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