Final Exam: Fluid, Electrolytes, and Acid-base

Normal pH range

7.35-7.45

Normal PaCO2

35-45 mmHg

Normal SpO2

95-100%

Respiratory acidosis labs

low pH, high CO2

Respiratory acidosis interventions

Elevate HOB to increase respirations
Assess RR, depth, and lung sounds Q1H
Admin broncho-dilators OR reversal agents
Prep for non-invasive ventilation

Respiratory alkalosis labs

High pH, low CO2

Respiratory alkalosis interventions

Assess anxiety and stop triggers
Encourage slow, deep breaths
Admin anti-anxiety medications as ordered
Reassure and calm patient to decrease RR
Adjust or lower mechanical vent if pt is over-ventilated

Metabolic acidosis labs

Low pH, low bicarb, high H+

Metabolic acidosis interventions

Monitor ECG for dysrhytmias and labs for K+ shifts
Monitor mental status and I/O ratio
Admin IV fluids to replace loss
Treat underlying/root cause of condition (diarrhea, sepsis, renal failure)

Metabolic alkalosis labs

High pH, high bicarb, low H+

Metabolic alkalosis interventions

STOP NG suctioning and vomiting
Administer anti-emetics if possible, adjust diuretics
ECG monitor for dysrhythmias & labs for K+ shifts
Replace any lost fluids/electrolytes
Encourage slow, deep breathing to increase acid

Which acid-base imbalances may cause shifts in potassium

Metabolic acidosis or alkalosis

Which acid base puts pt. at risk for hyperkalemia

Metabolic acidosis

Which acid base imbalance has increased risk for hypokalemia

Metabolic alkalosis

Isotonic fluid shifts

No fluid shifts

What happens to a cell in an isotonic solution?

Nothing

Hypotonic fluid shift

HIPPO-tonic, fluid moves into the cell

What happens to a cell in a hypotonic solution

Cell swells d/t rapid fluid movement into cell

Hypertonic fluid movement

Fluid moves OUT of the cell

What happens to a cell in a hypertonic solution

Cell shrinks/crenates d/t fluid rapidly leaving

Isotonic IV solution

0.9% NaCl, Lactated Ringers (LR)

Which IV fluids can you bolus?

isotonic (LR, NS)

Hypotonic IV solution

0.45% NS (1/2 normal saline)

Hypertonic IV solution

3% NaCl

Hypernatremia labs

High sodium, high osmolality

Interventions to treat hypernatremia

Restrict any intake of sodium
Encourage oral fluid intake
STOP admin of hypernatremic IV fluids & switch to 0.45% NS
Monitor neuro status, daily weight, and sodium conc

Hyponatremia labs

low sodium, low osmolality

Interventions to treat hyponatremia

STOP hypotonic IV solutions & admin 3% NaCl (5% for severe cases)
Place pt on fluid restrictions
Monitor I&O ratio, neuro status, and sodium concentrations
Educate pt on electrolyte replacement (sports drinks)

Hyperkalemia labs

high K+, possible metabolic acidosis

Interventions to treat hyperkalemia

Restrict potassium in the diet, stop any medications containing potassium
Continuous ECG monitoring for dysrhythmias
Medication list

What are the medications (in order) to treat hyperkalemia?

1. Calcium Gluconate

2. Insulin + dextrose

3. Kayexalate

4. Loop diuretics

5. Dialysis

6. Albuterol

If there are tall T-waves in hyperkalemia, what med do i admin and why?

Calcium gluconate: to protect the heart

If ECG is normal in hyperkalemia, what med do i admin and why

Insulin + dextrose to protect from rapid glucose shifts and to move potassium into cells

Calcium gluconate function

Protects the heart from dysrhythmias r/t K+ shifts

Insulin + dextrose function

Moves insulin into cells, dextrose prevents rapid glucose shifts for non-diabetic patients

Kayexalate function

Promotes elimination of potassium through stools

Loop diuretics function and assessment

Renal system must be fully functional to use
Encourages release of potassium through urine

Dialysis function

Physical removal of potassium

Albuterol indication

LAST resort medication for hyperkalemia

Hypokalemia labs

low K+, possible metabolic alkalosis

Interventions to help with hypokalemia

Encourage foods high in potassium
STOP potassium wasting medications/laxatives
Monitor ECG for dysrhythmias
Admin oral or IV potassium (NEVER PUSH)

Hypocalcemia labs

low potassium, high phosphorous

Interventions to help treat hypocalcemia

Encourage foods high in calcium and low in phosphorous
Admin oral/IV calcium
Monitor ECG, place patient on seizure precautions

Hypercalcemia labs

high calcium, low phosphorous

Interventions to help treat hypercalcemia

Encourage foods high in phosphorous, STOP high calcium foods
Admin phosphorous, calcitonin, or loop diuretics
Encourage weight-bearing exercise and increased fluid intake

Hypermagnesemia labs

High magnesium

Interventions to help treat hypermagnesemia

Stop any medications containing magnesium
Encourage fluids to flush out excess magnesium
Admin calcium gluconate to protect the heart from dysrhythmias & loop diuretics
Monitor ECG for dysrhythmias and RR

Hypomagnesemia labs

Low magnesium, possible low Ca2+, K+

Interventions to help treat hypomagnesemia

Encourage foods high in magnesium
Treat associated electrolyte imbalances AFTER fixing magnesium
Admin oral/IV magnesium medications
Monitor ECG, DTR’s and RR