Fluid Balance, Ca, Po4, & Mg, Med. Surg. Mod#1, Nursing Program, 2009

Front 1

What is the most important organ concerning fluid balance?

Back 1

The Kidneys

Front 2

What is the average daily urine output?

Back 2

1500ml in adults

Front 3

What is the minimum daily urine output required for excretion of metabolic waste?

Back 3

At least 400ml in a 24 hour period. (or 30ml hour)

Front 4

What is Isotonic fluid volume deficit?

Back 4

It is a loss of both fluids and electrolytes.

Front 5

Another type of fluid volume deficit where the fluid actually shifts to areas where it cannot be used by the body?

Back 5

Third Spacing

Front 6

Sweat, increased temperature, hyperventilation, vomitting, diarrhea and diuretics, GI suction, Ileostomy, dysphasia or motor problems?

Back 6

Causes for FVD.

Front 7

Tachycardia, hypotension, ortho hypotension, weak pulses, flat neck veins, decreased blood volume, and increased respirations or tachypenia?

Back 7

Cardiac and Respiratory signs and symptoms of fluid volume deficit or FVD.

Front 8

Pale color, dry membranes, tongue furrows, turgor - tinting, altered LOC, fever, oliguria, specific gravity greater than 1.030?

Back 8

Integumentary and Renal signs and symptoms of fluid volume deficit or FVD.

Front 9

An increased hemotacrit and hemoglobin due to an increased hemo concentration, increased Serum osmolality, increased glucose, increased BUN, and decreased electrolytes?

Back 9

Diagnostics for FVD (fluid volume deficit)

Front 10

Monitor VS, fall precautions second to hypertension and confusion, monitor labs, I&Os, daily weight?

Back 10

Client Safety interventions for fluid deficit.

Front 11

Administer IV therapy, promote oral intake over a twenty four hour period as appropriate, ENC. S.O. to assist with feedings, offer snacks that turn to fluid, oral rehydration therapies like pedialyte, may need thickened liquids?

Back 11

Fluid replacement therapies for FVD.

Front 12

Baseline assessment-check vital signs, breath sounds, urine output and mental status, administer the fluid as ordered, reassess baseline and repeat, will be 200-300ml over 5 to 10 minutes?

Back 12

A fluid challenge.

Front 13

Hypervolemia is?

Back 13

FVE

Front 14

Excessive fluid in the ECF space, impaired homeostasis, H2O and sodium gained in proportion?

Back 14

Hypervolemia-FVE

Front 15

Causes are heart failure, renal failure, liver failure, cirrhosis, cancers, drug therapies, high sodium intake, and stress?

Back 15

Causes of Fluid Volume Excess (FVE)

Front 16

Tachycardia, hypertension, DISTENDED NECK VEINS, weight gain (how much and how quick), tachypenia, increased RR, shallow RR, dispenia on exertion (DOE), crackles with breath sounds?

Back 16

Cardiac and Respiratory signs and symptoms of fluid volume excess.

Front 17

Treat the underlining cause, monitor vital signs, I&Os, daily weights, measure abdominal girth in ascites, measure extremities if necessary and mark, monitor lab values, especially albumin?

Back 17

TX of Third Spacing.

Front 18

Loss Phase - Lasts 48 to 72 hours, has Sx of FVD, Reabsorption Phase - fluid is gradually reabsorbed after problem subsides, monitor vital signs, I&Os and breath sounds?

Back 18

Phases of Third Spacing

Front 19

Burns (ITS A BIG ONE), peritonitis, bowel obstructions, bleeding into joint or cavity, liver or renal failure, low plasma protein, low albumin levels, increased capillary permeability, lymphatic blockage?

Back 19

Causes of Third Spacing

Front 20

Decreased urine output with adequate intake, increased heart rate, decreased BP, CVP, increased weight, pitting edema, ascites?

Back 20

Signs and symptoms of Third Spacing

Front 21

Pitting edema, skin pale and cool, change in LOC, headaches, visual problems, muscle weakness, increased GI motility?

Back 21

Integumentary Neuromuscular and GI signs and symptoms of fluid volume excess.

Front 22

Decreased hematocrit and hemoglobin, decreased serum protein, decreased serum osmolality, electrolytes are normal?

Back 22

Lab diagnostics for FVE.

Front 23

Prevention, monitor for S/S of FVE, keep in semi-fowlers, due to orthopenia it is difficult to breath when lying flat, watch for skin breakdown, turn every two hours, use a pressure relieving mattress, assess pressure areas due to stretched tissue?

Back 23

Clients Safety Precautions for FVE.

Front 24

Diuretics/TX Fluid Volume Excess

Low ceiling, prevents sodium and H2O reabsorption in the distal tubules while promoting potassium excretion?

Back 24

Diuretics/TX Fluid Volume Excess

Thiazides - Hydrochlorathiazide

Front 25

Diuretics/TX Fluid Volume Excess

A high ceiling, depresses sodium reabsorption in the ascending loop of henle and promotes sodium and potassium excretion?

Back 25

Diuretics/TX Fluid Volume Excess

Loop (Furosemide, Lasix)

Front 26

Diuretics/TX Fluid Volume Excess

Acts on distal tubule to inhibit reabsorption of Na in exchange for K+?

Back 26

Diuretics/TX Fluid Volume Excess

Potassium-sparring (Aldactone, Spironlactone)

Front 27

Fluid restrictions, giving more milliliters to the day shift than the night shift, sodium restrictions, no added salt, 2-4 gram restricted Na?

Back 27

Nutritional therapy for FVE.

Front 28

Monitor I&O, daily weight, VSs, breath sounds, monitor for pulmonary edema which can happen quickly and be fatal?

Back 28

Nursing Interventions for FVE.

Front 29

Normal is 8.5-10.0 mg per d/L?

Back 29

Normal calcium level.

Front 30

99% in the bones and teeth, 1% in the ECF and soft tissue?

Back 30

Calcium

Front 31

Stabilizes cell membranes, regulates muscle contraction and relaxation, maintains cardiac function and blood clotting?

Back 31

Calcium

Front 32

< 8.5mg/dL?

Back 32

Hypocalcemia

Front 33

Depressed function or surgical removal of the parathyroid gland?

Back 33

The most common reason for Hypocalcemia.

Front 34

Parathyroid hormone helps?

Back 34

Balance calcium.

Front 35

Electrolyte imbalances such as Hyperphosphatemia and Hypomagnesium are seen secondary to?

Back 35

Hypocalcemia

Front 36

Administration of large quantities of stored blood preserved with citrate?

Back 36

Hypocalcemia

Front 37

Renal insufficiency and decreased absorption of vitamin D can cause?

Back 37

Hypocalcemia

Front 38

Painful muscle spasms (charlie horses starting in hands and feet), numbness around the face, the 3 T's tetany, twitching and tremors, a positive Chvostek's sign and a positive Trousseau's sign?

Back 38

Signs and Symptoms of Hypocalcemia (assessments).

Front 39

Tap facial nerves and nose, eye, lip, or facial twitching occurs?

Back 39

A positive Chvostek's sign. Common in Hypocalcemia.

Front 40

Inflate a BP cup to 20mmhg above systolic pressure for 2-5 minutes. If hands and fingers point toward trousers?

Back 40

A positive Trousseau's sign.
Common in Hypocalcemia.

Front 41

Heart rate is slow or fast, blood pressure decreased, EKG changes, hyperactive bowel sounds, abdominal cramping and diarrhea, increased peristalsis, osteoporosis/loss of bone density?

Back 41

The cardiovascular, GI, and Skeletal signs and symptoms of Hypocalcemia.

Front 42

Patients are prone to fractures, sometimes without pain, due to parathyroid hormone pulling calcium from the bones to help increase the serum calcium in the body?

Back 42

Hypocalcemia patient. Keep in prone position, careful movement.

Front 43

Calcium replacements such as Tums and Oscal, enhance calcium absorption with vitamin D supplements?

Back 43

Hypocalcemia drug therapy.

Front 44

High calcium foods such as milk and dairy products?

Back 44

Hypocalcemia nutritional therapy.

Front 45

Maintain a quiet environment because of over stimulated muscles and excitability?

Back 45

Environmental management of hypocalcemia.

Front 46

Calcium glutamate is hard on the veins, given IV patient must be monitored?

Back 46

Hypocalcemia IV therapy.

Front 47

Hyperparathyroidism, high serum calcium levels, parathyroid pulls calcium from the bones into the body?

Back 47

Hypercalcemia

Front 48

Malignancies/bone metastases/ tumors excrete hormones similar to parathyroid hormone, causing bone destruction and?

Back 48

Hypercalcemia

Front 49

Prolonged immobility, increased reabsorption, renal failure, thiazide diuretics which interfere with the elimination of calcium, these things cause?

Back 49

Hypercalcemia

Front 50

Tachycardia, in severe cases Bradycardia and cardiac arrest, hypertension, blood clots/DVT, EKG changes, muscle weakness, decreased DTRs, change in LOC, confusion, coma, N/V anorexia, decreased peristalsis?

Back 50

Cardio, neuromuscular, GI signs and symptoms of Hypercalcemia.

Front 51

Monitor for fluid volume excess, VS, labs, stop calcium containing medications, in severe cases may need isotonic saline, stop thiazides, give loops, may need calcium cheleators (Calcitonin, gluco's) may need dialysis?

Back 51

Nursing Intervenctions for Hypercalcemia.

Front 52

When calcium is up?

Back 52

Phosphorus is down.

Front 53

When phosphorus is up?

Back 53

Calcium is down.

Front 54

Parathyroid hormone pulls what from the bone to increase serum levels?

Back 54

Calcium

Front 55

Calcitonin keeps what in the bone to decrease serum calcium?

Back 55

Calcium

Front 56

2.5 - 4.5 or 3.0 - 4.5 mg/dL?

Back 56

Normal phosphorus level.

Front 57

Is essential to tissue oxygination, normal CNS function, movement of glucose into cells, regulation of calcium, maintenance of acid-base balance?

Back 57

Phosphorus

Front 58

Influenced by parathyroid hormone and has inverse relationship to calcium?

Back 58

Phosphorus

Front 59

Phosphorus shifts to the intracellular space?

Back 59

Hypophosphatemia

Front 60

Malnourishment - refeeding syndome, medications, and hyperventilation can cause?

Back 60

Hypophosphatemia

Front 61

Weak pulses, weak ineffective cardiac contractions, chest pain and arrythmias, weak muscles, rhabdomyolysis, respiratory failure, ineffective respiratory effort secondary to muscle weakness, decreased bone density, irritability, seizures and coma?

Back 61

Cardiac, musculoskeletal, and neurological signs and symptoms of Hypophosphatemia.

Front 62

Stop meds that promote PO4 loss, oral PO4 replacement (neutraphos), IV PO4 therapy if level is <1.0?

Back 62

Hypophosphatemia drug therapy.

Front 63

Decrease calcium rich foods and increase PO4 rich foods (like meat and protein products)?

Back 63

Hypophosphatemia nutritional therapy.

Front 64

Acute or chronic renal failure, tumor lysis syndrome, increase intake of phosphorus, hypoparathyroidism?

Back 64

Causes of Hyperphosphatemia.

Front 65

> 4.5 mg/dL?

Back 65

Hyperphosphatemia.

Front 66

Tachycardia, hypertension, blood clots, EKG changes, muscle weakness, decreased DTRs, change in LOC, decreased paristalsis, N/V, and soft tissue calcification, phosphorus binds with calcium causing calcification?

Back 66

Cardiac, Neuro, GI, signs and symptoms of Hyperphosphatemia.

Front 67

Stop phosphate containing medications, administer phosphate binders with food unless the patient is NPO?

Back 67

Drug therapy for Hyperphosphatemia.

Front 68

Avoid high phosporus containing foods (like organ meats and milk products)?

Back 68

Nutritional therapy for Hyperphosphatemia.

Front 69

1.6 - 2.6 or 1.8 - 3.0 mg/dL?

Back 69

A normal magnesium level.

Front 70

Insures K+ and Na+ transport across cell membranes?

Back 70

Magnesium.

Front 71

Important to carbohydrate and protein metabolism?

Back 71

Magnesium.

Front 72

Plays a significant role in nerve cell conduction?

Back 72

Magnesium

Front 73

Important in transmitting CNS messages and maintaining neuromuscular activity?

Back 73

Magnesium

Front 74

Seen in the critically ill, chronic alcoholism is the number one cause, loss of GI fluids, malabsorption disorders, seen with hypokalemia and hypocalcemia, may have N/V or diarrhea?

Back 74

Causes of Hypomagnesium.

Front 75

Hyperactive DTRs, postive Chovets and Trousseau's signs, depression, psychosis, confusion, decreased GI motility and paralytic ileus?

Back 75

Neuromuscular, Neurological, and GI signs and symptoms of Hypomagnesium.

Front 76

Stop magnesium wasting drugs, use oral replacement, IV replacement if severe, monitor DTRs hourly?

Back 76

Drug therapy for Hypomagnesium.

Front 77

Encourage foods high in magnesium (like chocolate)?

Back 77

Nutritional therapy for Hypomagnesium.

Front 78

Renal failure, old pts, excessive intake of magnesium containing products, older pts are more likely to take magnesium containing products OTC?

Back 78

Causes of hypermagnesium.

Front 79

Bradycardia, peripheral vasodilation (flushing), hypotension, EKG changes, drowsy, coma, confusion, decreased DTRs, voluntary skeletal muscle contractions weak, or stop?

Back 79

Cardiac, Neuro, and Neuromuscular signs and symptoms of Hypermagnesium.

Front 80

Stop magnesium containing medications, use high ceiling diuretics, give calcium glutonate?

Back 80

Drug therapy for Hypermagnesium.

Front 81

Avoid magnesium containing foods?

Back 81

Hypermagnesium nutritional therapy.