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If a pt has hyponatremia and normal fluid volume use...
water restiction and treat underlying cause
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If a pt has hyponatremia with hypovalemia use
IV normal saline or lactated Ringers to correct ECF deficit
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if a pt has hyponatremia with hypertonic dehydration treat with
fluid restriction and treat underlying cause
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if pt has hypernatremia and hypervolemia
remove sources of sodium excess, administer diuretics and replace water as needed
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for a pt with hypokalemia and is not on fluid restriction encourage a
high fiber diet and high fluid intake to prevent constipation
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For a pt with hyperkalemia give what as an enema??
Kayexalate
*can be given orally with an osmotic agent to decrease constipation
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for a pt with hyperkalemia what can be given to drive K+ into cells
Give K+ wasting diuretics to eliminate via kidneys or 50% dextrose with regular insulin
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what can be given to a pt with hypocalcemia
oral calcium supplements , or calcium gluconate by slow IV push or in infusion of D5W of NS
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a pt with hypocalcemia is given thiazide diuretics to
decrease urinary excretion of calcium
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What emergencies should you be prepared for with a pt with hypocalcemia??
tetany, seizures, laryngospasm, and respiratory and cardiac arrest
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What precautions do you want to initiate with a pt with hypocalcemia
seizure precautions and maintain a quiet environment
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what emergency equipment should you have on hand for a pt with hypocalcemia who just had a thyroidectomy
emergency tracheostomy kit and IV calcium gluconate at bedside
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What will promote calcium excretion for a pt with hypercalcemia
loop diuretics-furosemide (lasix) or ethacrynic acid (Edecrin)
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How much and what kind of oral fluids should be given to a pt with hypercalcemia
- 3000-4000mL fluid/day
- oral fluids high in acid-ash (cranberry, prune juice)
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What kind of fluid should be infused for a pt with hypercalcemia
infuse NS at 300-500mL/hr up to 6 L until volume status restored then 0.45% NaCl;
Watch for fluid overload
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What can be given to a pt to decrease GI absorption of calcium for a pt with hypercalcemia
Corticosteroids (prednisone)
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What precautions do you want to watch for for a pt with hypomagnesemia
institute ECG monitoring
seizure precautions
-
What do you want to monitor for when a pt has hypomagnesemia
Monitor stridor and/or difficulty swallowing
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Pitting edema reflects fluid in the
interstitial spaces
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if there were excess fluid volume what would happen to you neck and hand veins
they would remain full
-
if there were excess fluid volume in a pt the pts peripheral pulses would be
bounding
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Normal saline (0.9% NaCl) ia an
isotonic fluid
prevents fluid shifts into or out of the GI tract
-
-
-
An excess response to diuretic therapy results in an excess of
water and electrolytes in the urine, leaving the blood hemoconcentrated and casuses a high BUN and Hct
-
3% saline is
very hypertonic
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Ringers solution contains
sodium, potassium, calcium and potassium in similar concentrations to plasma,
provides no calories or free water
-
Lactated Ringers solution contains
sodium, chloride, potassium, calcium and lactate in concentrations similar to normal plasma
Provides no dextrose, magnesium, or free water
-
Hypotonic IV fluids are used to prevent and treat
cellular dehydration by providing free water to the cells or to restore renal functioning
-
What triggers a release of ADH
Drop in BP or blood volume
Rise in blood osmolarity
-
When ADH is released from a trigger what happens to the kidneys
the kidneys reabsorb more water
resulting in higher vascular volume and low output of concentrated urine
-
What inhibits the release of ADH
rise BP or blood volume
Drop in blood osmolarity
-
When ADH is inhibited what happens to the kidneys
the kidneys excrete more water in the urine
resulting in lower vascular volume and high output of dilute urine
-
Aldosterone release is triggered by
- Drop in BP
- Drop in Sodium
- Rise in Potassium
-
Aldosterone causes the kidneys to
- reabsorb more sodium into the blood
- increasing sodium levels
-
Aldosterone release is inhibited by a
- Rise is BP
- Rise in Sodium
- Drop in Potassium
-
Decreasing aldosterone levels cause the kidneys to
- excrete more sodium in the urine,
- decreasing sodium levels
-
Glucocorticoids promote
renal retention or sodium and water
-
The minimum normal urine output in the average adult is
30 mL/hr
-
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if a person had a head injury which IV fluid would you not want to give the pt?
5% dextrose it has a hypotonic effect when infused
it puts free water into cells which would worsen the pts cerebral edema
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Which two electrolyte imbalances would the nurse assess for in a client with a high fever and severe dehydration
Hypernatremia and Hyperchloremia
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SIADH is caused by
excessive production of ADH or an ADH-like substance, resulting in decreased sodium and hypervolemia
-
Loop diuretics are given to promote
diuresis
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What are the clinical presentations when a pt is hyponatremia and hypervolemic state
CHF, cirrhosis, nephrotic syndrome, and renal failure
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What are the clinical presentations when a pt is hyponatremia and hypovolemic state
GI fluid loss, diuretic therapy, osmotic diuresis, adrenal insufficiency, burns, and sweating, hypotonic dehydration
-
Lactated Ringer or 0.9% sodium chloride(NS) can be used to treat
hyponatremia with isotonic dehydration
-
What two diseases are more prone to develop hypernatremia
- Cushings syndrome
- Diabete insipidus
-
HCTZ and Lasix are diuretics that increase
the excretion of potassium
-
Calcium gluconate is given to
antagonize the effects of the potassium on the conduction system of the heart
Not given to promote excretion of potassium
-
A client who has diarrhea or nasogastric suctioning will be more likely to develop
Hypokalemia
-
A pt with elevated calcium levels and PTH is the cause of
Hyperparathyroidism
-
Large doses of corticosteroids decrease
calcium absorption in the intestines, leading to further decrease in calcium levels
-
The overall effect of PTH is to increase______and decrease______
- increase calcium
- decrease phosphorus
-
calcitonin is directly secreted when calcium is
high
-
If magnesium is low, PTh release is _____
impaired, lowering the calcium level
-
Hypomagnesemia is also seen with
hyperkalemia and hypocalcemia
-
Chocolate has a small amount of _____
Magnesium
-
Decreased magnesium levels also contribute to reduction in
- potassium
- calcium
- phosphate
-
Magnesium decreases the amount of _________activity
Acetylcholine, causing muscle relaxation
-
Hyperactive reflexes are early signs of
tetany
Low magnesium level could lead to tetany and seizures
-
sources of magnesium in the diet include
- green leafy veggies
- nuts
- legumes
- whole grains
- seafood
- bananas
- oranges
- chocolate
-
depressed Deep tendon reflexes indicate an elevated
magnesium level
-
Increased use of sodium bicarbonate causes excretion of
chloride or hypochloremia
it would be appropriate to have chloride levels monitored for potential deficits
-
Foods high in chloride are
- canned veggies
- dates
- bananas
- cheese
- spinach
- milk
- eggs
- celery
- crabs
- fish
- olives
- rye
-
Predisposing fluid and electrolyte imbalances for hypochloremia
- Hyponatremia
- Hypokalemia
- prolonged administration of D5W IV therapy
- metabolic alkalosis
-
Predisposing fluid and electrolyte imbalances for Hyperchloremia
- Hypernatremia
- Metabolic acidosis
-
What is an anticipated manifestation for a pt with a high level of chloride
Weakness and lethargy
-
When a client is admitted with a chloride level of 80 the nurse anticipates administration of which of the following IV solutions
0.45% sodium chloride with 20 mEq of potassium
-
Normal Saline is an _______solution
isotonic solution that will replace lost vascular volume and promote perfusion
-
the loss of Sodium, potassium, chlorides, hydrogen is from
vomiting
-
The loss of Sodium, potassium, bicarb is from
diarrhea
-
Steroid make people ________fluids in
HOLD
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For a protein deficiency what kind of diet is given
high carbs and high protien
-
Plasma to interstitial causes
Increased capillary hydrostatic pressure
Decrease plasma protein
Increase cap. permeability
- everything is pushed out
- everything stays in tissue
-
Ascities can be called
Edema
-
Anasarca
generalized edema
-
Interstitial to Plasma Shift
Decrease in cap. hydrostatic pressure
Increase in colloidal osmotic pressure
Re-mobilization of fluid following burns or trauma
-
What would the nurse expect to assess in a pt with interstitial to plasma
Bp is going to be high, HR(quality will be bounding), kidney will try to get rid of it and urine will be dilute
Pulmonary edema: crackles, sob, coughing, activity intolerance, Hr increases becaouse of hypoxia,
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When the amount of water decreases in relation to # particles, the osmolality
osmolality increases and becomes concentrated
-
When the amount of water increases relative to solutes the osmolality
decreases and becomes more diluted
-
Hyper-Osmolar
Too much particles or too little water
Results in cell shrinking
Causes:Decrease water intake and Extracellular solute excess
-
What condition and manifestations would the nurse expect to find in this patient (Hyper-Osmolar)
Dry skin, sry mucous membrane, pour skin turgor, increase HR, decreased weight
Affect of brain cells skrinking: confuesion
-
HYPO-Osmolar
Too little particles or too much water
Results in cellular swelling
Causes: Replacing H20 and Na+ loss with only water
Inability to excrete urine (CRF)
Brain cells swelling can burst and get cerebral edema
-
What manifestations would the nurse expect with a pt with hypO-Osmolar
Increased output (urine will be clear), skin moist, HR stronger,
- Interventions
- Replace loss with Na+ and H20 (isotonic)
Utilize oral liquids with electrolytes
Give Isotonic fluids
-
Isotonic Imbalances
Na+ and H20 increase or decrease together in the same proportion
Cells do not shrink or swell
Volume of ECF changes but the concentration of the solutes remains the same
-
Isotonic Deficits
Decrease Bp, weak, hypoxic,
Treatment:
Treat underlying cause
Careful administration of isotonic solutions
-
What would the nurse asses with a pt with Isotonic excess
Assess lungs in fluid overload, HR will be bounding, kidneys (put out more urine),
- Treatment:
- Restrict fluids
- Careful monitoring of fluids
- diuretics
-
The pt is experiencing isotonic dehydration. When chekcing the serum lab values, the nurse expects to find the pts sodium level to be
Within normal limits
-
First spacing
normal distribution of ICF and ECF
pt is healthy
-
Second spacing
abnormal accumulation in interstitial space (edema)
pt has edema
-
Third spacing
- is trapped fluid and essentially unavailable. It is
- distributional shift of fluid in a space that is not easily exchanged with the ECF (peritonitis)
Thoracentesis
-
Ascitis can be third spacing but is usually
second
-
Hyperosmolar is close to
to hypernatremia : will hav signs of dehydration
results from cells shrinking and fluid shifting
-
Hyponatremia
OVer hydration
- Interventions
- Isotonic or Hypertonic solution
Restriction of water
-
K sparing diuretics: makes pt
hold potassium
-
Pseudohyperkalemia
false high potassium hemolized means false
*Assess pt and check Heart
-
Burns can cause
hyperkalemia
-
Calcium gluconate will not lower K, it
is for
heart dysrhythmias
-
The nurse recognizes that the pt is experiencing hyperkalemia whne the pt is manifesting
Bradycardia, diarrhea, muscle twitching
-
Hyperphoshatemia can be caused by
CRF
Excessive intake of phosphorus
Hypoparathyroidism (which is causes hypocalcemia)
-
Hypophoshatemia is caused by
hyperparathyroidism which is caused by hypercalcemia
-
Calcium and bicarb are low
renal failure
-
BUN
urea nitrogen are by products of metabolites and are waste products
- elevated BUN is dehydration and kidney
- failure
- Check
- creatine to see if it isbecause it will be renal
- failure
-
Creatine normal values
0.5- 1.2
-
Elevated bun and normal creatine is
dehydration
-
Decreased BUN is
overhydration
-
-
Urinalysis tests for
- ketones (none in urine diabetics will hav them) ketones breakdown fat and protien, glucose, protien, WBCs (almost none),
- blood,
- specific gravity (particles per solution and is measureing the concentration of
- urine),
- Ph (4-7)
-
if Specific gravity stays the same
that is not good it should change depending on what isbeing drank or eatin
-
Bicarbonate
made by the kidneys and primary role is our main buffer (acid base), loose a lot of bicarb by diahrrea,
-
Venous spasms
vessel are vasoconstriction (cold)
-
-
What would you find in a pt with fluid volume excess
- increased bounding pulse
- jugular venous distention
- presence of crackles
- elevated BP
- skin pale and cool to touch
-
a Pt who loses potassium and water will have a________aldosterone secretion
Increased
-
Pt at great risk for deficient fluid volume
- fever 103
- extensive burns
- thyroid crisis
- continuous fistula drainage
- diabetes insipidus
-
What chardovascular changes will the nurse asses in a dehydrated pt
tachycardia with weak peripheral pulses
-
a pt with hypovolemia and severe diarrhea will have (respiratory system)
increased RR
because the body perceives hypovolemia as hyoxia
-
a pt with bounding pulse, neck vein distention when supine, presence of crackles in lungs and increasing peripheral edema. the nurse will suspect
fluid excess
-
how does ADH affect urine output
increases permeability to water in the tubules causing a decrease in urine output
-
a pt with low sodium will have what GI changes
hyperactive bowel sounds and abdominal cramps
-
postoperative pt who has been NPO for 24 hr is at risk for developing
hyponatremia
-
pt with excessive intake of 5% dextrose solution is at risk for developing
hyponatremia
-
Decreased sodium excretion can lead to
primary hyperaldosteronism
-
what diuretic is best for a pt with low sodium and signs of fluid volume excess
Conivaptan (vaprisol)
-
pt with early signs of increased sodium level will show
muscle twitching and irregular muscle contractions
-
pt with low sodium around 126 will have
watery diarrhea with abdominal cramping
-
What can result from a pt with a NPO status for a prolonged period
hypernatremia
-
an older adult with a sodium level of 150 may have a common result of
altered cerebral fucntioning
-
what are conditions that cause a pt to be at risk for hypernatremia
- renal failure
- use of corticosteroids
- watery diarrhea
- cushings syndrome
-
a pt with low potassium will have
- general skeletal muscle weakness
- lethargy
- and weak hand grasps
-
what can happen to a pt that is taking potassium and digoxin
digoxin toxicity can result if hypokalemia is present
-
what assessment findings are associated with hyperkalemia
- numbness in hands, feet, and around the mouth
- frequent explosive diarrhea stools
- irregular HR
- hypotension
-
a pt with hyperkalemia resulting from dehydration will have which lab results
increased hematocrit and hemoglobin
-
What surgical procedure will produce hypocalcemia
thyroidectomy
-
what condition may require the pt the be put on seizure precaution
Hypocalcemia
-
clinical condition that can result from hypocalcemia
increased intestinal and gastric motility
-
what pt is at risk for developing hypocalcemia
recent ilestomy
-
The pt with chronic renal failure associated with hypocalemia will monitor what electrolyte imbalance
Hyperphosphatemia
-
What medications can be ordered for hypercalcemia
- calcitonin (calcimar)
- furosemide (lasix)
- plicamycin (mithracin)
-
A pt with severe hypermagnesemia will have what kind of HR and BP
-
the nurse monitors the effectiveness of magnesium sulfate by assessing which factor ever hour
deep tendon reflexes
-
what condition places the pt at risk for hypocalcemia, hyperkalemia, and hypernatremia
Chronic renal failure
-
The pt CHF is receiving loop diuretic. what electrolytes will the nurse monitor
- hypocalcemia
- hypokalemia
- hyponatremia
-
Why does the nurse infuse 10% dextrose through a central line
osmolarity of the solution cold cause phlebitis or thrombosis
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