Fluid And Electrolytes Flashcards
1
Q
Electrolyte found in extracellular fluid
A
Sodium
2
Q
Functions of sodium
A
Acid-base balance, fluid balance, active and passive transport, irritability and conduction of nerve muscle tissue
3
Q
Normal sodium range
A
135-145 mEq/L
4
Q
S/S of hypernatremia (>145 mEq/L)
A
FRIED SALT: Flushed skin, Restless/anxious/confused/irritable, Increased BP and fluid retention, Edema (pitting), Decreased UOP, Skin flushed and dry, Agitation, Low-grade fever, Thirst (dry mucous membranes)
5
Q
S/S of hyponatremia (<135 mEq/L)
A
SALT LOSS: Stupor/coma, Anorexia (n/v), Lethargy, Tachycardia (thready pulse), Limp muscles, Orthostatic hypotension, Seizures/headache, Stomach cramping (hyperactive bowel sounds)
6
Q
Hypernatremia risk factors
A
Increased sodium intake (oral, hypertonic fluids), loss of fluids (fever, v/d, DI, diaphoresis, infection), decreased sodium excretion (kidney problems)
7
Q
Hyponatremia risk factors
A
4 D’s: diaphoresis, diarrhea/vomiting, drains (NGT suction), diuretics (loop & thiazide)
Other: SIADH, inadequate intake, kidney disease, HF
8
Q
Hypernatremia management
A
IV infusions NS 0.9% (if d/t fluid loss), diuretics that promote sodium loss (loop and thiazide), restrict sodium and fluid as prescribed
9
Q
Hyponatremia management
A
ADD SALT: Administer IV sodium chloride infusions (if d/t hypovolemia), 3% NS, Diuretics (if d/t hypervolemia), Daily weights, Safety (OHTN = risk for falls), Airway protection, Limit water intake, Teach about foods high in sodium (canned foods, packaged/processed meats)
10
Q
Potassium and sodium are _________
A
Opposites; if Na is high K+ will be low (vice versa)
11
Q
Role of potassium
A
Cellular metabolism and transition of nerve impulses, cardiac, lung, and muscle tissue function, acid-base balance
12
Q
Normal potassium range
A
3.5-5 mEq/L
13
Q
S/S of hyperkalemia (> 5 mEq/L)
A
MURDER: Muscle cramps and weakness, Urine abnormalities, Respiratory distress, Decreased cardiac contractility (low HR and BP), ECG changes, Reflexes (increased DTRs)
14
Q
ECG changes related to hyperkalemia
A
Tall peaked T-waves, flat P waves, widened QRS, prolonged QT interval
15
Q
S/S of hypokalemia
A
Thready/weak/irregular pulse, OHTN, shallow respirations, anxiety/lethargy/confusion/coma, paresthesias, hyporeflexia, constipation, N/V/abdominal distention, ECG changes
16
Q
ECG changes related to hypokalemia
A
ST depression, shallow or inverted T-wave, prominent U wave
17
Q
Potassium imbalance can cause
A
Cardiac dysrhythmias (can be life threatening!)
18
Q
Hyperkalemia management
A
Monitor ECG, potassium-restricted diet, potassium excreting diuretics, IV calcium gluconate and IV sodium bicarb, avoid salt-substitutes
19
Q
Hypokalemia management
A
Oral potassium supplements, spironolactone, liquid potassium chloride
20
Q
Potassium is NEVER administered by
A
IV push, IM, or subq
21
Q
How to administer IV potassium
A
Diluted and administered using an infusion device
22
Q
Where is calcium found?
A
Cells, bones, and teeth
23
Q
Electrolyte needed for proper functioning of the cardiovascular, neuromuscular, endocrine systems, blood clotting, and teeth formation
A
Calcium
24
Q
Normal calcium range
A
9-11 mg/dL
25
S/S of hypercalcemia (> 11 mg/dL)
BACKME: Bone pain, Arrythmias, Cardiac arrest (bounding pulses), Kidney stones, Muscle weakness (decreased DTRs), Excessive urination, seizures
26
S/S of hypocalcemia
CATS GO NUMB: convulsions, arrythmias, tetany, spasms and stridor, numbness in fingers, face, and limbs
27
Carpal spasm caused by inflating a BP cuff; related to hypocalcemia
Positive Trousseau’s
28
Contraction of facial muscles with light tap over the facial muscle; related to hypocalcemia
Chvostek’s sign
29
A client with a calcium imbalance is at risk for
Pathological fracture (move them carefully and slowly!)
30
Hypercalcemia management
Administration of phosphorus, calcitonin, bisphosphonates, and prostaglandin synthesis inhibitors (NSAIDs), avoid foods high in calcium
31
Hypocalcemia management
Calcium PO or IV, aluminum chloride and vitamin D, seizure precautions, consume foods high in calcium
32
Calcium and phosphate are
Inverse; if Ca is high, PO4 is low (vice versa)
33
Most of the magnesium found in the body is found in the
Bones
34
Electrolyte that regulates BP, blood sugar, muscle contraction and nerve function
Magnesium
35
Normal magnesium range
1.5-2.5 mg/dL
36
S/S of hypermagnesemia (>2.5 mg/dL)
Low everything: energy, HR/BP/RR, bowel sound, DTRs
37
S/S of hypomagnesemia
High everything: HR/BP/DTRs, shallow respirations, twitches/paresthesias, tetany, seizures, irritability and confusion (may also see positive trousseau’s and Chvostek sign)
38
Hypermagnesemia management
Diuretics, IV calcium chloride or calcium gluconate, avoid laxatives and antacids containing mg
39
Hypomagnesemia management
IV or PO mag.sulfate, seizure precautions, increase magnesium-containing foods
40
Magnesium and calcium are
The same; if one is increased/decreased, so is the other
41
What electrolyte would you monitor for in a patient with thyroid disease?
Calcium
42
Describe what the blood is like when the serum osmolarity is >300
Concentrated
43
Most common electrolyte disorder
Hyponatremia
44
Tachycardia, flat neck veins, tachypnea, poor turgor, and decreased UOP are signs of
Dehydration
45
What is the most common route of potassium loss?
GI
46
Absorption of calcium requires
Vitamin D
47
What precautions would you place a patient with hypernatremia?
Seizure
48
In a patient with hypercalcemia, the blood will clot faster or slower?
Faster
49
What should you assess first with hypokalemia if the patient has a normal ECG?
Respiratory status
50
Example of potassium-sparing diuretic
Spironolactone
51
If a patient has hypophosphatemia, they will most likely have what other electrolyte imbalance?
Hypercalcemia
52
What should be the first assessment completed on a patient with hyperkalemia?
Cardiac
53
A nurse would expect an increased or decreased UOP with hypernatremia?
Decreased
54
Full and bounding pulse, HTN, JVD, dyspnea, crackles, pale and cool skin are S/S of
Over hydration or fluid overload
55
Which electrolyte maintains extracellular fluid?
Sodium
56
Which electrolytes maintain intracellular fluid?
Potassium and magnesium
57
Water goes with…
Sodium (were sodium goes, water flows)
58
What kind of fluid is normal saline?
Isotonic
59
Normal pH range
7.35-7.45
60
Low pH (<7.35)
Acidosis
61
High pH (>7.45)
Alkalosis
62
PaCO2 normal range
35-45
63
PaCO2 > 45
Acidosis
64
PaCO2 < 35
Alkalosis
65
HCO3 normal range
22-26
66
HCO3 < 22
Acidosis
67
HCO3 >26
Alkalosis
68
ROME method for ABGs
Respiratory Opposite Metabolic Equal
69
CO2 binds to H2O to form
Carbonic acid (H2HCO3); H2 (hydrogen ion — acidic), CO3 (bicarbonate — weak)
70
High hydrogen ions mean ___ blood pH
Low (acidic)
71
Low hydrogen ions mean ___ blood pH
High (alkaline)
72
What can cause alkalosis?
NGT suctioning, vomiting, diarrhea
73
What can cause respiratory alkalosis?
Hyperventilation, tachypnea, fever, NSAID/salicylate toxicity (Aspirin), high altitude (d/t decreased O2), pneumothorax, anxiety, pain
74
If patient has excessive diarrhea, the main electrolyte loss is
Potassium
75
Loop diuretics result in a loss of
Potassium
76
Kidney patients should not be given _________ because it is hard for them to excrete
Potassium
77
Hypotonic fluids _____ the cell
Swells
78
Hypotonic fluids are given for
Dehydration
79
Examples of hypotonic fluids
1/2 NS (0.45%), 0.33% NS, 2.5%DW
80
Hypertonic fluids _____ the cell
Shrinks (pulls water from cells)
81
Hypertonic fluids are given for
TBI (d/t swelling and increased ICP)
82
Examples of hypertonic fluids
3% saline (TBI/ICP), 5% saline, D51/2NS, D5LR, D5NS
83
_________ fluids do not change the volume of cell and are the go-to fluids for VOLUME
Isotonic
84
Isotonic fluids are given for
Hypovolemia
85
Examples of isotonic fluids
0.9% NS, LR, D5W
86
Best isotonic fluid option for fluid volume deficit
0.9% NS
87
Best isotonic fluid option for burns
LR
88
Fluid option for treatment of metabolic acidosis
Isotonic fluids
89
Priority assessment for patients with hypophosphatemia and hypercalcemia
Neuro status
90
IJ line is an example of
Central line (“intra”)
91
EJ is an example of
Peripheral line (“extra”)
92
PICC lines touch the
Heart
93
Why are PICC lines the most convenient central lines?
Nurses can insert it, patient can be sent home with PICC line if on long-term antibiotics (single-lumen), milrinone, and remodulin
94
PICC line patient education
How to care for PICC lines, come back to hospital or clinic for dressing changes, S/S of infection (pain, redness, fever, swelling)
95
Cardiac drip that can be administered via PICC line given for EF less than 20%
Milrinone
96
Drip that can be administered via PICC line used for pulmonary HTN
Remodulin
97
PICC line dressings should be changed every
7 days
98
___ should be used to wipe PICC lines every shift
CHG
99
Flushing a triple lumen PICC line
Scrub the hub — new alcohol wipe for each line, flush each line individually, scrub the hubs again, change cap each time you flush
100
What should the nurse do if resistance is felt when flushing PICC line?
STOP (could dislodge a clot); alteplase if line is blocked (clot buster; administered by PICC nurse)
101
What should the nurse do if PICC line infection is suspected?
Inform the physician (order will be given to removed PICC line); cut the tip of PICC line and send it to lab for culture
102
S/S of sepsis
Tachycardia (early sign) and hypotension (late sign)
103
Intervention for sepsis
Fluid resuscitation
104
Subclavian lines are for
Dialysis access
105
Chest access ports are for
Cancer patients
106
S/S of central line infection
Redness, drainage, blood around access site (especially in subclavian)
107
If bleeding from central line…
Apply pressure and call the physician (DO NOT remove the line)
108
Femoral line priority assessment
Infection
109
Key difference between infiltration and infection is
Skin temperature (cool to touch with infiltration and warm to touch with infection)
110
Interventions for infiltration
Removal is priority (can lead to infection)! Start a new IV site in a different area, cool compress for comfort
111
What are hypertonic solutions used for?
Cerebral edema, hyponatremia, metabolic alkalosis, maintenance fluid, hypovolemia
112
Monitor for __________ with hypertonic fluids
Fluid volume overload
113
Explain hypertonic solutions
More salt than water in solution. The vessel becomes more concentrated than the cell, causing water to leave the cell and the cell shrinks
114
Fluids used to expand intravascular fluid volume and replace fluid loss
Isotonic fluids
115
Isotonic fluids are used for
Blood loss (hemorrhage, burns, surgery), dehydration (V/D), fluid maintenance
116
What is the only solution compatible to use with blood or blood products?
Normal saline
117
Hypotonic fluids are used for
DKA, hypernatremia, helping kidneys excrete excess fluids
118
Hypotonic solutions should not be given with
Increased ICP, burns, trauma
119
Describe hypotonic solutions
More water than salt in solution. The vessel becomes less concentrated than the cell, causing water to enter the cells which swell the cells
120
Fluid inside the cell
Intracellular fluid
121
Fluid outside the cell
Extracellular fluid
122
Two categories of extracellular fluid
Interstitial fluid and intravascular fluid
123
Fluid that surrounds the cell (in the tissues)
Interstitial fluid
124
Plasma/fluid in the blood vessels
Intravascular fluid
125
Mixtures that have large molecules making it more efficient at increasing fluid volume in the blood (plasma expanders!)
Colloids
126
Examples of colloids
Albumin, fresh frozen plasma
127
Mixtures that have small molecules and provide immediate fluid resuscitation
Crystalloids
128
Examples of crystalloids
Hypertonic, isotonic, and hypotonic solutions
129
Colloids are used for
Shock, pancreatitis, burns, excessive bleeding
130
IV complication by which air enters the vein through the IV tubing
Air embolism
131
S/S of air embolism
Tachycardia, chest pain, hypotension, decreased LOC, cyanosis
132
Air embolism treatment
Clamp tubing, turn client on side and place in trendelenburg, notify HCP
133
IV complication in which IV fluid leaks into surrounding tissue
Infiltration
134
S/S of infiltration
Pain, swelling, coolness, and numbness at the site; no blood return
135
Infiltration treatment
Remove IV, elevate extremity, apply warm/cool compress, DO NOT rub the area
136
Entry of microorganism into the body via IV
Infection
137
Administration of fluids too rapidly
Circulatory overload (fluid volume overload)
138
S/S of fluid volume overload
HTN, distended neck veins, dyspnea, wet cough and crackles
139
Fluid overload treatment
Decrease IV flow rate, elevate HOB, keep client warm, notify HCP
140
Inflammation of the vein that can lead to a clot
Phlebitis
141
S/S of phlebitis
Heat, redness, tenderness at the site; decreased flow of IV
142
Phlebitis treatment
Remove the IV, notify HCP, restart IV on the opposite side
143
Collection of blood in the tissues
Hematoma
144
S/S of hematoma
Blood, hard and painful lump at the site; ecchymosis
145
Hematoma treatment
Elevate extremity, apply pressure and ice
146
Respiratory alkalosis
pH high, CO2 low
147
Respiratory acidosis
PH low, CO2 high
148
Metabolic alkalosis
PH high, HCO3 high
149
Metabolic acidosis
PH low, HCO3 low
150
How do kidneys compensate?
By excreting excess acid and bicarb (HCO3) OR retaining hydrogen and bicarb
151
How do the lungs compensate?
Through hyper or hypoventilation
152
Hyperventilation causes…
Decreased CO2 (alkalosis)
153
Hypoventilation causes…
Increased CO2 (acidosis)
154
PH is out of range and CO2 or HCO3 is in range
Uncompensated
155
CO2, HCO3 and pH are ALL out of range
Partially compensated
156
PH is in range
Fully compensated
157
causes of respiratory acidosis
Drugs (opioids and sedatives), edema (fluid in lungs), pneumonia, pulmonary emboli, asthma, COPD
158
Causes of respiratory alkalosis
Losing CO2 (tachypnea): fever, aspirin toxicity, hyperventilation
159
S/S of respiratory acidosis
Increased BP, RR, and HR, restlessness, confusion, headache, sleepy/coma
160
S/S of respiratory alkalosis
Increased HR, confused and tired, tetany, EKG changes, (+) chvostek
161
Causes of metabolic acidosis
DKA, AKI/CKD, malnutrition, severe diarrhea
162
Causes of metabolic alkalosis
Excess antacids, diuretics, excess vomiting, hyperaldosteronism
163
S/S of metabolic acidosis
Increased RR, hyperkalemia, decreased BP, confusion
164
S/S of metabolic alkalosis
Decreased RR, hypokalemia
165
Kidney problem in which there is too much hydrogen and too little bicarb; lungs compensate by blowing off CO2
Metabolic acidosis
166
Kidney problem in which there is too much bicarb and too little oxygen. Lungs compensated by retaining CO2
Metabolic alkalosis
167
Lung problem in which the lungs are retaining too much CO2. Kidneys compensate by excreting excess hydrogen and retaining bicarb
Respiratory acidosis
168
Lung problem in which the lungs are losing too much CO2. Kidneys compensate by excreting excess bicarb and retaining hydrogen
Respiratory alkalosis
169
For which acid base imbalance would you want the patient to rebreathe into a paper bag?
Respiratory alkalosis
