fluid & electrolytes

normal mg

1\.3-2.3 mg/dL or 1.8-2.6

alcoholism is the most common cause for this

low mag

burn patients are at risk for

high potassium due to rapid cell destruction

with hypernatremia you want to

encourage fluids bc it helps you become more concentrated and dilutes fluids (dilute your sodium)

primary cause of hypocalcemia

neck surgery due to problems with PTH

patient are at a high risk of kidney stones if they have

high calcium

overload of fluids can cause

low sodium

hyponutrimia

fluids you can measure

sensible

trousee sign

inflagte bf cuff

huge cause of hyperkalemia

kidney failure, Kidneys excete our K+

normal saline and LR solutions are

isotonic fluids = stays in the vessel

3% sodium chloride, 5% d5w

hypertonic fluids

hypertonic fluids

anything more than 0.09%

hypotonic fluids

anything less than 0.09%

fluids that replace fluid potential loss

isotonic fluids = same osmolality means same concentration as our blood

can cause respiratory depression/failure

high mag

restrict sodium with

high sodium

potassium values

3\.5 -5 mEq/L

hyperkalemia hallmark sign

peaked t waves

loop diurectics cause

low potassium

calcium values

8\.6-10.2 mg/dL

chevostak’s sign

tap the side of face

sodium levels

135-145

hypotonic fluids

vessel to cell, makes vessels swell

neck surgeries cause

low calcium

hypernatrenia

encourage fluids

hyponatremia

ommit fluids

Osmolality is the ____.

concentration of a solution

Isotonic fluids are used for ____ because they are the closest solution as our blood & almost the same tenacity.

fluid replacement

when do we give isotonic solutions?

loss of fluids, large sodium loss, & correct extra cellular fluid volume deficit

0\.9% sodium chloride is an __ solution that is just ___.

isotonic; normal saline

Isotonic solutions consist of what three types?

0\.9 NaCl, lactated ringers, D5W

Isotonic fluids are convenient because they have ___ & only expand current plasma volume of blood.

NO MOVEMENT

Isotonic solutions equate to more volume, meaning more pressure, meaning they may cause ___.

hypertension

Lactated ringers (LR) is an isotonic solution that is given when? (4)

1. dehydration


2. blood loss


3. sodium depletion


4. GI loss

why is lactated ringers isotonic solution is given for GI losses?

fluid & electrolytes are eliminated in the bowels

D5W is used when?

to supply water to correct & increase serum osmolality

D5W acts like a what when the blood has a high concentration?

diluting

Hypotonic solution DILUTE which means is ___ the cell.

swells

Hypotonic means ___ of the vessel.

OUT

Hypotonic means more or less concentrated?

hypo=low bc less NaCl

Anything less than 0.9% is ___.

hypotonic

Examples of hypotonic solutions are:

0\.45% NaCl, 0.225% NaCl

Hypotonic solutions more water from ___ to __.

ECF to ICF

Hypotonic solutions __ the cell.

hydrate

Hypotonic does or does not cause hypertension?

DOES NOT!!!

hypotonic solutions hydrates the cells-

hypo hippo, my hippo is swollen

Why may hypotonic solutions lead to fluid volume deficit?

water is moving from the vessel into the cell and possibly lower sodium bc the fluids have less sodium

Hypertonic solution are more or less concentrated.?

more concentrated bc they are PACKED with particles = shrunken RBC

Anything greater than 0.9% is considered a ___.

hypertonic solution

Hypertonic solutions move water from __ to _.

intracellular to extracellular

Hypertonic solutions enter the vessel which create more volume, which means more pressure, meaning ___.

hypertension

Hypertonic solutions include what three types?

3% NaCl, 5% dextrose in LR, 5% dextrose in NS

what is something an rn always need to look out when doing fluid replacement therapy?

overloading the circulatory system with excessive IV fluids

what diuretic helps with breathing/crackes?

loop diuretic like furosemide

Loop diuretic furosemide helps with what?

breathing/ crackles

Fluid overload s&s are? (5)

1. increased BP
2. distended neck veins
3. weight gain
4. wet lungs/shallow breaths/tachypnea
5. agitation/restlessness

what causes fluid overload?

1. fluid infusion


1. renal/hepatic/cardiac disease

how does rn treat fluid overload? (4)

1. slow MIVF rate
2. monitor vitals
3. high fowlers


1. diuretics- furosemide

ADH only retains ___.

water

Sensible fluid loss is fluids we can __ because it is typical routes for excretion like urination.

measure

Insensible fluid loss is fluids we cannot measures bc they are excreted via

sweating, lungs, etc.

Serum osmolality primarily reflects the concentration of ___.

sodium in the blood

Urine osmolality is composed of what three things?

urea, creatinine, uric acid

Normal serum osmolality is __.

275-290 mOsm/kg

What causes high serum osmolality? (7)

1. water loss- dehydration
2. hypernatremia
3. hyperglycemia (can lead to polyuria)
4. alcoholism
5. head injuries/stroke
6. burns
7. diabetes insipidus

what causes low serum osmolality? (3)

1. fluid volume excess
2. adrenal insufficiency


1. DKI

Why is urine specific gravity NOT or a less reliable indicator for evaluating fluid status?

bc it measures the WEIGHT of urine & particles meaning it also weighs particles such as protein & glucose (may indicate false positive)

Urine specific gravity indicates what?

how concentrated urine is

Normal urine specific gravity is ___.

1\.005-1.030

BUN should be excreted by the kidneys, which can vary, making it ___.

not a good indicator of kidney function

Normal BUN range ___.

10-20 mg/dL

An increased BUN may indicated that the kidneys are

useless, not working well

what increases BUN? (5)

1. decreased renal function
2. GI bleed
3. dehydration
4. increased protein intake


1. fever/sepsis

what decreases BUN? (4)

1. end-stage liver dx
2. low-protein diet
3. starvation


1. pregnancy

The most reliable indicator for kidney function is

creatinine

Why is creatinine the most reliable?

it does not vary with protein intake or hydration status

Creatinine has a small range bc it SHOULD almost be

totally cleared from metabolism from the bloodstream by the kidneys

Normal serum creatinine:

0\.7-1.4 mg/dL

Hemoglobin carries oxygen to organs & tissues. What is the mens normal range?

13\.8 - 17.2 g/dL (13-17 men got fucked in the ass that made them bleed)

Hemoglobin carries oxygen to organs & tissues. What is the womens normal range?

12\.1 - 15.1 g/dL (12-15 yr old women get their period)

Hematocrit is the % of RBCs in the blood. Men’s normal range:

42%-52% (42-52% of men are gay)

Hematocrit is the % of RBCs in the blood. Women’s normal range:

35%-47% (35-47 year old women are MILFs)

what increases H&H?

dehydration & polycythemia

what decreases H&H?

overhydration and anemia

what is fluid volume deficit

not enough fluid in the body (water & blood)

another name for fluid volume deficit is (FVD)

hypovolemia

In hypovolemia, sodium stays the increases, stays the same, or decreases?

stays the same/normal/low bc fluid & sodium are both lost

FVD vs dehydration:

FVD is both water/blood vs dehydration is just water

Dehydration causes the sodium to be?

HIGH bc there is not water, means more concentration

Why does hypovolemia occur? (7)

1. vomiting
2. diarrhea
3. GI suctioning
4. sweating
5. third-space fluid shifts (burns, lover dysfunction)
6. DIABETES INSIPIDUS


1. hemorrhage

\

Why does DI cause hypovolemia?

patient does not ADH (the do not pee hormone) which means they are “dumping urine” means they are losing all the their fluids

what does FVD look like? (9)

1. acute weight loss (can’t keep fluids in )
2. oliguria (little to no urine bc the body is retaining)
3. concentrated urine
4. low BP/orthostatic hypotension
5. thirst
6. tachycardia
7. weak/thready pulse
8. decreased skin turgor
9. shock

how to prevent FVD:

early identification and initiation of rehydration therapy/fluid promotion

a patient with FVD will have what type of labs?

HIGH urine specific gravity, HIGH BUN, HIGH Hct/RBCs

A late sign of a patient experiencing FVD is __.

orthostatic hypotension

When there is less or no fluid, everything will be more _ due to no fluid being able to dilute it, which means labs will be _.

concentrated, increased

what is the best indicator for FVD?

daily weights

A patient weighed 135 lbs at 0700 during the day shift on 7/18. The patient weighed 138 lbs at 0900 the next day. What does nurse do next?

call the provider