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NCLEX ( fundamentals/MegSurg) > fluids and electrolytes > Flashcards

fluids and electrolytes Flashcards

1
Q

Fluid Volume Deficit

A

Fluid intake not sufficient to meet body’s fluid needs

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2
Q

Causes of Fluid Volume Deficit remember vomiting colostomy

A
  • Vomiting/Diarrhea
  • Fistulas, Burns, Wound Drainage
  • ileostomy/colostomy drainage
  • GI irrigations/ suctioning
  • Increase urine output (diuretics) meaning increase specific gravity (dark, amber urine)
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3
Q

What to expect in a patient with fluid vol. deficit

A
  • 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
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4
Q

Fluid Deficit Intervention ( what meds to treat with )

A
  • Antidiarrheal
  • Antiemetic (vomiting nausea)
  • Antipyretic ( fever due to concentrated urine, can develop fever)
  • Antimicrobial ( prevent bacterial growth)
  • IV
  • check for what is listed above
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5
Q

Normal Potassium level

A

3.5 - 5

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6
Q

Fluid Volume Excess Think of what kinds of diseases will cause fluid overload

A
  • 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 )
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7
Q

What to expect in fluid volume excess Think of symptoms of each

A
  • Crackles
  • Edema (pitting)
  • Decreased hematocrit ( overhydration; reason for HF and kidney damage)
  • Weight gain
  • Veins are distended
  • Pt is confused
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8
Q

Interventions for fluid volume excess

A
  • 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
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9
Q

Hypokalemia ( Causes )

A
  • 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
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10
Q

Signs/Symptoms ( Hypokalemia)

A
  • Leg/Abd Cramping
  • lethargy/weakness
  • shallow respirations/weak pulse (Thready)
  • bowel sounds are hypoactive
  • ileus ( weak intestinal movement)
  • Hypotension
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11
Q

Hypokalemia on EKG

A

P- wave peaked
T- wave flat
ST segments is depressed
U waves

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12
Q

Pt taking oral potassium ( nursing considerations before administering to Pt.) Think Pt reactions Pt complaints

A
  • Not taken on empty stomach ( nausea/vomiting)
  • Pt. complaining of abd pain, distention, nausea/vomiting, GI bleeding, diarrhea
    (discontinue)
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13
Q

IV Phlebitis or infiltration (What should nurse do)

A
  • Stop IV

- RN notified/ IV site changed and restart

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14
Q

Pt on IV potassium (What to monitor) Think heart

A

Kept on cardiac monitor

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15
Q

For Pt. taking potassium depleting medication what should be considered/safety measures

A
  • will be stopped potassium retaining diuretic to be prescribed
  • safety measures to be monitored for Pt. experiencing muscle weakness (falls)
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16
Q

Hyperkalemia (Causes)

A
  • 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
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17
Q

Signs/Symptoms (Hyperkalemia)

A
  • muscle weak
  • paresthesias
  • hypotension
  • diarrhea
  • hyperactive bowel sounds
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18
Q

Hyperkalemia on EKG

A

QRS complex prolonged
PR interval depressed
ST segment narrow
T waves peaked

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19
Q

What routes should IV potassium never be administered by ? Think about what can happen to Pt.

A

IV Push
Intramuscular
Sub Cut

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20
Q

How should IV potassium be administered ?

A

Diluted and using an infusion device

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21
Q

Interventions (Hyperkalemia) Think what to monitor for/initiate

A
  • 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
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22
Q

What medication do you give if kidney function is impaired ? kay what does it do ?

A

kayexalate ( GI sodium absorption/ potassium excretion)

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23
Q

Calcium given in hyperkalemia ?

A

Helps to protect the heart and lower potassium levels if severely high

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24
Q

Why is hypertonic glucose and regular insulin administered in hyperkalemia ?

A

helps to move excess potassium into the cells

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25
Normal sodium level
135-145 mEq/L
26
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)
27
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*
28
Hyponatremia ( Interventions )
- GI - Cardiac - Respiratory - Cerebral - Renal - Increase sodium
29
If hyponatremia accompanied with hypovolemia what is to be prescribed ? *think loss of sodium*
Sodium Chloride
30
If hyponatremia is accompanied by hypervolemia what is to be prescribed ? *think excess amount/ how to decrease*
Osmotic Diuretics
31
Hyponatremic Pt on lithium how do they interfere with each other ?
diminished excretion of lithium do to being hyponatremic which can cause toxicity
32
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
33
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
34
Hypernatremia (Interventions)
- If fluid loss IV fluids given | - Diuretics prescribed if there is poor excretion of sodium
35
Normal Calcium level
8.6 - 10
36
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
37
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*
38
What can cause hypocalcemia ? (medications)
- Heparin (anticoagulant) - Diuretics - Laxatives - Anticonvulsants - Caffeine - Cigarettes
39
EKG changes in Hypocalcemia
prolonged QT interval *think prolonged line after the QRS complex*
40
Hypocalcemia (Interventions)
- Pt on cardiac monitor - Give medications that increase calcium - Seizure precautions - Quiet environment
41
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)
42
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
43
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
44
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
45
What medications prevent calcium from reabsorption
- Calcitonin - Calcitonin (calcimar) - Prostaglandin synthesis inhibitors (NSAIDS) - Bisphosphonates (prevent loss of bone density like in osteoporosis)
46
Normal Mg level
1.6 -2.6
47
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)
48
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
49
What do oral preparations of magnesium cause *think of laxatives*
Can cause diarrhea and loose Mg
50
What is adverse effect does Mg by intramuscular injection do ?
causes tissue damage and cause pain
51
During Mg administration what is closely monitored ?
- Deep tendon reflexes (indicates hypermagnesemia)
52
Hypermagnesemia (causes)
- Laxatives and Antacids (they contain Mg) - Renal insufficiency and renal failure - Treatment of pre-eclampsia with Mg
53
Hypermagnesemia (signs/symptoms)
- Hypotension - Bradycardia - Weak pulse - Sweating/Flushing - Respiratory depression - Loss of deep tendon reflexes
54
EKG changes in HyperMg
- Prolonged PR interval | - Widened QRS complex
55
HyperMg (interventions) *think medications*
- Diuretics (for excretion) - IV Ca Chloride/Ca Gluconate to reverse Mg effects on cardiac muscle - Restricting Mg intake
56
What is the antidote of Cal Gluconate ?
Magnesium *remember Where Mg goes Ca follows*
57
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
58
Hypophosphatemia (signs/symptom)
- Confusion - Seizures - Weakness - Decreased deep tendon reflexes - Shallow respirations- Increased bleeding tendency - Immunosuppressed - Bone pain
59
Normal Phosphorus level
2.7 - 4.5
60
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
61
What kind of foods contain phosphorus ?
- Fish - Organ meat - Nuts - Pork, beef, chicken - Whole grain breads and cereals - Dairy products
62
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
63
Hyperphosphatemia (causes)
- Excess intake - Overuse of phosphorus containing laxatives and enemas - Vit D intoxication - Hypoparathyroidism - Renal insufficiency - Chemotherapy
64
Hyperphosphatemia (signs/symptoms)
- Neuromuscular irritability - Muscle weakness - Hyperactive reflexes - Tetany - Positive Chvosteks or trousseaus
65
Interventions for Hyperphosphatemia
- Managing Hypocalcemia since there is am increase of phosphorus there is a decrease in calcium - Anything containing phosphorus (medications; laxatives/enemas
66
Normal Chloride level
97- 107
67
Hyperchloremia (causes) *think blood loss*
- Prolonged vomiting, diarrhea, sweating, high fever, diabetes insipidus, kidney failure
68
Hyperchloremia (signs/symptoms) *think everything is depressed*
- Respiratory depression - Hypotension - Bradycardia - Weak pulse - loss of deep tendon reflexes
69
Hypochloremia (causes)
- Dehydration - Vomiting - Diarrhea - Loss of salt - Diuretics (thiazides) - Addison's disease - SIADH
70
Hypochloremia (signs/symptoms)
Weakness/confusion

NCLEX ( fundamentals/MegSurg) (8 decks)

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