TOPIC 2 - fluids, electrolytes, infusions Flashcards
body systems involved in water regulation
kidneys, lungs, skin, GI/GU
fluid volume deficits
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
who is at risk for dehydration?
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
dehydration assessment
neuro, cardiac, resp, GI, GU, skin, musculoskeletal
serum sodium balance is regulated by …
the kidneys under the influence of aldosterone, ADH, and NP
what do potassium levels affect
every muscle (especially depolarization and repolarization in the heart)
regulate protein synthesis and regulate glucose use and storage
what is calcium important for
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.
how is calcium regulated
more calcium needed - PTH increases
excess calcium - PTH is inhibited by thyrocalcitonin
what does extracellular magnesium regulate
blood coagulation and skeletal muscle contractility
what do chloride imbalances affect and how can you intervene
occur as a result of other electrolyte imbalance and are corrected by correcting the other electrolyte or acid base problems
fluid volume deficit labs
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)
fluid volume deficit intervention
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
clinical manifestation of hypertonic fluid volume deficit
client has become confused
clinical manifestations of either hypertonic or isotonic fluid deficit
oliguria and hypotension
increase in interstitial fluid can lead to which manifestation
dependent edema
interventions for hypervolemia
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
age related changes regarding body fluids
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
what labs are expected for a rapid onset isotonic fluid volume
elevated RBC, elevated BUN and Crt
potassium function
transmit nerve impulse, cardiac and skeletal contraction, acid base balance, regulate insulin and storage
sodium function
acid base balance, regulate Cl, influence renal excretion of H2O, initiate neurotransmitter reaction, create a charge in opposition to K
calcium function
structure for bones and teeth, activate coagulation, nerve and muscle impulse, promote immune function, cardiac activation/excitation/contraction
phosphorous function
muscle contraction, maintain heart rhythm, kidney function, nerve conduction, RBC function, metabolism, regulate Ca, acid base balance, cell membranes
magnesium function
heart rhythm, nerve and muscle system function, immune system, balance electrolyte
causes of hypokalemia
N/V/D, fistulas, NGT suction, diaphoresis, alkalosis, steroids, insulin
interventions for hypokalemia
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
manifestations of hypokalemia
fatigue, weakness, confusion, PVCs, bradycardia, N/V, abdominal distention, hypoactive bowels, constipation, postural hypotension, bilateral muscle weakness, flaccid paralysis, dysrhythmia
hypokalemia lab level
below 3.5
causes of hyperkalemia
CKD, acidosis, blood transfusions
interventions of hyperkalemia
ECG, vitals, I/O, resp status, LOC
manifestations of hyperkalemia
weakness, asystole, resp failure, transient abdominal cramping, bilateral muscle weakness, flaccis paralysis, dsyrhytmia, cardiac arrest, tall T waves, conduction delays, V fib, heart block
hyperkalemia lab level
greater than 5
meds for hyperkalemia
diuretics, glucose, Ca chloride, dialysis, beta agonists, mag sulfate
a client with a potassium level of 3.1 would exhibit which assessment
decreased bowel sounds
causes of hyponatremia
fluid overload, psychogenic polydipsia, diuretics, edema, burns, poor Na intake
interventions for hyponatremia
if muscle weakness - immediately check resp
I/O, seizure prec, 0.9 NS, 3% NS, vitals, LOC, electrolytes, cardiac monitor
manifestations of hyponatremia
cerebral changes from intracranial pressure, alt LOC, confusion, seizures, weakness, abd cramping, malaise, anorexia, coma
causes of hypernatremia
dehydration, suction, drains, fever, burns, diarrhea
interventions for hypernatremia
life threatening - hemodialysis and blood ultrafiltration
monitor cardia, LOC, seizures, vitals, I/O, diuretics, IV D5W
manifestations of hypernatremia
seizures, agitation, alt mental, decreased cardiac, contractility, muscle twitch, thirst
what would the nurse anticipate when assessing a client who is diagnoses with hypernatremia
confusion, thirst, lethargy, seizures
if calcium is high then phosphate is …
low
(always inverse)
if calcium is high then phosphate is …
low
(always inverse)
causes of hypocalcemia
renal fail, diuretics, infections, ETOH, burns, bone cancer, pancreatitis
interventions for hypocalcemia
cardiac monitor, seizures, LOC, IV calcium, use a lift sheet to reposition because of frail bones
manifestations of hypocalcemia
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
causes of hypercalcemia
renal fail, dehydration, metastatic CA, HCTZ, too much Ca intake
small increases have severe effects on all systems
interventions of hypercalcemia
cardiac monitor, calcitonin, phosphorus, lasix, IV fluid
manifestations hypercalcemia
higher risk for blood clots, weakness, elevated EKG, increase heart rate and BP, decrease reflexes, decrease neuromuscular excitability, anorexia, stupor, decreased muscle tone, constipation
severe hypocalcemia would display which clinical manifestation
laryngospasm
causes of low phosphorus
vomiting, diarrhea, burns, ETOH
interventions of low phosphorus
neutraphos, K phos, vitamin D, decreased Ca intake
because phosphorus and calcium are interrelated, decreased phosphorus would do what to calcium levels
increase calcium
drugs that promote phosphorus loss are discontinued, vit D might correct moderate deficiency
signs and symptoms of low phosphorus
weak pulse, decrease CO, bradycardia, hypotension, bradypnea, weak muscles, decreased DTR, confusion, stupor, anorexia, shallow resp
management of hyperphosphatemia relates to what
hypocalcemia
management includes diuretics, phos-LO, renagel
there are actual few problems with hyperphosphatemia
what will the nurse assess for based on a lab value of phosphate at 3.1
tetany, hyperreflexia, shallow resp
causes of hypomagnesemia
ETOH, diarrhea, burns, renal failure
interventions for hypomagnesemia
avoid admin mag sulfate through IM, interventions aim at restoring normal serum calcium levels also, cardiac monitor, PO/IV, vitals, monitor electrolytes
manifestations of hypomagnesemia
tachycardia, HTN, resp depression, lethargy, positive chvostek and trousseau sign, hyperactive DTR, tremors, muscle cramps, dysphagia, nystagmus
causes of hypermagnesemia
renal failure, IV mag overdose, hypothyroid, metastatic bone disease, adrenal insufficiency, antacids/laxatives
manifestations of hypermagnesemia
flushed appearance, diaphoresis, N/V, decreased neuromuscular excitability, drowsy, lethargy, decreased DTR
interventions for hypermagnesemia
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
what question should be asked during a health history of a client who has hypermagnesemia
what type of laxatives do you use?
do you use over the counter antacids
isotonic infusions
D5W, 0.9% NS, LR
hypertonic infusions
D5%.45NS, D5%.9NaCl, D10W
hypotonic infusions
0.45% NS
