Unit 2 Flashcards
What are isotonic fluids? Examples?
Fluids that are equivalent to concentration in body fluids.
NS (0.9% sodium chloride) - use caution with heart failure, renal disease, or edema patients
LR (ringers lactate or Hartmann solution) - don’t use with renal or liver failure, contains electrolytes, doesn’t provide calories
Dextrose 5% in water (D5W) - Can cause fluid overload, 170 cal/L, doesn’t replace electrolytes
What are hypotonic fluids? Examples?
Fluids with low electrolytes and more fluid, used to hydrate the cells.
Tx: DKA
1/2 NS (0.45% sodium chloride) - CI for liver disease, trauma, or burns
What are hypertonic fluid? Examples?
Fluid contain more electrolytes than fluid, drain cells of fluid.
D5W in NS - only slightly hypertonic, watch for hypovolemia
D10W - monitor blood sugar
D50W - monitor blood sugar, use central line
3% sodium chloride - give slowly, only used in critical care with hemodynamic monitoring
What is crystalloids vs colloids?
Colloid solutions are volume expanders; they can’t shift into the cells. Like hypertonic solutions, except they last longer.
Ex: albumin, dextrans
Crystalloids can shift into cells.
What are the appropriate uses for isotonic fluids? (NS, LR, D5W)
NS - shock, hyponatremia, blood transfusions, DKA, hypercalcemia, heavy drainage from GI suction or wounds or fistulas
LR - dehydration, burns, lower GI fluid loss, hypovolemia, acute blood loss, surgery, electrolyte replacement
D5W - dehydration, fluid loss, hypernatremia
What are appropriate uses for hypotonic fluids?
1/2 NS - water replacement, DKA, fluid loss from NG or vomiting, helps kidneys excrete excess fluids
What are appropriate uses for hypertonic fluids?
D5W in NS - shock, Addison’s crisis
D10W - water replacement, hypoglycemia
D50W - hypoglycemia, given in IV bolus
3% Sodium Chloride - raises sodium lvls, highly hypertonic
What is the pathophysiology in acute renal injury?
Rapid reduction in kidney fxn due to perfusion, kidney tissue damage, or obstruction to urine output. This results in failure to maintain waste elimination, fluid/electrolyte imbalances, and acid-base imbalances.
What are the s/s of ARI?
Hyperkalemia
Pericarditis (inflammation of sac around heart)
Pericardial effusion (fluid around heart)
Pericardial tamponade (fluid compressing and constricting heart)
Anemia - only if BUN is high enough
Oliguria
HTN
Bone disease
What is the pathophysiology of chronic renal failure?
Progressive, irreversible kidney disorder lasting longer than 3 months
Stage 1 - normal GFR, abnormal urine findings
Stage 2 - GFR (60-89); albuminaria; increased urine output - dehydration
Stage 3 - GFR (30-59); albuminuria; azotemia (nitrogenous waste in blood); restrict the fluid intake
Stg 4 - GFR (15-29); prepare for renal replacement therapy
Stg 5 - GFR <15; implement renal replacement therapy
What are the s/s of CRF?
Uremia (metalic tastet, n/v, anorexia, FROST ON SKIN)
Fluid overload
Hyponatremia
Hyperkalemia
Metabolic Acidosis
Kussmaul respiration
Itching
HTN
Anemia
Pericarditis
Increased BUN and creatinine
What is the renal diet?
Low sodium, potassium, phosphate, and low sugar
How to prevent CKD?
Carefully manage DM, HF, and HTN; Drink water; limit NSAIDs long term use
What are normal lab values? Ca, Mg, K, Cl, P, Na
NA: 135-145
K: 3.5-5
Ca: 8.5-10.5
P: 2.5-4.5
Mg: 1.5-2.5
Cl: 95-105
What are s/s of hyponatremia? Causes?
S/S:
Low temperature
Confusion
Weak
Hypotension
CAUSES:
burns
high ADH secretion
excessive dilution
What are s/s of hypernatremia? Causes?
Dehydrated
Agitated/twitchy
Swollen
Hot/flushed
CAUSES:
Impaired renal fxn
excessive IV fluids with NaCl
Hypertonic enteral feedings
Diarrhea
Burns
What are s/s of hyperkalemia? Causes?
Irritability
Paresthesias
Oliguria
Diarrhea
k+ sparing diuretic
excessive consumption
What are s/s of hypokalemia? Causes?
Polyuria
Constipation
Leg cramps
K+ wasting diuretics, vomiting/diarrhea, strenuous activity
What are s/s of hypermagnesemia? Causes?
Respiratory distress
Flushing
Hypotension
Muscle weakness
Renal insufficiency
IV administration
Milk of magnesium
What are s/s of hypomagnesemia? Causes?
Tetany
Trousseu’s
Chvostek’s
Sensation changes
Gastric suctioning
Diabetes
What are s/s of hypercalcemia? Causes?
Diminished reflexes
Constipation
Confusion
Muscle Weakness
Hyperparathyroidism
Calcium supplementation
Thiazide diuretics
What are s/s of hypocalcemia? Causes?
Paresthesias
Twitching/tetany
Trousseaus
Chvostek’s
Diarrhea
Hypoparathyroidism
Malabsorption
Renal failure
What are s/s of hyperchloremia? Causes?
Tachypnea
Lethargy
Weakness
Kussmauls Respirations
HTN
Excess sodium chloride
Hypernatremia
Dehydration
Hyperparathyroidism
What are s/s of hypochloremia?
Agitation
Irritability
Weakness
Hyperexcitability of muscles
Dysrhythmias
Seizures
Addison’s disease
Reduced Chloride intake
GI loss
DKA
Fever
Burns
What are s/s of hyperphosphatemia?
Soft tissue calcifications
Tetany
Chvosteks
Trousseaus
Renal failure
Acidosis
(Think low calcium)
What are s/s of hypophosphatemia?
Confusion
Weakness
Diminished reflexes
Think the opposite of hypercalcemia
How do you calculate MAP? What is MAP?
How much blood the heart is pumping
(Systolic+diastolic*2)/3 = MAP
Higher the map the higher chance of afib
Lower the map the higher chance of ARI
What are normal GFR, BUN, Creatinine, and creatinine clearance?
GFR - report if below 60
BUN - 10-20
Creatinine - 0.6-1.2
How does hemodialysis work?
Recommended when 80% of nephrons no longer work. Usually 3-4 hrs a day for about 3 days a week.
Monitor I/Os and for possible fluid retention
Fluid restriction may occur
Dont give antihypertensive medications on dialysis days
Don’t take BP or do anything with the arm with the fistula
S/S: hypotension, n/v, anemia
How does peritoneal dialysis work?
Can be done during the day or overnight
Make sure to take VS and electrolyte lvls before
Fluid into the peritoneal membrane
What is the difference between prerenal, intrarenal, and postrenal AKI?
Prerenal - happens before the kidney, affects perfusion; elevated BUN, normal creatinine
Intrarenal - affected by damage to kidney tissue; acute tubular necrosis occurs
Postrenal - affected by obstruction to urine outflow
What are s/s of poor perfusion?
Tachycardia
Low BP (MAP <65)
Thready peripheral pulse
Low cognition
