Fluid and Electrolytes/Urinary

• What is hypertonic?

• Causes shift from cells to interstitial tissue to plasma

• More than 340 mOsm/L

• What is hypotonic?

• Causes shift from plasma to the interstitial tissue to the cells

• Less than 240 340 mOsm/L

• What is isotonic?

• No fluid shifts/most like blood

• 240-340 340 mOsm/L

• What is osmosis?

• Fluid moves from areas of low solute concentration  (low osmolarity) to areas of high solute concentration (high osmolality)

• What to assess in an IV?

• Infiltration

  • Swollen

  • Cold

  • Clammy

  • Pain

  • Redness

• Infection

• Phlebitis

• Patency

  • flushes/blood return

• Electrolyte levels

• Edema

• Lung sounds

  • In case of fluid overload

• Creatine

• I&O

• VS

• What drugs are isotonic fluids?

• 0.9% Normal Saline

• Lactated Ringers

• What is the classification of 0.9% Normal Saline?

• Isotonic fluids

• What is the classification of Lactated Ringers?

•  Isotonic fluids

• What are the uses of isotonic fluids?

• Simple hydration

• Medication administration

• Hypotension

• Diabetes (hydration/medication)

• Labor (surgery/blood loss)

• Dressing changes

• What is the action of isotonic fluids?

• No fluid shift

• Vascular expansion

• Electrolyte replacement

• What are the nursing considerations for isotonic fluids?

• May cause fluid overload

• Generalized edema

• Dilutes hemoglobin

• May cause electrolyte imbalances

• What is the thirst mechanism due?

• Osmoreceptors in hypothalamus

• What is antidiuretic hormone?

• Promotes reabsorption of water into blood from kidney tubules

• What is aldosterone?

• Determines resorption if sodium ions and water

• What is atrial natriuretic peptide die?

• Regulates fluid, sodium and potassium levels

• What drug is a hypotonic fluid?

• O.45 normal saline

• What is the classification of O.45 normal saline

• Hypotonic fluid

• What is the action of a hypotonic fluid?

• Shifts fluid out of vessels into cells

• Hydrates cells

• What are nursing considerations of hypotonic fluids?

• May worsen hypotension

• Can increase edema

• May cause hyponatremia

• What drug is a hypertonic fluid?

• D5 and 0.45 Normal saline

• What is the classification of D5 and 0.45 Normal saline?

•  hypertonic fluid

• What is the action of  hypertonic fluid?

• Shifts fluid back into circulation

• Dehydrates the cells

• What is the nursing consideration of  hypertonic fluid?

• Irritating to veins

• May cause fluid overload

• May cause hypernatremia

• May cause hyperchloremia

• What are the signs and symptoms of fluid overload?

• Changes in LOC

• Bounding pulse

• Increase Blood pressure

• Increase jugular vein distension (JVD)

• Tachycardia

• Anorexia

• Nausea

• Pulmonary congestion 

• Confusion

• Pitting edema

• What is the treatment for fluid overload?

• Stop IV fluid

• Use diuretics

• Fluid restriction

• Check weight

• Listen to lung sounds

• What is edema?

• Excessive amount of fluid in interstitial compartment

• What causes edema?

• Increased capillary hydrostatic pressure

• Loss of plasma proteins

• Obstruction of lymphatic circulation

• Increased capillary permeability

• What does edema cause?

• Swelling

• Pitting edema

• Weeping edema

  • Fluid leaks out of skin

• Increased in body weight

• What is dehydration?

• Insufficient body fluid

• May be accompanied by loss of electrolyte and proteins

• What is the cause of dehydration?

• vomiting/diarrhea

• Excessive sweating

• Diabetic keto macros

• Insufficient water intake

• Use of concentrated formula in infants

• What are the manifestations of dehydration?

• Weakness

• Poor skin turgor

• Cool skin

• LOC

• Dry mucous membranes

• Hypotension

• Tachycardia

• Increased 

  • BUn

  • Creatine

  • Hematocrit

  • Hemoglobin

• Decreased output

• Constipation

• Sunken fontanelles

• Sunken eyes

• What is the treatment of dehydration?

• Iv fluid

  • Isotonic

    • If organs are functioning

  • Hypotonic

    • Cellular dehydration

• Po fluids

• Watch VS

What are ways the body compensates for fluid loss?

• Increased thirst

• Increased heart rate

• Constriction of cutaneous blood vessels

• Producing less urine

• Concentration of urine

• What is hyponatremia?

• Low sodium

• Less than 135

• What causes hyponatremia?

• Losses from hypovolemia

• Diuretic drugs

• Low salt diets

• Hormonal imbalances

• Diuresis

• Excessive water intake

• What are the effects of hyponatremia?

• Causes fluid imbalances in compartments

• Decrease osmotic pressure in ECF compartment

• What are the manifestations of hyponatremia?

• Fatigue

• Muscle cramps

• Abdominal discomfort

• Cramps nausea

• Vomiting

• Decreased BP

• Confusion headache

• Weakness 

• Seizures

• What is hypokalemia?

• Low potassium

• Less than 3.5

• What causes hypokalemia?

• Diarrhea

• Diuretic drugs

• Excessive aldosterone/glucocorticoids

• Decreased dietary intake (decrease in food

• Diabetic ketoacidosis treatment

• What Are the Manifestations of hypokalemia?

• Cardiac arrest

• Nausea

• Constipation

• Muscle twitch

• Leg cramps

• Shallow RR

• Polyuria

• What is hypocalcemia?

• Low levels of calcium

• Less than 9

• What causes hypocalcemia?

• Hypoparathyroidism

• Malabsorption syndrome

• Deficient serum albumin

• Increased serum PH level

• Renal failure

• What are the effects of hypocalcemia?

• Increased permeability and excitability of nerve membranes

• Weak heart contraction

• What is the manifestation of hypocalcemia?

• Muscle twitching

• Delayed heart contraction

• Decreased blood pressure

• What drugs are urinary anticholinergics?

• Oxybutynin (Ditropan)

• What is the classification of Oxybutynin (Ditropan)

• urinary anticholinergics

• What is the action of Oxybutynin (Ditropan)

• Direct action on smooth muscle to relieve spasms

• What Are the side effects of Oxybutynin (Ditropan)

• Drowsiness

• Tachycardia

• Dizziness

• Fainting

• Blurred vision

• Dry mouth

• Constipation

• What are contraindications of Oxybutynin (Ditropan)

• Glaucoma

• Cards patient

• Renal patients

• Hepatic patients

• Prostate problems

• What is benign prostatic hyperplasia

• Enlargement of prostate gland

What drugs are alpha adrenergic blocking agents?

• Tamsulosin (Flomax)

• What is the action of Tamsulosin (Flomax)?

• Blocks neurotransmitter at level of a;pha 1 receptors in bladder and prostate

• Causes relaxation of smooth muscles

• What are the side effects of Tamsulosin (Flomax)

• Orthostatic hypotension

• Nasal congestion

• Dizziness

• Reflex tachycardia