Fluid and Electrolytes

What depletes electrolytes?

V: Vomiting

P: Pee

P: Poop

S: Sweating

What is potassium’s function?

Maintains heart and muscle contraction

Na+ (sodium)NORMAL lab value

135–145

K+ (potassium) NORMAL lab value

3.5–5.0

Ca+ (calcium) NORMAL range value

8.5–10.5

Mg (magnesium) normal range value

1.5–2.5

Signs of HYPOkalemia

🔻 Hypokalemia (<3.5)

• Weakness

• Constipation

• ↓ reflexes

• Arrhythmias

✅ Nursing:

• Give K⁺ (PO/IV slowly ⚠ never IV push)

• Monitor ECG

Signs of HYPERkalemia

🔺 Hyperkalemia (>5.0)

• Muscle weakness

• Peaked T waves ⚠

• Cardiac arrest risk

✅ Nursing:

• Calcium gluconate (protect heart)

• Insulin + glucose

• Kayexalate

Signs of HYPOnatremia

🔻 Hyponatremia (<135)

• Confusion

• Seizures ⚠

• Headache

✅ Nursing:

• Fluid restriction

• Seizure precautions

• Hypertonic saline (severe)

Signs of HYPERnatremia

🔺 Hypernatremia (>145)

• Thirst

• Dry skin

• Confusion

✅ Nursing:

• IV fluids (hypotonic)

• Monitor neuro status

Signs of HYPOcalcemia

🔻 Hypocalcemia

• Tetany (spasms)

• Chvostek’s sign

• Trousseau’s sign

✅ Nursing:

• Seizure precautions

• Give calcium

Sings of HYPERcalcemia

🔺 Hypercalcemia

• Weak muscles

• Kidney stones

• ↓ reflexes

✅ Nursing:

• Hydration

• Loop diuretics

Signs of HYPOmagnesemia

🔻 Hypomagnesemia

• Tremors

• Seizures

• Hyperactive reflexes

Signs of HYPERmagnesemia

🔺 Hypermagnesemia

• Lethargy

• ↓ respirations ⚠

• ↓ reflexes

✅ Nursing:

• Calcium gluconate (antidote)

• Monitor breathing

Isotonic Fluids

• Same as blood

• Example: 0.9% NS, LR
  👉 Used for shock, dehydration

*Shock? → isotonic FIRST!!!

HYPOtonic Fluids

Fluid goes INTO cells
👉 Cells swell
Example: 0.45% NS

*Brain issue? → avoid hypotonic (swelling ⚠)

HYPERtonic Fluids

Fluid goes OUT of cells
👉 Cells shrink
Example: 3% NS

*Fluid overload? → avoid hypertonic ⚠

🚨 PRIORITY TIPS (NCLEX GOLD)

• Heart issue? → Check K⁺ first

• Neuro issue? → Check Na⁺

• Spasms? → Think Ca²⁺ low

• Everything slow? → Mg²⁺ high

🧠 EASY MEMORY TRICKS

• K⁺ = cardiac

• Na⁺ = neuro

• Ca²⁺ = contractions

• Mg²⁺ = mellow

⚠ SAFETY POINTS

• NEVER IV push potassium

• Monitor ECG for K⁺ imbalance

• Seizure precautions = Na⁺ or Ca²⁺ problems

• Respiratory depression = Mg²⁺ high

🔴 ABCs (ALWAYS FIRST)

• A = Airway (highest priority)

• B = Breathing

• C = Circulation

🔴 UNSTABLE = PRIORITY

• New symptoms

• Sudden changes

• Abnormal vital signs

🟢 STABLE = WAIT

• Chronic conditions

• Expected findings

Acute (new)

Acute illnesses will always be PRIORITY

Chronic (long-term)

Chronic illnesses will be lower priority

🚨 Signs of deterioration

• Restlessness (EARLY hypoxia ⚠)

• ↓ BP

• ↑ HR

• ↓ O2 sat

👉 These patients = FIRST

💊 MEDICATION SAFETY

• Wrong dose → HOLD

• Question order if unsafe

👉 Never give unsafe meds

🦠 INFECTION CONTROL

• Isolation precautions

• Fever + immunocompromised = priority

🔥 DELEGATION (SUPER TESTED)

👩‍⚕ RN

• Assessment

• Teaching

• Critical patients

👨‍⚕ LPN

• Stable patients

• Basic meds

🧑‍⚕ CNA/ PCT

• ADLs

• Vitals (stable only)

🚫 WHAT TO AVOID ON NCLEX

• Don’t pick:

  • “Call the doctor” FIRST ❌

  • “Document” ❌

👉 Always:
✔ Assess or intervene FIRST

⚡ PRIORITY ORDER (FAST METHOD)

• Airway problem

• Breathing issue

• Circulation issue

• Acute change

• Unstable patient

• Safety risk

pH Normal Value

7.35 – 7.45

PaCO₂ Normal range value

35 – 45

HCO₃⁻ Normal range value

22 – 26

1⃣ Check pH (acid or base)

• < 7.35 = ACIDOSIS

• > 7.45 = ALKALOSIS

2⃣ Look at CO₂ (lungs)

• CO₂ = acid

• Opposite of pH

👉 Example:

• pH ↓ + CO₂ ↑ = Respiratory Acidosis

3⃣ Look at HCO₃⁻ (metabolic)

• HCO₃⁻ = base

• Same direction as pH

👉 Example:

• pH ↑ + HCO₃ ↑ = Metabolic Alkalosis

🫁 RESPIRATORY PROBLEMS (LUNGS)

🔻 Respiratory Acidosis

• pH ↓, CO₂ ↑

Causes:

• Hypoventilation

• COPD

• Opioids

Nursing:

• Improve breathing

• Oxygen

• Ventilator if needed

🔺 Respiratory Alkalosis

• pH ↑, CO₂ ↓

Causes:

• Hyperventilation

• Anxiety

• Pain

Nursing:

• Slow breathing

• Rebreathing (paper bag in old teaching)

🔻 Metabolic Acidosis

• pH ↓, HCO₃ ↓

Causes:

• DKA

• Kidney failure

• Diarrhea

Nursing:

• Treat cause

• IV fluids

• Bicarbonate (if severe)

🔺 Metabolic Alkalosis

• pH ↑, HCO₃ ↑

Causes:

• Vomiting

• NG suction

• Antacids

Nursing:

• Replace fluids

• Electrolytes

🧠 MEMORY TRICK (KEY FROM VIDEO STYLE) ACID BASE BALANCE

• R = Respiratory → Opposite

• M = Metabolic → Equal

⚡⚡⚡CHART TO IDENTIFY EACH CONDITION ⚡⚡⚡⚡

Condition	pH	CO₂	HCO₃
Resp. Acidosis	↓	↑	—
Resp. Alkalosis	↑	↓	—
Metabolic Acidosis	↓	—	↓
Metabolic Alkalosis	↑	—	↑