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Flashcards

Fluid and Electrolytes

Laura G English 75 cards

Cards in this deck (75)

  1. 1Phosphate Normal Levels2.5-4.5 mg/dL
  2. 2Role of phosphate in the bodyHelps build bones, teeth, nerve muscle and function.
    Stored mainly in the bones
  3. 3What two things play a role in phosphate regulation?The kidneys and parathyroid
  4. 4What influences phosphate?Calcium in the opposite way.
    When phosphate levels decrease, calcium levels increase.
  5. 5What vitamin plays an important role in phosphate absorption?Vitamin D
  6. 6Causes of hyperphosphatemia Remember "PhosHI"-Phospho-soda overuse: phosphate containing laxatives or enema, don't give to patients with renal failure
    -Hypoparathyroidism: due to under secretion of parathyroid hormone. This causes phosphate to become over absorbed by the kidneys.
    -Over use of Vit D: causes over absorption of phosphate.
    - Syndrome of tumor lysis: occurs with treatment of cancer. Causes electrolytes to imbalance due to the cell dying and releasing intracellular contents
    -rHabdomylosis: rapid necrosis of the muscle and lead to myoglobin being released into the bloodstream which affects kidneys and causes renal failure.
    -Insufficiency of kidneys: causes phosphate not to be excreted.
  7. 7S&S of Hyperphosphatemia "CRAMPS"Confusion
    Reflexes hyperactive
    Anorexia
    Muscle spasm in claves or feet, tetany, seizures
    Positive Trousseau's sign, pruritis
    Signs of Chovstek
  8. 8Nursing interventions of Hyperphosphatemia-Administer phosphate binding drugs (Phoslo) which works on the Gi system and excretes phos through the stool. (NCELX: give with meals or right after)
    -Avoid using phosphate medication like laxatives and enema
    -Restrict foods high in phosphate
    -Prepare patient for dialysis if patient in renal failure
  9. 9Causes of hypophosphatemia "Phosphate"-Pharmacy: drugs like aluminum hydroxide-based or mg based antacid cause malabsorption in GI system
    -Hyperparathyroidism: over secretion of PTH which causes phosphate to not be reabsorbed at all
    -Oncogenic osteomalacia: kidneys start to waste phosphate which leads to low phosphate levels and softening of the bones
    -Syndrome of Refeeding: causes electrolytes and fluid problems due to malnutrition or starvation
    -Pulmonary issues such as reap alkalosis (under alkalotic cond. phosphate moves out of the blood into the cell which causes phosphate blood levels to decrease)
    -Hyperglycemia: glycosuria, polyuria, ketoacidosis which causes kidneys to waste phosphate
    -Alcoholism: affects body's ability to absorb phosphate
    -Thermal Burns: due to shifting of phis intracellularly
    -Electrolyte imbalances: hypercalcemia, hypomagnesia, hypokalemia cause phosphate levels to decrease
  10. 10S&S of Hypophosphatemia "BROKEN"-Breathing problems from muscle weakness
    -Rhabdomyolysis: tea colored looking urine due to myoglobin in the urine and muscle weakness/pain
    -Osteomalacia (softening of bones) fractures and decreases bone density, Cardiac Output decreased
    -Kills immune system with immune suppression and decreased platelet aggregation
    -Extreme weakness, Eccymoses from decreased platelets
    -Neuro status changes (irritability, confusion, seizures)
  11. 11Nursing interventions for Hypophosphatemia-Admin oral phis with Vit D supplement
    -If TPN watch pt complaints of muscle weakness or pain (from rhabdomylosis or refeeding)
    -Ensure pt safety due to risk of bone fractures
    -Encourage foods high in phos but low in Ca+ (Fish, organ meats, nut, pork, beef chicken, whole grains)
    -If phos is less than 1 mg/dL dr may order Iv phos which affects Ca+ levels casing hypocalcemia or increase phosphate levels (hyperphos) (assess renal status (BUN/CRE) before admin because if kidneys are failing pt won't be able to clear phosphate.
    Also place on cardiac monitor and watch for EKG changes!!
  12. 12Magnesium Normal Levels1.3-2.3 mg/dL
  13. 13Magnesium affects the body by...Transferring and storing energy, regulation of PTH.
    Mg+ is absorbed in the small intestine
    Mg+ is excreted via the kidneys
  14. 14Cause of Hypermagnesemia "MAG"Hypermagnesemia is less common than hypomagnesemia.
    -Magnesium containing antacid and laxatives (Mylanta, Maalox)
    -Addison's disease (adrenal insufficiency)
    -Glomerular filtration insufficiency (<30 mL/min) renal failure. This is because kidneys are keeping too much mg+
  15. 15S&S of Hypermagnesemia "Lethargic"Mild cases=asymptomatic
    -Lethargy (profound)
    -EKG changes with PROLONGED PR & QT INTERVAL AND WIDENED QRS complex
    -Tendon reflexes absent/grossly diminished
    -Hypotension
    -Arrhythmias (bradycardia, heart blocks)
    -Respiratory arrest
    -GI issues (N,V)
    -Impaired breathing from skeletal weakness
    -Cardiac arrest
  16. 16Nursing interventions for Hypermagnesesmia-Monitor cardiac, resp, neuro, and renal stat. Put pt on cardiac monitor and watch EKG changes
    -Ensure safety due to lethargic/drowsiness
    -Admin diuretics that waste mg+ (if not in renal failure) like loop and thiazide diuretics
    -Patient in renal failure prep for dialysis
    -IV calcium may be ordered to reverse side effects of mg+ (watch for infiltration, prefer central line)
    -Prevention:
    1. Avoid giving mg+ containing antacids/lacatives to pt with renal failure
    2. Assess for hypermg during IV infusions of mg+ sulfate for hypomagnesemia (S&S are diminished/absent deep tendon reflexes)
    3. Withhold foods high in Mg+ (Avocado, Green leafy vegetables, PB, potatoes pork, Oatmeal, Fish (white tuna, mackerel), Cauliflower, dark chocolate, Legumes, nuts
  17. 17Causes of Hypomagnesemia "LOW MAG"-Limited intake mg+ (starvation)
    -Other electrolyte issues cause low mg+ levels (hypOkalemia, hypOcalcemia)
    -Wasting mg+ kidneys (loop & thiazide diuretics & cyclosporine)
    -Malabsorption issue (Chron's, Celiac, proton pump inhibitors
    -Alcohol (Stim kidneys to excrete mg+, acute pancreatitis)
    -Glycemic issues (DKA, insulin admin)
  18. 18S&S of Hypomagnesemia "TWITCHING"Twitching= body is experiencing neuromuscular excitability.
    -Trouesseau's (positive due to hypocalcemia)
    -Weak respirations
    -Irritability
    -Torsades de pointes (abnormal heart rhythm that leads to sudden cardiac death…alcoholism) tetany (seizures)
    -Cardiac Changes (mod: Tall T-waves & depressed ST segments) (severe: prolonged PR & QT interval) prolong of QT interval increases risk for Torsades de points, Chvostek's sign- from hypocalcemia
    -Hypertension, hyperreflexia
    -Involuntary movements
    -Nausea
    -GI issues (decreased bowel sounds and mobility)
  19. 19Nursing Interventions for Hypomagnesemia-Monitor cardiac, GI, resp, neuro stat. Place on cardiac monitor
    -May admin k+ supplements due to hypokalemia (hard to get mg+ levels up if k+ levels is down)
    -Administering ca+ supplements
    -Administer mg+ sulfate IV route. Monitor mg+ levels closely because pt can become mg+ toxic (watch for depressed or loss of deep tendon reflexes)
    -Place pt in seizure precautions
    -Oral forms of Mg+ can cause diarrhea, increase mg+ loss
    -Watch other electrolyte levels like ca+ and k+
    -Encourage foods rich in Mg+ (Avocado, green left veggies, PB, oatmeal, fish, cauliflower, legumes, nuts, oranges, milk)
  20. 20Sodium Normal levels135-145 mEq/L
  21. 21Hypernatremia, what is the problem,?Is a water problem rather than a sodium problem. This is because when the body collects Na it causes a lot of H2O retention and this is what causes the problem
  22. 22Role of Na in the bodyHelps regulate the amount of water inside and outside the cells.
  23. 23Causes of hypernatremia "HIGH SALT"-Hypercortisolism (cushing's syndrome), hyperventilation
    -Increased intake of sodium (oral or IV route)
    -Gi feeding tube without adequate water supplements
    -Hypertonic solutions
    -Sodium excretions decreased (body keeps too much Na) and coritcosteroids
    -Aldosterone overproduction
    -Loss of fluids (dehydrated), infection (fever), sweating, diarrhea, and diabetes insipidus
    -Thirst impairment
  24. 24S&S of Hypernatremia "No FRIED foods for you!"-Fever, flushed skin
    -Restless, really agitated
    -Increased fluid retention
    -Edema, extremely confused
    -Decreased urine output, dry mouth/skin
  25. 25Nursing Interventions for Hypernatremia-Restrict sodium intake, know foods high in Na
    -Keep patient safe b/c confused & agitated
    -Dr. may order isotonic or hypotonic solutions like 0.45% NA. Give sow because brain tissue is at risk/ risk for cerebral edema.
    -Educate patient and fan about S&S of high sodium level and proper foods to eat.
  26. 26Euvolemic Hyponatremia-Water in the body increases but sodium stays the same
    -Syndrome of inappropriate antidiuretic hormone secretion (SIADH) retain water in the body which dilutes sodium
    -Other causes: diabetes insipid us, adrenal insufficiency, Addison's disease
  27. 27Hypovolemia Hyponatremia-Where pt has lost a lot of fluids and sodium
    -V,D, NG suctions, diuretic therapy, burns, sweating
  28. 28Hypervolemic HyponatremiaBody has increased fluid and sodium.
    -sodium decreases due to dilution because total body water and sodium are regulated independently
    -Causes: congestive HF, kidney failure, IV infusion of saline, liver failure
  29. 29Causes of Hyponatremia "NO NA+"-Na+ excretion increased with renal probs, NG suction, vomiting, diuretics, sweating, diarrhea, decreased secretion of aldosterone
    -Overload of fluid with CHF, hypotonic fluids infusions, renal failure
    -Na+ intake lower through low salt diets or NPO
    -Antidiuretic hormone over secreted (SIADH)
  30. 30S&S of hyponatremia "SALT LOSS"-Seizures & stupor
    -Abdominal cramping, attitude changes (confusion)
    -Lethargic
    -Tendon reflexes diminished, trouble concentrating
    -Loss of urine & appetite
    -Orthostatic hypotension, overactive bowel sounds
    -Shallow respirations (skeletal muscle weakness)
    -Spasms of muscles
  31. 31Nursing interventions for Hyponatremia-Watch cardiac, resp, neuro, renal and GI stat
    -Hypovolemic Hypo: give IV Na+ Cl- infusion to restore Na and fluids (3% saline hypertonic solution) give in ICU
    -Hypervolemic Hyponatremia: restrict fluid intake and sometime administer diuretics to excretion of the extra water rather tan sodium
    -Caused by SIADH or antiduretic hormone probes: fluid restriction or treated with an antidiuretic hormone antagonist (Declomycin, which is part of the tetracycline family (DON'T GIVE WITH DAIRY OR ANTACIDS)
    -If pt takes lithium remember to monitor drug levels because its excretion will diminished and can cause lithium toxicity
    -Instruct to increase oral sodium intake and some may prescribe NA tablets.
  32. 32Calcium Normal Levels8.5-10.5 mEq/L
  33. 33Calcium Role in BodyPlays a huge role in bone, teeth, and muscle nerve function, cell and blood clotting
    -Calcium is absorbed in the GI system
    -Store in the bones
    -Excreted by the kidneys
    -Vit D helps play a role in Ca absorption
  34. 34Causes of Hypercalcemia "HIGH CAL"-Hyperparathyroidism (causes too much ca to be released into blood)
    -Increased intake of Ca
    -Glucocorticoids usage (suppressed Ca absorption which leaves more Ca in the blood)
    -Hyperthyroidism
    -calcium excretion decreased with Thiazide diuretics & renal failure, cancer of bones
    -Adrenal insufficiency (Addison's disease)
    -Lithium usage (affect the parathyroid and causes phosphate to decrease and Ca to increase)
  35. 35S&S of Hypercalcemia "The body is too WEAK"-Weakness of muscles (profound)
    -EKG changes SHORTENED QT INTERVAL (most common) and prolonged PR interval
    -Absent reflexes, absent minded (disorientated), abdominal distention from constipation
    -Kidney stone formation
  36. 36Nursing Interventions for HypercalcemiaMild:
    -Keep patients hydrated
    -Safe from falls or injury
    -Monitor cardiac, GI, Renal, Neuro stat
    -Assess for complaints of flank or ab pain & strain urine for stones
    -Decrease Ca+ rich foods and intake of Ca+ preserving drugs like thiazides, vit D
    (Yogurt, sardines, cheese, spinach, collard greens, tofu, rhubarb, milk)
    Mod cases:
    -Administer Ca reabsorption inhibitors: Calcitonin, prostaglandin synthesis inhibitors (ASA, NSAIDS)
    Severe:
    Prepare patient for dialysis
  37. 37Causes of Hypocalcemia "LOW CALCIUM"-Low parathyroid hormone due to the destruction or removal of parathyroid gland
    -Oral intake inadequate (alcoholism, bulimia)
    -Wound drainage (esp. GI system)
    -Acute pancreatitis
    -Low Vit D levels
    -Chronic Kidney Issues
    -Increased phos levels in the blood
    -Using meds like mg+ supplements, laxatives, loop diuretics, calcium binder drugs
    -Mobility issues
  38. 38S&S of Hypocalcemia "CRAMPS"-Confusion
    -Reflexes hyperactive
    -Arrhythmias (prolonged QT and ST interval)
    -Muscles spasms in claves or feet, tetany, seizures
    -Positive trousseau's (this sign may be positive before others)
    -Chvostek's sign
  39. 39Nursing Interventions for Hypocalcemia-Safety (fall risk bone fractures, seizure precautions, laryngeal spasms
    -Admin IV calcium. Assess for infiltration or phlebitis (tissue sloughing) WATCH FOR DIG TOX
    -Admin oral ca+ with vit D (given at meals or bedtime with water)
    -If phos is high dr. might order aluminum hydroxide antacids (TUMS) to decrease phos levels to increase Ca+
    -Encourage intake of foods high in ca+ (yogurt, sardines, cheese, spinach, collard greens, tofu, rhubarb, milk)
  40. 40Potassium Normal Levels3.5-5.0 mEq/L
  41. 41Potassium function in the body-It is found in the intracellular part of the cell compared to the extracellular which is where sodium is mainly found
    Responsible for nerve impulse conduction and muscle contraction
  42. 42Causes of Hypokalemia "Your body is trying to DITCH potassium"-Drugs (laxatives, diuretics, corticosteroids)
    -Inadequate consumption of Potassium
    -Too much water intake (dilutes potassium)
    -Cushing's syndrome (adrenal glands produce excessive amount of cortisol, and cause the body to retain Na+ and water but waste potassium)
    -Heavy fluid loss (NG suction, V, D, wound drainage, sweating)
  43. 43S&S of hypokalemiaSLOW and LOW
    -Weak pulses (irregular and thread)
    -Orthostatic hypotension
    -Depression ST, flat or inverted T wave and prominent u wave
    -Shallow respiration with diminished breath sounds, due to weakness of accessory muscles)
    -Flaccid paralysis
    -Decrease deep tendon reflexes
    -Decreased bowel sounds
  44. 447 L's of hypokalemia1. Lethargy
    2. Low, shallow respirations
    3. lethal cardiac dysrhythmias
    4. lots of urine
    5. Leg cramps
    6. Limps muscles
    7. Low Bp & heart
  45. 45Nursing interventions hypokalemia-Watch heart rhythm, respiratory status, neuro, GI, urinary output and renal status
    -Watch other electrolytes like mg+, glucose, Na, Ca
    -Administer oral supplements for K+ with dr order, give with food can cause GI upset
    -IV K+ for levels 2.5 less
    -Causes phlebitis or infiltration
    -Don't give lasix or thiazides (waste K+)
    -Physician will switch pt to K+ sparing diuretics spironolactone, dyazide
    -Eat food (Potatoes, Oranges, Tomatoes, Avocados, strawberries, spinach, fish, mushrooms, musk melons
  46. 46Causes of hyperkalemia "The Body CARED too much about Potassium"-Cellular Movement of Potassium from IC to EC (burns, tissues damages, acidosis)
    -Adrenal Insufficiency with addison's disease
    -renal failure
    -Excessive Potassium intake
    -Drugs (potassium-sparing)
  47. 47S&S of Hyperkalemia "MURDER"-Muscles weakness
    -Urine production little or none (renal failure)
    -Respiratory failure (decreased ability to use breathing muscles or seizures develop)
    -Decreased cardiac contractility (weak pulse, low blood pressure)
    -Early signs of muscles twitches/cramps, late profound weakness, flaccid
    -Rhythm changes: Tall peaked T Waves, flat P waves, Widened QRS and prolong PR interval
  48. 48Nursing interventions for hyperkalemia-Monitor cardiac, resp, neuromuscular, renal, and Gi status
    -Stop IV potassium if running and hold any PO potassium supplements
    -Initiate potassium restricted diet and remember foods that are high in k+
    -Prepared patient for dialysis (those who regularly get this will have high K+)
    -Doctor may order K+ wasting drugs like lasix
    -Administer a hypertonic solution of glucose and regular insulin to pull the potassium into the cell.
    -Stop foods rich in potassium (Potatoes, oranges, tomatoes, avocados, strawberries, spinach, fish mushrooms, cantaloupe)
  49. 49ChlorideMajor anion of ECF mostly found in lymph and interstitial.
    Inverse relationship with bicarbonate as cl moves from plasma into RBC.
  50. 50Chloride Norm level97-107 mEq/L
  51. 51Causes of Hypochloremia-Caused by GI tube drainage, suctioning, gastric surgery, severe vomiting and diarrhea
    -Admin of aldosterone, ACTH, corticosteroid, bicarb or laxatives cause decrease
    -Sodium and bicarb ions are retained in the kidney to balance the loss, bicarb accumulates in ECF, high blood pH, hypochloremic metabolic acidosis
  52. 52S&S Hypochloremia-Hyperexcitability of muscles, tetany, hyperactive DTR's weakness, twitching, muscle cramps
    -Hypokalemia can cause hyoichloremia, cardiac dysrhytmias
    -Low Cl levels, low Na+ levels, excess water, hyponatremia, seizures, coma
    -Slow, shawllow respirations, resp acidosis
  53. 53Nursing interventions Hypochloremia-Normal saline (0.9% or 0.45%) IV
    -Discontinue loop or thiazide diuretics
    -Ammonium chloride if renal/hepatic function normal
    -Encourage foods: tomato juice, bananas, dates, eggs, cheese, milk, salty broth, canned veggies, processed meats
  54. 54Causes of Hyperchloremia-Almost exclusively a result from iatrogenically induced hyperchloremic metabolic acidosis, stemming from excessive administration of Cl= relative to NA AKA 0.9% Na, 0.45% NS or LR
    -Can also be caused by loss of bar carbonate through kidneys or GI tract corresponding increased Cl- ions
    -Excess ACTH
  55. 55S&S of Hyperchloremia-Tachypenea (rapid breathing)
    -weakness
    -lethargy
    -deep rapid reps
    -diminished cog ability
    -hypertension
    -Can lead to decreased cardiac output, dysrhytmias and coma
    -High Cl- level = High Na+ level = fluid retention
  56. 56Nursing interventions Hyperchloremia-Administer hypotonic IV
    -LR can be prescribed to convert lactate into bicarb
    -Iv sodium bicarb to increase bicarb levels to secrete Cl- this is because bicarb and Cl- compete for combo with Na
    -Administer diuretics
    -Restrict Na+, Cl- and fluids
    -Monitor vitals, ABG, I&O
    -Educate pt about diet followed to manage hyperchloremia and maintain adequate hydration
  57. 57Normal ABG levels:pH: 7.35-7.45
    PaCO2: 38-42
    HCO3 22-26
  58. 58Metabolic acidosisa metabolic problem due to the buildup of acid in the body fluids which affect the bicarb (HCO3 levels)
    -Increased acid prod: increased in the body which decrease bicarb
    -Decreased acid execration: renal failure where there is high amount of waste left in the body which causes the acids increase and bicarb can't control imbalance
    -Loss of too much bicarb
    -body tries to compensate in the reps system with hyperventilation through kussmaul's respirations
  59. 59What is an anion gap?Patients lab work and calculates to see the difference between the anions and cations
  60. 60High anion acidosisCondition that causes the body to produce too much acid or not enough bicarb (DKA, ASA toxicity, renal failure, high fat diet, low carb diet, malnutrition)
  61. 61Normal Anion acidosisLoss of bicarb from the body (ex. diarrhea, ostomies or fistula drainage)
  62. 62Causes of Metabolic Acidosis "ACIDOTIC"-Aspirin toxicity (high anion gap)
    -Carbohydrate not metabolized (high anion gap)
    -Diarrhea (norma anion gap)
    -Ostomy drainage (normal anion gap)
    -Fistula (normal anion gap)
    -Intake of high-fat diet
    -carbonic anhydrase inhibitors
  63. 63S&S of metabolic acidosis-Kussmaul's respirations (bodes way of trying to compensate by exhaling the excessive CO2 in hopes of increase bicarb and blood ph)
    -Confused weak, low BP, cardiac changed, n, v
  64. 64Nursing interventions for Metabolic Acidosis-Watch resp system and ABGs
    -Assess other electrolyte levels
    -Watch neuro stat, safety and place in seizure precaution
    - Dialysis may be needed if they patent is experiencing acidosis
    -Diabetic ketoacidosis - administer prescribed insulin to help glucose go back into the cell
  65. 65Metabolic alkalosismetabolic problem cause by excessive loss of acids or increased amount of bicarb produced in the body that leads to an alkalotic state
    -disease processes and drugs can cause metabolic alkalosis
    -other systems try to compensate, like the resp system by hypoventilation
  66. 66Causes of Metabolic Alkalosis "Alkali"-Aldosterone production excessive (hyperaldosteronism) actives renin-angiotension-aldosterone system
    -Loop diuretics (lasix) or thiazide therapy
    -Alkali ingestion of food increases bicarb level in blood
    -Anticoagulant "cirate"
    -Loos of fluids (vomiting or GI suctioning)
  67. 67Nursing interventions for metabolic alkalosis-Based on the cause: vomiting, stop diuretics
    -Dr. may order diamox (carbonic anhydrase inhibitors): a diuretic which reduces the reabsorption of bicarb
    -Watch ABGs and signs of reap distress
    -Monitor potassium and Cl levels
  68. 68Respiratory AlkalosisMain cause of reap alkalosis is tachypnea (fast RR 20 bpm) which causes CO2 to decrease in the lungs)
  69. 69Causes of Resp Alkalosis "TACHYPNEA"-Temperature increases due to increased metabolic needs of the body from the reps center (Medulla pons) exhaling too much CO2
    -Aspring toxicity
    -Controlled ventilation- can hyperventilate a patient
    -Hyperventilation
    -Hysteria (anxiety)
    -Pain, pregnancy, pneumonia
    -Neuro injuries from head injury or stroke
    -Embolism or edema
    -Ashthma
  70. 70S&S of reps alkalosis-Fast RR tachypnea (>20 BPM)
    -Neuro changes: tired, lethargy, fast HR
    -tetany, dysrhythmias, muscle cramps, Positive chvostek's sign due to hypocalcemia and hypokalemia
  71. 71Nursing interventions for Resp. Alkalosis-Teach pt breathing tech. to slow breathing, hold breath (paper bag technique
    -Watch K levels and for s&s of low ca and k levels
    -closely watch pt on mech. ventilation to ensure breaths are not hyperventilating the pt
  72. 72Main cause of Resp. AcidosisBradypnea (slow RR which causes CO2 to build up in the lungs)
  73. 73Causes of reap acidosis "DEPRESS"-Drugs cause reap depression, and disease of the neuro system
    -Edema
    -Pneumonia
    -Resp center of brain damaged (Brain injury, stoke)
    -Emboli
    -Spasms of bronchial tubes
    -Sac elasticity of alveolar sacs are damaged and districts air flow (emphysema and COPD)
  74. 74S&S of resp Acidosis-Major neuro changes (confused, very drowsy, HA
    -RR less than 12
    -Low Bp
  75. 75Nursing Interventions for resp acidosis-Admin O2
    -encourage coughing and deep breathing
    -Suction pneumonia
    -May need resp treatment
    -Hold resp depression rugs
    -Watch k+ levels that are >5.1
    -Admin antibiotics for infection
    -May need endotracheal intubation if co2 mmhg or resp distress is present

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Flashcards on Fluid and Electrolytes, created by Laura G on 08/04/2018.
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