F & E Nclex & nur 265
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| Causes of hypervolemia | *Heart Failure *Renal Failure *Alka-Seltzer, Fleet enema, IVF with Na (lots of sodium)
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| what is the action of aldosterone and where is it found | when blood volume gets low (vomiting, blood loss, etc), aldosterone is secreted which makes you RETAIN Na and WATER and you retain fluids. It's made in the adrenal glands
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| what is the action of Atrial Natiuretic Peptide (ANP) and where is it found | Inverse relationship to aldosterone, which causes you to SECRETE Na and WATER. Found in the atria of the heart. released with bedrest.
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| Anti-diuretic Hormone (ADH) | THINK, three letter=H20. Makes you retain WATER. It'sfound in the pituitary
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| Disease(s) with too much Aldosterone | Cushings Disease
Conn's Syndrome
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| Disease(s) with too little Aldosterone | Addison's Disease
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| SIADH | too many letters, too much water! Urine is concentrated, blood is dilute. Remember, Soggy SID!!
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| think of potential ADH problem in what cases | craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy or any condition that could lead to increased ICP
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| Diabetes Insipidus | low ADH causes you to have FVD, dilute urine and concentrated blood. You're worried about shock.
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| When concentrated, what three things do you expect to go UP and what three things that when dilute, go DOWN | Specific Gravity, Sodium, & Hematocrit
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| synthetic ADH meds for diabetes insipidus | vasopressin (Pitressin)desmpressin acetate (DDAVP)
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| S/S of Hypervolemia | - distended neck veins/peripheral veins (vessels are full)
- peripheral edema, 3rd spacing (vessels can't hold any more so they start to leak), CVP goes up, lungs sound wet, polyuria, pulse and BP and weight increase (not fat)
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| Tx of Hypervolemia | - Low sodium diet/restrict fluids - I&Os & daily weights - diuretics (lasix, thiazide, aldactone (K+ sparing) - give IVFs with caution to the elderly
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| Hypovolemia | fluid volume deficit
THINK SHOCK
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| Causes of Hypovolemia ) | - loss of fluids from anywhere (thoracentisis, paracentisis, vomiting, diarrhea, hemorrhage, suction) - Third spacing (burns, ascites) - diseases with polyuria (polyuria > oliguria > anuria > renal failure
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| S/S of hypovolemia | - weight, urine output and turgor decreases, dry MM, - B/P and CVP decreases, pulse increases - Neck veins/ peripheral veins vasoconstrict (cool extremities), urine spec. gravity and pulse increase
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| Tx of hypovolemia | - prevent further loss - replace fluids (mild deficit: PO fluids, severe deficit: IV fluids) - safety precautions: at higher risk for falls, monitor for overload
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| Isotonic Solutions do what and give examples | 'I'sotonic Solutions "Stay where 'I' put it" TRICK TO REMEMBER - causes B/P to increase (NS, LR, D5W, D5 1/4 NS) CRYSTALLOID
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| Uses Isotonic Solutions when: | pt has lost fluids through N/V, burns, sweating, trauma
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| Isotonic Solutions CAUTION | when pt has hypertension, cardiac disease, or renal disease(they can cause FVE, hypernatremia)
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| Hypotonic Solutions | Hyp'O'tonic solutions "Go 'O'ut of the vessel" TRICK go into the vascular space then shift out into the cells to replace cellular fluid - rehydrate but do not cause B/P to increase (they do not stay in the vascular space) types: 1/4 DW, 0.33% NS, D 2.5 W
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| Use Hypotonic Solutions when: | pt has hypertension, renal or cardiac disease and needs fluid volume replacement because of N/V, burns, hemorrhage, etc - also use for dilution when a pt has hypernatremia and for cellular dehydration
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| Hypertonic Solutions action and name some | "'E'nter the vessel" TRICK TO REMEMBER - volume expanders that will draw the fluid into the vascular space (D10W, 3% NS, 5% NS, D5LR, D51/2 NS, D5NS, TPN, Albumin) COLLOID dangerous - acts like a SPONGE-THINK packed with particles
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| Use Hypertonic Solutions when: | if pt has hyponatremia or has shifted large amounts of vascular volume to a 3rd space, or has severe edema, burns, or ascites.
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| Hypertonic Solutions Alert: | watch for FVE because can happen quickly. Usually would be monitored in an ICU setting where you can watch B/P, pulse, and CVP.
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| causes of Hypermagnesemia | - renal failure
- Excessive Administration of MG IV
Excessive use of antacids with MG containing antacids
Severe dehydration
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| S/S of hypermagnesemia | Hypotension, heart block, flushing, bradycardia , depression, respiratory depression
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| Tx of hypermagnesemia: Medical mgmt | - discontinue all forms of MG salts
- calcium gluconate IV,
Loop diuretics and .45% NaCL IV if there is adequate renal functioning
ECG,neuro checks, vital signs
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| what is the anedote for Mg toxicity? | calcium gluconate IV
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| S/S of Hypercalcemia | - brittle bones, kidney stones, decreased DTRs
- possible arrythmias
- decreased LOC, pulse, RR
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| Tx of Hypercalcemia | - move, fluids (also prevent kidney stones)
- give Phospho Soda or Fleet enema, steroids, add phosphorus diet (anything with protein), safety precautions, must have Vit D
- calcitonin (decreases serum Ca)
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| Magnesium and/or Calcium must remember | They act like sedatives!
Think muscles first!
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| Causes of Hypomagnesemia | 1. Malnutrition
2. Malabsorption Symptoms
3. Metabolic acidosis with renal failure
4. Alcoholism
5. Loop and thiazide diuretic use/tetany/Muscular excitability
and tremors
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| Mg is excreted through... | kidneys and lost through the GI tract
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| S/S of Hypomagnesemia | Increased neuromuscular ability
Difficulty swallowing
Paralytic ileus
ECG changes
Psychological changes
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| Tx of Hypomagnesemia | Dietary Supplementation
Drug Therapy-Magnesium Sulfate IV
Check Magnesium, Calcium, and Potassium levels
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| S/S of Hypocalcemia | - rigid and tight muscles, poss. seizures, stridor/laryngospasm, positive Chvostek's sign: Tap cheek & twitches, positive Trousseau's sign: pump up B/P cuff and hand tremors - possible arrhythmias and swallowing problems due to heart/ esoph. smooth muscle
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| Tx of Hypocalcemia | - vitamin D
- Phosphate binders: Renagel, PhosLo, Os-Cal
- give IV Ca slowly & make sure pt is on a heart monitor (widens QRS complex & decreases heart rate)
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| Causes of Hypernatremia | Dehydration - too much Na, not enough water
- hyperventilation (insensible fluid loss)
- heat stroke
- DI
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| Causes of Hyperkalemia | - kidney trouble - aldactone
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| S/S of Hyperkalemia | - begins with muscle twitching to weakness to flaccid paralysis and finally life-threatening arrhythmias
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| Tx of hyperkalemia | - dialysis, calcium gluconate, glucose and insulin Any time you give IV insulin, worry about hypokalemia and hypoglycemia) *insulin carries glucose and K into the cell. -Kayexalate (sodium polystyrene) (Na/K have inverse relationship)
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| Causes of Hypokalemia | - vomiting - NG suction (lots of this in our stomach) - diuretics or not eating
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| S/S of Hypokalemia | muscle cramps
- weakness
- arrhythmias
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| Tx of Hypokalemia | - give K
- aldactone (makes them retain K)
- Eat more potassium
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| IV potassium rules | *Assess urine output * always put on a pump
NEVER IV PUSH, MIX WELL. It will burn during infusion
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| steps of orthostatic hypotension measuring | lie down flat for 3 minutes, V/S lying, sitting, standing, record BP and pulse with the positions noted
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| Bedrest causes: (4) things r/t dehydration. Explain | Diuresis (ANP increase and ADH decrease), possible dehydration risk, ileus, thick blood-DVT risk
Dehydration also causes thickened lung secretions, pneumonia
PUSH fluids
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| CVP measured where | right atrium
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| sodium deficit or excess, expect what system changes | neuro. It is the only electrolyte that cares about water.
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| Hypophosphatemia(Causes): | Decreased intestinal absorption; increased renal excretions via kidneys; Conditions:alcoholism, insulin IV, Hyperparathyroidism; A lack of phosphate interferes with oxygen transported by RBC’s and energy metabolism
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| S/S Hypophosphatemia acute: | acute: confusion, seizures, and coma;
difficulty speaking, weakness of respiratory muscles;
Decreased myocardial contractility with decreased cardiac output and blood pressure
possible bleeding
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| S/S Hypophosphatemia:chronic: | neuro memory loss and lethargy
strength: lethargy, weakness, joint stiffness
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| ADH=Anti-diuretic Hormone is | produced in the hypothalmus;stored and released by the Pituitary gland;ADH makes the body retain water
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| Aldosterone is | released by adrenal cortex;helps the body conserve sodium, sodium retention leads water retention;acts as a volume regulator
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| When is renin released in the body? | blood flow or pressure to the kidney decreases
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| Magnesium range | 1.2-2.1mg/dl
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| Nursing mgmt of hypermagnesemia: | Monitor VS, ECG strips, and urine output, report abnormal findings; Monitor serum magnesium levels as well as potassium; Teach the patient to avoid prolonged use of antacids and laxatives that contain magnesium; Increase po fluid intake
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| Medical mgmt of Hypophosphatemia | Serum phosphate levels; Vitamin D Supplements; Phosphorous IV/oral/enteral tube feedings;Check serum calcium levels; Vital signs; Strict I&O
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| Hyperphosphatemia causes | Dietary Changes-(Oral/IV); Hypoparathyroidism(lack of PTH; Renal Insufficiency-ESRD; Acidosis(either respiratory or metabolic)
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| S/S of Hyperphosphatemia | Tetany-Trousseau & Chvostek; Hyperreflexia/Seizure activity; Flaccid Paralysis; Muscular Weakness; Tachycardia; Nausea, diarrhea, abdominal cramps
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| Medical mgmt of hyperphosphatemia | Serum phosphate levels; Administering phosphate-binding gels;Restricting dietary phosphate; Dialysis; correcting the calcium deficiency through the use of Calcium supplements and agents that bind with phosphate in the GI tract.
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| Hypochloremia range | 90-110MEQ/LITER
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| Hypochloremia causes | Salt-restricted diets; GI tube drainage; Severe vomiting and diarrhea
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| S/S of Hypochloremia | Hyponatremia, hypokalemia; Metabolic alkalosis-hyperexcitability, tetany, weakness, twitching, muscle cramps, shallow breathing; Decrease B/P
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| Medical mgmt of hypochloremia | IV .9% NACL OR .45%NACL; Foods high in chloride-tomato juice, salty broths, processed meats, fruits;Ammonium Chloride; ABG’s
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| Nursing mgmt of hypochloremia | Monitor I&O, ABG’s, Serum electrolytes; Monitor the patient’s LOC; Assess muscle strength and movement; Teach the patient in regards to foods high in chloride content
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| hyperchloremia causes | Administration of 3%/5% Saline Solutions IV; Dietary intake with too much chloride content;Metabolic acidosis
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| S/S of hyperchloremia | Neuromuscular abnormalities-weakness, lethargy, unconsciousness; Respiratory problems-deep, rapid, vigorous breathing
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| Medical mgmt of hyperchloremia | Lactacted Ringers IV; Diuretics; Sodium and chloride po or IV may be restricted; Sodium Bicarbonate IV
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| Nursing mgmt of hyperchloremia | Monitor vital signs, ABG’s, and I&O; Assess for respiratory, neurologic, and cardiac symptoms; Diet teaching
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