F/E Issues

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F/E Issues
2011-09-29 11:26:02

Fluid and Electrolyte issues
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  1. Hypotonic Solutions
    • Shifts fluid from intravacular to intracellular; expands cells
    • 0.45% NS, 0.2% NS, 2.5% Dextrose
  2. Hypertonic Solutions
    • Shifts fluid from intracellular to intravascular to expand blood volume; shrinks cells
    • 5% Dextrose in 0.45% NS, 10% Dextrose in water, 3% NS
  3. Isotonic Solutions
    5% Dextrose in water, 0.9% NS, Lactated Ringers
  4. Types of fluid losses in hypovolemia
    • Sensible: diarrhea
    • Insensible: tachypnea (through moisture in our expirations)
    • Hospital induced: NG suctioning
    • Other: vomiting, diuretics, ATN, hyperventilation, wound drainage, burns, diaphoresis
    • ATN: all functioning components of tubulars of kidneys won't be able to absorb correctly
  5. S/S of hypovolemia
    • Mental status: anxious, restlessness
    • Skin: dry, tenting, decreased tugor
    • Mucous membrane: dry
    • CV: hypotension
    • Urinary: drop off
    • Musculoskeletal: cramping in gut, legs, and hands
    • Note: if on vent, mouth could look dry when body isn't
  6. Most dangerous type of 3rd spacing
    Cardiac Tamponade; pericardia can't expand anymore and things get squeezed
  7. Common cause of hypervolemia
    Organ failure: Heart, Renal, Liver
  8. S/S of hypervolemia
    • Crackles
    • Edema
    • JVD
    • Weight gain
    • HTN
    • Localized and Generalized
  9. What is the one assessment finding that can occur in hypo or hypervolemia?
    Low urine output: in hypervolemia the kidneys start to retain fluid because of compensatory mechanism in reaction to increased fluid; renal failure
  10. HYPOcalcemia Normal Level
    • <8.5
    • <4.2 inonized
  11. HYPOcalcemia causes
    • Hypoparathyroidism (surgery)
    • Acute pancreatitis: releasing Ca and being excreted by kidneys
    • Citrate ingestion: Ca binds to this and become unusable; from stored blood
    • Decreased magnesium and increased phosphorus
  12. S/S of HYPOcalcemia; start to show at <2.5
    • Musculoskeletal: muscle twitching, spasms, tetany, cramps, Chvostecks and Trousseaus signs
    • Neuro: irritability; muscles exciting
    • Cardiac: decreased CO
    • Skeletal: bone fractures
    • Hematological: increased clot formations
  13. HYPOcalcemia Treatment
    • First line: IV replacement; calcium gluconate/chloride
    • Correct underlying cause
    • Nursing care: monitor, PE, and VS
  14. HYPERcalcemia Normal Level
    • >10.5
    • >5.2 inonized
  15. HYPERcalcemia Causes
    • Mobilization out of bone: BE ACTIVE!
    • Malignancy: destruction of bone
    • Parathyroid secreting tumors
    • Meds: vit D, calcium, thaizide diuretics (not letting Ca out through kidneys)
    • Absorption: the slower the gut, the slower time moving things out
    • Over supplementation
  16. S/S of HYPERcalcemia
    • Neuromuscular: muscle weakness and general fatigue, exhaustion
    • Neuro: depressive state
    • Cardiac: primary or secondary block
    • Skeletal: bone fractures
    • GI: PUD
    • Renal: kidney stones
  17. HYPERcalcemia Treatment
    • Increase calcium elimination by the kidneys (IV fluids and diuretics)
    • Reduce calcium reabsorption from bone
    • Medications
    • Nursing care: monitor for dysrythmias, mental status, PE, and VS
  18. HYPOmagnesemia Normal Level
  19. HYPOmagnesemia Causes
    • Decreased intake: nutritional intake (veggies), chronic alcoholism
    • Decreased absorption: acute pancreatitis, Chrohns Disease, bariatric surgery pts
    • Increased Elimination: burns
    • hypoparathyroidism w/ resultant hypocalcemia can cause hypomagnesemia bc the regulatory mechanisms of Mg and Ca are related
  20. S/S of HYPOmagnesemia
    • Neuromuscular: tremors, tetany, Chrosteck and Trouseau
    • Cardiovascular: PVCs (can go into VF)
  21. HYPOmagnesemia Treatment
    • Increase levels: IV (will start, then PO)
    • Nursing care: monitor, notify, replace
  22. HYPERmagnesemia Normal Level
    • >2.5
    • Rare bc water soluble
  23. HYPERmagnesemia Causes
    • Renal failure: failure to excrete
    • Consumption of large quanitities of mag: medications (antacids, laxatives)
    • elderly have a lot of reasons to be constipated, so sometimes over do it on laxatives
  24. S/S of HYPERmagnesemia
    • Neuromuscular: lethargy, decreased deep tendon reflexes
    • Cardiovascular: hypotension, bradycardia, cardiac arrest
    • Respiratory: depression
    • Mag has a depressant effect
  25. HYPERmagnesemia Treatment
    • First line: give calcium
    • Hold mag rich meds/foods
    • Nursing care: monitor VS, PE, notify, administer
  26. HYPOphosphatemia
    • <1.7
    • Common imbalance in crititcally ill patients
  27. HYPOphosphatemia Causes
    • Malnourishment
    • Hyperparathyroidism
    • Some renal tubular defects
    • Metabolic acidosis (including DKA)
    • Disorders tha cause hypercalcemia
  28. S/S of HYPOphosphatemia
    • Cardiac: decreased CO
    • Musculoskeletal: weakness
    • GI: N/V
    • Neuro: disorientation, seizures
    • Hematologic: poor tissue oxygenation
  29. HYPOphosphatemia Treatment
    • IV or PO supplementation
    • Treat underlying cause
    • Nursing care: monitor respiratory and muscles r/t weakness and fatigue, notify, replace
  30. HYPERphosphatemia Normal Level
  31. HYPERphosphatemia Causes
    • Main: Chronic Renal Failure
    • Hyperthyroidism
    • Hypoparathyroidism
    • Severe catabolic states
    • Conditions causing hypocalcemia
  32. S/S of HYPERphosphatemia
    • Cardiac: tachycardia
    • GI: diarrhea, N/V, abdominal cramping (#1 complaint)
    • Musculoskeletal: weakness, muscle cramps in gut and legs
  33. HYPERphosphatemia Treatment
    • Lower serum levels: binders (absorb phosphorus and get excreted)
    • Nursing care: monitor pt and serum lab values
  34. Sodium and Dilutional Effect
    • A major factor in DKA because glucose is increased, and things can't get excreted; fluid shifts
    • Water replacement and diuretic use: too much or too little can alter levels but same content
  35. Acute Treatments of Hyperkalemia
    • 10 units of Regular Insulin IV
    • Full amp of IV Dextrose 50
    • will decrease glucose and push K+ into cells lowering K+ levels