Fluid and Electrolytes Hurst
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