Fluids and Electrolytes Flashcards
1
Q
What are the hypotonic solutions? (2)
A
D5W
0.45% NS
2
Q
What are the isotonic solutions? (4)
A
0.9% NS
lactated ringer solution
3
Q
This solution is considered isotonic but becomes free water after dextrose is metabolized; then it acts as a hypotonic solution:
A
D5W
4
Q
When administering D5W what are two things you should watch out for?
A
hyponatremia and hyperglycemia
5
Q
What isotonic solution replaces losses without altering fluid concentrations?
A
0.9% NS
6
Q
Continued fluid replacement with 0.9% NS can lead to what?
A
hypernatremia and hyperchloremia
7
Q
If a patient has heart failure, edema, or hypernatremia, what kind of solution should they NOT be given?
A
0.9% NS
8
Q
What type of IV solution most closely resembles blood plasma?
A
lactated ringer solution
9
Q
What IV solution is commonly used to treat hypovolemia and maintain normal fluid balance, especially in the postoperative period?
A
D5 0.45% NS
10
Q
Why shouldn’t you administer IV potassium as a push or bolus medication?
A
It can cause severe cardiac arrhythmias and death
11
Q
What are two herbs that act as diuretics?
A
celery and dandelion
12
Q
What herb can lead to sodium retention and hypokalemia?
A
licorice
13
Q
What are the clinical manifestations of respiratory acidosis?
A
headache, altered level of consciousness, dyspnea (hypoventilation), tachycardia, muscle twitching
14
Q
What are the clinical manifestations of respiratory alkalosis?
A
Hyperventilation, tachypnea (rapid and shallow)
numbness, tingling of fingers, muscle cramping, palpitations, anxiety, ECG changes
15
Q
What are the clinical manifestations of metabolic acidosis?
A
Kussmaul respirations, hypotension, headache, decreased LOC, weakness, nausea, vomiting
16
Q
What are the clinical signs of metabolic alkalosis?
A
hypotension, vomiting, mental confusion, tetany, increased deep tendon reflexes, tingling fingers/toes, seizures, polyuria
17
Q
Respiratory alkalosis is a result of _____ and excess exhalation of ______________.
A
hyperventilation; carbon dioxide
18
Q
Respiratory acidosis occurs when gas exchange is decreased due to abnormal ventilation, perfusion, or diffusion. This leads to ________ in the blood.
A
hypercapnia
19
Q
Why are the elderly more prone to hypokalemia?
A
Increased use of potassium-wasting diuretics
20
Q
What electrolyte disorder can enhance the effect of digitalis and lead to digitalis toxicity and cardiac arrest?
A
hypokalemia
21
Q
Patient teaching when prescribed digitalis and a potassium-wasting diuretic:
A
eat food high in potassium, take prescribed potassium supplements, learns signs of hypokalemia
22
Q
Clinical manifestations of hyponatremia:
A
lethargy, confusion, weakness, muscle cramping, seizures, nausea, vomiting
23
Q
What kind of IV solution will be administered for hyponatremia?
A
Hypertonic IV saline solutions as ordered
24
Q
Underlying causes of hyponatremia…
A
Diuretics, GI fluid loss, profuse diaphoresis, water intoxication
25
Symptoms of hypernatremia:
Thirst, dry mucus membranes, weakness, elevated temperatures; severe hypernatremia can cause confusion, decreased levels of consciousness, seizures
26
Interventions for hypernatremia:
Monitor LOC, I/O, limit salt intake, increase water intake, administer hypotonic IV solutions as ordered
27
Causes of hypernatremia:
Excess sodium intake, excessive loss of water, excessive hypertonic IV solutions
28
Normal sodium
136-145 mEq/L
29
Symptoms of hypokalemia:
```
Weak, irregular pulse
Decreased blood pressure
Lethargy
Muscle weakness/cramping
Hypoactive bowel sounds
Cardiac dysrhythmias
Increased risk of digitalis toxicity
```
30
Interventions for hypokalemia:
Monitor heart rate and rhythm, ECG, assess for digitalis toxicity, encourage foods high in potassium, administer potassium supplements as ordered/IV potassium
31
Normal potassium
3.5-5.0 mEq/L
32
Hyperkalemia signs and symptoms
Anxiety, confusion, dysrhythmias (bradycardia), muscle weakness, flaccid paralysis, paresthesia, abdominal cramping
33
Causes of hypokalemia:
Vomiting, gastric suctioning, laxative abuse, potassium-wasting diuretics, alcoholism
34
Causes of hyperkalemia:
Renal failure, massive trauma, hemolysis, IV potassium, potassium-sparing diuretics, acidosis: especially diabetic ketoacidosis
35
Interventions for hyperkalemia:
EKG, limit potassium-rich foods, administer Kayexalate as ordered, administer glucose and insulin as ordered (potassium moves back in cell)
36
Symptoms of Hypocalcemia:
Confusion, numbness and tingling in extremities, tetany, seizures, hyperactive reflexes, cardiac dysrhythmias, positive Trousseau and Chvostek signs
37
Interventions for hypocalcemia:
ECG, institute fall and seizure precautions, encourage calcium rich foods, administer supplements as ordered
38
normal calcium
9-10.5 mg/dL
39
Causes of hypocalcemia:
Hypoparathyroidism, pancreatitis, vitamin D deficiency, HYPERphosphatemia, chronic alcoholism
40
Symptoms of hypercalcemia:
```
Lethargy
Coma
Decreased muscle strength
Constipation
Dysrhythmias
Renal calculi
```
41
Hypercalcemia Interventions:
EKG, increased fluid intake, increased active ROM
42
Causes of Hypercalcemia:
Prolonged bed rest, hyperparathyroidism, bone cancer, osteoporosis
43
In cases of hypokalemia, what other electrolyte should be checked and replaced first in order for the the body to hold onto potassium?
magnesium
44
Metabolic alkalosis causes the shift of what electrolyte into cells?
potassium (hypokalemia)
45
What electrolyte imbalance causes tingling around the mouth?
hyperkalemia and hypocalcemia
46
Signs and symptoms of hyperkalemia:
low BP, hyperactive deep tendon reflexes, low HR, hyperactive bowel sounds, muscle twitching, water diarrhea, paresthesia (hands, feet, mouth), EKG changes
47
Causes of respiratory acidosis:
DEPRESS: drugs, edema, pneumonia, respiratory center of brain is damaged, emboli, Spasms of bronchial tubes, Sac (alveolar) elasticity damaged (COPD/emphysema)
48
Respiratory acidosis causes a buildup of _____ .
CO2
49
Nursing interventions for respiratory acidosis:
```
administer O2
encourage coughing and deep breathing
hold any resp. depressants
watch potassium levels - can cause hyperkalemia
assess for EKG changes
```
50
Respiratory alkalosis is the result of expelling too much ___ due to _______.
CO2; tachypnea
51
Causes of respiratory alkalosis:
```
TACHYPNEA
temperature increase
aspirin toxicity
controlled mechanical ventilation
hyperventilation/anxiety
pain
neurological injury
embolism/edema in lungs
asthma due to hyperventilation
```
52
Signs and symptoms of respiratory alkalosis:
```
very fast respiratory rate
confusion
increased HR
tetany, muscle cramps
+ Chvostek
EKG changes
decreases in potassium and calcium
```
53
What causes metabolic alkalosis?
```
"ALKALI"
aldosterone production is excessive
loop diuretics or thiazides
alKali ingestion - too many antacids
anticoagulant citrate
loss of fluids - vomiting, NG suction
increases sodium bicarb. administration (over-correcting)
```
54
Signs and symptoms of metabolic alkalosis:
bradypnea
| symptoms of hypokalemia
55
Nursing interventions for metabolic alkalosis:
if vomiting, give antiemetic
stop NG suctioning
stop diuretics and watch potassium and chloride levels
dr. may order diamox
56
What are some causes of metabolic acidosis?
DKA
renal failure
diarrhea (loss of bicarb)
salicylate toxicity
57
Signs and symptoms of metabolic acidosis:
kussmaul respirations
confusion, weakness, decreased BP
nausea, vomiting
cardiac changes due to hyperkalemia
58
Nursing interventions for metabolic acidosis:
watch for respiratory distress
watch for signs of hyperkalemia
monitor BUN, creatinine, glucose (DKA)
59
Clinical manifestations of respiratory acidosis:
```
Headache
Altered LOC
Dyspnea
Tachycardia
Muscle twitching
```
60
Clinical manifestations of respiratory alkalosis:
```
Tachypnea
Numbness, tingling of fingers
Muscle cramping
Palpitations
Anxiety, restlessness
```
61
Clinical manifestations of metabolic acidosis:
```
Kussmaul respirations
Hypotension
Headache
Decreased LOC
Weakness
Nausea, vomiting
```
62
Clinical manifestations of metabolic alkalosis:
```
Hypotension
Mental confusion
Muscle twitching, tetany
Increased deep tendon reflexes
Numbness, tingling of fingers and toes
Seizures
Polyuria
Nausea, vomiting
```
63
Cause of metabolic alkalosis:
```
Vomiting
NG suction
Overuse of antacids
Hypokalemia
Loop and thiazide diuretics
```
64
Causes of metabolic acidosis:
```
Shock
Trauma
Cardiac arrest
DKA
Salicylate overdose
Chronic diarrhea
```
65
Causes of respiratory alkalosis:
HYPERVENTILATION
Salicylate overdose
Pain
Nicotine overdose
66
Causes of respiratory acidosis:
HYPOVENTILATION
- asthma
- pulmonary edema
- opioids/CNS depressants
67
What acid base imbalance causes Kussmaul respirations?
Metabolic acidosis
68
What acid base imbalance can be caused by NG suctioning or overuse of antacids?
Metabolic alkalosis
69
For which acid base imbalance will you initiate seizure precautions?
Metabolic acidosis
70
For which acid base imbalance might you need to treat hypokalemia?
Metabolic alkalosis
71
For which acid base imbalance will you encourage deep breathing and coughing?
Respiratory acidosis
72
For which acid base imbalance might you administer sodium bicarbonate if ordered?
Metabolic acidosis
73
What electrolyte imbalance cause positive Chvostek and Trousseau signs?
Hypocalcemia
74
Normal magnesium:
1.3-2.1
75
Causes of hypomagnesemia:
```
malabsorption
loop and thiazide diuretics
laxative abuse
prolonged diarrhea
ulcerative colitis
```
76
What is the loss of water without the corresponding loss of sodium?
dehydration
77
What are the best ways to remove fluid volume excess without changing electrolyte composition or osmolality of ECF?
diuretics
fluid restriction
restriction of sodium intake
78
Nursing management of fluid volume imbalances:
```
daily weights
I/O
lab findings
cardiovascular care
respiratory care
patient safety
skin care
```
79
What is the body's primary protective mechanism against hypernatremia?
thirst
80
If a patient is experiencing severe hyponatremia (seizures) what IV solution would you expect to give?
small amount of hypertonic saline solution (3% NaCl)
81
If the cause of hyponatremia is abnormal fluid loss, what type of IV solution would you expect?
isotonic sodium-containing
82
In a case of hyperkalemia, what is an order you would expect to force K+ from ECF to ICF?
insulin with dextrose
83
In a case of hyperkalemia, what would be administered to stabilize cardiac cell membrane?
calcium gluconate IV
84
What should you always expect to monitor with hyperkalemia?
continuous ECG monitoring
85
What are two main causes of hypercalcemia?
hyperparathyroidism
| cancer
86
Nursing Management of hypercalcemia:
```
low calcium diet
increased weight-bearing activity
increased fluid intake
isotonic saline infusion
bisphosphonates
calcitonin
```
87
What electrolyte deficit causes positive Chvostek and Trousseau signs?
hypocalcemia
88
What electrolyte deficit causes laryngeal stridor?
hypocalcemia
89
Numbness and tingling around mouth and/or extremities is caused by:
hypocalcemia
90
Nursing Management of hypocalcemia:
calcium and vitamin D supplements
IV calcium gluconate
rebreathe into paper bag
treat pain and anxiety to prevent hyperventilation and respiratory alkalosis
91
Serum levels o phosphate are controlled by:
parathyroid hormone
92
Phosphate has an inverse relationship with _____.
calcium
93
If you have hyperphosphatemia, it is likely your calcium level is _____.
low
94
A loop diuretic such as furosemide might be ordered for which electrolyte imbalance?
hypermagnesemia
95
Symptoms of hypermagnesemia resemble those of:
hypocalcemia
96
Primary food sources of potassium:
```
fish (NOT shellfish), whole grains, nuts
broccoli, cabbage, carrots, celery,
cucumbers, potatoes with skins
spinach, tomatoes
apricots, bananas, cantaloupe, nectarines, oranges, tangerines
```
97
Primary food sources of calcium:
cheese, ice cream, milk, yogurt, rhubarb, spinach, tofu
98
Primary food sources of magnesium:
cashews, halibut, swiss chard and other leafy greens, tofu, wheat germ, dried fruit
99
Primary food sources of phosphate:
milk, meat, nuts, legumes, grains
100
Clinical manifestations of hypomagnesemia:
```
irritable nerves and muscles
hyperactive deep tendon reflexes (think restless leg syndrome)
dysrhythmias
ECG changes
dysphasia
```
101
Clinical manifestations of hypermagnesemia:
```
warm, flushed appearance
decreased muscle strength
decreased deep tendon reflexes
hypotension
slow, shallow respirations; respiratory arrest
```
102
rapid onset of hypernatremia is caused by:
severe vomiting
hypertonic IV fluids
excessive sweating
103
slow onset of hypernatremia may be caused by:
heart failure
renal failure
increased sodium intake
104
What herb acts has a cathartic/laxative and can lead to hypokalemia?
aloe
105
prolonged use of normal saline can lead to ____ and ______
hypernatremia; circulatory overload
106
hydrochlorothiazide causes losses of:
sodium, potassium, magnesium
107
What is a thiazide diuretic that promotes calcium reabsorption?
hydrochlorothiazide
108
What kind of diuretic is spironolactone?
potassium-sparing
109
patient teaching for spironolactone:
avoid direct sunlight (photosensitivity)
| avoid foods rich in potassium
110
What should you assess (history) before administering spironolactone?
is the patient taking potassium supplements or using a salt substitute
111
What type of diuretic is furosemide?
loop diuretic
112
What is the concern if your patient is taking furosemide and an aminoglycoside?
ototoxicity
113
What should you observe for if your patient is taking furosemide?
hypokalemia and digoxin toxicity
| also: monitor BP and weigh pt daily
114
What diuretic is given to decrease IOP in pt with narrow angle glaucoma?
acetazolamide (carbonic anhydrase inhibitor)
115
The osmotic diuretic _____ is potassium ______.
mannitol; wasting
116
lisinopril is an ______
ACE inhibitor
117
What pt history should you gather before administering lisinopril?
are they taking K+ supplements, potassium-sparing diuretics, or using salt substitutes?
118
What are side effects of lisinopril?
hyperkalemia and angioedema
119
normal phosphate
3-4.5
120
normal BUN
7-20
121
normal creatinine
0.7-1.3
122
normal urine specific gravity
1.010-1.030
123
Hgb
12-18
124
Hct
36-54%
125
2.2lbs is the equivalent of how much body fluid?
1L
126
therapeutic digoxin level
0.8-2
