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Flashcards in Fluid and electrolytes Deck (37)
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1

oncotic pressure

pulls fluid

2

Hydrostatic pressure

pushes fluid

3

First spacing

Normal distribution of fluids in ICF and ECF

4

Second spacing

Abnormal interstitial fluid (edema)

5

Third spacing

Fluid collection in a place difficult or impossible to move back to cells (Ascites, edema from burnsF)

6

Fluid volume deficit vs dehdyration

Fluid volume deficit is water AND sodium loss

Dehydration is just water loss

7

ECF volume deficit

Causes:

3rd space fluid shifts
Low fluid intake
Diuretic overuse
GI losses (NG suctioning, vomit, etc.)
DI
Fever/heatstroke

Manifestations:
Restless, drowsy, confused
Cold, clammy
Thirsty, dry mucous membranes
Inc. RR

8

ECF volume excess

Causes

SIADH
Cushing/long term corticosteroid
Heart/renal failure
excess hypo/isotonic IV fluids


Manifestations

Headache
Peripheral edema
JVD
S3 sounds
Bounding pulse
Pulmonary edema

9

Sodium range

135-145mEq/L

10

Hypernatremia manifestations

>145mEq/L

Manifestations
Dehydration of brain

Low ECF (wt loss, tachycardia, weakness, cramps post hypotension, LOW CVP)

High/normal ECF (Thirst, flushed skin, wt gain, edema, high BP, high CVP, seizures)

11

Hyponatremia assessment and interventions

Assess for:
Seizure, LOC, mental status, Vitals, weight, CVP, strength, skin, mucous membranes, labs

Interventions:
Volume status, IVF (type), sodium restriction (dietary), monitor labs, meds (vasopressin), seizure precautions

12

Hyponatremia manifestations

<135mEq/L

Low ECF: HA, irritability, confusion, tremors, seizures, dry membranes, tachycardia, cold/clammy

High ECF:
HA, confusion, seizures, N/V/D, Hypertension, HIGH CVP

13

Hyponatremia assessment/interventions

Assess: HA, LOC, seizures, VS, CVP, mucous membranes, weight, nausea

Interventions:
NA+ isotonic solution, inc. PO intake, hold diuretics, free water restriction, vasopressor receptor antagonists

**Avoid rapid or overcorrection due to osmotic demyelination syndrome

14

Hyperkalemia manifestations

>5mEq/L

Overexcited nerve/muscle impulse (HIGH POTASSIUM=HIGH CONTRACTION)
Cardiac irregularity, weak muscle tone, cramping, D/V, d/t,

15

Hyperkalemia assessment/interventions

Assess: ECG, muscle weakness, tetany, reflexes, respiratory effort, labs, pulses

Interventions:

Stop PO K+ intake/diuretics

Kayexalate or Patriomer

Shift potassium intracellular (insulin+dextrose+beta adrenergic- maybe bicarb/calcium gluconate)

16

Hypokalemia manifestations

<3.5mEq/L

Impaired muscle contraction (LOW POTASSIUM=LOW CONTRACTION)

decreased reflexes, shallow respirations, constipation, hyperglycemia

17

Hypokalemia assessment/interventions

Assess:
ECG, Muscle weakness, reflexes, resp. effort, bowel movements, blood glucose,

-On digoxin??


Interventions: K+ replacement IV or PO, telemetry, serial labs

18

Hypercalcemia manifestations >10.5mg/dL

Acidosis, reduced muscle excitability/tone, fatigue, hallucination, N/V/anorexia, bone pain/fractures, polyuria, confusion

19

Hypercalcemia assessments and intervention

Assess LOC, MS, Muscles, ECG, pain, seizures

Interventions:
Low Ca intake, inc. activity, hydrate IV meds (saline, bisphosphonates, calcitonin)

20

Hypocalcemia manifestations

<9.0mg/dL

Cell membrane depolarization, sustained contraction/tetany, decreased cardiac contractions, tingling

21

Hypocalcemia assessment and interventions

Assess: Swallowing, breathing, CHVOSTEK (face), TROSSEAU (carpal), ECG, sensation


Interventions: Diet/supplement, IV calcium gluconate, paper bag, adjust medications

22

Hyperphosphatemia manifestations

>4.5mg/dL

Can be asymptomatic until hypocalcemia, calciphylaxis

23

Hyperphosphatemia assessment/interventions

Assess:
Labs, signs/symptom of hypocalcemia, wounds

Interventions: decrease PO intake, phosphate binders with meals, PTH

24

Hypophospatemia manifestations

<3.0g/dL

Impaired cellular energy/O2 delivery, CNS depression

Weakness

Rhabdo

Soft bones

25

Hypophospatemia assessement/interventions

Assess: LOC, MS, muscles, resp. status, urine output and color

Interventions:

Inc. PO intake, hydration, IV replacement (KPhos, NaPhos)

26

Hypermagnesemia manifestations

>2.1mEq/L

Impaired nerve/muscle function, bradycardia

Low BP

facial flushing, urinary retention, N/V

Loss of DTR, paralysis

27

Hypermagesemia assessment/interventions

Assess LOC, muscles, N/V, reflexes, VS

Interventions:

Decrease PO intake/meds, IV calcium gluconate

If renal=ok then inc. fluid and diuretics

If renal not ok-dialysis

28

Hypomagnesemia manifestations

<1.3mEq/L

Similar to hypocalcemia, cramps, tremors, hyperreflexia, vertigo, seizures, dysrhythmias

29

Hypomagnesemia assessment/interventions

Assess muscle reflexes, VS, ECG, seizures, CHVOSTEK/TROSSEAU, LOC

Interventions:

Inc. PO intake, IV magnesium

30

Sodium range

135-145mEq/L