Sodium/Potassium/and Volume Imbalances Flashcards
Hyponatremia
results from loss of sodium-containing fluids or from water excess
causes hypo osmolality with shift of water into cells
- dilute urine
Clinical Manifestations of Hyponatremia
- CCNVS
C- confusion C - coma N - nausea V - vomiting S - seizures
Causes of hyponatremia (11)
- diuretics
- vomiting/diarrhea
- nasogastric suctioning
- burns
- water retention (high levels of ADH)
- dilution
- CHF
- Liver disease
- Renal failure
- Hormone imbalances
- Syndrome of inappropriate antidiuretic hormone
causes of Hypernatremia
- excessive IV fluid with saline
- IV sodium bicarb
- Severe water loss
- Severe vomiting or diarrhea
- Heat stroke - losing water
- Osmotic diuresis
- Diabetes insipidus
- Disease that influences RAA system
Collaborative Care of Hyponatremia (5)
- fluid restriction - not allowing them to drink a high amount of water or other fluids
- reduce sodium loss - antiemetic
- Dietary replacement
- IV hypertonic solution - only given in very severe cases. have to add sodium slowly.
- monitoring I & O and monitoring for neurologic changes
Collaborative care of hypernatremia (5)
- treat underlying cause
- give oral or IV fluid replacement
- diuretics - depending on if they have the volume
- dietary sodium restriction
- monitor for CNS changes
Hypovolemia
abnormal loss of normal body fluids (diarrhea, fistula drainage, hemorrhage), inadequate intake, or plasma-to-interstitial fluid shift)
Causes of hypovolemia
- fever, diaphoresis, hyperglycemia, gastrointestinal suction, burns, blood loss, hyperventilation
- diseases: hyperthyroidism, diabetes, addison’s disease, renal failure
- third - space fluid shifts (intravascular dehydration even through TBW is elevated)
Manifestations of hypovolemia
- I/O
- body weight
- VS
- Skin
- CNS
- Lab values
- I/O - decrease urine output; increased specific gravity
- body weight - decreased
- VS - decreased BP, postural hypotension, decreased CVP (central venous pressure), increased pulse
- Skin - dry mucous membrane, decreased skin turgor & soft, sunken eyes
- CNS - apprehension, restlessness & headache -> hallucinations & confusion, coma
- Lab values - increased or decrease Na+, increased hematocrit, increase Hgb, increased BUN, increased urine specific gravity
Nursing Care of Hypovolemia (6)
- address the problem
- Rehydration therapy: replace water and electrolytes - careful how much you give over how much time. patient may not be able to handle rapid rehydration. can give orally, IV or NG tube
- frequent oral care
- ensure safety - fall risk increased
- frequently assessing lab values, VS, signs of JVD, urine output, cap refill, I & O
- assessing for possibility of third spacing
Hypervolemia
Excessive intake of fluids, abnormal retention of fluids (CHF), or interstital-to-plasma fluid shift
- vascular system, third spacing
Causes of hypervolemia
- circulatory problems -CHF –> hypertension –> pulmonary & peripheral edema
- renal disease - decreased excretion of body fluids
- liver - third-spacing –> spaces that don’t normally have fluid
- Lymphatic obstruction - tumour –> pressure on lymph nodes –> local edema
Manifestations of Hypervolemia
- respiratory
- circulatory
- neurologic
- lab values
- fluid in alveolar sacs -> coughing, dyspnea, crackles, hypoxia (pallor, cyanosis, decreased O2 sat)
- JVD, increased BP, peripheral edema, weight gain, bounding pulses, ascites
- confusion & headache -> lethargy, seizures, coma
- decreased Na+, decreased BUN, hematocrit and urine specific gravity
Interventions for hypervolemia
- sodium and fluid restriction
- diuretics
- Bi-pap
- Facilitate oxygenation and reduce cardiac workload
Nursing Implementation: sodium & volume imbalances (5)
- intake and output
- monitoring for cardiac changes
- Assessing respiratory status and monitoring for changes
- daily weights
- skin changes
Potassium
- Major ICF cation
- necessary for: (transmission and conduction of nerve impulses, maintenance of cardiac rhythms, skeletal & smooth muscle contraction, Acid-base balance)
- 90% of daily intake eliminated by kidneys - rest lost in sweat or stool
- inverse relationship between Na+ and K+
Normal values of potassium
3.5-5 mmol/L
Inverse relationship between Na+ and K+
factors that cause Na+ retention cause K+ loss in urine such as low blood volume - and increased aldosterone.
- ability of the kidneys to conserve K+ is weak (even if body stores are depleted)
Hyperkalemia
high serum potassium
Causes of hyperkalemia (6)
- renal failure
- massive intake
- shift from intracellular fluid to extracellular fluid (severe cellular dehydration due to hyperglycemia)
- massive cell destruction
- catabolic state
- transfusion of aged blood
Manifestations of Hyperkalemia
- weak or paralyzed skeletal muscles - may experience cramping leg pain
- ventricular fibrillation or cardiac status
- abdominal cramping or diarrhea
Hypokalemia causes (6)
- abnormal losses via the kidneys or the GI tract
- shift from the extracellular to the intracellular
- inadequate intake
- diuretic use
- magnesium deficiency
- metabolic acidosis
Manifestations of severe hypokalemia (< 2.5) (6)
- most serious are cardiac
- skeletal muscle weakness & paralysis
- muscle cramping & muscle cell breakdown
- decreased GI motility
- Diuresis (kidneys are filtering too much fluid)
- Hyperglycemia - reduces insulin secretion
Nursing Management of hypokalemia
- potassium supplements - give very carefully because it is irritating to veins, never give IV flush.
