Fluid and Electrolytes & ABGs

hyponatremia < 135

• c: excessive water intake, SIADH, diuretics, vomiting, HF

• s/s: confusion, headache, seizures, muscle cramps, nausea

• nc: monitor neuro status, seizure precautions, monitor I&O, fluid restriction

• tx: sodium replacement, water restrictions

hypernatremia > 145

• c: dehydration, inadequate water intake, diabetes inspidus

• s/s: intense thirst, restlessness, altered mental status, dry mucous membranes, decreased skin turgor

• nc: monitor neurological status, increase fluid, monitor I&O

• tx: free water replacement, address underlying cause

hypokalemia < 3.5

• c: diuretics, vomiting, diarrhea, inadequate intake, alkalosis

• s/s: muscle weakness, cramping, weak/irregular pulse, decreased bowel sounds

• nc: monitor cardiac rhythm, encourage potassium-rich foods, assess respiratory

• ECG changes: flattened T waves, U waves, ST depression

hyperkalemia > 5

• c: renal failure, k- sparing diuretics, excessive intake, acidosis

• s/s: tetany, muscle spasms, seizures, prolonged QT interval

• nc: monitor cardiac rhythm, restrict potassium, check renal function

• ECG changes: peaked T waves, widened ORS, prolonged PR interval

hypocalcemia < 8.5

• c: hypoparathyroidism, vitamin D deficiency, pancreatitis, malabsorption, massive blood transfusions

• s/s: tetany, muscle spasms, seizures, prolonged QT interval

  • trousseau and chvostek’s sign

• nc: seizure precaution, respiratory status, administer calcium supplements

hypercalcemia > 10.5

• c: hyperparathyroidism, malignancy, prolonged immobility

• s/s: lethargy, confusion, muscle weakness, constipation, bone pain

• nc: encourage mobility, increase fluid intake, monitor kidney stones

hypomagnesemia < 1.5

• c: malnutrition, alcoholism, diarrhea, malabsorption

• s/s: cardiac arrhythmias, tremors, confusion

• nc: monitor deep reflex, assess for concurrent electrolyte, admin magnesium sulfate, monitor respiratory status

hypermagnesemia > 2.5

• c: renal failure, excessive magnesium intake

• s/s: decreased DTRs, muscle weakness, hypotension, bradycardia, respiratory depression, cardiac arrest

• nc: monitor tendon reflex, respiratory rate and depth, monitor cardiac rhythm, assess renal function

hypertonic fluids

• shrink the cells

• 3% NS, D10W, D5NS

• nc: vascular overload and cellular dehydration, monitor for fluid overload

hypotonic fluids

• swells the cell

• 0.45% NS, 0.33 NS, D5W (in body)

• nc: can cause cerebral edema, signs of intracranial pressure

isotonic fluids

• equal out the cell

• 0.9% NS, LR, D5W (initially)

• nc: monitor for fluid overload, safe for most patients, monitor I&O

extravasation

leakage of IV solution into surrounding tissues (meds- vesicant)

infiltration

IV fluid leaks into tissue (hard and cool)

phlebitis

inflammation of the vein (hard and warm)

fluid volume deficit (hypovolemia)

• c: vomiting, diarrhea, NG suction, diuretic therapy, diabetes insipidus, renal failure, hemorrhage, burns, excessive sweating, third spacing (ascites)

• s/s: hypotension, tachycardia, weak thready pulse, poor skin turgor, dry mucous membranes, delayed capillary refill, lethargy, confusion, weakness

• tx: oral rehydration therapy, intravenous fluid therapy, blood products

fluid volume excess (hypervolemia)

• c: HF, acute/chronic kidney disease, nephrotic syndrome, cirrhosis

• s/s: pitting edema, pulmonary crackles

• tx: loop diuretics, renal replacement therapy, invasive procedures

respiratory acidosis

retain CO2, lungs can’t remove CO2, breathing too slow (COPD, overdose)

• s/s: confusion, disorientation, changes in LOC, headache, hyperkalemia, muscle weakness

• tx: mechanical ventilation to improve ventilation

respiratory alkalosis

anxiety, panic attack, breathing too fast

• s/s: lightheaded, inability to concentrate, LOC, decreased or normal BP, hypokalemia

• tx: treat underlying cause (anxiety, blow into paper bag)

metabolic acidosis

holding onto acid, renal failure, DKA, diarrhea

• s/s: confusion, headache, nausea, vomiting, dec BP, changes in LOC, warm skin, hyperkalemia, kussmaul respirations

• tx: treat underlying cause

metabolic alkalosis

losing all your acid, vomiting

• s/s: tetany, dizziness, paresthesia, restlessness, confusion, nausea, vomiting, diarrhea, hypokalemia, tremors

• tx: 0.9 NS, PPI, treat underlying cause