NURS3805 Module 2: Fluid and Electrolytes

- IV

- PO

What are the 2 routes for fluid administration?

PO fluids

Which is preferred in a patient without contraindications: IV or PO fluids?

- used for medications that can damage the veins if administered into them

- longer-term use than PIV

What are benefits of a PICC line?

- ensure IV is patent

- clean out the line

What is the purpose of flushing an IV?

- use alcohol wipe to clean the IV port

- flush with NS

- administer medication

- flush with NS

- place a new Curos cap on the IV port

What is done to give a patient an IV medication?

to prevent blood clots

Why is heparin sometimes used to flush an IV line?

to protect the IV from infection when not in use

What is the purpose of curos caps?

7 days without removal

How long do curos caps protect an IV port for?

- catheter occlusion

- infection

- phlebitis

- infiltration

- extravasation

What are reasons that an IV may not be patent?

inflammation of a vein

What is phlebitis?

when IV fluids leak into the tissues instead of the vein

What is infiltration?

damage to the tissues around an IV site

What is extravasation?

- solution

- infusion rate

- amount of fluid remaining in the bag

- fullness of drip chamber

- assess that tubing is not kinked

- IV site: assess for complications and ensure dressing is clean, dry, and intact

What should be checked when assessing an IV?

the piggyback bag

Which bag should be placed higher: the primary bag or the piggyback bag?

serum: tests the content in the blood

urine: tests the content in the urine

What is the difference between serum and urine laboratory collection?

- thirst

- fluid output

- hormonal regulation

How is intake and output homeostasis regulated?

- increased plasma osmolality

- decreased blood volume

What stimulates thirst?

- kidneys

- skin

- lungs

- GI tract

What routes are fluids excreted from the body?

reduce urine production to conserve water

What is the function of antidiuretic hormone?

reabsorption of water in the kidneys which increases blood pressure

What is the function of the renin-aldosterone-angiotensin system?

- hypotonic

- hypertonic

- isotonic

- blood products

What are the 4 different types of IV fluids?

- neck vein distention

- elevated blood pressure

- pulmonary crackles

- respiratory distress

- intake that is greater than output

- weight gain

What are signs and symptoms of fluid volume overload?

- d/c fluids

- elevate head of bed for dyspnea

- inform provider

- administer O2 and diuretics as ordered

- monitor VS

- monitor output

What are nursing interventions for fluid overload?

crystalloids:

- substances that dissolve easily in fluid

- small particles

- stored at room temperature

- inexpensive

colloids:

- substances that do not dissolve easily in fluid

- large particles

- often require refrigeration

- expensive

Compare crystalloids vs colloids.

- 0.9% NaCl (NS)

- lactated ringers (LR)

What are examples of crystalloid IV fluids?

- blood

- plasma

- plasma proteins

What are examples of colloids?

fluids with the same osmolality as plasma

What are isotonic fluids?

fluids with a lower osmolality compared to plasma

What are hypotonic fluids?

fluids with a higher osmolality compared to plasma

What are hypertonic fluids?

causes them to swell

How do hypotonic fluids effect the cells?

causes them to shrink

How do hypertonic fluids effect the cells?

- first line of treatment for fluid loss

- help to expand plasma volume

- help to restore BP

When are isotonic fluids used?

- 0.9% NaCl (NS)

- lactated ringers (LR)

- 5% dextrose in water (D5W)

What are examples of isotonic fluids?

- Na

- Cl

- lactate

- K

- Ca

- low pH

What is in lactated ringers?

- hypernatremia

- cellular dehydration

What are hypotonic fluids used for?

- 0.33% NaCl

- 0.45% NaCl (half NS)

What are examples of hypotonic fluids?

- monitor neurological status for decrease in LOC

- assess for headache

- assess for weakness

- assess for vomiting

- assess for nervousness and confusion

- assess for tremors and convulsion

- monitor BP to assess for hypotension

What should be monitored and assessed when administering hypotonic fluids?

hypertonic saline

What is the antidote for a reaction to hypotonic solutions?

- 5% dextrose in 0.45% normal saline

- 5% dextrose in lactated ringers

- 5% dextrose in 0.9% NaCl

- 3% NaCl

What are examples of hypertonic fluids?

normal distribution of body fluids

What is 1st spacing?

abnormal accumulation of interstitial fluid

ex. edema

What is 2nd spacing?

abnormal collection of fluid in-between the cells in difficult areas for fluid removal

- ex. ascites

What is 3rd spacing?

hypovolemic shock

What is a potential complication of volume deficit?

pulmonary edema

What is a potential complication of volume overload?

- correct the underlying cause

- replace water and electrolytes

What is the treatment for fluid volume deficit?

remove fluid without changing electrolyte composition or osmolality of ECF with:

- diuretics

- fluid restriction

- sodium restriction

- removal of fluid to treat ascites or pleural effusion

What is the treatment for fluid volume excess?

- decreased intake

- diarrhea

- vomiting

- hemorrhage

- skin loss

- NPO status

What are causes of fluid volume deficit?

if volume lost is 25% of total intravascular volume

When does hypovolemic shock occur?

- tachycardia

- weak pulse

- hypotension

- tachypnea

- hypoxia

- dizziness

- syncope

- confusion

- weakness and fatigue

- thirst

- nausea/vomiting

- weight loss

- oliguria

- cool and clammy skin

- flattened neck veins

What are signs and symptoms of fluid volume deficit?

- increased hemoglobin

- increased hematocrit

- increased serum osmolality

- increased urine osmolality

- increased urine specific gravity

What are results of laboratory tests in a patient with fluid volume deficit?

a. Tachycardia

Your patient presents with prolonged fever for several days. What may be the first sign of dehydration?

a. Tachycardia

b. Bradycardia

c. Hypertension

d. Pruritus

- heart failure

- excess sodium intake

- renal failure

- excessive water replacement

What are risk factors for fluid volume excess?

- tachycardia

- bounding pulse

- hypertension

- dyspnea

- confusion

- muscle weakness

- weight gain

- ascites

- orthopnea

- crackles

- edema

- distended neck veins

What are signs and symptoms of fluid volume excess?

- decreased hemoglobin

- decreased hematocrit

- decreased BUN and creatinine

What are results of laboratory tests in a patient with fluid volume excess?

hydrochlorothiazide

What is an example of a thiazide diuretic?

mild to moderate hypervolemia

What are thiazide diuretics used for?

furosemide (Lasix)

What is an example of a loop diuretic?

moderate to severe hypervolemia

What are loop diuretics used for?

spironolactone

What is an example of a potassium-sparing diuretic?

patients with hypervolemia and hypokalemia

What are potassium-sparing diuretics used for?

potassium (K+)

Which electrolyte should be monitored when a patient is taking a diuretic?

- place patient in supine position if they are in hypovolemic shock

- monitor urine output and alert provider if < 30 cc/hr

- monitor intake and weight

- monitor VS

- monitor lung sounds

- monitor LOC

- assess mucus membranes and skin turgor

- fluid replacement PO or IV

- colloids if hemorrhage

- crystalloids if dehydrated

What are nursing interventions for fluid volume deficit?

136-145 mEq/L

What is the normal range for sodium?

- maintains blood volume and pressure

- helps transmit nerve impulses

- helps maintain acid-base balance

- vital to sodium-potassium pump

What are functions of sodium?

< 2,300 mg

What is the RDA for sodium?

- cellular edema

- decreased cellular function

- decreased transmission of nerve impulses

What are effects of hyponatremia to the cells?

- vomiting

- diarrhea

- NG suctioning

- diaphoresis

- diuresis

- certain medications

- decreased NaCl intake

- hypotonic IV fluids

- excess water intake

What are risk factors for hyponatremia?

- poor skin turgor

- dry mouth

- lethargy

- muscle cramping

- headache

- altered LOC

- decreased blood pressure

- rapid weak pulse

- hypothermia

- seizures

- coma

What are signs and symptoms of hyponatremia?

- fluid restriction

- increased PO sodium intake

- hypertonic fluids

What is the nursing care and treatment for hyponatremia?

- excess sodium intake

- inadequate water intake

- corticosteroids

- kidney injury

What are risk factors for hypernatremia?

- mental status changes

- cardiac disturbances

- restlessness

- agitation

- twitching

- thirst

- flushed skin

- edema

- oliguria

- dry mouth and tongue

- hyperthermia

- tachycardia

- orthostatic hypotension

What are signs and symptoms of hypernatremia?

- encourage patient to drink water

- administer IV fluids: hypotonic or isotonic

- diuretics

- educate patient on low sodium foods

What is nursing care and treatment for hypernatremia?

98-106 mEq/L

What is the normal range for chloride levels?

Na+ and Cl-

What does normal table salt contain?

- assess risk factors

- restrict or increase chloride as needed

- assess VS

- encourage salt for hypochloremia

- encourage water for hyperchloremia

What are nursing interventions for imbalanced chloride?

3.5-5 mEq/L

What is the normal range for potassium levels?

- neuromuscular activity

- nerve impulse conduction

- cardiac electrical activity

- smooth muscle activity

- vital to sodium-potassium pump

What are functions of potassium?

- vomiting

- diarrhea

- NG suctioning

- starvation

- diaphoresis

- dialysis

- increased insulin: insulin pulls K+ out of the blood and into the cells

- potassium-wasting diuretics

What are risk factors for hypokalemia?

- hyporeflexia

- respiratory arrest

- cardiac arrest

- flattened/shallow T waves on EKG

- premature ventricular contractions

- ventricular tachycardia or fibrillation

What are signs and symptoms of hypokalemia?

- increase oral intake of potassium-rich foods

- oral supplements

- potassium-based salt substitutes

- IV fluids with K+

- never administer K+ via IVP

- always use IV pump to administer K+

What is nursing care and treatment for hypokalemia?

- hyperactive bowel sounds

- diarrhea

- peaked T-waves

- ventricular dysrhythmias

- cardiac arrest

What are signs and symptoms of hyperkalemia?

traumatic venipuncture causes lysis of cells

may be due to:

- too small needle

- tourniquet too tight

What causes false hyperkalemia test results?

- increased intake

- renal failure

- vomiting

- diarrhea

- burns

- certain medications

What are risk factors for hyperkalemia?

- administer sodium polystyrene sulfonate (Kayexalate)

- administer IV calcium gluconate

What is nursing care and treatment for hyperkalemia?

it binds with K+ and excretes it into the feces to remove excess K+

What is the action of sodium polystyrene sulfonate (Kayexalate)?

- stabilizes the cardiac cell membrane of the heart

- does not decrease K+ levels

- can cause bradycardia or hypotension

What is the action of IV calcium gluconate?

9-10.5 mg/dL

What are normal levels of calcium?

in the bones

Where is the majority of the calcium stored in the body?

- absorption of vitamin D, Mg, Ph, and vitamin K

- muscle contraction

- structure and strength of bones and teeth

What are functions of calcium?

men: 1,000 mg

women: 1,200 mg

What is the RDA for calcium?

- hypoparathyroidism

- acute pancreatitis

- low vitamin D

What are risk factors for hypocalcemia?

- osteoporosis

- skeletal muscle stiffness and pain

- muscle cramping

- muscle excitability

- seizures

- tetany

What are signs and symptoms of hypocalcemia?

clinical finding associated with hypocalcemia where facial twitching occurs after tapping facial nerve

What is Chovtek's sign?

clinical finding associated with hypocalcemia where hand begins to posture after pressure is applied to the arm

What is Trousseau's sign?

- oral calcium supplements

- IV calcium gluconate

- monitor BP and EKG

- educate on calcium rich foods

What is nursing care and treatment for hypocalcemia?

- dairy

- green leafy vegetables

- edible fish bones

- soybeans

What are examples of calcium rich foods?

- excess intake of Ca or vitamin D

- hyperparathyroidism

- cancers

- malignancy with metastasis to bone

- excess use of Tumms or sodium bicarbonate for GERD

What are risk factors for hypercalcemia?

- confusion

- fatigue

- altered mental status

- reduced muscle and nerve excitement

- kidney stones

- hypoactive or absent bowel sounds

- constipation

- severe muscle weakness

What are signs and symptoms of hypercalcemia?

- limit intake of calcium-rich foods

- removal of parathyroid gland

- hydrate with IV NS or PO fluids

- loop diuretics

- hemodialysis

What is nursing care and treatment of hypercalcemia?

1.3-2.1 mg/dL

What is the the normal range for magnesium levels?