Fluid and Electrolytes Flashcards by Brianna Koopman

vascular space

fluid volume excess

any vessels- veins, arteries, capillaries

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fluid volume excess

too much fluid in vascular space

build up of pressure-can leak into interstitial space

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causes of FVE

heart failure (weak heart, decreased CO, decreased kidney perfusion, decreased urinary output, ** volume stays in vascular space

renal failure (kidneys don’t work *** stay in vascular space

excess Na (effervescent soluble meds, canned/processed foods, IVF with Na)

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hormonal regulation of fluid volume

aldosterone

adrenal glands above kidneys

when blood volume gets low r/t vomiting, hemorrhage aldosterone secretion increases to retain sodium and water and blood volume goes up

too much aldosterone (too much Na and water): Cushings, hyperaldosteroism–Conn’s)

too little aldosterone: Addisons

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action of ADH

retain H2O

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too much ADH

retain H20
FVE
SIADH (too many letters too much water)
urine concentrated
blood dilute
urine decreases

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not enough ADH

lose (diurese) H2O
FVD
DI ***** can go into shock
urine dilute
blood concentrated

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Concentrated vs Dilute for values

concentrated makes the #s go up
dilute makes the #s go down

urine specific gravity
sodium
hematocrit

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Words that make you think ADH issue

found in pituitary gland

craniotomy
head injury
sinus injury
transsphenoidal hypophysectomy (going through nose to remove pituitary) 
anything that can lead to increased ICP

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S/S of FVE

distended neck veins/peripheral veins (vessels are full)
peripheral edema/third spacing (vessels can’t hold anymore and start to leak)
CVP increases (more volume = more pressure)
crackles in lungs (heard at bases first)
polyuria (kidneys are trying to help you diurese
increased pulse (palpate artery, full and bounding, fluid is moving back into the lungs–HF and pulmonary edema)
BP increases (more volume more pressure)
weight increases

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CVP

measured in R atrium

normal 2-6mmHg
normal 5-10 cmH2O

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FVE treatment/interventions

low Na
restrict fluids
I and O 
daily weights
diuretics (furosemide or Bumetanide)-- Loop and will lose K+
hydrochlorothiazide
Spironolactone (retains K+)
bed rest 
**** if no hx give fluids fast
give IVF slow to elderly, young, or any heart or kidney issues 
**** watch lab values while on

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FVD causes

***** SHOCK
loss of fluid (thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage)

third spacing (fluid in a place that does no good ** not in vascular space)– burns, ascites

diseases with polyuria (DI)

polyuria–> oliguria–> anuria

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S/S of FVD

decreased weight
decreased skin turgor
dry mucous membranes
decreased urine output (kidneys not being perfused and hold on to urine to compensate)
BP decreases (less volume = less pressure)
pulse increases (weak and thready)
respirations increase
CVP decreases (less volume = less pressure)
peripheral veins/neck veins vasoconstrict (tiny)
cool extremities (peripheral vasoconstriction to shunt blood to vital organs)
urine specific gravity increases (concentrated)

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FVD treatment

prevent further loss
replace (PO or IV)
** safety r/t risk for falls, monitor for overload with IV

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isotonic solutions

stays in vascular space

NS
LR
D5W

Uses: lost fluids through N/V, burns, sweat, trauma

** don’t use with those who have HTN, cardiac or renal diseases

can cause FVE, HTN, or hypernatremia

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hypotonic solutions

goes into vascular space and then shifts into the cells to replace cellular fluid

hydrate w/o causing HTN

D2.5W, 1/2 NS, 0.33% NS

Uses: HTN, renal, or cardiac diseases and needs fluid replacement

** watch for cellular edema r/t fluid moving to the ells and can cause FVD and decreased BP (leaving vascular space)

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hypertonic solutions

leave cells to go into vascular space

D10W, 3% NS, 5%NS, D5LR, D5 1/2 NS, D5NS, TPN, Albumin

Uses: hyponatremia, 3rd spacing, severe edema, burns, or ascites

** watch for FVE, monitor in ICU if taking 3 or 5% NS

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other names for TPN

PN or TNA

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***** HIGH ALERT

MEDS TO DOUBLE CHECK WITH A 2ND NURSE

insulin
opiates and narcotics
injectable K chloride or phosphate concentrate
IV anticoags
sodium chloride solutions about 0.9 percent

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Mg and Ca

act like sedatives

** think muscles first

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hypermagnesemia causes

renal failure

antacids

hypermagnesemia S/S

flushing and warmth

vasodilation

hypermagnesemia treatment

ventilator
dialysis
calcium gluconate (antidote for Mg toxicity)*** administered very slow
safety precautions

hypercalcemia causes

hyperparathryoidism (serum Ca gets low, PTH kicks in and pulls Ca from bone to go into blood so serum Ca goes up) thiazides (retain Ca) immobilization

hypercalcemia s/s

brittle bones | kidney stones

hypercalcemia treatment

move fluids to prevent stones add protein (phosphorus) to diet*** inverse relationship steroids safety biphosphates calcitonin

Ca levels

9.0-10.5

Mg levels

1.3-2.1

common s/s for high Mg and Ca

``` DTRs decreases weak/flaccid muscle tone arrhythmia decreased LOC decreased pulse decreased respirations ```

hypomagnesemia causes

diarrhea | alcoholism

hypocalcemia causes

hypoparathyroidism radical neck thyroidectomy *** not enough PTH so serum Ca decreases

s/s for low Ca and Mg

``` tight/rigid muscle tone seizures stridor/laryngospasms (airway is smooth muscle) positive Chvostek's positive Trousseaus arrhythmia (heart is a muscle) DTRs increase mind changes swallowing issues (esophagus is a smooth muscle) ```

hypomagnesemia treatment

Mg assess kidney function during IV Mg seizure precautions stop IV Mg if they report flushing and sweating

foods high in Mg

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

hypocalcemia treatment

Ca IV Ca give SLOW and always on a heart monitor Vit D sevelamer hydrochloride or calcium acetate (phosphate binders)

sodium

think neuro changes depends on how much H2O you have in the blood

sodium levels

135-145

hypernatremia causes

dehydration too much Na not enough H2O hyperventilation heat stroke DI feeding tube clients

hypernatremia s/s

dry mouth thirsty swollen tongue neuro changes

hypernatremia treatment

``` restrict Na dilute client with fluids daily weights i & O labs ```

hyponatremia causes

``` too much H2O not enough Na drinking H2O for fluid replacement psychogenic polydipsia (loves to drink H2O) D5W (sugar and water) SIADH ```

hyponatremia s/s

headache seizure coma

hyponatremia treatment

give Na restrict H2O 3 or 5% NS if having neuro problems (hypertonic solution)

potassium levels/patho

3.5-5 excreted by kidneys increased K if kidneys dont work

hyperkalemia causes

kidney issues | spironolactone (retains K)

hyperkalemia s/s

``` arrhythmia muscle twitching/weakness flaccid paralysis bradycardia tall and peaked T waves prolonged PR intervals flat or absent P waves widened QRS vfib conduction blocks ```

hyperkalemia treatment

``` dialysis calcium gluconate (decreases arrhythmia) glucose and insulin (carries K into the cell) sodium polystyrene sulfonate (exchange Na for K in GI tract) ```

Na and K

inverse relationship

hypokalemia causes

vomiting NG suction diuretics not eating

hypokalemia s/s

``` muscle cramps/weakness arrhythmia U waves PVC vtach ```

hypokalemia treatment

give K | spironolactone (retains K)

what to do before/ during administering IV K

``` assess urinary output always put on pump mix well never give as a push can burn as infusion ```

foods high in K

``` greens (spinach, kale, mustard greens, brussel sprouts, broccoli, cucumber, bell pepper, cabbage, avocado) fruits (cantaloupe, tomatoes, apricots, banana, strawberries, kiwi, oranges) fennel eggplant parsley ginger roots tuna halibut cauliflower lima beans potatoes ```