FnE Flashcards
FVE
Causes
Heart failure
Renal failure
3 things with alot of sodium
Too much fluid in vascular space
Heart is weak-C.O. goes down-Kidney perfusion goes down-UO goes down
Kidneys are not working
Ivf with sodium
Effervescent soluble meds
Canned/processed foods
Aldosterone
Its found in?
Normal function is
Diseases with too much:
Diseases with too little:
Steroid,mineralocorticoid
Adrenal glands, on top of kidney
When blood volume goes down, aldosterone is secreted ehich retains sodium and water and excretes potassium
Hyperaldosteronism
Cushings
Addisons
ADH
Too much ADH
USG
Blood
Not enough ADH
USG
Blood
Found in the
Drug ADH replacement
Antidiuretic hormone. Makes you retain just water
SIADH. Too many letters too much water
Usg is concentrated
Blood is diluted
DI or diabetes insipidus. When you see DI think diuresis
Usg is dilute
Blood is concentrated
Pituitary
Vasopressin(Pitressin) and Desmopressin acetate
More volume means
Less volume means
Concentrated makes #s
Dilute makes #s
More pressure
Less pressure
Go UP (for USG, HGb, and Na)
Go Down (for USG, HGB, and Na)
Bed rest induces
Diuresis by releasing ANP( which is the opposite of aldactone) and decrease production of ADH
FVD
Causes
Loss of fluid from
Third
Diseases with polyuria
S/S Weak Pulse RR BP Cold and clammy
Fluid volume deficit
Anywhere. Examples are thoracentesis, paracentesis, vomiting and hemorrhage
Spacing( when fluid is in a place that does you no good). Like burns and ascites
Like DM. Polyuria: think shock first
Weak and thready
Increase because heart is trying to compensate by pumping
Increases because body perceives it as a hypoxia
Bp will go down. Remember less volume less pressure
Diverting the fluid by vasoconstriction to vital organs
Isotonic solution
Uses on clients that lost fluids through
Dont use with clients with
Goes into vascular space and stays there
N/V, burns, sweating and trauma
HPN,renal disease,cardiac disease
Hypotonic solution
They rehydrate but
Uses with clients who has
Could lead to FVD
The fluid shifts out of vascular space and makes the cells swell
They rehydrate but does not cause hypertension
HPN, cardiace diseases, renal problems and needs fluid replacement
Because fluid moves out and causes cellular edema and decreased blood pressure
Hypertonic solutions
Uses are those clients with severe
Could cause fluid volume
Packed with particles and they attract fluid into the vascular space and causes cells to shrink
Hyponatremia, burns or ascites
Excess due to fluid shifting towards the vascular space
Joint commission top 5 high alert meds
I³OS
Double check with
Insulin IV anticoagulants Injectable potassium chloride Opiates and Narcotics Sodium chloride solns above 0.9 percent
Must be double check with a 2nd licensed Nurse
Magnesium and calcium is excreted by
Calcium and phosphorus has an
Magnesium and calcium think
They act like
The kidneys but can be lost in other ways like the GI
Inverse relationship
MUSCLES FIRST!!!
Sedatives!!
Hypermagnesemia
Causes:
Renal failure
Antacids
S/S:
Flushing and
Magnesium causes vaso
Treatment: Ventilator Dialysis Calcium Gluconate -it is administered
The kidneys cannot excrete the excess magnesium
Some Antacids contain alot of magnesium
Flushing and warmth
Causes vasodilation
Ventilator if RR is less than 12
Dialysis to remove excess magnesium not excreted by the kidneys
This is the ANTIDOTE for magnesium toxicity. Reverses the arrhythmias and RR. It is administered IVP very slowly at a max rate of 1.5-2ml/min
Hypercalcemia
Causes:
Hyperparathyroidism
Diuretics
Immobilization
S/S:
Bones are
Kidney stones
Treatment: Move and Hydrate Diet Steroids Other meds like: Biphospates Calcitonin
There is too much PTH(parathormone) which responds when serum calcium gets low it pulls the calcium from the bone into the blood
Diuretics, specifically THIAZIDES,they retain calcium
Must bear weight to keep calcium in the bone. Calcium goes to blood if you are immobile
Brittle due to not enough calcium in the bones they are in the blood
Kidney stones that are made up of calcium
Move and bear weight
Increase fluids prevent kidney stones
Increase in phosphorus because they have an inverse relationship. Anything with protein has phosphorus
Steroids decreases calcium
Biphosphates is a form of phosphorus
Calcitonin pushes calcium back into the bone
Signs and symptoms that are common in clients with Hypermagnesemia and Hypercalcemia
DTRS Muscle tone Arrhythmias LOC Pules and RR
Because they are
goes down Weak and flaccid Yes Decreased Decreased
SEDATED. Remember magnesium and calcium acts like a sedative.
Hypomagnesemia
Causes: Diarrhea Alcoholism -ADH -vomit
S/S
Think
Act like
Treatment
Give Mg
Check kidney function
Seizure precautions
What do you do if client starts flushing and sweating when you start IV Mg?
Magnesium can be excreted through the GI. There are alot of magnesium in the GI
Alcoholics are not eating well and they vomit which includes magnesium and also alcohol suppresses ADH that is why you diurese
Think MUSCLES FIRST
ACT LIKE SEDATIVES
Of course give magnesium
Kidney function must always be assessed to before and after giving magnesium
They act like sedatives so if they dont have enough magnesium their muscles are hyperactive
STOP the infusion
Foods high in magnesium
SONGS
Spinach
brOcolli
Nuts/seeds
Green leafy vegetables
fiShHypocalcemia
Causes:
Hypoparthyroidism
Radical neck
Thyroidectomy
S/S
Think
They act like a
Treatment: Give Ca -heart monitor Vit D Phospate binders: - sevelamer hydrochloride and calcium acetate
All of these could lead to a decrease in PTH thus decrease in calcium because PTH pulls calcium from the bone into the blood
Think Muscles First
They act like a sedative so if there is not enough Calcium the muscles would be hyper or rigid
Of course calcium is given PO. Can also be given IV but must be given SLOWLY. Always make sure the client should be on a heart monitor
Helps in the absorption of calcium
Phosphate binders binds phosphate and is excreted to the GI tract. Remember phosphate and phosphorus has a inverse relationship
Signs and symptoms of Hypomagnesemia and Hypocalcemia
Muscle tone Seizure Stridor and Laryngospasm \+Chvosteks \+Trousseaus Arrhythmias DTRs Swallowing problems
Rigid and tight
Yes
Because airway is a smooth muscle
Tapping the cheeks
By leaving BP cuff inflated could lead to spasm
( these two are mostly seen on hypocalcemia)
Yes because heart is a muscle
Decreased
Esophagus is a smooth muscle and aspiration precautions must be observed
Sodium
Think
The sodium level is dependent on
Has S/S of life
Neuro changes. The brain does not like it when the sodium is messed up.
How much water you have in the blood
Life threatening Arrhythmias
Hypernatremia
Equals
Not enough
Causes:
Hyperventilation
Heat stroke
DI
S/S Dry Thirsty Swollen Neuro
Treatment
Restrict
Hydrate with
Daily weights and I and O
Feeding tube clients tend to
Dehydration
Not enough water in the blood and there is too much sodium. Remember concentrated makes numbers go up and diluted makes numbers go down. This is true for Na, HGB and USG
Hyperventilation could lead to insensible fluid loss
Heat stroke which there is loss of water
Diabetes insipidus where the client is diuresing alot
Dry mouth
Thirsty which means you are already dehydrated
Swollen tongue
Neuro changes
Sodium must be restricted
Hydrate with water because fluids make sodium go down
Daily weights and Intake and output is measured because if you have a sodium problem then you have a Fluid problem
They tend to get dehydrated
Hyponatremia
Too much
Not enough
Causes: Drinking only water for fluid replacement Psychogenic polydipsia SIADH D5W (sugar and water)
S/S
H➡️S➡️C
Treatment:
Give
Restrict
Hypertonic
Water
Sodium
This only replaces water and dilutes the blood
This is a mental disorder wherein the patient loves to drink WATER
Syndrome of inappropriate antidiuretic hormone is retaining too much water
This could cause hypotension. The fluid moves out of the cell
HEADACHE
SEIZURE
COMA
Of course sodium must be given
Water
If with neuro problems, give hypertonic soln which is packed with particles. This is one of the high alert medications (I³OS)
Potassium
Can cause life-threatening
Excreted by
Sodium and potassium has a
Can cause life-threatening Arryhythmias
Excreted by the kidneys
Inverse relationship
Hyperkalemia
Causes:
Kidney trouble
Spironolactone(Aldactone)
S/S: Begins with Then to muscle Then flaccid Ecg changes -tall,brady,prolonged, ventricular
Treatment: Dialysis Calcium gluconate Glucose and insulin Sodium Polystyrene sulfonate
Kidneys wre sick and cannot excrete potassium
This diuretic makes you retain Potassium
Muscle twitching
Muscle weakness
Flaccid paralysis
Tall and peaked T waves, Bradycardia, Prolonged PR interval, Ventricular Fibrillation
Because kidneys are not working
Decreases arrhythmias
Insulin carries glucose and potassium into the cell. Anytime you give IV insulin, worry about hypokalemia and hypoglycemia
Aka Kayexalate, exchanges Sodium for Potassium in the GI tract
Hypokalemia
Causes: Vomiting NG suction Diuretics Not eating
S/S
Muscle C and Muscle W
Ecg changes
-prominent,pvc,ventricular
Treatment:
Give
Diuretics
Eat more
Vomiting and NG suction could cause potassium loss because we have a lot of potassium in our stomach
Diuretics like furosemide are potassium wasting diuretics
Not eating food that have potassium or not eating anything at all (alcoholics)
Muscle Cramps then and muscle Weakness
Prominent U waves
Premature ventricular contractions
Ventricular tachycardia
Of course give more potassium
Diuretics which spares potassium- spironolactone(aldactone)
Eat more potassium rich foods
Major problems with oral poatssium?
In giving IV potassium, must assess?
Always put IV potassium on a
Never give potassium
Burns during infusion?
Gi upset, must be given with food
Urinary output before/during
PUMP
IV push, IM, SubQ
Yes!!
Phosphate and adenosine triphosphate
Phosphate is necessary for energy in the production of adenosine triphosphate or ATP, and when not produced leads to Generalized weakness
