Fluid & Electrolytes Flashcards by Madison Harding

Fluid therapy for a 16-year-old female trauma patient who has head trauma and suspected cerebral edema following an automobile accident. Would you give Albumin OR Mannitol?

Mannitol: Mannitol is an osmotic diuretic that decreases cerebral edema. Albumin is a protein that draws fluid into the vascular space and would make cerebral edema worse.

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Fluid therapy for a 22-year-old female patient who is pregnant and admitted with hyperemesis gravidarum after vomiting for the last seven days. Would you give Colloid OR Cyrstalcolloid?

Crystalcolloid: The use of colloid therapy would be contraindicated because fluid would pull from the extravascular to the intravascular space. Instead you want to rehydrate the cells

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Fluid requirement for a 58-year-old male patient admitted with hypokalemia who requires intravenous potassium replacement therapy. Give K+ IV bolus OR K+ IV solution?

K+ IV Solution: Potassium replacement therapy is considered a high-alert medication and should never be administered as an IVP bolus, which could cause dysrhythmias and cardiac arrest

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Fluid replacement therapy for an 80-year-old male patient who is hypotensive. Would you give 3% NS or NS?

NS: An isotonic fluid would be indicated for replacement therapy for a hypotensive elderly patient to fill the vascular space. Three percent normal saline is a hypertonic solution and would cause fluid shifting and worsen cellular dehydration.

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Fluid replacement for an 18-year-old male patient with a normal blood pressure, experiencing leg cramps after completing a marathon. Would you give Hyper OR Hypo tonic solution?

Hypo: A hypotonic solution shifts fluid out of the vessels into the cells, which improves the dehydration causing the leg cramps

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Treatment for a 45-year-old in hypovolemic shock from blood loss after a gunshot wound. Would you give Albumin OR Mannitol?

Albumin: Albumin expands the vascular space and is not contraindicated in bleeding disorders. Mannitol is an osmotic diuretic and will cause additional fluid loss.

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Fluid replacement for a 28-year-old female with severe hyponatremia and low blood pressure from adrenal insufficiency and a lack of aldosterone. Would you give Iso OR Hyper tonic solution?

Hyper: A hypertonic solution will increase serum sodium levels while shifting fluid into the circulation and creating vascular expansion, thereby raising the blood pressure. An isotonic solution would not correct the hyponatremia, only the low blood pressure.

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Sodium

135-145 mEq/L

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What disorder: HA, Lethargy, Confusion, Seizure, N/V, coma, Neurological symptoms

Hyponatremia

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What disorder: Irritability, hypotension, Shallow respirations, Hyperexcitability, Tetany

Hypochloremia

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What disorder caused by: 
Metabolic alkalosis
NG suctioning
Addison's disease
Severe burns
Respiratory acidosis

Hypochloremia

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Chloride

97-107 mEq/L

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Potassium

3.5-5 mEq/L

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What disorder caused by:
Renal failure, Metabolic acidosis
Soft tissue injury

Hyperkalemia

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What disorder: Generalized fatigue, muscle cramps

Bradycardia, ventricular dysrhythmias

Hyperkalemia

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What symptoms will you see if K+ is greater than 6 mEq/L

Narrow and peaked T wave
ST depression
Shortening of ST interval

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What symptoms will you see if K+ is 6.5-7.5 mEq/L

Lengthening of PR interval, QRS and QT interval
Decrease in amplitude of R wave
Increase depth of S wave

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What lab do you want to order for hyperkalemia?

BUN
Creatinine
Glucose levels

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What disorder caused by:
Bicarb loss through renal and GI systems
FVE
Hypernatremia
Metabolic acidosis

Hyperchloremia

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What disorder: Thirst, coma, seizures, agitation, restlessness, neuromuscular irritability

Hypernatremia

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What disorder: Deep rapid respirations
Lethargy
Tachypnea
Decrease LOC
Hypertension

Hyperchloremia

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What disorder caused by: Gastric suctioning, excessive use of enema, laxatives, or diuretics, hypernatremia

Hypokalemia

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Never give __ IV ___

K+ IV push

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What disorder: palpitations, N/V, weakness, lethargy

Hypokalemia

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Magnesium

1.6-2.2 mEq/L

Magnesium alters effects of __

Ca+

What disorder: tetany, hyperactive reflexes, tremors, Trousseau and Chvosteks, vertigo, high BP and HR, v tach, seizures

Hypomagnesemia

Interventions for Hypermagesemia

Iv hydrations | Loop diuretics

What disorder: Hypotension, arhythmias, loss of deep tendon reflexes, coma, bradycardia

Hypermagnesemia

Calcium

8.2-10.2 mg/dL

Ionized calcium

4.6-5.3 mg/dL

What is calcium regulated by?

Thyroid and Parathyroid

Increase in PTH = __

Increase in calcium

Increase in calcitonin = __

Decrease in calcium levels

Lithium toxicty causes what disorders?

Hypermagnesemia | Hypercalcemia

What disorder caused by: Alcohol abuse, malnutrition, chemotherapy, hypokalemia, hypocalcemia

Hypomagnesemia

What disorder: Excitability of nerves and muscles, muscle spasms, dysphagia, wheezing, bronchspasms, trousseau and Chvostek

Hypocalcemia

Interventions for hypocalcemia:

IV Calcium gluconate

Intervention for hypercalcemia:

NS IV Loop diuretic IV biphosphates Calcitonin

What disorder caused by: malignancies, hyperparathyroidism, lithium, thiazide diuretics, and excessive vitamin A and D

Hypercalcemia

Phosphorus

2.5-4.5 mEq/L

Phosphorus has a ___ relationship with calcium

Inverse

Hypophosphatemia is similar to ___

Hypercalcemia

What disorder caused by: Burns, DKA, excessive antacid use

Hypophosphatemia

Treatment for hypophosphatemia:

Oral/IV Phosphorus | TPN/enteral feeding for dysphagia pt.

Tx for hyperphosphatemia

Phosphate binders IV NS Loop diuretics

``` What disorder: Hyperreflexia Soft tissue calcification Convulsions Bone/joint pain ```

Hyperphosphatemia

Hyperphosphatemia is similar to:

Hypocalcemia

What disorder: Confusion, tremor, joint stiffness, bone pain, muscle weakness

Hypophosphatemia

Isotonic

D51/2NS

Hypertonic

D5W is ___ outside the vascular space but __ inside the vascular space

D5W is Isotonic outside the vascular space but Hypotonic inside the vascular space

1/2 NS

Hypotonic

What pt. should you use D51/2NS cautiously in?

CHF Renal failure Liver failure

You should NEVER admin hypotonic solution to what kind of pt.

Burn pt or Pt. w/ increase ICP

Pt. with cerebral edema needs what kind of IVF?

Hypertonic

What pt. needs hypotonic solution?

DKA | HHS

What is a potential complication when administering a hypertonic solution?

Fluid volume overload | Hypernatremia

What is a potential complication when administering a hypotonic solution?

Worsening hypotension | Increase edema

What is a potential complication when administering a Isotonic solution?

Fluid overload | Generalized edema

What is a potential complication in a pt. with FVD?

Hypovolemic shock

Tx for FVD:

PO fluids | IV replacement: NS

What is a potential complication in a pt. with FVE?

Pulmonary edema

Tx for FVE

Correct underlying cause Terminating/decreasing IVF Diuretics Renal dialysis (renal failure pt.)

Lab for FVE

Hematocrit BUN Serum osmolality Albumin (hypoalbumin present in cirrhosis)

Lab for FVD

``` Hemoglobin Hematocrit Serum osmolality Creatinine Specific gravity ```

The nurse is caring for a patient with a potassium level of 2.8 mEq/L. Which assessment change related to this is most concerning? a. ) lightheaded b. ) tremors c. ) bone/joint pain d. ) palpitations

d.) Palpitations: pt. at risk for lethal dyrhythmias

Pt. with lab values: (K+ 5.1) (Na+ 128) (Mg 1.5) (Ca+ 8.0) Phos 4.7) (Cl- 96) Priority action: a.) Pad bedrails and set up suction b.) Contact provider c.) Assess for Tousseau and Chvostek d.) Encourage oral fluids and monitor I and O

a.) Pt. with hyponatremia is at risk for neurological disorientation and can lead to seizures

The nurse is caring for a patient with celiac disease who lacks vitamin D absorption. What conclusion can the nurse make with this assessment finding? a. ) Pt. severely dehydrated b. ) Normal findings c. ) Mag level high d. ) Calcium level low

d.) Lack of vitamin D absorption or intake will decrease calcium levels

The nurse is admitting a patient with confusion and hallucinations. The laboratory report shows hyponatremia, normal potassium, hypomagnesemia, and hypocalcemia. What priority actions should the nurse take? Select all that apply. a. ) Neurological assessment b. ) Assess for irregular pulse c. ) Implement fall precautions d. ) Determine how much alcohol pt. drinks e. ) Evaluate for tremors and muscle weakness

A, B, C, D, E

he nurse is assessing a patient with a positive Chvostek’s sign. Which actions are a priority? Select all that apply a. ) Assess lung sounds b. ) Request soft diet c. ) Evaluate phosphorus levels d. ) Assess for clots e. ) Monitor BP and HR

A, B, C | Request soft diets: hypocalcemia can cause difficulty swallowing determine if aspiration risk

A nurse assessing a patient recovering from surgery notices an increased thirst, urine output, and the inability to swallow. The patient’s laboratory report indicates a serum magnesium level of 1.4 mEq/L. What treatment should the nurse request from the healthcare provider?

Mag replacement

The nurse is caring for an older adult who is unable to swallow and receiving a hypertonic nutritional supplement through an enteral tube. The nurse notes that the laboratory report shows hypernatremia. What action should the nurse take?

Monitor weight and Na+ levels: because receiving hypertonic feedings could cause water retention (weight gain) and hypernatremia

The nurse is caring for a patient with adrenal cortex insufficiency (Addison’s disease) with a lack of aldosterone production. Which electrolyte should the nurse monitor most closely?

Sodium Aldosterone release causes an increase of sodium. When there is a lack of aldosterone there is a lack of sodium. Additionally K+ will increase

The nurse is caring for a patient in metabolic acidosis with a potassium level of 6.0 mEq/L. What is the nurse’s priority action? a. ) EKG monitor b. ) Obtain baseline weight c. ) Deliver spironolactone d. ) Assess LOC

a.) EKG monitor

Foods high in K+

``` Fruits Potatoes Tomatoes Avocados Instant coffee Molasses Brazil nuts Banana Spinach Cantaloupe ```

Foods high in Ca+

``` Dairy products Canned fish with bones Broccoli/Kale Oranges Eggs Requires vitamin D for best absorption ```

Foods high in Mg+

``` Dark green leafy vegetables Whole grains Chocolate pudding, milk, bars Cashews, Almonds, Peanuts Mg2+-containing laxatives and antacids ```

Foods high in Phos

Milk Processed foods meats high-protein foods Cheese and other dairy products

Foods high in Na+

``` Potato chips Tomato soup/salsa Frozen vegetables Salad dressings Canned Foods Processed foods ```

What type of pt will you use caution when giving LR?

Renal pt. because contains electrolytes

Hypotonic fluids can cause vascular ___

Dehydration

What is normal urine output?

30 mL/hr

Fluid & Electrolytes Flashcards

(83 cards)