Fliuid and electrolyte

What is dehydration

Loss of water without proportional loss of electrolytes leading to increased serum osmality and cellular shrinkage

What is hypovolemia

Loss of water and electrolytes (isotonic fluid deficit) from the extracellular fluid, reducing circulating blood volume and cardiac output

What are the cardiovascular signs of hypovolemia

Tachycardia, hypotension, orthostatic hypotension, weak pulse, flat elk veins, delayed cap refill.

What are the respiratory signs of hypovolemia

Tachypnea and dyspnea

What are the renal signs of hypovolemia

Oliguria/decreased urine out put and dark yellow concentrated urine

What ate the skin and mucous membrane signs of hypovolemia

Cool, clammy, pale skin, poor skin turgor and dry mucous membranes

What are the lab changes that occur during dehydration and hypovolemia due to hemoconcentration

Increased hematocrit, increased BUN, increased urine specific gravity, increased blood osmolalit and elevated serum sodium

What i the “F’ in FILL IT for hypovolemia

Find the cause- identify and stop fluid loss (hemmorrage, vomitting, diarrhea, burns and NG suction)

What is the “I” in FILL IT for hypovolemia

Increase circulating volume- administer isotonic IV fluids via large bore IV; give blood products if bleeding

What is the first L in FILL IT for hypovolemia

Look at urin output: target >30 mL/hr

What is the second L in FILL IT for hypovolemia

Look at vital signs and perfusion- monitor BP, HR cap refill and mental status

What is the second I in FILL IT hypovolemia

Improve oxygen delivery- administer oxygen as prescribed, position for optimal breathing and promote rest

What is the “T” in FILL OIT for hypovolemia

Treat the cause continuously: provide ongoing treatment to prevent recurrence

Why are older adults at a significantly higher risk for dehydration?

-decrease in total body water percentage

-decrease kidney blood floe and reduced renal concentrating ability

-diminished thirst sensation and higher prevalence of chronic conditions/ diuretic use

What are the cardiovascular clinical manifestations of hypervolemia across body systems?

Bounding pulse, hypertension, tachycardia, elevated CVP and JVD

What are the respiratory clinical manifestations of hypervolemia across body systems?

Moist crackers in lungs, dypnea, orthopnea and cough

What are the mueromuscular clinical manifestations of hypervolemia across body systems?

Headaches, confusion, weakness

What are the GI clinical manifestations of hypervolemia across body systems?

As cites, parasites is and increased bowel motility

What are the edema clinical manifestations of hypervolemia across body systems?

Dependent pitting edema

What are the manifestations in weight with hypervolemia

Rapid weight gain

What lab findings are seen in hypervolemia due to hemodilution

Decreased hematocrit and hemoglobin, decreased blood osmolality, decreased urine specific gravity, decreases BUN

What are the primary nursing interventions for managing hypervolemia

-position in semi Fowler or Fowler position to ease breathing

-administer oxygen as prescribes nd monitor breathing for crackles

-enforce fluids and sodium restrictions

-and minister prescribed diuretics

What rate the signs of pulmonary edema

Severe dypnea, tachypnea, anxiety

Moist crackles, pink frothy sputum and decreased LOC

What to do if you notice signs of pulmonary edema

High Fowler position, administer high Flow oxygen, notify provider immediately, adminsister prescribed diuretics and prepare for intubation if needed

Sodium imbalances affect what first

The brain

Water… with hyponatremia

Moves INTO cells

Water… with Hypernatremia

Water moves OUT of the cells

What are the causes of hyponatremia

Diuretics, vomitting, diarrhea, heart failure, excessive hypotonic fluids

What are the SALT signs for hyponatremia

Seizures and stupor

Abdominal cramping and hyperactive bowel sounds

Lethargy

Tendon reflexes decreased

What is the critical safety correction rate from hyponatremia

Do not increase serum sodium by more than. 10-12 men/L in 24 hours to prevent permanent brain damage

What are the causes of hypernatremia

Dehydration, Diabetes inspires, fever, eat exposure, Cushing, excessive sodium intake

What are the “FRIED” signs of hypernatremia

Fatigue,

restlessness,

increased reflexes,

extreme thirst,

dry mouths and skin

What are the treatments for hypernatremia

Replace water slowly using hypotonic IV solutions, restricts sodium intake, monitor numerous status and treat underlying cause

What is the ATI NCLEX rule for potassium imbalances

Potassium problems kill the heart first

What happens to the heart with low K+

Muscles become weak; heart becomes irritable

What happens to the heart with high K+

Heart cannot maintain a steady beat which leads to a high risk for cardiac arrest

What are the 7 signs (7L’s) for Hypokalemia

Lethargy, Low respirations, Letha; cardiac rhythms, lots of voiding, leg cramps, limp muscles, Low BP and HR

What are the ECG changes of hypokalemia

Flattened T waves, ST depression, prominent. U waves

What are the treatments of hypokalemia

Give oral K+ with food, administer IV K+ infusion for levels <2.5 mEq/L.

What is the ABSOLUTE SAFETY RULE for IV potassium administration

Never administer potassium via IV push, IM or subcutaneous injections. It must be diluted and given as a controlled IV infusion using an infusion pump

What are the causes of hyperkalemia

Kidney failure, K+ sparing diuretics, ACE inhibitors, burns, DKA

What are the signs of hyperkalemia “DEATH”

Deacreased HR

Early muscle twitching weakness

Arrhythmias

Tummy trouble

Hypotension

What are the ECG changes of hyperkalemia

Tall peaked T waves, Flat P wave, Prolonged PR interval, Widened QRS complex

What is the 3 step emergency treatment sequence for hyperkalemia

Protect the heart- administer Calcium Gluconate IV to stabilize cardiac cell membranes

Shift K+ into cells- administer regular insulin and Dextrose

Remove K+ from the body- administer loop diuretics (furosemide), Kayexalate to perform dialysis

What are he reference ranges and ATI NCLEX rules for Calcium

(9.0-10.5 mg/dL) -calcium problems make your muscles twitch

What are the reference ranges and ATI NCLEX rules for magnesium

(1.3-2.1 mEq/L) magnesium problems make nerves unstable when low and sluggish when high

What are the signs of hypocalcemia

Numbness/tingling around mouth and fingertips, muscle cramps, tetany ,respiratory distress and siezurs

What are the causes of hypocalcemia

Thyroid and parathyroid surgery, vitamin D deficiency, chronic kidney disease, pancreatitis, massive blood transfusions

What are the ECG changes with hypocalcemia

Prolonged QT interval

How do you perform chvosteks sign

Lightly tap the facial nerve just in front of the ear

How do you interpret a positiv chvosteks sign

Twitching of facial muscles on the same side

What is a positive chvosteks sign indicative of

Nueromuscular excitability due to hypocalcamia

How do you perform trousseau’s sign

Inflate a blood pressure cuff on the upper arm to 20 mmHg above clients systolic BP snd hold for 3 minutes

What is a positive Trousseus sign

Carpopedal spasm (wrist flexion)

What os a positive trousseaus sign indicative of

Nueromuscular excitability due to hypocalcemia

What is the treatment and nursing care for hypocalcemia

Administer calcium gluconate IV slowly, give oral calcium and vitamin D, seizure and fall precautions and monitor ECG

What are the causes of hypomadnesemia

Chronic alcoholism, malnutrition, diarrhea, chronic, loop diuretics, PPI’s

Signs of hypomagnesemia

Tremors, muscle spasms, tetanus , positive chvosteks and troussseaus signs, insomnia, seizures, hypertension

Dangerous cardiac rhythms associated with hypomagnesemia

Tornadoes de pointes and Letha; dysrhythmias

How is magnesiun sulfate administered

Give IV magnesium sulfate slowly (1-2 g over 1 hour)

How do you monitor for magnesium toxicity

Continuously check DTRs and decrease or absent DTRs indicate magnesium toxicity

How big is a is an orange colored IV needle and what is it used for

14 gauge and its used for Trauma, surgery, resuscitation and rapid fluid or massive blood transfusion

How big is a green colored iv needle and what is it used for

18G and it’s used blood transfusions, rapid fluids, CT pE protocols

How big is a pink colored iv needle and what is it used for

Standard routine IV fluids and medications and blood transfusions

How big is a blue colored Iv needle and what is it used for

22 G and it is used for routine IV fluids meds ; preferred for elderly/fragile veins

How big is a yellow iv needle and what is it used for

24G and it is used for PEDs or elderly individuals

What are the 7 things that need to be documented following PIV insertion

Date and time

Specific location

Catheter size

Dressings type

Solution and flow rate

number of intention atttempts

Client response and tolerance

What is the osmolality in isotonic IV fluids

275 to 295 moms/L (same as blood)

What is the fluid shift in isotonic Iv fluids

No net fluid movement; stays in the vascular space

What is the osmolality if hypotonic IV fluids

< 275 moms/L (lower than blood)

What is the fluid shift in hypotonic IV fluids?

Water moves from vascular space Into cells

What is the osmolality of hypertonic IV fluids

295 moms/L

What is the fluid shift in hypertonic IV fluids

Water moves out of cells into the vascular space

What are colloid solutions and when are they used

Large protein molecules that cant cross capillary membranes and they pull water into the bloodstream

What is infiltration

Leakage of non-vesicant IV fluid into tissue

What is extravasation

Leakage of vesicant fluid into tissue

What are the signs of phlebitis

Pain, tenderness, warmth, redness along vine track

Treatment of phlebitis

Stop infusion immediately, remove catheter and apply a warm compress

Prevention of phlebitis

Change PIV site every 72 hours or per policy

What are the signs of fluid overload from IV therapy

JVD, increased BP, SOB, crackles in lungs and tachycardia

What are the actions to help fluid overload

Slow IV rate, raise head of bed, monitor O2 lung sounds, notify provider, administer diuretics

What are the signs if catheter embolus

Sudden chest pain, dypnea, tachycardia, cyanosis, hypoxia

What are the actions to help catheter embolus

Apply tourniquet high on extremity above insertion site, prepare for diagnostic X-Ray

What special needle is required to access and implantable Port

A non- coring Huber needle