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Flashcards in Fluid and Electrolytes Deck (54)
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1

vascular space

fluid volume excess
any vessels- veins, arteries, capillaries

2

fluid volume excess

too much fluid in vascular space
build up of pressure-can leak into interstitial space

3

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)

4

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

5

action of ADH

retain H2O

6

too much ADH

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

7

not enough ADH

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

8

Concentrated vs Dilute for values

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

urine specific gravity
sodium
hematocrit

9

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

10

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

11

CVP

measured in R atrium

normal 2-6mmHg
normal 5-10 cmH2O

12

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

13

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

14

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)

15

FVD treatment

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

16

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

17

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)

18

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

19

other names for TPN

PN or TNA

20

***** 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

21

Mg and Ca

act like sedatives

**** think muscles first

22

hypermagnesemia causes

renal failure
antacids

23

hypermagnesemia S/S

flushing and warmth
vasodilation

24

hypermagnesemia treatment

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

25

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

26

hypercalcemia s/s

brittle bones
kidney stones

27

hypercalcemia treatment

move

fluids to prevent stones

add protein (phosphorus) to diet*** inverse relationship

steroids

safety

biphosphates
calcitonin

28

Ca levels

9.0-10.5

29

Mg levels

1.3-2.1

30

common s/s for high Mg and Ca

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