NCLEX fluid and electrolytes

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NCLEX fluid and electrolytes
2015-06-08 21:35:42

Fluid and Electrolytes
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  1. Too much fluid in the vascular space (veins, arteries, capillaries, heart)
  2. Causes of Hypervolemia
    • Heart Failure
    • Renal Failure
    • Pharm (alka-seltzer, fleet enema, IVF with Na)
  3. Patho of Heart Failure:
    • Weak Heart
    • Decreased Cardiac Output
    • Decreased Kidney Perfusion
    • Decreased Urinary Output
    • (volume stays IN VASCULAR SPACE)
  4. Hormonal Regulation of Fluid Volume
    • Aldosterone
    • ANP (atrial natriuretic peptide)
    • ADH (antidiuretic hormone)
  5. What is aldosterone?
  6. Where is aldosterone found?
    Adrenal Glands (above kidneys)
  7. Normal action of aldosterone:
    When blood volume gets LOW (from hemorrhage, vomiting, etc...) aldosterone secretion INCREASES.

    Retains Na/Water

    Increases Blood Volume
  8. Diseases with too much aldosterone:
    • Cushing's
    • Conn's (hyperaldosteronism)

  9. Diseases with too little aldosterone:
    Addison's Disease


    (loss of Na/H20)
  10. Where is ANP found?
    Atria of the heart
  11. How does ANP work?
    Excretion of Na/Water

    (opposite of Aldosterone)
  12. ADH is _____ diuresis
  13. ADH makes you ____ fluid
  14. Two ADH problems:
    SIADH (too much)

    DI (not enough)
  15. When there is too much ADH...
    • Retain water
    • Fluid volume excess


    • Urine will decrease and will be concentrated¬†
    • Blood will be diluted and serum sodium will be low
  16. In SIADH, Urine is:
  17. In SIADH, Blood is:
    • Diluted
    • (serum sodium will be low)
  18. When there is not enough ADH:
    • Diruesis (loss) of Water
    • Fluid Volume Deficit (SHOCK!!!!)

    Diabetes Insipidus

    • Urine will be diluted
    • Blood will be concentrated
  19. When there is fluid deficit, always worry about:
  20. Concentrated makes specific gravity, sodium and hematocrit numbers _____
  21. Dilute makes specific gravity, sodium and hematocrit numbers ____
  22. ADH is found in the ____
  23. ADH issues are always ____
    • secondary¬†
    • (ie: craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy, increased ICP)
  24. Another name for anti-diuretic hormone (ADH)
    • Vasopressin (Pitressin)
    • Desmopressin acetate (DDAVP)
  25. ___ may be used as an ADH replacement in Diabetes Insipidus
    Vasopressin (pitressin) or Desmopressin Acetate (DDAVP)
  26. S/S of Hypervolemia
    Distended Neck Veins

    • Peripheral Edema, Third Spacing (because vessels can't hold any more fluid and start to leak....leading to¬†sacral skin breakdown)
    • CVP is increased

    Wet Lung Sounds

    Polyuria (kidneys are trying to get you to diurese)

    Bounding pulse

    Increased BP

    Weight Gain (quickly!)
  27. Treatment for Hypervolemia:
    • Low Na diet
    • Restriction of fluids
    • I/O
    • Daily Weights
    • Diuretics
    • Bed Rest (induces diuresis)
    • Physical Assessment (focused)
    • Give IVFs SLOWLY to elderly, young, kidney and heart pts
  28. Fluid volume defecit
  29. Hypovolemia can lead to:
    Big Time SHOCK!
  30. Causes of Hypovolemia
    Loss of fluid from anywhere (thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage, suctions, etc)

    Third Spacing (burns, ascites)

    Diseases with Polyuria (poly--oli--anuria)
  31. S/S of Hypovolemia
    Weight Loss

    Decreased skin turgor

    Dry mucous membranes

    Decreased urine output (kidneys aren't being perfused OR they are trying to hold fluid)

    Decreased BP (less fluid, less pressure)

    Increased weak, thready pulse

    Increased respirations

    Decreased CVP

    VERY TINY peripheral veins

    Cool Extremities

    Increased Urine Specific Gravity
  32. Tx for Hypovolemia
    Prevent Further Loss!

    Replace Volume (mild = PO, severe= IV)

    Safety Precautions (falls, overload)
  33. Isotonic Solutions:
    • "Stay where I put them"
    • Go into vascular space and STAY
  34. Examples of Iso Solutions
    • NS (for blood)
    • LR (for shock)
    • D5W
    • D5 1/4 NS
  35. Uses for Isotonic solutions
    For the pt that has lost fluids through nausea, vomiting, burns, sweating, and trauma

    NOT used for HTN pts, Cardiac Disease, Renal Disease
  36. Hypotonic Solutions:
    • "Go OUT of vessel"
    • Into vascular space and shift OUT into the cells to replace cellular fluid
  37. Examples of Hypotonic Solutions
    • D2.5W
    • .33% NS
  38. Uses for Hypotonic Solutions:
    Pt that has HTN, Renal or Cardiac Disease (needing fluid because of nausea, vomiting, burns, hemorrhage, etc)
  39. ALERT for Hypotonic Solutions
    Watch for cellular edema leading to fluid volume def and decreased BP
  40. Hypertonic Solutions:
    "Packed with Particles"

    "Enter the Vessel"

    Volume expanders that draw fluid into vascular space from the cells
  41. Examples of Hypertonic Solutions
    • D10W
    • 3% NS
    • 5% NS
    • D5LR
    • D5 1/2 NS
    • D5 NS
    • TPN
    • Albumin
  42. Uses for Hypertonic Solutions
    • Pt with hyponatremia or that has shifted large amounts of vascular volume to 3rd space or has severe edema, burns or ascites
    • (returns fluids to the vascular space where it should be)
  43. ALERT for Hypertonic Solutions
    • Watch for fluid volume excess
    • Monitor in ICU setting
    • Frequent BP, Pulse, CVP
  44. Mag and Ca act like:
  45. When you deal with Mg and Ca, think ____ first!
  46. Magnesium is excreted by the ____
  47. Causes of Hypermagnesmia:
    • Renal Failure
    • Antacids
  48. Causes of Hypercalcemia
    • Hyperparathyroidism (too much PTH)
    • Thiazides
    • Immobilization (must bear weight to keep Ca in bones)
  49. S/S of Hypermagnesemia
    • DTRs decreased
    • Decreased Muscle Tone
    • Arrhythmias
    • Decreased LOC
    • Decreased Pulse
    • Decreased Respirations

    • Flushing
    • Warmth (from vasodilation)
  50. S/S of Hypercalcemia
    • DTRs decreased
    • Decreased Muscle Tone
    • Arrhythmias
    • Decreased LOC
    • Decreased Pulse
    • Decreased Respirations

    • Brittle bones
    • Kidney Stones
  51. Tx for Hypermagnesemia
    • Ventilator < 12 RR
    • Dialysis
    • Calcium Gluconate (antidote)
    • Safety Precautions (because of sedation)
  52. ___ is antidote for Mag
    • Calcium Gluconate
    • (administered IVP very slowly at 1.5-2ml/min)
  53. Tx of Hypercalcemia
    • Move!!
    • Fluids (prevention of kidney stones)
    • Sodium Phosphate
    • Steroids
    • Add Phosphorus to diet
    • Safety precautions
    • Must have vitamin D to use
    • Calcitonin
  54. Calcium and ___ are inversely related
  55. Normal Mg:
  56. Norm Ca
    • 9-10.5
    • (8-11)
  57. Causes of Hypomagnesemia
    • (Not ENOUGH sedative)
    • Diarrhea (mg in intestines)
    • Alcoholism (most common)
    • Not Eating/Drinking
  58. Causes of Hypocalcemia
    Not Enough PTH!!!

    • Hypoparathyroidism
    • Radical Neck
    • Thyroidectomy
  59. S/S of Hypomagnesemia
    • Tight rigid muscles
    • Seizures
    • Stridor/Laryngospasm
    • +Chvostek's
    • +Trousseau's
    • Arrhythmias
    • Increased DTRs
    • Mind Changes
    • Swallowing Probs (risk for aspiration!!!)
  60. Tx for Hypomagnesemia
    • Mg
    • Check Kidney Function (before and after IV)
    • Seizure precautions
    • Eat Magnesium (spinach, mustard, squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, etc)
  61. Tx for Hypocalcemia
    • Vitamin D (to use Ca)
    • Phosphate binders
    • IV Ca (SLOWLY)
  62. How to give IV Ca:
    SLOWLY and put pt on heart monitor (widened QRS)
  63. Be watching for ___ changes as Sodium levels fluctuate
  64. Na levels in your blood are totally dependent on:
    How much water you have in your body
  65. Hypernatremia =
    Dehydration (not enough water!)
  66. Causes of Hypernatremia
    • Hyperventilation (loss of water)
    • Heat Stroke
    • DI (vomiting/diarrhea, etc)
  67. S/S of Hypernatremia
    • ***Neuro Changes!!!
    • Dry mouth
    • Thirsty
    • Swollen Tongue
  68. Tx for Hypernatremia
    • Restric Na+
    • Dilute client with fluids
    • Daily Weights
    • I/O
    • Labs!
  69. Feeding tube pts tend to get:
  70. Hyponatremia =
    Dilution (too much water, not enough Na)
  71. Causes of Hyponatremia
    Drinking H2O for fluid replacement (vomiting, sweating...just dilutes blood more)

    Psychogenic Polydipsia


    SIADH (retaining water)
  72. S/S of Hyponatremia
    • ***Neuro changes
    • Headache
    • Seizure
    • Coma
  73. Tx for Hyponatremia
    • Client needs SODIUM
    • Restrict Water
    • If having neuro probs...hypertonic saline is needed! 3% NS or 5% NS
  74. Potassium is excreted by the:
  75. Norm Na
  76. Norm Potassium
  77. Causes of Hyperkalemia
    • Kidney Trouble
    • Spironolactone (Aldactone) - makes you retain potassiun
  78. S/S of Hyperkalemia
    • ***Life Threatening Arrhythmias
    • EKG changes: brady, tall peaked T waves, prolonged PR intervals, absent P waves, widened QRS, V-Fib

    • Muscle Twitching
    • Muscle Weakness
    • Flaccid Paralysis
  79. Tx of Hyperkalemia

    Calcium Gluconate (decreases arrhythmias)

    Glucose/Insulin (insulin carries glucose and potassium into the cell)

    Sodium Polystyrene Sulfonate (kayexalate)
  80. Sodium and ___ have an inverse relationship
  81. Causes of Hypokalemia
    • Vomiting
    • NG Suction
    • DIuretics
    • Not eating
  82. S/S of Hypokalemia