Fluid & Electrolytes Flashcards by Rachel Mason

3 causes of fluid volume excess (hypervolemia):

Heart Failure
Renal Failure
Too much sodium

How well did you know this?

Not at all

Perfectly

3 things with excess sodium:

Effervescent soluble meds (Alka-Seltzer)
Canned, processed foods
IVF with Na

How well did you know this?

Not at all

Perfectly

What 3 hormones can regulate fluid volume and where are they released from?

1) Aldosterone - adrenal glands when vol too low
2) Atrial Natriuretic Peptide (ANP) - Atria of heart when vol too high
3) ADH - pituitary gland when vol too low

How well did you know this?

Not at all

Perfectly

Aldosterone retains ___ and ___
ANP excretes ___ and ___
ADH retains ___ ___

Aldosterone: Sodium and water
ANP: Sodium and water
ADH: water ONLY

How well did you know this?

Not at all

Perfectly

ADH excess leads to ____

ADH insufficiency leads to ____

Excess - SIADH (Syndrome of “INCREASED” ADH)

Insufficiency - DI (DI-uresis)

How well did you know this?

Not at all

Perfectly

Concentrated makes the #’s go ___
Dilute makes the #’s go ___
What are these 3 values effected here?

Concentrated --> Up
Dilute --> Down (remember the D's)
3 values: 
- Urine specific gravity
- Sodium
- Hct

How well did you know this?

Not at all

Perfectly

Central venous pressure (CVP) is measured in the ___ ___

Right atrium

How well did you know this?

Not at all

Perfectly

For fluid excess in the lungs, listen where?

Lower posterior area (due to gravity pooling it there)

How well did you know this?

Not at all

Perfectly

Fluid excess, the heart will beat faster or slower? Why?

Faster…Heart is trying to move fluid forward

How well did you know this?

Not at all

Perfectly

When getting daily weight, remember what?

Same:

time
clothes
scale
void 1st!!!

How well did you know this?

Not at all

Perfectly

If fluid retention…think ____ problems 1st.

Heart

How well did you know this?

Not at all

Perfectly

Diuretics:
Furosemide, bumetanide (K+ ____)
HCTZ (K+ ____)
Spironolactone (K+ ____)

Furosemide, bumetanide –> K+ losing
HCTZ –> K+ losing

Spironolactone –> K+ SPARING

How well did you know this?

Not at all

Perfectly

Bed rest good or bad for volume excess pts? Why?

Good

Induces diuresis by the release of ANP and, decrease production of ADH

How well did you know this?

Not at all

Perfectly

What does PID stand for regarding fluid volume?

Particle Induced Diuresis

How well did you know this?

Not at all

Perfectly

HYPOvolemia…heart beats faster or slower? Why?

Faster…Heart trying to pump what little fluid is left around
(Tachycardia for both hypo- and hypervolemia)

How well did you know this?

Not at all

Perfectly

HYPOvolemia…RR faster or slower? Why?

Faster…body perceives hypovolemia as HYPOXIA

How well did you know this?

Not at all

Perfectly

HYPOvolemia…CVP increase or decrease? Why?

Decrease…less volume, less pressure

How well did you know this?

Not at all

Perfectly

HYPOvolemia…urine specific gravity goes up or down? Why?

UP…concentrated makes it go up

How well did you know this?

Not at all

Perfectly

More, less, or same as cells?
Isotonic solution
Hypotonic solution
Hypertonic solution

Isotonic –> Same
Hypotonic –> Less
Hypertonic –> More

How well did you know this?

Not at all

Perfectly

Isotonic solution goes into the vascular space and ____ ____.

stays there

How well did you know this?

Not at all

Perfectly

Examples of isotonic solutions:

NS, LR, D5W, D5 1/4 NS

How well did you know this?

Not at all

Perfectly

What is unique about the isotonic solution D5W?

Only isotonic for a moment, then body uses up the dextrose

Used to keep lines open

How well did you know this?

Not at all

Perfectly

Who should NOT get isotonic fluids?

HTN
Cardiac dz
Renal dz

How well did you know this?

Not at all

Perfectly

Hypotonic solution goes into the vascular space then…

shifts out into the cells to replace cellular fluid

Rehydration w/o HTN

How well did you know this?

Not at all

Perfectly

Examples of hypotonic solution:

D2.5W, 0.45% NS (1/2 NS), 0.33% NS

Hypertonic solutions are ___ ___ that will draw fluid ___ the vascular space from the cells.

volume expanders | into

Examples of hypertonic solutions:

D10W, 3% NS, 5% NS, D5LR, D51/2 NS, D5 NS, TPN, Albumin | Just think, anything packed with particles is HYPERtonic. Any NS higher than 0.9%

Magnesium and calcium act like ___ | Think ___ first

sedatives | muscles

Lab values for: Mg Ca

Mg --> 1.3 - 2.1 | Ca --> 9 - 11

Causes of hypermagnesemia:

Renal failure | Antacids

Increased Mg can lead to ___

seizures

S/S of hypermagnesemia:

flushing warmth (because vasodilation)

S/S of too much Mg or Ca:

(Remember...low Mg and Ca act like sedatives) 1) Decreased DTR 2) Arrhythmias 3) Bradycardia 4) Muscle tone weak & flaccid 5) LOC decreased 6) Decreased RR

Treatment for hypermagnesemia

Vent --> manage low RR Dialysis --> clean the blood Calcium gluconate --> antidote

Causes of hypercalcemia:

- Too much PTH - Thiazides...retain Ca - Immobilization...you have to bear weight to keep Ca in the bones

S/S of hypercalcemia

Brittle bones | Kidney stones

Treatement of hypercalcemia:

``` Weight bearing movement Fluids...to prevent kidney stones Add phosphorus to diet (inverse r'ship with Ca) Steroids (Remember CUSHINGOID) Vit D ```

Meds that decrease serum Ca:

Biphosphonates (-dronate) Prostaglandin synthesis inhibitors Calcitonin (for osteoporosis...takes Ca from blood to bones)

Causes of HYPOmagnesemia

- Diarrhea...lots of Mg in intestines - Alcoholism - Alcohol suppresses ADH and it's hypertonic

S/S of not enough Mg and Ca

(Remember...NOT ENOUGH sedation here) 1) Muscles rigid and tight 2) Seizures 3) Stridor/laryngospasm --> airway is smooth muscle 4) + Chvostek's (C for Cheek) 5) + Trousseau's 6) Arrhythmias --> heart is a muscle 7) DTR are increased 8) Mind changes --> psychotic, wild, depressed 9) Swallowing probs --> esophagus is smooth muscle

Treatment for hypomagnesemia

- give Mg - check kidney function before and during IV Mg - Seizure precautions - Eat Mg (greens and seeds)

What should you do if pt c/o flushing and sweating during IV Mg infusion?

STOP the infusion

Causes of HYPOcalcemia

- hypoparathyroidism - radical neck surgery (may have taken parathyroids) - thyroidectomy (may have take parathyroids)

Treatment for HYPOcalcemia

- Vit D - Phosphate binders...decreasing phosphate will increase Ca (inverted r'ship) - IV Ca

Must be on a ___ ___ when administering Ca

cardiac monitor

Na imbalance...think ___ changes

neuro

Sodium is the only electrolyte that cares about ___

water

The Na level in the blood is totally dependent on how much ___ is in the blood. - hypernatremia = ___ - hyponatremia = ___

water Hypernatremia = dehydration Hyponatremia = dilution

Causes of hypernatremia

- hyperventilation (insensible fluid loss) - heat stroke - DI

S/S of hypernatremia

Neuro changes Dry mouth Thirsty Swollen tongue

Treatment of hypernatremia

``` Restrict Na Dilute client with fluids, diluting makes Na go down Daily weights I and O's Lab work ```

Feeding tube clients tend to get ___

dehydrated

Normal lab values for Na

135 - 145

Causes of hyponatremia

- Drinking water for fluid replacement (dilutes the blood w/o replacing electrolytes) - Psychogenic polydipsia - D5W - SIADH (retain water)

S/S of hyponatremia

(All brain issues) HA Seizure Coma

Treatment of hyponatremia

Admin Na Water restriction If having neuro probs, need HYPERtonic saline

Normal values for Potassium

3.5 - 5

K is mostly excreted by the ____

Kidneys | think K for Kidneys

Causes of hyperkalemia

Kidney probs | Spironolactone (K sparing diuretic)

S/S of hyperkalemia

First...muscle twitching Then...muscle weakness Then...flaccid paralysis

ECG changes with hyperkalemia

``` bradycardia tall, peaked T-waves prolonged PR intervals flat or absent P-waves widened QRS Conduction blocks V-fib ```

ECG changes with hypokalemia

U waves PVCs V-tach

Treatment for hyperkalemia

``` Dialysis...kidneys aren't working Calcium gluconate...decreases arrythmia Glucose and insulin Kayexcelate (sodium polystyrene, exchanges Na for K) - Na and K have an inverse r'ship ```

Causes of hypokalemia

Vomiting NG suction (we have lots of K in our stomach) K losing diuretics (Lasix and HCTZ) Not eating

S/S of hypokalemia

Muscle cramps | Muscle weakness

Treatment for hypokalemia

Give K Spironolactone (K sparing diuretic) Eat more K rich foods

Never give potassium IV ___

push | Always on a pump