1- Fluid & Electrolytes HURST review-FINAL

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1. Define Fluid Volume 14. Explain ANP release Atrial chambers expand due to
Excess/Hypervolemia increase fluid in vascular space
and chambers of the heart
atria releases ANP >> causes
kidneys to excrete excess fluid.
15. Function of ADH (anti- makes you retain water
diuretic hormone)
16. Two ADH (anti-diuretic SIADH
hormone) Problems DI
17. Too much ADH (anti- water retention
Too much fluid in the vascular space diuretic hormone) fluid volume excess
causes (3) SIADH (too many letters, too
2. Causes of FVE: (3) Heart Failure
much water)
Renal Failure
Sodium 18. SIADH characteristics Urine output decreases; urine is
concentrated (urine sodium
3. Heart Failure Heart is weak; cardiac output decreases
increases)
characteristics decreased kidney perfusion; urinary
blood is dilute (serum sodium
output decreases
decreases)
Volume stays in the vascular space
SIADH sodium & water DO NOT
4. Three things with a Effervescent soluble medications (Alka- follow each other
lot of sodium seltzer)
19. Not enough ADH Lose (diurese) water
Canned/processed foods
causes (3) fluid volume deficit (can cause
IVF with sodium
shock)
5. 3 Main Hormonal Aldosterone Diabetes Insipidus (has nothing to
Regulation of Fluid Atrial Natriuretic Peptide (ANP) do with blood sugar)
Volume Anti-diuretic hormone (ADH) DI (think DIuresis)
6. Where is aldosterone adrenal glands 20. Diabetes Insipidus Urine output increases; Urine is
found characteristics diluted (Urine sodium decreases)
7. Normal action of blood volume gets low (vomiting, Blood is concentrated (serum
aldosterone hemorrhage) >> aldosterone secretion sodium increases)
increases >> retain Na & water >>blood 21. large amount of urine shock
volume goes up output can lead to what
8. Diseases with too Cushings complication?
much aldosterone hyperaldosteronism (Conns syndrome) 22. urine specific gravity, Concentrated makes the #'s go
9. Characteristics of too much aldosterone Na, and hCT rule with UP
Cushings and Conns too much sodium & water ADH Dilute makes the #'s for DOWN
hypervolemia 23. ADH is found in the ? Pituitary
10. Disease with too little Addisons disease 24. Key words to think craniotomy
aldosterone potential ADH head injury
11. Characteristics of too little aldosterone problems (5) sinus surgery
Addisons too little sodium/water transsphenoidal hypophysectomy
hypovolemia any condition that can lead to an
increased ICP can lead to an
12. Where is ANP (atrial Atria of the heart ADH problem
natriuretic peptide)
found? 25. Trans = going all the way through

13. How does ANP (atrial Opposite of aldosterone 26. sphenoid = sinus
natriuretic peptide) causes excretion of sodium & water 27. hypophysis = pituitary
work?
28. ectomy = remove
29. Another name for anti-diuretic vasopressin (Pitressin) 39. Treatment FVE: - low sodium diet/restrict fluids
hormone (ADH) that may be desmopressin acetate
used as an ADH replacement in (DDAVP) (route-nasal diet (2) - I&O and daily weight
DI? spray) interventions (2)
med - Diuretics
30. Signs & Symptoms Fluid volume Distended neck
activity
excess/hypervolemia (FVE): veins/peripheral veins:
assessment - bed rest
vessels are full
precaution
Veins (2) Peripheral edema/third
- Physical assessment -pertinent s/sx
spacing/vessels can't
hold anymore and start
- Give IVF slow
to leak
40. Rules of daily same time
31. Signs & Symptoms Fluid volume CVP goes up
weights? same clothes
excess/hypervolemia (FVE): more volume; more
have pt void first
pressure
CVP 41. Diuretics to treat - furosemide (Lasix) loop diuretic -
fluid volume excess (lose potassium, worry about
32. CVP is measured where? in the right atrium
HYPOKALEMIA)
33. Normal CVP? 2-6 mmHg
34. Signs & Symptoms Fluid volume crackles / wet lung - hydrochlorothiazide/HCTZ
excess/hypervolemia (FVE): sounds (Thiazide): watch lab work with all
SOB diuretics for dehydration and
Lungs hear low in the bases - electrolyte problems.
listen posterior
- spironolactone (Aldactone)
35. Signs & Symptoms Fluid volume Polyuria: kidneys help to
(potassium sparing-monitor for
excess/hypervolemia (FVE): diurese
HYPERkalemia)
increase pulse & BP
kidneys increased: weight, CVP
(remember when educating patients
36. Signs & Symptoms Fluid volume Pulse: about eating potassium, which ones
excess/hypervolemia (FVE): increased/bounding should eat more and which should
your heart only wants limit)
Vitals (2) fluid to go forward
42. How does bed rest bed rest induces diureses by the
(heart beats harder &
benefit fluid volume release of ANP and decreased
faster to move fluid out)
excess? production of ADH

BP: increased; more

when supine (lay down) --> volume
volume, more pressure
shifts to heart >> atrium releases ANP
37. Signs & Symptoms Fluid volume Weight increases fast >> kidneys excrete excess fluid, tells
excess/hypervolemia (FVE): any acute gain or loss pituitary to decrease ADH
isn't fat-it's fluid. production
weight
43. what should you Focus on the pertinent signs &
38. If the fluid goes backwards into Heart failure and focus on during the symptoms
the lungs, it can lead to: (2) pulmonary edema physical assessment CVP
for fluid volume BP
overload pulse
lung sounds
weight
44. IVF are given slowly elderly ---> go into fluid overload fast 54. Signs and symptoms dry mucous membranes
to who? (4) fluid volume
very young deficit/hypovolemia
(FVD):
kidney disease
Dry
heart disease
55. Signs and symptoms BP decreased (less volume,
45. Fluid Volume Shock fluid volume lesspressure)
Deficit: deficit/hypovolemia Pulse increased, weak/thready;
Hypovolemia (FVD): heart is trying to pump what little
Big time deficit = fluid is left
vitals (3) Respiration increased; perceives
46. 3 Causes of Fluid loss of fluids from anywhere
fluid as hypoxia, increases
volume third spacing
respirations to decrease hypoxia
deficit/hypovolemia diseases with polyuria
56. Signs and symptoms peripheral veins/neck veins
47. Examples of loss of thoracentesis
fluid volume vasoconstrict (very tiny)
fluids: paracentesis
deficit/hypovolemia cool extremities (peripheral
procedures (3) surgery/trauma
(FVD): vasoconstriction in an effort to shunt
other (3) vomiting
blood to the vital organs)
diarrhea
vasoconstrict (3)
hemorrhage
57. Signs and symptoms urine specific gravity increases. If
48. third spacing When fluid is in the tissues instead of
fluid volume putting out any urine at all, it will be
definition the vascular space (where it does you
deficit/hypovolemia very concentrated
no good)
(FVD):
give 2 examples burns/ascites
Na & hCt also increases
49. Where does fluid go out to tissues - causes them to labs (3)
in a burn patient become edematous
58. Reasons for Kidneys either aren't being perfused
(third spacing)?
decreased urine or
50. Ascites cause & usually d/t liver disease >> huge output with fluid they are trying to hold on to fluid to
leads to (2) & abdomen full of fluid >> trouble volume deficit (2) compensate
intervention breathing from increased pressure on
59. FVD: Why does BP less volume, less pressure
diaphragm
decrease?
Measure abdominal girth daily 60. Why does pulse heart is trying to pump what little
Looks like in Fluid excess but are increase? fluid is left around
actually in fluid deficit because fluid
61. Why does pulse feel in shock - vessels constrict and get
is not where it should be.
thready in FVD? tiny - feels like a thread when pulses
51. Polyuria can Oliguria to anuria against finger
progress from ______
62. Why does CVP less volume, less pressure
to ____ and _____
decrease?
52. Why do diabetics PID - particle induced diuresis
63. Why are extremities in an effort to shunt blood to the
get polyuria? (osmotic diuresis)
cool? vital organs
too many particles (sugar) - have to
be removed 64. Treatment FVD (3) Prevent further losses - stop vomit,
bleeding
53. Signs and symptoms decreased weight
Replace volume -
fluid volume decreased UOP (kidney's either aren't
Mild deficit: PO fluids
deficit/hypovolemia being perfused or they are trying to
Severe deficit: IV fluids
(FVD): hold on to fluid (compensate).
Safety precautions - high risk for falls
decreased CVP (less volume, less
d/t vital sign & mental status
decreased (4) pressure)
changes - Monitor for fluid volume
decreased skin turgor
overload
65. Isotonic Solution - into the vascular space and stays 76. Hypertonic solution - "volume expander" -
where does it go? there thick, packed with
Stay where I put it What type of solution is it? particles
where does the fluid go? will draw fluid into
66. Examples of isotonic NS (0.9% Na Cl)
the vascular space
solutions (4) LR
from the cells
D5W
D5 1/4 NS
"HypEr = Enter the
67. Uses of isotonic nausea/vomiting vessel"
solutions: burns
77. Examples of hypertonic solution: 3% NS
When the client has sweating
5% NS
lost fluids through (4) trauma
4-NS D5 1/2 NS
68. What is the basic Normal Saline (NS) 1 D5 NS
solution when 3 D10W
administering blood? D5LR
69. ALERT: DO NOT use HTN TPN
isotonic solutions in cardiac disease albumin
clients with? (3) renal disease 78. Uses of hypertonic solution client who has:
70. Complications of fluid volume excess (FVE) hyponatremia
isotonic solutions (3) HTN (1) shifted large amounts
hypernatremia (only if solution (1) of volume to a 3rd
contains Na) (3) space
severe edema, burns,
71. HypOtonic Solution - goes into the vascular space and
or ascites
where does it go? then shifts out into the cells to
replace cellular fluid 79. Complication of hypertonic fluid volume excess
solution-
HypO Goes Out to the cells 80. Where and what (3) should you In an ICU setting
72. Benefit of hypotonic rehydrate but does not cause HTN monitor when administering a Frequently monitor:
solution hypertonic solution? BP
Pulse
73. Examples of hypotonic D2.5W
which 2 types of hypertonic CVP
solution (3) 1/2 NS (0.45% Na Cl)
solutions should be monitored especially if they are
0.33% NS
especially close? receiving 3% or 5%
74. Uses for hypotonic clients with: NS
solution HTN
81. Magnesium and Calcium act like sedatives
(5) renal disease
cardiac disease 82. Mg normal value 1.3-2.1
fluid replacement because of 83. Ca normal value 9.0 - 10.5
nausea/vomiting, burns,
84. Magnesium is excreted by the kidneys
hemorrhage, etc.
_____________, but it can be lost in
dilution when a client has
other ways (GI tract )
hypernatremia and used for
cellular dehydration 85. If you want to get Mg and Ca muscles first
questions right think ________
75. Complications of cellular edema (because this fluid
hypotonic solution (3) is moving out to the cells) 86. Causes of hypermagnesemia (2) renal failure
which can lead to fluid volume antacids
deficit and decreased BP
87. Magnesium makes you _______________ vasodilate
88. 3 main hypermagnesemia signs and decrease BP
symptoms flushing
warmth
89. Which 2 s/sx ONLY occur with flushing
hypermagnesemia? warmth
90. Common symptoms of decrease DTR 99. Treatment of - Move! (Ca back to bone)
hypermagnesemia and decreased LOC Hypercalcemia - Fluids (prevent kidney
hypercalcemia: decrease pulse stones)
(think too much sedative) decrease respirations - Ca has an inverse
relationship with phosphorus
Decreased (4) arrhythmias add phosphorus to diet
(1) weak and flaccid muscle (protein)
(2) tone -steroids
-safety precautions (sedated
91. hypermagnesemia treatment Ventilator if RR is < 12
from increased calcium)
(4) (<12=Mg toxicity)
Dialysis - b/c kidneys may 100. Hypercalcemia: fluids
not be working
Calcium gluconate What prevents kidney
safety precautions stones?
92. Antidote for calcium gluconate 101. Ca has an inverse phosphorus
hypermagnesemia? IVP very slowly relationship with ?
how to administer it? max rate 1.5-2 mL/min Phosphorus UP --> Ca
Max does? should always be available DOWN
at bedside with Mg pts
102. What should be added to protein=phosphorus
93. Causes of hypercalcemia (3) hyperparathyroidism (too the diet with
much PTH) hypercalcemia?
Thiazides (retain calcium)
103. Must have what vitamin in Vitamin D
immobilization (causes Ca
order to use Ca?
to leave bones and go into
blood) 104. 2 Medications that Biphosphates (etidronate)
decrease serum Ca Calcitonin
94. With hyperparathyroidism PTH (parathormone)
there is too much of which 105. Calcitonin prevents which osteoporosis - drives calcium
hormone? disease back into the bone

95. When serum calcium gets parathormone (PTH) 106. Main treatment for Move!
low, _____________ kicks in. hypercalcemia

96. What does PTH do? pulls Ca from the bone and 107. Hypomagnesemia & not enough sedative
puts it in the blood; hypocalcemia =
therefore, the serum calcium 108. 2 causes of diarrhea
increases hypomagnesemia alcoholism
97. How does immobilization you have to bear weight to 109. Why does alcohol cause It causes diurese
cause hypercalcemia? keep calcium in the bones hypomagnesemia
110. Which two ways does It suppresses ADH (causes
If you do not bear weight,
alcohol cause diureses? diurese)
calcium will leave the
its hypertonic so it draws fluid
bones
into vascular space (causing
98. Two main Signs and brittle bones diuresis)
symptoms hypercalcemia kidney stones
111. Alcoholics can have low Mg Not eating (get Mg in diet)
because they are ? Drinking (peeing a lot)
112. Signs and symptoms for Muscle tone rigid & tight
hypomagnesemia and Increased DTR's
hypocalcemia: + Chvostek's
4 outward s/sx + Trousseau's
113. Signs and symptoms for seizures 124. Treatment for hypocalcemia (4 PO calcium
hypomagnesemia and arrhythmia meds) IV Ca
hypocalcemia: Vitamin D
prone to (2) Phosphate binders:
sevelamer hydrochloride
114. Signs and symptoms for Stridor/laryngospasm
(Renegel) & calcium
hypomagnesemia and - airway is a smooth
aceate (PhosLo)
hypocalcemia: muscle
airway/swallowing Swallowing problems 125. Precautions to take while GIVE SLOWLY
- esophagus is a giving IV Ca (2) ALWAYS make sure the
smooth muscle - client is on a heart
aspiration risk monitor (can widen QRS
complex and cause
115. Signs and symptoms for Mind changes - wont
asystole)
hypomagnesemia and be acting like
hypocalcemia: themselves 126. A client receiving magnesium Stop the infusion!
neuro possible sulfate has a drop in output:
hallucinations What would be the priority
nursing intervention?
116. Treatment for hypomagnesemia Give some Mg
117. What should you always check kidney function 1. Call the primary healthcare
before and during IV administration (because kidneys are provider
of Mg the only way to 2. Decrease the infusion
excreter Mg --> bad 3. Stop the infusion
kidney func = 4. Reassess in 15 minutes
Hypermagnesemia)
127. Intervention is required with Client that is 8 hours post
118. What precautions should a patient seizure which client? heart cath due to high risk
with hypomagnesemia be on? Client with a history of grand- of hemorrhage
119. If a client receiving IV Mg sulfate kidney function mal seizures or a client that is
has a hourly UOP of 180 and then decreasing 8 hours post heart cath?
an hour later it drops to 140 what is (REMEMBER : Mg can 128. Sodium normal values? 135-145
happening? only be excreted via .
129. Think what for sodium think neuro changes
retaining Mg.
problems? The brain HATES sodium
changes
What do you do?
- stop the infusion 130. The sodium level in your blood how much water you have
is totally dependent on what? in your blood
120. What do you do if your client STOP the infusion
reports flushing, and sweating 131. Sodium follows _______? water
when you start the IV Mg? s/sx that something is
132. In which conditions does SIADH
wrong
sodium NOT follow water? (4) DI
121. What are these food high in? magnesium hypernatremia
spinach, mustard greens, summer hyponatremia
squash, broccoli, halibut, turnip
133. Hypernatremia = dehydration
greens, pumpkin seeds,
peppermint, cucumber, green 134. hypernatremia = water
beans, celery, kale, sunflower too much sodium, not
seeds, sesame seeds and flax enough_________
seeds. 135. 3 main causes of hyperventilation
122. Main cause of hypocalcemia Not enough PTH hypernatremia heat stroke
DI
123. Three things that cause hypoparathyroidism
hypocalcemia due to not enough radical neck 136. How does hyperventilation You lose water when you
PTH thyroidectomy cause hypernatremia? exhale = insensible loss
137. 3 main Signs and symptoms of dry mouth
Hypernatremia thirsty
swollen tongue
138. By the time you are thirsty you dehydrated 154. Complication of risk for FVE
are already ______________ hypertonic solution
139. Treatment for hypernatremia (2) restrict Na 155. Potassium normal 3.5 - 5.0
Dilute client with IV value
fluids
156. Potassium is kidneys
140. What kind of IV fluid do you give hypotonic excreted by
a pt with hypernatremia? ________________________
141. If you've got a sodium problem, fluid 157. If the kidneys are up
you've got a _________ problem not working well,
serum potassium will
142. Interventions for hypernatremia daily weights
go ____
(3) I&O
lab work 158. 2 Main causes of kidney problems
hyperkalemia spironolactone
143. Common complication with dehydration
feeding tube clients? (check Na every day) 159. Potassium problems life threatening arrhythmias
=
Which lab should be checked?
160. 4 signs and muscle twitching
144. Hyponatremia = dilution symptoms of muscle weakness
Too much water, not enough sodium hyperkalemia flaccid paralysis
_________ life threatening arrhythmias
145. 4 main causes of hyponatremia Drinking ONLY water 161. ECG changes with bradycardia, conduction blocks, V
for fluid replacement hyperkalemia: (3) fib
(vomiting/sweating) T waves? tall and peaked T waves
psychogenic polydipsia PR interval? prolonged PR interval
(pt LOVES to drink P waves? flat or absent P waves
water) QRS? widened QRS
D5W (only sugar and
162. 4 treatments of - dialysis
water --> can get too
hyperkalemia - calcium gluconate (decrease
diluted)
arrhythmia)
SIADH (retaining TOO
- glucose and insulin
MUCH water)
- push fluids
146. What should be used for fluid Gatorade - contains
163. Why/when dialysis if the kidneys are not working
replacement instead of water? electrolytes
to treat
147. Why does drinking water for It only replaces water hyperkalemia?
fluid replacement decrease and dilutes the blood
164. Advantage of decreases arrythmias
sodium?
calcium gluconate to
148. What is psychogenic polydipsia water poisoning from treat hyperkalemia?
drinking too much water
165. Why is insulin used Insulin carries glucose and
149. What happens in SIADH retains water to treat potassium into the cell
hyperkalemia?
150. 3 main signs and symptoms of Headache
hyponatremia seizures 166. Anytime you give IV HYPOglycemia
coma insulin to treat HYPOkalemia
hyperkalemia, worry
151. Treatment of hyponatremia: sodium
about what 2 things?
Client needs ______ water
and doesnt need ______ 167. Why is Glucose Insulin is carrying glucose out of
given with IV insulin blood vessels and into the cells -->
152. Which IV solution do you use for hypertonic
to treat BSG drops --> give glucose to
a client with hyponatremia and
hyperkalemia? balance it out / prevent
neuro symptoms?
hypoglycemia
153. Hypertonic solution means? packed with particles
3% NS or 5% NS
2 examples?
168. How does sodium polystyrene Poop out Potassium - 183. These foods are high in what? potassium
sulfonate (kayexalate) work? exchanges Na for K in spinach, fennel, kale, mustard greens, brussels
GI tract sprouts, broccoli, eggplant, cantaloupe,
tomatoes, parsley, cucumber, bell pepper,
169. What is patient at risk for when dehydration
apricots, ginger root, strawberries, avocado,
being given sodium polystyrene Na & K has inverse
banana, tuna, halibut, cauliflower, kiwi,
sulfonate (Kayexalate) and why? relationship
oranges, lima beans, potatoes (white or
-driving the Na UP in
sweet ), and cabbage
effort to bring K+
down
risk for dehydration
because of HIGH Na -
--> Need to push
fluids
170. Potassium has an inverse sodium
relationship with ______
171. 4 causes of hypokalemia vomiting
NG suction
Diuretics
not eating
172. We have a lot of potassium where? GI tract
173. 3 main Signs and symptoms muscle cramps
hypokalemia muscle weakness
Life threatening
arrythmia
174. 3 ECG changes with hypokalemia U waves
PVCs
v tach
175. 3 Treatments for hypokalemia Give potassium:
Spironolactone
(Aldactone) (makes
the client retain
potassium)
eat more potassium,
176. Why Spironolactone? makes you retain
potassium
177. Intervention before/during IV Assess urinary output
potassium
178. Adverse effect / major problem GI upset
with PO potassium and how do you give with food
prevent?
179. When should UOP be assessed before & during
when giving IV potassium? administration
180. IV potassium should always be infusion pump
given by _____
181. Never give potassium _______________ IV push - always has
to be diluted
insomething
182. Does potassium burn during Yes - potassium eats
infusion? peripheral veins