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69 Cards in this Set
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Fluid volume deficits |
Hypovolemia and dehydration |
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Hypovolemia |
Loss of volume |
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causes of hypovolemia |
fluid shift to 3rd space hemorrhage diruerics DM with inc urination excessive diaphoresis laxative use |
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sx's of hypovolemia |
ortho hypotension, change in mental status, capillary refill > 3 sec, cool pale skin → worse neuro sx, thirst, dec BP, inc HR → hypovolemic shock |
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tx of hypovolemia |
replace lost fluid (IV → 0.9% Normal Saline (isotonic) or Lactated Ringers (volume expanders)) O2 blood transfusion trendelenberg position (if BP dropping) vasopressor (dopamine) → inc BP until fluid level returns to normal |
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dehydration |
loss of water |
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causes of dehydration |
inadequate response to thirst having to depend on others for providing fluid diabetes insipidus (DI) prolonged fever (102-103°) watery d |
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sx's of dehydration |
mental status changes hypernatremia vertigo weakness extreme thirst dry skin and mucous membranes sunken eyeballs non-elastic skin turgor dec BP, inc HR → coma |
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tx of dehydration |
fluid replacement (oral or IV (hypotonic (D5W) or low Na (0.45% NS)) |
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Fluid volume excess |
hypervolemia and water intoxication |
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hypervolemia |
excess water and Na in extracellular space |
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causes of hyervolemia |
excess intake/retention of Na and water fluid shift heart failure renal failure corticosteroids (prednisone) dec protein intake |
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sx's of hypervolemia |
edema (body and lungs) wt gain inc BP (unless heart failure) S3 heart sounds LAB → dec HCT, dec osmolarity, dec K, Na normal or dilutional hyponatremia) CXR → pulmonary congestion |
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tx of hypervolemia |
Na and fluid restriction diuretics heart failure → other cardiac meds daily wt inc HOB O2 |
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water intoxication |
excess fluid in intracellular space from extracellular space (d/t excessive low Na in extracellular space) |
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causes of water intoxication |
SIADH (CNS/lung problems, head trauma, irrigation) rapid hypotonic IV solution infusion use of tap water as NG tube irrigation inc water intake |
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sx's of water intoxication |
neuro changes (d/t inc ICP) GI and muscle cramping inc ICP LAB → dec Na and osmolarity |
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tx of water intoxication |
correct underlying cause freq neuro checks and VS daily wt labs |
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normal Na and daily requirement |
135 - 145 mEq/L 0.5 - 2.7 g/day |
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hyponatremia |
Na level <135 mEq/L |
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cause of hyponatremia |
excessive Na loss (d, v, fistulas, NG suctioning, diuretics, adrenal insufficiency, Na wasting from kidneys, burns, wound drainage inadequate intake/depletion (fasting diets) excessive water gain/dilutional (excessive hypotonic Iv solutions, polydipsia, SIADH, heart failure, hypoaldosteronism |
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general sx's of hyponatremia |
VS - hypothermia, tachycardia, hypotension initial sx's - HA, lethargy, confusion, muscle weakness, abd cramping, n, v,anorexia, dec serum osmol Na |
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sx's of hyponatremia when there is fluid volume deficit (FVD) |
initial sx's AND - dry mucosa membranes, orthostatic hypotension, dec skin turgor, weak/thready pulse |
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sx's of hyponatremia when there is fluid volume excess (FVE) |
initial sx's AND - HTN, rapid bounding pulse, wt gain, lung crackles, tachypnea |
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sx's of hyponatremia with Na < 110 |
stupor and coma |
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tx of hyponatremia |
assess VS, neuro check, LOC labs - Na, osmolarity monitor I&Os, daily wt acute hyponatremia → hypoertonic fluids (oral and/or IV) restore fluid balance (isotonic IV (0.9% NS or LR)) monitor for vertigo monitor any fluid restrictions (to inc Na) pt edu about high salt foods |
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hypernatremia |
Na levels > 145 mEqu/L |
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causes of hypernatremia |
excessive intake (high Na foods, IV fluids, tube feedings without free water, inadequate water intake, impaired thirst, inability to get water) excessive water loss (fever, heatstroke, hyper-ventilation, osmotic diuretics, d diabetes insipidus, hyperaldosterone, Cushings, DM |
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general sx's of hypernatremia |
VS - hyperthermia, tachycardia, ortho hypotension initial - agitation, confusion, flushed skin, lethargy, low grade fever, thirst, restlessness, muscle twitching, weakness |
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sx's of hypernatremia when there is fluid loss |
intense thirst, dry swollen tongue, sticky mucous membranes, postural hypotension, wt loss |
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sx's of hypernatremia when there is fluid gain |
wt gain, edema, inc BP, dyspnea |
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tx of hypernatremia |
assess VS, neuro check, LOC labs - Na, osmolarity monitor I&Os, daily wt monitor for vertigo pt education on high salt foods (processed foods, adding salt to food) |
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tx of hypernatremia if d/t fluid loss |
restore fluid balance (isotonic IV (0.9% NS) or hypotonic (045% NS)) |
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tx of hypernatremia if d/t excess Na intake |
inc water intake, administer diuretic (→ inc excretion of Na) |
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normal K and daily need |
3.5 - 5.0 mEq/L need 40 mEq/day |
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hypokalemia |
K < 3.5 mEq/L |
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causes of hypokalemia |
K loss (d, v, fistulas, NG suction, diuretics, hyperaldosteronisn, Mg deficit, excessive diaphoresis, dialysis) dec intake (starvation, low intake, IV fluids without K and NPO) |
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sx's of hypokalemia |
muscle sx's first (fatigue, muscle weakness, leg cramps, paranesthesia) heart (palpitations, irregular rate, arrhythmias, EKG changes (T wave changes, U-wave), bradycardia or tachycardia) GI (n, v, dec motility, constipation ileus) VS (hypotension, weak irregular pulse) |
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tx of hypokalemia |
assess VS, cardiac, MS treat underlying cause monitor labs (K, Mg) administer K po (oral supplement with food, pills, powder mixed with water or juice) educate K rich foods IV K (given IVPB do NOT push), 5 - 10 mEq/hr |
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hyperkalemia |
K level > 5 mEq/L |
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cause of hyperkalemia |
excess K intake (excessive IV administration, K sparing diuretics, K containing salt substitutes or foods) shift of K out of cells (acidosis, tissue breakdown, crush injuries) dec excretion (renal disease, K sparing diuretics, adrenal insufficiency, ACE inhibitors (lisinopril), NSAIDS) |
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sx's of hyperkalemia |
muscle sx's first (restlessness, irritability, weakness → ascending flaccid paralysis) heart (irregular HR, arrhythmia, ECG changes (peak T wave, prolonged PR interval), heart block, cardiac arrest if K>7) GI (abn cramping, d (smooth muscle hyperactivity)) VS (hypotension, slow irregular HR |
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tx of hyperkalemia |
assess VS, cardiac, MS treat underlying cause monitor labs (K) hold po K supplements/stop IV K infusions educate resticting K rich foods dialysis if >6.5 mEq/L promote movement of K into cells (IV fluids with dextrose and insulin, aminister NaHCO3- to reverse acidosis) promote excretion of K (loop diuretic (lasix), Kayexalate (po or enema → binds with K in the GI tract) |
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normal Mg and daily need |
1.5 - 2.5 mEq/L 300 - 350 mg (25 mEq/L) |
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causes of hypomagnesemia |
d, v, NG suctioning, chronic alcoholism, impaired GI absorption, large urine output, diuretics |
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sx's of hypomagnesemia |
sx's start once level < 1 mEq/L → overstimulation of neuromuscular system muscles (twitching, tremors, tetany (+ trousseau's and chvostek's signs), hyper DTRs, parasthesia, sz, dysphagia) cardiac (tachycardia, disrhythmia, EKG changes) GI (hypoactive BS, constipation, abn distention) may see hypokalemia that does not respond to K replacement |
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tx of hypomagnesemia |
asses cardiac, MS, and GI status monitor labs (Ca, K, Mg levels) → often same sx's as low Ca and/or K administer po (few times/day, can cause d) or IM/IV replacement (more severe levels, IV slowly) pt education on Mg rich foods (chocolate, green leafy vegetables, nuts, meats, seafood, whole grains, dry peas and beans) |
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hypermagnesemia |
Mg levels > 2.5 mEq/L |
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cause of hypermagnesemia |
impaired excretion excessive administration of Mg to pts with renal insufficiency/failure excessive intake of mg containing antacids, laxatives, and/or enemas adrenal insufficiency |
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sx's of hypermagnesemia |
usually not seen until > 4 mEq/L depresses neuromuscular system (lethagy, drowsiness, muscle weakness (hand gasp → flaccid paralysis), hypo DTRs, facial parasthesia) GI (n, v, d) respiratory (shallow depressed respirations) cardiac (cardiac arrest, bradycardia, hypotension) |
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tx of hypermagnesemia |
assess cardiac, musculoskeletal adn GI status, renal function monitor labs - Ca, K, Mg, renal function administer diuretics (excrete Mg through urine) emergency tx with CaCl2 or calcium glutanate (antagonizes Mg) severe levels → mech ventilation prep for dialysis educate pt on restricting Mg rich foods, avoid laxatives, Maalox if pt has renal disease |
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normal Ca and daily need |
normal 2 - 3 mEq/L daily need = |
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hypocalcemia |
Ca levels < 2 mEq/L |
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causes of hypocalcemia |
dec production of PTH multiple blood transfusions alkalosis inc Ca loss |
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sx's of hypocalcemia |
+Trousseau's or Chvostek's sign laryngeal stridor dysphagia tingling around mouth or in the extremities cardiac dysrhythmias |
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tx of hypocalcemia |
treat cause po or IV Ca supplement (po - Calcitonin, tums; IV - Ca gluconate) rebreathe into paper bag treat pain and anxiety (prevent hyperventilation-induced resp alkalosis) |
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hypercalcemia |
Ca levels > 3 mEq/L |
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causes of hypercalemia |
hyperparathyroidism malignancy |
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sx's of hypercalcemia |
fatigue, lethargy, weakness, confusion hallucinations, sz, coma cardiac dysrhythmias bone pain, fx, nephrolithiasis polyuria, dehydration |
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tx of hypercalcemia |
loop diuretic (excrete Ca) bisphosphonates isotonic saline infusion (hydration) IM or SC calcitonin low Ca diet mobilization |
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normal (PO4)-3 and daily need |
normal daily need |
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hypophosphatemia |
low serum (PO4)-3 |
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causes of hypophosphatemia |
malnourishment/malabsorption d use of phosphate binding antacids inadequate replacement during parenteral nutrition |
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sx's of hypophosphatemia |
CNS depression muscle weakness/pain respiratory and heart failure Rickets osteomalacia |
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tx of hypophosphatemia |
oral supplement ingestion of phosphorous rich foods IV administration of Na(PO4)-3 or K(PO4)-3 |
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hyperphosphatemia |
serum (PO4)-3 > |
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causes of hyperphosphatemia |
acute kidney injury/CKD chemotherapy excess intake of phosphate or vitamin D hypoparathyroidism |
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sx's of hyperphosphatemia |
neuromuscular irritability tetany calcified deposition in soft tissues (joints, arteries, skin, kidneys, corneas) |
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tx of hyperphosphatemia |
identify and treat underlying cause restrict foods and fluids containing phosphorus po phosphate-binding agents volume expansion forced diuresis correct any hypocalcemia hemodialysis |
