Fluid and Electrolyte Notes and Mnemonics PDF

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Fluid and Electrolyte Notes and Mnemonics...

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Fluid and Electrolyte Notes and Mnemonics Please note that this sheet does not contain all the electrolytes, fluids and content we covered in lecture. Normal electrolyte values: +¿ Sodium ( Na¿ ): 135-145 mEq/L Potassium ( K +¿ : 3.5-5.5mEq/L Calcium (

2+¿ ): 8.5-10.5mg/dL Ca¿

Magnesium (

2+¿ ): 1.6-2.6 mEq/L Mg¿

Dehydration: negative fluid balance as the result of the loss of water from the intracellular, extracellular and intravascular spaces. Causes: (Examples) 1.

Insufficient fluid intake

2.

Excessing fluid loss a. Gastrointestinal losses (vomiting, diarrhea, Nasogastric suctioning) b. Prolonged fever

3.

Fluid shifts a. intravascular into body tissues b. burns

Clinical Manifestations (aka Signs and Symptoms): a. Thirst (early sign) b. Increased heart rate, thready pulse c. Increased blood pressure (later sign is orthostatic hypotension) d. As a compensatory mechanism, fluids shift from the interstitial spaces into the intravascular fluid. This causes dry mucous membranes, and poor skin turgor. e. Increased body temperature (will older adults experience a rise in body temperature?) f. acute weight loss Assess: Blood Pressure (orthostatic). How much does the SBP have to drop when obtaining orthostatic readings to determine if orthostatic blood pressure is present? Body weight Also See focused assessment pgs 1476-1477 in Treas and Wilkinson text

Laboratory Studies: Think hemoconcentration! Hematocrit (Hct): increases in BUN increases Urine specific gravity increases Electrolytes increase Nursing Interventions: Increase fluid intake Fall prevention measure r/t orthostatic hypotension Replace volume with isotonic fluids as ordered Oral care Prevent skin breakdown Hypovolemia: The loss of both water and electrolytes Causes: (examples) Excessive GI losses Excessive skin loss (diaphoresis) Third spacing Excessive fluid loss (examples: renal system or from wounds) Blood loss (hemorrhage) Clinical Manifestations: Decreased urine output Syncope Hypotension Confusion Cool clammy skin Absence of tears Tachycardia with a weak thready pulse Weakness Assess: Vital signs Daily weights Monitor cardiac rhythm (remember the role of electrolytes in cardiac rhythm)

Laboratory values: Hct increases BUN to creatinine ration increases Neurological status Capillary refill GI symptoms (n/v….) Respiratory system Also See focused assessment pgs 1476-1477 in Treas and Wilkinson text Nursing Interventions: Replace fluids with isotonic fluids as ordered Replace electrolytes as ordered Possible blood transfusion Safety measures IV Fluids: Isotonic: Used for vascular expansion, electrolyte replacement. Isotonic solutions do not cause fluid to shift. Useful in hypotension & hypovolemia. Closely monitor CHF clients for FVO. Isotonic solutions may cause FVO, electrolyte imbalances and dilutes hemoglobin. Examples: 0.9% Sodium Chloride / 09 % NaCl (AKA Normal Saline NS) and Lactated Ringers (LR) Hypotonic: Pull fluids from intravascular compartment into the interstitial compartment. Used for hyperglycemic conditions such as diabetic ketoacidosis. Never give to clients at risk for increased intracranial pressure (ICP). Hypotonic solutions hydrate cells. May make hypotension worse, can cause increased edema and hyponatremia. D5W is irritating to veins. Examples: 5% dextrose in water ( D 5 W) 0.45% NaCl (1/2 NS) 0.33 % NaCl Hypertonic: Pull fluids and electrolytes from intracellular & interstitial compartments into intravascular compartment. Used to help stabilize BP, ↑UO, and ↓Edema. These may case fluid overload, hypernatremia, and hyperchloremia. Volume expanders. Examples:

D 5 0.9% NaCl ( D 5 NS) D5

0.45% NaCl ( D 5

D5

lactated Ringer’s

½ NS)

3% NaCl and 5% NaCl (used only in critical situations) Monitoring Intravenous Therapy: Look at Table 39-8 for complications related to IV therapy.

Mnemonics: Hypokalemia potential causes: IS BAD I= inadequate intake S= Severe losses (GI diarrhea, laxative abuse, prolonged gastric suction, prolonged vomiting, increased wound drainage) B= high dose B 12 injections for anemia, K+ shits into RBCs. A= Alkalosis (K+ back shifts into cells) D= diuresis from drugs loop and thiazide diuretics. Low Mg+ level, IV insulin, corticosteroids, diabetic keto acidosis (DKA) , and diseases like Cushing’s Disease, increased aldosteronism (loss of K+ through urine). Hypokalemia clinical manifestations: SUCTION S= skeletal muscle weakness in legs and arms. U= U wave on ECG – slow repolarization of ventricles. C= Constipation T= toxic effects of digoxin, flat or inverted T wave. I= Irregular weak pule. O= orthostatic hypotension. N= numbness or paresthesia Hyperkalemia potential causes: MACHINE M= medications like ACE inhibitors and NSAIDS, beta blockers A= acidosis (K+ moves out of cells), Addison’s disease C= cellular destruction from burns, trauma, chemotherapy (K+ released from cells) H= hemolysis damaged RBCs release K+ from cells I= excessive intake of salt substitutes N= nephrons fail (renal failure) E= excretion impaired (Addison’s disease) Hyperkalemia clinical manifestations: MURDER M=muscle cramps and weakness and increased GI motility (diarrhea) U= urine output low R= respiratory distress related to skeletal muscle weakness D= decreased cardiac contractility with slow irregular heart rate and decreased BP E= ECG changes (tall T waves, flat P wave, widened QRS) R= reflexes increased ie. muscle twitches, then reflexes become decreased Hyponatremia causes: LID L= loss of Na+ (vomiting, diarrhea, gastric suctioning, burns, wound drainage, overuse of diuretics, adrenal insufficiency Addisons disease). I= inadequate intake of NA+ D= dilution of serum NA+ from over hydration, syndrome of

inappropriate anti-diuretic administration of hypotonic water instead of saline.

hormone (SIADH) causing kidneys to retain water, over solutions or irrigation with hypotonic solutions such as

Hypernatremia causes: MODEL M= meals too high in Na+, overuse of mediations such as antacids that contain sodium O= osmotic diuretics such as mannitol D= diseases like diabetes insipidus & Cushing’s disease. E= excessive water loss (heatstroke, hyperventilation, high fever, diaphoresis, diarrhea) L= low water intake Hypernatremia clinical manifestations: SALT S= skin flushed and dry (dehydration) A= altered mental function, agitation (brain cells dehydrated as water shifts from intracellular fluid into extracellular fluid). L= low-grade fever T= thirst...