Fluid and electrolytes Flashcards
oncotic pressure
pulls fluid
Hydrostatic pressure
pushes fluid
First spacing
Normal distribution of fluids in ICF and ECF
Second spacing
Abnormal interstitial fluid (edema)
Third spacing
Fluid collection in a place difficult or impossible to move back to cells (Ascites, edema from burnsF)
Fluid volume deficit vs dehdyration
Fluid volume deficit is water AND sodium loss
Dehydration is just water loss
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
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
Sodium range
135-145mEq/L
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)
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
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
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
Hyperkalemia manifestations
> 5mEq/L
Overexcited nerve/muscle impulse (HIGH POTASSIUM=HIGH CONTRACTION)
Cardiac irregularity, weak muscle tone, cramping, D/V, d/t,
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)
Hypokalemia manifestations
<3.5mEq/L
Impaired muscle contraction (LOW POTASSIUM=LOW CONTRACTION)
decreased reflexes, shallow respirations, constipation, hyperglycemia
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
Hypercalcemia manifestations >10.5mg/dL
Acidosis, reduced muscle excitability/tone, fatigue, hallucination, N/V/anorexia, bone pain/fractures, polyuria, confusion
Hypercalcemia assessments and intervention
Assess LOC, MS, Muscles, ECG, pain, seizures
Interventions:
Low Ca intake, inc. activity, hydrate IV meds (saline, bisphosphonates, calcitonin)
Hypocalcemia manifestations
<9.0mg/dL
Cell membrane depolarization, sustained contraction/tetany, decreased cardiac contractions, tingling
Hypocalcemia assessment and interventions
Assess: Swallowing, breathing, CHVOSTEK (face), TROSSEAU (carpal), ECG, sensation
Interventions: Diet/supplement, IV calcium gluconate, paper bag, adjust medications
Hyperphosphatemia manifestations
> 4.5mg/dL
Can be asymptomatic until hypocalcemia, calciphylaxis
Hyperphosphatemia assessment/interventions
Assess:
Labs, signs/symptom of hypocalcemia, wounds
Interventions: decrease PO intake, phosphate binders with meals, PTH
Hypophospatemia manifestations
<3.0g/dL
Impaired cellular energy/O2 delivery, CNS depression
Weakness
Rhabdo
Soft bones
