Fluids & Electrolytes Flashcards
what are electrolytes
minerals that conduct electricity
what test is done to examine the electrolytes
basic or complete metabolic panel (BMP/CMP)
BMP vs. CMP
CMP is BMP (Na, K, Cl, BUN, creatinint, glucose, acid-base) & liver panel
Blood urea nitrogen (BUN) indication
kidney function
carbon dioxide indication
blood bicarbonate level
creatinine (CR) indication
kidney function
calcium (Ca) indication
liver function
ALP, ALT, AST indication
liver function
ALP, ALT, AST stands for what
ALP: alkaline phosphate
ALT: alanine transaminase
AST: aspartate aminotransferase
bilirubin indication
liver function
protein vs. albumin
protein: total blood protein
albumin: liver function
5 functions of electrolytes
- maintain water balance
- move wastes out of cells
- move nutrients into cells
- balance blood pH /acid-base level
- function of body’s muscles, heart, nerves, and brain
average person’s water %
1/2 - 2/3 water
men: 60%
women: 54%
kids: 70%
dehydration vs. hypovolemia
dehydration: excess water loss without the loss of Na
hypovolemia: loss of blood volume
osmolality definition
measure solutes within a solution
reference range of serum osmolality (blood)
275-295 mOsm/kg
most commonly used for body fluid status
referance range of urine osmolality
50-1,200 mOsm/kg
list 3 main fluid compartments in and out of cells
intracellular space: in the cells - 67%
extracellular space: interstitial + intravascular space - 25%
where is the thirst response center in the brain
lamina terminalis (edge of hypothalamus) monitors osmolality & 1% change would send signal
explain the kidneys response to the hypothalamus
posterior pituitary releases ADH (vasopressin) and acts on the nephrons to increase reabsorption of water
list 3 ways the body tries to maintain water homeostasis
Thirst response
ADH to the nephrons
osmosis
K expected range
3.5 - 5 mEq/L
Na expected range
135 - 145 mEq/L
Ca expected range
9 - 10.5 mg/dL
Mg expected range
1.3 - 2.1 mEq/L
osmosis vs. diffusion
osmosis: solvent moving from high to low concerntration
diffusion: movement of solvents and solutes from high to low concentration
active transport
using energy to move solutes
function of K
electrolyte responsible for nerve and muscle function; especially the heart
where is K mostly excreted
kidneys
causes of hypokalemia
meds - diuretics
less intake
heart problems
metabolic alkalosis
excessive alcohol drinking
chronic kidney disease
diabetic ketoacidosis
excessive sweating
folic acid deficiency
V&D
signs of life-threatening hypokalemia
respiratory paralysis/failure
paralytic ileus
hypotension
tetany
rhabdomyolysis (muscle tissue breakdown)
intense cardiac arrhythmias -> see ECG
repeated episodes of hypokalemia can affect what
renal function
what are the specifications for giving K IV
- needs to be diluted -> never from the vial
- dose doesn’t exceed 40 mEq/L
- rate of administration 10 - 20 mEq/L
- continuous ECG and checking levels
foods that are high in potassium
baked potato, sweet potato
prune, carrot juice
white beans
plain, nonfat yogurt
salmon
banana
spinach, avocado
causes of hyperkalemia
renal failure (#1 cause)
dehydration
diabetes mellitus
meds - Ksparing diuretics, ACE inhibitors, NSAIDs
trauma, burns, sepsis
RBC blood transfusions
excessive intake
common symptoms of mild hyperkalemia
N&V
muscle aches and weakness
decreased deep tendon reflexes
paralysis
dysrhythmias/palpitations
meds to take while with hyperkalemia
calcium gluconate (for heart)
diuretics - loop, thiazide
calcium chloride (for heart)
resin
insulin (monitor for hypoglycemia)
what does resin medication do
bind to K and excreted via stool
ex: sodium polystyrene sulfonate
expected range of blood glucose
74-106 mg/dL
why monitor people trying to lower Na with salt substitutes
those contain a lot of K and could lead to hyperkalemia
largest electrolyte
K
Na function
blood pressure
blood volume
pH balance
critical value for Na
less than 120 mEq/L
where is Na mostly excreted from
urine and sweat
causes for developing hyponatremia
meds - thiazide diuretics
N&V
drinking lots of water
excessive alcohol intake
heart, kidney, liver issues - heart failure, cirrhosis
severe burns
mild hyponatremia symptoms
nausea and general unwellness
could lead to cerebral edema
moderate hyponatremia symptoms
lethargy, confusion, headache, irritiability, restlessness
severe hyponatremia symptoms
muscle twitching, decreased LOC, seizures, coma
what population is more prone to getting hyponatremia & hypernatremia
older adults
critical value of hypernatremia
greater than 160 mEq/L
cause of hypernatremia
loss of body water (#1 cause)
meds
gastroenteritis
impaired thirst response
diabetes
chronic kidney disease
vomiting, prolonged suction
burns
excessive sweating
manifestations of hypernatremia
same as hyponatremia
foods high in Na
roasted ham
shrimp
frozen pizza
canned soup
vegetable juice
cottage cheese
vanilla pudding
functions of Ca
Bone
Blood clotting
Beats (heart)
nerve conduction
what vitamin is required for the absorption of calcium
vitamin D
why is ionized calcium lvl a better measurement than serum calcium lvl
ionized Ca show the calsium that’s active and not yet bound to protein
what is the range of ionized calcium
4.5 - 5.6 mg/dL
critical low value for serum Ca and ionized Ca
serum Ca: 6 mg/dL
ionized Ca: 2.2 mg/dL
causes for hypocalcemia
meds: stimulant laxatives, glucocorticoids, loop diuretics, decrease body’s gastric acid
not enough vit D
hormonal changes (menopause)
hypoparathyroidism (body produces less PTH)
renal disease
multiple blood transfusions
sepsis
low albumin
electrolyte imbalance of Mg, or P
long term hypocalcemia can lead to what
osteopenia: low bone mass; increased risk of fractures and osteoporosis
body will take Ca from the bones
what body systems does hypocalcemia effect
respiratory, cardiac, neurologic, sensory, neuromuscular, integumentary
what population is at risk for geting hypocalcemia
neonates and infants with moms that have diabetes, pre-eclampsia (high BP and protein during pregnancy), or hyperparathyroidsm
2 physical examinations that could indicate hypocalcemia (not diagnose though)
Chvostek sign: tap face nerve and muscle twitch
Trousseau sign: BP cuff inflated for more than 3 mins will cause irritability to nerve and carpopedal spasm will occur ( bigger indication than Chvostek sign)
limit Ca supplement to how much to increase absorption
less than 600mg per dose
foods high in Ca
milk, almond milk, soymilk
yogurt
cheese
critical high value for Ca
serum Ca: 13 mg/dL
ionized Ca: 7 mg/dL
reasons for hyperclacemia
cancer, hyperparathyroidism (top reasons)
vit D toxicity
meds - thiazide diuretics
renal failure
hypercalcemia “mnemonic”
abdominal moans: constipation, N&V
painful bones
kidney stones
groans
neurologic overtones: delirium, psychosis, coma
treatment for hyper and hypocalcemia
hypocalcemia: phosphate PO
hypercalcemia: saline bolus IV, loop diuretic
hemodialysis for extreme cases
magnesium function
nerve and muscle function
BP
blood glucose
making DNA, protein, bone
where is Mg stored
in bones
what route is Mg excreted
pee and poo
critical values for hypo and hypermagnesia
hypomagnesemia: 0.5 mEq/L
hypermagnesemia: 3 mEq/L
cause of hypomagnesemia
meds - loop, thiazide diuretic
decreased intake
decreased absorption due to crohn’s or celiac disease
increased excretion
excessive alcohol use
diabetes type 2
burns
hypokalemia, hypocalcemia (electrolyte imbalances)
signs of hypomagnesemia from mild to moderate to worse
- N&V, change in appetite, fatigue
- neuromuscular changes: seizures, tetany, tingling, etc.
- cardiac dysrhythmias
foods with Mg
spinach
pumpking seeds
black beans, soybeans
cashews
dark chocolate
avocados
salmon
banana
tofu
what to monitor when you give Mg IV
double check with another nurse for concentration;
can cause flushing, sweating, respiratory depression if administered too quickly;
decreased LOC if pt also on CNS depressant;
monitor urine output for those with impaired renal function
causes for hypermagnesemia
kidney disease (#1 cause)
excessive intake
meds
trauma
hypothyroidsm
chronic alcohol use
acidotic states
what happens when Mg levels increase to above 7 or 12
7: neurologic manifestations
12: muscle issues, decreased RR, hypotension, bradycardia, dysrhythmias
what reflex to check with hypermagnesemia
paterlla reflex
treatment of hypermagnesemia
calcium gluconate or calcium chloride
IV diuretics
hemodialysis
note: has long 1/2 life so decreasing serum lvls will take more than 24 hours
causes for dehydration
lack of intake
GI losses replaced with hypertonic fluids
fever
meds - benzodiazepines, SSRI decrease thirst sensation
diabetic ketoacidosis
what does urine specific gravity measure and its reference range
measures the solutes in urine
1.005 - 1.030
fluid of choice for IV rehydration
dextrose 5% in water
contains no Na and glucose will be quickly metabolized
dehydration vs. hypovolemia
dehydration: loss of water
hypovolemia: loss of fluid and electrolytes
what is third spacing and causes
fluids move from intravascular space to interstitial space
typically from cirrhosis and pancreatitis
what is considered hypovolemic shock
loss of 20% or 1/5th of blood or fluid supply
what happens if hypovolemic shock isn’t reversed
multiple organ failure where tissue death happens
what ratio of BUN/CR means there’s a lack of blood flow to the kidneys
20 (BUN) : 1 ( CR)
how does hematocrit change based on reasons for hypovolemia
increase due to volume loss
decrease along with hemoglobin to show bleeding
treatment for hypovolemia
0.9% normal saline or Ringer’s lactate IV
blood transfusion for blood loss
causes of hypervolemia
heart failure, kidney failure
cirrhosis
pregnancy
excess IV fluid
meds: Ca channel blockers, vasodilators
treatments and monitoring of hypervolemia
diuretics, limit fluid and Na intake, DW
check for jugular vein distension, adventitious lung sounds, I&O, dyspnea, hypertension, bounding pulse
dialysis for kidney failure
paracentesis for cirrhosis (needle in abdomin to take out fluid)
most common cause of fluid loss in infants and young children
V&D
why are older clients more at risk for fluid/electrolyte imbalances
renal, cardiovascular system less work
decrease in thirst sensation
decrease in RAAS system
polypharmacy
why are infants and children more at risk for luid/electrolyte imbalances
maybe can’t communicate it
requires high fluid volume
high metabolism
high ratio of surface are to volume -> loose fluids faster
where should the tourniquet be placed to dilate the veins for IV; what’s the immediate assessment
5-10cm above selected site
assess distal pulse to make sure not too tight
contraindications for the use of a tourniquet
high risk for bleeing
compromised circulation
fragile skin
how else to establish IV access without tourniquet
BP cuff set to 30mm Hg
warm compress
open and close the fist
position arm in dependent position
avoid starting IV in which cases
axillary node dissection (lymph node taken out)
arteriovenous fistula
radiation therapy
stroke
crystalloid solutions
IV fluids that have solutes - electrolytes or dextrose, can easily diffuse through cell membranes
how are crystalloid solutions classified
hypotonic, isotonic, or hypertonic
tonicity: ability to osmosis (move water in n out)
colloidal solutions
IV fluids that have large molecules that can’t pass through capillary membranes; also known as plasma or volume expanders
purpose of using colloidal solutions
increase in osmotic pressure with plasma so fluids are drawn into the intravascular space
synthetic vs. natural colloidal solutions
synthetic: dextrans, starches
natural: albumin
adverse effects with colloidal solutions IV
allergic reaction
renal failure
blood clotting disorder
what gauge needle for colloidal solutions IV
18 g central or peripheral line
how often should IV tubing be changed for continuous and intermittent infusions
continuous: 96 hrs (every 4 days)
intermittent: every 24 hrs
how often should IV tubing be changed for lipid or blood administeration
lipid: q12 hrs
blood: q4 hrs
what are central venous access devices (CVADs) used for
inserted into a central vein (subclavian or jugular vein) to administer fluids, blood, meds;
used long-term i.e. chemotherapy
where are peripherally inserted central catheters (PICCs) inserted
anterior arm
median cubital, cephalic, basilic, brachial vein
what are PICC lines at risk for
infection, make sure to use aseptic technique
nontunneled vs. tunneled CVADs
nontunneled: short term use, emergency, higher chance of infection
tunneled: long-term use, require healing period, lower chance of infection
how to prevent clot formation in a CVAD
flush with saline or low-concentrations of heparin
what is phlebitis
inflammation of the inner lining of the vein
causes of phlebitis
vein too small for cannula
cannula movement
inadequate dressing
speed of infusion
type of medication infused
length of therapy
failure for aseptic technique
administration of contaminated solution
symptoms of phlebitis
pain, swelling, erythema, fever, palpable cord along vein
what are vesicants
fluids considered irritating to the veins -> use larger vein or CVAD
what are infusates
fluid to be infused
things to consider when minimize likelihood of phlebitis
- follow aseptic technique
- vesicants use large vein or CVAD
- use CVAD or midline catheter if therapy longer than 5 days
- use smallest cannula for the client and infusate
- don’t place in areas of flexion, if must -> use stabilization board
- maintain prescribed infusion rates
- monitor site q4hrs & q1-2hrs if irritating, decreased LOC, location of flexion
- monitor q1hr for babies and kids
how often should IV catheter sites be monitored?
- monitor site q4hrs & q1-2hrs if irritating, decreased LOC, location of flexion
- monitor q1hr for babies and kids
what to do immediately in case of phlebitis & comfort measures
discontinue IV and notify provider;
comfort measures: warm compress, elevation, administer analgesics
documenting IV catheter site
- description of site
- objective & subjective findings
- phlebitis rating score
- notification of provider
- interventions
- location of new IV site if started
cause of circulatory overload
- excessive amounts of crystalloid fluid
- blood products
- infusion too fast
signs of circulatory overload
- tachycardia, tachypnea
- increased BP, weight
- decreased O2 satu, crackles in lungs
- jugular venous distension, edema
- pallor, cyanosis
infiltration is what
IV administration of fluids into surrounding tissue due to displacement of the catheter tip
extravasation is what
administration of vesicant fluid into tissues around IV cannula;
could lead to tissue damage or necrosis
medications that are considered vesicants
antineoplastic (chemotherapy meds)
high osmolarity meds: dextrose 50%
vasoconstriction meds: dopamine
highly alkaline or acidic meds: phenytoin
signs of infiltration or extravasation
- coolness of skin surrounding
- leaking of fluids
- localized edema
- pallor or delayed capillary refill
- report of pain, burning, or discomfort
- change in infusion rate
do’s and don’ts after infiltration or extravasation
- aspirate fluid from cannula, DON’t flush site
- discontinue IV and notify PCP
- skin mark area
- DON’t apply pressure, DO elevate
*reassess q1hr
air embolism IV
obstruction of a vessel by air
signs of air embolism in IV
- difficulty breathing, cough, wheeze
- low BP
- tachycardia
- chest, shoulder pain
- shock, neurologic injury, MI, death
things to do to prevent air embolism in IV
- prime everything
- check set junctions are secure before repositioning client
- monitor bubbles, leaks in tubing
- change IV bags before the previous one is dry
- clamp CVAD before changing
what to do if pt has air embolism in IV
- stop infusion & clamp line
- position pt with head down on left side
- notify rapid response team
if a nurse is unsure if something is within their scope of practice, where should they check
state’s nurse practice act
