RNSG 1910 > Fluids & Electrolytes > Flashcards
Fluids & Electrolytes Flashcards
Chvostek sign?
Assessment that can indicate hypokalemia or hypomagnesemia
Purpose of ADH?
Stops kidneys from excreting urine and restores fluid volume to body.
A hormone excreted by the hypothalamus in the brain that maintains blood pressure and fluid volume. Also knows as vasopressin
Sodium level >145?
Hypernatremia
Potassium level of 3.4?
Hypokalemia
Why older adults are at risk of dehydration?
Lowered thirst response, total body fluid decline, decreased kidney function, meds, chronic illness
Phlebitis?
Inflammation of vein with redness, tenderness, swelling, and pain
1L H20 = ?KG
1KG = 2.2LBS
Components of extracellular fluid (ECF)?
Intravasular fluid (plasma) and interstitial fluid (fluid around cells)
Intracellular fluids (ICF)?
Fluid inside cell (02, electrolytes, glucose, etc/)
What is diffusion?
movement of molecules from high concentration to low concentration
What is Osmosis
Movement of H2O
What is filtration?
fluid and solutes move across membrane from higher pressure to lower pressure
What is active transport?
movement of solutes across cell membrane from lower concentration to higher concentration
*Requires ATP
Regulators of fluid intake?
Thirst mechanism (in hypothalamus), kidneys/ADH, osmosis
Normal electrolyte values:
Potassium (K+)
Function: Assists with nerve and muscle cell function, esp in the heart
Role: Acid-base balance
Normal: 3.5 - 5mEq/L
HYPOKALEMIA - <3.5
Causes:
Inadequate intake
Use of diuretics
Vomiting and diarrhea
Laxative abuse
NG suctioning
Heat induced diaphoresis
Starvation
Hyperglycemia leading to diuresis
Increased secretion of aldosterone
S/sx:
Anorexia, N/V
Leg cramps/muscle cramps
Muscle weakness
Cardiac arrhythmias
Hypoactive bowel sounds, motility
Fatigue, lethargy
Hypo deep-tendon reflexes
Weak irregular pulses
Serum K+ <3.5mEq/L
ECG changes
Alkalosis on ABGs
Interventions:
Cardiac monitoring
High potassium- low sodium diet
Oral or IV potassium replacement
If on diuretic, check to change to a K+ sparing diuretic
I&O’s
Daily weight
Education
Monitor labs
Neuro checks
If on digoxin, monitor for dig toxicity - can cause hypokalemia
HYPERKALEMIA: > 5
Causes:
Decreased K+ excretion
Renal failure/kidney failure
Hypoaldosteronism
K+-sparing diuretics
Increased K+ intake
Excessive use of K+ containing salt substitutes
Excessive or rapid IV infusion of K+
K+ shift out of cells into plasma
Severe Infections, ex: sepsis
Severe Burns
Acidosis
S/sx:
GI hyperactivity, diarrhea
Irritability, apathy, confused
Cardiac dysrhythmias or arrest
Muscle weakness, areflexia
Decreased heart rate
Irregular pulse
Paresthesias
Numbness in extremities
Serum K+ level >5.0mEq/L
ECG changes – peaked T-waves, widened QRS complex
Interventions:
Cardiac monitoring
Close cardiac monitoring, ECGs
Administer ordered meds – diuretics, glucose, insulin, Kayexalate, etc.
Hold K+ supplements
Education
No salt substitutes
Avoid foods high in K+
Monitor labs
*Bodys largest intracellular electrolyte
**Obtained from diet, body does not proceed on its own
**Check potassium level if on furosemide (Lasix)
Loop/thiazide diuretics and potassium go hand in hand
*Kidneys are responsible for the primary excretion of potassium (90%), while the rest is lost through sweat and the digestive tract. Potassium is excreted even if levels are low
**Salt substitutes can increase potassium
Purpose of aldosterone?
To hold onto sodium, and secrete potassium in its place
Other kidney hormones besides ADH and aldosterone?
Renin-Aldosterone-Angeotensin System (RAAS) and Atrial Natriuretic Factor (ANF)
What functions are electrolytes responsible for?
Maintaining the balance of water in the body
Balancing the blood pH (acid–base) level
Moving nutrients into the cells
Moving wastes out of the cells
Maintaining proper function of the body’s muscles, heart, nerves, and brain)
Po
Sodium (Na+)
**Sodium = most common extracellular electrolyte
**Usually followed by H2O in imbalances
**Loop/thiazide diuretics cause loss of Na+ in urine
Function: supports proper neurologic and neuromuscular function, regulates fluid balance, maintains blood pressure
Normal: 136 to145 mEq/L
HYPONATREMIA: < 136 (critical < 120)
Causes:
Excess water in body
Medications
Chronic or severe vomiting or diarrhea
Drinking excess amounts of water
Excess alcohol intake
Heart, kidney, and liver problems
Severe burns
SIAHD
S/sx:
Lethargy
Confused
Apprehension
Muscle twitching/cramps
Abdominal cramps
Anorexia
N/V
Seizures
Coma
Low Na+ level
Serum Osmolality (concentration) low <280mOsm/kg
Interventions:
Assess S/Sx
Monitor I&O
Monitor lab values
Assess closely if administering hypertonic saline (3% or higher)
If diet order allows, encourage high Na+ intake (table salt, bacon, ham, processed cheese, etc.)
Limit water intake
HYPERNATREMIA: >145
Causes:
Loss of H20
Insensible water loss – hyperventilation, fever
Diarrhea
H2O deprivation
Gain of Na+
IV administration of saline solutions
Hypertonic tube feedings without adequate water
Excessive intake of salt (1tsp = 2300mg)
Conditions
Diabetes Insipidus
Heat stroke
S/sx:
extreme dehydration/thirst
Dry/sticky mucous membranes
Red, dry, swollen tongue
Weakness
Serum Na+ >145mEq/L
Serum Osmolality >300mOsm/kg
In severe cases:
Fatigue
Restlessness
Decreasing LOC
Disorientation
Convulsions/seizures
Interventions:
Monitor behavior changes
Monitor I&O
Monitor lab values
Daily weights
Encourage fluids as ordered
Monitor diet as ordered, needs low Na+ diet
**Sodium = most common extracellular electrolyte
**Usually followed by H2O in imbalances
**Loop/thiazide diuretics cause loss of Na+ in urine
Calcium (Ca++)
** Major extracellular fluid (ECF) cation+
** Mainly found in the hard parts of the bone where it is stored
**Concentration of calcium is kept constant by the calcium pump that constantly moves calcium in and out of cells.
** The PTH (parathyroid hormone) raises the plasma calcium level by promoting the transfer of calcium from bone to plasma
PTH helps with GI absorption of calcium by activating Vitamin D, gut can only absorb about 500mg at one time, anymore needs to be >6 hrs apart
Normal PTH level 11-54pg/mL
Functions in the body:
exerts a calming/sedating effect on the nerve cells
plays a role in skeletal and heart muscle relaxation, activation, excitation, and contraction
helps nerve impulse transmission
helps with blood clotting by converting prothrombin to thrombin
helps regulate acid-base balance
gives firmness and rigidity to bones and teeth
HYPOKALEMIA: < 8.5
Causes:
decreased intake, absorption, or increased secretion
Diagnoses that can cause Hypocalcemia:
Hypoparathyroidism
Hypomagnesiumia
Alkalosis
Hypoparathyroidism
Vitamin D deficiency
Malabsorption (Crohn’s Disease, excessive laxative use, alcoholism)
Renal Diagnoses - hyperphosphatemia
Gram negative sepsis - severe infection
Medullary thyroid cancer
Burns
Acute pancreatitis
S/sx:
Tingling of hands, feet, and around mouth
Muscle spasms/cramps/tremors
Hyperactive reflexes - not enough stuff in there to keep it calm
Irritability
Mental status changes (depression, memory impairment, delusions, hallucinations, convulsions)
Hypotension
Cardiac changes – dysrhythmias, ECG changes, arrest
+ Trousseau’s & Chvostek’s signs
Respiratory arrest
Increased bleeding or bruising
Dry/brittle hair and nails
Interventions:
Treatment is focused on restoring normal values
Identify risk factors
Medication evaluation
Diet
IV and/or PO supplements
Cardiac monitor
V/S
Neuro checks
Monitor labs
Education
HYPERKALEMIA: >10.5
Causes:
Hyperparathyroidism
Metastatic cancer
*Thiazide diuretics
Sarcoidosis
Multi-organ inflammatory disease
Immobility
Lithium therapy
Vitamin D intoxication
Hyperthyroidism
Renal tubular acidosis
Hypophosphatemia
S/sx:
(may not occur until level is >12.5 mg/dL):
Muscle weakness, fatigue
Depressed DTRs - deep tendon reflexes
Hypoactive bowel sounds
N/V, anorexia
Constipation
Bone pain, path. fx.
HTN
ECG changes
Cardiac arrest
HA
Polyuria
Renal colic/kidney stones
Personality changes/Acute psychosis
Confusion
Interventions:
Cardiac monitor
Vital signs, Labs
Increase fluids, ↓ Ca++ intake
X-Ray for bone changes
Diuretics (lasix)
Corticosteroids
Neuro checks
Daily weights
I&O’s
Increase mobility and exercise if possible
Magnesium (Mg++)
**2nd most abundant cation
**Absorbed in the small intestines and conserved and excreted by the kidneys
Function:
has 300 roles in the enzymatic reactions
powers the Na+-K+ pump
transmits electrical pulses across nerves
maintains normal heart rhythm
needed for thiamine activity, calcium and Vitamin B-12 absorption
relaxes lung muscles that opens airway
fights tooth decay
fatty acid oxidation, carbohydrate metabolism and protein synthesis
acts as a smooth muscle relaxant
Normal: 1.4 - 2.5 mEq/L
HYPOMAGNESIUM: <1.4
Causes:
(may not occur until level is <1.0mEq/L)
Excessive loss from GI tract
Burns
Pancreatitis
Chronic alcoholism
S/sx:
Neuromuscular:
Tremors, hyperreflexes, convulsions, positive Chvostek’s and positive Trousseau’s signs
Respiratory difficulty
Cardiac
Increased HR, Increased BP, ECG changes
Neuro deficits
confusion, convulsion, hallucinations, vertigo
Anorexia, dysphagia
Interventions:
Mg++ replacement
Dietary changes
Monitor labs
Cardiac monitor
Neuro checks
Identify the cause
Education
ETOH abuse treatment
I&O’s
HYPERMAGESIUM: > 2.5
Causes:
DKA untreated
adrenal insufficiency
lithium ingestion
volume depletion
S/Sx:
Decreased reflexes
Hypotension, bradycardia
EKG changes
Face flushing
Weakness
Lethargy
Respiratory/cardiac arrest with severely high levels
Coma
Interventions:
Correct underlying cause
Monitor VS, Cardiac monitor
Neuro checks including DTR’s
Monitor respiratory status
I &O’s
Diet
Education
Chloride
Function: circulates with SODIUM and WATER and helps maintain cellular integrity by maintaining a balance between ICF and ECF in the body. Forms CSF.
Normal: 96-106 mEq/L
HYPOCHLOREMIA: < 95
Causes:
Diuresis
NVD
Dietary changes
Burns
Fever
Large skin wounds
Metabolic alkalosis
GI suctioning and GI surgery
Advanced renal disorders.
S/sx:
Hyper excitability
Slow/shallow breathing
Hypotension
Muscle tremors
Twitching
Interventions:
Replacement therapy
Vital signs
Neuro checks
I&O’s
Labs for re-evaluation
ABG’s
Oral therapy if tolerating diet (salt tablets)
Education
HYPERCHLOREMIA: >108
Causes:
Metabolic and respiratory acidosis
Severe vomiting
Salicylate (aspirin) intoxication
Increased retention or intake
Reduced GFR
Head trauma
Profuse perspiration
S/sx:
Neuro:
Weakness
Lethargy
Stupor
Coma
Deep/rapid respiratory rate
Risk of dysrhythmias
Interventions:
Decrease chloride intake
IV hydration
Diet changes
Vital signs
Cardiac monitor
I&O’s
Safety, fall risk due to weak/lethargic
Monitor labs
Identify risk factors
Evaluate patients response to treatment
Phosphorus
Function: Essential for muscle, red blood cells, and nervous system function
Regulates calcium levels
Aids in renal regulation
Found in cell membranes called (phospholipids)
They help maintain call membrane integrity
Normal: 2.5 - 4.5 mg/dL
HYPOPHOSPHATEMIA:<2/5
Causes:
Alcohol abuse, especially withdrawal
TPN administration - total parenteral nutrition, pt’s who cannot eat orally - nourished through IV
DM
Increased renal excretion
Decreased intestinal absorption from:
Vitamin D deficiency
Malabsorption disorders
Starvation
S/sx:
(may not show until < 2.0 mg/dL):
Anemia, bruising, bleeding
Seizures, coma, slurred speech, confusion
Tremors, spasms, tetany
Chest pain, EKG changes, CHF
Respiratory depression
Anorexia, dysphagia, NV, diminished bowel sounds.
Interventions:
Replacement via IV or oral
Diet
Vital Signs
Cardiac monitor
Safety
Seizure precautions
Neuro checks
Re-evaluate lab values
Risk assessment, education
HYPERPHOSPHATEMIA: > 4.5
Causes:
Tissue trauma or chemotherapy causing PO43- to shift from ICF to ECF
Renal failure
Excess amounts administered or ingested
Infants who are fed cow’s milk
Use of phosphate containing enemas or laxatives (ex-lax)
S/sx:
OLIGuria - decreased urine output
Conjunctivitis, corneal haziness
Tachycardia, irregular heart rate
Tetany, muscle weakness, numbness & tingling around mouth & fingers
anorexia, NV
Interventions:
PO meds (TUMS, phosphate binders)
Identify the cause
I&O’s
Vital signs, cardiac monitor
diet avoid (carbonated drink) foods high in phosphates
Fluid/electrolyte replacement purpose?
To restore homeostasis
Admin of fluid/electrolytes?
Oral, NG tube, IV
Oral: Water, supplements
IV:
Isotonic: (Normal Saline- sodium chloride (0.9% NaCl), D5W- nutrient solution, Lactated Ringer’s - contains sodium, chloride, potassium, lactate, and calcium) initially remains in the vascular compartment, expanding vascular volume.
Hypotonic ( 0.45%NS, 0.25 NS)- are used to provide free water and treat cellular dehydration, promote waste elimination by the kidneys.
Hypertonic-(D5NS, D5 ½ NS, D5 LR) draw fluid out of the ICF and interstitial compartments into the vascular compartment, expanding vascular volume. Not used for dehydration .
Fluid volume deficit
HYPOVOLEMIA: Loss of H2O and electrolytes from ECF in similar proportions
Causes:
Abnormal losses through the skin - profuse sweating, burns, environmental heat, fevers
Bleeding
Diabetes insipidus
Gastrointestinal tract – NVD, malnutrition, prolonged NPO, decreased fluid intake
Hyperglycemia
Kidneys – poor function, diuretics
Movement of fluid into third space
S/sx:
Mental Status – changes in behavior, confusion (due to decreased blood flow to brain), altered LOC
Weight loss
Hypotension
Tachycardia
Tachypnea
Oliguria
Delayed capillary refill
Medications – diuretics, OTC medications, dietary supplements
Difficulty swallowing
Kidney disease
Interventions:
Oral fluid intake (avoid fluids such as soda, fruit drinks, sports drinks bc of sugar content)
Avoid salty food
Avoid caffeine (mild diuretic)
IV isotonic fluid 1 to 2L within 30 mins
Monitor patient: vital signs (hypotension, tachycardia-weak, tachypnea), monitor for mental status changes, I&O’s, daily weights, implement measures for N/V/D
Teaching: Diet, frequent sips of water, oral hygiene
Identify the cause of the dehydration
HYPERVOLEMIA: When body retains Na+ and H2O
Causes:
Over-infusion of fluids
Use of plasma proteins
Excessive intake of solutes in foods or meds
Long term corticosteroid administration
Disease Processes:
Heart failure, chronic liver disease, chronic renal failure, SIADH, adrenal dysfunction, Cushing’s syndrome,
Remobilization of fluids after burns
Polydipsia - excessive thirst
Stress response causing increase in aldosterone levels
Metabolic problems
S/sx:
Increasing daily weights
Cardiac:
Positive JDV, HTN, bounding pulses
Respiratory:
Low O2 sat, tachypnea, dyspnea, cough, cyanosis, wet lungs (crackles)
Neuro:
Headache, confusion, seizures, coma
Excessive urinary output
Ascites -
Muscle spasms
Interventions:
Fluid restriction
Administer medications as ordered
Diuretics, Morphine, Nitroglycerin for pulmonary edema
O2
Bedrest
I&O’s
Daily weights
Vital signs, pulse ox
Elevate HOB (head of bed)
Monitor respiratory status
Assess neurological status
Position changes for edema and protect from skin breakdown
Monitor labs for drecreased BUN and Hct
Third space shift
Large collection of useless fluid in extracellular body spaces where it is not typically present.
Common sites:
Tissue - general edema
Abdomen (ascites)
Pleural spaces (pleural effusion)
Pericardial spaces (pericardial effusion)
Causes:
Inflammation or injury - massive trauma, crush injuries, burns, sepsis, cancer, intestinal obstruction, abdominal surgery
Malnutrition or liver dysfunction. (starvation, cirrhosis, chronic alcoholism)
High vascular hydrostatic pressure (heart failure, renal failure, or other forms of vascular fluid overload)
S/sx:
Hypovolemia
Hypotension
Tachycardia
Decreased central venous pressure (CVP)
Decreased urinary output
Interventions:
Assess the following:
-lung sounds
-Skin turgor
-Vital signs – low grade fever is common
-Oral cavity and tongue
-Urinary output (oliguria)
-Thirst
-Mental status for changes
-Daily weight
-Capillary refill for delays
*Slow position changes
Administer any ordered fluid &electrolyte replacement, plasma protein replacement.
Careful considerations about replacing fluids too quickly; hypervolemia can occur which would result in HTN, increased CVP, weight gain, and SOB, pulmonary edema
