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Nursing: A Concept-Based Approach to Learning, Volume 1, 3rd Ed.
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Fluids and Electrolytes

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Nursing: A Concept-Based Approach to Learning, Volume 1, 3rd Ed. | Registered Nurse (RN) School Study Aid

Fluids and Electrolytes
32 Picmonics to Learn | 53 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)
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3 mins
Sodium (Na+) Lab Value
135-145 mEq/L
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24 secs
Potassium (K+) Lab Value
3.5 to 5.0 mEq/L
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20 secs
Calcium (Ca2+) Lab Value
8.5 to 10.5 mg/dL
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26 secs
Magnesium (Mg2+) Lab Value
1.5 to 2.5 mEq/L
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28 secs
Chloride (Cl-) Lab Value
95-105 mEq/L
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28 secs
Phosphate (PO43-) Lab Value
2.5 to 4.5 mg/dL
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29 secs
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
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2 mins
Spironolactone (Aldactone)
Mechanisms
Inhibition of Aldosterone
Potassium Retention
Indications
Hypertension
Edema
Heart Failure
Side Effects
Hyperkalemia
Endocrine Effects
Consideration
Avoid Potassium Supplements
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2 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
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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
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1 min
Types of Heart Failure
Left Sided
Pulmonary Congestion
Right Sided
Peripheral Edema
High Output
Unable to Meet Metabolic Needs
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1 min
Complications of Cirrhosis
Portal Hypertension
Ascites
Esophageal Varices
Coagulation Defects
Portal-Systemic Encephalopathy
Hepatorenal Syndrome
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1 min
Cirrhosis Assessment
Mechanism
Degeneration and Destruction of Liver Cells
Signs and Symptoms
Jaundice
Fatigue
Palmar Erythema
Spider Angiomas
Hepatosplenomegaly
Edema
Gynecomastia
Change in LOC
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2 mins
Therapeutic Diets
Common Therapeutic Diets
High Fiber
Low Residue (Fiber)
Low Sodium
Low Cholesterol
Diabetic
Renal
Dysphagia
Nursing Considerations
Diet Education
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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
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2 mins
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)
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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
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2 mins
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
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3 mins
Hypercalcemia
Assessment
> 10.5 mg/dL Ca2+
Pathologic Fractures
Lethargy
Hypercoagulation
Constipation
ECG Changes
QT Shortening
Interventions
No Calcium Intake
Chelating Drugs
Calcitonin
Bisphosphonates
Loop Diuretics instead of Thiazide Diuretics
Considerations
Increased Risk for Renal Calculi
Increase Fluids
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3 mins
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
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2 mins
Hypocalcemia Causes
Hypoalbuminemia
Hypomagnesemia (Less Common Hypermagnesemia)
Hypovitaminosis D
Hypoparathyroidism
Medications
Hyperphosphatemia
Malnutrition
Acute Pancreatitis
Alkalosis
Sepsis
Chronic Kidney Disease
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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+
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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
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1 min
Loop Diuretic Education
Furosemide (Lasix)
Indications
Heart Failure
Pulmonary Edema
Acute Renal Failure (ARF)
Edema
Education
Notify the provider of weakness, dizziness, or muscle cramping
Increase Potassium Intake
Check BP Daily
Daily Weights and Monitor IandOs
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1 min
Urinary Excretory Anatomy
Characteristics
Renal Medulla
Renal Cortex
Nephron
Bowman's Capsule
Glomerulus
Proximal Tubule
Loop of Henle
Distal Tubule
Collecting Duct
Ureter
Urinary Bladder
Urethra
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2 mins
K+ Sparing Diuretics
Indications
CHF and Hypertension
Hypokalemia
Hyperaldosteronism
Mechanism of Action
Collecting Tubule
Spironolactone
Competitive Aldosterone Receptor Antagonist
Amiloride and Triamterene
Block Na+ Channels
Side Effects
Hyperkalemia
Gynecomastia
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2 mins
Ethacrynic Acid
Mechanism of Action
Non-sulfa Drug
Phenoxyacetic Acid Derivative
Loop Diuretic
Inhibits Na+-K+-2Cl- Cotransporter
Thick Ascending Loop of Henle
Clinical Use
Diuresis
Side Effects
Hypokalemia
Ototoxicity
Gout
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2 mins
Mannitol (Osmitrol)
Mechanism
Osmotic Diuresis
Indications
Reducing Intracranial Pressure
Reducing Intraocular Pressure
Renal Failure Prophylaxis
Side Effects
Edema
Fluid and Electrolyte Imbalance
Considerations
Avoid Use in Cardiac Patients
IV Administration
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2 mins
Chronic Kidney Disease Early Symptoms Assessment
Characteristics
GFR < 60mL/min
Accumulation of Waste Products
Clinical Features
General Malaise
Hypertension
Proteinuria
Hyperkalemia
Mineral and Bone Disorders
Neuropathy
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2 mins
Chronic Kidney Disease Late Symptoms Assessment
Metabolic Acidosis
Severe Uremia
Arrhythmias
Edema
CNS Depression
Anemia
Oliguria
Pruritus
Considerations
End Stage Renal Disease (ESRD)
GFR < 15mL/min
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2 mins
Chronic Kidney Disease Interventions
Interventions
Daily Weights
Strict I/O
Renal Diet
Strict Medication Regimen
Erythropoietin
Manage Hyperkalemia
Manage CKD-MBD
Dialysis
Kidney Transplant
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2 mins

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