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NSG 320 - MED SURG > Topic 2: Fluid Balance > Flashcards

Topic 2: Fluid Balance Flashcards

1
Q

isotonic fluid loss

A

water and sodium are lost in the same proportion that’s in normal body fluids
-Usually a loss of fluid volume from hemorrhaging (bleeding), vomiting, diarrhea).

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2
Q

hypertonic (dehydration)

A

proportionately more water than sodium is lost. Water moves out of the cells by osmosis, causing them to shrink.

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3
Q

why are elderly clines at great risk for dehydration

A

*Lose skin elasticity
*Decreased GFR, decreased kidney ability to concentrate urine
*Loss of muscle mass
*Diminished thirst reflex
*They also may take drugs such as diuretics, antihypertensive, and laxatives that increase fluid excretion.

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4
Q

Causes of ECF volume deficit

A

-increase insensible water loss or perspitation (high fever, heat stroke)
-diabetes insipidus
-osmotic diuresis
-hemorrhage
-GI loses: vomiting, NG suction, diarrhea, fistual drainage
-overuse of diuretics
-inadequate fluid intake
-thirs space fluid shifts, burns, pancreatitis

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5
Q

manifestations of ECF volume deficit: cardiac

A

-postural hypotension, increase pulse, decrease CVP
-seizures, coma

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6
Q

manifestations of ECF volume deficit: neuro

A

-restlessness, drowsiness, lethargy, confusion
-seizures, coma

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7
Q

manifestations of ECF volume deficit: respiratory

A

increased RR

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8
Q

manifestations of ECF volume deficit: GI

A

weight loss

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9
Q

manifestations of ECF volume deficit: GU

A

decrease UO, concentrated urine

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10
Q

manifestations of ECF volume deficit: skin

A

-thrist, dry mucous membranes
-cold, clammy skin
-decreased skin turgor, decrease cap refil

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11
Q

manifestations of ECF volume deficit: musculoskeletal

A

weakness, dizziness

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12
Q

Causes of ECF volume excess

A

-Excessive isotonic or hypotonic IV fluids
-Heart failure
-Renal failure
-Primary polydipsia
-SIADH
-Cushing syndrome
-Long-term use of corticosteroids

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13
Q

manifestations of ECF volume excess: cardiac

A

-peripheral edema
-jugular venous distention
-s3 heart sounds
-bounding pulse, increase BP and CVP

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14
Q

manifestations of ECF volume excess: neuro

A

HA, confusion, lethargy
seizures, coma

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15
Q

manifestations of ECF volume excess: respiratory

A

dyspnea, crackles, pulmonary edema

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16
Q

manifestations of ECF volume excess: GU

A

polyuria (with normal renal function)

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17
Q

manifestations of ECF volume excess: GI

A

weight gain

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18
Q

manifestations of ECF volume excess: musculoskeletal

A

muscle spasms

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19
Q

Normal sodium levels

A

136-145 mEq/L

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20
Q

Normal calcium levels

A

9-10.5 mg/dL

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21
Q

normal potassium levels

A

3.5-5.0 mEq/L

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22
Q

Normal magnesium levels

A

1.3-2.1 mEq/L

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23
Q

normal chloride levels

A

98-106 mEq/L

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24
Q

Normal phosphorus level

A

3.0-4.5 mg/dL

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25
Q

fluid volume deficit BUN level

A

elevated

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26
Q

fluid volume excess BUN level

A

may be normal

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27
Q

fluid volume deficit serum osmolality level

A

maybe normla (isotonic FVD) or elevated (hypertonic FVD)

Isotonic Fluid Loss (Normal Osmolality): If you lose water and solutes (mostly sodium) in the same proportion as they exist in normal extracellular fluid—say, from hemorrhage, vomiting, or certain types of diarrhea—your serum osmolality might remain normal.

Hypertonic Fluid Loss (Elevated Osmolality): If you lose more water than solutes—such as from excessive sweating, fever, or respiratory loss—your serum osmolality can indeed become elevated.

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28
Q

fluid volume excess serum osmolality level

A

may be normal or low

29
Q

fluid volume deficit RbC and H&H level

A

elevated if FVD develops rapidly

30
Q

fluid volume excess RbC and H&H level

A

normal (isotonicn FVE) or low (hypotonic FVE)

31
Q

fluid volume deficit urinalysis

A

increased urine specificitic gravity and osmplarity

32
Q

fluid volume excess urinalysis

A

normal or decresed specific gravity and osmolality

33
Q

nursing interventions of fluid volume deficit

A

*Monitor symptoms
*ACCURATE intake/output
*Maintain IV access as ordered
*Watch for s/sx of cerebral edema when replacing fluids
*Monitor serum sodium, urine osmolality and specific gravity
*Provide safe environment
*Daily Weights
*Skin and oral care

34
Q

Hypervolemia: Signs & Symptoms

A

-Rapid, bounding pulse
-Increased blood pressure
-S3 develops
-Distended neck veins
-Edema (Tissues,Lungs)
-With progression: falling BP and cardiac output
-Sudden weight gain (1+ kg in 24 hours)
-Shortness of breath
-Crackles when you auscultate the lungs
-Pink frothy sputum
-Cough
-Cerebral edema

35
Q

Hypervolemia: Nursing Interventions

A

*Assess vital signs and response to treatment
*Monitor respiratory status for worsening distress
*Monitor ABGs
*Watch for distended neck or hand veins
*Record I/O hourly: Foley if needed, restrict fluids prn
*Assess breath sounds regularly to check for pulmonary edema
*Elevate head of bed to facilitate breathing
*Maintain IV access
*Give diuretics and other meds as ordered
*Watch for edema (especially dependent)
*Check for S3
*Frequent oral care
*Daily weights, evaluate
*Skin care

36
Q

Causes of hypokalemia

A

N/V/D, fistulas, NGT suction
Diaphoresis
alkalosis
insulin

37
Q

manifestations of hypokalemia

A

LOW AND SLOW
-prominent u-wave
-decrease DTR, flaccid paralysis
-decrease motility, constipation, hypoactive bowel sounds
-parlytic ileus *can lead to SBO

38
Q

Interventions for hypokalemia

A

-monitor cardiac, respiration, VS, I&Os, electrolytes
-potassium replacement

39
Q

what can you not give potassium supplements by

A

IM, SC, IV push

40
Q

Do not give intravenous potassium at a rate greater than ____

A

20 mEq/hr.

41
Q

potassium and IV

A

Because potassium is a severe irritant to the vein, assess the IV site hourly, and ask the patient whether he or she feels burning or pain at the site.

42
Q

when giving oral potassium supplements…

A

give during or anfer a meal to preven GI upset

43
Q

manifestations of hyperkalemia

A

TIGHT AND CONTRACTED
-heart “cramps”
-hypotension and bradycardia
-diarrhea & hyperactive bowel sounds
-paralysis in extremity
-increase DTR
-muscle weakness

44
Q

interventions for hyperkalemia

A

-monitor VS,EKG, I&O, repiratory, LOC
-anticipate order of diuretic (ex: lasix), kayexalate, glucose/insulin , Ca chloride, dialysis

45
Q

How to treat hyperkalemia: insulin administered with glucose

A

*Facilitates the uptake of glucose into the cell, which brings potassium with

46
Q

How to treat hyperkalemia: b 2 adrenergic agonist

A

*Promote cellular reuptake of potassium

47
Q

How to treat hyperkalemia: diuretic

A

*Cause potassium loss through the kidney

48
Q

How to treat hyperkalemia: magnesium sulfate

A

*: Has been successfully used to treat acute overdose of slow-release oral potassium

49
Q

manifestations of hyponatremia

A

DEPRESSED AND DEFLATE
-**seizure and coma
-tachycardia
-thready weak pulse
-respriatory arrest

50
Q

interventions for hyponatremia

A

-I&Os, VS, elecrolytes, EKG
-Seizure prec.
-0.9 saline
-3% saline

51
Q

manifestations of hypernatremia

A

BIG & BLOATED
-flushed and red
-edema
-low grade fever
-thirsty
-swollen dry beefy tongue
-increase muscle tone

52
Q

interventions for hypernatremia

A

-monitor cardiac, VS, I&O, LOC
-seizure pre.
-limit Na intake
- IV D5%W
-Diuretics

53
Q

calcium and phosphate

A

They are always OPPOSITE - if calcium is high, then phosphate is low

54
Q

what are the three components of calcium function

A

-bone
-blood
-beats

55
Q

manifestations of hypocalcemia

A

-trousseaus
-chevostek
-diarrhea
-circumoral tingling
-weak bones (risk for bone fx)
-decrease clot (risk for bleeding)
-cardiac dysrhythmia

56
Q

Trousseau’s sign

A

A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client’s systolic pressure and leaving it in place for 3 minutes.

57
Q

chvostek’s sign

A

Hypocalcemia (facial muscle spasm upon tapping on masseter muscle)

58
Q

interventions hypocalcemia

A

-IV Ca+ (10% ca gluconate SLOW)
-Monitor cardiac, LOC
-seizure pre
-admin ca with vit D

59
Q

manifestation of hypercalcemia

A

SWOLLEN & SLOW, MOANS GROANS & STONES
-constipation
-bone pain
-renal calculi (kidney stones)
-decrease DTR, muscle weakness

60
Q

interventions for hypercalcemia

A

-monitor EKG,
-decrease Ca rich foods
-calcitonin
-phosphorus
-lasix
-IV fluids (stay hydrated to decrease kidney stone formation)

61
Q

interventions for hypomagnesmia

A

-increase magnesium foods or give IV/PO (PO may cause diarrhea)
-monitor cardiac, VS, electrolytes
-place in seizure prec.
-may need to give K supplements (hard to increase Mg if K is low)

62
Q

manifestations of hypomagnesemia

A

DEPRESSED & DEFLATE
-*SEIZURE & COMA
-tachycardia
-thready weak pulse
-resp. arrest

63
Q

manifestations of hypermagnesemia

A

CALM & QUIET
-bradycardia & hypotension
-hyporefelxia, decrease DTR
-shallow respiration
-hypoactive bowel sounds

64
Q

interventions of hypermagnesemia

A

-monitor cardiac, respirations, EKG
-ENSURE SAFETY due to lethargy
-avoid giving patient in renal failure antacids/laxatives
-MD may order diuretics waste Mg
-renal failure: prep for dialysis

65
Q

manifestations of hypophosphatemia

A

SAME AS HIGH CA+
-decrease DTR, mucle weakness
-decrese HR & RR
-increase BP

66
Q

Treatment of hypophosphatemia

A

-NeutraPhos (oral phos)
-K+ phos
- admin Vitamin D
-↓Ca intake

67
Q

manifestations of hyperphosphatemia

A

SAME AS LOW CA+
-trosseaus
-chovetsk
-diarrhea
-“weak B’s

68
Q

interventions of hyperphosphatemia

A

*Phos-Lo (gove w ot after meal)
*Diuretics-Diamox
*Renagel

NSG 320 - MED SURG (63 decks)

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