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13 - Concepts of Fluid and Electrolyte BalanceAce Your Medical-Surgical Nursing, 10th Ed., Ignatavicius & Workman, 2020 Classes and Exams with Picmonic: #1 Visual Mnemonic Study Tool for Registered Nurse (RN) Students
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Medical-Surgical Nursing, 10th Ed., Ignatavicius & Workman, 2020 | Registered Nurse (RN) School Study Aid
Normal Electrolyte Lab Values
- Potassium (K+)
- 3.5 to 5.0 mEq/L
- Calcium (Ca2+)
- 8.5 to 10.5 mg/dL
- Phosphate (PO43–)
- 2.5 to 4.5 mg/dL
- Magnesium (Mg2+)
- 1.5 to 2.5 mEq/L
- Sodium (Na+)
- 135 to 145 mEq/L
- Chloride (Cl–)
- 95 to 105 mEq/L
2 mins
Hypertension Intervention
- Lifestyle Modifications
- Weight Reduction and Exercise
- Diet Changes
- Relaxation Techniques
- Smoking Cessation
- Medications
- Encourage Self Monitoring
1 min
Hypertension Medications
- Diuretics
- ACE Inhibitors
- Angiotensin Receptor Blockers (ARBs)
- Beta Blockers
- Dihydropyridine Calcium Channel Blockers
2 mins
Angiotensin-Converting Enzyme (ACE) Inhibitors
- "-pril" Suffix
- Mechanism of Action
- Block Renin Angiotensin-Aldosterone System (RAAS)
- Indications
- Hypertension
- Heart Failure
- Side Effects
- Dry Non-productive Cough
- Hypotension
- Dizziness
- Possible Hyperkalemia
- Angioedema
- Nursing Considerations
- Slowly Change Position
- Do Not Stop Abruptly
2 mins
Angiotensin II Receptor Blockers (ARBs)
- Ends in "-sartan"
- Mechanism of Action
- Blocks Angiotensin II Receptor
- Indications
- Hypertension
- Side Effects
- Angioedema
- Contraindications
- Renal Artery Stenosis
- Pregnancy
1 min
Fever
- Flushed skin, warm to touch
- Chills
- Sweating
- Change in LOC
- Provide adequate fluids
- Monitor Electrolytes and Fluid
- Monitor vital signs, esp temperature
- Remove excess clothing and blankets
- Sponge bath with tepid water
2 mins
IV Solutions
- Hypotonic (< 280 mOsm/L)
- 1/4 Normal Saline (0.225% NaCl)
- 1/2 Normal Saline (0.45% NaCl)
- Isotonic (280-300 mOsm)
- Normal Saline (0.9% NaCl)
- Lactated Ringer's (LR)
- Dextrose 5% in Water (D5W)
- Hypertonic (> 300 mOsm)
- 3% or 5% NaCl
- Dextrose 5% in 0.45% NaCl
- Dextrose 10% in Water (D10W)
3 mins
Loop Diuretics
- Mechanism of Action
- Thick ascending limb of Loop of Henle
- Inhibits Na+-K+-2Cl-
- Sulfa drug
- Drug Names
- Furosemide
- Lasix
- Side Effects
- Ototoxicity from Rapid Injection
- Gout
- Dehydration
- Hypocalcemia
- Hypokalemia
- Orthostatic Hypotension
2 mins
Sodium (Na+) Lab Value
- 135-145 mEq/L
24 secs
Hyponatremia
- Assessment
- < 135 mEq Na+
- Nausea and Vomiting
- Decreased LOC
- Confusion / Lethargy
- Seizures
- Priority Interventions
- Assess Airway
- Reduce Diuretic Dosage
- Fluid Excess Hyponatremia
- Mannitol (Osmitrol)
- Fluid Restriction
- Fluid Deficit Hyponatremia
- Hypertonic Solution (3% or 5% NaCl)
2 mins
Hypernatremia
- Assessment
- > 145 mEq/L Na+
- Change in LOC
- Extreme Thirst
- Orthostatic Hypotension
- Dry Flushed Skin
- Muscle Twitching
- Seizures
- Priority Interventions
- Treat and Prevent Dehydration
- Hypotonic Solutions (0.225% or 0.45% NaCl)
- Sodium Restriction
- Diuretics
2 mins
Potassium (K+) Lab Value
- 3.5 to 5.0 mEq/L
20 secs
Hypokalemia
- Assessment
- < 3.5 mEq/L
- Muscle Weakness
- Arrhythmia
- U Wave
- Ileus
- Hyporeflexia
- Interventions
- IV K+ Infusion at 5-10 mEq/hr
- Give Orally with Food
- Nursing Considerations
- Monitor Respiratory Status
3 mins
Acute Digoxin Toxicity
- Clinical Symptoms
- Hyperkalemia
- Cholinergic (Nausea, Vomiting, Diarrhea)
- Blurry Yellow Green Vision with Halo of Light
- Arrhythmia
- Bradycardia
- EKG Changes
- Prolonged PR interval
- Decreased QT
- Scooping on EKG
- T Wave Inversion
2 mins
Digoxin Toxicity Treatment
- Activated Charcoal
- Slowly Normalize K+
- Digibind (Anti-Digoxin Fab)
- Magnesium Sulfate
- Lidocaine
- Cardiac Pacing
2 mins
Hyperkalemia
- Assessment
- > 5.0 mEq/L K+
- Abdominal Cramps
- Muscle Weakness
- Diarrhea
- Arrhythmia
- Tall, Peaked T Waves
- Interventions
- IV Calcium
- Infusion of Glucose and Insulin
- Loop or Thiazide Diuretics
- Kayexalate
- Dialysis
- Prevention Education
2 mins
Hydrochlorothiazide HCTZ
- Mechanism of Action
- Inhibits Reabsorption NaCl and H2O
- Indications
- Edema
- Mild to Moderate Hypertension
- Side Effects
- Hypokalemia
- Hyponatremia
- Dehydration
- Hyperglycemia
- Gout
- Contraindications
- Sulfa Allergy
- Pregnancy and Breastfeeding
1 min
Spironolactone (Aldactone)
- Mechanisms
- Inhibition of Aldosterone
- Potassium Retention
- Indications
- Hypertension
- Edema
- Heart Failure
- Side Effects
- Hyperkalemia
- Endocrine Effects
- Consideration
- Avoid Potassium Supplements
2 mins
Parathyroid Gland
- Characteristics
- Blood Calcium Sensor
- Parathyroid Hormone
- Bone Resorption
- Blood Calcium Increases
- Vitamin D Activation
- Calcium Absorption From The Small Intestine
1 min
Calcium (Ca2+) Lab Value
- 8.5 to 10.5 mg/dL
26 secs
Hypocalcemia
- Muscle Spasms
- Assessment
- < 8.5 mg/dL Ca2+
- Decreased Bone Density
- Tetany
- Chvostek's Sign
- Trousseau's Sign
- Increased DTR
- ECG Changes
- QT Prolongation
- Considerations
- Oral and IV Replacement of Ca2+
- Seizure Precautions
2 mins
Hypocalcemia Causes
- Hypoalbuminemia
- Hypomagnesemia (Less Common Hypermagnesemia)
- Hypovitaminosis D
- Hypoparathyroidism
- Medications
- Hyperphosphatemia
- Malnutrition
- Acute Pancreatitis
- Alkalosis
- Sepsis
- Chronic Kidney Disease
2 mins
Hypercalcemia Treatments
- Treat Underlying Disorder
- Hydration
- Dialysis
- Calcium Restriction
- Bisphosphonates
- Calcitonin
- Cinacalcet
- Glucocorticosteroids
- Denosumab
2 mins
Hypomagnesemia
- Assessment
- Confusion
- Increased Deep Tendon Reflexes (DTRs)
- Neuromuscular Irritability
- Seizures
- Muscle Cramps
- Tremors
- Insomnia
- Tachycardia
- Interventions
- Magnesium Sulfate
- Foods High in Magnesium
1 min
Magnesium Sulfate
- Mechanism
- Muscle Relaxant
- Indications
- Preterm Labor Contractions
- Preeclampsia
- Side Effects
- Warm Feeling
- Hypotension
- Decreased Deep Tendon Reflexes (DTRS)
- Decreased Respiratory Rate
- Decreased Urine Output
- Paralytic Ileus
- Antidote
- Calcium Gluconate
2 mins
Hypermagnesemia
- Assessment
- Flushing
- Lethargy
- Muscle Weakness
- Decreased Deep Tendon Reflexes (DTRs)
- Decreased Respirations
- Bradycardia
- Hypotension
- Interventions
- Dialysis
- IV Calcium Gluconate
- Diuretics
- Avoid Antacids and Laxatives containing Mg2+
2 mins
Chloride (Cl-) Lab Value
- 95-105 mEq/L
28 secs
Magnesium (Mg2+) Lab Value
- 1.5 to 2.5 mEq/L
28 secs
