Week 6 Fluid and Electrolytes Flashcards
Movement of fluid through capillary walls depends on
Hydrostatic pressure exerted on walls of blood vessels
Osmotic Pressure- exerted by protein in plasma- oncotic pressure by albumin
The direction of fluid movement depends on differences
Hydrostatic and Osmotic pressure
Most abundant protein in plasma is
Albumin
Where is albumin synthesized at?
Liver hepatocytes and rapidly excreted into the blood stream
Serum Albumin function
Oncotic pressure
transporter of endogenous and exogenous ligands
Patient nutritional marker for sensitivity is
Serum albumin labs
Also aid in liver function of patients
Colloid fluid given for people in need of fluid resuscitation
Albumin
Especially in trauma setting or in large volume paracentesis
Excess protein in urine
Hypoalbuminemia
Fluid retention that causes swelling in feet or hands
Hypoalbuminemia
Signs of hypoalbuminemia
Jaundice- Indicates liver disease
Feelings of weakness or exhaustion
Rapid Heartbeat
Prolonged vomiting, diarrhea
Appetite changes- nausea
Hyperalbuminemia Causes
Excessive fluid losses
Dehydration, diarrhea, vomiting
High protein diet
Routes of gains
Dietary intake of fluid, food, or enteral feeding
Parenteral Fluids
IV fluids, Medications, TPN
Inability to release fluids
Retains
Sweat, cry, GFR
Route of Losses
Loss
- Kidney, urine output
- Skin
- Lungs
- GI Tract
-Other
Gerontological Considerations
Reduced homeostatic mechanisms
-Cardiac, Renal, Resp. Function
Decreased body fluid %
Medication Use
Presence of concomitant conditions
Fluid Volume Deficit
Hypovolemia
Fluid Volume Excess
Hypervolemia
Nursing Dx for fluid imbalances
Fluid balance, readiness for enhanced
Fluid Volume deficit
Fluid volume excess
Fluid volume risk for
Fluid volume risk for imbalance
Loss of extracellular fluid exceeds intake ratio of water
Fluid Volume Deficit
Electrolytes lost in the same proportion as they exist in normal body fluids
Loss of water along with increased sodium levels
Dehydration
Causes of Fluid Volume Deficit
Fluid loss from: vomiting, diarrhea, GI suctioning, sweating, decreased intake, inability to gain access to fluid
Risk Factors of fluid Volume Deficit
DI
Osmotic Diuresis
Adrenal Insufficiency
Hemorrhage
Coma
3rd spacing shifts
Manifestations of FVD
Rapid weight loss, decreased skin turgor, oliguria, concentrated urine, postural HTN, rapid weak pulse, increased temperature, cool clammy skin, thirst, nausea, muscle weakness, cramps
Elevated BUN and HCT in
FVD
Serum Electrolyte may change
Medical Management of FVD
Oral fluids
IV solutions
FVD nursing management
I and O
Daily weight
Monitor S/S- skin and tongue turgor, mucosa, urine output, mental status
Measures to minimize fluid loss
Oral care
Administration of parenteral fluids
FVE
Due to overload or diminished homeostatic mechanisms
Risk Factors
Heart failure, renal failure, cirrhosis of liver
Contributing factors for FVE
Excessive dietary sodium or sodium containing iv solutions
Manifestations of FVE
Edema, distended neck veins, abnormal lung sounds, tachycardia, increased BP, pulse pressure, increased weight, increased urine output, SOB and wheezing
Medical Management of FVE
Directed at cause, restriction of fluids and sodium, administration of diuretics
FVE Nursing management
I&O and daily weights, Assess lung sounds, edema, other symptoms
Monitor responses to medications- Diuretics
Promote adherence to fluid restrictions, pt teaching related to sodium and fluid restrictions
Monitor, avoid sources of excessive sodium, including medications
Promote rest
Semi fowlers for orthopnea
Skin care: positioning and turning
General Characteristics of diuretics
Act on kidneys to decrease reabsorption of sodium, chloride, water, other substances
Major Subclasses
Thiazide Diuretics
Thiazide -Like
Loop Diuretics
Potassium Sparing Diuretics
Osmotic Diuretics
Combination Drugs
Hydrochlorothiazide
Not strong and only works if UOP adequate
Decrease reabsorption of sodium, water, chloride, and bicarbonate in DCT
Use: mild and moderate HTN and Edema
Renal pt helpful with edema but decreases GFR
Thiazide Diuretics
Adverse effects of thiazide diuretics
Hypotension, weak, dizzy, diarrhea, constipation, lyte imbalance, hyperglycemia
Example drugs :Chlorothiazide, chlorthalidone, indapamide, metolazone
Loop diuretics
Furosemide
Diuretic of choice when rapid effects needed and renal function impaired
Action of loops
Inhibit sodium and chloride reabsorption in the ascending loop of henle, where most sodium is reabsorbed
Use of loops
HTN, Pulmonary edema, HF, hepatic, renal disease
Adverse effects of Loops diuretics
Lyte/ fluid imbalance, ototoxicity, hypotension
Bumetanide, ethacrynic, torsemide
Potassium sparing diuretics
Spironolactone
Mild diuretic
Acts on the DCT decreases sodium reabsorption and potassium excretion
Blocks the effects of aldosterone in renal tubules
Use of potassium sparing diuretics
HF, Ascites, HTN, hyperaldosteronism
Adverse effects of Potassium Diuretics
Dizzy, h/a, ABD cramps, diarrhea, deep voice, gynecomastia, mensural changes, testicular atrophy, not for severe renal impairment
Ex: amiloride, triamterene
Osmotic Diuretics
Mannitol
Combination Products
Aldactizide
Dyazide, maxide
Maxide
Modiuretic
Principle of therapy of diuretics
Drug selection and dosing depend on pt condition
Loop is preferred when rapid diuretic effect is necessary with renal impairment
Potassium sparing used concurrently to prevent hypokalemia
Prevention and management of Potassium Imbalances
Hypokalemia is cardiotoxic
Low dosing of diuretics
Use supplemental potassium along with potassium losing medications
Increase intake potassium intake
Restrict sodium intake
Causes of hyponatremia
Adrenal insufficiency, water intoxication, SIADH or losses of vomiting, diarrhea, sweating, diuretics, excessive water drinking
Manifestations Hyponatremia
Poor skin turgor, dry mucosa, headache, decreased salivation, decreased blood pressure, nausea, abd. cramping, neuro changes due to brain swelling
Medical management of hyponatremia
Water restriction, sodium replacement
Nursing Management Hyponatremia
Assessment and prevention, dietary sodium and fluid intake, identify and monitor at risk patients , effects of medication
Causes of Hypernatremia
Excess water loss, dehydration, excess sodium administration, DI, heat stroke, Hypertonic IV solutions
Manifestations of Hypernatremia
Thirst
Elevated temperature
Dry swollen tongue
sticky mucosa
Neuro symptoms
Restlessness
Weakness
Medical management of hypernatremia
Hypotonic electrolyte solution and D5W
Nursing management of hypernatremia
Assessment and prevention, assess for otc sources of sodium, offer and encourage fluids to meet patient needs, provide sufficient water with tube feedings
Trousseaus Sign
Carpopedal spasm that results from ischemia such as pressure induced by blood pressure cuff
Can be caused by hyperventilation
Chovesteks Sign
Described as twitching of facial muscles in response to tapping over facial nerve
Nerve excitability
Hypocalcemia
Serum levels in conjunction with albumin
Causes of hypocalcemia
Hypoparathyroidism
Malabsorption
Vitamin D deficiency
Pacreatitis
Massive transfusion of citrated blood, renal failure, medications and others
Manifestations of hypocalcemia
Tetany, circumoral numbness, parathesis, hyperactive deep tendon reflexes, trousseaus signs, Chvostek’s sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety
Medical Management of hypocalcemia
IV of calcium gluconate
calcium and vitamin d supplements and diet
Nursing management of hypocalcemia
Assessment
Severe hypocalcemia is life threatening
Weight bearing exercises decrease bone calcium loss
Pt teaching related to diet and medications
Nursing related to Iv calcium administration
Each 1g of albumin will lower total calcium concentration by
0.8 mg/dl
Chovostek Sign
Found in respiratory alkalosis
Hyperventilation
Decrease in Ca by shifting to albumin
If you see a pt hyperventilating and you see this
Have pt rebreathe CO2 with nonrebreather mask
do not add supplemental o2
assess pt every 15 min
remove mask and teach purse lipped breathing
Hypercalcemia causes
Malignancy and hyperparathyroidism
Bone loss related to immobility
Manifestations of hypercalcemia
Muscle weakness, incoordination, anorexia, constipation, nausea and vomiting, abd. and bone pain, polyuria thirst, ecg changes, dysrhythemias
Medical management of Hypercalcemia
Treat underlying cause, fluids, furosemide, phosphates, calcitonin, biphosphantes
Nursing management of hypercalcemia
Assessment, hypercalcemic crisis has high mortality, encourage ambulation, fluids of 3 to 4, provide fluids containing sodium, fiber for constipation, ensure safety
Causes of hypomagnesmia
Alcholism, GI losses, parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood, contributing causes of DKA, sepsis, burns, hypothermia
Manifestations of hypomagnesemia
Neuromuscular irratibility, muscle weakness, tremors, athetoid movements, ecg changes and dysrhythemias, alterations in mood and LOC
Medical management: diet, oral mag., mag sulfate IV
Nursing management of hypomag
Assessment, ensure safety, pt teachingrelated to diet, medications, alcohol use, and nursing care related to IV magnesium sulfate
Hypomagnesium often accompanied by hypocalcemia
Need to monitor, treat potential hypocalcemia
Dysphasia common in magnesium depleted patients
True
Assess ability to swallow with water before administering food or meds
causes of hypermag
renal failure, DKA, excessive administration of mag
Manifestations of hypermag
Flushing, lowered BP, nausea, vomiting, hypoactive, DTR, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias
Medical management of hypermag
IV calcium gluconate, loops, IV NS or RL, hemodialysis
Nursing management of hypermag
Assessment
Do not administer meds with mag
Pt teaching regarding OTC meds with mag
Phosphates occur naturally in
foods
Phosphorus supports bones and teeth to develop and turn food into energy for the body to use
Most common cause is
CKD
Not associated with classic symptoms
Underlying causes of hyperphosphatemia
Kidney disease
Uncontrolled diabetes
DKA
Hypoparathyroidism
Hypocalcemia
Hypophosphatemia causes include
Malnutrition
DKA
Severe alcoholism
Severe burns
Symptoms- very low levels
-muscle weakness, stupor, coma, death
Acute drop may result in dysrhythemias
Chronic low levels of hypophosphatemia causes
Hyperparathyroidism
Chronic diarrhea
Chronic use of diuretics
Large amounts of aluminum based antacids
Large amounts of theophylline
In mild chronic hypophosphatemia
bones can weaken and resulting in bone pain and fractures
People may become weak and lose their appetite
Name the 3 types of body fluids
Hypertonic
Hypotonic
Isotonic
Purpose of IV fluids
Maintenance
When oral intake is not adequate
Replacement
When losses have occurred
Serum OSM- 270-300
Hypotonic IV fluids
Replaces cellular fluid, provides free water for excretion of body wastes
More water than electrolytes
Water moves from ECF -ICF by osmosis into cells
0.45 NaCL, o.33 Nacl, 2.5 % dextrose, D5W
Hypotonic solutions
Expands only ECF, no net loss or gain from ICF
OSM250-275
Isotonic
O.9 Nacl, LRs
Isotonic solution
Intially expands and raises the osm of ECF- out of cells
Hypertonic solutions
Requires frequent monitoring of
- BP
-Lung sounds
- Serum sodium levels
5% dextrose in.45 NaCl, 5% dextrose in 0.9% NaCl, 5% dextrose in LR, 10% dextrose in water
Hypertonic Solutions
Kidneys regulate bicarb in the
ECF
Lungs regulate
Under control of medulla regulate CO2, carbonic acid in ECF
Symptoms include sudden increase of pulse, rr, and bp
Mental changes, feeling of fullness
Resp. Acidosis
Tx aimed improving ventilation
Resp. Acidosis
Rapid shallow respirations
Decreased BP
Skin pale
Headache
Cyanotic
Hyperkalemia
Dysrhythemias
Drowsiness, dizziness, disorientation
Muscle weakness
Causes Resp. depression
Overdose
Increased ICP
Airway obstruction
Resp. Alkalosis
Due to hyperventilation
Manifestations : Lightheadedness, inability to concentrate, numbness, tingling, loss of consciousness
Correct the cause of hyperventilation
S/S of Resp. Alkalosis
Seizures
Deep rapid breathing
Tachycardia
Hyperventilation
decrease Bp
hypokalemia
Lethargy and confusion
Nausea and vomiting
Metabolic Alkalosis
Most commonly due to vomiting or gastric suction
May also because of meds or diuretics
Hypokalemia will produce what?
Alkalosis
