia is accompanied by hypervolemia what is to be prescribed ? think excess amount/ how to decrease
Osmotic Diuretics
Hyponatremic Pt on lithium how do they interfere with each other ?
diminished excretion of lithium do to being hyponatremic which can cause toxicity
Hypernatremia ( causes )
- Decreased water intake
- Fever think unable to concentrate urine
- excess sweating
- dehydration
- hyperventilation
- enteral nutrition and parenteral nutrition(deplete cells in water)
- Diabetes insipidus ( look up )
- Cushing’s ( think corticosteroids )
- impaired kidney function
Hypernatremia (signs/symptoms)
- Thirst
- dry mucous
- Loss of skin turgor
- Oliguria urine output decreased due to poor in water intake
- Muscle twitching
- Confusion
- Fatigue
- Seizures
- Elevated Temp
Hypernatremia (Interventions)
- If fluid loss IV fluids given
- Diuretics prescribed if there is poor excretion of sodium
Normal Calcium level
8.6 - 10
Hypocalcemia (causes)
- Not enough calcium and Vit D intake
- low absorption of calcium in intestines (diarrhea)
- Diarrhea (need calcium to move muscle)
- immobile ( long term) * demineralizes bone
- Decreased secretion of parathyroid hormone Think aids in calcium balance in bones
- Acute pancreatitis
- Crohn’s (diarrhea)
- Excess blood transfusions
- GI losses (draining/diarrhea)
- End stage renal disease
Hypocalcemia (signs/symptoms)
- Tachycardia
- Hypotension
- Paresthesias
- Twitching/Tetany
- Cramps
- Positive Chvostek’s and trousseaus
- Diarrhea
- Hyperactive bowel sounds think no calcium no control of muscle movement
What can cause hypocalcemia ? (medications)
- Heparin (anticoagulant)
- Diuretics
- Laxatives
- Anticonvulsants
- Caffeine
- Cigarettes
EKG changes in Hypocalcemia
prolonged QT interval think prolonged line after the QRS complex
Hypocalcemia (Interventions)
- Pt on cardiac monitor
- Give medications that increase calcium
- Seizure precautions
- Quiet environment
What medications are given in Hypocalcemia ?
- 10% Cal gluconate in severe hypocalcemia
- Vit D for absorption of calcium in intestinal tract
- Oral or IV calcium ( watch for any EKG changes)
- Aluminum hydroxide ( reduce phosphorus levels that can cause an increase in calcium)
Hypercalcemia (causes)
- High intake of Calcium and Vit D
- Bone destruction due to increase resorption (tumors, fractures, osteoporosis, immobility)
- Decrease excretion
- Kidney disease
- Hyperparathyroid
- Lithium use
- Glucocorticoid use
- Adrenal insufficiency
Hypercalcemia (sign/symptoms)
- Increased HR/blood pressure
- Bounding pulse
- Bradycardia (late stage) *
- Weak muscle (hypotonicity)
- Diminished deep tendon reflexes
- Distended ABD muscles think muscles are become tight in excessive use of Cal
- Constipation
- Hypoactive bowel sounds
- Nausea/Vomiting
Hypercalcemia (Interventions)
- IV/oral/vitamin containing calcium are to be discontinued
- Thiazide diuretics discontinued (they reabsorb calcium in distal tubules)
- Dialysis (if severe)
- Monitor for flank or abdominal pain, strain urine to check for stones
What medications prevent calcium from reabsorption
- Calcitonin
- Calcitonin (calcimar)
- Prostaglandin synthesis inhibitors (NSAIDS)
- Bisphosphonates (prevent loss of bone density like in osteoporosis)
Normal Mg level
1.6 -2.6
Hypomagnesemia (causes)
- Malnutrition ( not enough intake in diet)
- Diarrhea such as in(Crohn’s/Celiac)
- Alcoholism
- Gastric suctioning, colostomy, intestinal fistulas
- DKA
- Chemotherapy
- Sepsis
- Eclampsia (Seizures/ Mg lost, treat with Mg Sul)
Hypomagnesemia (interventions)
- Remember when there is Hypomagnesemia there is also Hypocalcemia so you must restore calcium levels as well*
- IV Mag Sulfate (severe such as in eclampsia)
- Food with Mg
What do oral preparations of magnesium cause think of laxatives
Can cause diarrhea and loose Mg
What is adverse effect does Mg by intramuscular injection do ?
causes tissue damage and cause pain
During Mg administration what is closely monitored ?
- Deep tendon reflexes (indicates hypermagnesemia)
Hypermagnesemia (causes)
- Laxatives and Antacids (they contain Mg)
- Renal insufficiency and renal failure
- Treatment of pre-eclampsia with Mg
Hypermagnesemia (signs/symptoms)
- Hypotension
- Bradycardia
- Weak pulse
- Sweating/Flushing
- Respiratory depression
- Loss of deep tendon reflexes
EKG changes in HyperMg
- Prolonged PR interval
- Widened QRS complex
HyperMg (interventions) think medications
- Diuretics (for excretion)
- IV Ca Chloride/Ca Gluconate to reverse Mg effects on cardiac muscle
- Restricting Mg intake
What is the antidote of Cal Gluconate ?
Magnesium remember Where Mg goes Ca follows
Hypophosphorus (causes) phosphorus is needed for bones
- Decrease intake/malnutrition think diet
- Mg based or aluminum hydroxide based antacids
- Kidney failure
- Hyperparathyroidism
- Malignancy
- Hypercalcemia
- Alcohol withdrawal
- DKA
- Respiratory alkalosis
Hypophosphatemia (signs/symptom)
- Confusion
- Seizures
- Weakness
- Decreased deep tendon reflexes
- Shallow respirations- Increased bleeding tendency
- Immunosuppressed
- Bone pain
Normal Phosphorus level
2.7 - 4.5
Nursing Interventions for Hypophosphatemia
- Medications that contribute to hypophosphatemia will be discontinued
- Administer phosphorus with Vit D supplement
- IV Phos may be prescribed if levels get too low
- Monitor for fracture/move Pt. Carefully
- Increase Phosphorus containing foods
What kind of foods contain phosphorus ?
- Fish
- Organ meat
- Nuts
- Pork, beef, chicken
- Whole grain breads and cereals
- Dairy products
When there is a decrease in Phosphorus is there an increase or decrease in calcium ?
Increase Hypercalcemia and opposite if there is an increase in phosphorus
Hyperphosphatemia (causes)
- Excess intake
- Overuse of phosphorus containing laxatives and enemas
- Vit D intoxication
- Hypoparathyroidism
- Renal insufficiency
- Chemotherapy
Hyperphosphatemia (signs/symptoms)
- Neuromuscular irritability
- Muscle weakness
- Hyperactive reflexes
- Tetany
- Positive Chvosteks or trousseaus
Interventions for Hyperphosphatemia
- Managing Hypocalcemia since there is am increase of phosphorus there is a decrease in calcium
- Anything containing phosphorus (medications; laxatives/enemas
Normal Chloride level
97- 107
Hyperchloremia (causes) think blood loss
- Prolonged vomiting, diarrhea, sweating, high fever, diabetes insipidus, kidney failure
Hyperchloremia (signs/symptoms) think everything is depressed
- Respiratory depression
- Hypotension
- Bradycardia
- Weak pulse
- loss of deep tendon reflexes
Hypochloremia (causes)
- Dehydration
- Vomiting
- Diarrhea
- Loss of salt
- Diuretics (thiazides)
- Addison’s disease
- SIADH
Hypochloremia (signs/symptoms)
Weakness/confusion
