Fluid And Electrolyte

Front 1

Interventions fluid volume deficit

Back 1

Monitor cardiocascular, respiratory, neuromuscular, renal, intefumentary, and GI status
Precent further fluid losses and increase fluid comaprtment columes to normal ranges
Provide oral rehydration therapy if possible and IV fluid replacement if the dehydration is severe, monitor I & O
Administer medications as prescribed such as antidiarrheal, antimicrobial, antiemetic, and antipyretic to correct the cause and treat any symptoms
O2 as prescribed
Monitor electrolyte levels

Front 2

Assessment fluid volume deficit Cardiovascular

Back 2

thready, increased pulse rate
decreased BP and othrostatic hypotension
flat neck and hand veins in dependent positions
diminished peripheral pulses

Front 3

Assessment fluid colume deficit repiratory

Back 3

Increased depth and rate

Front 4

Assessment fluid colume deficit Neuromuscular

Back 4

decreased cnetral nervous system activity, from lethary to coma
fever

Front 5

Assessment fluid colume deficit renal

Back 5

decreased urinary output
increased urinary specific gravity

Front 6

Assessment fluid colume deficit Integumentary

Back 6

dry skin, poor skin turgor tenting present, dry mouth

Front 7

Assessment fluid colume deficit GI

Back 7

decreased motility and diminished bowel sounds
Constipation
thirst
decreased body weight

Front 8

Assessment fluid colume deficit hypotonic

Back 8

skeletal muscle weakness

Front 9

Assessment fluid colume deficit hypertonic

Back 9

hyperactive deep endon reflexes, pitting edema

Front 10

Assessment fluid colume deficit labratory findings

Back 10

increased serum osmolaltiy
increased heatocrit
increased BUN
increased seum NA level

Front 11

Causes fluid volume deficit isotinic

Back 11

inadequate intake of fluids and solutes
fluid shifts between comaprtments
Excessive losses of isotnic body fluids

Front 12

Causes fluid volume deficit hypertonic

Back 12

conitions that increase fluid loss, such as excessive perspiration, hyperventialtion, ketoacidosis, prolonged feverd, diarrhea, early stage renal failure, diabetes insipidus

Front 13

Causes fluid volume deficit hypotonic

Back 13

chronic illness
excessive fluid replacement
renal failure
chronic malnutrition

Front 14

Types fluid volume deficit isotnic

Back 14

water and dissolved electrlytes are lost in equal proportions
known as hypovolemia, istonic dehydration is the most common tyrpe of hehydration
results incdecreased circulating bood volume and inadequate tissue perfusion

Front 15

Types fluid volume deficit hypertonic

Back 15

water loss exceeds electrolyte loss
clinical problems that occur result from alterations in the concentrations of specific plasma electrolytes
fluid moved from the intracellular compartment into the plasma and interstitial fluid spaces, causing cellular dehydration and shrinkage

Front 16

Types fluid volume deficit hypotonic

Back 16

electrolyte loss exceeds water loss
clinical problems that occur result from fluid shifts between comaprtments, causing a decrease in plasma volume
fluid moved from the plasma and intersitial fluid spaces into the cells, causing a plasma colume deficit and causing the cells to swell

Front 17

Hydrostatic pressure

Back 17

-is the force exerted by the weight of a solution
-when a difference exists in the hydrostatic pressure on two sides of a membrane, water and diffusible solutes move out of the solution that has the higher hydrostatic pressure by the rocess of filtration
-at the arterial end of the capillary, the hydrostatic pressure is higher than the osmotic pressure, therefore fluids and diffusibel solutes move out of the capillary
- at the venous end, the osmotic pressure or pull is higher than the hydrostatic pressure, and fluids and some solutes move intothe capillary
-excess fluid and solutes remaining in the interstitial spaces are returned to the intravascular compartment by the lymph channels

Front 18

Types fluid volume excess isotonic

Back 18

known as hypervolemia, reuslts from excessive fluid in the extracellular fluid compartment
-only the extracellular fluid compartment is expanded, and fluid does not shift between the extracellular and intracellular compartment
-causes circulatory overload and interstitial edema: when severe or with poor cardiac function, CHF and pulmonary edema can result

Front 19

Types fluid volume excess hypertonic

Back 19

occurance is rare, and is caused by an excessive Na intake
-fluid is drawn from the intracellular fluid compartment: the ectracellular fluid volume expands, and the intracellular fluid volume contracts

Front 20

Types fluid volume excess hypotonic

Back 20

known as water intoxication
-excessive fluid moved inot the intracellular space, and all body fluid compartments expand
-electrolyte imbalances occur as a reslut of dilution

Front 21

Causes Fluid volume excess
isotonic

Back 21

inadequately controlled IV therapy
-renal failure
long-term corticosteriod therapy

Front 22

Causes Fluid volume excess hypertonic

Back 22

excessive Na ingestion
-rapid infusion of hypertonic saline
-excessive Na bicarbonate therapy

Front 23

Causes Fluid volume excess hypotonic

Back 23

early renal fialure
-CHF
-syndrome of inappropriate antidiuretic hormore secretion
-inadequately controlled IV therapy
-replacement of isotonic fluid loss with hypotonic fluids
-irrigation of wounds and body cavities with hypotinic fluids

Front 24

Assessment Fluid volume excess Cardiovascular

Back 24

-bounding increased pulse rate
-elevated BP
-distened nech and hand veins
-elevated central venous pressure

Front 25

Assessment Fluid volume excess Respiratory

Back 25

increased respiratory rate (shallow)
-dyspnea
-moist crackles on auscultation

Front 26

Assessment Fluid volume excess Neuromuscluar

Back 26

Altered LOC
-headache
-visual disturbances
-skeletal muscle weakness
-paresthesias

Front 27

Assessment Fluid volume excess integumentary

Back 27

-pitting edema in dependent areas
-skin pale and cool to touch

Front 28

Assessment Fluid volume excess Hypotonic

Back 28

polyuria
-diarrhea, nonpitting edema
-dysrhythmias
-projectile vomiting

Front 29

Assessment Fluid volume excess Lab findings

Back 29

decreased seum osmolality, benatocrit, BUN, serum Na level, urine specific gravity

Front 30

Fluid volume excess Interventions

Back 30

Prevent further fluid overolad and restore mornal fluid balance
-administer diuretics: osmotic diuretics typically are prescribed first to prevent severe electrolyte imbalances
-restrict fluid and Na intake
-I&O and weight monitored

Front 31

Hyponatremia Causes

Back 31

Increased Na excretion
-Inadequate Na intake
-Dilution of serum Na

Front 32

Hyponatremia Increased Na excretion

Back 32

Excessive diaphoresis, diuretics, vomitting, diarrhea, wound drainage, especially GI, renal disease, decreased secretion of aldosterone

Front 33

Hyponatremia Inadewuate Na intake

Back 33

NPO, low-salt diet

Front 34

Hyponatremia dilution of serum Na

Back 34

excessive ingestion of hypotonic fluids or irrigation with hypotonic fluids
-renal failure, freshwater drowning
-syndrome of inappropriate antidiuretic hormone secretion
-hyperglycemia, CHF

Front 35

Hyponatremia Assessment Cardiovascular

Back 35

symptoms vary with changes in vascular volume
-nomovolemis: rapid pulse rate, normal BP
-Hypovolemic: thready, weak rapid pulse, hypotension, flat neck veins, normal or low central venous pressure
Hypervolemic: rapid, bounding pulse, BP normal or elevated noraml or elevated cenrral venous pressure

Front 36

Hyponatremia Assessment Respiratory

Back 36

shallow, ineffective movements as a late manifestation

Front 37

Hyponatremia Assessment Neuromuscular

Back 37

generalized skeletal muscel weakness that is wose inthe extremities
-diminished deep tendon relexes

Front 38

Hyponatremia Assessment cerebral function

Back 38

headache, personality changes, confusion, seizures, coma

Front 39

Hyponatremia Assessment GI

Back 39

increased motility and hyper active bowel sounds
-nausea
-ABD cramping and diarrhea

Front 40

Hyponatremia Assessment Renal

Back 40

decreased urinary specific gravity
-increased urinary output

Front 41

Hyponatermia Interventions

Back 41

If with FD: IV NaCl infusion are administerd to restore Na content and fluid volume
-If with FE: osmotic diuretics are adminitered to promote the excretion of water rather than Na
-Increase oral Na intake

Front 42

Hypernatermia Causes

Back 42

decreased Na excretion
-cushings syndrome
-renal failure
-hyperaldosteronism
-Increased Na intake
-Decreased water intake, NPO
-Increased Water loss

Front 43

Hypernatermia Assessment Cardiovascular

Back 43

heart rate and BP that repsond to cascular colume status

Front 44

Hypernatermia Assessment Neuromuscular

Back 44

Early: spntaneous muscle twitches, irregular muscle contractions
Late: skeltal muscle weakenss, deep tendon relexes diminished or absent

Front 45

Hypernatermia Assessment CNS

Back 45

altered cerebral function is the most common manifestation of hypernatermia
-normovolemia or hypovolemia agitation confusion seizures
-herpvolemia: lethargy stupro coma

Front 46

Hypernatermia Assessment Renal

Back 46

-increased urinary specific gravity
-decreased urinary output

Front 47

Hypernatermia Assessment integumentary

Back 47

dry skin
-presence or absence of edema, depending on fluid volume changes

Front 48

Hypernatermia Interventions

Back 48

If cause is fluid loss, prepare to administer IV infusion
-if cause is inadequate renal excretion of Na, prepare to administer diuretics that promote Na loss
-restrict Na and fluid intake

Front 49

Hypokalemia Causes

Back 49

Actual total body K loss
Inadequate K intake
movement of K from the extracellular fluid to eh intracellular fluid
-dilution of serum K

Front 50

Hypokalemia Causes total K loss

Back 50

-excessive use of medications such as diuretics
-increased secretion of aldosterone, such as in Cushing's syndrome
-Vomiting, diarrhea
-Wound drainage, particularly GI
-prolonged nasogastric suction
-excessive diaphoresis
-renal disease impairing reabsorption of K

Front 51

Hypokalemia Assessment Cardiovascular

Back 51

Thready, weak, irregular pulse
-peripheral pulses weak
-orthostatic hypotension
-ECG changes: ST depression, shallow, flat or inverted T wave, and prominent U wave

Front 52

Hypokalemia Assessment Respiratory

Back 52

Shallow, ineffective respirations that result from profound weakness of the skeletal muscle of respiration
-Diminished breath sounds

Front 53

Hypokalemia Assessment Neuromuscular

Back 53

Axiety, lethargy, confusion, coma
-Skeletal muscle weakness, eventual flacci paralysis
-loss of tactile discrimination
-Deep renson hyporeflexia

Front 54

Hypokalemia Assessment GI

Back 54

Decreased Motility hypoactive to absent bowel sounds
-Nausea, vomiting, constipation, abd distention
-Paralytic ileus

Front 55

Hypokalemia Assessment Renal

Back 55

Decreased urinary specific gravity
-increased urinary output

Front 56

Hypokalemia Interventions

Back 56

Give K supplements
-Never given IV push or by IM or SubQ

Front 57

Hyperkalemia Causes

Back 57

Excessive K intake: rapid infusion
-Decreased K excretion: K sparing diuretics, renal failure, adrenal insufficiency (addison's disease)
-Movement of K from the Intracellular to the extracellular fluid: tissue damage, acidosis, hyperuricemia, hypercatabolism

Front 58

Hyperkalemia Assessment Cardiovascular

Back 58

Slow weak pulse, irregular heart rate
-Decreased BP
-ECG changes: tall peakes T waves, flat P waves, wisened QRS complex, prolonged PR intervals

Front 59

Hyperkalemia Assessment Respiratory

Back 59

Profound weakness of the skeletal muscles leading to respiratory failure

Front 60

Hyperkalemia Assessment Neuromuscular

Back 60

Early: muscle twitches, crapms, paresthesias (tingling and burning followed by numbness in the hands and feet and around the mouth)
Late: profound weakness, ascending flaccid paralysis int he arms and legs

Front 61

Hyperkalemia Assessment GI

Back 61

Increased motility hyperactive bowel sounds
-diarrhea

Front 62

Hyperkalemia Interventions

Back 62

DC IV K and hold oral K
-K restricted diet
-K excreting diuretics if renal function not impaired
-If bad renal function give Kayexalate
-Prepare IV administaration of hyperonic glucose with regular insulin to move excess K into the cells
-Avoid using salt substitutes

Front 63

Hypocalcemia Causes

Back 63

Inhibition of Ca absorption form GI: inadequate oral intake, lactose intolerance, malabsorption syndromes such as celiac sprue, inadequate intake of Vit D, end-stage renal failure
-Increased Ca disease: renal failure, polyuric phase, diarrhea, steatorrhea, wound drainage, esp GI
-Hperproteinuria, alkalosis, acute pancreatitis, hyperphophatemia, immobility, removal or sestruction of the parathyroid glands

Front 64

Hypoclacemia Assessment Cardiovascular

Back 64

Decreased heart rate, hypotension, diminished peripheral pulses, ECG changes: prolonged ST interval, prolonged QT interval

Front 65

Hypoclacemia Assessment Neuromuscular

Back 65

Irritable skeletal muslces: twitches, cramps, tetany, seizures
-Painful muslce spasms int he calf or foot durign periods of inactivity
-Paresthesias followed by numbness that may affect the lips, nose, and ears in addition to limbs
-Positive trousseu's and Chvostek's signs
-Hyperactive deep tendon reflexes, anxiety, irritability

Front 66

Hypoclacemia Assessment GI

Back 66

increased gastric motility, hyperactive bowel sounds
-abd cramps, diarrhea

Front 67

Hypocalcemia Interventions

Back 67

Ca supplements
-when giving IV warm to body temp before administration, and administer slowly
-Seizure percautions
-monitor for fractures
-keep 10% Ca gluconate available
-consume foods high in Ca

Front 68

Hypercalcemia Causes

Back 68

-Increased Ca absorption: excessive oral intake, excessive intake vit D
-decreased Ca excretion: renal failure, use of thiazide diuretics
-increased bond resorption: hyperparathyroidis, hyperthyroidism, malignancy, immobility, use of glucocorticoids
-hemoconcentration: dehydration, use of lithium, adrenal insufficiency

Front 69

Hypercalcemia Assessment Cardiovascular

Back 69

Increased heart rate in the early phase, bradycardia, that can lead to cardiac arrest, increase BP, bounding full perpheral pulses, ECG: shortened ST segment, widened T wave

Front 70

Hypercalcemia Assessment Respiratory

Back 70

ineffective repiratory movemtn as a result of profound skeletal muscle weakness

Front 71

Hypercalcemia Assessment Neuromuscular

Back 71

profound muscle weakness, diminished or absent deep tendon reflexes, disorientation, lethargy, coma

Front 72

Hypercalcemia Assessment Renal

Back 72

increased urinary output leading to dehydration, formation of renal calculi

Front 73

Hypercalcemia Assessment GI

Back 73

decreased motility and hypoactive bowel sounds, anorexia, nausea, abd distention, constipation

Front 74

Hypercalcemia Interventions

Back 74

DC IV infusions of solutions containing Ca or oral meds containing Ca or Vit D
-DC thiazide diuretics
monitory for flank and abd pain strain urine to check for presence of urinary stones
Restrict foods high in Ca