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Module 4 (MedSurg 2) > Fluids & Electrolytes > Flashcards

Fluids & Electrolytes Flashcards

1
Q

Organs used in Fluid Balance

A

Kidneys
Hypothalamus
Pituitary gland
Adrenal Cortex

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2
Q

What is the major filtering of fluid that needs pressure to work?

A

Kidneys

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3
Q

Electrolytes are

A

electronically charged solutes
necessary to maintain life

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4
Q

Hypothalamus gives the perception of

A

thirst

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5
Q

The posterior pituitary gland releases what

A

releases and inhibits ADH

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6
Q

ADH focuses on

A

holding and letting go of water

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7
Q

Adrenal cortex regulates

A

Na though aldosterone

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8
Q

Hydrostatic pressure is increasing

A

artery pressure

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9
Q

Functions of electrolytes

A

neuromuscular irritability
maintain the body’s osmolality
regulate acid/base
regulate the distribution of body fluids

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10
Q

Increase in hydrostatic pressure caused by

A

venous obstruction
sodium and water retention

(Heart and renal failure)

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11
Q

Hypoalbuminemia

A

decrease in plasma oncotic pressure caused by low plasma albumin

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12
Q

Inflammation and immune response happen due to what abnormal fluid movement?

A

increase in capillary permeability

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13
Q

Obstruction of lymph channels caused by

A

tumors
inflammation
surgical removal

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14
Q

Complications of edema

A

pressure injuries
infections
life-threatening to the brain, lungs, and larynx

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15
Q

What are the 4 abnormal fluid movements?

A

Increase in hydrostatic pressure
decrease in plasma oncotic pressure
Increase in capillary permeability
obstruction of lymph channels

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16
Q

Assessing electrolyte balance includes

A

-Assess overall fluid balance by monitoring daily weight, I&O
-Assess neurological status; LOC
-Evaluate sensor and motor function; neuromuscular irritability
- (LAB AND V/STRENDS)
-Look at EKF to detect changes
-Assess nutritional status (electrolytes are obtained through the food we eat)
-Evaluate health hx for medical conditions
-Evaluate medication hx for prescription or OTC drugs that can interfere

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17
Q

Daily wts and I&Os show what

A

retaining
contains PO/IV

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18
Q

What electrolyte affects an EKG?

A

Potassium

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19
Q

Homeostasis functions of electrolytes

A

Promote neuromuscular irritability
Maintain body fluid osmolality
Regulate acid-base balance
Regulate the distribution of body fluid amount of body fluid compartments

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20
Q

The ECF used what electrolytes

A

Sodium
Cloride

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21
Q

ICF

A

fluid inside the cell 2/3rd (28L)

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22
Q

Factors that influence body fluid

A

age
gender
body fat
skeleton vs muscle, bone, and skin

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23
Q

What is the percentage of total body water as proportion to body weight?
Neonate -
Infant (6 months) -
Child (5 yo) -
Adult male -
Elderly male -
Adult female -

A

80%
70%
65%
60%
50%
50%

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24
Q

What gender has more body fluid? except when?

A

men
women are pregnant

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25
Q

What age has more body fluid?

A

infants

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26
Q

How does weight affect body fluid?

A

obese people have less body fluid than thin

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27
Q

ECF

A

fluid outside the cell 1/3

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28
Q

Intracellular fluid has what electrolytes

A

potassium and magnesium
Proteins

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29
Q

ECF has what electrolytes

A

sodium
chloride

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30
Q

What type of fluids are in ECF

A

Intravascular (plasma)
Interstitial ( surround cells)
Transcellular

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31
Q

Transcellular

A

works in individual way different from circulatory
(pleural, spinal fluid, sweat, and digestive)

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32
Q

What fluid shifting is abnormal?

A

3rd spacing

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33
Q

Spacing 1 through 3

A

1st - normal
2nd - edema
3rd - ascites, burn edema

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34
Q

3rd spacing s/s

A

decreased urine output (shifted toward interstitial space)
increase heart rate (compensate)
decreased BP and CVP
edema
increase body weight
I&O not balanced

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35
Q

What is a form of 3rd spacing?

A

ascites
burn edema

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36
Q

Electrolyte Cations

A

sodium
potassium
calcium

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37
Q

Electrolyte Anions

A

bicarbonate
chloride
phosphate

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38
Q

What are the different types of fluid regulators?

A

osmosis and osmolarity
diffusion
filtration
sodium-potassium pump

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39
Q

Osmosis

A

spontaneous passage of water or other solvents through a permeable membrane

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40
Q

Diffusion

A

from higher to lower concentration

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41
Q

Filtration

A

high pressure to lower pressure

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42
Q

Sodium-Potassium Pump

A

maintains normal sodium levels by active transport

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43
Q

Output

A

kidney
Skin(1L an hour)
Lungs
GI Tract (100-200mL)

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44
Q

Sodium does what

A

SUCKS

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45
Q

What is the primary regulator of body fluid?

A

sodium

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46
Q

Where sodium goes

A

water flows

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47
Q

What is the major electrolyte in ECF?

A

sodium

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48
Q

If sodium is low, then serum osmolality is

A

low
visa versa

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49
Q

Lab Value of NA

A

135-145

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50
Q

If you have a decrease in serum Na, the ECF becomes

A

dilutes
H2O drawn into cells

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51
Q

If you have an increase in serum Na, the ECF becomes

A

concentrated ECF
H2O pulled out of the cells

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52
Q

When NA moves into cells, it kicks what out

A

K

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53
Q

When serum sodium increases and ECF becomes concentrated, what is stimulated?

A

Thirst by hypothalamus

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54
Q

Thirst stimulates ________ released from the pituitary gland.

A

ADH

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55
Q

What does ADH do to the kidneys?

A

conserve water

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56
Q

The adrenal gland releases

A

aldosterone
in which the kidneys conserve water and sodium
Increases ECF

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57
Q

Sodium is followed by

A

chloride and water

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58
Q

Chloride functions

A

maintains electrical neutrality
osmotic gradient

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59
Q

I&O OF Na

A

Intake = diet
Outtake = kidneys

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60
Q

Function of Na

A

-electrochemical state of muscle contraction and nerve impulses
BP (ECF vol and encloses water distribution with chloride - affects the concentration and absorption of K and Cl)
Blood volume
PH balance

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61
Q

Na is regulated by

A

ADH
Thirst
Aldosterone (RAAS)
Sodium Potassium Pump

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62
Q

ADH is also known as what drug

A

vasopressin

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63
Q

ADH does what

A

controls water retention

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64
Q

Aldosterone

A

hold Na inside the body by blocking it at the kidney
- causes kidneys to maintain water and sodium to keep BP up
- releases if sodium is low and K is high (to excretion K)

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65
Q

Sodium and Potassium Pump

A

moves NA out of the cells via ATP
-provides energy through muscle and energy and removes acid

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66
Q

Sodium and Potassium Pump uses what to move Na out

A

ATP

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67
Q

HYPONATREMIA Causes (NO Na)

A

-Na excretion with renal problems, NG suction, vomiting, diuretics, sweating, diarrhea,
- a decrease of aldosterone secretion (fluid stays)
-Overload of fluid (Congestive Heart Failure, renal failure, hypotonic fluid infusion)
-Na intake is low (low salt diet, NPO)
-Antidiuretic hormone (SIADH)

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68
Q

Hyponatremia s/s depend on the _____, ______,and _____ at which deficit occurs

A

cause
magneitude
speed

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69
Q

What mnemonic is used as Hyponatremia S/S?

A

SALT LOSS

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70
Q

Hyponatremia S/S
SALT LOSS

A

Seizures and stupor
Abdominal cramping, attitude confusion
Lethargic
Tendon reflexes diminished, and trouble concentrating
Low urine and appetite
Orthostatic hypotension, overactive bs
Shallow respirations (late due to skeletal weakness)
Spasms of muscles

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71
Q

Is your hyponatremic pt a fall risk

A

yes, confusion = fall risk

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72
Q

Hyponatremia lab values

A

Low Labs
Serum Na+ < 135 mEq/L
Serum osmolality < 280 mOsm/kg
Urinary Na+ < 20 mEq/L
Urine specific gravity < 1.010

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73
Q

Treatment of Hyponatremia
- watch for?

A

Na replacement (PO, NGT, IV)
Depends on the rate of loss (LR, NS)
- Watch for fluid overload/pulmonary edema

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74
Q

If a nurse is giving sodium to a hyponatremic pt too quickly, what should you watch out for?

A

neurological damage
-cerebral edema

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75
Q

Rule of Thumb for NA replacement

A

serum Na must not be increased greater than 12 mEq/L in 24 hours

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76
Q

What solutions are used to tx as Hyponatremia?

A

Lactate Ringers
Normal Saline

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77
Q

Medical Tx for hyponatremia due to water gain

A

GOAL: slowly elevate Na until seizures, lethargic, stupor are gone
restrict fluids safer than giving Na
hypertonic solution 3-5% NaCl (if neuro problem - give small amounts)
edema only - restrict Na
edema and Na - restrict both
Loop Diuretics (Lasix) with IV fluids

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78
Q

Loop diuretics induce isotonic diuresis w/o further

A

hyponatremia

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79
Q

Nursing Interventions for Hyponatremia

A

Identify pt. at risk (Lithium pts)
Monitor labs, I&O, daily weight
Review medications
GI manifestations
Monitor for S/S of hyponatremia
Monitor for neurological changes
Oral hygiene (restrict fluids)

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80
Q

If a pt is at risk of a seizure, what are some precautions that need to be taken?

A

fall precaution
mats
Suction

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81
Q

Lithium patients with low Na can cause them to go into

A

lithium toxicity with urinary sodium loss

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82
Q

HYPERnatremia lab values

A

greater than 145

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83
Q

Hypernatremia ____ fluid _____ of the cells

A

pulls fluid out

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84
Q

Primary protection of Hypernatremia

A

Thirst

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85
Q

HYPERnatremia mnemonic

A

HIGH SALT

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86
Q

HIGH SALT
HYPERnatremia Causes

A

Hypercortisolism (Cushing’s, hyperventilation)
Increased intake of sodium
GI feeding w/o adequate water supplements
Hypertonic solutions (Na is more than isotonic
Sodium excretion decreased and corticosteroids
Aldosteronism
Loss of fluids (infection, sweating, diarrhea, DI)
Thirst impairment

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87
Q

Hypernatremia S/S
mnemonic

A

No FRIED foods for you!

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88
Q

Hypernatremia S/S

A

-Neuro-
Fever, flushed skin
Restless, really agitated
Increased fluid retention
Edema, extremely confused
Decreased urine output, dry mouth/skin

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89
Q

Hypernatremia lab value

A

High Numbers
Serum Na+ > 145 mEq/L
Serum osmolality > 300 mOsm/L
Urine specific gravity > 1.015

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90
Q

Hypernatremia Treatment

A

decrease Na gradually
decrease 0.5-1 L/ hr over 48 hours
Monitor for neuro changes and cerebral edema
Hypotonic solutions (D5W or 1/2 NS)
Desmopressin for DI

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91
Q

What medication would you use to treat hypernatremia if the underlying factor is DI?

A

Desmopressin

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92
Q

Nursing Interventions for Hypernatremia

A

Identify pt at risk (ELDERLY and INFANTS, confused, trauma, post-op, burn, immobile)
Monitor fluid loss/gain
Daily wt
Labs
ORAL Na Intake(processed, canned, frozen)
Neuro precautions and behavior changes
Offer fluids
Note medication with high Na+ content

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93
Q

What medications have high Na content?

A

Alka-seltzer

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94
Q

Pathway of Potassium

A

Intake: diet
Absorbed: Kidneys
Excreted: kidneys/bowels

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95
Q

Normal lab values Potassium

A

3.5-5

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96
Q

Potassium functions

A

skeletal and cardiac muscle activity
Sodium/Potassium Pump

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97
Q

What is the major electrolyte of intracellular fluid?

A

Potassium
- it can be found in ECF

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98
Q

How is K obtained? absorbed? and excreted?

A

diet
intestines
kidneys/bowels

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99
Q

What meds could affect K?

A

diuretics
laxatives
antibiotics
parental nutrition
chemo

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100
Q

Potassium enriched foods

A

Bananas
Watermelon
White beans
Spinach
Avocado
Sweet potatoes

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101
Q

What percentage of K is excreted by the kidneys?

A

80

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102
Q

Does the body conserve K?

A

no even with a deficit

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103
Q

What system is important in keeping balanced potassium?

A

renal
body does not conserve potassium

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104
Q

Hypokalemia Causes mnemonic

A

Body is going to DITCH potassium

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105
Q

Hypokalemia Causes

A

Drugs (diuretics, laxatives, insulin, corticosteroids)
Inadequate consumption of K
Too much water intake (IV fluids w/o K)
Cushing’s syndrome
Heady fluid loss (GI, V/D, SUCTION)

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106
Q

What is the number 1 reason of hyperkalemia?

A

renal failure

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107
Q

Cushing’s disease

A

tumor on the pituitary gland makes too much ACTH. In response, adrenal glands produce too much cortisol. This causes problems with your body’s hormone balance.

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108
Q

What drugs cause hypokalemia?

A

diuretics
laxatives
insulin
corticosteroids

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109
Q

Hypokalemia S/S mnemonic

A

SLOW
LOW

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110
Q

Hypokalemia S/S
SLOW/LOW

A

Weak, irregular pulses
Orthostatic hypotension
Arrhythmias
Shallow respirations
Confusion, weak
Deep tendon reflexes decreased
Decreased bowel sounds

Lethargy (confusion)
Low, shallow respirations
Lethal cardiac dysrhythmias
Lots of urine
Leg** cramps**
Limp muscles
Low BP & Heart

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111
Q

Renal loss of K

A

loop diuretics with potassium
hyperaldosteronism
high dose of sodium PCNs
large dose corticosteroids

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112
Q

Digoxin does what to the heart

A

contracts

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113
Q

Hypokalemia at risk pts

A

elderly

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114
Q

Hypokalemia
-Cardiac Changes-

A

low strength of contraction
Myocardium irritability extra beats
ST segment depression
K+ < 2.7 mEq/L may result in PACs, PVC’s, V-fib or cardiac arrest
K+ < 3.5 assoc. with met. alkalosis, high pH & high HCO3
Digoxin toxicity

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115
Q

Digoxin and low K do together

A

potentiate
so best not to usually give buth meds

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116
Q

Hypokalemia lab values

A

K+ deficit < 3.5 mEq/L
K+ < 3.5mEq/L often assoc. with metabolic alkalosis, high pH, & high HCO3
K+ < 2.7 may result in dangerous dysrhythmias
high pH & HCO3

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117
Q

Hypokalemia Treatment

A

K replacement (PO/IV)
Increase on a daily basis (40-80 a day)
at-risk pt (50-100 a day)
potassium-rich foods
treat underlying cause

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118
Q

Oral K Supplements

A

minimize GI irritation
- dilute liquid and effervescent supplement
- give tabs and caps q/ 8 oz water
- give K with food

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119
Q

Adverse reactions of K oral supplements

A

N/V/D
GI bleed

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120
Q

IV K supplements

A

Must be diluted
Check K before giving K
NOT Direct IVP
Max. dose is 60 mEq at a time
Must use IV pump
Monitor renal output, site
Telemtery

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121
Q

Nursing Interventions of Hypokalemia

A

Identify pt at risk – esp. if on Digoxin
Monitor ECG & BP (LETHAL DYSRRHYTHMIAS)
Monitor serum K+
Pt education – diuretics & laxatives
Administer K+ supplements PO or IV
increase dietary K+
Monitor urine output

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122
Q

Digoxin __________ K

A

potentiates

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123
Q

Hyperkalemia Causes mnemonic

A

CARED (treatment induced)

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124
Q

When looking at fluid in our body, what are we looking to measure with?

A

Daily weight

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125
Q

Which potassium disorder is the most dangerous? Why?

A

Hyperkalemia
- cardiac arrest

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126
Q

Hyperkalemia Causes

A

Cellular mvmt
Adrenal insufficiency with Addison’s disease
Renal failure
Excessive potassium intake
Drugs

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127
Q

What part of the body does sodium affect the most?

A

brain (swelling)

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128
Q

How can cellular mvmt cause Hyperkalemia

A

burns, chemo
the cells die and K are released

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129
Q

Addison’s disease

A

adrenal insufficiency
Na lost and K released

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130
Q

What drugs can cause Hyperkalemia?

A

ACE inhibitors
NSAIDs
Beta-blockers
- increase aldosterone

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131
Q

Hyperkalemia S/S mnemonic

A

Muscle weakness
Urine production is little/none
Respiratory failure
Decrease cardiac contractibility
Early signs of muscle twitches/cramps
Rhythm changes
-telemetry

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132
Q

Hyperkalemia cardiac changes

A

Slows heart rate
ECG changes
Risk for Heart Block, A-fib, or, V-fib
Severe high K+
Decreased heart contraction strength
Dilated & flaccid heart

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133
Q

Hyperkalemia lab value

A

Serum potassium > 5.3 mEq/L
ECG abnormalities
ABG – low pH indicating acidosis

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134
Q

Hyperkalemia treatment

A

restrict diet
stop k containing meds
monitor for digitalis toxicity
cation exchanging resins
dialysis (if absolutely needed)

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135
Q

Meds containing K

A

ACE inhibitors
NSAIDS
Beta Blockers

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136
Q

Kayexalate aka

A

Polystyrene sulfonate

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137
Q

Kayexalate is a

A

laxative binding to K and releases in the stool

138
Q

If a patient has a digestive issue, would they be able to take Kayexalate?

A

no

139
Q

Emergency med tx Hyperkalemia

A

Ca Gluconate - IV
Hypertonic Glucose and Insulin
Sodium Bicarbonate

140
Q

Ca Gluconate - IV

A

not lower K
protects the heart allowing others to work
monitor ECG and telemetry

141
Q

How long do you give Ca Gluconate?

A

over 3 mins

142
Q

If the pt has bradycardia, do you stop Ca Gluconate?

A

Yes

143
Q

Hypertonic Glucose and Insulin

A

Insulin - puts K into cells
Glucose - high insulin release from the pancreas
not for diabetics

144
Q

What med do you give with glucose and insulin?

A

albuterol (shifts K into the cells)
- they won’t feel good and fall risk
- fast hr and shakes

145
Q

Sodium Bicarbonate moves

A

into the cells temporarily

146
Q

Nursing Interventions of Hyperkalemia

A

Be aware of pt at risk
Monitor for:
-Generalized weakness & dysrhythmias
-Irritability & GI symptoms
-Nausea & intestinal colic
ECG or lab abnormalities
Prevention of hyperkalemia
Educate pt: medication & diet
Do NOT draw blood above K+ infusion

147
Q

When should you check K after giving it?

A

2 hours

148
Q

During dialysis, what happens to the BP?

A

BP lowers
-so don’t give BP lowering meds

149
Q

Why should aldactone (potassium-sparing diuretics) not be given to renal pts?

A

potassium in sodium substitutes

150
Q

Magnesium is absorbed and excreted by

A

GI Tract
Kidneys

151
Q

Mg Normal values

A

1.5-2.5 mg/dL

152
Q

Mg critical values

A

<1.2 or > 4.9

153
Q

Potassium and Magnesium are

A

best friends

154
Q

Mg functions

A

Regulating Muscle and nerve function
Blood Sugar levels
Immune System

155
Q

Mg is needed for what system

A

cardiac (arrhythmias)

156
Q

Mg stimulates what hormone to regulate what

A

parathyroid hormone
regulates Ca

157
Q

Hypomagnesemia is often associated with

A

hypokalemia

Low Mg makes low K resistant to treatment
Keep cardiac pt at 2.0

158
Q

Hypomagnesemia S/S

A

Tight airway
–Stridor, laryngospasm, difficulty swallowing–
Hyperflexion-Muscle twitching
N/V/D
(increased brain activity)
Irritability, insomnia, confusion, seizure
Increased BP and HR

159
Q

Hypomagnesemia Causes

A

Mg absorbed in the intestine*
Renal loss
Chronic alcoholism (Most common)
Antibiotics
GI Loss (N/V/D)
Malabsorption (Crohn’s, celiac disease)

160
Q

Nursing Interventions for Mg

A

Safety with swallowing
-THICK LIQUIDS, sit up and awake, tuck chin down
IV Mg sulfate (give slowly)
monitor respiratory status and reflexes

161
Q

Food Rich in Mg

A

DARK Chocolate
Avocados
Milk
Peas
Peanut butter
Oranges
Nuts
Bananas

162
Q

Hypermagnesemia Causes

A

Antiacids
Renal Failure
Potassium Excess

163
Q

Hypermagnesemia Nursing Interventions

A

Hemodialysis
IV Calcium Gluconate
Monitor Labs

164
Q

Hypermagnesemia S/S

A

Heart- calm and quiet
-Low and shallow Respirations
-Bradycardia
-Hypotension
Lung
-Low and shallow Respirations
GI
-Hypoactive Bowel Sounds
Neuro
-Drowsiness, lethargy
MS
-Weakness

165
Q

Calcium (total) lab normal value

A

8.4-11

166
Q

What percentage of Calcium is stored in bones and teeth?

A

99%

167
Q

What are the 3 functions of Calcium in the body?

A

Bones and teeth- forms
Blood - clots blood
Beats - squeezing and relaxing for muscles (keep normal beats)

168
Q

What are the 3 forms of Calcium?

A

Bound
Ionized
Complexed

169
Q

Bounded Calcium is bounded to

A

proteins - albumin (less than 50%)

170
Q

Ionized Calcium is found in

A

serum

171
Q

What type of Calcium is most important?

A

ionized

172
Q

What percentage of calcium is ionized?

A

50

173
Q

Children have _____ level of serum Ca than elderly.

A

higher
bc of bone growth

174
Q

Complexed Calcium is combined with

A

nonprotein anions
-Phosphate
-Citrate
-Carbonate

175
Q

Ionized Calcium functions

A

activate body chemical reaction
muscle contractions and relaxations
promote transmission of nerve impulse
cardiac contractility and automaticity
formulation of prothrombin

176
Q

Ionized Ca carries out

A

most of the functions

177
Q

What relationship do albumin and Calcium have?

A

same
low = low
high = high

178
Q

Calcium and Phosphorus relationship

A

inverse
Low Cal = High P
High Cal = Low P

179
Q

Parathyroid Hormone does what to Calcium

A

pulls Calcium out of the bones and into blood plasma for absorption through GI and renal

180
Q

When Calcium is low, this regulator “pulls” Ca and phosphorus from the bone.

A

Parathyroid Hormone

181
Q

What are the Calcium regulators?

A

Parathyroid Hormone
Calcitonin
Phosphate
Vitamin D

182
Q

Calcitonin is secreted by the

A

thyroid

183
Q

Calcitonin has a ________ relationship with PTH

A

ANTAGONIST

184
Q

When Calcium is too high, this hormone is secreted from the thyroid to “keep” Ca.

A

Calcitonin
-tones down Ca-

185
Q

When is Calcitonin secreted?

A

high serum Ca

186
Q

What is the function of Calcitonin?

A

inhibits Ca reabsorption from bone
“keeps” Ca in the bone

187
Q

Phosphate has what relationship with Calcium?

A

inverse
high Calcium = low Phosphate

188
Q

What does Phosphate do as a Ca regulator?

A

inhibits Ca reabsorption in the intestines

189
Q

Vitamin D is necessary for what in relation to Calcium?

A

absorption and utilization of Ca

190
Q

What foods are rich in Vitamin D?

A

mushrooms
egg yolk
fatty fish
tuna
spinach
safe sun exposure

191
Q

Hypocalcemia Causes mnemonic

A

LOW CAL

192
Q

Hypocalcemia Causes

A

Low PTH (no regulation from surgery)
Oral intake inadequate (alcoholism and bulimia)
Wound drainage (low absorption)
Celiac, Crohn’s (malabsorption)
and corticosteroids (increase the bone breakdown and body unable to absorb)
Acute pancreatitis (low PTH secretion)
Low Vitamin D (no absorption)

193
Q

High doses of steroids cause

A

osteoporosis

194
Q

Hypocalcemia S/S mnemonic

A

CRAMPS

195
Q

Hypocalcemia S/S

A

Confusion
Reflexes hyperactive
Arrhythmias (cardiac floor)
Muscle spasms (tetany, seizures)
- mouth and fingertips
Positive Trousseau’s
Signs of Chvosteks (facial)

196
Q

Trousseau’s

A

hand spasm when BP is taken due to the low blood supply and pressure on nerve
-increase in systolic BP

197
Q

Chvostek’s

A

facial nerve spasm
tap facial nerve anterior to ear lobe below zygomatic process

198
Q

Hypocalcemia - Cardiac effects

A

dysrhythmias
torsades de pointe
decrease cardiac contractibility
decrease sensitivity to Digoxin

199
Q

Torsades de pointe

A

ventricular tachycardia by hypocalcemia
arrhythmias

200
Q

Low serum calcium (hypocalcemia) = _______ albumin

A

low

201
Q

What hormone levels can affect Ca?

A

Parathyroid Hormone

202
Q

What levels should be obtained along with Calcium?

A

Mg
Phosphorus

203
Q

What is the purpose of IV Therapy?

A

Provide
-H2O
-Electrolyte
-Nutrients
Replace deficits
Administer meds and blood
TPN, dysphagia
Emergency situations

204
Q

TPN can only go through

A

Central line

205
Q

Advantage of IV Therapy

A

emergency access
administration route when PO is not available
continuous fluids
control over rate

206
Q

Disadvantages of IV Therapy

A

damage
fluid overload
overdose
infections
immobility
incompatibility
adverse reactions
electrolyte imbalance

207
Q

If a pt has an allergic reaction to an IV medication, what should you do?

A

Stop infusion
Call infusion
Get help

208
Q

When assessing an IV, what do you do?

A

check patency, wear gloves
signs of infection
check rate and med, allergies and compatibility

209
Q

What are the signs of an infection?

A

fever
tenderness
redness
respirations increase
swelling

210
Q

Hypovolemia AKA

A

dehydration
deficient in fluid

211
Q

When do you change an IV?

A

48 hours
PRN

212
Q

Hypovolemia leads to

A

hypovolemic shock

213
Q

Hypovolemia Causes

A

loss of fluid from anywhere
-Thoracentesis/Paracentesis
-hemorrhage/bleeding
-NG Tube
-Trauma
-n/v
-severe dehydration
-conditions causing polyuria
-diuretics
-3rd spacing (burns and ascites)

214
Q

Hypovolemia via polyuria diseases

A

Diabetes
Diabetes Insipidus
Diuretics

215
Q

3rd Spacing is when

A

fluid shifts from intravascular to the interstitial

216
Q

Hypovolemia S/S

A

DECREASE WT
increase hr (thready)
Low BP, urine output, and CVP
dark concentrated urine
increase respiration rate
Tenting skin
Thirst and dry mouth**
flat neck veins

217
Q

What is a severe symptom of hypovolemia?

A

HR increases by compensating

218
Q

When remembering BP and Volemia (hypo and hyper), what do you need to know?

A

Low volume = low pressure
High volume = High pressure

219
Q

Hypovolemia Labs

A

concentrated
= higher numbers of serum osmolality, specific gravity, hematocrit, serum sodium, and BUN

220
Q

Hypovolemia Treatment

A

Replace fluid (PO or IV)
- Monitor for Fluid overload
Orthostatic hypotension safety precautions
- rise slowly when standing
Daily wt and I&Os

221
Q

Hypervolemia AKA

A

OVERHYDRATION
excess

222
Q

Hypervolemia Causes

A

Heart failure
kidney dysfunction
cirrhosis
increase sodium intake

223
Q

Hypervolemia is more common in

A

elderly pts

224
Q

Hypervolemia S/S

A

daily wt gain
increase HR (BOUNDING)
increase BP, CVP, URINE (polyuria)
wet lung sounds
edema
distended neck veins JVD

225
Q

When should a pt be concerned with gaining weight and contact a doctor?

A

increase of 2 lbs a day
5 lbs a week

226
Q

Hypervolemia Labs

A

diluted
low values

227
Q

Hypervolemia Tx

A

low sodium diet
Daily I&O and Wt
Monitor V/S and assess respiratory rate
Diuretics
High-Semi-Fowler’s position (relieve lungs)

228
Q

What are the different crystalloids in IV Solutions?

A

isotonic
hypotonic
hypertonic

229
Q

What 3 things determine the type of IV solution given to the pt?

A

condition
diagnosis
lab values

230
Q

Aquaporin channels

A

allow water molecules to pass through cell membranes without using energy

231
Q

Diffusion

A

movement of particles from higher to lower concentration

232
Q

Hypertonic

A

higher concentration of salt
water rushes out of the cell
cell shrinks - plasmolysis

233
Q

Hypotonic

A

very watery
water goes into the cell and attaches to NaCl
cell swells and possible cytolysis

234
Q

Isotonic

A

stays the same dynamic equilibrium

235
Q

The osmolality of the blood

A

the concentration of all chemical particles found in the intravascular/fluid part of the blood

236
Q

Osmolality primarily reflects concentration of:

A

sodium
BUN
glucose

237
Q

What relationship does sodium have with osmolality?

A

direct (low = low)

238
Q

What is the normal value of osmolality?

A

280-300

239
Q

Factors Increasing Osmolality

A

dehydration (concentration of Na)
free water loss
DI (polyuria)
Hypernatremia
Hyperglycemia
Stroke from a head injury
Renal Tubular necrosis (kidney’s dead)

240
Q

Factors Decreasing Osmolality

A

fluid vol excess
SIADH
Renal failure
Hyponatremia
Overhydration

241
Q

Isotonic Solutions are given to

A

replace fluid loss

242
Q

Isotonic Solutions osmolality

A

similar to ECF
280-300

243
Q

T/F: Isotonic Solutions DO cause RBCs to shrink or swell.

A

False, they do not.

244
Q

Isotonic Solutions are given through IV where does it go?

A

stays in the intravascular system

245
Q

Isotonic Solutions

A

D5W (changes to hypotonic)
NS
LR

246
Q

D5W contains

A

water and glucose

247
Q

How does D5W change from isotonic to hypotonic?

A

isotonic outside the body but once infused dextrose is rapidly metabolized, then the water becomes hypotonic

248
Q

What isotonic solution do we need to use caution with for diabetics, hypernatremia, and head trauma pts?

A

D5W
cause hyperglycemia bc dextrose
cause hypotonic after sugar is used and cause cells to swell (cerebral edema)

249
Q

Can you reverse cerebral edema?

A

no

250
Q

D5W is primarily used to treat

A

hypernatremia
BUT use it with caution

251
Q

If too much D5W goes into the cells, then what is your first sign of swelling?

A

decrease LOC

252
Q

NS is used to correct

A

correct extracellular volume deficit
- hypovolemia
- resuscitative efforts
- shock
-metabolic alkalosis
- hypercalcemia
- hyponatremia

253
Q

Does NS have calories?

A

no

254
Q

What is the only solution that can be given with NS?

A

blood

255
Q

NS replaces large amounts of sodium ___________

A

losses

256
Q

NS is not used/cautioned for what pts?

A

CHF
Pulmonary edema
renal impairment
trauma

257
Q

If at-risk pts, start having crackles in the lungs, dyspnea, and anxiety, then what should the nurse do?

A

stop infusion
sit up
O2
dr notification
- let pt know and try to decrease anxiety
possible diuretics given

258
Q

LR contains what electrolytes?

A

potassium
calcium
sodium chloride

259
Q

LR is used to correct

A

dehydration
sodium loss
GI loss (vomiting, diarrhea)

260
Q

LR should be used with caution with what pts

A

CHF
Renal insufficiency
edema
sodium retention
hyperkalemia

261
Q

Hypotonic Solutions osmolairty

A

less than 280
-depletes ECF

262
Q

Hypotonic _________ ECF

A

DILUTES
lowering serum osmolality

263
Q

Hypotonic solutions are used for

A

hypernatremia
(not for fluid replacement)

264
Q

If hypotonic solutions are given for too long,

A

cells swell to a cerebral edema

265
Q

Hypotonic solutions _______ BP

A

lower

266
Q

Hypotonic solutions types

A

lower amounts or fractions

267
Q

Hypotonic fluid shifts such as

A

intravascular fluid depletion
low BP
cerebral edema

268
Q

What patients are at risk of worsening hypotension if given hypotonic fluid? Select all that apply.
ICP
CVA
Head trauma
Burns
Malnutrition
Liver disease

A

All of the above.
ICP
CVA
Head trauma
Burns
Malnutrition
Liver disease

269
Q

Hypertonic solutions osmolality

A

greater than 300
- water to move out of the cells

270
Q

Hypertonic solutions are given to

A

decrease risk of edema
stabilize BP
regulate urine output
-repair electrolytes and acid/base imbalances
-TPN

271
Q

Hypertonic solutions are usually given through a

A

Central line

272
Q

Hypertonic solutions are used to with caution in patients with

A

diabetes
impaired heart and kidney function

273
Q

What should be closely monitored for hypertonic solutions?

A

circulatory overload

274
Q

Hypertonic solution types are

A

high numbers

275
Q

Colloids are

A

large molecules not dissolved and can’t pass through membrane
- volume expansion

276
Q

Primary reason for colloids

A

pull fluid into the bloodstream

277
Q

What is given after dialysis to stabilize BP?

A

albumin

278
Q

What is the most common colloid given?

A

albumin

279
Q

Dextran

A

plasma vol expander

280
Q

Hetastarch

A

synthetic vol expander

281
Q

Mannitol

A

alcohol sugar (usually neuro)

282
Q

Albumin pulls what into the blood vessels

A

salt and water
- to not leak out fluid from intravascular to maintain BP

283
Q

If you have a pt who came back from a Paracentesis, which they drained 3L of fluid from, what is their expected BP going to be? What would the nurse expect to be given or prescribed to the pt?

A

low
-Albumin (to stabilize BP)

284
Q

Albumin carries what throughout the body

A

hormones
vitamins
enzymes

285
Q

What should be monitored when giving patients an infusion of colloids?

A

increase in BP
Dyspnea
bounding pulse
fluid overload (JVD, high BP, resp distress)
anaphylaxis
I&O, wt, v/s

286
Q

What electrolytes need to be monitored on albumin?

A

potassium
sodium

287
Q

Phlebitis

A

inflammation of vein

288
Q

Causes of phlebitis

A

poor asepsis
high osmolality infusion
improperly diluted meds
incorrect gauge
too rapid infusion

289
Q

S/S of phlebitis and thrombophlebitis

A

tenderness
redness
heat
edema

290
Q

Prevention of phlebitis and thrombophlebitis

A

rotate site
dilute properly
slow infusion
aseptic

291
Q

Intervention of phlebitis and thrombophlebitis

A

stop infusion
remove
apply warm compress

292
Q

How long can an IV stay in place

A

48 hours
PRN

293
Q

Thrombophlebitis

A

formation of clots and inflammation in the vein
- occurs after phlebitis

294
Q

Causes of thrombophlebitis

A

injury to vein
infection
chemical irritation
prolonged use of the same vein

295
Q

Infection

A

pathogen in surrounding tissue of IV site

296
Q

Causes of infection

A

lack of aseptic
loose or contaminated dressing
prolonged use of vein

297
Q

S/S of infection

A

redness
tenderness
swelling
edema

298
Q

Air embolism

A

air entering the vein becomes trapped in the blood as it flows
- rate of entry very important

299
Q

Causes of air embolism

A

solution runs dry
improper priming
loose connections
poor technique in dressing, tubing, and removal of central lines

300
Q

How do you remove Central lines?

A

left reverse Trendelenburg
hold for 5 mins

301
Q

S/S of air embolism

A

dyspnea, unequal breath sounds
cyanosis
hypotension
weak, rapid pulse
LOC
chest, shoulder, low back pain
shock
death

302
Q

Air embolism Tx

A

stop infusion and clamp
call for help
left Trendelenburg
O2
V/S
emergency equipment ready

303
Q

Speed shock

A

systemic reaction when med is rapidly introduced into circulation
-caused by too rapid infusion

304
Q

S/S of speed shock

A

dizzy
face flushing
HA
hypotension
chest tightness
irregular pulse
shock progress

305
Q

Prevention of speed shock

A

correct rate
pump
close monitor

306
Q

What fluid shifting is abnormal?

A

3rd spacing

307
Q

K lower than 2.7 may result in what happens to the heart

A

V-fib
cardiac arrest

308
Q

Hypocalcemia Tx

A

10% Ca Gluconate (severe symptoms)
Ca-Chloride (never IM)
Oral Ca (antacids and dairy and vit D)

309
Q

With acute symptomatic hypocalcemia, what should the nurse do?

A

EMERGENCY
-requires prompt admin. of IV Calcium

310
Q

With IV Calcium, what needs to be watched closely and why?

A

IV site
Infiltration
- cause necrosis and sloughing

311
Q

Rapid infusion of Calcium can cause what complications?

A

bradycardia leading to cardiac arrest

312
Q

Calcium does what to the BP of a patient and what risk might they be placed on?

A

Posterior hypotension
- Fall risk - stay in bed

313
Q

Nursing Interventions of Hypocalcemia?
At risk?

A
  • At risk = parathyroid surgery/injury
    seizure precautions if severe low
    monitor airway and telemetry
    Educate- Calcium rich diet
314
Q

HYPERcalcemia Causes mnemonic

A

HIGHCAL

315
Q

HYPERcalcemia Causes

A

Hyperparathyroidism and cancer
Increased Ca intake
Glucocorticoid usage (increase CA excretion = increase PTH and increase bone reabsorption)
Hyperthyroidism
Calcium excretion** w/ thiazide diuretics** (potentiates and raises PTH)
Adrenal insufficiency (Addison’s)
Lithium (affects parathyroid)
-prolonged immobilization

316
Q

HYPERcalcemia S/S mnemonic

A

WEAAAK

317
Q

HYPERcalcemia S/S

A

Weakness of muscles
EKG changes (slows heart rate)
Absent reflexes, mind (disoriented)
Abdominal distension (constipation)
Kidney stones

318
Q

HYPERcalcemia - Cardiac

A

stimulates contractibility and lowers heart rate
Arrthymias lead to cardiac arrest
potentiate digoxin toxicity

319
Q

Digoxin and Calcium do what with each other?

A

potentiate
- worry about K in the blood with these

320
Q

Digoxin toxicity

A

confused
vision changes
irregular hr
loss of appetite

321
Q

Hypercalcemia Labs

A

greater than 11
dysrrthymias
PTH high
Xray osteoporosis
Urine

322
Q

Hypercalcemia Tx

A

treat underlying cause
Dilute serum Ca with NS
Loop Diuretics - Lasix
IV Phosphate - inverse relations
Calcitonin
Glucocorticoids - inhibit reabsorb
Hemodialysis

323
Q

What drug is safe to give HYpercalcemia pts with heart or renal issues too?

A

Calcitronin

324
Q

Hypercalcemia Nursing Interventions
-at risk

A
  • AT risk =
    Increase activity and fluids
    lower Ca intake
    Confusion safety
    Monitor EKG, I&O, breath sounds
    Dig toxicity
    Prevent kidney stones
325
Q

Phosphorus lab normal

A

2.5-4.5

326
Q

High Calcium =

A

low phosphate
-cardiac and neuromuscular problems

327
Q

Phosphorus is mainly found in the

A

teeth and bones like Ca

328
Q

Functions of Phosphorus

A

bone and teeth form
repair cell tissues and energy
nervous system
muscle function

329
Q

Phosphorus is regulated by

A

parathyroid
and calcitriol

330
Q

Phosphorus is high in foods

A

dairy
meats and beans

331
Q

Hypophosphatemia Causes

A

Malnutrition/starvation - most common
Increased Phosphorous excretion
Hyperparathyroidism (Calcium increases: Phos drops)
Malignancy
Diuretics/Diarrhea
Use of magnesium/aluminum antacids (Increases Ca, depletes phos)

332
Q

Hypophosphatemia S/S

A

SAME AS HYPERCALCEMIA
Cardio: Decreased BP/HR**
GI: hypoactive Bowel sounds**
GU: Kidney stones**
NEURO: Altered LOC**
MUSC: Severe muscle weakness**
Bone pain/fractures

333
Q

Hypophosphatemia Interventions

A

replace Phosphorus IV/PO
give slow
PO with Vitamin D
Fracture precautions

334
Q

Hyperphosphatemia Causes

A

Increased Phosphorus intake
Overuse of laxatives-elderly
Renal insufficiency= Decreased excretion
Hyperparathyroidism
Hypocalcemia

335
Q

Hyperphosphatemia

A

Diarrhea
Hyperactive bowel sounds
Positive Trousseau’s/Chvostek’s
Painful muscle spasms
Hyperactive Deep tendon reflexes
Irritable skeletal muscles –twitches, tetany, seizures
Osteoporosis

336
Q

Hyperphosphatemia Interventions

A

Replace Calcium (IV/PO)
IV Calcium gluconate 10% (Monitor BP, HR)
Vitamin D when giving PO
Aluminum Hydroxide (Tums)*
Initiate seizure precautions
Move pt carefully
Educate on calcium-rich foods
dairy

337
Q

Thyroid inflammation is known as a

A

goiter

338
Q

SIADH

A

retain too much water
leads to hyponatremia

339
Q

DI

A

BODY MAKES TOO MUCH URINE (20qts/day)
-polyuria
hypernatremia

340
Q

Potassium can go through ________ __ but you prefer a central line

A

peripheral IV (slowly - 10 mEq)

Module 4 (MedSurg 2) (36 decks)

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