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Fluid & Electrolyte / Acid & Base Flashcards

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1
Q

Causes of Fluid Volume Excess

A

Heart failure

  • CO down, kidney perfusion down, UOP down
  • no fluid can leave

Renal failure
- kidneys aren’t filtering out excess water

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2
Q

Three things w a lot of sodium

A

effervescent soluble meds
canned / processed foods
IVF w sodium

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3
Q

What two hormones regulate fluid volume?

A

ADH & aldosterone

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4
Q

Aldosterone

A
  • found in adrenal cortex
  • causes body to retain sodium & water
  • increases blood volume
  • it’s a steroid (mineralocorticoid)
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5
Q

Diseases w too much aldosterone

A

Cushing’s Dz

Hyperaldosteronism / Conn’s Dz

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6
Q

Diseases with too little aldosterone

A

Addison’s Dz

- lose sodium & water –> fluid volume deficit

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7
Q

Does ADH make you retain or diurese?

A

retain water ONLY

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8
Q

Too much ADH:

A

retain water
fluid volume excess
SIADH (too much water)

urine concentrated
blood dilute

too little sodium (dilute)

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9
Q

Not enough ADH

A

lose (diurese) water
fluid volume deficit
DI (#1 concern is shock)

urine diluted
blood concentrated

increased sodium

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10
Q

Urine specific gravity, sodium, and hematocrit numbers go ___ when its concentrated?

A

up

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11
Q

What are some causes of ADH problems?

A

craniotomy, head injury, sinus surgery, transsphenoidal hypophysectomy, increased ICP

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12
Q

Another name for ADH

A

vasopression (Pitressin)

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13
Q

What two drugs can be utilized as an ADH replacement in DI?

A

Vasopressin or desmopressin acetate

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14
Q

S/sx of FVE

A

distended neck veins / peripheral veins
— vessels are full

peripheral edema / third spacing
— vessels start to leak

Central Venous Pressure (CVP) increases

Crackles and wetness in lungs

Polyuria
— kidneys trying to get out excess fluid

Increased pulse
— bounding and full

Increased blood pressure

increased weight

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15
Q

Treatment for FVE

A

low sodium diet / restrict fluids

I&O / Daily weights

Diuretics
—-Loop (furosemide) (bumetanide may be given when furosemide doesn’t work)

—-hydrochlorothiazide

—- potassium-sparing (spiralactone)

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16
Q

CVP normal ranges

A

2-6 mmHg

5-10 cmH2O

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17
Q

CVP info

A

measured in right atrium
number increases in FVE
more volume = more pressure

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18
Q

ANP (Atrial natriuretic peptide)

A

released when walls of heart are stretched / makes you lose water & sodium

decreases ADH

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19
Q

bed rest induces

A

diuresis by releasing ANP which decreases ADH production

  • means you can easily become dehydrated, get DVTs, kidney stones, pneumonia, and constipation
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20
Q

Fluid Volume Deficit (hypovolemia) Causes:

A

Loss of fluid from anywhere (thoracentesis, paracentesis, V/D, hemorrhage)
Third spacing (burns, ascites)
Diseases with polyuria (Diabetes)

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21
Q

Ascites

A 
makes it harder to breathe
looks like FVE but is FVD since its third spacing
measure abdominal girth daily
worry hypotension
--- decreased HR (wt may be the same)
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22
Q

Polyuria

A

think shock first!
losing fluids
polyuria –> oliguria –> anuria –> worry about renal failure

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23
Q

S/sx of FVD

A

decreased weight
decreased skin turgor
dry mucous membranes
decreased urine output (kidneys aren’t being perfused or are trying to retain fluids)
decreased BP
increased pulse (weak and thready / compensation)
increased RR (body can’t tell difference b/t decreased volume and O2)
decreased CVP
Peripheral veins / neck veins vasoconstrict (hard to get IV)
cool extremities
increased urine specifiic gravity (very concentrated urine)

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24
Q

Treatment for FVD:

A 
prevent further losses
replace volume (oral or IV)
Safety precautions 
-- higher risk for falls (VS and mental changes)
-- monitor for overload w IV replacement
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25
Isotonic
balanced solutions - goes into vascular space and stays there - NS, LR, D5W, D5(1/4)NS -client that has lost fluids through nausea, vomiting, burns, sweating, and trauma - DO NOT use isotonic w HTN, cardiac or kidney dz - - can cause FVE, HTN, or hypernatremia
26
Hypotonic
Goes into vascular space then shifts out into the cells to replace cellular fluid - rehydrate WITHOUT causing HTN - D2.5W, 1/2 NS, 0.33% NS - used for HTN, renal or cardiac dz, or dilution w hypernatremia and cellular dehydration - - nausea, vomiting, burns, hemorrhage WATCH FOR cellular edema bc fluid is moving out to the cells which could lead to fluid volume deficit and decreased BP
27
Hypertonic
HIGH ALERT / packed w particles - volume expanders that will draw fluid into the vascular space from the cells - --hypertonic solution returns fluid to vasculature - D10W, 3% NS, 5%NS, D5LR, D5(1/2)NS, D5N5, TPN, Albumin, Mag.Sulfate - used w hyponatremia, third spacing (severe), severe edema, burns, ascites - WATCH FOR FVE!! - Monitor in ICU setting w frequent BP, pulse, CVP esp w NS 3 or 5%
28
Isotonic v. Hypotonic v. Hypertonic
Isotonic - stay where I put it Hypotonic - go Out of the vessel Hypertonic - Enter the vessel
29
Magnesium
1.3 - 2.1 mEq/L excreted by kidneys or lost in GI tract (vomiting/ severe diarrhea)
30
Hypermagnesemia Causes
Renal failure | Antacids
31
Hypermagnesemia S/sx
flushing and warmth vasodilation hypermagnesemia and hypercalcemia s/sx: - - decreased DTRs - - weak / flaccid muscles - - increased arrhythmias - - decreased LOC - - decreased pulse - - decreased RR
32
Hypermagnesemia Treatment
ventilator (if RR less than 12) dialysis clacium gluconate (ANTIDOTE** for mag toxicity) (reverses resp. depression) safety precautions
33
Calcium
9.0 - 10.5 mg/dL
34
Hypercalcemia Causes:
Hyperparathyroidism Thiazides Immobilization
35
Hyperparathyroidism
can cause hypercalcemia - too much PTH - when serum calcium gets low, PTH pulls Ca from the bones to put in the blood
36
Hypercalcemia S/sx:
bones are brittle / weak kidney stones Same as hypermagnesemia - - decreased DTRs - - weak / flaccid muscles - - increased arrhythmias - - decreased LOC - - decreased pulse - - decreased RR
37
Hypercalcemia Treatment
``` activity fluids prevent kidney stones phosphurous in diet (inverse relationship w ca) steroids (decrease ca) safety precautions ``` Meds that decrease serum Ca: - - Biphosphates (etidronate) - - Calcitonin
38
Calcitonin
treats hypercalcemia and osteoporosis?
39
Hypomagnesemia Causes
diarrhea alcoholism (alcohol suppresses ADH / hypertonic) not eating / drinking
40
Hypomagnesemia S/sx
- rigid / tight muscle tone - seizures - stridor / laryyngospasm - +Chvostek's - +Trousseau's - arrhythmias - DTRs increased - mental changes - dysphagia
41
Hypomagnesemia Treatment
- give / eat Mg - check kidney function (before and during) - seizure precautions
42
Foods high in magnesium
spinach, mustard greens, summer squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, celery, kale, sunflower seeds, sesame seeds, flax seeds
43
Causes of Hypocalcemia
hypoparathyroidism radical neck thyroidectomy ** not enough PTH which decreases serum Ca
44
Hypocalcemia S/sx:
- rigid / tight muscle tone - seizures - stridor / laryyngospasm - +Chvostek's - +Trousseau's - arrhythmias - DTRs increased - mental changes - dysphagia
45
Hypocalcemia Treatment
PO calcium IV calcium (give slowly or heart arrythmia) (heart monitor) Vitamin D Phosphate binders (inverse relationship so decreasing phosphate will increase Ca) -- sevelamer hydrochloride -- calcium acetate
46
Sodium
Think Neuro Changes!! Sodium is dependent on water levels 135-145 mEq/L
47
Hypernatremia vs. Hyponatremia
hyper = dehydration hypo = dilution
48
Hypernatremia Causes:
hyperventilation heat stroke DI
49
Hypernatremia S/sx
dry mouth thirst swollen tongue neurochanges
50
Hypernatremia Treatment
``` restrict sodium dilute w fluids daily weights I&Os Lab Work ```
51
Hyponatremia Causes
Drinking H2O for fluid replacement psychogenic polydipsia D5W SIADH
52
Hyponatremia S/sx
headache seizure coma
53
Hyponatremia Treatment
client needs sodium / not a lot of water neuro problems = they need to be on hypertonic saline
54
3% or 5% NS can cause...?
cerebral edema
55
Potassium
excreted by kidneys (poor kidney function = increased potassium) 3.5-5.0 mEq/L
56
Hyperkalemia Causes:
kidney trouble spironolactone
57
Hyperkalemia S/sx
begins w muscle TWITCHING then proceeds to muscle WEAKNESS then FLACCID PARALYSIS --> life-threatening arrhythmias
58
ECG changes w hyperkalemia
``` bradycardia tall and peaked T waves prolonged PR intervals flat or absent P waves widened QRS conduction blocks ventricular fibrillation ```
59
Hyperkalemia Treatment
dialysis (kidneys aren't working) calcium gluconate (decreases arrhythmias) Glucose and insulin Sodium polystyrene sulfonate (Kayexalate) (enema)
60
Potassium has an inverse relationship with ...?
sodium
61
Any time you give IV insulin, worry about _________ and _________.
hypokalemia and hypoglycemia
62
Hypokalemia Causes
vomitting NG suction diuretics (other than spiralactone) not eating
63
Hypokalemia S/sx
muscle crmaps | muscle weakeness --> flaccid paralysis --> life-threatening arrhythmias
64
Hypokalemia Treatment
Give potassium spironolactone makes client retain potassium eat more potassium
65
ECG Changes with hypokalemia
U waves, PVCs, ventricular tachycardia
66
How to fix GI upset with oral potassium
give w food
67
What do we need to assess with IV potassium
Urinary output before and during
68
IV potassium always needs to be on
a pump! never gravity
69
Foods high in potassium
spinach, fennel, kale, mustard greens, brussel sprouts, broccoli, eggplant, cantaloupe, tomatoes, parsley, cucumber, bell pepper, apricots, ginger root, strawberries, avocado, banana, tuna, halibut, cauliflower, kiwi, oranges, lima beans, potatoes, cabbage
70
Normal pH range
7.35 - 7.45
71
acidotic person
lethargic
72
alkalotic person
excitable CNS is stimulated / sensitive
73
Hyperventilation
more CO2 getting out
74
hypoventilation
not eliminating CO2
75
Respiratory Acidosis
**ACUTE Lungs have problem so kidneys compensate! -CO2 is the problem. Too MUCH. Caused by HYPOventilation. Kidneys compensate with bicarb and hydrogen. It'll excrete hydrogen and retain bicarb.
76
PaO2
80-100 mmHg
77
PaCO2
35-45 mmHg
78
HCO3
Bicarb | 22-26 mEq/L
79
increased CO2 means?
decreased LOC
80
increased CO2 means?
decreased O2 (inverse relationship)
81
Causes of resp acidosis
retain CO2 - mid-abdominal incision, narcotics, sleeping pills, pneumothorax, collapsed lung, pneumonia * anything that decreases RR or gas exchange * anything that causes HYPOventilation (decreased RR)
82
Restlessness thing _____ first!
hypoxia early signs of hypoxia are tachycardia and restlessness
83
S/sx of resp acidosis
headache / confusion / sleepy / coma Hypoxic (give oxygen)
84
Resp acidosis treatment
fix the breathing problem! - if pneumonia is cause... liqueefy and mobilize secretions - percusion, deep breathing, suctioning, fluids, elevate HOB, IS - pneumothorax = chest tubes - post -op = turn, cough, deep breathe
85
respiratory alkalosis
too little CO2 = HYPERventilation Kidneys will excrete bicarb and retain hydrogen
86
Causes of resp alkalosis
hyperventilation = hysterical (client breathing too fast) = acute aspirin OD (client breathing too fast)
87
S/sx of resp alkalosis
lightheaded or faint feeling peri-oral numbness numbless and tingling in fingers & toes
88
Treatment for resp alkalosis
may have to sedate to decrease RR treat the cause monitor ABGs
89
Metabolic Acidosis
lungs compensate with CO2 by increased RR to blow off acid (hyperventilate) too little bicarb and too much hydrogen
90
Causes of metabolic acidosis
DKA Starvation Renal Failure Severe diarrhea *DKA and starvation due to breakdown of ketones
91
S/sx of metabolic acidosis
depend on cause hyperkalemia (muscle twitching, muscle weakness, flaccid paralysis, arrhythmias) increased RR (Kussmaul respirations for DKA)
92
Treatment for metabolic acidosis
Treat problem
93
Causes of Metabolic Alkalosis
loss of upper GI contents (vomiting, NG suctioning) too many antacids
94
Upper GI tract think _____ Lower GI tract think _____
``` upper = acid lower = base ```
95
S/sx of Metabolic Alkalosis
depends on cause observe LOC serum potassium will decrease monitor for mucle cramps and life threatening arrhythmias (Hypokalemia)
96
serum potassium will ______ in metabolic acidosis and _________ in metabolic alkalosis
increase decrease
97
Treatment for metabolic alkalosis
fix problem replace potassium
98
Phosphate binders
(inverse relationship so decreasing phosphate will increase Ca) - - sevelamer hydrochloride - - calcium acetate

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