Fluid and Electrolytes

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You find yourself in a room filled with fluid...you have to escape again!

Intravascular Space

Interstitial Space

Intracellular Space

When you look at lab results, what fluid compartment is represented by these results?

Labs are drawn from the vascular space and represent values from that.

That one was not correct, that is okay, let us take a second to review the 3 compartments

From the least amount of water to the most amount of water

From the most amount of water to the lowest amount of water

Which direction does water flow?

0.45% has more water. 1 - 0.9 = 99.1% water 1 - 0.45 = 99.55% water

Which of the two has more water? 0.9% sodium chloride 0.45% sodium chloride

When you have intravenous (IV) fluids, they contain substances. An example is 0.9% sodium chloride. 0.9% is sodium chloride, the rest of it is water. 1 - 0.9 = 99.1% water

Water will move from the most amount of water to the least amount of water

5% albumin

0.45% sodium chloride

5% dextrose in 0.9% sodium chloride

0.9% sodium chloride

Which of the following fluids would be an example of a hypotonic solution?

When we administer fluids to a patient, the concentration of the fluids we administer will promote fluid shifts depending upon the tonicity of the fluid and the patient status.

Interstitial space -> Intravascular space

Intracellular space -> Interstitial space

Intravascular space -> Interstitial space

Intravascular space -> Intracellular space

The nurse is caring for a client that is receiving albumin through an IV infusion. The nurse know's this fluid type will cause what type of fluid shift?

Hemoglobin

Platelets

The nurse is caring for a client that is receiving packed red blood cells. The nurse anticipates which lab value to change after this is administered?

Cryoprecipitate is also used to restore clotting factors

Fresh Frozen Plasma (FFP) are used to restore clotting factors

Platelets are used for low platelet levels

Packed Red Blood Cells (PRBCs) are used for blood loss and will correspond with an increase in hemoglobin / hematocrit

Not quite, let us review the 4 types of blood products!

A type and crossmatch was performed prior to the infusion being started

Signs of an allergic reaction were assessed prior to the infusion being started

A consent was obtained prior to the infusion being started

The nurse is caring for a client that is receiving blood. Which statement below indicates that the nurse made an error when starting the blood?

If you suspect a transfusion reaction has occurred, stopping the transfusion of blood is a priority.

What is required once an infusion has started? - observe for signs of an allergic reaction such as fever, chills, altered blood pressure, respiratory difficulty, or other allergic signs - vital signs checked at start, 15 minutes after start, and then every hour after that

What is required before a unit of packed red blood cells are transfused? - a consent - a type and crossmatch (in an emergency they can use O negative blood, but the question did not say it was an emergency)

Let's review what is needed for blood administration real fast before continuing

Decreased serum osmolality

Elevated creatinine

Increased blood pressure

Hyponatremia

The nurse is caring for a client that has dehydration. What vital sign or lab abnormality supports that diagnosis?

Third-spacing or when fluid builds up in the interstitial space also causes a type of dehydration. The fluid is not where it is supposed to be. This changes the type of fluid that you would administer to the patient.

With dehydration there generally is a decreased blood volume leading to hypotension, tachycardia, orthostatic hypotension, decreased urine output, flat neck veins, and a weak pulse

Serum osmolality = the particles in a given weight of fluid. If you have less fluid, then you have more particles, therefore serum osmolality would increase with dehydration

Dehydration represents a loss of overall body fluid without a change in electrolytes

Administer albumin intravenously

Limit the client's fluid intake to 3 liters a day

Administer Furosemide intravenously

Begin administration of 0.45% sodium chloride

The nurse is caring for a client that has a diagnosis of fluid volume excess. What treatment would the nurse expect to administer?

Medications that may be used to treat fluid volume excess are: diuretics like furosemide, spironolactone, bumetanide, or hydrochlorothiazide. Client's may also be placed on a fluid restriction. 2 liters of intake or less would be an expected fluid restriction.

Symptoms include weight gain of more than 0.5 kg a day, hypertension, bounding pulse, distended neck veins, dyspnea, crackles, and orthopnea

Do you know what some symptoms of fluid volume excess are? Think of them. They will appear in 15 seconds..

Fluid volume excess has multiple causes: heart failure, renal failure, cirrhosis, excess fluids, or medications that cause sodium and water retention.

It is time to switch from fluids over to electrolytes, feel free to take a brief mental break before continuing! If you need a break to create some output…

Oh oh!

Oxycodone (Oxycontin)

Furosemide (Lasix)

Pantoprazole (Protonix)

Polyethylene glycol (Miralax)

The nurse is caring for a client with hypokalemia. Which medication in the client's history could explain this result?

The signs and symptoms you will see include: cardiac arrythmias, constipation, fatigue. More severe ones include paralytic ileus, respiratory paralysis, tetany, hypotension, rhabdomyolysis, or more life threatening arrythmias

Other causes for hypokalemia include: metabolic alkalosis, chronic kidney disease, folic acid deficiency, gastrointestinal losses, and a decreased intake of potassium

Hypokalemia or a low potassium can be caused by diuretics, such as furosemide

The concentration is 1 mEq per 1 mL

The patient may report burning at the site

Oral formulations of potassium have a higher degree of bioavailability

Potassium chloride is administered as an intravenous push medication with a syringe

You are caring for a client scheduled to receive potassium chloride via an intravenous infusion. The nurse knows what to be true regarding this infusion?

Pharm Review: IV administration has higher bioavailability than oral administration

The patient may report burning at the IV site while it is infusing. In those cases the nurse may need to contact the provider to get a slower rate.

With a peripheral IV the safest concentration is 10 mEq / 100 mL. With a central access device concentrations can go up to 40 mEq / 100 mL, but never 1 mEq / 1 mL.

Intravenous potassium should only be done through a slow infusion

Administering potassium is one of the treatments for hypokalemia and the intravenous route has certain traits a nurse needs to know

Furosemide

Calcium gluconate

Sodium polystyrene sulfonate

Dextrose

Respuesta incorrecta

Respuesta incorrecta

Respuesta incorrecta

Respuesta correcta

The nurse is preparing to provide treatment to a client that has hyperkalemia. The nurse has 4 treatments lined up, and 3 of them are correct. Which treatment listed would the nure need to contact the provider about getting changed?

Intravenous insulin can help push potassium from the intravascular space to the intracellular space. However, insulin also will lower dextrose. It is common to administer insulin and dextrose when treating hyperkalemia. Dextrose by itself would not impact the potassium level.

Loop diuretics like furosemide or bumetanide to excrete potassium through the urine

Calcium gludonate to stabilize the electrical activity of the heart (does not reduce the potassium level)

Treatments include:

Sodium polystyrene sulfonate (Kayexalate): this helps the potassium get pooped out

Your patient may present with nausea, vomiting, muscle aches, weakness, dysrhythmias (synonymous with arrythmias). More severe symptoms include paralysis, heart failure, and death

Hyperkalemia can be caused by acute renal failure, dehydration, diabetes, burns, acidosis, or a blood transfusion

Respiratory changes

Nausea

Constipation

Altered mental status

The nurse is caring for a client with hyponatremia. The nurse is administering 3% sodium chloride. What symptom specific to 3% sodium chloride administration would indicate the treatment needs to stop?

In general, fluid replacement for hyponatremia would be 0.9% sodium chloride to allow the sodium to correct slowly to prevent rapid changes in the cerebral cells

When you administer 3% sodium chloride, you are giving a hypertonic solution. The intravascular space will be concentrated with sodium. The body will draw fluid into the intravascular space from the intracellular space. The cerebral cells may shrink if this is too fast and it will show as signs of altered mental status.

Symptoms can be mild with nausea and general feeling of being unwell. Nausea by itself would not indicate stopping the infusion. The severe symptoms all relate to issues of fluid shifts in cerebral cells. Cerebral edema, lethargy, confusion, irritability, seizures, coma, or altered mental status in general.

Sodium is an important electrolyte for fluid movement. When sodium levels change, fluids shift from the intracellular space to the interstitial space or the intravascular space.

Hyponatremia can be caused by vomiting, diarrhea, excess water intake, excess alcohol, thiazide diuretics (and other diuretics), heart disease, and liver disease

True

False

True or False: Hypernatremia has symptoms similar to hyponatremia, and the causes of it in general are things that cause dehyration

Hypotonic solutions or 0.45% sodium chloride are only used if there is not an indication of shock. If a patient is on tube feeding you may see the provider increase the amount of water being flushed routinely to help lower sodium. Either way, if the patient has hypernatremia and hypovolemic shock, then isotonic fluids only.

The treatment for hypernatremia requires restoring the fluid status. What causes cerebral edema? Lowering the sodium too quickly. Sodium should not change quickly. This is why you use hypotonic IV fluids instead of just free water when restoring dehydration in the setting of hypernatremia.

Hypernatremia is caused by things that cause dehydration primarily. The signs and symptoms are similar to hyponatremia.

Respiratory Rate

Oral temperature

Blood Pressure

Heart Rate

The nursing student is performing a set of vital signs manually. Which vital sign may elicit a response that informs the student that the client could have a calcium issue?

One of you is probably thinking "I don't keep the cuff on for 3 minutes". Let this be an invitation to take a manual blood pressure to see if you can beat the 3 minute clock...but wait until after you've escaped first.

Trousseau's sign occurs when you have a blood pressure cuff inflated for over 3 minutes. The patient will have a carpopedal spasm. A picture below:

Heartburn

Asthma

Congestive heart failure

Diabetes

The nurse is caring for a client that presents with hypercalcemia. What in the client's medical history could explain an elevated level of calcium?

Hypercalcemia is treated with IV fluids, loop diuretics, or hemodialysis in severe cases. Another treatment is phosphorus containing compounds like potassium phosphate or sodium phosphate. Phosphorus and Calcium have an inverse relationship. If you replace phosphorus, it will lower the calcium

Someone presenting with hypercalcemia may experience: constipation, abdominal pain, nausea, vomiting. Severe symptoms can include confusion, renal failure, arrythmias, coma, and death.

An over the counter medication called Tums contains calcium carbonate and is a common treatment for heartburn

high calcium levels can be caused by renal failure, cancer, vitamin D toxicity, hyperparathyroidism, and overconsumption of calcium.

meat

peanut butter

carrots

canned soup

The nurse is caring for a client with hypomagnesemia. What food items could the nurse recommend as magnesium-rich foods?

Foods high in magnesium include: nuts and peanut butter, egg yolk, milk, whole grain cereals, bananas, citrus fruits, dark green vegetables, legumes, seafood, chocolate.

The symptoms can include: decreased appetite, fatigue, nausea, weakness. Severe symptoms can include msucle cramps, numbness and tingling, seizures, tetany, and personality changes.

Treatment includes oral or intravenous magnesium. One fun fact, oral magnesium is used for constipation as well. Dietary sources of calcium are also part of the treatment. Due to the occurrence of altered potassium or calcium levels when magnesium is altered, treating those is a priority.

Hypomagnesemia is caused by a decreased intake of magnesium. It occurs along with hypokalemia and hypocalcemia, or it has specific causes like type 2 diabetes, diarrhea, pancreatitis, Crohn’s disease or celiac disease.

Here is a visual of the table from the lecture

Another table from the lecture

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https://westerncarolina.instructure.com/courses/26663/pages/sleep-and-rest-case-study?module_item_id=2077052

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