Module 2: Fluid & Electrolytes and Acid-Base Balance Flashcards
Potassium Normal Range
3.5-5.0 mEq/L
Sodium Normal Range
135-145 mEq/L
Calcium Normal Range
8.5-10.2 mg/dL
Function of Sodium in the body
regulates fluid balance (water retention)
nerve impulses
muscle contractions
Main factors that increase sodium
DEHYDRATION
kidney dysfunction
TUBE FEEDINGS (bc it’s hypertonic)
vomiting/diarrhea
diaphoresis
Main factors that decrease sodium
fluid overload
excess fluid loss
GI suctioning
vomiting/diarrhea
potassium-sparing diuretics
inadequate sodium intake
hypertonic solutions
Main S/S of decreased sodium
CONFUSION
seizures
MUSCLE WEAKNESS
restlessness
(seizure -> coma -> death)
Main S/s of increased sodium
edema
HYPERTENSION
CNS effects
excessive thirst
DRY
nausea/vomiting
LOW GRADE FEVER
DECREASED URINE OUTPUT
Nursing considerations for sodium
hyponatremia is helped by hypertonic IV fluids
I&O
daily weights
monitor fluid balance
NEURO ASSESSMENT
Function of Potassium in the body
cardiac (rhythm)
CNS
if Na goes up, K goes down (vice versa)
Main factors that cause increased potassium
RENAL FAILURE
diabetes
DEHYDRATION
ACIDOSIS (metabolic or respiratory)
burns/traumatic injury
excessive potassium intake
Main factors that cause decreased potassium
diuretics (non-potassium sparing)
DIARRHEA
VOMITING
Main S/S of decreased potassium
muscle twitches/cramps
NUMBNESS/TINGLING
NAUSEA
VOMITING
ILEUS (no peristalsis)
Main S/S of increased potassium
heart palpitations
SOB
angina
cramping
arrhythmias
diarrhea
tachypnea
bradycardia
abdominal cramping
decreased BP
Nursing considerations for potassium
non-K sparing diuretics (furosemide) = hypokalemia, closely monitor, may require K+ supplements
NEVER give K+ as IV push or injection - only oral route or via infusion pump (on slow)
I&O
Function of Calcium in the body
blood coagulation
bone/teeth formation
Main Factors causing decreased calcium
renal disease
decreased Ca and vitamin D intake
increased Mg levels
Main S/S of decreased calcium
positive trousseau’s sign:
-wrist flexion when inflating BP cuff
positive chvostek’s sign:
tap on cheek and will cause muscles to contract
-facial twitching
-arrhythmias
-numbness and tingling
-diarrhea
Main S/s of increased calcium
muscle weakness
fatigue and weakness
constipation
hypo-active reflexes
bone pain
renal calculi
bradycardia/bradypnea
Nursing considerations for calcium
hypocalcemia = increased risk for fractures and bleeding
Function of hypotonic fluids
ECF moves inside cell
CELL SWELLS
Uses for hypotonic fluids
dehydrated cells
diabetic ketoacidosis
hyperglycemia (increased bl sugar)
Side effects of hypotonic fluids
can cause cell lysis
decreased bp
Examples of hypotonic fluids
5% dextrose in water (D5W)
0.25% NaCl (1/4 NS)
0.45% NaCl (1/2 NS)
Function of isotonic fluids
increase ECF volume (blood volume)
Uses for isotonic fluids
blood loss
surgery
vomit
diarrhea
dehydration
Examples of isotonic fluids
lactated ringers (LR)
0.9% NaCl (NS)
5% dextrose in water (D5W) (in bag)
Function of hypertonic fluids
ICF moves outside of cell
CELL SHRINKS
Uses of hypertonic fluids
swollen cells
CEREBRAL EDEMA
HYPONATREMIA
Side effects of hypertonic fluids
can cause fluid overload (PE)
can cause phlebitis
Examples of hypertonic fluids
5% dextrose in 0.45% NaCl
5% dextrose in 0.9% NaCl (NS)
3% NaCl
Phlebitis: definition, S/S, intervention
inflammation of a vein
pain, increased skin temp, redness
D/C IV line, apply moist warm compress, monitor IV site for redness/tenderness to prevent infection
Infiltration: definition, S/S, intervention
leakage of IV solution or med into extravascular tissue (non-vesicant - doesn’t irritate tissue)
edema, pallor, decreased skin temp around site, pain
D/C IV line, elevate extremity, warm compress to absorb fluid
Extravasation: definition, S/S, intervention
IV catheter becomes dislodged and med infuses into tissues (vesicant - irritates tissue)
pain, stinging, burning, swelling, redness at site
D/C IV line, apply cool compress, admin antidote if exists for med
Hypervolemia cause
overhydration
Hypervolemia VS
hypertension
increased temp
bounding pulses
increased RR, HR
Hypervolemia S/S skin
moist/wet/oozy skin/wounds
warm to touch skin
redness
edema (may be pitting)
moist mucous membranes
Hypervolemia S/S neuro/musculoskeletal
decreased mobility
decreased ROM
confusion
weakness
Hypervolemia S/S CV/pulmonary
tachycardia
tachypnea
crackles
regurgitation in heart
productive cough
dyspnea
JVD
S3 sounds
Hypervolemia S/S GU
increased urination/output
clear urine
Hypervolemia labs
decreased Hct, K, Na, osmolality (bl thickness)
Nursing assessments for hypervolemia
cardiac assess (for heart failure)
pulmonary assess
Nursing interventions for hypervolemia
diuretics
daily weights
fluid restriction
hypertonic fluids
Hypovolemia cause
dehydration
rapid loss of 3% body wt associated with fluid and electrolyte imbalances
Hypovolemia VS
hypotension
weak pulses
increased RR, HR
decreased SpO2
Hypovolemia S/S skin
dry
cool to touch
pallor
decreased skin turgor
dry mucous membranes
Hypovolemia S/S neuro/musculoskeletal
confusion
weakness
lethargy
cramping
no perspiration
Hypovolemia S/S CV/pulmonary
tachycardia
tachypnea
orthostatic hypotension
weak pulses
slow cap refill
Hypovolemia S/S GU
decreased urination/output
dark urine/concentrated
no output
Hypovolemia labs
hyperkalemia
hypernatremia
INCREASED HCT
increased Hgb
increased osmolality (dense/thick)
Nursing assessments for hypovolemia
cardiac/pulmonary
Nursing interventions for hypovolemia
CIRCULATION
IV fluids
increased oral intake
assist w/ ambulation
bed alarm
pH normal range
7.35 - 7.45
PaCO2 normal range
35 - 45 mmHg
HCO3 normal range
22 - 26
PaO2 normal range
80-100
SpO2 normal range
97-100%
Osmolality (serum) normal range
275-295
if HIGH pt is dehydrated, if LOW pt is overhydrated
What causes metabolic acidosis?
kidney failure
liver failure
severe diarrhea (ASSidosis)
Anticipating ABG Values for metabolic acidosis
pH < 7.35
HCO3 < 22
PaCO2 = normal (uncompensated)
How does the body compensate for metabolic acidosis?
respiratory system increases pH and decreases acidity by increasing RR to remove CO2 (kussmaul breathing)
What else is retained with metabolic acidosis?
potassium ions (hyperkalemia)
What causes metabolic alkalosis?
loss of gastric contents; vomiting (AHHHlkalosis)
Anticipated ABG values for metabolic alkalosis
pH > 7.45
HCO3 > 26
CO2 = normal (uncompensated)
How does the body compensate for metabolic alkalosis?
respiratory system by increasing CO2 via HYPOventilation
What causes respiratory acidosis?
HYPOventilation: drug overdose, opioids, sleep apnea, COPD, asthma
Anticipated ABG values for respiratory acidosis
pH < 7.35
CO2 > 45
HCO3 = normal (uncompensated)
How does the body compensate for respiratory acidosis?
kidneys increase HCO3 and absorb HCO3 (use more of it)
What causes respiratory alkalosis?
HYPERventilation: pain, anxiety, fear
Anticipated ABG values for respiratory alkalosis
pH > 7.45
CO2 < 35
HCO3 = normal (uncompensated)
How does the body compensate for respiratory alkalosis?
kidneys excrete (get rid of) HCO3
How many abnormalities do uncompensated imbalances have?
2 will be abnormal (including pH)
1 will be normal
How many abnormalities do partially compensated imbalances have?
All 3 will be abnormal
How many abnormalities do fully compensated imbalances have?
pH will be normal
other 2 will be abnormal
Diuretics do what to potassium levels?
DROP THEM
Do you give diuretics if the potassium level is low?
NO bc it will drop it even more
What is the first type of fluids that will most likely be given?
isotonic
What is the priority electrolyte?
potassium
