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Fundamentals > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Isotonic dehydration

A

Water and electrolytes are lost in equal proportions.

Leads to decreased blood volume and tissue perfusion.

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2
Q

Hypertonic dehydration

A

Water loss exceeds electrolyte loss
Fluid moves from the intracellular space into the plasma and interstitial fluid causing cellular dehydration and shrinkage.

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3
Q

Hypotonic dehydration

A

Electrolyte loss exceeds water loss.
Fluid moves from the interstitial space and plasma into the intracellular space causing plasma fluid deficit and swelling in the cells.

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4
Q

Causes of isotonic dehydration

A
  • Inadequate intake of fluids and solutes
  • Fluid shifts between compartments
  • Excessive losses of isotonic body fluids
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5
Q

Causes of hypertonic dehydration

A

Increase fluid loss:

  • Excessive perspiration
  • Hyperventilation
  • Ketoacidosis
  • Prolonged fevers
  • Diarrhea
  • Early stage kidney disease
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6
Q

Causes of hypotonic dehydration

A
  • Chronic illness
  • Excessive hypotonic fluid replacement
  • Kidney disease
  • Chronic malnutrition
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7
Q

Assessment of fluid volume deficit

A
  • Thready fast pulse, diminished peripheral pulses
  • Dysrhythmias
  • Increased rate and depth of respirations
  • Diminished CNS: lethargy to coma
  • Decreased urine output
  • Poor turgor, dry skin and mouth
  • Decreased motility and BS, constipation
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8
Q

Hypovolemia laboratory findings

A
  • Increased serum osmolarity
  • Increased hematoma
  • Increased blood urea nitrogen (BUN)
  • Increased serum sodium
  • Increased urinary specific gravity
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9
Q

Hypovolemia interventions

A
  • Monitor patient assessment
  • Prevent further fluid loss
  • Provide oral hydration of possible, IV replacement if severe
  • Monitor intake and output
  • Depending on cause administer antidiarrheal, antimicrobial, antiemetic or antipyretic
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10
Q

Causes Isotonic hypervolemia

A
  • Inadequately controlled IV therapy
  • Kidney disease
  • Long term corticosteroid therapy
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11
Q

Causes of hypertonic hypervolemia

A
  • Excessive sodium ingestion
  • Rapid infusion or hypertonic saline
  • Excessive sodium bicarbonate therapy
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12
Q

Causes of hypotonic hypervolemia

A
  • Early kidney disease
  • Heart failure
  • Syndrome of inappropriate antidiuretic hormone secretion
  • Inadequately controlled IV therapy
  • Replacement of isotonic fluid loss with hypotonic fluids
  • Irrigation of wounds and body cavities with hypotonic fluids
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13
Q

Assessment of hypervolemia

A
  • Bounding increased bounding pulse and hypertension
  • Distention of veins, elevated CVP, dysrhythmias
  • Increased RR, dyspnea, crackles on auscultation
  • Altered level of consciousness
  • Headache, visual disturbance, muscle weakness, paresthesia
  • Increased urine output if kidneys can compensate
  • Pitting edema
  • Increased motility and BS diarrhea , liver enlargement, ascites
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14
Q

Hypervolemia laboratory findings

A
  • Decreased serum osmolarity
  • Decreased hematocrit
    Decreased BUN level
  • Decreased serum sodium level
  • Decreased urine specific gravity
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15
Q

Hypervolemia interventions

A
  • Monitor assessment
  • Prevent further overload and restore balance
  • Administer diuretics, osmotic diuretics may be prescribed to prevent sever electrolyte imbalances
  • Restrict fluid and sodium intake
  • Monitor intake and output + weight
  • Monitor electrolyte values
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16
Q

Normal Serum Potassium levels

A

3.5-5.0 mEq/L (mmol/L)

17
Q

Causes of body potassium loss

A
  • Medications such as diuretics (loop/thiazide), corticosteroids, bronchodilators
  • Increased aldosterone (cushings)
  • Vomiting, diarrhea, excessive diaphoresis
  • GI wound drainage
  • Prolonged NG succion
  • Kidney disease
18
Q

Causes of hypokalemia

A
  • Actual body K+ loss
  • Inadequate potassium intake (NPO)
  • Movement from extra to intracellular space (alkalosis, hyperinsulinism)
  • Dilution or serum K+ (water intoxication, IV therapy)
19
Q

Assessment of a patient with hypokalemia

A
  • Thready weak irregular pulse and orthostatic hypotension
  • Shallow ineffective breathing with diminished breath sounds
  • Anxiety, lethargy, confusion, coma
  • Skeletal muscle weakness , legs cramps
  • Loss of tactile discrimination, paresthesia, deep tendon hyporeflexia
  • Decreased motility, hypoactive bowel sounds
  • Nausea, vomiting, constipation, abdo distention
  • Paralytic ileus
20
Q

ECG for hypokalemia

A
  • ST depression
  • Shallow flat or inverted T wave
  • Prominent U wave
21
Q

Interventions of hypokalemia

A
  • Monitor assessment + electrolytes
  • PO K+: causes N/V not to be taken on an empty stomach, if vomiting give IV
  • DC meds, prescribe K+ retaining diuretics
  • Educate about foods high in K+
22
Q

Precautions of IV K+

A
  • Never give push, never give more than 20 mEq/H (average 5-10 mmol/h)
  • More than 10 mEq/h should be on a cardiac monitor
  • Infusions can cause phlebitis or infiltration
23
Q

Causes of hyperkalemia

A
  • Excessive K+ intake
  • Decreased K+ excretion (Spironolactone, Addison’s (increased aldosterone), kidney disease)
  • Movement of K+ from intra et extracellular space
24
Q

Assessment of a patient with hyperkalemia

A
  • Slow, weak, irregular irregular hear rate, decreased blood pressure
  • Respiratory failure (muscle weakness)
  • Early: muscle twitches, paresthesia, cramps, numbness
    Late: pronounced weakness, paralysis in arms and legs,
  • Increased motility, hyperactive bowel sounds, diarrhea
25
Q

ECG for hyperkalemia

A
  • Tall peaked T waves
  • Flat P waves
  • Widened QRS complexes
  • Prolonged PR interval
26
Q

Interventions hyperkalemia

A
  • Monitor assessment and electrolyte values
  • Initiate a K+ restricted diet
  • K+ excreting diuretics if good kidney function
  • If bad renal function give Kayexelate (eliminates in stool)
  • Dialysis if critically high
  • IV calcium to avoid myocardial excitability
  • If blood transfusions use fresh blood, cell decay releases K+
27
Q

Normal serum sodium levels

A

135 - 145 mEq/L (mmol/L)

28
Q

Normal calcium values

A

9.0 - 10.5 mg/dL (2.25 - 2.75 mmol/L)

29
Q

Normal magnesium values

A

1.3 - 2.1 mEq/L (0.65 - 1.05 mmol/L)

30
Q

Normal phosphate values

A

3.0 - 4.5 mg/dL (0.97 - 1.45 mmol/L)

31
Q

Hypocalcemia ECG changes

A
  • Prolonged ST segment

- Prolonged QT interval

32
Q

Hypercalcemia ECG changes

A
  • Shortened ST segments

- Widened T waves

33
Q

Hypomagnesemia ECG changes

A
  • Tall T waves

- Depressed ST segment

34
Q

Hypermagnesemia ECG changes

A
  • Prolonged PR interval

- Widened QRS complexes

35
Q

Causes of Hyponatremia

A
  • Increased sodium excretion (sweating, diuretics, vomiting, diarrhea wound drainage, kidney disease, low aldosterone)
  • Inadequate sodium intake
  • Dilution of serum sodium (heart failure, fresh water drowning, syndrome of ADH secretion)
36
Q

Causes of Hypernatremia

A
  • Decreased sodium excretion: corticosteroids, cushings, kidney, hyperaldosteronism
  • Increased sodium intake
  • Decreased water intake
  • Increased water loss: increased metabolic rate, fever, hyperventilation, diabetes insipidus

Fundamentals (18 decks)

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