hyper/hypo & fluids
what is the biggest indicator of fluid status???? Describe how to monitor? When do you notify the provider?
Daily Weights
Monitor I & O, provide education! remember 1kg is 2.2lbs!
If there is a 1-2lb weight gain in 24 hours or a 3lb weight gain in 1 week
POLYURIA, POLYPHASIA, AND NOCUTRIA IS A SYMPTOM OF
DI
EXCRETE LARGE VOLUMES OF URINE, ELEVATED NA AND HCT, HYPOTENTION AND TACHYCARDIA DUE TO HYPOVOLEMIA
EXCESSIVE LOSS OF WATER, ELEVATED SODIUM AND HCT, HYPOTENSION AND TACHYCARDIA IS A SYMPTOM OF WHAT?
DIABETES INSIPIDUS
ADMINISTER DDAVP
WHICH PATIENT IS AT HIGHEST RISK OF DEVELOPING HYPERKALEMIA?
ESRD
DM
PARTIAL THICKNESS BURNS
LOOP DIRURETICS
ESRD-KIDNEYS CANNOT FILTER!
HYPERTONIC SOLUTIONS PUSHES INTRAVASCULAR INTO EXTRACELLULAR TO INCREASE CIRCULATING VOLUME.
FALSE.
HYPERTONIC FLUIDS ENTERS THE VESEL AND PULLS FLUID FROM INTERSTITIAL AND INTRACELLULAR SPACE AND PUSHES IT INTRAVASCULAR
A patient is admitted for dehydration, what would be urine output that is indicative of rehydration and adequate urine output??
0.7ml/kg/hr
0.6ml/kg/hr
0.5ml/kg/hr
0.5ml/kg/hr
RESTRICTING FLUIDS, SEIZURE PRECAUTIONS, AND IN SOME CASES HYPERTONIC SOLUTION ADMINISTRATION IS USED IN THE TREATMENT OF
SIADH
HYPERTONIC FLUIDS MAY HELP WITH HYPONATREMIA- OSMOLARITY IS >375 SHIFTS FLUID BACK INTO CIRCULATION AND REPLACES ELECTROLYTES, SEIZURE PRECAUTIONS DUE TO LOW NA
Are all symptoms of?
loss of skin turgor
oliguria
restlessness and anxiety
clammy skin
hypovolemia
RAAS IS IN CHARGE OF WHAT IN THE BODY???
RAAS ASSISTS IN MAINTAINING BLOOD PRESSURE AND INTRAVASCULAR FLUID STATUS
HYPOTONIC FLUIDS CAN INCREASE BLOOD PRESSURE
FALSE.
SHIFTS FLUID OUT OF THE VESSELS INTO THE CELLS AND HYDRATES THE CELLS. CAN WORSEN BLOOD PRESSURE AND INCREASE EDEMA. MAY CAUSE HYPONATREMIA.
WHAT IS OSMOLARITY?
WHAT IS HYPOVOLEMIA?
WHAT IS HYPERVOLEMIA?
OSMOLARITY: CONCENTRATION OF SOLUTION
(DETERMINED BY # OF SOLUTES IN A KG OF WATER OF BLOOD OR URINE) sodium glucose urea etc. can be urine osmo or serum osmo
HYPOVOLEMIA: DECREASED FLUID, INCREASE OSMOLARITY (LESS FLUID MORE CONCENTRATION)
HYPERVOLEMIA: INCREASED FLUID, DECREASED OSMOLARITY (SOLUTE DOESN'T CHANGE THER IS JUST MORE FLUID)
HYPERNATREMIA AND AN INCREASE OF VASOPRESSION IS AN EXAMPLE OF?
SIADH: HYPERVOLEMIA
SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORJMONE
POLYDIPSIA, LOW GRADE FEVER, EDEMA ARE ALL MANIFESTATIONS OF WHICH ELECTROLYTE IMBALANCE
HYPERNATERMIA
PATIENT COMES IN WITH RENAL CALCULI, BONE PAIN, CONSIPATION THE NURSE MIGHT ANTICIPATE CHECKING WHICH LAB?
CALCIUM
SIGNS OF HYPERCALEMIA
LASIX AND THIAZIDE DIRUETICS CAN CASE HYPONATREMIA AND HYPOKALEMIA
TRUE LOOP DIURETICS BLOCK THE REABSORPTION OF SOIDUM AND CHLORIDE IN THE LOOP OF HENLE
what is
INTRAvascular??
INTERstitial?
INTRAcellular?
intravascular is within the blood vessels
interstitial between blood vessels and cells
intracellular within the cell
PATIENT COMES IN WITH MUSCLE WEAKNESS, LETHARGY, CONFUSION FOR 1 WEEK.
LAB VALUES AS FOLLOWS:
NA OF 125
SERUM OSMO OF 230 (LOW)
URINE OUTPUT 0.6/KG/HR
SIADH:
a condition where the body produces too much antidiuretic hormone (ADH), leading to excessive water retention and dilution of the blood.
SERUM OSMO IS LOW NORMAL IS 275-295
HYPONATREMIA 125 NORMAL 135-145
URINE OUTPUT IS ABOUT NORMAL
TETANY, SPASMS, PARASTHESIA ARE ALL SIGNS OF?
HYPOCALCEMIA
CHEVOSTEK & TROUSSEAU SIGNS
LOW CA CAUSES ELECTRICAL IMPULSES TO FIRE CAUSING SPASMS
TROUSSEAU: CARPAL SPASM
CHEVOSTECK: CHEEK FACIAL NERVE TWITCH
TOURSADES AND NYSTAGMUS IS CAUSED BY WHICH ELECROLYTE IMBALANCE?
HYPOMAGNESIA
LOW MAG INCREASES ACTIVITY
ST DEPRESSION, TORSADES, VIFIB, TACHYCARDIA, INCREASED DTS, DIARREAH, ABNORMAL EYE MOVEMENT
CALCIUM GLUCONATE, ALBUTEROL AND INSULIN CAN BE USED TO TREAT HYPERKALEMIA
TRUE
CA GLUCONATE PROTECTS THE HEART CELL MEMBRANE
ALBUTEROL ACTIVATES BETA 2 RECEPTORS AND NA+/K+ PUMPS IN CELLS REDUCTING EXTRACELLUALR K CONCENTRATION
INSULIN PUSHES GLUCOSE INTO THE CELL WHICH LOWERS POTASSIUM BUT MUST BE GIVEN WITH DEXTROSE WHICH PUSSES EXTRACELLULAR K INTO THE CELL
DESCRIBE 3RD SPACING
when fluid shifts from the blood (intravascular space) to the "third space," which is the interstitial or other body cavities where it is not functional
A PATIENT COMES IS POST HEAD INJURY. THERE IS NOW DAMAGE TO THE HYPOTHALAMUS AND PITUITARY GLAND.
LAB VALUES ARE AS FOLLOWS:
URINE OUTPUT OF 5ML/KG/HR
URINE OSMOLARITY LESS THAN 300 (LOW)
SODIUM OF 155
TRAMATIC BRAIN INJURY CAN DAMAGE AREAS THAT PRODUCE ADH. THIS WOULD BE AN EXAMPLE OF CENTRAL DI.
HIGH URINE OUTPUT OF 5ML/KG (NORMAL WOULD BE 0.5ML/KG)
URINE OSMOLARITY 300-900
NOMRAL SODIUM LEVEL 135-145
PVC'S, T WAVE INVERSION, AND PROMINENT U WAVES ARE A SIGN OF WHICH ELECTROLYTE IMBALANCE?
HYPOKALEMIA
name normal sodium, potassium, magnesium, calcium levels
K: 3.5-5
Mg: 1.6-2.2
Ca: 8.2-10.2
END STAGE RENAL DISEASE PTS. ARE AT RISK OF HPOKALEMIA AND HYPOPHOSPHATERMIA
FALSE.
FAILING KIDNEYS CANNOT EXCRETE POTASSIUM OR PHOSPHORUS PROPERLY.