NUR 310 Exam 2 Fluids and Electrolytes

ECF Volume Deficit Causes

• ↑ Insensible water loss or perspiration (high fever, heatstroke)
• Diabetes insipidus
• Osmotic diuresis
• Hemorrhage
• GI losses: vomiting, NG suction, diarrhea, fistula drainage
• Overuse of diuretics
• Inadequate fluid intake
• Third-space fluid shifts: burns, pancreatitis

ECF Volume Deficit Manifestations

• Restlessness, drowsiness, lethargy, confusion
• Thirst, dry mucous membranes
• Cold clammy skin
• Decreased skin turgor, ↓ capillary refill
• Postural hypotension, ↑ pulse, ↓ CVP
• ↓ Urine output, concentrated urine
• ↑ Respiratory rate
• Weakness, dizziness
• Weight loss
• Seizures, coma

ECF Volume Excess Causes

Excessive isotonic or hypotonic IV fluids
Heart failure
Renal failure
Primary polydipsia
SIADH
Cushing syndrome
Long-term use of corticosteroids

ECF Volume Excess Manifestations

• Headache, confusion, lethargy
• Peripheral edema
• Jugular venous distention
• S3 heart sound
• Bounding pulse, ↑ BP, ↑ CVP
• Polyuria (with normal renal function)
• Dyspnea, crackles, pulmonary edema
• Muscle spasms
• Weight gain
• Seizures, coma

Sodium(Na) normal level ?

136-145

Potassium(K) normal level?

3.5-5

What is the purpose of sodium ?

influences renal excretion of H20
initiates neuromuscular reactions

Hypernatremia (high sodium)- cause, assessment findings, interventions and complication risk

Cause- dehydration
Assessment findings- altered mental status, seizures, agitation, twitching, decreased cardiac output, sticky/dry mucous membranes
Interventions- cardiac monitoring, seizure precautions, I/O, IV D5%W (hypotonic fluid)
Complication risk- seizures

Hyponatremia (low sodium)- cause, assessment findings, interventions and complication risk

Cause- hypervolemia, psychogenic polydipsia, diuretic, burns, poor na intake, syndrome of inappropriate ADH
Assessment findings- altered level of consciouness, seizures, weakness, abdominal cramps
Interventions- I/O, seizure precautions, 0.9 nacl, 3% nacl, monitor vital signs electrolytes, cardiac monitoring, withholding diuretics
Complication risk- seizures

what is the purpose of potassium?

transmit nerve impulse, cardiac contraction, skeletal contractions

Hyperkalemia (high potassium) -cause, assessment findings,collabrative care, and complication risk

Cause- renal failure, acidosis, excessive intake, ACE inhibitors, burns, fever, crushing injuries
Assessment findings- irrtability, abdominal cramps, weakness, cardiac arrhytmias, peaked t-waves
Collabrative care- regular insulin, dextrose 50%IV, kayexalate, cardiac monitoring, diuretics, monitor vitals, electrolytes, possible renal dialysis
Complication- cardiac arrest

Hypokalemia (low potassium) -cause, assessment findings,interventions, and complication risk

Cause- nausea, vomititng, diarrhea, DIURETICS, diaphoresis, alkalosis, poor intake, insulin
Assessment findings- fatigue, weakness, bradycardia, irregular pulse, paresthesias
Interventions- potassium IV (diluted and slowly), cardiac monitoring, monitor vitals and electrolytes
Complication- abnormal heart rythms

The nurse is reviewing labratory results. Which electrolyte will the nurse observe is the most abundant in the blood?

Sodium

A client is receiving 3% saline continous IV infusion for hyponatremia. Which assessment data will require the most rapid response by the nurse?

There are crackles throughout both lung fields

hypotonic

-no movement between ECF and ICF
-normal saline 0.9% and lactated ringers
-used to treat hypovolemia (liquid blood plasma is too low) with sodium loss

hypertonic

-3% sodium chloride
-initially expands and raises the osmolality ECF
-higher osmolality compared to plasma
-draws water out of cells
- Monitor blood pressure lung sounds in serum sodium levels
-Used to treat dehydration and hypernatremia and reduce ICP

isotonic

-there is no movement between extracellular and intracellular fluids
-Most used to treated hypovolemia and dehydration
-Normal saline 0.9%
-only solution use with blood

risk factors for electrolyte and fluid imbalances

nausea, vomiting, diarrhea, fever, diuretics, IV fluid administration, bleeding, burns