FLUID & ELECTROLYTES

Question 1

FLUID VOLUME EXCESS……

Answer 1

HYPERVOLEMIA

too much fluid/vascular space

Question 2

Fluid volume excess/ Causes….

Answer 2

Heart failure, renal failure, processed foods, IVF with sodium, effervescent soluble meds

Question 3

Aldosterone secretion increases…….

Answer 3

Retain sodium/water=> Blood volume goes UP

Question 4

SIADH
too many letters
too much water

Answer 4

Fluid volume excess
Urine concentrated
Blood Diluted

Question 5

Concentrated makes the #s go down

Dilute makes the #s go down

Answer 5

Urine specific gravity, sodium and hematocrit

Question 6

ADH found in…….

Answer 6

Pituitary Gland

Question 7

ADH replacement in Diabetes Insipidus….

Answer 7

Vasopressin or Desmopressin acetate

Question 8

Diabetes Insipidus

losing water, worried about…..

Answer 8

SHOCK
Urine diluted
Blood concentrated

Question 9

Fluid volume excess

S&S

Answer 9

JVD, peripheral edema, crackles in lungs, Polyuria

Increased CVP, Pulse, BP, Weight

Question 10

FVE

Treatments…….

Answer 10

low sodium, limit fluids, diuretics, bedrest, give IV’s slowly to very young, also heart/kidney problems

Question 11

FVD=Hypovolemia
Worry about……
Causes…….

Answer 11

SHOCK

Fluid loss from anywhere/procedures, 3rd spacing, Diseases with polyuria….think shock 1st

Question 12

FVD

S&S……..

Answer 12

Weight loss, dry mucous membranes
Increased pulse, respirations, urine specific gravity
Decreased BP, skin turgor, UO, CVP

Question 13

FVD

Treatment……

Answer 13

Prevent further fluid loss, replace fluids, Safety precautions/fall risk

Question 14

ISOTONIC SOLUTIONS

Examples, Uses, Alerts……..

Answer 14

NS 0.9%, LR, D5W, D5 1/4 NS
Fluid loss from vomiting, burns, sweating, trauma, Use NS when giving blood
Don’t use these with hypertension, cardiac disease or kidney disease.

Question 15

HYPOTONIC SOLUTIONS

Examples, Uses, Alerts……..

Answer 15

D2.5W, 1/2NS, 0.33%NS
Hypertension, cardiac/renal disease, hemorrhage, hypernatremia, cellular dehydration
Watch for cellular edema, FVD, decreased BP

Question 16

HYPERTONIC SOLUTIONS(packed with particles)
Examples, Uses, Alerts.....

Answer 16

D10W, 3%NS, D5LR, D5 1/2NS, TPN, Albumin
Hyponatremia, 3rd spacing, severe edema, burns, ascites
Watch for FVE, Monitor in ICU setting bp, pulse and cvp

Question 17

J CO’s Top 5 High Alert Meds

Double check with 2nd nurse!!!……

Answer 17

Insulin, Narcotics, Injectable Potassium or Phosphate, IV Anticoagulants, IV sodium solutions above 0.9%

Question 18

Magnesium & Calcium, Act like…………

Answer 18

Sedatives

Think muscles 1st

Question 19

Hypermagnesemia

Causes, S&S, Treatment……..

Answer 19

Renal failure, Antacids

Flushing & warmth, Mg causes vasodilation, Arrhythmias, Decreased DTR’s, Muscle tone, LOC, pulse, respirations

Ventilator, Dialysis, Safety precautions, Antidote for Mag toxicity-Calcium gluconate

Question 20

Hypercalcemia
Causes, S&S, Treatment………..

Calcium & Phosphate= Inverse Relationship

Answer 20

Hyperparathyroidism, Thiazides, Immobilization

Brittle bones, kidney stones, Decreased DTR’s, Muscle tone, LOC, pulse, respirations

Move around, fluids, Protein, Steroids. Safety precautions, Medications to decrease serum Ca: Biphosphates, Calcitonin

Question 21

Hypomagnesemia

Causes, S&S, Treatment………….

Answer 21

Diarrhea/Mg in intestines, Alcoholism= suppresses ADH & it’s not hypertonic

Rigid/tight muscles, seizure, Laryngospasm, +Chvostek’s, +Trousseau’s, Arrhythmias, Mind changes, Swallowing problems, Increase DTR’s

PO Calcium, IV Ca(give slowly, heart monitor), Vitamin D, Phosphate binders

Question 22

Sodium= Think……

Answer 22

Neuro Changes

135-145

Level is dependent on how much water is in the blood

Question 23

Hypernatremia= Dehydration

Causes, S&S, Treatment………..

Answer 23

Hyperventilation, heat stroke, Diabetes Insipidus

Dry mouth, Thirsty, Swollen tongue, Neuro Changes

Restrict Sodium, Fluids will decrease levels, Daily weights, I & O, Lab work

Question 24

Hyponatremia= Dilution

Causes, S&S, Treatment………

Answer 24

Drinking too much water, D5W, SIADH

Headache, Seizure, Coma

Sodium, Restrict water, If Neuro problems 3%NS or 5%NS

Question 25

Potassium excreted by the kidneys, if not working well serum potassium will go....................

Answer 25

UP

Question 26

Hyperkalemia Causes, S&S, Treatment........................ Potassium & Sodium= Inverse Relationship

Answer 26

Kidney trouble, Spironolactone=retain K+ 1st Muscle twitching, Life threatening Arrhythmias, Then muscle weakness, finally flaccid paralysis Dialysis, Calcium gluconate/decreases Arrhythmias, Glucose & Insulin, Sodium polystyrene sulfonate

Question 27

Hypokalemia Causes, S&S, Treatment...........

Answer 27

Vomiting, NG Suction/K+ in stomach, Diuretics, Not eating Muscle cramps, muscle weakness Give Potassium, Spironolactone/retain K+, Eat more K+

Question 28

``` Oral K+ problem....... Assess UO......... Always put K+ on a......... Mix well Never give K+......... Does K+ burn during infusion?....... ```

Answer 28

GI upset/ give with food Before/during IV potassium Pump IV Push Yes, watch IV site