NUR 112 Exam 1 Electrolytes: FVD, FVE & Na+ Flashcards
What is hypovolemia?
ECF volume deficit
What is hypervolemia?
ECF volume excess
Is FVD the same as dehydration?
No!
Dehydration = loss of pure water w/out Na+
List the 3 MAIN causes of FVD
- abnormal loss of body fluid
- inadequate fluid intake
- Shift of fluid from plasma to IF (edema)
List 5/10 causes/examples of abnormal loss of body fluids leading to FVD
vomiting diarrhea fistula hemorrhage polyuria NG suction x.s. diuretics insensible loss/perspiration diabetes insipidus (x.s. ADH) third spacing - burns, intestinal obstruction
list 3 possible Tx for FVD
LR
0.9% NS
Blood
s/s FVD 1. CNS related (5)
- restlessness, drowsiness, lethargy, confusion, coma
Do the following indicate FVD or FVE? inc resp rate inc pulse rate dec CVP dec urine output urine specific gravity 1.035
FVD
less vol blood to carry O2 so resp rate inc.
less vol blood to carry O2 so HR rate inc
less blood vol so CVP dec
kidneys compensate by reabsorbing H2O
urine becomes more concentrated
What do the following s/s indicate? thirst dec skin turgor postural hypotension weakness dizziness weight loss
FVD
List the 3 MAIN causes of FVE
- Excess in take of fluids
- Abnormal retention of fluids
- Shift of fluid from IF to plasma
List 3/5 causes/examples of abnormal retention of body fluids leading to FVE
heart failure (correct exchange does not occur with IF/cells) renal failure (kidneys do not excrete appropriate fluid) SIADH too much ADH = too much H2O kept Cushing's (x.s. cortisol acts like aldosterone and retains Na+ which in turn retains H2O) Long term corticosteroid use (see above)
list 3 possible Tx for FVE
- restrict fluids
- diuretics
- restrict Na+
s/s FVE related to lungs (3)
- dyspnea
- crackles
- pulmonary edema
What do the following s/s indicate? headache confusion lethargy peripheral edema weight gain
FVE
cells swell and x.s.fluid in blood puts pressure on nerves causing pain
CNS - cells swell
CNS - cell swell
pressure caused by x.s.fluid in intravascular forces fluid to interstitium = edema
1L weighs 2.2 lbs
Pt. presents with bounding pulse, JVD, normal renal function and polyuria what do you suspect is the primary cause?
FVE
FVE or FVD?
seizures, muscle spasms progressing to coma
FVE
pressure on nerves causes seizures
electrolytes overdiluted causes muscle spasms
What do nurses assess for FVE/FVD?
6 main categories/systems
1. I & O urine specific gravity 2. daily weights 3. Cardiac system HR, Pulse pressure, JVD, BP 4. Respiratory system resp rate inc = FVD SOB, crackles, cough = FVE 5. Neurological LOC A&O x3, pupillary response, voluntary movement of extremities & strength 6. Integumentary skin turgor dry mucous membranes,
Edematous skin may be cool to touch - why?
dec in blood flow, secondary to increased pressure of interstitial fluid build up.
Pt. on NG suction are not typically given water to drink - why?
H2O pulls electrolytes from GI cells - which are then suctioned and removed from body.
What fluid is used to irrigate a NG suction tube?
0.9% NS
3 ways Na+ excreted from body?
urine
sweat
feces
- ADH regulates water or sodium?
2. Aldosterone directly regulates water or sodium?
- H2O - retention
2. Na+ - reabsorption
changes in serum Na+ may reflect a primary _________________ imbalance.
A primary _______________ imbalance or __________
- water (too much or too little)
- sodium (too much or too little)
- both!
hypernatremia caused by 1. _______ of H2O, or ___________ of Na+
- loss H2O
2. gain Na+
list 4 disease states that cause hypernatremia
- diabetes insipidus (too much ADH - too much H2O lost in urine)
- hyperglycemia - due to uncontrolled diabetes mellitus - causes osmotic diuresis so dilute urine is lost & Na+ is left behind.
- cushing’s X.S. cortisol acts like aldosterone and keeps Na+
- primary aldosteronism - x.s. aldosterone made by body.
s/s hypernatremia with normal ECF volume
do not list all that occur with FVD and normal FV - just those specific to normal FV
Intense thirst with normal mucous membranes
weight gain
s/s hypernatremia with FVD
restlessness agitation twitching (neurons more easily activated) seizures coma weakness lethargy intense thirst - dry swollen tongue - sticky mucous membranes postural hypotension weight loss
Tx for H2O deficit hypernatremia
- aim of Tx
- fluids used
- Tx fast or slow & why?
- Replace H2O, prevent further loss
- IV D5W
Hypotonic NS (0.45% NS) - slow - prevent cerebral edema
Tx for X.S Na+ hypernatremia (2)
- diuretics
2. restrict Na+ intake
loss of Na+ from body
inc. in H2O in body can both lead to …….
hyponatremia
2 types of Iv fluids can cause hyponatremia
- hypotonic
2. sodium free
does SIADH cause hypernatremia or hyponatremia?
Explain:
Hypo.
x.s. ADH causes body to retain x.s. H2O - dilutes Na+ alters ratio. effectively dec. Na+ in body
List 6 ways Na+ rich fluids are abnormally lost from body
diarrhea vomiting NG suction fistulas burns wound drainage
What effect do hypoaldosteronism and adrenal insufficiency have on the body?
too little Na+ reabsorbed
What do the following indicate? irritability apprehension confusion dizziness personality changes tremors seizures coma tachycardia thready pulse orthostatic hypotension cold clammy skin dry mucous membranes
Dec ECF Vol hyponatremia
cells swell - CNS effects
Normal ECF Vol with hyponatremia s/s include:
NVD abdominal cramps headache apathy confusion muscle spasms seizures coma
Tx hyponatremia caused by x.s. H2O (2)
- fluid restrictions
2. if seizures develop 3% NS
Tx hyponatremia caused by fluid loss
replace fluid with IV solutions containing Na+
Drugs that block ADH can be used to Tx hyponatremia (2)
Conivaptan - inc urine output while conserving Na+ & K+
Tolvaptan - used for HF, Liver cirrhosis, SIADH
Implementation of nursing care for a patient with hypernatremia includes:
a. fluid restriction
b. administration of 3% NS IV fluids
c. administration of D5W IV fluids
d. administration of drugs that block ADH such as Conivaptan
c. administration of D5W IV fluids
hypotonic - adding free water to dilute NA+
