Fluid and Electrolytes
heart failure (HF)
-Heart is weak. -Cardiac output decreases. -Kidney perfusion decreases. -Urinary output decreases. -Volume stays in the vascular space.
Disease with too little aldosterone
Addison's disease.
Where is aldosterone produced?
Adrenal gland.
IV Potassium
Assess urinary output before/during administration.
ADH
Found in the pituitary gland.
Oral Potassium
Give with food to prevent GI upset.
Any condition that can lead to increased ICP
Observe for ADH problem.
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?
Perform neurological assessment.
Testing Strategy
The brain doesn't like it when the sodium is messed up. Neuro changes are common in clients with hyponatremia and hypernatremia.
Vasopressin (Pitressin), Desmopressin acetate (DDAVP)
Utilized as an ADH replacement in diabetes insipidus.
Isotonic solution ("Stay where I put it")
-Goes into the vascular space and stays there. -NS, LR, D5W. -Used for fluid replacement from nausea, vomiting, burns, sweating, and trauma. -Contraindicated in HTN, cardiac disease, or renal disease.
HypOtonic Solution ("Go Out of the vessel")
-Goes into the vascular space, then shifts out into cells to replace cellular fluid. -DO NOT cause HTN. -D2.5W, 1/2 NS, 0.33% NS. -Used for fluid replacement in pt with HTN, renal, or cardiac disease. -Used for dilution when client has hypernatremia.
A client is admitted following a severe burn. What changes related to fluid status would the nurse anticipate?
-Hypovolemia. -Third spacing. -Low CVP. -Increased urine specific gravity.
Not ENOUGH ADH
-Lose (diurese) water. -Fluid volume deficit. -Diabetes Insipidus. -Urine = diluted. -Blood = concentrated. -Urine output increases.
Hypokalemia ECG signs
Prominent U waves, depressed ST segment, flat T waves.
Hyperkalemia ECG signs
Tall T waves, prolonged PR interval, wide QRS.
Normal action of adrenal glands?
When blood volume gets low due to hemorrhage, or vomiting, aldosterone secretion increases to retain sodium/water....blood volume increases.
Anti-diuretic hormone (ADH)
Causes body to retain water.
HypErtonic solution ("Enter the vessel")
-Volume expanders that will draw fluid from the cells into the vascular spacing. -D10W, 3%NS, 5%NS, D5LR. -Used for hyponatremia or in a client who has large amount of vascular volume. -Returns fluid volume to the vascular space.
Sodium
135-145 -HypOnatremia = Volume (O)verload = SIADH -HypErnatremia = D(E)hydration = DKA, DI, DM, HHNK
Potassium
3.5-5.0 -S/S are same as prefix except heart rate and urine output.
Calcium
9.0-10.5 -S/S are opposite of prefix. -Sedative.
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?
Fluid volume excess.
Thyroidectomy (post op)
Monitor for hypocalcemia due to accidental removal of parathyroid glands. (Numbness/tingling in fingers, toes, and around mouth).
Fluid volume excess (hypervolemia)
Too much fluid in the vascular space.
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?
"I will be retaining sodium and water due to the increased amount of aldosterone."
Urine specific gravity, Sodium, and Hematocrit
-Concentrated makes the #'s go UP! -Dilute makes the #'s go DOWN!
Diseases with too much aldosterone
-Cushings. -Hyperaldosteronism (Conns).
S/S of FVE (fluid volume excess) a.k.a Hypervolemia
-Distended veins. -Peripheral edema. -Increased CVP. -Wet lungs. -Polyuria. -Increased pulse. -Bounding pulses. -Increased BP. -Fast weight gain.
The nurse 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?
-Effervescent soluble medications. -Chicken noodle soup. -Deli-ham sandwhiches.
A client is admitted with hypocalcemia. Which treatment would the nurse anticipate for this client?
-PO Calcium. -Vitamin D. -Sevelamer hydrochloride.
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?
-Respiratory rate. -Deep tendon reflexes. -Urinary output.
Too MUCH ADH
-Retain water. -Fluid volume excess. -SIADH. (Too many letters, too much water). -Urine = concentrated. -Blood = diluted. -Urine output decreases.
S/S of FVD (fluid volume deficit) a.k.a Hypovolemia
-Weight loss. -Decreased skin turgor. -Dry mucous membranes. -Decreased urine output. -Decreased BP. -Increased pulse. -Weak/thready pulse. -Decreased respirations. -Decreased CVP. -Peripheral vasoconstriction. -Increased urine specific gravity.
Magnesium
1.3-2.1 -S/S are opposite of prefix. -Sedative.
A client is admitted to the ICU with diabetes insipidus following a head injury. Which finding would the nurse anticipate in this client?
Low urine specific gravity.
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?
Spironolactone.
A client was admitted with reports of prolonged diarrhea. The client's admission potassium level was 3.3 mEq/L (3.3 mmol/L) and is receiving an IV of D5 ½ NS with 20 mEq KCL at 125 mL/hr. The UAP reports an 8 hour urinary output of 200 mL. The previous 8 hour urinary output was 250 ml. What should be the nurse's priority action?
Stop the IV potassium infusion.