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Flashcards in Fluid & Electrolytes Deck (67):
1

3 causes of fluid volume excess (hypervolemia):

Heart Failure
Renal Failure
Too much sodium

2

3 things with excess sodium:

Effervescent soluble meds (Alka-Seltzer)
Canned, processed foods
IVF with Na

3

What 3 hormones can regulate fluid volume and where are they released from?

1) Aldosterone - adrenal glands when vol too low
2) Atrial Natriuretic Peptide (ANP) - Atria of heart when vol too high
3) ADH - pituitary gland when vol too low

4

Aldosterone retains ___ and ___
ANP excretes ___ and ___
ADH retains ___ ___

Aldosterone: Sodium and water
ANP: Sodium and water
ADH: water ONLY

5

ADH excess leads to ____
ADH insufficiency leads to ____

Excess - SIADH (Syndrome of "INCREASED" ADH)
Insufficiency - DI (DI-uresis)

6

Concentrated makes the #'s go ___
Dilute makes the #'s go ___
What are these 3 values effected here?

Concentrated --> Up
Dilute --> Down (remember the D's)
3 values:
- Urine specific gravity
- Sodium
- Hct

7

Central venous pressure (CVP) is measured in the ___ ___

Right atrium

8

For fluid excess in the lungs, listen where?

Lower posterior area (due to gravity pooling it there)

9

Fluid excess, the heart will beat faster or slower? Why?

Faster...Heart is trying to move fluid forward

10

When getting daily weight, remember what?

Same:
- time
- clothes
- scale
- void 1st!!!

11

If fluid retention...think ____ problems 1st.

Heart

12

Diuretics:
Furosemide, bumetanide (K+ ____)
HCTZ (K+ ____)
Spironolactone (K+ ____)

Furosemide, bumetanide --> K+ losing
HCTZ --> K+ losing

Spironolactone --> K+ SPARING

13

Bed rest good or bad for volume excess pts? Why?

Good
Induces diuresis by the release of ANP and, decrease production of ADH

14

What does PID stand for regarding fluid volume?

Particle Induced Diuresis

15

HYPOvolemia...heart beats faster or slower? Why?

Faster...Heart trying to pump what little fluid is left around
(Tachycardia for both hypo- and hypervolemia)

16

HYPOvolemia...RR faster or slower? Why?

Faster...body perceives hypovolemia as HYPOXIA

17

HYPOvolemia...CVP increase or decrease? Why?

Decrease...less volume, less pressure

18

HYPOvolemia...urine specific gravity goes up or down? Why?

UP...concentrated makes it go up

19

More, less, or same as cells?
Isotonic solution
Hypotonic solution
Hypertonic solution

Isotonic --> Same
Hypotonic --> Less
Hypertonic --> More

20

Isotonic solution goes into the vascular space and ____ ____.

stays there

21

Examples of isotonic solutions:

NS, LR, D5W, D5 1/4 NS

22

What is unique about the isotonic solution D5W?

Only isotonic for a moment, then body uses up the dextrose
Used to keep lines open

23

Who should NOT get isotonic fluids?

HTN
Cardiac dz
Renal dz

24

Hypotonic solution goes into the vascular space then...

shifts out into the cells to replace cellular fluid
(Rehydration w/o HTN)

25

Examples of hypotonic solution:

D2.5W, 0.45% NS (1/2 NS), 0.33% NS

26

Hypertonic solutions are ___ ___ that will draw fluid ___ the vascular space from the cells.

volume expanders
into

27

Examples of hypertonic solutions:

D10W, 3% NS, 5% NS, D5LR, D51/2 NS, D5 NS, TPN, Albumin
(Just think, anything packed with particles is HYPERtonic. Any NS higher than 0.9%)

28

Magnesium and calcium act like ___
(Think ___ first)

sedatives
muscles

29

Lab values for:
Mg
Ca

Mg --> 1.3 - 2.1
Ca --> 9 - 11

30

Causes of hypermagnesemia:

Renal failure
Antacids

31

Increased Mg can lead to ___

seizures

32

S/S of hypermagnesemia:

flushing
warmth
(because vasodilation)

33

S/S of too much Mg or Ca:

(Remember...low Mg and Ca act like sedatives)
1) Decreased DTR
2) Arrhythmias
3) Bradycardia
4) Muscle tone weak & flaccid
5) LOC decreased
6) Decreased RR

34

Treatment for hypermagnesemia

Vent --> manage low RR
Dialysis --> clean the blood
Calcium gluconate --> antidote

35

Causes of hypercalcemia:

- Too much PTH
- Thiazides...retain Ca
- Immobilization...you have to bear weight to keep Ca in the bones

36

S/S of hypercalcemia

Brittle bones
Kidney stones

37

Treatement of hypercalcemia:

Weight bearing movement
Fluids...to prevent kidney stones
Add phosphorus to diet (inverse r'ship with Ca)
Steroids (Remember CUSHINGOID)
Vit D

38

Meds that decrease serum Ca:

Biphosphonates (-dronate)
Prostaglandin synthesis inhibitors
Calcitonin (for osteoporosis...takes Ca from blood to bones)

39

Causes of HYPOmagnesemia

- Diarrhea...lots of Mg in intestines
- Alcoholism
- Alcohol suppresses ADH and it's hypertonic

40

S/S of not enough Mg and Ca

(Remember...NOT ENOUGH sedation here)
1) Muscles rigid and tight
2) Seizures
3) Stridor/laryngospasm --> airway is smooth muscle
4) + Chvostek's (C for Cheek)
5) + Trousseau's
6) Arrhythmias --> heart is a muscle
7) DTR are increased
8) Mind changes --> psychotic, wild, depressed
9) Swallowing probs --> esophagus is smooth muscle

41

Treatment for hypomagnesemia

- give Mg
- check kidney function before and during IV Mg
- Seizure precautions
- Eat Mg (greens and seeds)

42

What should you do if pt c/o flushing and sweating during IV Mg infusion?

STOP the infusion

43

Causes of HYPOcalcemia

- hypoparathyroidism
- radical neck surgery (may have taken parathyroids)
- thyroidectomy (may have take parathyroids)

44

Treatment for HYPOcalcemia

- Vit D
- Phosphate binders...decreasing phosphate will increase Ca (inverted r'ship)
- IV Ca

45

Must be on a ___ ___ when administering Ca

cardiac monitor

46

Na imbalance...think ___ changes

neuro

47

Sodium is the only electrolyte that cares about ___

water

48

The Na level in the blood is totally dependent on how much ___ is in the blood.
- hypernatremia = ___
- hyponatremia = ___

water
Hypernatremia = dehydration
Hyponatremia = dilution

49

Causes of hypernatremia

- hyperventilation (insensible fluid loss)
- heat stroke
- DI

50

S/S of hypernatremia

Neuro changes
Dry mouth
Thirsty
Swollen tongue

51

Treatment of hypernatremia

Restrict Na
Dilute client with fluids, diluting makes Na go down
Daily weights
I and O's
Lab work

52

Feeding tube clients tend to get ___

dehydrated

53

Normal lab values for Na

135 - 145

54

Causes of hyponatremia

- Drinking water for fluid replacement (dilutes the blood w/o replacing electrolytes)
- Psychogenic polydipsia
- D5W
- SIADH (retain water)

55

S/S of hyponatremia

(All brain issues)
HA
Seizure
Coma

56

Treatment of hyponatremia

Admin Na
Water restriction
If having neuro probs, need HYPERtonic saline

57

Normal values for Potassium

3.5 - 5

58

K is mostly excreted by the ____

Kidneys
(think K for Kidneys)

59

Causes of hyperkalemia

Kidney probs
Spironolactone (K sparing diuretic)

60

S/S of hyperkalemia

First...muscle twitching
Then...muscle weakness
Then...flaccid paralysis

61

ECG changes with hyperkalemia

bradycardia
tall, peaked T-waves
prolonged PR intervals
flat or absent P-waves
widened QRS
Conduction blocks
V-fib

62

ECG changes with hypokalemia

U waves
PVCs
V-tach

63

Treatment for hyperkalemia

Dialysis...kidneys aren't working
Calcium gluconate...decreases arrythmia
Glucose and insulin
Kayexcelate (sodium polystyrene, exchanges Na for K)
- Na and K have an inverse r'ship

64

Causes of hypokalemia

Vomiting
NG suction (we have lots of K in our stomach)
K losing diuretics (Lasix and HCTZ)
Not eating

65

S/S of hypokalemia

Muscle cramps
Muscle weakness

66

Treatment for hypokalemia

Give K
Spironolactone (K sparing diuretic)
Eat more K rich foods

67

Never give potassium IV ___

push
Always on a pump