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MED SURG > TOPIC 2 - fluids, electrolytes, infusions > Flashcards

TOPIC 2 - fluids, electrolytes, infusions Flashcards

1
Q

body systems involved in water regulation

A

kidneys, lungs, skin, GI/GU

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2
Q

fluid volume deficits

A

isotonic: water and sodium lost in the same proportion
hypertonic: proportionately more water than sodium is lost - water moves out of the cells by osmosis

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3
Q

who is at risk for dehydration?

A

strenuous exercise, prolonged exercise
increased caffeine and alcohol
client who lives at high elevation or dry geography
elderly clients are at a greater risk because of lost elasticity, decreased GFR, loss of muscle, diminished thirst

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4
Q

dehydration assessment

A

neuro, cardiac, resp, GI, GU, skin, musculoskeletal

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5
Q

serum sodium balance is regulated by …

A

the kidneys under the influence of aldosterone, ADH, and NP

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6
Q

what do potassium levels affect

A

every muscle (especially depolarization and repolarization in the heart)

regulate protein synthesis and regulate glucose use and storage

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7
Q

what is calcium important for

A

functions closely with phosphorus and magnesium

important for maintaining bone strength and density, activating enzymes, allowing skeletal and cardiac muscle contraction, controlling nerve impulse transmission, and allowing blood clotting.

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8
Q

how is calcium regulated

A

more calcium needed - PTH increases
excess calcium - PTH is inhibited by thyrocalcitonin

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9
Q

what does extracellular magnesium regulate

A

blood coagulation and skeletal muscle contractility

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10
Q

what do chloride imbalances affect and how can you intervene

A

occur as a result of other electrolyte imbalance and are corrected by correcting the other electrolyte or acid base problems

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11
Q

fluid volume deficit labs

A

elevated BUN, normal serum osmolality if isotonic/ elevated serum osmolality if hypertonic, elevated RBC and H&H if developed rapidly, increased urine specific gravity (unless hypertonic cause by ADH deficiency)

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12
Q

fluid volume deficit intervention

A

monitor symptoms, accurate I/O, maintain IV access, wash for s/s of cerebral edema when replacing fluids, monitor serum sodium, safe environment, daily weights, skin and oral care, manage dehydration

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13
Q

clinical manifestation of hypertonic fluid volume deficit

A

client has become confused

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14
Q

clinical manifestations of either hypertonic or isotonic fluid deficit

A

oliguria and hypotension

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15
Q

increase in interstitial fluid can lead to which manifestation

A

dependent edema

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16
Q

interventions for hypervolemia

A

asses vitals and response to treatment, monitor resp status and ABGs, watch for distended neck veins, record I/O, foley if needed, assess breath sounds and pulmonary edema, elevate HOB, maintain IV access, give diuretics as orders, check for S3, daily weights, emotional support, skin and oral care

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17
Q

age related changes regarding body fluids

A

skin - assess skin and mucous membranes for color, moisture, and turgor (lost elasticity)
renal - affect urine volume concentration, output below 500mL is concern
neuro - change in mental status and reduced blood flow is one of first signs of dehydrated

muscular
endocrine

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18
Q

what labs are expected for a rapid onset isotonic fluid volume

A

elevated RBC, elevated BUN and Crt

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19
Q

potassium function

A

transmit nerve impulse, cardiac and skeletal contraction, acid base balance, regulate insulin and storage

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20
Q

sodium function

A

acid base balance, regulate Cl, influence renal excretion of H2O, initiate neurotransmitter reaction, create a charge in opposition to K

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21
Q

calcium function

A

structure for bones and teeth, activate coagulation, nerve and muscle impulse, promote immune function, cardiac activation/excitation/contraction

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22
Q

phosphorous function

A

muscle contraction, maintain heart rhythm, kidney function, nerve conduction, RBC function, metabolism, regulate Ca, acid base balance, cell membranes

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23
Q

magnesium function

A

heart rhythm, nerve and muscle system function, immune system, balance electrolyte

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24
Q

causes of hypokalemia

A

N/V/D, fistulas, NGT suction, diaphoresis, alkalosis, steroids, insulin

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25
Q

interventions for hypokalemia

A

potassium replacement, IV, cardiac monitor, I/O, LOC, vitals, monitor electrolytes, assess resp status, check the dilution of the drug before IV, DO NOT give IV potassium at a rate greater than 20/hr, never give IM or IVP, assess IV site hourly, stop infusion for infiltration or phlebitis, give oral potassium during or after a meal

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26
Q

manifestations of hypokalemia

A

fatigue, weakness, confusion, PVCs, bradycardia, N/V, abdominal distention, hypoactive bowels, constipation, postural hypotension, bilateral muscle weakness, flaccid paralysis, dysrhythmia

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27
Q

hypokalemia lab level

A

below 3.5

28
Q

causes of hyperkalemia

A

CKD, acidosis, blood transfusions

29
Q

interventions of hyperkalemia

A

ECG, vitals, I/O, resp status, LOC

30
Q

manifestations of hyperkalemia

A

weakness, asystole, resp failure, transient abdominal cramping, bilateral muscle weakness, flaccis paralysis, dsyrhytmia, cardiac arrest, tall T waves, conduction delays, V fib, heart block

31
Q

hyperkalemia lab level

A

greater than 5

32
Q

meds for hyperkalemia

A

diuretics, glucose, Ca chloride, dialysis, beta agonists, mag sulfate

33
Q

a client with a potassium level of 3.1 would exhibit which assessment

A

decreased bowel sounds

34
Q

causes of hyponatremia

A

fluid overload, psychogenic polydipsia, diuretics, edema, burns, poor Na intake

35
Q

interventions for hyponatremia

A

if muscle weakness - immediately check resp
I/O, seizure prec, 0.9 NS, 3% NS, vitals, LOC, electrolytes, cardiac monitor

36
Q

manifestations of hyponatremia

A

cerebral changes from intracranial pressure, alt LOC, confusion, seizures, weakness, abd cramping, malaise, anorexia, coma

37
Q

causes of hypernatremia

A

dehydration, suction, drains, fever, burns, diarrhea

38
Q

interventions for hypernatremia

A

life threatening - hemodialysis and blood ultrafiltration
monitor cardia, LOC, seizures, vitals, I/O, diuretics, IV D5W

39
Q

manifestations of hypernatremia

A

seizures, agitation, alt mental, decreased cardiac, contractility, muscle twitch, thirst

40
Q

what would the nurse anticipate when assessing a client who is diagnoses with hypernatremia

A

confusion, thirst, lethargy, seizures

41
Q

if calcium is high then phosphate is …

A

low
(always inverse)

42
Q

if calcium is high then phosphate is …

A

low
(always inverse)

43
Q

causes of hypocalcemia

A

renal fail, diuretics, infections, ETOH, burns, bone cancer, pancreatitis

44
Q

interventions for hypocalcemia

A

cardiac monitor, seizures, LOC, IV calcium, use a lift sheet to reposition because of frail bones

45
Q

manifestations of hypocalcemia

A

hypotension, bradycardia, dsyrhythmia, increased RR, parasthesias, chvosteks sign, trosseus sign, laryngospasm, muscle cramps and tetany, numbness and tingling, hyperactive reflex, menopausal women = decreased estrogen levels

46
Q

causes of hypercalcemia

A

renal fail, dehydration, metastatic CA, HCTZ, too much Ca intake

small increases have severe effects on all systems

47
Q

interventions of hypercalcemia

A

cardiac monitor, calcitonin, phosphorus, lasix, IV fluid

48
Q

manifestations hypercalcemia

A

higher risk for blood clots, weakness, elevated EKG, increase heart rate and BP, decrease reflexes, decrease neuromuscular excitability, anorexia, stupor, decreased muscle tone, constipation

49
Q

severe hypocalcemia would display which clinical manifestation

A

laryngospasm

50
Q

causes of low phosphorus

A

vomiting, diarrhea, burns, ETOH

51
Q

interventions of low phosphorus

A

neutraphos, K phos, vitamin D, decreased Ca intake

52
Q

because phosphorus and calcium are interrelated, decreased phosphorus would do what to calcium levels

A

increase calcium

drugs that promote phosphorus loss are discontinued, vit D might correct moderate deficiency

53
Q

signs and symptoms of low phosphorus

A

weak pulse, decrease CO, bradycardia, hypotension, bradypnea, weak muscles, decreased DTR, confusion, stupor, anorexia, shallow resp

54
Q

management of hyperphosphatemia relates to what

A

hypocalcemia

management includes diuretics, phos-LO, renagel

there are actual few problems with hyperphosphatemia

55
Q

what will the nurse assess for based on a lab value of phosphate at 3.1

A

tetany, hyperreflexia, shallow resp

56
Q

causes of hypomagnesemia

A

ETOH, diarrhea, burns, renal failure

57
Q

interventions for hypomagnesemia

A

avoid admin mag sulfate through IM, interventions aim at restoring normal serum calcium levels also, cardiac monitor, PO/IV, vitals, monitor electrolytes

58
Q

manifestations of hypomagnesemia

A

tachycardia, HTN, resp depression, lethargy, positive chvostek and trousseau sign, hyperactive DTR, tremors, muscle cramps, dysphagia, nystagmus

59
Q

causes of hypermagnesemia

A

renal failure, IV mag overdose, hypothyroid, metastatic bone disease, adrenal insufficiency, antacids/laxatives

60
Q

manifestations of hypermagnesemia

A

flushed appearance, diaphoresis, N/V, decreased neuromuscular excitability, drowsy, lethargy, decreased DTR

61
Q

interventions for hypermagnesemia

A

oral and parenteral mag preps are discontinued, in the absence of kidney failure IV fluid and loop diuretics can reduce levels, severe problems - calcium may reverse

limit mag, increase fluids, drugs, diuretics, IV calcium gluconate, avoid potassium containing drugs

62
Q

what question should be asked during a health history of a client who has hypermagnesemia

A

what type of laxatives do you use?

do you use over the counter antacids

63
Q

isotonic infusions

A

D5W, 0.9% NS, LR

64
Q

hypertonic infusions

A

D5%.45NS, D5%.9NaCl, D10W

65
Q

hypotonic infusions

A

0.45% NS

MED SURG (30 decks)

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