f & e Flashcards
1
Q
hypervolemia is
A
fluid volume excess
2
Q
hypovolemia is
A
fluid volume deficit
3
Q
fluid volume excess: definition
A
too much fluid in the vascular space
4
Q
how does heart failure lead to fluid volume excess?
A
heart is WEAK cardiac output DECREASES kidney perfusion DECREASES urine output DECREASES volume stays in VASCULAR SPACE
5
Q
3 meds that can lead to fluid volume excess and why
A
alka-seltzer
fleet’s enema
IVF with Na
all 3 have a lot of Na
6
Q
hormones that regulate fluid volume
A
aldosterone
atrial natriuretic peptide
anti-diuretic hormone
7
Q
aldosterone: what and where
A
steroid (mineralocorticoid) made by the adrenal glands
8
Q
aldosterone: normal action
A
in response to LOW blood volume (d/t vomiting, hemorrhage, etc) –>aldosterone secretion increases
- -> Na + H2O retained
- -> blood volume goes up
9
Q
diseases with too much aldosterone x2
A
Cushing’s Syndrome (too much of all electrolytes)
hyperaldosteronism aka Conn’s Syndrome
10
Q
disease with too little aldosterone
A
Addison’s Syndrome
lose Na + H2O = fluid volume deficit
11
Q
atrial natriuretic peptide: where & action
A
secreted by atria (in response to stretch due to increased volume)
causes excretion of Na and H2O
12
Q
opposite action from aldosterone
A
atrial natriuretic peptide –>
13
Q
anti-diuretic hormone: where and action
A
secreted by pituitary gland
causes retention of H2O (and therefore Na)
14
Q
too much ADH / not enough ADH: diseases x2
A
too much ADH: SIADH
not enough ADH: diabetes insipidus
15
Q
siadh
A
syndrome of inappropriate anti-diuretic hormone
TOO MANY LETTERS TOO MUCH H2O
retain H2O –> fluid volume excess
blood: dilute
urine: concentrated
16
Q
diabetes insipidus
A
DI = DIuresis
lose (diurese) H2O –> fluid volume deficit
blood: concentrated
urine: dilute
THINK: SHOCK
17
Q
see diabetes insipidus, think…
A
DIuresis
shock!
18
Q
key words to make you think potential ADH problem
A
craniotomy, head injury, sinus injury, transphenoidal hypophysectomy, any condition leading to ICP
19
Q
other names for ADH
A
vasopressin
DDAVP
- may be utilized as ADH replacement in DI -
20
Q
hypervolemia s/s: vessels full therefore…
A
distended neck and peripheral veins
leak –> peripheral edema, third spacing
21
Q
hypervolemia s/s: CVP…
A
increased
MORE VOLUME MORE PRESSURE
22
Q
hypervolemia s/s: lung sounds
A
wet
- down low, listen posteriorly at bases
23
Q
hypervolemia s/s: polyuria
A
kidneys trying to help you diurese
24
Q
hypervolemia s/s: pulse
A
full and bounding
25
hypervolemia s/s: BP
increases
MORE VOLUME MORE PRESSURE
26
hypervolemia s/s: weight
increases
fluid not fat
27
fluid retention think...
heart problems first!
28
hypervolemia: treatments x5
- low Na diet
- restrict fluids
- daily i/o and weights
- diuretics
- bed rest
29
with all diuretics watch...
lab work - potential dehydration and electrolyte problems
30
how does bedrest induce diuresis?
through the release of ANP and decreased production of ADH
| - fluid returns to core, heart stretches, ANP produced and pituitary signaled to decrease ADH production
31
why give IVF slowly to the elderly?
this age group goes into fluid volume excess easier
32
why are IVF given during bedrest?
prevent DVT, PE, pneumonia
33
major fluid deficit results in
shock
34
hypovolemia: causes + why
loss of fluids
- thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage
third spacing
- burns, ascites
diseases with polyuria
- polyuria becomes oliguria becomes anuria
35
hypovolemia s/s: weight
decreases
36
hypovolemia s/s: skin turgor
decreased
37
hypovolemia s/s: mucus membranes
dry
38
hypovolemia s/s: urine output + why
decreased
| - kidneys aren't being perfused or are trying to retain fluid to compensate
39
hypovolemia s/s: BP
decreased
LESS VOLUME, LESS PRESSURE
40
hypovolemia s/s: pulse
increased and weak and thready - heart is trying to pump what little fluid is left
41
hypovolemia s/s: respirations + why
increased because body perceives decrease in circulating blood volume as hypoxia
42
hypovolemia s/s: CVP
decreased
LESS VOLUME, LESS PRESSURE
43
hypovolemia s/s: peripheral/neck veins
vasoconstrict, very tiny!
44
hypovolemia s/s: extremities + why
cool d/t peripheral vasoconstriction in an effort to shunt blood to vital organs
45
hypovolemia s/s: urine specific gravity
increased - very concentrated
46
hypovolemia treatment x3
prevent further losses
replace volume
safety precautions
47
how do you replace volume with mild hypovolemia?
PO
48
how do you replace volume with severe hypovolemia?
IVF
49
what safety precautions should be taken for hypovolemic patient? x2
fall risk: r/t changes in vitals and mental staus
| monitor for fluid overload
50
isotonic solutions: action
goes into vascular space and stays there
51
isotonic solutions: examples
NS, LR, D5W, D5 1/4 NS
52
isotonic solutions: uses x2
for client that needs blood volume
- fluids lost via n/v, burns, sweating, trauma
also, NS is basic solution when administering blood
53
isotonic solutions: in excess can cause x3
fluid volume excess, hypertension, hypernatremia
54
never give isotonic solutions to x3
patients with hypertension, renal disease, cardiac disease
55
hypernatremia is an alert only when administering isotonic solutions...
that contain sodium
56
hypotonic solutions: action
go into vascular space, hang out, shift out into the cells to replace cellular fluids
rehydrate but do not cause hypertension
57
hypotonic solutions: examples
D 2.5 W, 1/2 NS (0.45%), 0.33% NS
58
hypotonic solutions: uses x3
for client who has hypertension, renal, or cardiac disease and needs fluid replacement because of nausea, vomiting, burns, hemorrhage, etc.
also used for dilution when client has hypernatremia and for cellular dehydration
59
hypotonic solutions: alert
watch for cellular edema because this fluid is moving out to the cells which could lead to fluid volume deficit and decrease blood pressure (when used to the extreme)
60
hypertonic solutions: action
packed with particles! volume expanders that draw fluid into the vascular space from the cell
61
hypertonic solutions: examples
D10W, 3% NS, 5% NS, D5LR, D5 1/2NS, D5 NS, TPN, albumin
62
hypertonic solutions: uses
client with hyponatremia or
| who has shifted large amounts of vascular volume due to a third space, severe edema, burns, ascites
63
hypertonic solutions: alert
watch for fluid volume excess
monitor in an ICU setting: hourly BP, HR, CVP -- ESPECIALLY for 3% or 5% NS (Na = worry about rapid shifts of fluid)
64
magnesium is excreted by
the kidneys, but can be lost other ways (such as via GI tract)
65
Mg and Ca act like
sedatives
66
see Mg and Ca think...
muscles first!
67
hypermagnesemia: causes x2
renal failures
| antacids (in ESRD)
68
hypermagnesemia: s/s
flushing
warmth
vasodilation (decreased BP)
69
hypermagnesemia, hypercalcemia: s/s in common
decreased: DTR, LOC, HR, RR
arrhythmias
weak, flaccid muscle tone
70
hyper Mg or Ca s/s: DTR
decreased
71
hyper Mg or Ca s/s: LOC
decreased
72
hyper Mg or Ca s/s: HR
decreased
73
hyper Mg or Ca s/s: RR
decreased
74
hyper Mg or Ca s/s: heart & muscle
arrhythmias
| weak, flaccid muscle tone
75
hypermagnesemia: treatment & why x4
ventilator
- Mg toxic, RR less than 12
dialysis
- kidney excretion
calcium gluconate
- reverses decreased RR and potential arrhythmias
safety precautions
76
Ca, phosphate relationship
inverse!
77
hypercalcemia: causes x3
hyperparathyroidism
thiazides
immobilization
78
PTH and calcium relationship
serum Ca low
PTH secreted and moves Ca from bones into the blood
serum Ca increases
79
how do thiazides cause hypercalcemia?
retention of Ca+
80
how does immobilization cause hypercalcemia?
weight-bearing necessary to keep Ca in bones
81
hypercalcemia: s/s x2
brittle bones, kidney stones
82
hypercalcemia: treatment
- BOOM BOOM
- fluids
- sodium phosphate enema
- steroids
- add phosphorus to diet
- vitamin D
- calcitonin
83
hypercalcemia treatment: fluids purpose
prevent kidney stones
84
hypercalcemia treatment: sodium phosphate enema purpose
Ca and P have an inverse relationship
increase P, Ca goes down!
85
hypercalcemia treatment: steroids purpose
decrease serum Ca
86
hypercalcemia treatment: calcitonin purpose
decreases serum Ca by returning it to the bones
| - typically given for osteoporosis
87
hypercalcemia treatment: why safety precautions?
think: SEDATION!
88
hypomagnesemia: causes
diarrhea (lots of Mg in intestines)
alcoholism
- alcohol suppresses ADH & it's hypertonic
89
hypomagnesemia and hypocalcemia s/s
- rigid, tight muscle tone
- seizures
- stridor/laryngospasm
- positive chvostek's
- positive trousseau's
- arrhythmias
- increased DTRs
- AMS (anything)
- dysphagia
90
hypomagnesemia and hypocalcemia s/s: muscle tone
rigid, tight
91
hypomagnesemia and hypocalcemia s/s: stridor and laryngospasms why
smooth muscle
not enough sedative!
92
hypomagnesemia and hypocalcemia s/s: arrhythmias why
heart muscle - not enough sedative
93
hypomagnesemia and hypocalcemia s/s: dysphagia why
smooth muscle
not enough sedative!
94
chvostek's sign
tap cheek = twitch
| sign of hypomagnesemia or hypocalcemia
95
trousseau's sign
inflate BP cuff = arm jerks
| sign of hypomagnesemia or hypocalcemia
96
hypomagnesemia: treatment
- give Mg
- check kidney function before and after IV Mg (excretion of Mg!)
- seizure precautions
- diet
97
what do you do if client reports flushing and sweating when IV Mag started?
STOP INFUSION!!
98
magnesium effect on vessels
vasodilation
99
hypocalcemia: causes
hypoparathyroidism
radial neck
thyroidectomy
100
not enough PTH =
reduced serum Ca
101
hypocalcemia: treatment
- vitamin D
- phosphate binders
- IV Ca
102
nursing considerations for administration of IV Ca
- give slowly
| - telemetry
103
hypocalcemia treatment: why Vitamin D
needed to utilize Ca
104
hypocalcemia treatment: why phosphate binders
because of inverse relationship between Ca and P
| - bind PO4 = increase in Ca
105
sodium think...
neurological changes
106
Na level in blood is totally dependent on
how much water you have in your body.
107
hypernatremia
= dehydration; too much Na, not enough H2O
108
hypernatremia: causes x4
hyperventilation
heat stroke
diabetes insipidus
vomiting, diarrhea, etc
109
hypernatremia: s/s x3
dry mouth
thirst
swollen tongue
110
significance of thirst and hypernatremia
you are already dehydrated by the time you are thirsty
111
swollen tongue
sign that is very specific to hypernatremia
112
hypernatremia: treatment
- restrict Na
- dilute client with fluids (DILUTION MAKES #s GO DOWN)
- daily weight
- i/o
- lab work
113
if you've got an Na problem...
you've got a fluid volume problem
114
feeding tube clients to get ? + how to fix?
dehydrated; offset with free water
115
hyponatremia
dilution; too much H2O, not enough Na
116
hyponatremia: causes x4
- drinking H2O for fluid replacement
- psychogenic polydipsia
- D5W
- SIADH
117
hyponatremia: s/s x3
- headache
- seizure
- coma
118
hyponatremia: treatment
CLIENT NEEDS Na CLIENT DOESN'T NEED H2O
neuro problems? need hypertonic saline
- 3% or 5% NS
119
note about saline infusion for hyponatremia
pulling water in vascular space rapidly = beware fluid volume excess
- ICU to monitor HR, BP, CVP
brain cannot handle rapid shifts of volume quickly
120
potassium is excreted by
kidneys
| therefore if kidneys are not working well, serum K goes up
121
hyperkalemia: causes
kidney issues
| spironolactone
122
hyperkalemia: s/s
in this order:
muscle twitching
weakness
flaccid paralysis
also, life-threatening arrhythmias
123
hyperkalemia: treatment
- dialysis
- calcium gluconate
- glucose and insulin
- Kayexalate
124
hyperkalemia treatment: why dialysis
kidneys aren't functioning
125
hyperkalemia treatment: why calcium gluconate
decreases arrhythmias
126
hyperkalemia treatment: why glucose and insulin
insulin carries GLUCOSE and POTASSIUM into the cell
127
any time you give IV insulin, worry about...
hypoglycemia and hypokalemia
128
Kayexalate
sodium poylystyrene sulfonate
- given for hyperkalemia
- exchanges Na for K in GI tract = VOLUMINOUS DIARRHEA!
129
hypokalemia: causes
- vomiting
- ng suction
- diuretics
- not eating
130
why does ng suction contribute to hypokalemia?
we have a lot of K in our stomachs
131
hypokalemia: s/s
- muscle cramps
- weakness
- life threatening arrhythmias
132
hypokalemia: treatment
- give potassium (CHECK KIDNEY FUNCTION!)
- spironolactone
- diet
133
if you give potassium for hypokalemia...
check kidney function!
134
sodium and potassium relationship
INVERSE!
135
major problem with PO K+?
GI upset, so give with food
136
assess what before/during IV K+
UOP
137
never give IV K+...
BOLUS. always administer ON A PUMP
138
hyperkalemia EKG changes
```
bradycardia
tall and peaked T waves
prolonged PR intervals
flat or absent P waves
widened QRS
conduction blocks
v fib
```
139
hypokalemia EKG changes
U waves
PVC
v tach
