NCLEX-RN COMPREHENSIVE ATI REVIEW MED SURG: SECTION 1 FLUID & ELECTROLYTES

NCLEX-RN COMPREHENSIVE ATI REVIEW MED SURG: SECTION 1 FLUID & ELECTROLYTES Intravenous Fluids • Hypertonic - Higher osmolality than ECF - Use only when serum osmolality is critically low - D10W, D50W, D5NS, D5W in 0.45% NaCl, D5LR • Hypotonic - Lower osmolality than ECF - For intracellular dehydration - 0.45% NS, 2.5% dextrose in 0.45% NS • Isotonic - Concentration equal to plasma - For deficit of fluid in vascular system - 0.9% NS, LR, D5W Fluid Volume Deficit (FVD) • Causes: excess GI/renal loss, fever, diaphoresis, long term NPO, hemorrhage, insufficient intake, burns, diuretics, aging (older adults have less body water and decreased thirst) • S/S: weight loss, dry mucous membranes, rapid/weak/thready pulse, cap refill 3 seconds, weakness/fatigue, orthostatic hypotension, poor skin turgor, specific gravity 1.030, 30 ml/hr, increased RR - LATE SIGNS: oliguria, decreased CVP, flattened neck veins • Diagnosis: serum electrolytes, BUN, creatinine, Hct (may be high due to hemoconcentration), urine specific gravity and osmolality • Monitor vitals (pulse quality), I&Os (output at least 0.5 mL/kg/hr), skin turgor, weigh daily, fall precautions (RISK FOR FALL IS PRIORITY) • Correct cause with: Fluid replacement (oral or IV for severe); electrolyte replacement/IV fluids Fluid Volume Excess (FVE) • Causes: kidney failure, heart failure, cirrhosis, burns, hypertonic solutions, excessive water intake, long term corticosteroid therapy • S/S: cough, dyspnea, crackles, increased BP, tachycardia/tachypnea, bounding pulse, weight gain, JVD, increased CVP, pitting edema • Diagnosis: serum electrolytes, BUN, creatinine, Hct (may be low due to dilution), urine specific gravity and osmolality. Chest x-ray if respiratory complications present. • Monitor vitals (RR, symmetry, and effort), breath sounds for pulmonary edema • Monitor for edema: pitting edema scale 1+ (minimal) to 4+ (severe); dependent edema measured by circumference of extremities • Monitor for ascites (measure abdominal girth) • Weigh daily, admin diuretics, strict I&O (limit fluid intake), semi-fowlers, restrict sodium POTASSIUM (K+) Hypokalemia • S/S: muscle weakness, fatigue, decreased DTR N/V, irritability, confusion, decreased bowel motility, abdominal distention, paralytic ileus, paresthesia, dysrhythmias, orthostatic hypotension, flat/inverted T waves, ST depression, prominent U wave • Caused by meds, body fluid loss, excessive diaphoresis, kidney disease, dietary deficiency, and alkalosis • See pg. 81 • Initiate fall precautions, give potassium; monitor- ECG, I&O, respiratory status • NOTE never give K+ bolus, dilute it! Also it should not exceed 20 mEq/hr! • Also remember “No P= No K” don’t give potassium if client isn’t urinating Hyperkalemia • S/S: muscle twitching and paresthesia (early), ascending muscle weakness (late), increased DTR, increased bowel motility, diarrhea, ventricular dysrhythmias, hypotension and bradycardia, elevated/peaked T waves • Caused by adrenal insufficiency, renal failure, acidosis; meds- ACE inhibitors & potassium sparing diuretics • Monitor ECG, bowel sounds, initiate dialysis, dietary restriction/teaching • Admin meds - Kayexalate (monitor bowel sounds)- think K+ exit kayexalate - 50% glucose with insulin - Calcium gluconate - Bicarbonate - Loop diuretics SODIUM (Na+) Hyponatremia • Caused by GI loss, SIADH, NPO, water intoxication, excessive diaphoresis, meds such as - Diuretics, anticonvulsants, SSRI’s, lithium, demeclocycline • S/S: weakness, lethargy, confusion, seizures, headache, anorexia, N/V, muscle cramps/twitching, hypotension, tachycardia, weight gain, edema, low specific gravity, elevated Hgb • Give sodium, restrict oral fluids, monitor weight, I&O • NOTE with hypertonic solutions risk for cerebral edema Hypernatremia • Caused by dehydration, burns, kidney failure, DI • S/S: fever, swollen/dry tongue, sticky mucus membrane, hallucinations, lethargy, restlessness irritability, seizures, tachycardia, HTN, hyperreflexia, twitching, pulmonary edema • Initiate seizure precautions, IV isotonic/hypotonic fluids, diuretics, sodium restriction, daily weight CALCIUM (Ca+) & MAGNESIUM (Mg+) Hypocalcemia Hypomagnesemia Hypercalcemia Hypermagnesemia Causes Hypoparathyroidism, hypomagnesemia, vitamin D deficiency, G.I. loss, kidney failure, diseases (celiac disease, crohn’s, alcohol use disorder, lactose intolerance) GI loss (alcohol, hypocalcemia, DKA, TPN, laxative abuse, meds, hyperparathyroidism Hyperparathyroidism, dehydration, vitamin D excess, meds, immobilization. Renal failure, adrenal insufficiency, laxative overdose ...........................................CONTINUED.............................................