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HURST > Fluid & Electrolyte / Acid & Base > Flashcards

Fluid & Electrolyte / Acid & Base Flashcards

1
Q

Causes of Fluid Volume Excess

A

Heart failure

  • CO down, kidney perfusion down, UOP down
  • no fluid can leave

Renal failure
- kidneys aren’t filtering out excess water

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2
Q

Three things w a lot of sodium

A

effervescent soluble meds
canned / processed foods
IVF w sodium

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3
Q

What two hormones regulate fluid volume?

A

ADH & aldosterone

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4
Q

Aldosterone

A
  • found in adrenal cortex
  • causes body to retain sodium & water
  • increases blood volume
  • it’s a steroid (mineralocorticoid)
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5
Q

Diseases w too much aldosterone

A

Cushing’s Dz

Hyperaldosteronism / Conn’s Dz

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6
Q

Diseases with too little aldosterone

A

Addison’s Dz

- lose sodium & water –> fluid volume deficit

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7
Q

Does ADH make you retain or diurese?

A

retain water ONLY

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8
Q

Too much ADH:

A

retain water
fluid volume excess
SIADH (too much water)

urine concentrated
blood dilute

too little sodium (dilute)

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9
Q

Not enough ADH

A

lose (diurese) water
fluid volume deficit
DI (#1 concern is shock)

urine diluted
blood concentrated

increased sodium

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10
Q

Urine specific gravity, sodium, and hematocrit numbers go ___ when its concentrated?

A

up

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11
Q

What are some causes of ADH problems?

A

craniotomy, head injury, sinus surgery, transsphenoidal hypophysectomy, increased ICP

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12
Q

Another name for ADH

A

vasopression (Pitressin)

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13
Q

What two drugs can be utilized as an ADH replacement in DI?

A

Vasopressin or desmopressin acetate

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14
Q

S/sx of FVE

A

distended neck veins / peripheral veins
— vessels are full

peripheral edema / third spacing
— vessels start to leak

Central Venous Pressure (CVP) increases

Crackles and wetness in lungs

Polyuria
— kidneys trying to get out excess fluid

Increased pulse
— bounding and full

Increased blood pressure

increased weight

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15
Q

Treatment for FVE

A

low sodium diet / restrict fluids

I&O / Daily weights

Diuretics
—-Loop (furosemide) (bumetanide may be given when furosemide doesn’t work)

—-hydrochlorothiazide

—- potassium-sparing (spiralactone)

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16
Q

CVP normal ranges

A

2-6 mmHg

5-10 cmH2O

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17
Q

CVP info

A

measured in right atrium
number increases in FVE
more volume = more pressure

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18
Q

ANP (Atrial natriuretic peptide)

A

released when walls of heart are stretched / makes you lose water & sodium

decreases ADH

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19
Q

bed rest induces

A

diuresis by releasing ANP which decreases ADH production

  • means you can easily become dehydrated, get DVTs, kidney stones, pneumonia, and constipation
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20
Q

Fluid Volume Deficit (hypovolemia) Causes:

A

Loss of fluid from anywhere (thoracentesis, paracentesis, V/D, hemorrhage)
Third spacing (burns, ascites)
Diseases with polyuria (Diabetes)

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21
Q

Ascites

A 
makes it harder to breathe
looks like FVE but is FVD since its third spacing
measure abdominal girth daily
worry hypotension
--- decreased HR (wt may be the same)
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22
Q

Polyuria

A

think shock first!
losing fluids
polyuria –> oliguria –> anuria –> worry about renal failure

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23
Q

S/sx of FVD

A

decreased weight
decreased skin turgor
dry mucous membranes
decreased urine output (kidneys aren’t being perfused or are trying to retain fluids)
decreased BP
increased pulse (weak and thready / compensation)
increased RR (body can’t tell difference b/t decreased volume and O2)
decreased CVP
Peripheral veins / neck veins vasoconstrict (hard to get IV)
cool extremities
increased urine specifiic gravity (very concentrated urine)

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24
Q

Treatment for FVD:

A 
prevent further losses
replace volume (oral or IV)
Safety precautions 
-- higher risk for falls (VS and mental changes)
-- monitor for overload w IV replacement
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25
Q

Isotonic

A

balanced solutions

  • goes into vascular space and stays there
  • NS, LR, D5W, D5(1/4)NS

-client that has lost fluids through nausea, vomiting, burns, sweating, and trauma

  • DO NOT use isotonic w HTN, cardiac or kidney dz
    • can cause FVE, HTN, or hypernatremia
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26
Q

Hypotonic

A

Goes into vascular space then shifts out into the cells to replace cellular fluid

  • rehydrate WITHOUT causing HTN
  • D2.5W, 1/2 NS, 0.33% NS
  • used for HTN, renal or cardiac dz, or dilution w hypernatremia and cellular dehydration
    • nausea, vomiting, burns, hemorrhage

WATCH FOR cellular edema bc fluid is moving out to the cells which could lead to fluid volume deficit and decreased BP

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27
Q

Hypertonic

A

HIGH ALERT / packed w particles

  • volume expanders that will draw fluid into the vascular space from the cells
  • –hypertonic solution returns fluid to vasculature
  • D10W, 3% NS, 5%NS, D5LR, D5(1/2)NS, D5N5, TPN, Albumin, Mag.Sulfate
  • used w hyponatremia, third spacing (severe), severe edema, burns, ascites
  • WATCH FOR FVE!!
  • Monitor in ICU setting w frequent BP, pulse, CVP esp w NS 3 or 5%
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28
Q

Isotonic v. Hypotonic v. Hypertonic

A

Isotonic - stay where I put it

Hypotonic - go Out of the vessel

Hypertonic - Enter the vessel

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29
Q

Magnesium

A

1.3 - 2.1 mEq/L

excreted by kidneys or lost in GI tract (vomiting/ severe diarrhea)

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30
Q

Hypermagnesemia Causes

A

Renal failure

Antacids

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31
Q

Hypermagnesemia S/sx

A

flushing and warmth
vasodilation

hypermagnesemia and hypercalcemia s/sx:

    • decreased DTRs
    • weak / flaccid muscles
    • increased arrhythmias
    • decreased LOC
    • decreased pulse
    • decreased RR
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32
Q

Hypermagnesemia Treatment

A

ventilator (if RR less than 12)
dialysis
clacium gluconate (ANTIDOTE** for mag toxicity) (reverses resp. depression)
safety precautions

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33
Q

Calcium

A

9.0 - 10.5 mg/dL

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34
Q

Hypercalcemia Causes:

A

Hyperparathyroidism
Thiazides
Immobilization

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35
Q

Hyperparathyroidism

A

can cause hypercalcemia

  • too much PTH
  • when serum calcium gets low, PTH pulls Ca from the bones to put in the blood
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36
Q

Hypercalcemia S/sx:

A

bones are brittle / weak
kidney stones

Same as hypermagnesemia

    • decreased DTRs
    • weak / flaccid muscles
    • increased arrhythmias
    • decreased LOC
    • decreased pulse
    • decreased RR
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37
Q

Hypercalcemia Treatment

A 
activity
fluids prevent kidney stones
phosphurous in diet (inverse relationship w ca)
steroids (decrease ca)
safety precautions

Meds that decrease serum Ca:

    • Biphosphates (etidronate)
    • Calcitonin
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38
Q

Calcitonin

A

treats hypercalcemia and osteoporosis?

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39
Q

Hypomagnesemia Causes

A

diarrhea

alcoholism (alcohol suppresses ADH / hypertonic)

not eating / drinking

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40
Q

Hypomagnesemia S/sx

A
  • rigid / tight muscle tone
  • seizures
  • stridor / laryyngospasm
  • +Chvostek’s
  • +Trousseau’s
  • arrhythmias
  • DTRs increased
  • mental changes
  • dysphagia
41
Q

Hypomagnesemia Treatment

A
  • give / eat Mg
  • check kidney function (before and during)
  • seizure precautions
42
Q

Foods high in magnesium

A

spinach, mustard greens, summer squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, celery, kale, sunflower seeds, sesame seeds, flax seeds

43
Q

Causes of Hypocalcemia

A

hypoparathyroidism
radical neck
thyroidectomy

** not enough PTH which decreases serum Ca

44
Q

Hypocalcemia S/sx:

A
  • rigid / tight muscle tone
  • seizures
  • stridor / laryyngospasm
  • +Chvostek’s
  • +Trousseau’s
  • arrhythmias
  • DTRs increased
  • mental changes
  • dysphagia
45
Q

Hypocalcemia Treatment

A

PO calcium
IV calcium (give slowly or heart arrythmia) (heart monitor)
Vitamin D
Phosphate binders (inverse relationship so decreasing phosphate will increase Ca)
– sevelamer hydrochloride
– calcium acetate

46
Q

Sodium

A

Think Neuro Changes!!

Sodium is dependent on water levels

135-145 mEq/L

47
Q

Hypernatremia vs. Hyponatremia

A

hyper = dehydration

hypo = dilution

48
Q

Hypernatremia Causes:

A

hyperventilation

heat stroke

DI

49
Q

Hypernatremia S/sx

A

dry mouth
thirst
swollen tongue
neurochanges

50
Q

Hypernatremia Treatment

A 
restrict sodium
dilute w fluids
daily weights
I&Os
Lab Work
51
Q

Hyponatremia Causes

A

Drinking H2O for fluid replacement
psychogenic polydipsia
D5W
SIADH

52
Q

Hyponatremia S/sx

A

headache
seizure
coma

53
Q

Hyponatremia Treatment

A

client needs sodium / not a lot of water

neuro problems = they need to be on hypertonic saline

54
Q

3% or 5% NS can cause…?

A

cerebral edema

55
Q

Potassium

A

excreted by kidneys (poor kidney function = increased potassium)

3.5-5.0 mEq/L

56
Q

Hyperkalemia Causes:

A

kidney trouble

spironolactone

57
Q

Hyperkalemia S/sx

A

begins w muscle TWITCHING
then proceeds to muscle WEAKNESS
then FLACCID PARALYSIS

–> life-threatening arrhythmias

58
Q

ECG changes w hyperkalemia

A 
bradycardia
tall and peaked T waves
prolonged PR intervals
flat or absent P waves
widened QRS
conduction blocks
ventricular fibrillation
59
Q

Hyperkalemia Treatment

A

dialysis (kidneys aren’t working)
calcium gluconate (decreases arrhythmias)
Glucose and insulin
Sodium polystyrene sulfonate (Kayexalate) (enema)

60
Q

Potassium has an inverse relationship with …?

A

sodium

61
Q

Any time you give IV insulin, worry about _________ and _________.

A

hypokalemia and hypoglycemia

62
Q

Hypokalemia Causes

A

vomitting
NG suction
diuretics (other than spiralactone)
not eating

63
Q

Hypokalemia S/sx

A

muscle crmaps

muscle weakeness –> flaccid paralysis –> life-threatening arrhythmias

64
Q

Hypokalemia Treatment

A

Give potassium
spironolactone makes client retain potassium
eat more potassium

65
Q

ECG Changes with hypokalemia

A

U waves, PVCs, ventricular tachycardia

66
Q

How to fix GI upset with oral potassium

A

give w food

67
Q

What do we need to assess with IV potassium

A

Urinary output before and during

68
Q

IV potassium always needs to be on

A

a pump! never gravity

69
Q

Foods high in potassium

A

spinach, fennel, kale, mustard greens, brussel sprouts, broccoli, eggplant, cantaloupe, tomatoes, parsley, cucumber, bell pepper, apricots, ginger root, strawberries, avocado, banana, tuna, halibut, cauliflower, kiwi, oranges, lima beans, potatoes, cabbage

70
Q

Normal pH range

A

7.35 - 7.45

71
Q

acidotic person

A

lethargic

72
Q

alkalotic person

A

excitable

CNS is stimulated / sensitive

73
Q

Hyperventilation

A

more CO2 getting out

74
Q

hypoventilation

A

not eliminating CO2

75
Q

Respiratory Acidosis

A

**ACUTE
Lungs have problem so kidneys compensate!

-CO2 is the problem. Too MUCH.

Caused by HYPOventilation.

Kidneys compensate with bicarb and hydrogen. It’ll excrete hydrogen and retain bicarb.

76
Q

PaO2

A

80-100 mmHg

77
Q

PaCO2

A

35-45 mmHg

78
Q

HCO3

A

Bicarb

22-26 mEq/L

79
Q

increased CO2 means?

A

decreased LOC

80
Q

increased CO2 means?

A

decreased O2 (inverse relationship)

81
Q

Causes of resp acidosis

A

retain CO2

  • mid-abdominal incision, narcotics, sleeping pills, pneumothorax, collapsed lung, pneumonia
  • anything that decreases RR or gas exchange
  • anything that causes HYPOventilation (decreased RR)
82
Q

Restlessness thing _____ first!

A

hypoxia

early signs of hypoxia are tachycardia and restlessness

83
Q

S/sx of resp acidosis

A

headache / confusion / sleepy / coma

Hypoxic (give oxygen)

84
Q

Resp acidosis treatment

A

fix the breathing problem!

  • if pneumonia is cause… liqueefy and mobilize secretions
    • percusion, deep breathing, suctioning, fluids, elevate HOB, IS
  • pneumothorax = chest tubes
  • post -op = turn, cough, deep breathe
85
Q

respiratory alkalosis

A

too little CO2 = HYPERventilation

Kidneys will excrete bicarb and retain hydrogen

86
Q

Causes of resp alkalosis

A

hyperventilation

= hysterical (client breathing too fast)

= acute aspirin OD (client breathing too fast)

87
Q

S/sx of resp alkalosis

A

lightheaded or faint feeling

peri-oral numbness

numbless and tingling in fingers & toes

88
Q

Treatment for resp alkalosis

A

may have to sedate to decrease RR
treat the cause
monitor ABGs

89
Q

Metabolic Acidosis

A

lungs compensate with CO2 by increased RR to blow off acid (hyperventilate)

too little bicarb and too much hydrogen

90
Q

Causes of metabolic acidosis

A

DKA
Starvation
Renal Failure
Severe diarrhea

*DKA and starvation due to breakdown of ketones

91
Q

S/sx of metabolic acidosis

A

depend on cause

hyperkalemia (muscle twitching, muscle weakness, flaccid paralysis, arrhythmias)

increased RR (Kussmaul respirations for DKA)

92
Q

Treatment for metabolic acidosis

A

Treat problem

93
Q

Causes of Metabolic Alkalosis

A

loss of upper GI contents (vomiting, NG suctioning)

too many antacids

94
Q

Upper GI tract think _____

Lower GI tract think _____

A 
upper = acid
lower = base
95
Q

S/sx of Metabolic Alkalosis

A

depends on cause

observe LOC

serum potassium will decrease

monitor for mucle cramps and life threatening arrhythmias (Hypokalemia)

96
Q

serum potassium will ______ in metabolic acidosis and _________ in metabolic alkalosis

A

increase

decrease

97
Q

Treatment for metabolic alkalosis

A

fix problem

replace potassium

98
Q

Phosphate binders

A

(inverse relationship so decreasing phosphate will increase Ca)

    • sevelamer hydrochloride
    • calcium acetate

HURST (15 decks)

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