- Preserve tissue perfusion - H2O and Na balance

S3 E1 Flashcards by Ashley Cancel

Hypertonic

Pushes water out
Shrinks
Tx: hyponeutremia

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Hypertonic solutions

D5 NS
D5 1/2 NS
3% NS

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Concerns it giving hypertonic solutions

Fluid overload
⬆️ Na (neuro assessment)

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Isotonic

⬆️ fluid volume
Without moving in or out
Give with blood

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Isotonic solutions

LR
9% NS

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Hypotonic

Push water into cell
Swells
Tx: hyper neutremia, hyperosmotic

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Hypotonic solutions

. 45% NS
D5 in H20

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Diffusion

Movement of molecules from⬆️ to⬇️ concentration

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Osmosis

Movement of H20 from⬇️ to⬆️ concentration

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Why do fluids move?

Preserve tissue perfusion
H2O and Na balance

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1st space said

Fluid is Where it belongs

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2nd space fluid

Abnormal blind in interstitial space
Edema

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3rd spacing fluid

Fluid moves into extracellular&extravascular
Difficult to move back into cell
Ascites

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Hemoconcentration

High & dry
⬇️ fluid
Thick, sludge
⬆️ lab values
Fluid dehydration

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Solution to corrected hemoconcentration

Isotonic
NS

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Hemodilution

Low & liquidy
⬆️ fluid⬇️ sodium
⬇️ lab values
🚨Fluid overload = renal/heart failure

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Dehydration

Pure water loss
⬇️ ICF
Hyper osmolar
⬆️ Na
Thirst & neuro symptoms

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How to replace water deficit for a patient with dehydration

Orally
IVF (NS or LR)
Blood
Depends on cause

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Hypovolemia

Electrolyte & H2O ⬇️
ECF is impacted
Array or symptoms

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How to treat a patient who is hypovolemic

Correct hypovolemic symptoms 1st
Orally and diet
Replace NA & H2O
Isotonic (NS or LR)
Blood transfusion

🚨 prevent hypovolemic shock

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Labs you may see with hypovolemia (9)

Albumin
Bun
Creatinine
Hematocrit
Serum sodium
Serum osmolality (280 - 295)
Urine Osmo
Specific gravity (1.005 - 1.030)
Daily wts

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Symptoms of hypovolemic shock (10)

AMS
Pale/blush, cool moist skin
Rapid breathing
Restlessness/irritable
Excessive thirst
Rapid and week pulse
Cause and/or vomiting
⬇️ BP
⬇️ urine output
Absent bowel sounds

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Sodium normal values, ECF or ICF

136 - 145
ECF

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Potassium lab values, ECF or ICF

3.5-5.0
ICF

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Magnesium lab values, ECF or ICF

1.3-2.1 ICF

Calcium lab values, ECF or ICF

9.0-10.5 ECF

Sodium major roles

Neuro BP control Fluid balance Nerve impulse

Potassium major roles

Kardiac Heartbeat Cardiac rhythm Nerve function

Magnesium major roles

Muscle 💪 Contraction Assist in ATP production = Energy ⚡️

Calcium major roles

Strong bones 🦴 Blood clotting Muscle contraction

Phosphate major role

Bone formation

How to correct imbalances?

Acute vs chronic Oral replacement Diet/nutrition IVF Electrolyte replacement PO/IV Restrictions Dialysis Meds

What imbalance is this? Cell shrinkage = Neuro impairment Cause: acute dehydration

Hypernatremia

What imbalance is this? Mental status change Muscle weakness Seizures with very low values

Hyponatremia

Acute hyponatremia tx

Get pt hx 3% NS Slow infuse No more than 6-12 meq/L in first 24 hrs

Chronic hyponatremia tx

Water restriction Review meds Correct slowly

Nursing process

Assess Analysis/diagnosis Planning Implementation Evaluation

Hypokalemia s/s

Telemetry changes Hyperexcitability PVCs, VT, VF T-wave depression Weakness Excess vomiting Paralytic ileus Resp depression

Hyperkalemia : relative excess causes

Trauma/crush injury Uncontrolled diabetes Acidosis Inappropriate blood draw technique Addisons disease

Hyperkalemia : actual excess causes

⬆️ K intake Renal failure K sparing diuretics

Hyperkalemia s/s

Peaked T-waves

Hyperkalemia tx (C A BIG KLD)

Calcium gluconate Albuterol Bicarbonate Insulin Glucose(dextrose) Kayexalate Loop diuretic Dialysis

Hypokalemia tx

Treat underlying cause PO/IV replacement (never IVP or bolus) IV K? Monitor tele, resp and LOC

Hypercalcemia/ hyperparathyroidism s/s

Groans (constipation, N/V) Moans (fatigue, lethargy, depression) Bones (bone pain) Stones (kidney stones) Overtones (psychiatric, depression, confusion, psychosis) Can’t pick up the phone (muscle weakness, lack of coordination)

Hypocalcemia

Tetany Chvosteks sigh (cheek) Trousseau sign (arm)

Hypocalcemia tx

Replace Ca ⬆️Ca in diet Calcium gluconate via IV Calcium carbonate (tums)

Hypercalcemia tx

Treat underlying issue ⬇️ Ca in diet Hydrate 3-4L/day ⬆️ wt baring activity Loop diuretics

SEVERE Hypercalcemia tx

Calcitonin NS Bisphosphonate

Hypomagnesemia s/s

Confusion Tremors Hyperactive DTR Chvosteks sign (cheek) Trousseau sign (arm)

Hypermagnesemia s/s

Smooth muscle reflexes -flushing -hypotension Lethargy NVD Impaired reflexes (⬇️DTR) Resp/cardiac arrest

Hypomagnesemia tx

Treat underlying cause (stop meds, etc) IV and PO replacement Diet ⬆️ in Mg

Hypermagnesemia tx

Avoid food with Mg ⬆️ fluid & diuretics (if kidneys are good) IV calcium gluconate

What is caused by…(resp/met acid/alk) Chronic resp disease (copd) Barbiturate/sedative overdose Chest wall abnormality Severe pneumonia Atelectasis Resp muscle weakness Mechanical hypoventilation Pulmonary edema

Resp acidosis

What is caused by…(resp/met acid/alk) Hyperventilation Stimulated resp center Liver failure Mechanical hyperventilation

Resp alkalosis

What is caused by…(resp/met acid/alk) DKA Lactic acidosis Starvation Diarrhea Renal tubular acidosis Renal failure GI fistula Shock

Metabolic acidosis

What is caused by…(resp/met acid/alk) Vomiting NG suctioning Diuretic therapy Hypokalemia Excess NaHCO3 intake Mineralocorticoid use

Metabolic alkalosis

Resp acidosis symptoms

Headache Neuro symptoms Seizures ⬇️ BP Hyperkalemia Hypoventilation

Symptoms of (resp/met acid/alk) Headache Neuro symptoms Seizures ⬇️ BP Hyperkalemia Hypoventilation

Resp Acidosis

Symptoms of (resp/met acid/alk) ⬆️ RR ⬆️ HR N/V Tetany

Resp alkalosis

Symptoms of (resp/met acid/alk) Headache Lethargy NVD Coma Death

Metabolic acidosis

Symptoms of (resp/met acid/alk) Irritability Lethargy Confusion Headache ⬇️ RR Tachycardia Dysrhythmias NV Muscle cramps Tetany

Metabolic alkalosis

Assessment and interventions for metabolic acidosis

ABCs VS Cardiac GI Resp I/Os Monitor muscle strength

Assessment and interventions for metabolic alkalosis

ABCs Labs (Ca, K, repeat ABGs) GI Cardiac Neuromuscular Resp

DKA risk factors

Illness/infection Inadequate insulin dose Undiagnosed T1DM Lack of education/understanding resources/neglect

DKA s/s

Early Lethargy Weakness Later Dehydration Acetone breath Tachycardia Orthostatic hypotension Kussmaul resps Glucose >250 pH <7.30 Bicarbonate <16 ⬆️ K Ketones in urine and serum

DKA nurse management ASSESSMENTS

May not always need hospitalization Assess for: Fever NVD AMS cause of DKA HCP communication

Normal glucose value

70-100

Normal HgA1C

<6.5%

S3 E1 Flashcards

(68 cards)