Fluids & Electrolytes Flashcards
1
Q
What medication is hard on the kidneys?
A
NSAIDS; Ibuprofen
2
Q
The RAAS releases
A
Renin
(Renin-Angiotensin-Aldosterone system)
3
Q
Aldosterone regulates
A
Water
4
Q
Atrial natriuretic peptide (ANP) reduces
A
Fluid volume
5
Q
Antidiuretic hormone (ADH) controls
A
Water retention
(vasopressin!!)
6
Q
Vasopressin is a
A
Vasoconstrictor
7
Q
Anti-Diuretic hormone (ADH)
A
Controls JUST water retention (increases)
Raises BP
Helps restore blood volume
8
Q
Aldosterone (RAAS)
A
Causes kidneys to retain Na+ and water; excretes K+
Released is Na+ is low and K+ is high
Think sodium AND water retention!!
9
Q
Low aldosterone =
A
High K+
10
Q
High aldosterone =
A
Low K+
11
Q
When blood pressure drops….
A
Renin is released by the kidneys
12
Q
RAAS causes
A
Increased BP due to increased water and sodium retention
Increased respiratory rate — tachypnea
Increased heart rate — tachycardia
13
Q
Angiotensin 2 =
A
Vasoconstriction!
14
Q
Atrial Natriuretic peptide (ANP)
A
Stops action of RAAS
Decreases BP by vasodilation
Reduces fluid volume by increasing secretion of Na+ and water
15
Q
Brain natriuretic peptide (BNP)
A
Blocks aldosterone
Common lab test for heart failure
16
Q
Patients with heart failure
A
Have increased fluid retention —> need a diuretic! (Furosemide)
17
Q
Furosemide is a
A
Diuretic
18
Q
Lasix is
A
Furosemide
19
Q
Older adults do not have
A
Thirst stimulation
20
Q
S/S of dehydration
A
Dizzy
Weak
Thirst
Dry
Oliguria
Anuria
21
Q
With hypovolemic shock, what does the nurse need to do?
A
Replace fluid volume ASAP
-IV (large bore in both arms)
-isotonic fluids (LR, NS)
Needs indwelling catheter for strict I&O
May need blood transfusion
22
Q
S/S of mild hypovolemic shock
A
Hypotension
Tachypnea
Tachycardia
23
Q
S/S of severe hypovolemic shock
A
Bradypnea
Bradycardia
24
Q
Hypovolemia
A
Can be produced by salt and water loss due to vomiting, diarrhea, diuretics, or third spacing
25
Water loss alone
Dehydration
26
Dehydration is always
Hypernatremic
27
Dehydration treatment
Free water administration
28
Electrolytes separate into
Ions (charged particles) when dissolved in water
29
Cations
+ charge
Na+, K+, Ca+, Mg+
30
Anions
- charge
Cl, HCO3, phosphate
31
Depletion of electrolytes
Think fluid — where fluids go, electrolytes go!
-vomiting
-urination
-bowel movement
-sweating
32
Magnesium levels
1.5 — 2.5 mg/dL
33
Phosphorus levels
2.4 — 4.5 mg/L
34
Potassium levels
3.5 — 5.0 mEq/L
35
Calcium levels
8.5 — 10.5 mg/dL
36
Chloride levels
95 — 105 mEq/L
37
Sodium levels
135 — 145 mEq/L
38
What foods can help raise potassium levels?
Fruits
Green leafy vegetables
Spinach
Salt substitutes
Cantaloupe
39
What foods can help raise sodium levels?
Table salt
Cheese
Spices
Canned, processed foods
40
What foods can help raise magnesium levels?
Spinach
Almonds
Yogurt
Green vegetables
Nuts
Dark chocolate!!!
41
What foods can help raise calcium levels?
Milk
Cheese
Green vegetables
42
what foods can help raise phosphorus levels?
Dairy
Meats
Beans
43
What foods can help raise chloride levels?
Salty foods, salt substitutes
Canned foods
Vegetables — tomatoes, lettuce, celery, and olives
44
What food should you avoid if your magnesium levels are high?
Nuts
45
What is the priority when sodium is involved?
Think brain!!
Neuro checks
Safety
46
Sodium is a major electrolyte in
Extracellular fluid
47
Sodium controls
Water balance
Maintains BP
48
Where Na goes,
Water flows
49
SIADH
Impaired water excretion caused by inability to suppress secretion of ADH
50
Water retention causes
Dilutional Hyponatremia
51
Sodium is regulated by
ADH and aldosterone, Na+ K+ pump
52
Hyponatremia levels
Less than 135 mEq/L
53
Increased Na+ excretion
4 D’s — diarrhea, diuretics, drainage, diaphoresis
Vomiting
Kidney disease
Hypoaldosteronism
54
Hypoaldosteronism
Addisons
Sodium loss and water retention
55
Three flavors of Hyponatremia
Euvolemic
Hypovolemic
Hypervolemic
56
Euvolemic
Low Na+ with ECF volume normal
57
Hypovolemic
Na+ loss with ECF volume depletion
58
Hypervolemic
Na+ loss with increased ECF volume
59
Severe Hyponatremia
Seizures
brain stem herniation
respiratory arrest
death
60
Severe Hyponatremia occurs
Rapidly, suddenly
Levels 115-120
61
Moderate Hyponatremia
Lethargy
Weakness
Altered LOC
62
What brain related thing can happen in Hyponatremia?
Cerebral swelling
63
Hyponatremia interventions
Replace sodium slowly!
0.5 mEq/L per hour MAXIMUM
Should raise 6-12 points in 24 hour period
64
Spironolactone
A diuretic that doesn’t lose K+
65
What should you stop/hold in Hyponatremia?
Sodium wasting diuretics
-Loop diuretics
-Thiazides
66
Safety is extremely important in
Hyponatremia
Bedrest, make sure pt calls for help
Frequent falls!
67
What should you put a patient on instead of a loop diuretic in Hyponatremia?
Spironolactone
68
IV fluids/medications for Hyponatremia
Hypovolemic — 0.9% NS
3% NS
Hypervolemic — osmotic diuretics (Mannitol)
Euvolemic — SIADH
69
3% normal saline is used for
Extremely low sodium (Na)
70
What do you do for a patient that has too much fluid?
Restrict fluids
71
Give 3% normal saline
Through a central line, it is highly caustic on veins
72
Severe Hyponatremia interventions
Administer 3% saline IV SLOWLY
Plan for CVAD (3% highly caustic)
Indwelling catheter for strict I&O
Neurological checks
Bedrest
73
Mannitol
Excretes water but not Na+
74
If severe Hyponatremia is over corrected too quickly
Damage to nerve cells in brain
Locked in syndrome
75
Locked in syndrome
Can’t move, blink, speak
76
Severe Hyponatremia levels
Less than 120
77
What do you need to monitor with severe Hyponatremia?
Na level closely!
78
SIADH
Syndrome of inappropriate anti-diuretic hormone
Euvolemic
79
SIADH decreases
Sodium
Most common form of low Na/hyponatremia
80
Syndrome of inappropriate ADH (SIADH)
SI
Soaked inside
Stops urination
81
Too much ADH
Hyponatremia
82
SIADH causes
3 s’s
Small cell lung cancer (new cancers)
Severe brain trauma
Sepsis infections of brain
83
SIADH retains
Fluid
84
ADH
Adds Da H2O
85
Synthetic ADH
Desmopressin, Vasopressin
Decreases urine output
Pressin the BP up!
86
Cautions with ADH
Headaches!!!!!
Seizures
Death
HTN
87
Treatment for SIADH
Fluid restriction — 800-100mL/day
Demeclocycline
Diuretics
Increase oral sodium intake (bacon, salt)
Daily weight and I&O
88
Signs of SIADH
Low sodium
Oliguria
High BP
89
Why should you never reduce fluid intake by a lot? (3000 ml)
Too much restriction can lead to dehydration
90
Hypernatremia level
Greater than 145
91
Do we see hypernatremia or hyponatremia more?
Hyponatremia
92
Causes of hypernatremia
Corticosteroids
Cushing’s syndrome
Hyperaldosteronism
Increased sodium intake
Increased water loss (hemoconcentration)
Diabetes insipidus!
93
Corticosteroids cause kidneys to retain
Sodium
94
Cushing’s syndrome
Occurs due to prolonged exposure to glucocorticoids (prednisone) or a tumor producing excessive cortisol by adrenals
95
Hyperaldosteronism
High sodium and water retention
Potassium loss
96
Severe hypernatremia is defined as sodium levels
>160
97
What can cause an increased sodium intake?
Too many processed foods
Hypertonic solution (3% or 5% NS)
Alkaseltzer, aspirin
98
Increased water loss (hemoconcentration)
Dehydration (too much water loss and sodium gain)
Infection
Diabetes insipidus!
99
Diabetes insipidus is associated with
Hypernatremia
100
Hypernatremia interventions
Bring sodium levels down slowly
IV fluids/meds — hypotonic solutions, 1/2 NS, D5W
Diuretics — thiazides, loop diuretics
Restrict sodium intake
Free water intake
101
Patients can become __________ and ____________ with hypernatremia
Confused and agitated
102
Moderate symptoms of hypernatremia
Confusion, irritability
Swollen and dry red tongue
Hyperreflexia
Muscle twitching
Edema
Thirst*
103
Severe symptoms of hypernatremia
N/V
Increased muscle tone
Seizures
Coma
104
Diabetes insipidus
DI = Dry inside = labs high
Increased sodium & diluted urine
Dehydrated, DIE ADH
105
Dehydration due to hypernatremia S/S
Polydipsia
Light headed
Polyuria
106
Causes of diabetes insipidus
ADH (vasopressin) deficiency
Damage to brain
Tumors
Trauma
107
Risk for diabetes insipidus
Hypovolemic shock
108
Risk for SIADH
Seizures
109
Potassium is a major electrolyte in
Intracellular fluid
110
What is the main source of potassium?
Diet
111
What is a major cause of hypokalemia?
Steroids
112
Never give potassium —
IVP
Potassium can burn/irritate peripheral vein
113
If a patient is NPO, how do you give potassium?
Diluted through IV pump
114
Fast form of potassium
Oral
115
What is the number one cause of hypokalemia?
Diuretics! (Furosemide, loop diuretic)
116
Digoxin toxicity
Low potassium causes this!
Cautions using diuretics with digoxin = increased risk for hypokalemia
117
If K+ loss,
Stop diuretics!
118
Higher levels of aldosterone cause
More K+ excretion
119
Cushings is characterized by
Too much cortisol
120
Vomiting, diarrhea, and prolonged NG suction can cause
Hypokalemia
121
Excess insulin moves
K+ into the cell
122
In alkalosis,
There is less H+ in blood, causes H to shift out of cells and K+ to shift into cells
123
severe hypokalemia level
Less than or equal to 2.5
124
Patient presentation with hypokalemia — cardiovascular
Torsades de pointes
Irregular HR
Lethal dysrhythmias
Bradycardia
125
Patient presentations with hypokalemia — neuromuscular
Confusion, lethargy
Muscle weakness
Diminished DTR’s!!
126
Patient presentation with hypokalemia — GI
Constipation
-if bowel sounds absent, think paralytic ileus— portion of bowel not moving and can lead to small bowel obstruction
127
If low K+,
Find out Mg+ levels!
Correct Mg first to correct K
128
Torsades de pointes
Twisting of the points
Irregular QRS complexes appearing to wrap around the EKG baseline
129
Treatment for Torsades de pointes
IV Mg+
Slow 2g IVP
130
Long QT interval means
Heart is taking longer to electrically charge for the next heartbeat
131
Hyperkalemia EKG
Peaked Twaves
P wave flattening
132
What is most important to monitor in Hypokalemia?
Cardiac and respiratory status
133
If a patient with hypokalemia is taking a diuretic,
May need to stop or switch to spironolactone (K+ sparing diuretic)
134
If giving potassium orally,
Must take with food
Never give on empty stomach bc it is very irritating to stomach
135
Potassium is never administered
IV push, intramuscular, or SQ
136
Hyperkalemia levels
> 5
137
Number 1 cause of Hyperkalemia
Kidney disease! (Renal failure)
138
Adrenal insufficiency in Hyperkalemia
Addisons = low aldosterone = retention of K+
139
Ace inhibitors hold on to
“Prils”
Hold on to potassium = excess!
140
NSAIDS decrease
Renal profusion
(Hyperkalemia)
141
In acidosis,
There is more H+ in blood, causes H+ to shift into cells and K+ to shift out
142
Severe Hyperkalemia level
Greater than or equal to 6.5
143
Lethal Hyperkalemia level
Greater than or equal to 8.5
144
Patient presentation of Hyperkalemia — cardiovascular
Low BP
Dysrhythmias — lethal! Vfib/cardiac standstill
145
Patient presentation of Hyperkalemia — GI
Hyperactive bowel sounds
Diarrhea
146
Mild Hyperkalemia interventions
Monitor cardiac
Restrict K+ in diet
Diuretics
Dialysis
147
Emergency medical treatment for Hyperkalemia (>6.5)
Ca+ gluconate 10% IV — protects heart from lethal dysrhythmias, does NOT lower K+
Hypertonic glucose and INSULIN
NaHCO3
Diuretics
148
Ca+ gluconate 10% IV
Protects heart from myocardial irritability (lethal dysrhythmias)
IT DOES NOT LOWER POTASSIUM
Given over 3-5 mins
Monitor BP, HR, dysrhythmias
149
Low parathyroid =
Hypocalcemia!
150
High parathyroid =
Hypercalcemia!
151
Ca+ and Mg+ are
Best friends, when one goes up, the other follows
152
Calcium keeps
The 3 B’s strong
-Bone
-Blood clotting
-Beat (heart)
153
Calcium is regulated by 3 hormones;
Parathyroid hormone
Calcitonin
Calcitrol
154
Calcitrol
Vitamin D analog
(Renal/kidney issues)
155
PTH increases
Blood calcium levels
156
Calcitonin decreases
Blood calcium levels
157
What must you have to absorb calcium?
Vitamin D
158
Hypocalcemia levels
<8.5
159
Causes of Hypocalcemia
Vit D deficiency
Long term corticosteroids
Hypoparathyroidism
Diarrhea
Hyperphosphatemia
Meds
160
Long-term corticosteroids can
Break down bone
Cause osteoporosis
161
Hypoparathyroidism
Decrease in parathyroid hmone
Removal of parathyroid glands
162
Hyperphosphatemia
Inverse relationship with calcium
163
Meds that cause Hypocalcemia
Diuretics
Laxatives!
Corticosteroids
164
Thyroidectomy or any neck surgeries can
Irritate or remove parathyroid glands,
Watch for Hypocalcemia!!!!!
165
Patient presentation of Hypocalcemia — cardiovascular
Hypotension
Dysrhythmias
Decreased HR
166
Patient presentation of Hypocalcemia — neuromuscular
Twitching, cramps
Tetany — jerking
Seizures
Parenthesias — numb/tingle
Trousseaus and Chvostek signs
Hyperactive deep tendon reflexes (DTRs)
167
Chvosteks signs
Tap nerve by ear and pt will twitch
168
Trousseaus signs
BP cuff, leave pumped for 2-3 mins and watch hand
169
Patient presentation of Hypocalcemia — GI
Hyperactive bowel sounds
Diarrhea
170
Hypocalcemia interventions
Replace calcium (IV or PO)
-IV calcium gluconate 10% over 10-20 mins (SLOW)
-monitor BP, HR, place on heart monitor
-vitamin D if giving PO
-Tums calcium supplements
171
When dealing with Hypocalcemia, what precautions should be initiated?
Seizures and bleeding precautions (look at platelets)
172
Hypercalcemia levels
>10.5
173
Causes of hypercalcemia
Hyperparathyroidism — too much parathyroid
Malignancies — of bone; cancer in bone, breast cancer, Mets in bones!
174
Patient presentation of hypercalcemia — GI
Hypoactive bowel sounds (constipation)
175
Patient presentation of hypercalcemia — Renal
Think kidney stones, painful bones, abdominal moans (constipation), N/V
176
What gland abnormality causes kidney stones, painful bones, moans from constipation, N/V, muscle weakness?
Parathyroid
177
Hypercalcemia interventions
Give IV fluids (0.9% saline)
Discontinue calcium
Loop diuretics (furosemide)
Meds (phosphorus)
178
IV normal saline and loop diuretics =
Less severe hypercalcemia
179
Magnesium general rule
Calms, relaxes us (sleep!)
Good for constipation!!
180
Magnesium helps to maintain
Blood glucose control
BP
Neurological function — more alert
Immune system — fights inflammation
181
Calcium and magnesium
Rely on each other for absorption
182
Hypomagnesemia levels
< 1.5
183
Number 1 cause for hypomagnesemia
Chronic alcohol se
Poor diet/malnutrition, starvation
Malabsorption due to effects of alcohol on GI tract
184
Hypomagnesemia GI loss
NG, diarrhea
185
With hypomagnesemia, unable to
Maintain order; everything goes crazy
186
Hypomagnesemia neuromuscular presentations
Tetany, twitches, parenthesias
Trousseaus and chovsteks sighs
Increased DTRs
Tachycardia
187
Hypocalcemia has the same neuromuscular s/s as
Hypomagnesemia
188
Hypocalcemia accompanies Hypomagnesemia, interventions aim to restore
Calcium levels, this will help Mg+ be absorbed.
189
Hypomagnesemia interventions
Replace Mg+ and Ca+ (IV or PO)
Give Mg+ IV slowly — can slow HR
Monitor K+ if magnesium is low
190
Treat hypomagnesemia prior to
Hypokalemia, when the body is in a state of low Mg, it is unable to process and absorb K
191
Hypermagnesemia levels
>2.5
192
Hypermagnesemia presentation — heart
Calm and quiet
Respirations low and shallow
Bradycardia
Hypotension
193
Hypermagnesemia interventions
Calcium gluconate is an antidote for Mg overdose
Diuretics for Mg+ excretion
194
Do not give what with Mg+
Laxatives!
195
Phosphorus helps regulate
Calcium
Inverse relationship with Ca and Mg
196
Phosphorus is essential for
Bone and teeth
197
Hypophosphatemia levels
< 2.4
198
Causes of hypophosphatemia
Malnutrtion
Hyperparathyroidism; calcium rises, phosphorus drops (INVERSE)
Malignancy
Mg or aluminum based antiacids
199
Patient presentation of hypophosphatemia
Decreased BP, HR
Hypoactive bowels
Kidney stones
Altered LOC
Decreased DTR
Weakness
200
Hypophosphatemia interventions
Replace phosphorus IV or PO
-phosphorus slow if severely low
-oral phosphorus with vit D
201
What precautions need to be taken with hypophosphatemia?
Fracture precautions
202
Hyperphosphatemia levels
> 4.5
203
Causes of Hyperphosphatemia
Overuse of laxatives and enemas with phosphorus
Hyperparathyroidism
Hypocalcemia — s/s
204
Hyperphosphatemia patient presentation
Twitching, cramps, tetany, seizures, parasthesias
Trousseaus and chvosteks
Hyperactive DTRs
Osteoporosis
Hyperactive bowels, diarrhea
205
Hyperphosphatemia interventions
Same as Hypocalcemia
-IV calcium gluconate 10%
-vit d if PO
-tums
-seizure and bleeding precautions
206
Chloride
Inverse relationship to HCO3 (bicarbonate
Directly related to Na and K
Chloride always follows sister sodium
207
Hypochloremia =
Same symptoms as hyponatremia
208
Hypochloremia levels
< 95
209
Hypercloremia levels
> 105
210
Hyperchloremia s/s, causes
Same as hypernatremia
211
Hypochloremia acid base balance
Alkalosis
212
Hypercloremia acid base imbalance
Acidosis
213
Meds affecting electrolytes
Corticosteroids
Ace inhibitors
Spironolactone
ARBs
Insulin
Furosemide
Laxatives
NSAIDS
214
Meds to avoid with renal failure
Ace inhibitors
Spironolactone
ARBs — sartans
NSAIDS — ibuprofen
