NUR317 Fluid and Electrolytes Exam 1 Blueprint guide

Fluid volume excess (hypervolemia)

Too much fluid in the body; weight gain is the most common sign

Fluid volume deficit (hypovolemia)

Too little fluid in the body; weight loss is a major indicator

Best indicator of fluid volume change

Daily body weight

1 L of water weighs how much?

2.2 lb (1 kg)

First spacing

Normal fluid distribution in the ICF and ECF

Second spacing

Abnormal accumulation of fluid in the interstitial space = edema

Third spacing

Fluid becomes trapped where it is difficult or impossible to return to the cells or blood vessels

Hyponatremia

Low sodium; associated with fluid retention

Hypernatremia

High sodium; associated with dehydration

Signs of hyponatremia

Weight gain, edema, neurologic changes (fluid retention)

Serious complications of hyponatremia

Irritability, seizures, coma

Signs of hypernatremia

Decreased urine output + neurologic changes

Serious complications of hypernatremia

Confusion, seizures, coma

Treatment for hyponatremia from excess fluid

Diuretics, fluid restriction, or 3% NaCl

Treatment for hypernatremia

Oral fluids or IV isotonic/hypotonic solution

Hyperkalemia

High potassium

Major causes of hyperkalemia

Renal failure, potassium-sparing diuretics, excessive potassium intake

Hyperkalemia mnemonic

MURDER

What does MURDER stand for in hyperkalemia

muscle cramps/tetany, urine abnormalities, respiratory distress, decreased cardiac contractility, EKG changes, reflexes

Major complication of hyperkalemia

Cardiac/EKG changes

Treatment for severe hyperkalemia

Dialysis, insulin, medication changes, sodium polystyrene sulfonate

What does IV insulin do during hyperkalemia treatment?

Moves K⁺ from the ECF into the ICF

What medication stabilizes the cardiac membrane during severe hyperkalemia?

IV calcium chloride or calcium gluconate

What monitoring is important with severe hyperkalemia?

Continuous ECG monitoring

Hypokalemia

Low potassium

Major causes of hypokalemia

Loop diuretics and poor nutrition

Hypokalemia mnemonic

7 L's

What does the 7 L’s stand for in hypokalemia

lethargy, low shallow respirations, lethal cardiac dysrhythmias, lots of urine, leg cramps, limp muscles, low BP & heart rate

Can IV KCl be given IV push?

NEVER

Can IV KCl be given as a bolus?

NEVER

What must happen before giving IV KCl?

Dilute it

Maximum IV KCl rate in this lecture

10 mEq/hr

What should be used when administering IV KCl?

Infusion pump

Foods high in potassium

Spinach, banana, fish, potato, mango, avocado, beans, strawberries

Hypercalcemia

High calcium

Major causes of hypercalcemia

Hyperparathyroidism and cancer

Hypercalcemia mnemonic

"Bones, stones, abdominal groans, psychic moans"

Complications of hypercalcemia

Dysrhythmias, seizure, coma

Treatment for hypercalcemia

Weight-bearing exercise, push fluids 3-4 L/day, bisphosphonates, calcitonin

Hypocalcemia

Low calcium

Causes of hypocalcemia from lecture

Decreased PTH, blood/diet factors, hyperventilation

Hypocalcemia mnemonic

CATS

What does CATS stand for in HYPOcalcemia

convulsions, arrhythmias, tetany, spasms/stridor

Classic signs of hypocalcemia

Positive Trousseau's or Chvostek's sign

Other signs of hypocalcemia

Numbness/tingling around mouth or extremities

Treatment for hypocalcemia

Calcium + vitamin D or IV calcium gluconate

Hypotonic solution

Causes cells to swell (HIPPO)

Isotonic solution

Causes no major cellular change

Hypertonic solution

Pulls water out of cells → cells shrink (SKINNY)

Main effect of hypotonic

Water moves into cells

Hypotonic used for

Treating hypernatremia

Nursing priority for hypotonic

Monitor neurologic status

Examples of hypotonic solutions

0.45% NS, 0.25% NS

Main effect of isotonic solutions

No major cellular change

Isotonic solution used for

Fluid volume replacement/bolus

What to monitor for isotonic solutions

monitor I&O and fluid overload

Examples of isotonic solutions

0.9% NS, Lactated Ringer's, D5W

Which IV fluid is the only solution used with blood?

0.9% normal saline

Main effect of hypertonic solution

Pulls water out of cells

Hypertonic solution used for

Replacing electrolytes

What to monitor with hypertonic solution

Electrolytes and I&O

Examples from lecture for hypertonic solutions

TPN and solutions containing Mg, Na, K, or glucose

Normal saline concentration

0.9% NaCl

Normal saline tonicity

Isotonic

When is normal saline used?

When both fluid and sodium are lost

Which IV solution can be used with blood products?

0.9% NS

LR (lactated ringer’s) tonicity

Isotonic

What does LR contain?

Sodium, potassium, chloride, calcium, and lactate

What does LR do?

Expands the ECF

LR is ideal for

Surgery, burns, and GI losses

When is LR contraindicated according to the lecture?

Liver problems, hyperkalemia, and severe hypovolemia

What is TPN?

Nutrition containing concentrated carbohydrates, fats, proteins, and electrolytes

When is TPN used?

When a patient has limited or no oral intake

Can TPN supplement enteral feedings?

Yes

What must happen to TPN before administration?

It requires refrigeration prior to administration

How long can a TPN bag be up before discarding?

24 hours

What should be done when starting a new TPN bag?

Hang a new line and new filter

Major TPN complications

Fluid/electrolyte imbalances, fat embolism, infection

What does IVPB stand for?

IV piggyback

What is IVPB used for?

Administering IV medications or fluids

Where should the primary bag be compared with the secondary IVPB bag?

The primary bag should be lower than the secondary bag

Before starting an IVPB, what clamp should you check?

Make sure the secondary clamp is open

If the nurse hangs the secondary bag below the primary bag

Something is wrong. The secondary bag needs to be higher than the primary bag.

PICC stands for

Peripherally inserted central catheter

Where is a PICC inserted?

A vein in the arm, with the catheter terminating centrally

How long might a PICC be used?

1 week to 6 months

Can you draw blood from the PICC arm?

The lecture says cannot use the arm for BP or blood draw

Can you perform venipuncture in the PICC arm?

Avoid it

Major PICC complications

DVT and phlebitis

Major advantage of a PICC

Lower infection rate, fewer insertion complications, decreased cost

Where does a centrally inserted catheter terminate?

Distal end of the superior vena cava

What can central venous access be used for?

IV fluids/medications, vesicants, blood products, PN, hemodynamic monitoring, blood samples, and contrast

Major disadvantage of central venous access

Increased risk of systemic infection

Central line infection signs/concern

Infection can occur from contamination or migration of organisms

Pneumothorax can occur because of

Perforation of the visceral pleura

Catheter migration can occur because of

Improper suturing

Catheter damage can occur because of

Trauma or forceful flushing

What should you do if a PICC has moved?

Stop using it

Why avoid BP in a PICC arm?

To avoid complications involving the catheter/vascular access

What syringe size should be used for central line flushing?

10 mL syringe or larger