Fluid & Electrolytes- HURST

Treatment for hyperkalemia?

- Dialysis - Calcium gluconate decreases arrythmias - Glucose & insulin (insulin carries glucose & K+ into cells - Sodium polystyrene sulfonate

Sign/ symptoms of hypermagnesemia?

- Flushing/ warmth (only see this with mag) - Vasodilation so ^BP, but decrease HR & RR

Three causes of hypernatremia (dehydration)?

- Hyperventilation (insensible loss) - Heat stroke - DI

Causes of hypocalcemia include:

- Hypoparathyroidism (not enough PTH) - Radical neck (not enough PTH) - Thyroidectomy (not enough PTH)

Treatment of hypercalcemia?

- Move! - Fluid (to prevent kidney stones) - Add phosphorus to diet (decreases Ca) - Increase steriods

Causes of Hypokalemia?

- Vomiting - NG suction (lots of K+ in intestines) - Diuretics - Not eating

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

1,3,4

S/s of hyperkalemia?

1. Muscle twitching, then 2. Muscle weakness 3. Then flaccid paralysis 4. Life threatening arryhthmias!!!!

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

2,3,5,6

What foods have phosphorus?

Anything with protein

What can you use hypotonic solutions on?

Clients with hypertension, renal or heart failure Or someone with hypernatremia

Two diseases when the client is making too much Aldosterone?

Cushing's- too much of ALL steroids & Conn's Syndrome (hyperaldosteronism)

What 3 things with sodium can also cause FVE?

Effervescent soluble medications (Alkaseltzer), Canned/ processed foods, IVF with sodium

Someone in FVD is at high risk for what?

FALLS- brain not being perfused correctly

Fluid retention, think what?

Heart problems!

If someone has hypermagnesemia or hypercalcemia what do we think first?

MUSCLES

If cardiac output decreases, is anything perfusing correctly in the body?

NO

What is Calcitonin for?

Osteoporosis It drives the calcium from the blood back into the bone

Someone with polyuria you think what?

SHOCK (FVD) - Think Diabetes because they are trying to get rid of glucose particles so it takes away volume

What disease is caused when we have too much ADH?

SIADH (Syndrome of Inappropriate ADH) TOO MANY LETTERS, TOO MUCH WATER

What is the tell all sign that someone in shock is in DI?

They are still diuresing!

What is SIADH?

Too much ADH (ANTI diuretic) Urine output decreases, so urine is concentrated But blood is diluted because they are holding in the water (H &H increases Serum Na decreases but URINE Na goes UP because urine is concentrated

After any surgery for sinuses near the pituitary you check for what s/s?

Urine output increases/ decrease @ risk for DI/ SIADH WORRY ABOUT SHOCK IF TOO MUCH URINE OUTPUT

what is hypophysis?

pituitary

Causes of FVE?

B - A promotes alkaline urine, should also avoid citrus juices, excessive amounts of milk, carbonated beverages B correct-promotes acidic urine, minimizes risk of urinary tract infection and stone formation, also use cranberry, tomato juice, bouillon C excessive amounts of milk promotes alkaline urine D promotes alkaline urine, should also avoid citrus juices, excessive amounts of milk and carbonated beverages

Monitor what with anyone getting hypertonic solutions?

BP, HR, CVP - ESPECIALLY 3% or 5% NS

S/S of both hypomagnesemia and hypocalcemia

**** NOT ENOUGH SEDATION**** 1. Muscle tone rigid/ tight 2. AT RISK FOR SEIZURES 3. Stridor/ laryngospasm- airway is smooth muscles getting tight 4. + Chvostek's (C is for cheeck) 5. + Trousseau's (Pump BP cuff) 6. DTR's ^ 7. Mind changes- can be crazy or even depressed 8. arrhythmias- heart is a muscle 9. Swallowing problems (muscle) ***Risk for aspiration****

Causes of hypercalcemia include:

- Too much PTH - Thiazides - Immobilization (weight bearing keeps calcium in the bone) - Brittle bones - Kidney stones (made of Ca)

causes of hypomagnesemia

- diarrhea (lost from the intestines) - alcoholism-suppresses ADH to make you diuresis & its packed with particles that make you diuresis anyway; alcoholics don't eat or drink anything but alcohol

What are isotonic solutions?

0.9% NS LR (favorite for SHOCK) D5W D5 1/4NS - Goes into the vascular space and stays there

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? Choose One 1. Spironolactone 2. Furosemide 3. Bumetanide 4. Hydrochlorothiazide

1

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? Choose One 1. Fluid volume excess 2. Cellular edema 3. Severe hypotension 4. Decreasing CVP

1. Correct: Albumin is a hypertonic solution. This type of solution will draw fluid from the cell into the vascular space. This builds up the volume in the vascular space. Therefore, the nurse must watch for fluid volume excess. Hypertonic solutions are used in clients who have 3rd spacing, severe edema, or ascites.

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? Choose One 1. Administer 3% NS at 150 mL/hr 2. Perform neurological assessment 3. Increase oral intake of sodium 4. Decrease fluid intake

2

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? Choose One 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

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? Select All That Apply 1. Liver function 2. Respiratory rate 3. Calcium levels 4. Deep Tendon Reflexes (DTRs) 5. Urinary output

2,4,5

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? 1. Encourage the client to increase PO fluid intake. 2. Administer a supplemental PO dose of potassium. 3. Stop the IV potassium infusion. 4. Administer polystyrene sulfonate PO

3

Why sit someone up who has lots of edema?

Fluid settles- you want to take the fluid off of the heart

Treatment for hypomagnesemia?

Give Mg: PO, supplement, IV (check kidney functions) seizure precautions

________ and ________ act like sedatives

Magnesium and Calcium

If your kidneys are messed up can you get rid of magnesium?

NO- so it goes into blood Renal failure can cause hypermagnesemia

Sodium and ____ have an inverse relationship

Potassium

Sodium makes us __________ fluid

Retain

What is diabetes insipidus (DI)?

Too little ADH FLuid volume deficet; Urine output increases Urine is diluted and blood is concentrated since they are not retaining a lot of fluid *** WE ARE WORRIED ABOUT SHOCK BECAUSE OF HYPOVOLEMIA****

How to take daily weights?

Void FIRST, same time, same scale, same clothes - NOT same nurse

S/S of hypokalemia

muscle weakness & cramps, irregular pulse (V tach)

Treatment for hypermagnesemia?

ventilator dialysis calcium gloconate (antidote)

What is psychogenic polydipsia?

water poisoning from drinking too much water - Leads to low sodium

Treatment for FVE?

-low sodium diet/restrict fluids -I&O and daily weights -Diuretics -Bed rest (promotes diuresis- releases ANP)

Causes of hyperkalemia?

1) kidney trouble 2) Drugs like Spironolactone- makes you retain K+

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? Select All That Apply 1. Broiled, fresh fish 2. Effervescent soluble medications 3. Seasoning with lemon pepper 4. Chicken noodle soup 5. Deli-ham sandwiches

2., 4., & 5. Correct: Think about fluid volume excess and heart failure. Things such as effervescent soluble medications and canned/processed foods should be avoided because they all contain a lot of sodium which increases fluid retention. Therefore, the chicken noodle soup and the cold cut deli-ham sandwiches should be avoided.

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

4. Correct: Diabetes insipidus is a condition that results from decreased ADH production. Therefore, the client will be diuresing large volumes of water which leads to a fluid volume deficit. We worry about shock in these clients. Keep in mind that concentrated makes #s go up and dilute makes #s go down in reference to specific gravity, sodium, and hematocrit. Here, the urine is very dilute which means the urine specific gravity will be low.

If you have ICP what should you observe for?

ADH problems

When volume gets low after vomiting, diarhhea, etc, our body secretes what?

Aldosterone- makes us retain sodium and water

What are hypertonic solutions?

D10W D5-1/2NS D5LR 3% saline 5% saline, TPN Albumin - Brings fluid from cells back into the vascular space so it DOES raise BP

What are hypotonic solutions?

D2.5W 1/2NS 0.33% NS - Goes into the vascular space, then out to the cells so it does NOT raise BP

What disease is caused when you have too little ADH?

DI (Diabetes Insipidus) - Nothing to do with blood glucose

S/s of FVD?

Decreased CVP, Low BP, HIGH HR, increased RR, low urine output (urine gravity goes up), decreased skin turgor, dry mucous membranes, weak/ thready pulse, cool extremities

S/s of both hypermagnesemia & hypercalcemia?

Decreased: Deep Tendon Reflex's, muscle tone (weak/ flaccid), LOC, Pulse, RR Increased: Arrhythmias Because they act like a sedative!!!

Who do you give fluids slow to?

Elderly & very young - People with HF & kidney problems

What is third spacing and can it cause shock?

Fluid in a NOT helpful area (not in the vascular space) Ex: Ascites will have build up of fluid in abdomen; burns pull fluid into the tissues

Whats the major problem with PO Potassium?

GI upset- so give with food!

Someone one IV Ca will always be on a what?

HEART MONITOR- Ca causes the QRS complex to widen

If a client has hyponatremia, what type of IVF do they need?

HYPERtonic fluids - 3% or 5% NS

Explain how heart failure affects FVE ?

Heart is weak, cardiac output goes down, so kidney perfusion goes down, so urine output goes down So the volume stays in the vascular space

Do NOT use isotonic solutions for clients with?

Hypertension, Cardiac disease, renal disease

Anytime you give someone IV insulin what are you worried about?

Hypokalemia & hypoglycemia

How does renal failure affect FVE?

Kidneys simply are not working so no urine output- fluid staying in vascular space

Calcium has an inverse relationship with

Phosphorus

Where is ADH hormone produced?

Pituitary gland - So you think ADH problems with craniotomy, head injury, sinus surgery, transsphenoidal hypophysectomy (Pituitary removal) or anything that causes increased ICP

What electrolyte do we worry about when taking diuretics?

Potassium! - Lose it with the "ides" - Retain it with the spirolactone

Concentrated/ diluted volume makes what numbers go up?

Sodium, urine specific gravity, and Hematocrit Concentrated= goes up Diluted= goes down

Who should get HYPERtonic solutions?

Someone who has 3rd spacing to pull fluid back into vascular space- burns, ascites, hyponatremia, edema

What is a s/s that you only see with hypernatremia?

Swollen tongue : Also include neuro changes, dry mouth, thirst

The nurse is preparing a patient for an 8:00 AM outpatient electroconvulsive (ECT) treatment. Which of the following questions is the MOST important for the nurse to ask? A. "Did you have anything to eat or drink before you came in today?" B. "Have you had any headaches since your last treatment?" C. "Who came with you to the hospital today?" D. "Have you had much memory loss since you began your treatments?"

THAT is when it leaks out into the tissues/ interstitial space & you see edema

What are some medicines that are used for ADH replacement?

Vasopressin or desmopressin

How to treatment hypocalcemia?

Vitman D- help utilize calcium Phosphate binders- Sevelemar, calcium acetate - They bind the phosphate so the calcium can get to the cell first

Anti-diuretic hormone (ADH), causes us to retain what?

WATER - NOT sodium

If someone is getting TPN do they also need IVF?

YES! no water in the TPN/ TNA

If you look at someone with a large abdominal girth are they in FVE or FVD?

You would worry about FVD because the fluid is in the INCORRECT place for ascites- NOT in the vascular space - CHECK BP

Where is CVP measured?

right atrium

Always assess _________ when giving IV Potassium?

urine output! If it goes down they could be retaining and this could kill them - Burns while its going in

What does PTH do when there is too much?

when serum calcium gets low PTH kicks in and pulls Ca from the bones to the blood- too much of this for too long can cause Osteoporosis