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44 Cards in this Set
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Hypotonic Solutions
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< 250mOsm/L
0.33% NS 0.45% NS D5W |
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Uses for Hypotonic solutions
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-shifts fluid out of vessels into cells
-Hydrates cell |
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Nursing considerations for Hypotonic solutions
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May worse hypotension
Can increase edema May cause Hyponatremia |
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Isotonic Solutions
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>250mOsm/L
0.9% NS Lactated Ringers |
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Uses for Isotonic solutions
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Vascular expansion
No fluid shift Electrolyte replacement |
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Nursing considerations for Isotonic solutions
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May cause FVE
Generalized edema Hemogloblin dilution |
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Hypertonic Solutions
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> 375 mOsm/L
D5 0.45%NS D5 0.9% NS Hypertonic Saline 3%Saline 5% Saline |
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Uses for Hypertonic solutions
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-Shifts fluid into vasculature
-Vascular expansion -Electrolyte replacement |
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Colloid solutions
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Albumin, 5 or 25 %
Dextran Hetastarch (HES) Mannitol |
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Albumin Uses and Nursing considerations
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Used to
-keep fluid intravascular -maintain volume -replace protein -treat shock |
Nursing considerations
-Anaphylaxis bc blood product - May cause FVE -Pulmonary edema |
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Dextran and Hetastarch (HES)
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Synthetics
Used to -shift fluid into vessels -expand vasculature |
Nursing considerations
-May cause FVE and hypersenstivity -Increased risk of bleeding |
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Mannitol
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Used for
-oliguric diuresis -treat cerebral edema |
Nursing consideration
May cause -FVE -electrolyte imbalances -cellular dehydration |
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Normal serum value range for Sodium (Na)
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135-145 mEq/L
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Normal serum value range for Potassium (K)
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3.5-5.5 mEq/L
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Normal serum value range for Chloride (Cl)
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96-106 mEq/L
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Normal serum value range for Carbon dioxide (CO2)
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24-30 mEq/L
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Normal serum value range for Blood urea nitrogen (BUN)
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10-20 mg/dL
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Normal serum value range for Creatinine
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0.7-1.5-mg/dL
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Normal serum value range for Glucose
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80-110 mmol/L
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Urine normal pH and specific gravity
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pH 4.5-8.0
Spec gravity 1.010- 1.020 |
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Hyponatremia
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<135 mEq/L
Most common causes Loss of Na -diruetics-lasix -loss of GI fluids Gain of Water -excess hypotonic IV fluid Relative increase of H20 with gain of Na |
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Nursing interventions for Hyponatremia
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TREAT THE CAUSE
Replace Na, 3% or 5% NS IV Restrict fluids |
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Assessment for Hyponatremia
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Low Na levels
CNS: mental status changes, headache, personality changes, irritability GI: anorexia, n/v, abdominal cramps Na of 115 or less: muscle twitches, focal weakness, seizures coma |
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Hypernatremia
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<145mEq/L
Most common causes -Excessive fluid loss -decreased fluid intake Na excess-Diabetes insipidus |
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Nursing assessment for Hypernatremia
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Na >145
CNS: restlessness, irritable, delirium, twitching, seizures, coma Hypernatremia with FVD: - Thirst, poor skin turgor, rapid HR, decreased BP, increased T, oliguria, |
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Nursing interventions for Hypernatremia
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Treat the cause
IV D5W Oral glucose-electrolyte solutions w/ low Na Restrict Na intake |
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Hypokalemia
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< 3.5 mEq/L
Causes -loss from GI tract -Diet: eating disorders -Diuretics |
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Hypokalemia assessment
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change in neuromuscular activity
-ECG changes; depressed ST segment, low T wave, U wave -fatigue -constipation |
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Hypokalemia interventions
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Administer K+
-PO: Klor,KDor -IV: KCL *NEVER PUSH KCL= DEATH must have urine output > 30cc/hour |
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Hyperkalemia
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>5.5 mEq/L
Causes -Kidney failure -Excess intake -Crush injuries -Burns -Addison's disease |
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Hyperkalemia assessment
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-irregular heart beat, slow, weak/absent HR
-nausea -Paresthesias, muscle cramps -acidosis -ECG changes= peaked T wave, low p wave |
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Hyperkalemia interventions
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Calcium gluconate
IV fluids IV Na-bicarb Hemodialysis Kayexalate Insulin and Glucose IV |
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Hypercalcemia
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>10.5 mg/dL
Causes -increased bone resorption -Cancer -immobility |
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Hypercalcemia assessment
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serum levels greater than 10.5mg/dL
lethargy, weakness decreased reflexes constipation |
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Hypercalcemia interventions
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restricted intake
lasix calcitonin ambulation |
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Hypocalcemia
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<8.5 mg/dL
Causes -inadequate intake -anorexia -renal failure -lasix |
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Hypocalcemia assessment
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serum levels < 8.5mg/dL
-muscle cramping/twitching -tetany, convulsions -arrhythmias -Trousseau's sign- BP/claw -Chvostek's sign- facial nerve tapping/contraction |
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Hypocalcemia interventions
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Emergencey:= CaCl or Ca gluconate IV
Chronic= Increase dietary intake/supplements |
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Fluid volume excess- FVE/Hypervolemia
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Caused by
-Fluid overload; excessive IV fluids, replacement of H20 w/o Na -Dysfx of fluid regulation: ADH secretion, aldosterone from renal and andrenals, CHF and liver failure -Excess intake of Na |
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FVE Assessment
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-Rapid weight gain
-Peripheral & periorbital edema -JVD, bounding HR and increased BP - Increased CVP -SOB, crackles -Decreased Hct, Na through dilution -Personality changes |
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FVE Interventions
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-Decrease interstitial fluid: restrict Na & H20, lasix, IV hypertonic albumin
-Promote circulation: avoid constricting clothing, exercise, compression/pneumatic stockings -Maintain skin integrity: increase protein diet, keep skin clean and dry, use draw sheet -Semi fowlers -I & O's -Daily weights |
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Fluid Volume deficit-FVD/Hypovolemia
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Caused
-decreased intake -increased output -decreased absorption of fluid |
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FVD Assesment
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-dry mouth, thirst, sordes
- decreased skin turgor -increased temperature -oliguria/anuria -increased Hct, Na, BUN -restlessness, delerium, convulsions -decreased BP, orthostatic hypotension -decreased CVP -death |
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FVD Interventions
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-Prevention
-Fluids, PO if possible -Daily weights -Maintain skin integrity -Assess for hypovolemic shock -Orthostatic Hypotension-risk for falls |
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