Fluids & Electrolytes II Flashcards
Describe Isotonic Solution: AKA balanced solution
Examples, Uses and Alerts!
Isotonic Solution goes in the vascular space and stays there, increases BP. We are isotonic!
Examples:
Norm Saline, lactaid ringers, D5W, D5W1/4 NS.
USES:
used for PT. who lost fluids thru nausea, vomiting, burns, sweating, trauma, diareah. Also, basic solution when administrating blood.
ALERT:
Do not use isotonic solution if PT. has hypertension, cardiac disease or renal. These solutions can cause FVE, hypertension or hypernatremia.
Hypernatremia is only an alert when?
Administering isotonic solutions with sodium.
Describe Hypotonic Solutions:
Examples, Uses and Alerts!
Goes into the vascular space then shifts out into the cells to replace cellular fluid. They rehydrate, but do not cause hypertension or increase in BP.
EXAMPLE:
D25W, 0.5% NS, 0.33% NS
USES:
PT. with hypertension, renal or cardiac disease need fluid replacement b/c nausea, vomiting, burns, hemorrhage.
Also, used for dilution when PT. has hypernatremia and cellular dehydration.
ALERT: look for edema b/c fluid moving out to cells, which can lead to FVD and decrease BP.
Describe Hypertonic Solutions:
Examples, Uses and Alerts!
Volume expanders that will draw fluid into the Vas. Space from the cell.
Examples: D10W, 3%NS, 5%NS, D5LR, D51/2NS, D5NS, TPN, Albume
USES: PT with hyponatremia or shifted large amts of vas. vol. into 3rd space or has severe edema, burns, ascites.
Note: A hypertonic solution will return fluid vol. into vas. space.
ALERT: Look for FVE, monitor in an ICU setting - BP, Pulse and CVP esp. if 3%NS or 5%NS
What are some quick tips for I.V. Solutions?
“I”sotonic Solutions “ Stay where “I’ put them”.
Hyp”O”tonic Solutions “ Go “O”ut of the vessels”.
Hyp”E”rtonic Solutions “E”nter the vessel”.
What are the normal lab values for Magnesium and Calcium?
Mg: 1.3-2.1 mEq/L ( 0.65-1.05 mmol/L
Cal: 9.0-10.5 mg/dl (2.25-2.62 mmol/L)
Fact: Mg is excreated by kidneys, but it can be lost in other ways i.e. G.I. tract
What are the Causes and S/S of Hypermagnesmia?
CAUSES: Renal Failure and Antacids
HINT: when answering MG and CA questions THINK MUSCLES FIRST!
S/S: Flushing, Warmth, Mg makes you vasodilate and BP decrease
What are the Causes and S/S of Hypercalcemia?
CAUSES:
1. Hyperparathyroidism-too mush PTH (parathyroid hormone) when serum Ca gets low PTH kicks in and pulls Ca from the bone and puts it into the blood. Therefore serum Ca increases.
- Thiazides (retain Ca).
- Immobilization you have to bear weight to keep Ca in the blood.
- S/S -bones are brittle, kidney stones the majority are made of Ca.
What are the S/S common in PT. with Hypermagnesemia or Hypercalcemia?
- DTR’s
- Muscle Tone decrease
- Arrhythmias
- LOC decrease
- Pulse decrease
- Resp. decrease
Treatment for Hypermagnesmia
- Ventilator - RESP decrease 12 need ventilator b/c toxic on Mg.
- Dialysis
- Ca. Gluconate must admin IVP very SLOWLY! Max rate
- 5-2ml/min
- Safety Precautions -Ca & Phosphorus have an inverse relationship.
Treatment for Hypercalcemia
- MOVE!!! bear weight so Ca leaves blood and returns to bones.
- FLUIDS- prevent kidney stones.
- Ca has inverse relationship with Phosphorus- Add Phosphorus to diet, anything with protein!
- Steroids
- Safety Precautions
- Must have Vit D to use Ca
- Meds that decrease serum Ca
* Biphospahtes ( etidronate)
* Prostaglandin Synthesis Inhibitor
* Calcitonin decrease serum Ca.
What are the causes of hypomagnesemia?
- Diarrhea - lots of Mg in intestines.
- Alcoholism
- Alcohol suppresses ADH and its hypertonic.
No eating or drinking causes diaressising.
What are the causes of hypocalcemia?
- Hyperthyroidism
- Radical Neck
- Thyroidectomy
* All these = not enough PTH, so serum Ca. decreases.
What are the S/S of HYPOmagnesmia or HYPOcalcemia?
- Muscle tone rigid and tight
- Seizures
- Stridor/Larynogospasm - airway is smooth muscle.
- Chvosteks (tap cheek)
- Trousseau’s - pump increase BP cuff hand will start to tremor
- Arrhythmias
- DTR’s increase
- Mind changes
- Swallowing probs. - Esophagus is a smooth muscle so, # 1 concern = aspiration.
Treatment: HYPOmagnesmia
- Give some Mg
- Check kidney function b/f and during I.V. Mg.
- Seizure precautions
- Eat Mg.
- STOP infusing if PT. is showing signs of flushing/sweating.
Treatment: HYPOcalcemia
- Vitamin D
- Phosphate binders Sevelmar Hydrochloride (Renagel) Calcium acetate (PhosLo)
- I.V. Ca. (GIVE SLOWLY) and always make sure PT> is on a monitor b/c QRS complex widens.
- Sodium: Sodium level in blood ( think neuro changes) dependent on how much H20 you have in the blood.
List foods that are high in Mg.
Spinach Mustard Greens Summer squash Broccoli Halibut Turnip Greens Pumpkin Seeds peppermint Cucumber Gr. beans Celery Kale Sunflower Seeds Sesame seeds Flax seeds
PT. receiving Mg. Sulfate has a drop in urine output. What would be the priority nursing intervention?
- Call the HCP
- Decrease infusion
- STOP infusion
- Reassess in 15 min
- STOP infusion!!!!
2. Then call HCP
Intervention is required with which PT.? A PT with a HX. of grand-mal seizures or a PT. that is 8hrs post heart cath?
Post heart Cath b/c worried about hemorrhage because they can bleed to death.
Define Hypernatremia
List the causes and S/S
Hypernatremia = Dehydration to much sodium; not enough water.
Causes:
- Hyperventilation leads to DI-Diareah and Vomiting
- Heat Stroke
S/S:
- Dry mouth
- Thirsty- already dehydrated by the time your thirsty.
- Swollen tongue
Define Hyponatremia
List the causes and S/S
Hyponatremia = dilution too much water, not enough sodium.
Causes:
- Drinking H20 for fluid replacement, vomiting, sweating.
- D5W (sugar and water)
- SIADH - Retaining water
S/S
- Headache
- Seizure
- Coma
Treatment: Hypernatremia (dehydration)
Restrict Sodium
Dilute PT. with fluids - diluting makes sodium go down.
Daily Weights
I/O
Lab Work
* if you have a sodium problem you have a fluid problem!
PT. with feeding tube often get dehydrated.
Treatment: Hyponatremia (dilution)
PT. needs sodium
PT. does not need water
If having neuro problems need hypertonic saline b/c this means packed with particles, so give 3% NS or 5% NS given slowly b/c can’t handle sodium shift.
Testing Strategy: Neuro changes
The brain does not like when the sodium is messed up!
Neuro chnages are common in PT. with Hypo/Hypernatremia.
What are the Normal Lab Values of Potassium?
Potassium: 3.5-5.0 mEq/L 3.5-5.0 mmol/L
Potassium is excreted by the kidneys.
If the kidneys are not working well then the serum potassium will go up.
Hyperkalemia: Causes and Signs/Symptoms
Causes:
Kidney problems and Spironolactone (Aldactone) makes you retain potassium.
S/S:
Begin with muscle twitching ( life threatening arrhythmias), proceeds to muscle weakness, then flaccid paralysis.
Hypokalemia: Causes and Signs/Symptoms
Causes:
- Vomiting
- NG suction-make you lose K+ b/c we have alot of K+ in our stomachs.
- Diuretics
- Anorexia
S/S:
- Muscle cramps
- Muscle weakness
- Arrhythmia’s
Treatment: Hyperkalemia
- Dialysis - kidneys are not working
- Ca. gluconate decreases = Arrhythmia’s
- Glucose + Insulin b/c insulin carrys glucose and potassium into the cell. Any time you give I.V. insulin, worry about Hypokalemia and Hypoglycemia.
- Sodium polystyrene sulfonate (Kayexalate)
* NOTE sodium and potassium have an inverse relationship.
Treatment: Hypokalemia
Give Potassium
Spironolactone (Aldactone) makes PT. retain potassium)
Eat more potassium!
List Foods High in Potassium
Apricots Avocado Banana Bell pepper Broccoli Brussel Sprouts Cabbage Cantaloupe Cauliflower Cucumber Egg Plant Fennel Ginger root Halibut Kale Kiwi Mustard Greens oranges Parsley Potatoes white/sweet Spinach Strawberries Tomatoes Tuna
What ECG changes occur with HYPERkalemia and HYPOkalemia?
Hyperkalemia: Bradycardia, tall peaked T waves, prolonged PR intervals, flat/absent P waves, widened QRS, conduction blocks, vfib.
Hypokalemia: u waves, PVC’s and Vtach!
