fluid and electrolytes

does skeletal muscle weakness and paresthesias happen in fluid overload or dehydration?

fluid overload

what can hyperventilation, arginine vasopressin deficiency, and arginine vasopressin resistance cause?

dehydration

what can heart failure and long-term corticosteroid therapy cause?

fluid overload

what actions are you going to take for fluid overload?

diuretic therapy, heart monitor, monitor electrolytes, monitor I&O,and protect skin breakdown.

What are signs and symptoms of hyponatremia?

muscle cramps, confusion, weakness, nausea, diarrhea, and cramping

what are some other signs and symptoms you may see with hyponatremia?

tachycardia, weak thready/bounding pulse, hypotension, and increased intracranial pressure

What are signs and symptoms of hypernatremia?

Thirst, dry flushed skin

What do you need to assess for in a patient with hypernatremia? (s/s)

assess mental status for attention span and cognitive function, and decrease contractility (BP, pulses)

What is a big thing that causes hypokalemia?

Diuretics (& corticosteroids)

What are signs and symptoms of hypokalemia?

weak, flat T waves, prominent U waves, dysrhythmias - everything slows down

if you are hypokalemic from fluid overload limit salt to how many grams per day?

2

what are signs and symptoms of hyperkalemia?

decrease deep tendon reflexes, tall peaked T waves, respiratory arrest, and twitching (HOTN, brady, palpitations, hyperactive bowels)

you are going to notify the rapid response team for hyperkalemia if what two things happen?

heart rate below 60 BPM or spiked T waves

Signs and symptoms of hypocalcemia

increase deep tendon reflexes, seizures, tachycardia, and Chvostek’s & trousseau’s

Signs and symptoms of hypercalcemia

decrease deep tendon reflexes, cardiovascular changes, and blood clots

Signs and symptoms of hypomagnesemia

increase reflexes, cardiovascular changes, seizures, and may see chvostek and trosseaus

Signs and symptoms of hypermagnesemia

drowsy, lethargic, decreased reflexes, and respiratory arrest

fluid balance is closely linked to/affected by __________ concentrations

electrolyte

fluid intake is regulated through __________ drive

thirst

who has more fat cells (which have less water)?

males or females

females

what is the minimum amt of fluid per day to excrete toxic waste products and other excretions through the kidneys?

400-600 ml (per day)

how many ml of fluid should you excrete per hour at the minimum?

30 ml (per hour)

true or false

if you fall below 400-600 ml/day your electrolytes can build up to legal doses bc your kidneys aren't excreting

true

if fluid intake/retention does NOT meet body's fluid needs it will result in a fluid volume _________

deficit

if you are DEHYDRATED,

CV cue: INCREASE OR DECREASE HR ?

increase (HR)

if you are DEHYDRATED,

respiratory- INCREASE OR DECREASE resp rate?

increase (resp rate)

if you are DEHYDRATED,

will your skin be :

A) smooth and elastic

B) not elastic, dry cracked skin, mucous memranes may be sticky/pasty, tenting

B (loss of elasticity, dry cracked skin, mucus membranes might be sticky, tenting)

if you are DEHYDRATED,

neurological cue: will you be....

A) alert x4

B) altered mental status (decreased loc, confusion)

B (altered mental status)

if you are DEHYDRATED,

renal cue: will your urine be...

A) decreased output and more concentrated (dark color and strong odor)

B) increased otuput, clear watery urine

A (decreased output, more concentrated, dark color, odor)

in dehydration, fluid volume loss is form INTRACELLULAR OR EXTRACELLULAR fluid

it shifts from the plasma into difference spaces and will lose electrolytes and fluid in that movement

extracellular

1.030 specific gravity means urine is NOT or VERY CONCENTRATED

very concentrated

Causes:

not drinking a lot of fluids (ex: illness, NPO)

- someone who is not swallowing well (parksinsons, alzheimers)

- injury (ex: hemorrhage, burns, vomit, diarrhea, GI suctioning, diuretics)

- fever

dehydration

1 L of water weighs how many pounds?

2.2 (lbs)

a weight change of 1 LB is the same as how many ml of fluid volume?

500 (ml)

best indicator of improved treatment (w/ a patient who is dehydrated) is ______ them

weighing

weigh every ______ hours (or every day)

8

if patient is mildly or moderately dehydrated, we will use ______ rehydration solutions: water based solution that has glucose and electrolytes

(ex: sports drink)

oral

(will help them get that electrolyte replacement and a little bit of glucose as well as hydrating them)

treatment for mild to moderate dehyration, you should have how many ml/hr PO?

60-120 (ml/hr)

treatment for severe dehydration (and sometimes moderate) will need?

IV fluids

true or false

even though elderly skin has a loss of elasticity the skin WILL tent on hands and arms even if they are hydrated
where do you test?

true - test their elasticity on their sternum

fluid overload or dehydration?

CV cues:

- increased HR

- bounding pulses

- elevated BP

- distended neck veins

- weight gain

fluid overload

fluid overload or dehydration

respiratory cues:

- increased, shallow respirations

- dyspnea w/ exertion

- crackles

fluid overload

fluid overload or dehydration?

skin:

- red shiny skin

- pale clammy cold

- pitting edema

* AT RISK FOR SKIN BREAKDOWN

fluid overload

fluid overload or dehydration

neuro:

- altered LOC

- weakness

- paresthesia

- headache and visual disturbances (bc of the HIGH BP)

fluid overload

fluid overload or dehydration

GI:

- increased motility

- enlarged liver

fluid overlaoad

prolonged fluid overload will DILUTE electrolytes especially _____ and _____.

when you have dilution of electrolytes, it can lead to seizures, coma, and death

sodium

potassium

causes:

- excessive fluid replacement

- kidney failure

- heart failure

- water intoxication

fluid overload

if you have fluid overload will you restrict or not restrict sodium intake

restrict (sodium intake)

this can occur as a result of changes in fluid I & O

can be life threatening if severe, can occur in any setting

electrolyte imbalance

normal level for sodium

136-145 (mmol/L)

Action: excitable extracellular activity

- skeletal muscle contraction

-cardiac contraction

- nerve impulse transmission

- fluid balance

sodium

- DECREASED CELLULAR ACTIVITY

- neuro: decreased (confusion and weakness)

- GI: increased motility, nausea, diarrhea, cramping

- cardio: weak thready pulse, hypotensive, tachy, dizzy (with hypovolemia) or bounding pulse & hypertensive (with hypervolemia)

hyponatremia

if someone is hyponatremic bc they have a fluid deficit give them _____ fluids

isotonic IV

if someone is hyponatremic because they are on diuretics, you should HOLD the diuretics

true or false

true

this is a cause of hyponatremia

both sodium and water is loss (ex: burn patient)

hypOvolemia

this is a cause of hyponatremia

water moves into cell and dilutes out the sodium

(wouldn't want to give extra fluid to them)

hypErvolemia

- EXCITABLE CELLULAR ACTIVITY

- irritable confused drowsy

- decreased DTR/contractility, thirst, dry, flushed skin

hypernatremia (monitor BP and pulses)

to correct hypernatremia you can have _____ therapy

IV

will you see high or low sodium levels in a patient who is dehydrated

high (sodium)

normal potassium levels

3.5-5.0 (MeQ/L)

action:

INTRACELLULAR EXCITATION (cardiac muscle, nerves, and muscle contraction and electrical conductivity)

potassium

potassium affects which organ of the body?

heart

(potassium deals w/ electrical conductivity of heart and the contraction of the heart muscle)

(you will see arrythmias w/ a potassium imbalance --> can lead to dysfunction in circulation and death)

sources of ________

- meat

- fish

- fruits and veggies (bananas, oranges, avocadoes, tomatoes, spinach, potatoes)

potassium

"relaxed heart, GI, and muscles"

- shallow respirations

- hyporeflexive and weakness/paresthesias (will see large skeletal muscles decrease 1st and then the heart and lungs)

- flattened T waves, prominent U waves

hypokalemia

biggest cause of death in hypokalemia is _______ failure

respiratory

watch respiratory effect every ____ hours for a patient w/ hypokalemia

2 (hours)

potassium is a high alert medication: can never be administered IV ________ by itself.

can stop the heart if it's given pure

undiluted

"tight/contracted heart, GI, muscles" - increases cell excitability

- bradycardia, hypotension

- ECG changes (tall peaked T waves)

- hyperactive bowel sounds (diarrhea)

- respiratory arrest

- paresthesias/twitching

hyperkalemia

normal calcium level

9-10.5 (mg/dl)

action:

- neuronal excitability through skeletal and cardiac muscle inhibition and stabilization.

- maintaining bone strength and density

- structure and function of teeth and bones

calcium

calcium interferes w/ the absorption of __________

(if patient is anemic they should not take a class of milk w/ an iron tablet....they should take vitamin c for iron)

iron

"excessive muscle contraction"

- increased neuromuscular excitability

- Chvostek’s or Trousseau’s sign

- Increased reflexes

- Seizures

hypocalcemia

a sign of hypocalcemia

left palmar flexion (pump up BP cuff and leave if for a couple of min and then it will elicit a response)

Trousseau's sign

a sign of hypocalcemia

facial grimace

Chvostek's sign

"decreased muscle contraction"

- muscle relaxed, decreased DTR reflexes

- dysrthymias/cardiovascular changes in ECG

- poor tissue blood flow and clot formation

hypercalcemia

interventions:

- reduce calcium levels (give IV normal saline)

- drug therapy- calcium binders can be given to bind and then excrete the calcium

- cardiac monitoring (can have dangerous cardiac dysrhythmias)

hypercalcemia

if someone has hypercalcemia, give them normal saline because ________ increases the EXCRETION of calcium

sodium

normal magnesium levels

1.3-2.1

action: muscle relaxation after skeletal muscle contraction, carbohydrate metabolism, vitamin activation, cell growth

magnesium

dietary sources:

- green veggies

- grains and nuts

- seafood

- meat

magnesium

about 60% of magnesium is is stored in _________

bone

"muscles excited"

- increased DTR reflexes

- seizures

- dysrthymias/cardiovascular ECG changes

- May see Chvostek and Trousseau’s sign

hypomagnesemia

IV magnesium sulfate can be given to treat hypomagnesemia

but be careful because they could transition to _________ easily

- monitor breathing

- monitor urine output

- monitor reflexes

hypermagnesemia

"muscles relaxes"

- decreased LOC and drowsiness/lethargic

- decreased DTR reflexes

- decreased respiratory drive/respiratory arrest

hypermagnesemia

if someone has hypermagnesemia you can give them a loop ________ that can pull magnesium from the body

diuretic

movement of water through semipermeable membrane to achieve an equilibrium of osmolarity

osmosis

number of milliosmoles in a kg of a solution

osmolality

interventions:

- cause should be determined

- drug therapy (stop or hold diuretics)

- nutrition therapy - increase sodium intake

hyponatremia

interventions:

- cause should be determined

- drug therapy- IV therapy

- nutrition therapy- sodium restriction

hypernatremia

interventions:

- prevent potassium loss

- increase serum potassium

- ensure patient safety- cardiac monitoring

hypokalemia

interventions:

- reduce serum potassium level

- prevent recurrence

- ensure patient safety- cardiac monitoring

hyperkalemia

interventions:

- restore normal calcium levels

- drug therapy (oral or IV)

- increase calcium rich foods

- reduce environmental stimuli- patient will have neuro excitability

- prevent injury- ma have brittle bones

hypocalcemia

interventions:

- reduce calcium levels (may give normal saline bc sodium increases excretion of calcium)

- drug therapy (may be given a calcium binders to bind and excrete calcium)

- cardiac monitoring- may have dangerous dysrhythmias

hypercalcemia

interventions:

- cause should be determined

- any med that leads to losing magnesium should be stoped

- may be given IV mag sulfate (but need to monitor breathing, urine output, and reflexes)

hypomagnesemia

interventions:

- cause should be determined

- reduce magnesium level

- correct underlying problem

- drug therapy- can give a loop diuretic to pull of magnesium from body

hypermagnesemia

dehydrated, dizzy, fatigue, muscle weakness

hypochloremia

no specific symptoms (HTN?)

hyperchloremia

weakness and respiratory arrest

hypophosphatemia

tetany (MUSCLES EXCITED)

hyperphosphatemia