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

fluids and electrolytes Flashcards

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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
Q

Normal sodium level

A

135-145 mEq/L

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26
Q

Hyponatremia ( causes )

A
  • 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)
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27
Q

Signs/symptoms (Hyponatremia)

A
  • 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*
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28
Q

Hyponatremia ( Interventions )

A
  • GI
  • Cardiac
  • Respiratory
  • Cerebral
  • Renal
  • Increase sodium
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29
Q

If hyponatremia accompanied with hypovolemia what is to be prescribed ? think loss of sodium

A

Sodium Chloride

30
Q

If hyponatremia is accompanied by hypervolemia what is to be prescribed ? think excess amount/ how to decrease

A

Osmotic Diuretics

31
Q

Hyponatremic Pt on lithium how do they interfere with each other ?

A

diminished excretion of lithium do to being hyponatremic which can cause toxicity

32
Q

Hypernatremia ( causes )

A
  • 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
Q

Hypernatremia (signs/symptoms)

A
  • 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
Q

Hypernatremia (Interventions)

A
  • If fluid loss IV fluids given

- Diuretics prescribed if there is poor excretion of sodium

35
Q

Normal Calcium level

A

8.6 - 10

36
Q

Hypocalcemia (causes)

A
  • 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
Q

Hypocalcemia (signs/symptoms)

A
  • Tachycardia
  • Hypotension
  • Paresthesias
  • Twitching/Tetany
  • Cramps
  • Positive Chvostek’s and trousseaus
  • Diarrhea
  • Hyperactive bowel sounds think no calcium no control of muscle movement
38
Q

What can cause hypocalcemia ? (medications)

A
  • Heparin (anticoagulant)
  • Diuretics
  • Laxatives
  • Anticonvulsants
  • Caffeine
  • Cigarettes
39
Q

EKG changes in Hypocalcemia

A

prolonged QT interval think prolonged line after the QRS complex

40
Q

Hypocalcemia (Interventions)

A
  • Pt on cardiac monitor
  • Give medications that increase calcium
  • Seizure precautions
  • Quiet environment
41
Q

What medications are given in Hypocalcemia ?

A
  • 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
Q

Hypercalcemia (causes)

A
  • 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
Q

Hypercalcemia (sign/symptoms)

A
  • 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
Q

Hypercalcemia (Interventions)

A
  • 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
Q

What medications prevent calcium from reabsorption

A
  • Calcitonin
  • Calcitonin (calcimar)
  • Prostaglandin synthesis inhibitors (NSAIDS)
  • Bisphosphonates (prevent loss of bone density like in osteoporosis)
46
Q

Normal Mg level

A

1.6 -2.6

47
Q

Hypomagnesemia (causes)

A
  • 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
Q

Hypomagnesemia (interventions)

A
  • 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
Q

What do oral preparations of magnesium cause think of laxatives

A

Can cause diarrhea and loose Mg

50
Q

What is adverse effect does Mg by intramuscular injection do ?

A

causes tissue damage and cause pain

51
Q

During Mg administration what is closely monitored ?

A
  • Deep tendon reflexes (indicates hypermagnesemia)
52
Q

Hypermagnesemia (causes)

A
  • Laxatives and Antacids (they contain Mg)
  • Renal insufficiency and renal failure
  • Treatment of pre-eclampsia with Mg
53
Q

Hypermagnesemia (signs/symptoms)

A
  • Hypotension
  • Bradycardia
  • Weak pulse
  • Sweating/Flushing
  • Respiratory depression
  • Loss of deep tendon reflexes
54
Q

EKG changes in HyperMg

A
  • Prolonged PR interval

- Widened QRS complex

55
Q

HyperMg (interventions) think medications

A
  • Diuretics (for excretion)
  • IV Ca Chloride/Ca Gluconate to reverse Mg effects on cardiac muscle
  • Restricting Mg intake
56
Q

What is the antidote of Cal Gluconate ?

A

Magnesium remember Where Mg goes Ca follows

57
Q

Hypophosphorus (causes) phosphorus is needed for bones

A
  • Decrease intake/malnutrition think diet
  • Mg based or aluminum hydroxide based antacids
  • Kidney failure
  • Hyperparathyroidism
  • Malignancy
  • Hypercalcemia
  • Alcohol withdrawal
  • DKA
  • Respiratory alkalosis
58
Q

Hypophosphatemia (signs/symptom)

A
  • Confusion
  • Seizures
  • Weakness
  • Decreased deep tendon reflexes
  • Shallow respirations- Increased bleeding tendency
  • Immunosuppressed
  • Bone pain
59
Q

Normal Phosphorus level

A

2.7 - 4.5

60
Q

Nursing Interventions for Hypophosphatemia

A
  • 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
Q

What kind of foods contain phosphorus ?

A
  • Fish
  • Organ meat
  • Nuts
  • Pork, beef, chicken
  • Whole grain breads and cereals
  • Dairy products
62
Q

When there is a decrease in Phosphorus is there an increase or decrease in calcium ?

A

Increase Hypercalcemia and opposite if there is an increase in phosphorus

63
Q

Hyperphosphatemia (causes)

A
  • Excess intake
  • Overuse of phosphorus containing laxatives and enemas
  • Vit D intoxication
  • Hypoparathyroidism
  • Renal insufficiency
  • Chemotherapy
64
Q

Hyperphosphatemia (signs/symptoms)

A
  • Neuromuscular irritability
  • Muscle weakness
  • Hyperactive reflexes
  • Tetany
  • Positive Chvosteks or trousseaus
65
Q

Interventions for Hyperphosphatemia

A
  • Managing Hypocalcemia since there is am increase of phosphorus there is a decrease in calcium
  • Anything containing phosphorus (medications; laxatives/enemas
66
Q

Normal Chloride level

A

97- 107

67
Q

Hyperchloremia (causes) think blood loss

A
  • Prolonged vomiting, diarrhea, sweating, high fever, diabetes insipidus, kidney failure
68
Q

Hyperchloremia (signs/symptoms) think everything is depressed

A
  • Respiratory depression
  • Hypotension
  • Bradycardia
  • Weak pulse
  • loss of deep tendon reflexes
69
Q

Hypochloremia (causes)

A
  • Dehydration
  • Vomiting
  • Diarrhea
  • Loss of salt
  • Diuretics (thiazides)
  • Addison’s disease
  • SIADH
70
Q

Hypochloremia (signs/symptoms)

A

Weakness/confusion

NCLEX ( fundamentals/MegSurg) (8 decks)

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