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Nursing III > IV and Electrolyte Therapy > Flashcards

IV and Electrolyte Therapy Flashcards

1
Q

Biggest give away to a fluid/electrolyte imbalance?

A

change in mentation

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2
Q

the effect of a fluid on cell volume

A

tonicity

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3
Q

moves water into cell, making it swell

A

hypotonic

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4
Q

no impact of water movement in or out of the cell

A

isotonic

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5
Q

water leaves cell, making it shrink

A

hypertonic

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6
Q

primary organ for regulating fluid and electrolyte balance

A

kidneys

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7
Q

kidneys maintain balance by adjusting ___ volume and selectively reabsorbing water and electrolytes

A

urine

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8
Q

adult kidneys absorb 99% of filtrate, producing __L of urine/day

A

1.5L

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9
Q

with impaired renal function, ___ can’t maintain fluid/electrolyte balance; resulting in edema, potassium and phosphorus retention, acidosis, and other electrolyte imbalances

A

kidneys

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10
Q

adrenal cortex secretes ___ and ___

A

glucocorticoids (cortisol) and mineralocorticoids (aldosterone)

regulate fluid/electrolyte balance

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11
Q

in cardiac regulation ____ are antagonists to the RAAS and ADH

they are produced by cardiomyocytes in response to increased atrial pressure and increase serum sodium

A

natriuretic peptides (ANP and BNP)

work in the renal tubules to promote secretion of sodium and water to decrease blood volume and BP

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12
Q

___ intake accounts for most water intake

A

oral

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13
Q

GI tract secretes about ___mL/day of digestive fluid (reabsorbed)

A

8,000mL

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14
Q

___ and ___ prevents GI reabsorption of secreted fluid (which can lead to significant fluid/electrolyte loss)

may need isotonic solution (NS)

A

diarrhea and vomiting

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15
Q

3 geriatric changes that affect fluid/electrolyte balance

A

1) kidney changes: decrease in renal BF, GFR, and ability to concentrate urine
2) hormonal changes: decrease RAAS, increase ADH and ANP
3) loss of subq: inability to respond quickly to temp changes

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16
Q

fluid and electrolyte imbalances can be directly caused by __ and/or as a result from __ measures

A

illness/disease (burns, CHF, malabsorption)

therapeutic (diuretics, colonoscopy prep)

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17
Q

prolonged NG suction/decompression can lead to ___

A

metabolic alkalosis

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18
Q

deficient fluid volume

A

hypovolemia
**things would be very concentrated

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19
Q

excess fluid volume

A

hypervolemia
**things would be very diluted

flash pulmonary edema

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20
Q

what is the most accurate measure of fluid volume?

A

daily weights

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21
Q

how many mLs is equal to 1kg (2.2lbs)

A

1,000mL

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22
Q

normal urine specific gravity

A

1.010-1.025
diluted-concentrated

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23
Q

skin turgor can be used to assess fluid status. What would indicate dehydration/fluid deficit?

A

tenting
**test on forearm or over clavicle

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24
Q

who do we have to be careful giving fluids to?

A

COPD, CHF, MI

**listen to lungs and heart and monitor SpO2

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25
Q

major ECF cation

plays a big role in ECF volume and osmolality

generation and nerve transmission of nerve impulses, muscle contractility, acid-base balance

A

sodium (135-145 mEq/L)

2,000mg/day sodium intake

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26
Q

rare in people who are conscious and have access to water

high sodium

deficit in ADH (central or nephrotic diabetes insipidus)

what does HIGH SALT stand for?

A

hypernatremia
**primary protection is thirst from hypothalamus

H- hypercortisone (cushings)
I- increased Na+ intake
G- GI feeding w/o adequate water
H- hypertonic solutions

S- sodium excretion decreased
A- aldosterone problems
L- loss of fluids
T- thirst impairment

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27
Q

manifestations of hypernatremia

A

alteration in mental status:
agitation, restlessness, confusion and lethargy to seizures and coma

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28
Q

best way to treat hypernatremia

A

oral fluids

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29
Q

what foods contain high sodium

A

processed, canned, bacon, lunch meats, pickled
dairy products

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30
Q

what fluids to give in hypernatremia

A

sodium free IV fluids and diuretics to promote excretion (D5W)

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31
Q

when lowering sodium levels do not lower faster than __-__ mEq/8hr

A

8 - 15 mEq/8hr of sodium

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32
Q

results from loss of sodium-containing fluids and/or from water excess

A

hyponatremia

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33
Q

hyponatremia occurs most frequently in which kinds of pt population

A

elderly, athletes, excessive diarrhea, hypotonic fluids, NG suction, vomiting, diuretic use, diabetic

pts after surgery, trauma, renal failure

psych pts b/c some meds lead to extreme thirst

liver failure, CHF, NPO, SIADH

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34
Q

manifestations of mild hyponatremia

A

HA, irritability, difficulty concentrating, abdominal cramps, loss of appetite, decreased urination

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35
Q

manifestations of more severe hyponatremia

A

confusion, vomiting, seizures, coma, slow deep tendon reflexes

overactive bowel sounds, muscle spasms

**LATE FIND: shallow respirations

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36
Q

nursing interventions to treat hyponatremia

A

fluid restriction

small amount of hypertonic 3% NS (can cause hypernatremia)

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37
Q

what systems to monitor with hyponatremia

A

resp, neuro, GI, renal

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38
Q

with hyponatremia due to over dilution, what meds can be given to block ADH

A

ADH antagonists

Convaptan and Tolvaptan

39
Q

psych med lvl that needs to be monitored when pt has hyponatremia

A

lithium (increase toxicity with decreased Na+)

40
Q

what is the most lethal electrolyte imbalance?

A

hyperkalemia (cardiac dysrhythmias)

41
Q

what is the major ICF cation

A

potassium (muscle cell contains 140 mEq/L)

need insulin to move K+

determines the resting potential of nerves and muscles

helps with glycogen deposit in liver and muscles

42
Q

normal serum lvl of K+

A

3.5 - 5.1 mEq/L (>7 is lethal)

43
Q

food sources of K+

A

fruits and veggies (bananas, oranges, potatoes, pork, tomatoes, avocados, strawberries, spinach, fish, mushrooms)

salt substitutes

diet is a big source of K+ recommended 4,000 mg/day (50-100 mEq)

44
Q

potassium through an IV always needs to be on a __

A

pump (KCl causes discomfort and can cause extravasation if infiltrated)

45
Q

primary route of K+ excretion is by the kidneys and they eliminate around ___% if kidneys are fully functioning

A

90%

46
Q

sodium and potassium reabsorption in the kidneys have a __ relationship

A

inverse
(increase in serum K+, increase in urine output *vice versa)

47
Q

3 factors that can cause hyperkalemia

A

1) impaired renal excretion (most common in renal failure)
2) shift from ICF to ECF
3) massive intake (herbal supplements, DASH)

48
Q

what drugs can cause hyperkalemia

A

dig-like drugs, beta adrenergic drugs, heparin, K+ sparing diuretics, ARBs, ACEs

and metabolic acidosis

49
Q

manifestations of hyperkalemia

A

cardiac dysrhythmias, leg cramps, weak/paralyzed muscles, abdominal cramping or diarrhea

urine deceases output, resp failure, seizures, lethargy, coma

50
Q

early signs of hyperkalemia

A

muscle twitching, spasms, rhythm changes

51
Q

what would pt EKG look like with hyperK+

A

peak T, flat P, wide QRS, prolonged PR

52
Q

what interventions can be done to lower K+

A

diuretics, dialysis, Kayexalate

hypertonic solution of glucose with insulin to move K+ into cells

53
Q

first thing to do when finding out pt has a high K+

A

cardiac monitoring

54
Q

what can we give to protect the heart of a pt with hyperK+

A

calcium gluconate IV (can cause hypotension)

55
Q

causes of hypok+

A

kidney or GI losses (diarrhea, vomiting, ileostomy), alkalosis (shift of K+ from ECF to ICF for H+)

associated with low mag

diuresis due to increase in aldosterone (excrete K+)

56
Q

manifestations of hypoK+

A
  • cardiac (most serious)
  • skeletal muscle weakness (legs)
  • decreased GI motility
  • hyperglycemia (impaired insulin secretion)
  • orthostatic hypotension
    **low and slow with hypoK+
57
Q

what would EKG of pt with hypoK+ look like

A

ST depression, shallow T, prominent U

58
Q

can only give KCl if urine output is what

A

0.5 mL/kg/hr

may cause hyperK+

59
Q

nursing considerations when administering KCl

A
  • never give IVP/bolus (IM or SubQ)
  • do not exceed 10 mEq/hr
  • always dilute (invert bag to mix)
  • use an infusion pump
60
Q

what are the functions of Ca+

A
  • formation of teeth and bone
  • blood clotting
  • transmission of nerve impulses
  • myocardial contractions
  • muscle contractions
61
Q

normal lvl of calcium

A

8-10 mg/dL

62
Q

what vit do we need to absorb and use calcium

A

vit D

63
Q

what two factors can affect calcium lvls

A

pH (affect ionized Ca+ w/o affecting total)
serum albumin (decrease in albumin, decreases total but not ionized)

64
Q

what hormones is calcium controlled by

A

PTH (bone and tubular reabsorption)
Calcitonin (from thyroid, decreases GI absorption and promotes renal excretion)

65
Q

what can hypercalcemia be caused by

A

1) hyperparathyroidism
2) malignancy (blood, breast, lung bc of bone destruction)

**thiazide diuretics, prolonged immobilization, increased intake (antacids), glucocorticoids, renal failure, addisons, lithium (increase calcium)

66
Q

what has an inverse relationship with calcium

A

phosphate

67
Q

manifestations of hypercalcemia

A

fatigue, lethargy, weakness, confusion, hallucinations, seizures, coma, cardiac dysrhythmias, bone pain, fractures, nephrolithiasis, polyuria, dehydration, absent reflexes, constipation

68
Q

EKG changes with hypercalcemia

A

prolonged ST segment, short QT

69
Q

nursing interventions for hypercalcemia

A
  • loop diuretic
  • increase fluids (3-4 L/day)
  • low Ca+ diet
  • mobilization (increase osteoblasts)
  • biphosphonates (effective in malignancy)
  • IM or SubQ calcitonin

**aspirin/NSAIDS can also decrease calcium

strain urine to find chemical makeup of stone

70
Q

causes of hypocalcemia

A
  • decreased production of PTH
  • multiple blood transfusions (citrate, anticoag binds with Ca+)
  • alkalosis (increases Ca+ protein binding)
  • Ca+ loss (colostomy, ileostomy, crohns, celiac, low vit D, high phosphate, laxatives, diuretics
71
Q

early manifestation of hypocalcemia

A

lip numbness

72
Q

other manifestations of hypocalcemia

A
  • troussea’s or chvostek’s sign
  • laryngeal stridor (late sign)
  • dysphagia
  • tingling of mouth and extremities
  • cardiac dysrhythmias
  • increase muscle excitability
73
Q

potential lethal complication of hypocalcemia

A

resp arrest

74
Q

how to treat hypocalcemia

A
  • oral or IV (calcium gluconate can cause dig toxicity)
  • rebreathe into paper bag
  • thiazide not loop diuretic
75
Q

primary anion in ICF

2nd most abundant after Ca+ in bones and teeth

A

phosphate

essential to function of muscle, RBCs, and nervous system

involved in the acid-base buffering system, ATP production, cellular uptake of glucose, and metabolism of carbs, proteins, and fats

76
Q

normal phosphate lvl

A

2.4 - 4.5 mg/dL

77
Q

phosphate lvls are controlled by __ hormone

A

PTH (decrease in PTH, increase in phosphate reabsorption)

78
Q

causes of hyperphosphatemia

A
  • AKI or CKD
  • chemo
  • excess intake of phosphate or vit D (laxatives/enemas)
  • hypoparathyroidism
  • bulimia/anorexia
79
Q

manifestations of hyperphosphatemia

A

asymptomatic unless hypercalcemic (hyperreflexia, tetany, seizures)

neuromuscular irritability and tetany

calcified deposition in soft tissue (joints, arteries, skin, kidneys, and corneas)

80
Q

what foods are high in phosphate

A

fish, nuts, whole grains, diary

81
Q

if hyperphosphatemia (or any critical lvl of electrolyte) is severe what can be done

A

hemodialysis

82
Q

hypophosphatemia is caused by what

A
  • malnourishment/malabsorption
  • diarrhea
  • use of phosphate-binding antacids
  • inadequate replacement during parenteral nutrition
83
Q

manifestations of hypophosphatemia

A
  • CNS depression
  • muscle weakness and pain
  • resp and heart failure
  • rickets and osteomalacia
  • CO decreases
84
Q

how to manage hypophosphatemia

A
  • oral supplements
  • ingestion of foods high in phosphorus
  • IV admin of sodium or potassium phosphate

**monitor Ca+ lvls, BUN, creatinine, EKG changes

85
Q

coenzyme in metabolism of carbs, required for DNA and protein synthesis, blood glucose control, BP regulation, necessary for ATP production

A

magnesium

86
Q

normal mag lvl

A

1.5 - 2.5 mEq/L

87
Q

what is hypermag caused by

A
  • too much intake when renal insufficiency is present
  • excess IV mag (pregnant women trying to prevent eclampsia)

**GFR < 30 mL/min (normal 80 - 100)

88
Q

manifestations of hypermag

A
  • lethargy
  • N/V
  • impaired reflexes
  • muscle paralysis
  • resp and cardiac arrest
    **hypoten, flushing, urine retention

PR and QT intervals prolonged, wide QRS

89
Q

how to manage hypermag

A
  • restrict mag
  • IV CaCl or calcium gluconate
  • fluids and IV furosemide (w/ adequate renal function)

**if severe = dialysis

90
Q

causes of hypomag

A
  • prolonged fasting
  • chronic alcoholism
  • fluid loss from GI
  • prolonged PN w/o supplements
    -diuretics
  • hyperglycemic osmotic diuresis
91
Q

manifestations of hypomag

A
  • hyperactive deep tendon reflexes (trousseaus)
  • muscle cramps
  • tremors
  • seizures
  • cardiac dysrhythmias
  • corresponding hypoCa and hypoK
  • decreased bowel sounds

**torsades de pointes (twisting w/ wide QRS)

92
Q

management of hypomag

A
  • oral supplements
  • increase dietary intake (nuts, bananas, veggies)
  • parenteral IV or IM mag (mag sulfate)

**monitor heart

93
Q

these stay in the vascular space and increase osmotic pressure (pull fluid into blood)

A

colloids

human plasma products (albumin, FFP, blood) 5% albumin is iso, 25% albumin is hyper

semisynthetics (dextran and starches, Hespan)

Nursing III (3 decks)

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