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Fluid & Lytes

Fluid regulators (water retention) ADH, aldosterone, natriuretic peptides and renin
ADH Released from pituitary, changes osmolality & promotes water retention
Aldosterone Released from adrenals, promotes sodium & water retention, causes K+ loss
Natriuretic peptides Decreases blood volume, causes sodium & water excretion
FVD (hypovolemia) Loss of ECF exceeds intake, loss can be seen ex. Vomiting, diarrhea
5 Causes of FVD Vomiting, diarrhea, GI Suctioning, sweating & decreased intake
5 Risk factors of FVD GI disorders, third spacing (ascites), diabetes, coma, age
Major sign of FVD in ELDERLY Change in mental status
10 FVD symptoms Weight loss, oliguria, postural hypotension, tachycardia, weak pulse, cool skin, decresed temperature, thirst, nausea & muscle weakness
4 FVD labs INCREASED Hct, BUN, hgb & positive serum electrolytes
IV treatment of FVD Isotonic fluids ex. NS
9 FVD management PUSH FLUIDS, Monitor I&O, daily wieghts, vitals, oral care, assess: URINARY OUTPUT, mental status, skin/tongue turgor & mucosa
What is urine output when FVD occurs? Less than 30 ml per hour
Chronic stimulation of aldosterone result in? FVE (hypervolemia)
5 FVE risk factors CHF, renal failure, cirrhosis, excess hypertonic IV & excess sodium intake
10 FVE signs EDEMA, distended neck veins, dyspnea, crackles, BOUNDING PULSE, tachycardia, INCREASED: BP, pulse pressure, CVP and weight
Pulse pressure Systolic minus diastolic (40mmHg)
3 FVE labs DECREASED sodium, BUN & Hct
Chest X-ray of FVE patient Pulmonary congestion
13 Management of FVE FLUID RESTRICTION, LOW SODIUM DIET, diuretics, hemodialysis, turning & positioning, semi fowlers, rest, compression device, monitor: IV, I&O, daily weights, lung sounds & edema
Sodium level 135-145
3 Functions of sodium Nerve impulse transmission, skeletal muscle & heart contraction
Loss or gain of sodium = Loss or gain of water
Hypernatremia DEHYDRATION (FVD)
2 types of hypernatremia Water deprivation & sodium gained
Water deprivation hypernatremia Client unable to respond to thirst due to altered mental status or disability
Sodium gained hypernatremia is caused by Excessive salt intake or hypertonic IV, hypertonic tube feeding or concentrated infant formula
4 Common victims of hypernatremia Unconscious, elderly, infants & cognitively impaired clients
14 Symptoms of hypernatremia Initial thirst, mild temp, flushed skin, depressed fontanel, dry mucus membranes, altered neurologic function, lethargy, restlessness, twitching, DARK URINE, SWOLLEN TONGUE, seizure, coma & death
5 Treatment hypernatremia HYPOTONIC IV ex. 0.45% NaCl or D5W (for diabetics) given SLOWLY Orally give water, assess: I&O, mental status & vitals Give water with tube feedings
What disease can develop from hypernatremia? Diabetes
Hypernatremia serum sodium level Above 145
Hyponatremia Sodium deficit, sodium less than 135, affects CNS
5 Causes of hyponatremia Loss of sodium, gain of more water than sodium, CHF, liver/renal failure, excessive hypotonic IV
Dilutional hyponatremia Gain of more water than sodium, ECF volume high but no edema pesent, HOLD FLUIDS
6 Ways sodium is lost resulting in hyponatremia Through urine (diuretics or kidney disease), vomiting, diarrhea, GI suction, sweating, irrigation with water instead of NS
Ways water is gained causing dilutional hyponatremia Renal failure, CHF, hypotonic IV, SIADH, tap water enemas or excessive intake of water during exercise
EARLY Symptoms of hyponatremia SODIUM LESS THAN 125, muscle & abdominal cramps, weakness, fatigue GI: anorexia, vomiting, diarrhea, nausea, LOW BP
LATE signs of hyponatremia SODIUM LESS THAN 120, CEREBRAL EDEMA, headache, depression, personality changes, lethargy, muscle twitch, tremors, convulsions & coma
Lab results of hyponatremia Serum osmolality down & urine specific gravity increased
Treatment of hyponatremia caused by loss of sodium Assess: weight, I&O, CNS changes Isotonic IV ex. Ringers lactate, normal saline Increase sodium rich foods
Sodium rich foods Processed & preserved foods, condiments
Treatment of dilutional hyponatremia FLUID RESTRICTION, hypertonic IV ex. 3% NaCl for severe cases (USED IN ICU ONLY)
Chloride level 97-107
Chloride Produced in stomach, major anion of ECF, found in interstitial fluid & lymph mostly, essential for acid base balance, primarily obtained from table salt
Hypochloremia Chloride level below 97, accumulation of bicarbonate in ECF which in return causes pH to rise, associated with renal failure
Causes of Hypochloremia GI loss by NG tube, fistula drainage, excess sweating, METABOLIC ALKALOSIS, steroids, diuretics, loss of chloride along with K+ or Na
Symptoms of hypochloremia TETANY, irritability, weakness, muscle twitch, tremors, seizure & coma (same as sodium symptoms)
What does a chloride problem lead to? An acid base problem
Hypochloremia management I&O, vital signs, avoid free water, high chloride foods, monitor ABG & serum level
IV used to treat hypochloremia Normal saline or 0.45% NS Also potassium chloride
Chloride rich foods Table salt, canned vegetables, milk, egg, fish, bananas, cheese, processed meats, tomato juice & dates
Hyperchloremia Chloride above 107, METABOLIC ACIDOSIS
Causes of Hyperchloremia Head trauma, profuse perspiration, excess adrenocortical hormone, renal failure hypernatremia, dehydration & excessive admin of NS, 0.45% NS or lactated ringers
Symptoms of HYperchloremia Weakness, lethargy, kussmaul respiration (deep & fast), high BP, METABOLIC ACIDOSIS
What happens if hyperchloremia is untreated? Coma & decreased cardiac output
Treatment of HYPERCHLOREMIA HYPOTONIC IV ex. 0.45%, NaCl & D5W Ringers lactate, diuretics, decrease chloride intake, I&O, educate client to avoid foods high in chloride
Potassium level 3.5 - 5
Potassium Major ICF, 98% in cell & balance critical for generating action potential (sodium potassium pump), essential for NUEROMUSCULAR & CARDIAC function
Hypokalemia Less than 3.5 K+, most hospital patients are at risk because of stress hormones or NPO
Types of Hypokalemia Inadequate intake & loss of potassium
Inadequate potassium intake Unable or unwilling to eat, NPO & alcoholism
Loss of potassium Kidneys: because of drugs, steroids, insulin & DIABETES MELLITUS GI: vomiting, suction, diarrhea or ileostomy drainage ALKALOSIS: shift from ECF to ICF
Clients at risk of developing Hypokalemia Debilitated elderly, alcoholic, anorexic & bulimic
Signs of Hypokalemia Variable pulse, DYSRYTHMIA, pvc, DIMINISHED BOWEL SOUNDS, muscle weakness,leg cramps & paresthesias
What happens if there is too much acid in the blood? H+ ions move into cell & K+ moves out resulting in acidosis & hyper kalmia
Hypokalemia prevention Replace K+ losses through GI, assess NPO patients for replacement, diet teaching & K+ supplements with meds that predispose to Hypokalemia ex. Lasix, get client out of bed
Treatment of Hypokalemia IV 10mEq KCl in 100ml D5W over 1 hour *3 (SLOWLY & ASSESS CITE) Oral KCl ( DO NOT TAKE ON EMPTY STOMACH) K+ rich foods
Potassium rich foods Raisins, bananas, oranges, legumes, fruit juices & whole grains
Client at risk of hyperkalemia Client with renal failure
Causes of hyperkalemia IMPAIRED RENAL EXCRETION OF K+ Untreated: Renal failure & adrenal insufficiency Rapid admin of IV potassium TRANSFUSION OF AGED BLOOD Shift from ICF to ECF- burns, infection, trauma, ACIDOSIS
Sypmtoms of hyperkalemia BRADYCARDIA, dysrythmia (may progress to heart attack), skeletal muscle irritability (progresses to paralysis), GI DISTURBANCES (colic, diarrhea, cramping)
Treatment of hyperkalemia ECG, STOP ALL K+ supplements, give calcium gluconate, IV GLUCOSE & INSULIN, KAYEXALATE (if renal impairment), diuretics, dialysis, monitor ABG
Where is magnesium found? In bone & soft tissues
How is magnesium eliminated? By the kidneys
Magnesium regulates Nueromuscular function
Normal magnesium level 1.3 to 2.3
Magnesium rich foods Greens, legumes, whole grains, nuts, egg yolk, soy, peanut butter & chocolate
Effects of magnesium on nueromuscular junction SEDATIVE
Substances in body affected by magnesium Potassium, calcium & albumin
Effects of magnesium on cardiac Vasodilation (decreased peripheral resistance)
What particular condition is magnesium used for? Treatment of preeclampsia
Effects of magnesium on GI DIARRHEA
Causes of Hypomagnesium Loss of GI fluids (diarrhea, fistula), impaired nutrition, alcoholism, TPN, decreased K & Ca, chronic laxative use
Symptoms of hypomagnesium Difficulty swallowing (check gag reflex), change in mood, depression, seizures, hyperactive reflexes (twitching), dysrythmia & sudden death
Treatment of hypomagnesemia Mg rich diet, Mg containing antacid (DO NOT GIVE IF DIARRHEA PRESENT), IV Mg sulfate (slowly- can cause heart attack if too fast), assess for rebound hypermagnesium, loss of patella reflex
Hypomagnesemia serum Mg level Below 1.3
Causes of Hypomagnesemia Loss of GI fluids ex. Fistulas & vomiting; ALCOHOLISM; impaired nutrition; TPN; chronic laxative use; decreased K+& Ca
Symptoms of Hypomagnesemia DIFFICULTY SWALLOWING, changes in mood ex. Depression, TREMORS/ SEIZURES, sudden death, dysrythmia & TWITCHING (hyperactive reflex)
Treatment of Hypomagnesemia High Mg diet, Mg containing antacids, IV Mg sulfate SLOWLY on pump, Assess for hypermagnesemia ( loss of patella reflex)
What happens if Mg is infused too quickly Cardiac arrest
What 2 electrolyte imbalances are associated with Hypomagnesemia? Hypocalcemia & Hypokalemia
What is a major side effect of Mg? Diarrhea
Hypermagnesemia serum Mg level Above 2.3
Causes of hypermagnesemia Renal failure & diabetic ketoacidosis
Symptoms of hypermagnesemia Facial flush, weak reflexes, weakness, low BP, bradycardia(slow)
Treatment of hypermagnesemia Dialysis, hold Mg meds for pt with renal failure, Ca gluconate to reverse heart & nerve effects, LASIX
Normal Calcium level 8.6 to 10.2
Where is calcium found? In bones & teeth
How is calcium absorbed? In the presence of normal GASTRIC ACIDITY & VITAMIN D
How is calcium regulated? By PTH, calcitrol & calcitonin
3 Functions of calcium Nueromuscular, CARDIAC, BLOOD CLOTTING
Hypocalcemia calcium serum level Below 8.5
10 Causes of Hypocalcemia High phosphate intake, hypoparathyroidism, VITAMIN D DEFICIENCY, lactose intolerance, ALKALOSIS, massive transfusion, chronic diarrhea, pancreatitis, shock, massive hemorrhage
7 symptoms of hypocalcemia Laryngeal spasm, tetany, convulsions, numbness & tingling around mouth, CHVOSTEK & TROUSSEAU SIGNS, impaired clotting, osteoporosis
Who commonly has hypocalcemia? Client with renal failure because of high phosphate
If given a choice between Calcium & phosphate, which will the body choose? Phosphate
What 2 substances should never be used with Ca+ because of risk precipitation? Bicarbonate & phosphate
6 treatment of hypocalcemia High calcium diet, Ca supplements with vitamin D, IV Ca if severe, treat alkalosis, avoid alcohol & caffeine, weight bearing activities
What solution is used to dilute Ca? D5W
Major side effect of Ca on GI system Calcium causes CONSTIPATION
What question should a patient be asked before given a Mg or Ca supplement? What is your normal bowel status?
Parathyroid problem = Calcium problem eg. Neck surgery
Hypercalcemia Serum Ca above 10.2 High mortality
6 Causes of hypercalcemia Hyperparathyroidism, malignancies (cancer), decreased phosphate, renal impairment, prolonged bed rest & fractures
8 symptoms of hypercalcemia HEART BLOCK, muscle weakness, depression, anorexia, n/v, fracture, kidney stones, cardiac arrest
4 treatments of hypercalcemia Increase fluid volume (NS), diuretics, calcitonin & treat cancer
Phosphorus serum level 2.5 to 4.5
4 functions of phosphorus Formation of bones/ teeth, neuromuscular activity, releases oxygen from RBC, acid base balance
Hypophosphatemia serum level Below 2.5
9 causes of hypophosphatemia MALNUTRITION, alcoholism, pancreatitis, hyperparathyroidism, vitamin D deficiency, TPN, aluminum antacids, diuretics & alkalosis
5 manifestation of hypophosphatemia Muscle weakness/ tremors leading to resp dysfunction, SLOW WEAK PULSE, tissue hypoxia/ confusion, PLATELET DYSFUNCTION & BLEEDING
4 treatment of hypophosphatemia High phosphate diet, neutrophos po, IV potassium phosphate, stop drugs that promote phosphorus loss eg. Antacids & Ca supplements
2 causes of hypophosphatemia Renal insufficiency & hypoparathyroidism
3 manifestation of hyperphosphatemia Signs & symptoms hypocalcemia (tetany/chvostek & troussea), bone & joint pain, tachycardia
3 Treatment of hyperphophatemia Avoid high phosphorus foods, diuretics & IV fluidsz
Created by: 100000478935494