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Pathopharm I > Fluid > Flashcards

Fluid Flashcards

1
Q

Intracellular fluid

A

70%

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2
Q

Extracellular fluid

A

30%

Interstitial fluid + intravascular fluid (plasma)

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3
Q

Normal sodium

A

136-145 mEq/L

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4
Q

Normal potassium

A

3.5-5.0 mEq/L

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5
Q

Normal magnesium

A

1.7-2.2 mg/dL

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6
Q

Normal calcium

A

9-11 mg/dL

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7
Q

Normal phosphate

A

3.2-4.3 mg/dL

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8
Q

Sodium

A 
Main ECF cation
Governs osmolality
Influences water distribution 
Aids in acid-base balance
Activates muscle and nerve cells
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9
Q

Hyponatremia (<136) causes

A

GI loss: diarrhea, vomiting, fluid loss from fistula, excessive NG suction
Renal loss: diuretics, adrenal insufficiency
Skin loss: burns, wounds
Fasting
Drinking too much water
Excess hypotonic fluid

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10
Q

Hyponatremia signs/symptoms

A 
Confusion
Altered LOC
Anorexia
Muscle weakness
Seizures
Coma
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11
Q

Dilutional hyponatremia

A

Hypervolemic

Too much fluid lowers sodium concentration

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12
Q

Depletional hyponatremia

A

Hypovolemic

Absolute sodium loss

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13
Q

Dilutional hyponatremia symptoms

A 
Hypervolemia
High blood pressure
Weight gain
Bounding rapid pulse
Increased urine specific gravity
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14
Q

Depletional hyponatremia symptoms

A 
Hypovolemia
Decreased blood pressure
Tachycardia
Dry skin
Weight loss
Decreased urine specific gravity
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15
Q

Hyponatremia treatment

A

Sodium replacement (must do slowly)
Can replace IV or PO
NS
Fluid restriction for dilutional hyponatremia

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16
Q

Sodium bicarbonate MOA

A

Dissociates to sodium ion and bicarbonate ion—neutralizing ion concentration, raising pH, and increasing sodium plasma concentration

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17
Q

Sodium bicarbonate indication

A

Metabolic acidosis

Long-term hyponatremia

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18
Q

Sodium bicarbonate SE

A

Edema, cerebral hemorrhage, hypernatremia, electrolyte abnormalities, metabolic alkalosis, flatulence (with PO), tetany, pulmonary edema, heart failure exacerbation

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19
Q

Sodium bicarbonate nursing considerations

A

Do not give IV for hyponatremia (irritant/vesicant at high concentration)—only IVP through central line
If IV monitor IV patency
IVP for metabolic acidosis
Cardiac monitor
Monitor ABGs and electrolytes
Many drug interactions if drug is diluted in sodium solution
For PO give 1-3 after or before meals

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20
Q

Hypernatremia causes

A

IV fluids, tube feeds, near drowning in salt water, insufficient water intake, significant water loss (cognitively impaired, diarrhea, high fever, heatstroke), profound diuresis, cannot get from consuming salty foods

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21
Q

Hypernatremia signs/symptoms

A 
Altered LOC
Confusion
Seizure
Coma
Extreme thirst
Dry and sticky mucous membranes
Muscle cramps
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22
Q

Hypernatremia treatment

A

Add water or remove sodium
Fluid replacement must occur slowly to prevent cerebral edema
Gradually achieve normal sodium over 48 hours to avoid cerebral edema

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23
Q

Potassium

A

Main source: diet

Main source for loss: kidneys

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24
Q

Hypokalemia causes (<3.5)

A

Renal/GI losses: diuresis, diuretics, diarrhea, vomiting, ileostomy
Acid-base disorders

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25
Hypokalemia signs/symptoms
``` Cardiac rhythm disturbances Muscle weakness Cramps Decreased bowel motility Constipation Nausea Ileus ```
26
Potassium chloride indication
Potassium depletion when dietary measures are inadequate
27
Potassium chloride nursing indications
Given PO or IV If given PO, dilute with smth to decrease GI distress as taste is bad Must dilute IV potassium Never give potassium IVP
28
Potassium chloride SE
GI ulcers/bleeding | Nausea/vomiting
29
IV potassium chloride nursing implications
Always dilute IV potassium and give slowly us. over an hour Only give to patients with documented urine output May cause phlebitis and pain IV solutions should not contain more than 40 mEq/L and rate should not be greater than 10-20 mEq/hr Patient must be placed on telemetry Contraindicated for patients with renal failure Never give IVP
30
Undiluted IV potassium
Can cause v-fib Must dilute IV potassium Must never be given IVP
31
Hyperkalemia causes
Renal failure and decreased urination causing decreased potassium output Burns/crush injuries/sepsis causing cell bursting Potassium-sparing diuretics, ACE inhibitors, ARBs, NSAIDs
32
Hyperkalemia symptoms
``` Cardiac rhythm disturbances Muscle weakness Cramps Abdominal cramps Diarrhea Vomiting ```
33
sodium polystyrene sulfonate
Trade name: Kayexalate Class: cation exchange resin Indication: hyperkalemia MOA: binds to K and replaces K for sodium ions Routes: PO, oral/rectal powder, oral/rectal suspension, rectal enema Precaution: only use if bowel functions normal
34
sodium polystyrene sulfonate SE
``` Constipation Diarrhea Nausea Vomiting Hypokalemia Intestinal obstruction Intestinal necrosis ```
35
D50/insulin
Indication: hyperkalemia MOA: insulin temporarily shifts potassium into the cell Usually give 10 units regular insulin and 1 amp D50 Must check BS before/after
36
Magnesium functions
Stabilizes cardiac muscle cells Blocks/controls movement of K+ out of cardiac cells Stabilizes smooth muscle 1.7-2.2
37
Hypomagnesemia (<1.7)
Causes: GI/renal loss, limited dietary intake, alcohol abuse, pancreatitis, hyperglycemia
38
Hypomagnesemia s/s
``` Hyperactive reflexes Cramps Tremors Confusion Seizures Nystagmus ```
39
Hypomagnesemia treatment
PO: Mylanta, magnesium sulfate IV: magnesium sulfate
40
Magnesium sulfate, magnesium oxide
Indication: hypomagnesemia, to prevent/treat seizures in preeclampsia, to treat cardiac rhythm disturbances, constipation (given PO), as an antacid Magnesium oxide can be given for long-term hypomagnesemia Route: IV (us. for hypomagnesemia) or PO (for GI symptoms) Nursing: IV magnesium sulfate must be replaced over several days, IVP allowed if needed
41
Magnesium sulfate, magnesium oxide SE
Hypermagnesemia, confusion, feeling sluggish, slow movements, SOB, nausea, dizziness (low calcium), abnormal heart rhythm, burning sensation when given IV
42
Hypermagnesemia (>2.2)
Causes: increased intake with renal failure (I.e., chronic renal failure pt taking milk of magnesium), IV magnesium in OB patients to prevent seizures Treatment: discontinue replacement, dialysis if chronic decreased intake
43
Hypermagnesemia s/s
``` Lethargy Floppiness Muscle weakness Decreased reflexes Flushed/warm skin Decreased pulse Decreased blood pressure ```
44
Calcium functions
Enzyme reactions Membrane potentials/nerve excitability Skeletal/smooth/cardiac muscle contraction Release of hormones, neurotransmitters, and chemical mediators Influences cardiac contractility Blood clotting
45
Hypocalcemia causes
``` Hypoparathyroidism Hypomagnesemia Increased renal loss from renal failure Increased binding to albumin (inactive form) Decreased intake Decreased vitamin D Acute pancreatitis Thyroid/parathyroid surgery ```
46
Hypocalcemia symptoms
``` Causes increased neuromuscular excitability Parasthesias Muscle cramps Bone pain Tetany (muscle spasms) Laryngeal spasm Hyperactive reflexes Cardiac insufficiency Prolonged QT interval Positive Chvostek’s sign Positive Trousseau’s sign ```
47
Chvostek’s sign
Ipsilateral twitching of the circumoral muscles in response to gentle tapping of the facial nerve just anterior to the ear
48
Trousseau’s sign
Carpal spasm upon inflation of BP cuff to 20 mmHg above systolic for 3 minutes
49
Hypocalcemia treatment
IV calcium chloride (ionized form; preferred) IV calcium gluconate: preferably through central line PO calcium: elemental Ca, calcium carbonate May also need vitamin D (active form of liver impaired and/or kidney dysfunction)
50
Hypercalcemia causes
Hyperparathyroidism (PTH increases serum Ca2+), cancers, TUMS overdose
51
Hypercalcemia s/s
``` Calcium acts like a sedative Fatigue Lethargy Confusion Weakness Seizures COma Kidney stones (chronic hypercalcemia) ```
52
Hypercalcemia treatment
``` Adequate hydration Increased urine output Diuretics NaCl (sodium excretion accompanied by calcium excretion) Dialysis in renal failure ```
53
Phosphorous
Calcium and phosphate collaborate (low Ca-high P) Found in bone, involved in bone formation Essential for ATP formation Part of DNA/RNA Needed for enzymes in glucose/protein/fat metabolism Involved in acid-base buffer Needed for WBC and platelet function Inorganic: circulating, measured Organic: intracellular
54
Hypophosphatemia (<3.2) Causes
``` Decreased absorption Antacid overdose Severe diarrhea Increased kidney elimination Malnutrition Alcoholism TPN ```
55
Hypophosphatemia s/s
``` Tremor Paresthesia Muscle weakness Joint stiffness Bone pain Confusion Coma Hemolytic anemia Platelet dysfunction Impaired WBC function Seizure ```
56
Hyperphosphatemia (>4.3) causes
Kidney failure Laxatives/enemas with phosphorous Shift from intra- to extra cellular compartment due to massive trauma or heat stroke Hypoparathyroidism
57
Hypophosphatemia treatment
IV or PO replacement (give IV over long period), increase oral intake, manage CKD or hypercalcemia (increased risk of calcifications)
58
Hyperphosphatemia treatment
Calcium-based phosphate binders, hemodialysis (for renal failure)
59
Intracellular electrolytes
Potassium Magnesium Phosphorous
60
Extracellular electrolytes
Sodium Chloride Bicarbonate

Pathopharm I (10 decks)

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