intro to medsurg - week 4, fluid and electrolytes

what are hypotonic solutions?

0.45% NaCl and 5% dextrose in water D5W

what are isotonic solutions?

0.9% NaCl (NS), Lactated ringers

what are hypertonic solutions?

3% NaCl and mannitol

what are s/s of hyponatremia?

CNS effects, pale cool and clammy, tachycardia

what are s/s of hypernatremia?

CNS symptoms caused by water being pulled out, may have pulmonary and peripheral edema

what lab tests do we run for fluid volume deficit?

Hct (ratio of solid:liquids).

how do you treat hypermagnesium?

IV calcium gluconate and limit MG

what meds help move potassium into cells?

IV insulin w/ dextrose to not bottom out their sugar (50% dextrose), albuterol

how do you treat severe hypomagnesium?

IV magnesium sulfate and monitor with EKG

how do you treat mild hypomagnesium?

PO magnesium supplements

what are s/s for hypervolemia?

SOB, productive cough bringing up sputum, NEED DIURETIC

what are some causes of hypocalcemia?

alkalosis, chronic alcoholism, blood transfusions, vitamin d deficiency

what causes hypermagnesium?

antacids and renal failure

what are some potassium rich foods?

avocado, banana, oranges, potato, tomato

what happens to the blood pressure when a patient has hypovolemia?

blood pressure is low

what should you associate with muscles?

calcium

what are causes of hypercalcemia?

cancers of bone, hyperparathyroidism

what is potassium most important role?

cardiac electrical conduction system, HEART

what are some s/s of hyperkalemia?

cardiac symptoms show up before ABCs and circulatory. Dysrhythmias, peaked T wave, muscle weakness, cramps, loss of tone, ascending muscle paralysis, and respiratory arrest, starts in legs

what type of line is preferred for a patient who has hypokalemia?

central line

what is seen with fluid overload?

cerebral and peripheral edema

what is a hypertonic solutions automatically used for?

cerebral edema and severe hyponatremia

what are the s/s of hypomagnesium?

chvostek and trousseau sign

what are some s/s of hypocalcemia?

chvosteks and trousseau signs, numbness and tingling around the mouth

what are s/s of hypermagnesium?

decreased deep tendon reflexes, respiratory depression, bradycardia, hypotension

what falls under fluid volume deficit?

dehydration and hypovolemia

what is an example of when we would use hypotonic solutions?

dehydration without low blood pressure

what is a sign of magnesium toxicity?

depressed deep tendon reflexes

what causes hypokalemia?

dialysis, diarrhea, vomiting, NG suction, ileostomy drainage, hyperaldosteronism, furosemide

if patient has hypernatremia and the problem is sodium excess, what do you do?

dilute with IV fluids not containing D5W

Hypervolemia can lead to pulmonary edema, which will kill a patient first. What would you give the patient?

diuretic to get fluid out

what are s/s for dehydration?

dry skin and mucous membranes

what causes hypovolemia?

due to diuretics, diarrhea, vomiting, diaphoresis w/o sodium and water replacement

what causes fluid overload?

due to excess hypotonic IV fluids (D5W), 0.45% NS

what is priority intervention for patient who has hyperkalemia?

ecg 12 lead, cardiac monitoring

what is hypervolemia?

excess of both water and electrolytes in proportion, too much fluid in the blood

what causes hypernatremia?

excess of isotonic or hypertonic IV fluids

what do we for patients who have orthostatic hypotension?

fall risk

what are s/s for hypovolemia?

flat jugular veins, small, flat peripheral veins

what are s/s for hypokalemia?

flattened T waves and presence of U waves, muscle weakness, paresthesias, paralysis, respiratory muscles, intercostals, diaphragm

what does high salt indicate?

fluid goes inside the blood

what does low salt indicate?

fluid goes outside the blood

what falls under fluid volume excess?

fluid overload and hypervolemia

what is a priority intervention for a patient who has hypokalemia?

get a 12 lead ECG and continuous cardiac monitoring

if a patient has fluid volume deficit and you first look at circulation and find the patient with a weak pulse and hypotension, what do you do?

give isotonic solutions to increase BP.

what can cause hypervolemia?

heart failure, renal failure, liver cirrhosis, use of corticosteroids, excess of iso or hypertonic solutions

what is a big cause of hypervolemia?

hypernatremia

what is used as a last resort to pull fluid out of the brain?

hypertonic saline

What is 10% Dextrose in Water (D10W)?

hypertonic solution

Fluid overload can lead to cerebral edema and that can kill a patient. What would you give the patient?

hypertonic solutions

what is hypomagnesium the same as?

hypocalcemia

what is hyponatremia considered?

hypotonic overload

what does it mean if Hct is elevated?

if Hct goes up that means there are more solids than liquid which means fluid has been lost

how would we treat mild hypercalcemia?

increase fluids (3,000-4,000 mL/day to prevent kidney stones; cranberry and prune juice are good

what causes dehydration?

insufficient fluid intake, prolonged fever, excessive salt, DKA

if patient is oriented, hyponatremia, and low BP what do you give?

isotonic solutions to avoid huge fluid shifts

What is 10% dextrose in water used for?

keep around for patients using TPN in case it isn't ready

what is hypovolemia?

lack of both water and electrolytes results in decreased blood volume, CARDIOVASCULAR system is dehydrated

what is dehydration?

lack of water without salt loss, CELLS are dehydrated

what med works fastest to remove potassium?

loop diuretics (Lasix)

if a patient has fluid volume deficit and shows CNS symptoms what does that mean and what do we do?

means fluid is in the brain and to get it out we need hypertonic solutions

what foods have magnesium in it?

nuts, green veggies, peanut butter

what can hyponatremia differentiate between?

patient lost a bunch of salt or gained too much fluid without salt

what can cause hyponatremia?

prolonged diarrhea, vomiting, GI suctioning, puts pt at risk for fluid volume deficit and electrolyte imbalances

what is the most common cause of hyperkalemia?

renal failure

if patient has hypernatremia and the problem is water deficit, what do you do?

replace fluids orally or with isotonic IV

what should IV potassium chloride NOT be infused at?

should NOT be infused at a rate greater than 10 mEq per hour

A patient has fluid overload, low blood sodium, confused, irritable, lethargic, what can you predict is wrong?

something neurologically is wrong

what happens to the blood pressure when someone is dehydrated?

stays normal

what do you do if magnesium toxicity develops?

stop IV magnesium and support ABCs

"water follows salt" and if sodium is off, what should you worry about?

the brain

what are s/s of hypercalcemia?

think slow for hypercalcemia, sedation, fatigue, lethargy , may progress to seizures and coma

what is fluid overload?

too much water w/o electrolytes causes dilution of blood and third-spacing

how would we treat severe hypercalcemia?

treat w/ IV NS, biphosphate meds, and calcitonin, dialysis may be required

how would we treat severe hypocalcemia?

treat with IV calcium gluconate

how would we treat mild hypocalcemia?

treat with increase intake of calcium rich foods + Vit D

why do we use hypertonic solutions?

we use these to pull fluid into the vascular system to get it out of places it shouldn't be in

when will lasix not work?

when its a dialysis patient with renal failure

why do we use hypotonic solutions?

when we want fluid to leave the vascular space and go into the cells

whats an example of when we would use isotonic solutions?

when we want to increase a low blood pressure

Lactated Ringers contain potassium, when would we NOT use it?

with renal failure and liver disease because it cannot metabolize lactate