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Causes of fluid volume excess

Heart failure= heart weak, decreases co2, decreased kidney perfusion, urine output goes down, fluid stays in the vascular space.

Renal failure.

Alka-Seltzer, fleet enema, IV fluids with sodium because all three have a lot of sodium which retains water.

1

Aldosterone

It is a steroid/mineralocorticoid found in the adrenal glands and helps increase fluid by retaining sodium and water.

When blood volume gets low aldosterone secretion increases.

Diseases with too much aldosterone include Cushing's disease and hyperaldosteronism/cons syndrome.

Diseases with two little include Addison's disease

2

ANP. Atrial natriuretic peptide

It is found in the atria of the heart and causes fluid volume to go down. It works the opposite of aldosterone so it causes the excretion of sodium and water.

3

ADH antidiuretic hormone

Normally makes you retain water. Found in the pituitary. Other names include vasopressin or desmopressin acetate/DDAVP which is a nasal spray.

ADH problem may be caused by a craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy, or any condition that can lead to an increased ICP

Too much ADH is called SIADH
Retains water, fluid volume excess, urine decreases and becomes concentrated, blood is dilute.

Too little ADH is called diabetes insipidus. They loose water, fluid volume deficit, urine is dilute, blood is concentrated.

4

Treatment for fluid volume excess

Low-sodium diet, restrict fluids.

Intake and output and daily weights.

Diuretics such as Lasix or Bumex, Hydrochlorothiazide. Both of these can cause loss of potassium. Aldactone is a potassium sparing diuretic

Bedrest induces diuresis and release of ANP and decreased production of ADH. There's more blood to the heart so it causes the body to diurese.

Give IV fluids slowly to the elderly and young to prevent overload. Be careful when there are heart and kidney problems.

5

Treatment for fluid volume deficit

Prevent further loss.

Replace volume: mild deficit with oral fluids, severe deficit with IV fluids.

Safety precaution: at higher risk for falls, monitor for overload

6

Isotonic IV fluids

Also called crystalloid
NS, LR, D5W, D5 1/4 NS

b. Uses: The client that has lost fluids through nausea, vomiting, burns, sweating,
trauma. Use LR for shock cuz it has electrolytes.
• Normal Saline is the basic solution when administering blood.

c. Alert: Do not use isotonic solutions in clients with hypertension, cardiac disease or renal disease.
These solutions can cause FVE, or hypertension, hypernatremia

7

Hypotonic solution

2. Hypotonic Solutions: Go into the vascular space then shift out into the cells to replace cellular fluid.
They rehydrate but do not cause HTN.

Examples: D2.5W, 1/2NS, 0.33% NS
Uses: The client who has hypertension, renal or cardiac disease and needs fluid
replacement because of nausea, vomiting, burns, hemorrhage, etc.
• Also used for dilution when a client has hypernatremia, and for cellular dehydration.
Alert: Watch For cellular edema because this fluid is moving out to the cells which could lead to fluid volume deficit and decreased blood pressure.

8

Hypertonic solutions

Hypertonic Solutions/colloid: Volume expanders that will draw fluid into the vascular space from the cell.

a. Examples: D10W, 3% NS, 5% NS, D5LR, D51⁄2 NS, D5 NS, TPN, Albumin

b. Uses: The client with hyponatremia or a client who has shifted large amounts of
vascular volume to a 3rd space or has severe edema, burns, or ascites.
• A hypertonic solution will return the fluid volume to the vascular space.
c. Alert: Watch for fluid volume excess. Monitor in an ICU setting with frequent monitoring of blood pressure, pulse, and CVP, especially if they are receiving 3% NS or 5% NS.

9

Magnesium and calcium

Act like sedatives/think muscle first.
Mg 1.2-2.1
Ca. 9.0-10.5

10

Hypermagnesemia

1. Causes: Renal failure and Antacids

2. S/S: Flushing, Warmth, Mg makes you vasodilate. Decreased deep tendon reflexes, muscle tone, LOC, pulses, and respirations. It can cause arrhythmias.

3. Tx: Ventilator, Dialysis, Calcium gluconate
**Calcium gluconate is administered IVP very slowly (Max rate: 1.5-2 ml/min). Safety precautions because it causes sedation

11

Hypercalcemia

1. Causes: Hyperparathyroidism: too
much PTH. When your serum calcium gets low parathormone (PTH) kicks in and pulls Ca from the bone and puts it in the blood, therefore, the serum calcium goes up. Thiazides (retain calcium). Immobilization(you have to bear weight to keep Ca in the bone.

2. S/S: Bones are brittle, Kidney stones *majority made of calcium

3. Tx: Move! Fluids prevent kidney stones. PhosphoSoda®&Fleet®
Enema both have phosphorous
Ca has inverse relationship with phosphorus. When you drive Phos up, Ca goes down. Steroids. Add phosphorus to diet. Safety Precautions. Must have Vitamin D/sun to use
Ca. Calcitonin decreases serum
Ca. (Osteoporosis trtmnt)

12

Hypomagnesemia

Causes: diarrhea because magnesium is lost in the intestines, alcoholism, alcohol suppresses ADH and is hypertonic which causes diuresis, and they don't eat.

S/S
Muscle Tone rigid and tight
Seizures
Stridor/laryngospasm-airway is a smooth muscle
+Chvostek’s – tap cheek (“C” is for Cheek) +Trousseau’s – pump up BP cuff
Arrhythmias – heart is a muscle
DTRs increase
Mind Changes
Swallowing Problems – esophagus is a smooth muscle.
*these sign and symptoms are common in a client with hypomagnesia or hypocalcemia*

Treatment: Give some Mg, Check kidney function (before and during IV Mg). Seizure precautions. Eat magnesium.

13

Hypocalcemia.

Causes: Hypoparathyroidism, radical neck, thyroidectomy which causes there to not be enough PTH

S/S
Muscle Tone rigid and tight
Seizures
Stridor/laryngospasm-airway is a smooth muscle
+Chvostek’s – tap cheek (“C” is for Cheek) +Trousseau’s – pump up BP cuff
Arrhythmias – heart is a muscle
DTRs increase
Mind Changes
Swallowing Problems – esophagus is a smooth muscle.
*these sign and symptoms are common in a client with hypomagnesia or hypocalcemia*

Treatment: Vitamin D, Phosphate binders Sevelamer hydrochloride (Renagel®)
Calcium Acetate (PhosLo®), IV Ca (GIVE SLOWLY) and Always make sure client is on a heart monitor

14

Foods high magnesium

spinach, mustard greens, summer squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, celery, kale, sunflower seeds, sesame seeds and flax seeds

15

Sodium

Think neuro changes
135-145
Your sodium level in your blood is totally dependent on how much water you have in your body. The brain does not like it when sodium is messed up. It will be affected whether there is too much or too little.

16

Hypernatremia

Dehydration: Too much sodium not enough water.

Causes: hyperventilation because you're losing insensible water, heat stroke, diabetes insipidus, vomiting, diarrhea.

Signs and symptoms: dry mouth, thirsty, swollen tongue when severe.

Treatment: restrict sodium, dilute with fluids to make sodium go down, daily weights, intake and output, Lab work.

If you have a sodium problem you have a fluid problem. Clients with feeding tubes tend to get dehydration.

17

Hyponatremia

Dilution: too much water not enough sodium

Causes: Drinking H2O for fluid replacement (vomiting, sweating). This only replaces water
and dilutes the blood.
Psychogenic polydipsia: loves to drink water
c. D5W(sugar&water)
d. SIADH

S/S:
a. Headache
b. Seizure
c. Coma

3. Tx:
a. Client needs sodium.
b. Client doesn’t need fluid.
c. If having neuro problems:
needs hypertonic saline • Means “packed with
particles”
• 3%NSor5%NS. These are dangerous and should be given slowly in ICU. Watch for fluid overload.

18

Potassium

Excreted by the kidneys. The kidneys are not working well potassium will go up.
Sodium and potassium have an inverse relationship.
3.5 to 5.0

19

Potassium foods

Foods high in potassium: spinach, fennel, kale, mustard greens, Brussels sprouts, broccoli, eggplants, cantaloupe, tomatoes, parsley, cucumber, bell pepper, apricots, ginger root, strawberries, avocado, banana, tuna, halibut, cauliflower, kiwi, oranges, lima beans, potatoes (white or sweet), and cabbage.

20

Hyperkalemia

Causes:
a. Kidney trouble
b. Aldactone- makes you retain K

2. S/S:
a. Begins with muscle twitching
b. Then proceeds to weakness
c. Then flaccid paralysis

Life-threatening arrhythmias
ECG changes with hyperkalemia: bradycardia, tall and peaked T waves, prolonged PR intervals, flat or absent P waves, and widened QRS, conduction blocks, ventricular fibrillation.

3. Tx:
a. Dialysis- Kidneys aren’t
working
b. Calcium gluconate
decreases arrythmias.
c. Glucose and insulin
Insulin carries glucose & K into the cell. Any time you give IV insulin worry about hypokalemia & hypoglycemia.
d. Sodium Polystyrene Sulfonate (Kayexalate®). Push fluids.

21

Hypokalemia

1. Causes:
a. Vomiting
b. NG suction: We have lots of K+ in our stomach
c. Diuretics
d. Not eating

2. S/S:
a. Muscle cramps
b. Weakness
C. Life-threatening arrhythmias:
ECG changes with hypokalemia: U waves, PVCs, and ventricular tachycardia

3. Treatment
a. Give potassium
b. Aldactone makes them retain potassium
c. Eat more potassium