Hurst Fluid and Electrolytes
What is a normal magnesium level?
- 1.3-2.1 mEq/L
What is a normal calcium level?
- 9.0-10.5 mg/dL
Always put IV potassium through _________.
- A pump
How does bed rest induce diuresis?
- ANP is released when atrium is stretched - ANP decreases production of ADH - Decreased ADH= diuresis
What disease is associated with too little aldosterone?
- Addison's Disease
What are signs and symptoms of hypocalcemia?
- Arrhythmias - DTRs increased - Mind changes - Swallowing problems ** Mainly causes muscle problems
What are signs and symptoms of hypercalcemia?
- Bones are brittle - Kidney stones
What does anti-diuretic hormone (ADH) do?
- Causes the body to retain fluid - WATER ONLY
What should you monitor for when administering hypotonic solutions?
- Cellular edema because fluid is moving out of the cells - Can lead to fluid volume deficit and decreased BP
What surgeries or conditions can lead to ADH problems?
- Craniotomy - Head injury - Sinus surgery - Any condition that can increase ICP
What are two diseases associated with too much aldosterone?
- Cushing's Disease - Hyperaldosteronism (Conn's Syndrome)
Feeding tube patients tend to become _________.
- Dehydrated
Too little ADH Associate disease ____________ Fluid volume __________ Blood: __________ Urine: ___________
- Diabetes Insipidus - Deficit - Concentrated - Diluted
How do you treat hyperkalemia?
- Dialysis - Calcium gluconate decreases arrythmias - Glucose and insulin (insulin carries glucose and K+ into the cells) - Sodium polystyrene sulfonate (Kayexalate)
What are causes of hypomagnesemia?
- Diarrhea - Alcoholism (suppresses ADH= diuresis) - Not eating or drinking
What are signs and symptoms of hypervolemia?
- Distended neck veins - Bounding peripheral pulses - Peripheral edema and third spacing - Wet lung sounds - Polyuria - Tachycardia - Increased BP - Weight gain
What are causes of hyponatremia?
- Drinking water for fluid replacement - Psychogenic polydipsia (loves water) - D5W (sugar and water) - SIADH (retain water)
What are signs and symptoms of hypernatremia?
- Dry mouth - Thirst due to dehydration - Swollen tongue - Neuro changes
What should you monitor for when administering hypertonic solutions?
- Fluid volume excess - Monitor in ICU setting for BP, HR, and CVP
If your patient reports _______ and _______ when receiving IV magnesium, stop the IV immediately.
- Flushing - Sweating
What are signs and symptoms of hypermagnesemia?
- Flushing and warmth - Sedation
What is the major problem with oral potassium?
- GI upset
How do you treat hypomagnesemia?
- Give magnesium IV - Check kidney function - Seizure precautions - Eat magnesium
How do you treat hypokalemia?
- Give potassium - Spironolactone - Eat more potassium
What are isotonic solutions?
- Go into the vascular space and stay there - NS, LR, D5W, D5 1/4NS - Does not stay isotonic in the body, so only acute use
What are hypotonic solutions?
- Go into the vascular space and then shift out into the cells to replace cellular fluid - D2.5W, 0.45% NS, 0.33% NS
What are signs and symptoms of hyponatremia?
- Headache - Seizure - Coma
What are causes of hypervolemia?
- Heart is weak - Cardiac output decreased - Kidney perfusion decreased - Urinary out decreased - Volume stays in the vascular space
How can heart failure cause hypovolemia?
- Heart is weak - Cardiac output goes down= renal perfusion goes down= urinary output goes down
Do not use isotonic solutions on patients with what conditions?
- Hypertension - Cardiac disease - Renal disease
What are causes of hypernatremia?
- Hyperventilation - Heat stroke - Vomiting and diarrhea
What are causes of hypocalcemia?
- Hypoparathyroidism - Radical neck - Thyroidectomy - ALL CAUSE NOT ENOUGH PARATHYROID HORMONE= DECREASED CALCIUM
What should you assess before and during IV potassium administration?
- I&O
What are 5 common medications need a two nurse check?
- Insulin - Opiates and narcotics - Injectable potassium chloride or phosphate concentration - IV anticoagulants - Sodium chloride solutions above 0.9%
What are IV solutions that cause hypervolemia?
- Isotonic: goes into vascular space and stays there - Hypertonic: causes fluid to be drawn into the cell
Why can hypomagnesemia be life threatening?
- It can cause a seizure - Patient is excitable - Everything is rigid and tight
Why do you want to increase fluids in a patient with hypercalcemia?
- Kidney stones are made of calcium - Want to prevent by flushing out the kidneys
What are causes of hyperkalemia?
- Kidney troubles - Spironolactone (retain potassium)
What is hypovolemia?
- Loss of fluid from everywhere (thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage) - Big time deficit= shock
How do you treat hypervolemia?
- Low sodium diet - Fluid restrictions - Diuretics (Furosemide, Bumetanide, hydrochlorothiazide, spironolactone) - I&O - Daily weights
Why can hypermagnesemia be life threatening?
- Magnesium is a sedative - Decreases HR and RR
What is central venous pressure and where is it measured?
- Measured in right atrium - Increases with hypervolemia - More volume= more pressure
What is the best position to place a patient with ascites?
- Mid-Fowlers to decrease pressure on the lungs
How do you treat hypercalcemia?
- Move - Increase fluids to prevent kidney stones - Increase phosphorus in diet - Steroids to decrease serum calcium
What are signs and symptoms of hypokalemia?
- Muscle cramps - Muscle weakness
What are signs and symptoms of hyperkalemia?
- Muscle twitching - Muscle weakness - Flaccid paralysis
What are signs and symptoms of hypomagnesemia?
- Muscles tone rigid - Seizures - Stridor - Positive Chovestek's sign - Positive Trousseau's sign
What happens to the following lab values with hypovolemia? Na+ Hematocrit Urine specific gravity
- NA+: decreased - Hematocrit: decreased - Urine specific gravity: decreased ** DILUTE makes the numbers go DOWN
What happens to the following lab values with hypervolemia? Na+ Hematocrit Urine specific gravity
- Na+: elevated - Hematocrit: elevated - Urine specific gravity: elevated ** Concentration=elevation
How do you treat hypocalcemia?
- PO calcium - IV calcium - Vitamin D - Phosphate binders
How do you treat hyponatremia?
- Patient needs sodium - Patient doesn't need water - Hypertonic saline (3% or 5% NS)
Where is ADH found?
- Pituitary gland
How do you treat hypovolemia?
- Prevent further loss of fluids - Antiemetics, antidiarrheals - IV and PO fluids - Safety precautions (high fall risk, monitor for fluid overload)
Never give IV potassium __________.
- Push
What are causes of hypermagnesemia?
- Renal failure - Antacids
How do you treat hypernatremia?
- Restrict sodium - Dilute patient with fluids - Daily weights - I&O - Lab work
Too much ADH- 'Associated disease: __________ Fluid volume __________ Blood: __________ Urine: ___________
- SIADH - Excess - Diluted - Concentrated
What are foods high in potassium?
- Spinach - Fennel - Kale - Mustard greens - Brussels sprouts - Broccoli - Eggplant - Cantaloupe - Tomatoes - Parsley - Cucumber - Bell pepper - Apricots - Ginger root - Strawberries - Avocado - Banana - Tuna - Halibut - Cauliflower - Kiwi - Oranges - Lima beans - Potatoes - Cabbage
What foods are high in magnesium?
- Spinach - Mustard greens - Summer squash - Broccoli - Halibut - Turnip greens - Pumpkin seeds - Peppermint - Cucumber - Green beans - Celery - Kale - Sunflower seeds - Sesame seeds - Flax seeds
What is aldosterone?
- Steroid found in the adrenal glands (top of kidneys) - Blood volume gets low - Aldosterone released - Retain sodium and water - Blood volume goes up
What is the major sign that your patient is having a problem with their sodium level?
- Think neuro changes
What are causes of hypovolemia?
- Third spacing (burns, ascites - Diseases with polyuria
What is hypervolemia?
- Too much fluid in the vascular space (capillaries, arteries, veins, chambers of the heart)
What are causes of hypercalcemia?
- Too much parathyroid hormone (pulls calcium from bones) - Thiazides (retain calcium) - Immobilization (need to move to keep calcium in bones)
How do you treat hypermagnesemia?
- Ventilator - Dialysis - Calcium gluconate (antidote to magnesium)
What are hypertonic solutions?
- Volume expanders that will draw fluid into the vascular space from the cells - D10W, 3% NS, 5% NS, D5LR, D5 1/2NS, D5NS, TPN, albumin
What are causes of hypokalemia?
- Vomiting - NG suctioning - Diuretics - Not eating
What are signs and symptoms of hypovolemia?
- Weight loss - Decreased skin turgor - Dry mucous membranes - Decreased urine output - Decreased BP - Increased HR (weak, thready) - Increased RR - Decreased CVP - Cool extremities - Increased urine specific gravity