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Module 2 > Fluids & Electrolytes > Flashcards

Fluids & Electrolytes Flashcards

1
Q

What medication is hard on the kidneys?

A

NSAIDS; Ibuprofen

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2
Q

The RAAS releases

A

Renin
(Renin-Angiotensin-Aldosterone system)

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3
Q

Aldosterone regulates

A

Water

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4
Q

Atrial natriuretic peptide (ANP) reduces

A

Fluid volume

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5
Q

Antidiuretic hormone (ADH) controls

A

Water retention
(vasopressin!!)

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6
Q

Vasopressin is a

A

Vasoconstrictor

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7
Q

Anti-Diuretic hormone (ADH)

A

Controls JUST water retention (increases)
Raises BP
Helps restore blood volume

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8
Q

Aldosterone (RAAS)

A

Causes kidneys to retain Na+ and water; excretes K+
Released is Na+ is low and K+ is high
Think sodium AND water retention!!

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9
Q

Low aldosterone =

A

High K+

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10
Q

High aldosterone =

A

Low K+

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11
Q

When blood pressure drops….

A

Renin is released by the kidneys

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12
Q

RAAS causes

A

Increased BP due to increased water and sodium retention
Increased respiratory rate — tachypnea
Increased heart rate — tachycardia

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13
Q

Angiotensin 2 =

A

Vasoconstriction!

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14
Q

Atrial Natriuretic peptide (ANP)

A

Stops action of RAAS
Decreases BP by vasodilation
Reduces fluid volume by increasing secretion of Na+ and water

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15
Q

Brain natriuretic peptide (BNP)

A

Blocks aldosterone
Common lab test for heart failure

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16
Q

Patients with heart failure

A

Have increased fluid retention —> need a diuretic! (Furosemide)

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17
Q

Furosemide is a

A

Diuretic

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18
Q

Lasix is

A

Furosemide

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19
Q

Older adults do not have

A

Thirst stimulation

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20
Q

S/S of dehydration

A

Dizzy
Weak
Thirst
Dry
Oliguria
Anuria

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21
Q

With hypovolemic shock, what does the nurse need to do?

A

Replace fluid volume ASAP
-IV (large bore in both arms)
-isotonic fluids (LR, NS)
Needs indwelling catheter for strict I&O
May need blood transfusion

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22
Q

S/S of mild hypovolemic shock

A

Hypotension
Tachypnea
Tachycardia

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23
Q

S/S of severe hypovolemic shock

A

Bradypnea
Bradycardia

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24
Q

Hypovolemia

A

Can be produced by salt and water loss due to vomiting, diarrhea, diuretics, or third spacing

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25
Q

Water loss alone

A

Dehydration

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26
Q

Dehydration is always

A

Hypernatremic

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27
Q

Dehydration treatment

A

Free water administration

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28
Q

Electrolytes separate into

A

Ions (charged particles) when dissolved in water

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29
Q

Cations

A

+ charge
Na+, K+, Ca+, Mg+

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30
Q

Anions

A
  • charge
    Cl, HCO3, phosphate
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31
Q

Depletion of electrolytes

A

Think fluid — where fluids go, electrolytes go!
-vomiting
-urination
-bowel movement
-sweating

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32
Q

Magnesium levels

A

1.5 — 2.5 mg/dL

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33
Q

Phosphorus levels

A

2.4 — 4.5 mg/L

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34
Q

Potassium levels

A

3.5 — 5.0 mEq/L

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35
Q

Calcium levels

A

8.5 — 10.5 mg/dL

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36
Q

Chloride levels

A

95 — 105 mEq/L

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37
Q

Sodium levels

A

135 — 145 mEq/L

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38
Q

What foods can help raise potassium levels?

A

Fruits
Green leafy vegetables
Spinach
Salt substitutes
Cantaloupe

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39
Q

What foods can help raise sodium levels?

A

Table salt
Cheese
Spices
Canned, processed foods

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40
Q

What foods can help raise magnesium levels?

A

Spinach
Almonds
Yogurt
Green vegetables
Nuts
Dark chocolate!!!

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41
Q

What foods can help raise calcium levels?

A

Milk
Cheese
Green vegetables

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42
Q

what foods can help raise phosphorus levels?

A

Dairy
Meats
Beans

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43
Q

What foods can help raise chloride levels?

A

Salty foods, salt substitutes
Canned foods
Vegetables — tomatoes, lettuce, celery, and olives

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44
Q

What food should you avoid if your magnesium levels are high?

A

Nuts

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45
Q

What is the priority when sodium is involved?

A

Think brain!!
Neuro checks
Safety

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46
Q

Sodium is a major electrolyte in

A

Extracellular fluid

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47
Q

Sodium controls

A

Water balance
Maintains BP

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48
Q

Where Na goes,

A

Water flows

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49
Q

SIADH

A

Impaired water excretion caused by inability to suppress secretion of ADH

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50
Q

Water retention causes

A

Dilutional Hyponatremia

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51
Q

Sodium is regulated by

A

ADH and aldosterone, Na+ K+ pump

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52
Q

Hyponatremia levels

A

Less than 135 mEq/L

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53
Q

Increased Na+ excretion

A

4 D’s — diarrhea, diuretics, drainage, diaphoresis
Vomiting
Kidney disease
Hypoaldosteronism

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54
Q

Hypoaldosteronism

A

Addisons
Sodium loss and water retention

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55
Q

Three flavors of Hyponatremia

A

Euvolemic
Hypovolemic
Hypervolemic

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56
Q

Euvolemic

A

Low Na+ with ECF volume normal

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57
Q

Hypovolemic

A

Na+ loss with ECF volume depletion

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58
Q

Hypervolemic

A

Na+ loss with increased ECF volume

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59
Q

Severe Hyponatremia

A

Seizures
brain stem herniation
respiratory arrest
death

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60
Q

Severe Hyponatremia occurs

A

Rapidly, suddenly
Levels 115-120

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61
Q

Moderate Hyponatremia

A

Lethargy
Weakness
Altered LOC

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62
Q

What brain related thing can happen in Hyponatremia?

A

Cerebral swelling

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63
Q

Hyponatremia interventions

A

Replace sodium slowly!
0.5 mEq/L per hour MAXIMUM
Should raise 6-12 points in 24 hour period

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64
Q

Spironolactone

A

A diuretic that doesn’t lose K+

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65
Q

What should you stop/hold in Hyponatremia?

A

Sodium wasting diuretics
-Loop diuretics
-Thiazides

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66
Q

Safety is extremely important in

A

Hyponatremia
Bedrest, make sure pt calls for help
Frequent falls!

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67
Q

What should you put a patient on instead of a loop diuretic in Hyponatremia?

A

Spironolactone

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68
Q

IV fluids/medications for Hyponatremia

A

Hypovolemic — 0.9% NS
3% NS
Hypervolemic — osmotic diuretics (Mannitol)
Euvolemic — SIADH

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69
Q

3% normal saline is used for

A

Extremely low sodium (Na)

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70
Q

What do you do for a patient that has too much fluid?

A

Restrict fluids

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71
Q

Give 3% normal saline

A

Through a central line, it is highly caustic on veins

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72
Q

Severe Hyponatremia interventions

A

Administer 3% saline IV SLOWLY
Plan for CVAD (3% highly caustic)
Indwelling catheter for strict I&O
Neurological checks
Bedrest

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73
Q

Mannitol

A

Excretes water but not Na+

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74
Q

If severe Hyponatremia is over corrected too quickly

A

Damage to nerve cells in brain
Locked in syndrome

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75
Q

Locked in syndrome

A

Can’t move, blink, speak

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76
Q

Severe Hyponatremia levels

A

Less than 120

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77
Q

What do you need to monitor with severe Hyponatremia?

A

Na level closely!

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78
Q

SIADH

A

Syndrome of inappropriate anti-diuretic hormone
Euvolemic

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79
Q

SIADH decreases

A

Sodium
Most common form of low Na/hyponatremia

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80
Q

Syndrome of inappropriate ADH (SIADH)
SI

A

Soaked inside
Stops urination

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81
Q

Too much ADH

A

Hyponatremia

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82
Q

SIADH causes

A

3 s’s
Small cell lung cancer (new cancers)
Severe brain trauma
Sepsis infections of brain

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83
Q

SIADH retains

A

Fluid

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84
Q

ADH

A

Adds Da H2O

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85
Q

Synthetic ADH

A

Desmopressin, Vasopressin
Decreases urine output
Pressin the BP up!

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86
Q

Cautions with ADH

A

Headaches!!!!!
Seizures
Death
HTN

87
Q

Treatment for SIADH

A

Fluid restriction — 800-100mL/day
Demeclocycline
Diuretics
Increase oral sodium intake (bacon, salt)
Daily weight and I&O

88
Q

Signs of SIADH

A

Low sodium
Oliguria
High BP

89
Q

Why should you never reduce fluid intake by a lot? (3000 ml)

A

Too much restriction can lead to dehydration

90
Q

Hypernatremia level

A

Greater than 145

91
Q

Do we see hypernatremia or hyponatremia more?

A

Hyponatremia

92
Q

Causes of hypernatremia

A

Corticosteroids
Cushing’s syndrome
Hyperaldosteronism
Increased sodium intake
Increased water loss (hemoconcentration)
Diabetes insipidus!

93
Q

Corticosteroids cause kidneys to retain

A

Sodium

94
Q

Cushing’s syndrome

A

Occurs due to prolonged exposure to glucocorticoids (prednisone) or a tumor producing excessive cortisol by adrenals

95
Q

Hyperaldosteronism

A

High sodium and water retention
Potassium loss

96
Q

Severe hypernatremia is defined as sodium levels

A

> 160

97
Q

What can cause an increased sodium intake?

A

Too many processed foods
Hypertonic solution (3% or 5% NS)
Alkaseltzer, aspirin

98
Q

Increased water loss (hemoconcentration)

A

Dehydration (too much water loss and sodium gain)
Infection
Diabetes insipidus!

99
Q

Diabetes insipidus is associated with

A

Hypernatremia

100
Q

Hypernatremia interventions

A

Bring sodium levels down slowly
IV fluids/meds — hypotonic solutions, 1/2 NS, D5W
Diuretics — thiazides, loop diuretics
Restrict sodium intake
Free water intake

101
Q

Patients can become __________ and ____________ with hypernatremia

A

Confused and agitated

102
Q

Moderate symptoms of hypernatremia

A

Confusion, irritability
Swollen and dry red tongue
Hyperreflexia
Muscle twitching
Edema
Thirst*

103
Q

Severe symptoms of hypernatremia

A

N/V
Increased muscle tone
Seizures
Coma

104
Q

Diabetes insipidus

A

DI = Dry inside = labs high
Increased sodium & diluted urine
Dehydrated, DIE ADH

105
Q

Dehydration due to hypernatremia S/S

A

Polydipsia
Light headed
Polyuria

106
Q

Causes of diabetes insipidus

A

ADH (vasopressin) deficiency
Damage to brain
Tumors
Trauma

107
Q

Risk for diabetes insipidus

A

Hypovolemic shock

108
Q

Risk for SIADH

A

Seizures

109
Q

Potassium is a major electrolyte in

A

Intracellular fluid

110
Q

What is the main source of potassium?

A

Diet

111
Q

What is a major cause of hypokalemia?

A

Steroids

112
Q

Never give potassium —

A

IVP
Potassium can burn/irritate peripheral vein

113
Q

If a patient is NPO, how do you give potassium?

A

Diluted through IV pump

114
Q

Fast form of potassium

A

Oral

115
Q

What is the number one cause of hypokalemia?

A

Diuretics! (Furosemide, loop diuretic)

116
Q

Digoxin toxicity

A

Low potassium causes this!
Cautions using diuretics with digoxin = increased risk for hypokalemia

117
Q

If K+ loss,

A

Stop diuretics!

118
Q

Higher levels of aldosterone cause

A

More K+ excretion

119
Q

Cushings is characterized by

A

Too much cortisol

120
Q

Vomiting, diarrhea, and prolonged NG suction can cause

A

Hypokalemia

121
Q

Excess insulin moves

A

K+ into the cell

122
Q

In alkalosis,

A

There is less H+ in blood, causes H to shift out of cells and K+ to shift into cells

123
Q

severe hypokalemia level

A

Less than or equal to 2.5

124
Q

Patient presentation with hypokalemia — cardiovascular

A

Torsades de pointes
Irregular HR
Lethal dysrhythmias
Bradycardia

125
Q

Patient presentations with hypokalemia — neuromuscular

A

Confusion, lethargy
Muscle weakness
Diminished DTR’s!!

126
Q

Patient presentation with hypokalemia — GI

A

Constipation
-if bowel sounds absent, think paralytic ileus— portion of bowel not moving and can lead to small bowel obstruction

127
Q

If low K+,

A

Find out Mg+ levels!
Correct Mg first to correct K

128
Q

Torsades de pointes

A

Twisting of the points
Irregular QRS complexes appearing to wrap around the EKG baseline

129
Q

Treatment for Torsades de pointes

A

IV Mg+
Slow 2g IVP

130
Q

Long QT interval means

A

Heart is taking longer to electrically charge for the next heartbeat

131
Q

Hyperkalemia EKG

A

Peaked Twaves
P wave flattening

132
Q

What is most important to monitor in Hypokalemia?

A

Cardiac and respiratory status

133
Q

If a patient with hypokalemia is taking a diuretic,

A

May need to stop or switch to spironolactone (K+ sparing diuretic)

134
Q

If giving potassium orally,

A

Must take with food
Never give on empty stomach bc it is very irritating to stomach

135
Q

Potassium is never administered

A

IV push, intramuscular, or SQ

136
Q

Hyperkalemia levels

A

> 5

137
Q

Number 1 cause of Hyperkalemia

A

Kidney disease! (Renal failure)

138
Q

Adrenal insufficiency in Hyperkalemia

A

Addisons = low aldosterone = retention of K+

139
Q

Ace inhibitors hold on to

A

“Prils”
Hold on to potassium = excess!

140
Q

NSAIDS decrease

A

Renal profusion
(Hyperkalemia)

141
Q

In acidosis,

A

There is more H+ in blood, causes H+ to shift into cells and K+ to shift out

142
Q

Severe Hyperkalemia level

A

Greater than or equal to 6.5

143
Q

Lethal Hyperkalemia level

A

Greater than or equal to 8.5

144
Q

Patient presentation of Hyperkalemia — cardiovascular

A

Low BP
Dysrhythmias — lethal! Vfib/cardiac standstill

145
Q

Patient presentation of Hyperkalemia — GI

A

Hyperactive bowel sounds
Diarrhea

146
Q

Mild Hyperkalemia interventions

A

Monitor cardiac
Restrict K+ in diet
Diuretics
Dialysis

147
Q

Emergency medical treatment for Hyperkalemia (>6.5)

A

Ca+ gluconate 10% IV — protects heart from lethal dysrhythmias, does NOT lower K+
Hypertonic glucose and INSULIN
NaHCO3
Diuretics

148
Q

Ca+ gluconate 10% IV

A

Protects heart from myocardial irritability (lethal dysrhythmias)
IT DOES NOT LOWER POTASSIUM
Given over 3-5 mins
Monitor BP, HR, dysrhythmias

149
Q

Low parathyroid =

A

Hypocalcemia!

150
Q

High parathyroid =

A

Hypercalcemia!

151
Q

Ca+ and Mg+ are

A

Best friends, when one goes up, the other follows

152
Q

Calcium keeps

A

The 3 B’s strong
-Bone
-Blood clotting
-Beat (heart)

153
Q

Calcium is regulated by 3 hormones;

A

Parathyroid hormone
Calcitonin
Calcitrol

154
Q

Calcitrol

A

Vitamin D analog
(Renal/kidney issues)

155
Q

PTH increases

A

Blood calcium levels

156
Q

Calcitonin decreases

A

Blood calcium levels

157
Q

What must you have to absorb calcium?

A

Vitamin D

158
Q

Hypocalcemia levels

A

<8.5

159
Q

Causes of Hypocalcemia

A

Vit D deficiency
Long term corticosteroids
Hypoparathyroidism
Diarrhea
Hyperphosphatemia
Meds

160
Q

Long-term corticosteroids can

A

Break down bone
Cause osteoporosis

161
Q

Hypoparathyroidism

A

Decrease in parathyroid hmone
Removal of parathyroid glands

162
Q

Hyperphosphatemia

A

Inverse relationship with calcium

163
Q

Meds that cause Hypocalcemia

A

Diuretics
Laxatives!
Corticosteroids

164
Q

Thyroidectomy or any neck surgeries can

A

Irritate or remove parathyroid glands,
Watch for Hypocalcemia!!!!!

165
Q

Patient presentation of Hypocalcemia — cardiovascular

A

Hypotension
Dysrhythmias
Decreased HR

166
Q

Patient presentation of Hypocalcemia — neuromuscular

A

Twitching, cramps
Tetany — jerking
Seizures
Parenthesias — numb/tingle
Trousseaus and Chvostek signs
Hyperactive deep tendon reflexes (DTRs)

167
Q

Chvosteks signs

A

Tap nerve by ear and pt will twitch

168
Q

Trousseaus signs

A

BP cuff, leave pumped for 2-3 mins and watch hand

169
Q

Patient presentation of Hypocalcemia — GI

A

Hyperactive bowel sounds
Diarrhea

170
Q

Hypocalcemia interventions

A

Replace calcium (IV or PO)
-IV calcium gluconate 10% over 10-20 mins (SLOW)
-monitor BP, HR, place on heart monitor
-vitamin D if giving PO
-Tums calcium supplements

171
Q

When dealing with Hypocalcemia, what precautions should be initiated?

A

Seizures and bleeding precautions (look at platelets)

172
Q

Hypercalcemia levels

A

> 10.5

173
Q

Causes of hypercalcemia

A

Hyperparathyroidism — too much parathyroid
Malignancies — of bone; cancer in bone, breast cancer, Mets in bones!

174
Q

Patient presentation of hypercalcemia — GI

A

Hypoactive bowel sounds (constipation)

175
Q

Patient presentation of hypercalcemia — Renal

A

Think kidney stones, painful bones, abdominal moans (constipation), N/V

176
Q

What gland abnormality causes kidney stones, painful bones, moans from constipation, N/V, muscle weakness?

A

Parathyroid

177
Q

Hypercalcemia interventions

A

Give IV fluids (0.9% saline)
Discontinue calcium
Loop diuretics (furosemide)
Meds (phosphorus)

178
Q

IV normal saline and loop diuretics =

A

Less severe hypercalcemia

179
Q

Magnesium general rule

A

Calms, relaxes us (sleep!)
Good for constipation!!

180
Q

Magnesium helps to maintain

A

Blood glucose control
BP
Neurological function — more alert
Immune system — fights inflammation

181
Q

Calcium and magnesium

A

Rely on each other for absorption

182
Q

Hypomagnesemia levels

A

< 1.5

183
Q

Number 1 cause for hypomagnesemia

A

Chronic alcohol se
Poor diet/malnutrition, starvation
Malabsorption due to effects of alcohol on GI tract

184
Q

Hypomagnesemia GI loss

A

NG, diarrhea

185
Q

With hypomagnesemia, unable to

A

Maintain order; everything goes crazy

186
Q

Hypomagnesemia neuromuscular presentations

A

Tetany, twitches, parenthesias
Trousseaus and chovsteks sighs
Increased DTRs
Tachycardia

187
Q

Hypocalcemia has the same neuromuscular s/s as

A

Hypomagnesemia

188
Q

Hypocalcemia accompanies Hypomagnesemia, interventions aim to restore

A

Calcium levels, this will help Mg+ be absorbed.

189
Q

Hypomagnesemia interventions

A

Replace Mg+ and Ca+ (IV or PO)
Give Mg+ IV slowly — can slow HR
Monitor K+ if magnesium is low

190
Q

Treat hypomagnesemia prior to

A

Hypokalemia, when the body is in a state of low Mg, it is unable to process and absorb K

191
Q

Hypermagnesemia levels

A

> 2.5

192
Q

Hypermagnesemia presentation — heart

A

Calm and quiet
Respirations low and shallow
Bradycardia
Hypotension

193
Q

Hypermagnesemia interventions

A

Calcium gluconate is an antidote for Mg overdose
Diuretics for Mg+ excretion

194
Q

Do not give what with Mg+

A

Laxatives!

195
Q

Phosphorus helps regulate

A

Calcium
Inverse relationship with Ca and Mg

196
Q

Phosphorus is essential for

A

Bone and teeth

197
Q

Hypophosphatemia levels

A

< 2.4

198
Q

Causes of hypophosphatemia

A

Malnutrtion
Hyperparathyroidism; calcium rises, phosphorus drops (INVERSE)
Malignancy
Mg or aluminum based antiacids

199
Q

Patient presentation of hypophosphatemia

A

Decreased BP, HR
Hypoactive bowels
Kidney stones
Altered LOC
Decreased DTR
Weakness

200
Q

Hypophosphatemia interventions

A

Replace phosphorus IV or PO
-phosphorus slow if severely low
-oral phosphorus with vit D

201
Q

What precautions need to be taken with hypophosphatemia?

A

Fracture precautions

202
Q

Hyperphosphatemia levels

A

> 4.5

203
Q

Causes of Hyperphosphatemia

A

Overuse of laxatives and enemas with phosphorus
Hyperparathyroidism
Hypocalcemia — s/s

204
Q

Hyperphosphatemia patient presentation

A

Twitching, cramps, tetany, seizures, parasthesias
Trousseaus and chvosteks
Hyperactive DTRs
Osteoporosis
Hyperactive bowels, diarrhea

205
Q

Hyperphosphatemia interventions

A

Same as Hypocalcemia
-IV calcium gluconate 10%
-vit d if PO
-tums
-seizure and bleeding precautions

206
Q

Chloride

A

Inverse relationship to HCO3 (bicarbonate
Directly related to Na and K
Chloride always follows sister sodium

207
Q

Hypochloremia =

A

Same symptoms as hyponatremia

208
Q

Hypochloremia levels

A

< 95

209
Q

Hypercloremia levels

A

> 105

210
Q

Hyperchloremia s/s, causes

A

Same as hypernatremia

211
Q

Hypochloremia acid base balance

A

Alkalosis

212
Q

Hypercloremia acid base imbalance

A

Acidosis

213
Q

Meds affecting electrolytes

A

Corticosteroids
Ace inhibitors
Spironolactone
ARBs
Insulin
Furosemide
Laxatives
NSAIDS

214
Q

Meds to avoid with renal failure

A

Ace inhibitors
Spironolactone
ARBs — sartans
NSAIDS — ibuprofen

Module 2 (15 decks)

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