F&E for pharm 2 and 301 exam 2

crystalloid vs colloid IV fluids

crystalloid = clear

colloid = opaque from fat/protein

Isotonic solutions are used for

-Fluid loss or hypovolemia

-fluid resuscitation after GI suctioning

Hypotonic solutions are used for

-maintenance and hydrating fluid

-used for surgical patients to avoid sodium

Hypertonic solutions are used for

-treat water intoxication (hyponatremia)

Name the isotonic solutions

0.9 NS

LRs

D5W (to start)

Nursing considerations for giving 0.9 NS

Monitor closely for hypervolemia, especially with heart failure or renal failure. 

0.9 NS is used for

(isotonic soln)

Fluid resuscitation for hemorrhaging, severe vomiting, diarrhea, GI suctioning losses, wound drainage, mild hyponatremia, or blood transfusions. 

Nursing consideration for giving LR’s

Should not be used if serum pH is greater than 7.5 because it will worsen alkalosis. May elevate potassium levels if used with renal failure. 

LRs are used for

(isotonic)

Fluid resuscitation, GI tract fluid losses, burns, traumas, or metabolic acidosis. Often used during surgery. 

Nursing considerations for giving D5W

Should not be used for fluid resuscitation because after dextrose is metabolized, it becomes hypotonic and leaves the intravascular space, causing brain swelling. Used to dilute plasma electrolyte concentrations. 

D5W is used for

(isotonic, then hypotonic)

Provides free water to help renal excretion of solutes, hypernatremia, and some dextrose supplementation. 

Name the hypotonic solutions

0.45 NS

D5W (after dextrose metabolism)

Nursing considerations for giving hypotonic solns

Monitor closely for hypovolemia, hypotension, or confusion due to fluid shifting into the intracellular space, which can be life-threatening. Avoid use in clients with liver disease, trauma, and burns to prevent hypovolemia from worsening. Monitor closely for cerebral edema. 

0.45 NS is used for

(hypotonic)

Used to treat intracellular dehydration and hypernatremia and to provide fluid for renal excretion of solutes. 

Name the hypertonic solutions

3 NS

D5 0.45 NS

D5LR

D10

Nursing considerations for giving hypertonic solns

Monitor closely for hypervolemia, hypernatremia, and associated respiratory distress. Do not use it with clients experiencing heart failure, renal failure, or conditions caused by cellular dehydration because it will worsen these conditions. 

3 NS is used for

(hypertonic)

Used to treat severe hyponatremia and cerebral edema. 

Complications with giving IV fluids

K+ normal lab value

3.5-5

(do not need to memorize)

Na+ normal lab value

135-145

(do not need to memorize)

Mg normal lab value

1.3-2.1

(do not need to memorize)

Which electrolyte affects CNS/neuro?

Sodium

think N = neuro

How to check for hypervolemia/fluid overload

-JVD - jugular venous distension → have pt sit up and check to see if jugular is distended or pulsating

-pitting edema

TKO

“to keep open”

Used in peds, means keeping the line open constantly. Always run a line in a TKO

-usually will give a hypotonic soln like .45 NS

Sodium pathophysiology

Most abundant cation in extracellular fluid 

*Maintain osmotic pressure of extracellular fluid 

*Regulates renal retention & excretion of water 

*Responsible for stimulation of neuromuscular reactions & maintains SBP 

Sodium food sources

Canned food, fast food, processed meat and cheese

Hypernatremia causes

-Excess water loss due to lack of fluid intake, vomiting, or diarrhea 

-Cellular dehydration = extra sodium in blood causes water to leave cells (solutes suck) and cells will shrink 

Hypernatremia symptoms

Affects the neurological function -> fluid shift out of brain cells = confusion, lethargy, seizure, irratable 

Other symptoms = severe thirst and sticky mucous membranes 

Hypernatremia treatment

-Give water orally 

-Decrease sodium intake 

-rehydrate with hypotonic iv soln

Hyponatremia cause

-Excess water intake 

-excessive administration of hypotonic IV solns 

-water poisoning 

Hyponatremia symptoms

Affects the neurological function -> fluid shift into brain cells = confusion, headache, seizure, coma 

Hyponatremia treatment

-limit water intake 

-discontinue hypotonic IV solns 

-administer hypertonic soln to increase Na lvl 

Potassium pathophysiology

*Most abundant intracellular cation and is essential for transmission of electrical impulses in cardiac and skeletal muscle 

*Helps maintain acid-base balance and has inverse relationship to metabolic pH…decrease in pH of 0.1 (acidosis) increases K+ by 0.6 mEq/L 

*80-90% K+ filtered through the kidney 

Potassium food sources

Green leafy veggies, banana, avocado, salt substitutes

Hyperkalemia causes

-kidney failure 

-metabolic acidosis 

-administration of potassium-sparing diuretics 

-oral potassium supplements 

Hyperkalemia symptoms

Symptoms are cardiac in nature (ECG abnormalities) -> can stop the heart

Others = irritability, cramping, diarrhea 

Shows elevated T wave 

Hyperkalemia treatment

-decrease K diet 

-adjust meds 

-give calcium gluconate to protect heart from arrythmias 

-administering polystyrene sulfonate (Kayexalate) helps bind excess potassium to be excreted thru GI 

-insulin can push K into cells and decrease serum K levels -> give dextrose THEN insulin (watch BGL) 

-temporary hemodialysis if it is severe 

Hypokalemia causes

-excessive vomiting or diarrhea 

-potassium wasting diuretics 

-insulin use

-low K diet 

**If client has low K+, Make sure to check the Mg level on the same blood sent to lab. K+ can’t absorb without normal Mg 

Hypokalemia symptoms

Weakness, arrhythmias, lethargy, and a thready pulse. They are cardiac in nature

Shows U wave 

Hypokalemia treatment

-increase K diet 

-K IV soln, **never too quickly, and never inject K directly into vein as it can stop the heart

Calcium pathophysiology

*Most abundant cation in body and necessary for almost all vital processes 

*Half of total body calcium circulates as free ions that participate in coagulation, neuromuscular conduction, intracellular regulation, control of skeletal and cardiac muscle contractility 

*98-99% calcium reserves stored in teeth and skeleton 

calcium food sources

green leafy veggies, almonds, oranges, dairy

Hypercalcemia causes

- prolonged immobilization that allows calcium to leach out of the bones and into the serum 

-cancers that cause excessive calcium release from bones 
- hyperparathyroidism, parathyroid tumors cause too much PTH secretion, causing too much calcium to be reabsorbed in the kidneys and intestines and released from bone 

Hypercalcemia symptoms

Symptoms  affect GI and musculoskeletal -> nausea, vomiting, constipation, increased thirst and/or urination, and skeletal muscle weakness 

Hypercalcemia treatment

-decrease Ca in diet 

-phosphate supplements 

-hemodialysis 

-surgical removal of the parathyroid gland (if hyperparathyroidism is causing the hypercalcemia) 

-weight-bearing exercise 

Hypocalcemia causes

- hypoparathyroidism where not enough PTH is excreted, causing a decreased reabsorption of calcium and decreased release of calcium from the bones 

-vitamin D deficiency 

-renal disease -> because phosphorus is inversely related to calcium, an abnormally high phosphorus level as seen with renal failure can also result in hypocalcemia 

Hypocalcemia symptoms

 GI and musculoskeletal --> paresthesias (numbness and tingling), muscle cramps, tetany.

-Chvostek’s sign (involuntary twitching of facial muscles when the facial nerve is tapped)

-Trousseau’s sign (a hand spasm aused by inflating a blood pressure cuff to a level above the client’s systolic pressure for three mins)

Hypocalcemia treatment

-increase Ca in diet

-increase vit D in diet

-more sun exposure

Which 3 ions all go low and high together?

Magnesium, Potassium and Calcium

Magnesium pathophysiology

Second most abundant intracellular cation 

*Required for transmission of nerve impulses and muscle relaxation 

*Controls absorption of sodium, potassium, calcium, and phosphorus (low Mg = the others will be low too)

Magnesium food sources

green leafy veggies, spinach, almonds, yogurt

Hypermagnesemia causes

-renal failure 

-excess Mg replacement 

-use of Mg containing laxatives or antacids 

Hypermagnesemia symptoms

bradycardia, weak and thready pulse, lethargy, tremors, hyporeflexia, muscle weakness, and cardiac arrest.

Hypermagnesemia treatment

-increase fluid 

-stop Mg medications 

- hemodialysis or peritoneal dialysis for severe cases 

-can administer calcium gluconate to help heart from arrythmias

Hypomagnesemia causes

-not enough Mg diet 

-loop diuretics that excrete Mg 

-alcohol use disordeer due to concurrent poor diet and impaired nutrient absorption from alcohol 

-chronic PPI use 

Hypomagnesemia symptoms

nausea, vomiting, lethargy, weakness, leg cramps, tremor, dysrhythmias, and tetany that is associated with concurrent hypocalcemia that can occur with hypomagnesemia. 

Hypomagnesemia treatment

-increase dietary intake of Mg 

-IV or Mg supplement 

Phosphate pathophysiology

*stored in bones 

*important in energy metabolism, RNA and DNA formation, nerve function, muscle contraction, and for bone, teeth, and membrane building and repair 

* excreted by the kidneys and absorbed by the intestines 

Phosphate food sources

dairy products, fruits, vegetables, meat, beans, and cereal 

Hyperphosphatemia causes

too much phosphate in your blood. Causes include advanced chronic kidney disease, hypoparathyroidism and metabolic and respiratory acidosis. 

Hyperphosphatemia symptoms

Usually asymptomatic, but signs of associated hypocalcemia may be present due to the inverse relationship between phosphorus and calcium 

Hyperphosphatemia treatment

-decrease phosphorus diet 

- administration of phosphate-binder medications to help with excretion 

-hemodialysis 

Hypophosphatemia causes

blood has a low level of phosphorous.

Hypophosphatemia symptoms

Many symptoms such as muscle weakness, respiratory or heart failure, seizures, or comas

Hyperphosphatemia treatment

-treat the cause of the imbalance 

-oral or IV phosp replacement 

-increase phosp diet