IV and Electrolyte Therapy Flashcards
Biggest give away to a fluid/electrolyte imbalance?
change in mentation
the effect of a fluid on cell volume
tonicity
moves water into cell, making it swell
hypotonic
no impact of water movement in or out of the cell
isotonic
water leaves cell, making it shrink
hypertonic
primary organ for regulating fluid and electrolyte balance
kidneys
kidneys maintain balance by adjusting ___ volume and selectively reabsorbing water and electrolytes
urine
adult kidneys absorb 99% of filtrate, producing __L of urine/day
1.5L
with impaired renal function, ___ can’t maintain fluid/electrolyte balance; resulting in edema, potassium and phosphorus retention, acidosis, and other electrolyte imbalances
kidneys
adrenal cortex secretes ___ and ___
glucocorticoids (cortisol) and mineralocorticoids (aldosterone)
regulate fluid/electrolyte balance
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
natriuretic peptides (ANP and BNP)
work in the renal tubules to promote secretion of sodium and water to decrease blood volume and BP
___ intake accounts for most water intake
oral
GI tract secretes about ___mL/day of digestive fluid (reabsorbed)
8,000mL
___ and ___ prevents GI reabsorption of secreted fluid (which can lead to significant fluid/electrolyte loss)
may need isotonic solution (NS)
diarrhea and vomiting
3 geriatric changes that affect fluid/electrolyte balance
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
fluid and electrolyte imbalances can be directly caused by __ and/or as a result from __ measures
illness/disease (burns, CHF, malabsorption)
therapeutic (diuretics, colonoscopy prep)
prolonged NG suction/decompression can lead to ___
metabolic alkalosis
deficient fluid volume
hypovolemia
**things would be very concentrated
excess fluid volume
hypervolemia
**things would be very diluted
flash pulmonary edema
what is the most accurate measure of fluid volume?
daily weights
how many mLs is equal to 1kg (2.2lbs)
1,000mL
normal urine specific gravity
1.010-1.025
diluted-concentrated
skin turgor can be used to assess fluid status. What would indicate dehydration/fluid deficit?
tenting
**test on forearm or over clavicle
who do we have to be careful giving fluids to?
COPD, CHF, MI
**listen to lungs and heart and monitor SpO2
major ECF cation
plays a big role in ECF volume and osmolality
generation and nerve transmission of nerve impulses, muscle contractility, acid-base balance
sodium (135-145 mEq/L)
2,000mg/day sodium intake
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?
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
manifestations of hypernatremia
alteration in mental status:
agitation, restlessness, confusion and lethargy to seizures and coma
best way to treat hypernatremia
oral fluids
what foods contain high sodium
processed, canned, bacon, lunch meats, pickled
dairy products
what fluids to give in hypernatremia
sodium free IV fluids and diuretics to promote excretion (D5W)
when lowering sodium levels do not lower faster than __-__ mEq/8hr
8 - 15 mEq/8hr of sodium
results from loss of sodium-containing fluids and/or from water excess
hyponatremia
hyponatremia occurs most frequently in which kinds of pt population
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
manifestations of mild hyponatremia
HA, irritability, difficulty concentrating, abdominal cramps, loss of appetite, decreased urination
manifestations of more severe hyponatremia
confusion, vomiting, seizures, coma, slow deep tendon reflexes
overactive bowel sounds, muscle spasms
**LATE FIND: shallow respirations
nursing interventions to treat hyponatremia
fluid restriction
small amount of hypertonic 3% NS (can cause hypernatremia)
what systems to monitor with hyponatremia
resp, neuro, GI, renal
with hyponatremia due to over dilution, what meds can be given to block ADH
ADH antagonists
Convaptan and Tolvaptan
psych med lvl that needs to be monitored when pt has hyponatremia
lithium (increase toxicity with decreased Na+)
what is the most lethal electrolyte imbalance?
hyperkalemia (cardiac dysrhythmias)
what is the major ICF cation
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
normal serum lvl of K+
3.5 - 5.1 mEq/L (>7 is lethal)
food sources of K+
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)
potassium through an IV always needs to be on a __
pump (KCl causes discomfort and can cause extravasation if infiltrated)
primary route of K+ excretion is by the kidneys and they eliminate around ___% if kidneys are fully functioning
90%
sodium and potassium reabsorption in the kidneys have a __ relationship
inverse
(increase in serum K+, increase in urine output *vice versa)
3 factors that can cause hyperkalemia
1) impaired renal excretion (most common in renal failure)
2) shift from ICF to ECF
3) massive intake (herbal supplements, DASH)
what drugs can cause hyperkalemia
dig-like drugs, beta adrenergic drugs, heparin, K+ sparing diuretics, ARBs, ACEs
and metabolic acidosis
manifestations of hyperkalemia
cardiac dysrhythmias, leg cramps, weak/paralyzed muscles, abdominal cramping or diarrhea
urine deceases output, resp failure, seizures, lethargy, coma
early signs of hyperkalemia
muscle twitching, spasms, rhythm changes
what would pt EKG look like with hyperK+
peak T, flat P, wide QRS, prolonged PR
what interventions can be done to lower K+
diuretics, dialysis, Kayexalate
hypertonic solution of glucose with insulin to move K+ into cells
first thing to do when finding out pt has a high K+
cardiac monitoring
what can we give to protect the heart of a pt with hyperK+
calcium gluconate IV (can cause hypotension)
causes of hypok+
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+)
manifestations of hypoK+
- cardiac (most serious)
- skeletal muscle weakness (legs)
- decreased GI motility
- hyperglycemia (impaired insulin secretion)
- orthostatic hypotension
**low and slow with hypoK+
what would EKG of pt with hypoK+ look like
ST depression, shallow T, prominent U
can only give KCl if urine output is what
0.5 mL/kg/hr
may cause hyperK+
nursing considerations when administering KCl
- never give IVP/bolus (IM or SubQ)
- do not exceed 10 mEq/hr
- always dilute (invert bag to mix)
- use an infusion pump
what are the functions of Ca+
- formation of teeth and bone
- blood clotting
- transmission of nerve impulses
- myocardial contractions
- muscle contractions
normal lvl of calcium
8-10 mg/dL
what vit do we need to absorb and use calcium
vit D
what two factors can affect calcium lvls
pH (affect ionized Ca+ w/o affecting total)
serum albumin (decrease in albumin, decreases total but not ionized)
what hormones is calcium controlled by
PTH (bone and tubular reabsorption)
Calcitonin (from thyroid, decreases GI absorption and promotes renal excretion)
what can hypercalcemia be caused by
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)
what has an inverse relationship with calcium
phosphate
manifestations of hypercalcemia
fatigue, lethargy, weakness, confusion, hallucinations, seizures, coma, cardiac dysrhythmias, bone pain, fractures, nephrolithiasis, polyuria, dehydration, absent reflexes, constipation
EKG changes with hypercalcemia
prolonged ST segment, short QT
nursing interventions for hypercalcemia
- 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
causes of hypocalcemia
- 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
early manifestation of hypocalcemia
lip numbness
other manifestations of hypocalcemia
- troussea’s or chvostek’s sign
- laryngeal stridor (late sign)
- dysphagia
- tingling of mouth and extremities
- cardiac dysrhythmias
- increase muscle excitability
potential lethal complication of hypocalcemia
resp arrest
how to treat hypocalcemia
- oral or IV (calcium gluconate can cause dig toxicity)
- rebreathe into paper bag
- thiazide not loop diuretic
primary anion in ICF
2nd most abundant after Ca+ in bones and teeth
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
normal phosphate lvl
2.4 - 4.5 mg/dL
phosphate lvls are controlled by __ hormone
PTH (decrease in PTH, increase in phosphate reabsorption)
causes of hyperphosphatemia
- AKI or CKD
- chemo
- excess intake of phosphate or vit D (laxatives/enemas)
- hypoparathyroidism
- bulimia/anorexia
manifestations of hyperphosphatemia
asymptomatic unless hypercalcemic (hyperreflexia, tetany, seizures)
neuromuscular irritability and tetany
calcified deposition in soft tissue (joints, arteries, skin, kidneys, and corneas)
what foods are high in phosphate
fish, nuts, whole grains, diary
if hyperphosphatemia (or any critical lvl of electrolyte) is severe what can be done
hemodialysis
hypophosphatemia is caused by what
- malnourishment/malabsorption
- diarrhea
- use of phosphate-binding antacids
- inadequate replacement during parenteral nutrition
manifestations of hypophosphatemia
- CNS depression
- muscle weakness and pain
- resp and heart failure
- rickets and osteomalacia
- CO decreases
how to manage hypophosphatemia
- oral supplements
- ingestion of foods high in phosphorus
- IV admin of sodium or potassium phosphate
**monitor Ca+ lvls, BUN, creatinine, EKG changes
coenzyme in metabolism of carbs, required for DNA and protein synthesis, blood glucose control, BP regulation, necessary for ATP production
magnesium
normal mag lvl
1.5 - 2.5 mEq/L
what is hypermag caused by
- too much intake when renal insufficiency is present
- excess IV mag (pregnant women trying to prevent eclampsia)
**GFR < 30 mL/min (normal 80 - 100)
manifestations of hypermag
- lethargy
- N/V
- impaired reflexes
- muscle paralysis
- resp and cardiac arrest
**hypoten, flushing, urine retention
PR and QT intervals prolonged, wide QRS
how to manage hypermag
- restrict mag
- IV CaCl or calcium gluconate
- fluids and IV furosemide (w/ adequate renal function)
**if severe = dialysis
causes of hypomag
- prolonged fasting
- chronic alcoholism
- fluid loss from GI
- prolonged PN w/o supplements
-diuretics - hyperglycemic osmotic diuresis
manifestations of hypomag
- 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)
management of hypomag
- oral supplements
- increase dietary intake (nuts, bananas, veggies)
- parenteral IV or IM mag (mag sulfate)
**monitor heart
these stay in the vascular space and increase osmotic pressure (pull fluid into blood)
colloids
human plasma products (albumin, FFP, blood) 5% albumin is iso, 25% albumin is hyper
semisynthetics (dextran and starches, Hespan)
