Fluid and Electrolytes Hurst

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IV insulin worry about

decrease in K hypoglycemia

With loop diuretics what happens to K

decreased K

The drug __ may be used as ADH replacement in DI

desmopressin

Causes of hypomg

diarrhea alcoholism alcohol supresses ADH and hypertonic

hyponatremia

dilution

Bed rest induces

diuresis

Medications for FVE

diuretics Loop-furosemide Thiazide Spironolactone

Which client is at risk for developing a Na level of 130? -client taking diuretics -client with hyperaldosteronism -cushing client -client takinf steriods

diuretics client

High alert medications should be

double check with another nurse

Causes of hyponatremia

drinking water Psychogenic polydipsia D5W SIADH

Hypertonic solutions think

enter the vessel

WHen should we draw type and match

every 72 hours

Sodium lab value

135-145

Clients with ___ become easily dehydrated...

feeding tube

What is ascites

fluid in the abdomen

S/S of hypermagnesemia

flusing warmth*** vasodilation DTRS decreased Muslce Tone weak flaccid Arrythmia LOC decreased Pulse Decreased RR decreased

IV POTASSIUM BURNS

give central line if possible or largest vessel

What type of steriod decreases CA

glucocorticoid

When giving IVF to elderly or young

go SLOW

When giving IVF to heart or kidney clients

go SLOW

Where do Hypotonic solutions go

goes into the vascular space and then shifts out into the cells to replace cellular fluids

trans

going through

Testing strategy: FVE think ___

heart FIRST

When should we not give isotonic fluids

heart failure HTN renal failure

Causes of hypervolemia

heart failure Renal failure Sodium Rentention

Hypertonic solutions are a ___

high alert medication

Safety precautions for FVD

high risk for falls monitor for overload with IV fluid replacement

What is ADH?

hormone which when secrete makes people retain water ONLY

___ is an alert only when administering IV fluids that contain sodium

hypernatremia

Causes of hypercalcemia (3)

hyperparathyroidism, thiazides, immobilization

Causes of hypernatremia

hyperventilation heat stroke DI

Uses of hypertonic solutions

hyponatermia third spacing(volume in the tissue we want it in the vessel) severe edema (volume in the tissue we want in the vessel) burns (FVD) ascites (volume in ab we want in tissue)

Causes of hypo Ca

hypoparathyroidism radical neck thyroidectomy AKA not enough PTH

With a hypernatremic client give

hypotonic solutions

A client is admitted following a severe burn. What changes related to fluid status would the nurse anticipate? 1. Fluid volume excess 2. Hypovolemia 3. Third spacing 4. Increased urine output 5. Low CVP 6. Increased urine specific gravity

hypovolemia third spacing low cvp increased urine specific gravity

CVP is measured where

in the right atrium

Isotonic Solutions goes __

into the vascular space and stays

Phosphorus

3-4.5

Potassium is excreted by the

kidneys

Magnesium is excrete by __

kidneys but it can be lost in other ways like the GI tract

Not enough ADH

lose water, fluid volume deficit DI urine is dilute blood is concentrated

What interventions for ascites

measure abdomnal girth worry about hypotension

Aldosterone is a ___

mineralocorticoid/steriod

Tx for Hyperca intervention diet meds

move flds to prevent kidney stones Add phosphorus to diet Steriods Meds to decrease Ca (Phosphate binders and calcitonin)

S/S of hypoca

muscle tone rigid tight seizure stridor spasm +Chovstek +Trousseau Arrhythmia increase DTR Mind changing Difficulty Swallowing

S/s of hyperkalemia

muscle twitching muscle weakness flaccid paralysis

If you want to get mg and ca questions correct think

muslces first

What should we think with low Mg and CA

not sedated

How to remember signs and symptoms of MG and CA

opposite so hyper think sedated hypo think excited

Why are extremities cool in FVD?

peripheral vasoconstriction shunting blood to vital organs

Add what to the diet of a hyper ca patient

phosphours

ADH is found in the

pituitary

hypophysis

pituitary gland

What is albumin

plasma protein created by the liver

Where should we auscultate lung sounds in FVE?

posteriorly look for crackles

Treatment for FVD

prevent further loss replace volume safety precautions

Backward movement of blood causes

pulmonary edema and heart failure

ALWAYS put IV potassium on a _____

pump

+trousseaus

pump up BP hand moves in

ectomy

removal

tx for hypernatremia

restrict na dilute with flds daily weights i&O Labs

Foods high in K

salt substitutes, oranges and juices, bananas, spinach, tomatoes, cantaloupe, nuts and beans, chocolate, dried fruit, avacodos.

Magnesium and Calcium act like a

sedative

What are phosphate binders

sevelamer hydrochloride calcium acetate

sphenoid

sinus

The airway is a

smooth muscle

Treatment/interventions for FVE

sodium restriction fluid restriction I&O daily weights diuretics bed rest physical assessment IVF

What foods have high mg

spinach flax cucumber (GREENS AND SEADS)

A client is admitted to the cardiac floor in heart failure. The lung sounds reveal crackles bilaterally, and the BP is 160/98. The client has been on diuretics at home and the potassium level is 3.3 mEq/L (3.3 mmol/L). Which diuretic would the nurse anticipate being prescribed for this client to minimize potassium loss? 1. Spironolactone 2. Furosemide 3. Bumetanide 4. Hydrochlorothiazide

spironolactone

Isotonic Solutions saying

stay where I put it

What do you do if your pt reports flushing and sweating when you start IV mg

stop infusion could be a sign of adverse reaction

Hyperkalemia ECG

tall t wide QRS

+chovsteks

tap cheek and eye lip twitches

What are causes of FVD

thoracentesis paracentesis vomiting diarrhea hemorrhage NG tube suctioning

How do we describe a weak pulse

thready 1+

hyperparathyroidism

too much PTH when you serum ca gets too low the body pulls it out of the boneand puts it into the blood

Causes of hypernatremia define

too much sodium not enough water

Define Hypervolemia

too much volume in the vascular space

Potassium lab value

3.5-5

The nurse is assessing a client with a lactose intolerance disorder for a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? -Twitching -Hypoactive bowels sounds -Negative Trousseaus -Hypoactive deep tendon reflex

twitching

Another name for ADH is

vassopressin

What is the alert for hypotonic solutions

watch for cellular edema because this fld is moving out to the cells which could cause FVD and decreased bP

the nurse is caring for a client who has bee receiving IV diuretics suspects that the client is experiencing FVD. Which assessment finding indicates this? -weight loss and poor skin tugor -lung congestion and increase HR -decreased HCT and increase UO -Increased RR and increased BP

weight loss and poor skin tugor

What is the normal action of aldosterone?

when blood volume gets lows aldosterone is secreted making the person retain NA and water

third spacing

when fluid leaks into the tissue

Diseases with too little aldosterone

Addisons Disease "we need to ADD aldostrone"

Effervescent Soluble Medications

Alka-seltzer

Three things with alot of sodium

Canned processed food IV fluids Effervescent Soluble Medications

Diseases with too much aldosterone

Cushing Conns hyperaldosteronism "they look bloated full"

Examples of Hypertonic SOlutions

D10W 3%NS 5%NS D5LR D5-1/2NS D5NS TPN Albumin (this is a colloid though)

Examples of hypotonic solutions (3)

D2.5W, 1/2 NS, 0.33% NS

Monitor ___ with CA and K

ECG!

Alert with hypertonic solutions monitor for

FVE monitor in the ICU frequent CVP BP and pulse checks

Hypotonic Saying

Go out of the vessel

S/S of hyponatremia

HA, seizure, Coma

Severe FVD

IV fluids

Treatment for Hypo MG

MG check kidney function seizure precautions eat mg

What is spironolactone?

Potassium Sparing

Fluid VOlume deficit think __ first

SHOCK

What is the number one cause of hypomg

alcoholism

Insulin does what

carries glucose and K into the cell

Hypernatremia

dehydration

With spironolactone think

hyperkalemia

Where is lots of mg found

in the intestines

Calcium Gluconate is administered

slowly IVP

How do we give iv Ca

slowly and always make sure the client is on a heart monitor

When do most severe reaction occur with blood transfusion

within first 15

After the first set of VS, can the RN delegate Vs to LPN

yes

S/S of hypernatremia

- dry mouth - thirsty - swollen tongue (severe) - neuro changes

Order of Completion for BLood

-confirm transfusion order -confirm type and cross -Two RN sign off --Y tubing 20 gauge or larger infusin pump -NS -hang within 30 minutes of receiving -infuse

The nurse is caring for a client with Crohns Disease who Ca level is 8. Which patterns would the nurse watch for on the ECG? -U waves -Wide T waves -Prominent U Waves -Prolonged QT interval -Prolonged ST interval

-prolonged QT interval -Prolonged ST interval

Examples of Isotonic Solutions

0.9% NS LR D5W D5 1/4 NS

Tx for hypokalemia

1. Give K+ 2. spironolactone Aldactone makes them retain K+ 3. Eat more potassium

Magensium normal lab value

1.3-2.1

What is the max rate of IVP calcium gluconate

1.5-2 ml/min

First assessment after blood admin

15 min

treatment for SIADH

3% water restriction

Crystalloids

3% 7% LR o.9% D5 D10 0.45%

Colloids

Albumin

A client with chronic liver disease has ascites and is being treated with an albumin infusion. What should the nurse anticipate and monitor in this client? 1. Fluid volume excess 2. Cellular edema 3. Severe hypotension 4. Decreasing CVP

FVE

Hypotonic solutions do not cause

HTN

On review of the medical record, the nurse determines which client is at risk for fluid volume excess? -The client taking diuretics -The client with an illesotomy -The client hooked up to suction -The client with kidney disease

Kidney disease

Signs and Symptoms of FVE Neck Veins Peripheral ___ CVP Lung Sounds Kidneys Pulse BP Weight

Neck Veins Distended and full Peripheral edema / third spacing CVP increases lung sounds: wet crackles polyuria pulses increase BP increases Weight increases

The nurse reviews a clients record and determines that the client is at risk for developing a K level deficit if which situation is documented? -Sustained Tissue damage -Requires NG suction -Has a history of Addisons Disease -Uric acid level 9.4

Requires NG suction Any loss of content the client can become hypokalemic

Too Much ADH

SIADH retain water urine concentrated blood diluted

A client was admitted with reports of prolonged diarrhea. the clients admission potassium level was 3.3 and is receiving an IV of D51/4NS with 20 KCL at 125. The UAP reports an 8 hour UO of 200 ml. The previous 8 hour UO was 250 ml. What should the nurses priority action be? Encourage the client to increase PO flds ADmin supplmental PO dose of K Stop the infusion Admin polystyrene sulfonate PO

Stop IV K

autologous transfusion

a blood donation that may be performed before an elective surgery which gives the donor their own blood back

Sodium and K have

an inverse relationship

What is the vascular space?

any vessel in the body including the chambers of the heart

What do we palpate veins are arteries

arteries

What is ANP?

atrial natriuretic peptide which is found in the atria of the heart and induces diuresis

Which client is at risk for the development of a potassium level of 5.5? -The client with colitis -The client with Cushings -The client that overused Laxatives -The client with a traumatic burn

burn cleitn

What is the antidote for Mg toxicity

calcium gluconate

What are the hazards of immobility?

clots pressure injury kidney stone pneumonia constipation

Psychogenic polydipsia

compulsive water drinking

Lung sounds with FVE

crackles

Measurements for CVP

2-6 depending on monitoring system

A nurse has performed teaching with a client diagnosed with Cushing's disease. Which statement by the client would best indicate understanding of the teaching? 1. "The increased level of ADH will cause my potassium level to be too high." 2. "I will be retaining sodium and water due to the increased amount of aldosterone." 3. "I will be losing lots of fluid due to the hormonal imbalance I have." 4. "I will feel jittery and nervous due to the elevated thyroxine levels."

2. "I will be retaining sodium and water due to the increased amount of aldosterone."

Blood must be administered within

4 hours

A client is admitted with hypocalcemia. Which treatment would the nurse anticipate for this client? 1. PO Calcium 2. Rapid IV Push Calcium 3. Vitamin D 4. Sevelamer hydrochloride 5. Phosphate supplements

PO Ca Vitamin D Sevelamer Hydrochloride

For mild FVD

PO fluids

Desmopressin

*****

tx hyperkalemia

- dialysis -calcium gluconate decrease arrhytmia -glucose and regular insulin (FAST) *insulin carries glucose and K into the cell. Any time you give IV insulin, worry about hypokalemia and hypoglycemia) -Kayexalate (sodium polystyrene) (Na/K have inverse relationship) (SLOW)

After reviewing the clients medical records, which on is most likely in fluid volume deficit? -The client with the ilesotomy -the client with HF -The client with long term corticosteriod us -The client receiving wound irrigations

-The client with the ilesotomy

BLood should be hung withing __ of receiving

30 min

Calcium normal lab value

9-11

The nurse is caring for client with heart failure. On assessment, the nurse notes that the client is dyspenic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present? -weight loss and dry skin -flat neck and hand veins and decreased UO -An increase in BP and RR -Weakness and decreased CVP

An increase in BP and increase in RR

The nhurse is preparing a teaching plan for a client newly diagnosed with fluid retention and heart failure. what should the nurse advise the client to avoid? SATA Broiled fresh fish Effervescent soluble medications Seasoning with lemon pepper Chicken noodle soup Deli ham sandwiches

Effervescent soluble medications chicken noodle soup deli ham sandwiches

Major problem with oral K?

GI upset, give with food

What are the problems with isotonic solutions (3)

HTN FVE hypernatremia

Uses of hypotonic solutions

HTN renal cardiac N/V burns Hemorrhage (Think retaining volume means increase Sodium)

What is the key word to make you think ADH problem?

Head Trauma!!!

Diabetes Insipidus think

If you are sipping you are peeing

Joint Commission Top 5 high ALert medications

Insulin Opiates INjectable K IV Anticoags NA Cl >0.9%

Before during and after MG monitor

Kidney function

Hyperkalemia Causes

Kidney trouble Spironolactone

With Sodium Imbalances think

LOC

With NA imbalances think

LOC first

A client is admitted to the ICU with diabetes insipidus following a head injury. Which finding would the nurse anticipate in this client? 1. Low serum hematocrit 2. High serum glucose 3. High urine protein 4. Low urine specific gravity

Low urine specific gravity

TX hypo CA (4)

PO Ca IV Ca Vitamin D Phosphate binders

The nurse is preparing to administer magnesium sulfate IV to an alcoholic client with hypomagnesemia. Prior to the initiation of IV magnesium, which assessment data would be important for the nurse to document? 1. Liver function 2. Respiratory rate 3. Calcium levels 4. Deep Tendon Reflexes (DTRs) 5. Urinary output

RR DTR UO

ECG changes with hyperkalemia

Tall t ST elevation bradycardia prolong PR Absent P Wide QRS Conduction block V Fib

What is insensible fluid loss

The amount of fluid lost on a daily basis from the lungs, skin, respiratory tract, and water excreted in the feces. The exact amount cannot be measured, but it is estimated to be between 40 and 600 mL in an adult under normal circumstances.

The nurse reviews the clients electrolyte lab report and notes that the K level is 2.5. Which patterns should the nurse watch for on the ECG as a result SATA. -U waves -Absent P waves -Inverted T waves -Depressed ST -Wide QRS

U waves Inverted T waves Depressed ST

ECG changes with hypokalemia

U waves, PVCs, Ventricular tachycardia

ALWAYS assess ____ before/during IV potassium administration!

UO

Where is aldosterone found?

adrenal glands

What are the three hormones that regulate fluids

aldosterone ADH ANP

what happens if the blood does not move forward?

backward flow

you have to ___ to keep Ca in the bone

bear weight

Medications that decrease CA

biphosphates Calcitonin

What would you describe the pulse in FVE?

bounding full 3+

S/S of hyperca

brittle bones kidney stones DTR decreased Muscle tone flaccid weak Arrhythmia LOC decreased Pulse decreased RR decreased

Causes of third spacing

burns ascites

Why does bed rest induce diuresis

by the release of ANP and the decrease in ADH

thiazides make you retain

ca

Ca has an __ with phosphorus

inverse relationship

What is FVD?

loss of fluid from anywhere

Causes of fluid volume deficit

loss of fluids third spacing diseases with polyuria: DI

What are the uses for isotonic solutions

loss of fluids through N/V burns sweating trauma

The nurse reviews a clients lab report and notes the clients serum phosphorous level is 1.8. Which condition most likely caused this serum phos level? -malnutrition -renal insufficiency -hypoparathyroid -tumor lysis syndrome

maluntrition -even though we could not think of phos we know that with a low phos means a high ca because they have an inverse relationship... what causes a high ca? bone break down aka not moving aka nutrition issues

s/s of hypokalemia

muscle weakness & cramps, irregular pulse, cardic arrthymia

S/s of hypo mg

muslce tone rigid seizures stridor/laryhngospasm +chovesteks +trousseaus Arrhythmia DTR increase mind change swallowing problems

A client is admitted with prolonged nausea and vomiting. The client's admission sodium level is 149 mEq/L (149 mmol/L). What action by the nurse would be most appropriate at this time? 1. Administer 3% NS at 150 mL/hr 2. Perform neurological assessment 3. Increase oral intake of sodium 4. Decrease fluid intake

perform neuro check

What is radical neck

removal of cervical lymph nodes

causes of hypermagnesmia

renal failrue antacids

Treatment for Hypermg

ventilator <12 RR Dialysis Calcium gluconate Safety Precautions

Hypertonic solutions define

volume expanders that will draw fld into the vascular space from the cells

Hypokalemia causes

vomiting, NG suction, diuretics, not eating

signs and symptoms of FVD weight ___ skin tugor mucous membranes UO BP Pulse RR CVP neck veins extermeities specific gravity

weight decrease decreased skin tugor dry mucous membranes decreased UO BP Decrease Pulse increase RR increased CVP decreased think flat neck veins cool extermeities increase specific gravity

Tx of hyponatremia

NA H20 Restriction hypertonic saline with neuro changes

When referring to concentration and dilution what three items are we referring to

NA specific gravity hematocrit

K Cl IV is prescribed for a client with HF experiencing hypokalemia. Which actions should the nurse take to plan for preparation of admin K? SATA -Obtain IV pump -Monitor UO -Prepare medication for bolus -Monitor IV for infiltration -Ensure med is diluted in appropriate solution -Ensure bag is labeled

Pump monitor UO Monitor IV Ensure med diluted Ensure bag labeled

Define Heart Failure

a weak heart Cardiac Output decreases Poor kidney perfusion Renal Failure Decreased UO


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