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Fluid & Electrolytes Flashcards

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1
Q

Hypovolemia
Signs/symptoms

A

Acute weight loss
Poor skin turgor
Concentrated urine
Low BP
High HR
Dizziness, weakness, confusion
Cool clammy skin

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2
Q

Hypovolemia
Treatment

A

Treat cause
Isotonic IV fluid administration
Monitor vital signs (BP and HR)
Skin assessments
I+O

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3
Q

Dehydration vs hypovolemia

A

Hypovolemia means electrolyte and water loss in the same ratio

Dehydration may have elevated sodium

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4
Q

Hypervolemia
Signs/symptoms

A

Edema
Distended neckveins
SOB
Crackles in lungs
Acute weight gain
High BP
Bounding pulse
Increased urine output

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5
Q

Hypervolemia
Treatment

A

Diuretics
Restricted dietary sodium
Dialysis for kidney failure
Monitor I+O and vital signs (BP and HR)
Respiratory, cardiac, and skin assessments

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6
Q

Hypervolemia
Causes

A

Retention of water and sodium in extracellular space
Kidney failure
Heart failure

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7
Q

General functions of electrolytes

A

-Contraction of muscle
-Sending nerve impulses
-Creating bones
-Maintaining acid-base balance
-Balancing fluids in body

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8
Q

What two hormones have the biggest effect on fluid & electrolytes?

A

Aldosterone
ADH

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9
Q

What are the main functions of sodium in the body?

A

-Regulates water in and out of the cell
-Muscle contraction
-Nerve impulses

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10
Q

Main causes of hyponatremia

A

-Low consumption
-Diuretics - especially thiazides
-Vomiting, GI suction
-Diarrhea, sweating
-Addison’s disease (low aldosterone)
-SIADH (Syndrome of Inappropriate Antidiuretic Hormone)

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11
Q

What are the signs and symptoms of hyponatremia?

A

SALT LOSS

Seizures & stupor
Abdominal cramping
Lethargic
Tendon reflexes diminished, trouble concentrating

Loss of appetite
Orthostatic hypotension, Overactive bowel sounds
Spasms of muscles
Shallow respirations (late)

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12
Q

What causes hypernatremia?

A

-Consumption is high (e.g. hypertonic solutions) or consumption of water is low (or water is lost [e.g. burns, diabetes insipidus])
-Corticosteroids
-Cushing’s (high cortisol)
-Conn’s Syndrome (high aldosterone)

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13
Q

What are the signs & symptoms of hypernatremia?

A

FRIED

Fatigue
Restless agitation
Increased reflexes (seizure/coma)
Extreme thirst
Decreased urine output, dry mouth/skin

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14
Q

Signs of dehydration

A

Increased HR
Decreased BP
Fever
Vomiting
Diarrhea
Lethargic

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15
Q

What are the main causes of hypokalemia?

A

-Loop diuretics
-Corticosteroids
-Insulin
-Cushing’s (high cortisol)
-Starvation
-Metabolic alkalosis
-Vomiting, diarrhea

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16
Q

What affect does Cushing’s have on sodium and potassium?

A

Increases cortisol
Increases sodium
Decreases potassium

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17
Q

If you have a high sodium level, you probably have a _____ potassium level

A

LOW

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18
Q

If you have a high potassium level, you probably have a ____ sodium level

A

LOW

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19
Q

Signs and symptoms of hypokalemia

A

muscle weakness
Ventricular asystole or fibrillation
EKG: T wave inversion, ST depression, prominent U wave

Seven L’s

Lethargic
Low, shallow respirations
Lethal cardiac dysrhythmias
Lots of urine
Leg cramps
Limp muscles
Low BP & HR

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20
Q

Causes of hyperkalemia

A

-Burns, tissue damage such as in rhabdomylosis (breakdown of muscle)
-Addison’s disease (decreased aldosterone)
-Renal failure
-Meds: potassium-sparing diuretics (like spironolactone), ACE inhibitors, NSAIDs

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21
Q

Signs and symptoms of hyperkalemia

A

Muscle weakness, cramps
Decreased Urine Output
Dysrhythmias

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22
Q

What 3 hormones are most important in regulating calcium?

A

Vitamin D
PTH
Calcitonin

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23
Q

What are the causes of hypocalcemia?

A

-Decreased PTH (thyroidectomy)
-Decreased intake (lactose intolerant)
-Low vitamin D
-CKD
-Bisphosophonates
-Aminoglycosides (“mycin” - cause kidneys to waste calcium)
-Anticonvulsants that affect Vitamin D (phenobarbital, phenytoin)
-Malabsorption

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24
Q

Bisphosphonates:
Use & Mechanism

A

-Osteoporosis
-Slow down the ability of the bones to release calcium into the blood

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25
Signs and symptoms of hypocalcemia
CRAMPS Convulsions Reflexes hyperactive Arrhythmias (prolonged QT interval) Muscles spasms (tetany) Positive signs (Trousseau's, Chvostek's) Sensation of tingling/numbness +Osteoporosis
26
How do you assess for Trousseau's sign?
Inflate cuff greater than SBP, hold for 3 mins, observe hand spasms.
27
What gland makes calcitonin?
Thyroid gland
28
What glands make PTH?
Parathyroid glands
29
Chvostek's Sign
-Sign of hypocalcemia -Nerve hyperexcitability of cranial nerve VII -To test, tap the masseter muscle at angle of mandible -Positive sign: facial muscles contract or twitch
30
What are the common causes of hypercalcemia?
-Hyperactive PTH -Vitamin D or calcium supplements -Thiazides, Lithium (PTH affected) -Cancer (when it spreads to bones)
31
What are the common signs/symptoms of hypercalcemia?
WEAK Weakness of muscle (profound) EKG changes - shortened ST and QT interval, heart block Absent reflexes, altered mental status, ABD distention-> N/V Kidney stones
32
What are the common causes of hypomagnesemia?
-Not consuming enough -Other electrolyte imbalances (calcium, potassium) -Malabsorption disorders -PPIs -Alcoholism
33
Signs and symptoms of hypomagnesemia
TWITCH Trousseau & Chvostek Sign Weakness Increased deep tendon reflex Torsades de pointes/ tetany Calcium & Potassium levels low Hypertension
34
What are the common causes of hypermagnesemia?
-Rare - usually from trying to correct low mag or magnesium sulfate (L&D) -Impaired renal function
35
Signs and symptoms of hypermagnesemia
LETHARGIC Lethargic (profound) EKG changes - prolonged PR/QT interval & QRS complex -Tendon reflexes absent/diminished -Hypotension -Arrhythmias (bradycardia, heart block) -Red and hot face (flushing) -GI issues (N/V) -Impaired breathing (skeletal weakness) -Confusion
36
If you have a low calcium level, you likely also have a ____ magnesium level
low
37
What are the common causes of hypophosphatemia?
-Aluminum antacids (block gut absorption of phosphate) -Starvation/refeeding syndrome (phosphate is needed to convert glucose into energy) -Overactive parathyroid -Low vitamin D levels
38
What are the common causes of hyperphosphatemia?
-Phosphate laxatives (fleet enemas) -Too much vitamin D -Rhabdomyolysis - Renal damage -Hypoparathyroidism
39
Signs and symptoms of hypophosphatemia
BONE Bone pain and fractures Osteomalacia (softening of the bones - rickets) Neuro status changes Erythrocyte destruction
40
Signs and symptoms of hyperphosphatemia
CRAMPS Convulsions Reflexes hyperactive Arrhythmias (prolonged QT interval) Muscles spasms (tetany) Positive signs (Trousseau's, Chvostek's) Sensation of tingling/numbness
41
1/2 NS 1/4 NS and 1/3 NS are all _______ solutions
Hypotonic
42
0.9% NS D5 1/3 NS LR are all _____ solutions
Isotonic
43
This solution is isotonic in the bag, but turns hypotonic in the body (due to glucose metabolism)
D5W
44
3% NS 5% NS D10W D5NS D5 1/2 NS D5LR are all examples of _____ solutions
Hypertonic
45
This type of solution causes cells to swell and cell lysis
Hypotonic
46
This type of solution causes cells to shrink
Hypertonic
47
This type of solution can cause hypovolemia
Hypotonic
48
This type of solution can cause hypervolemia
Hypertonic
49
This type of solution is contraindicated in patients s/p surgery, hypotension, ICP, burns, and trauma
Hypotonic
50
What kind of solution has the following indications: Dehydrated cells DKA Hyperosmolar hyperglycemia (HHS)
Hypotonic
51
What kind of solution has the following indications: Blood loss Surgery Dehydration from vomiting or diarrhea Hypovolemia Fluid volume deficit Hypotension
Isotonic
52
What kind of solution has the following indications: Hyponatremia Cerebral edema
Hypertonic
53
This type of solution replaces extracellular fluid
Isotonic
54
What kind of solution(s) increase vascular volume?
Hypertonic Isotonic
55
Contraindications for isotonic solutions
Hypervolemia
56
Contraindications for hypotonic solutions
S/p surgery Hypotension Trauma Burns ICP
57
Contraindications for hypertonic solutions
HTN Intracellular dehydration Hyperosmolar state
58
How do you treat hyponatremia?
-Replace sodium -Restrict fluids -Arginine vasopressin receptor antagonists (ex: conivaptan HCL [Vaprisol] and tolvaptan [Samsca] -Monitor electrolytes, fluid balance, I&O, daily weights Keep in mind, you have to do it slowly.
59
Hypokalemia: Treatment
-Treat underlying cause -Oral or parenteral KCL -If mild-moderate deficiency, oral K, recheck next day -If severe, IV K, check in a few hours -Monitor for the s/s in pts at risk -Encourage diet rich in K+ -Place pt on cardiac monitor
60
Daily requirements for sodium
meq 100-150
61
How much Mg, Ca, and Phos does the body store?
Healthy body has several weeks of stores of Mg, Ca, and Phos
62
Fluid requirements for resuscitation: For rapid and massive losses, replace fluids at a ratio of _____
3 to 1
63
Treatment of hyperkalemia
-Treat underlying cause -If mild, restrict K+ intake -If severe administer kayexalate D50 with insulin -Monitor ECG -Calcium gluconate
64
What does an EKG look like for a patient with hyperkalemia?
Tented T waves Prolonged PR interval and QRS Absent P waves ST depression
65
What does hypomagnesemia look like on an ECG?
PVCs on ECG Flat or inverted T wave Depressed ST segment Prolonged PR interval and widened QRS
66
What kind of solution is contraindicated for the conditions? HTN Intracellular dehydration Hyperosmolar state
Hypertonic
67
When are hypertonic solutions indicated?
Severe hypotension S/p neuro surgery, ICP
68
Expected Serum Osmolality
275-290 mosm/L
69
Diabetes Inspidus - treatment for hypernatremia
Use desmopressin acetate (synthetic ADH)- holds on to fluid to dilute concentrated sodium
70
Treatment for hypernatremia
-Gradual lowering of serum sodium levels (too quickly can cause cerebral edema) -Use of isotonic or hypotonic solution -Diuretics -Strict I+O management -Monitor patient’s thirst level, ----Monitor for elevated body temperature, restlessness, disorientation and lethargy
71
Treatment for hyperkalemia
Treat underlying cause -if mild: restrict intake (bananas, oranges, potatoes, tomatoes) -if severe: administer kayexalate or D50 with insulin, monitor ECG, calcium gluconate
72
Treatment for hypocalcemia
Oral supplement of calcium with Vit D, IV replacement if severe, seizure precautions if severe, monitor ECG
73
Treatment of hypercalcemia
Treat underlying cause, IV fluid with diuretic, calcitonin, increase mobility, monitor ECG
74
Hypomagnesemia: Treatment
Increase intake, IV or PO supplements, monitor ECG, seizure precautions, monitor for dysphagia
75
Hypermagnesemia: Treatment
IV calcium gluconate, Hemodialysis, Monitor VS and ECG, Monitor for decreased deep tendon reflexes, Changes in LOC, diuretics
76
- An isotonic solution that expands the extracellular fluid (ECF) volume; used in hypovolemic states, resuscitative efforts, shock, diabetic ketoacidosis, metabolic alkalosis, hypercalcemia, mild Na+ deficit -Not for maintenance
0.9% NaCl
77

Med-Surg (7 decks)

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