Roberto Shared "Fluid, Electrolyte & Acid Base Imbalances" - 33 Picmonics
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Fluid, Electrolyte & Acid Base Imbalances
Respiratory Acidosis Assessment
- Assessment
- Decreased pH < 7.35
- Increased PaCO2 > 45
- Reduced Respirations
- Anxiety
- Change in LOC
- Tachycardia
- Cyanosis
- Increased Electrolytes
- ECG Changes
- Muscle Weakness
- Hyporeflexia
2 mins
Respiratory Alkalosis Assessment
- Assessment
- Increased pH > 7.45
- Decreased PaCO2 < 35 mmHg
- Hyperventilation
- Brainstem Stimulation
- Head Injury
- Shock
- Lightheadedness
- Tingling Lips or Fingers
- Trousseau's
- Chvostek's Sign
- Anxiety
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
Types of Blood Products
- Types
- Whole Blood
- Packed Red Blood Cells
- Fresh Frozen Plasma
- Immunoglobulins
- Clotting Factors
- Albumin
- Platelets
- Considerations
- Use within 24 Hours
- Washing Removes Antibodies
- Irradiation Destroys WBCs
2 mins
Blood Types and Compatibilities
- ABO Compatibility
- No Antigens (Type O Blood)
- Universal Donor
- A Antigen (Type A Blood)
- B Antigen (Type B Blood)
- AB Antigen (Type AB Blood)
- Universal Recipient
- Rhesus (Rh) Compatibility
- Rh (Rhesus) Antigen
- Never Rh+ to Rh-
- Considerations
- Blood Transfusion
- Obstetric Patient
2 mins
Blood Transfusion Administration
- Proper Patient Identification
- Large Bore Needle
- Y Tubing
- Baseline Vital Signs
- Slow IV Infusion
- Monitor During First 15 Minutes or 50 mL of Blood
- Monitor for Reactions
- Considerations
- Do Not Add Anything To Same IV Line
- No Dextrose or Lactated Ringers
- Jehovah's Witnesses, No Transfusions
3 mins
Transfusion Reactions
- Acute Hemolytic
- Febrile, Non-Hemolytic
- Mild Allergic
- Anaphylactic
- Circulatory Overload
- Sepsis Reaction
- Transfusion-Related Acute Lung Injury (TRALI)
- Massive Blood Transfusion
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
3 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
Hypocalcemia Causes
- Hypoalbuminemia
- Hypomagnesemia (Less Common Hypermagnesemia)
- Hypovitaminosis D
- Hypoparathyroidism
- Medications
- Hyperphosphatemia
- Malnutrition
- Acute Pancreatitis
- Alkalosis
- Sepsis
- Chronic Kidney Disease
2 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
2 mins
Hypocalcemia Treatments
- Characteristics
- Treat Underlying Disorder
- Acute Treatments
- IV Calcium Gluconate
- Cardioprotective
- Chronic Treatments
- Calcium Carbonate
- Calcium Citrate
- Vitamin D Supplements
- Considerations
- Treat Hypomagnesemia
2 mins
Hypercalcemia Causes
- Two CHIMPANZEES Acronym
- Thyroid Disorders
- Calcium Supplements
- Hyperparathyroidism
- Iatrogenic (Drugs, immobility)
- Milk-Alkali Syndrome
- Paget's Disease of Bone
- Acromegaly or Addison's Disease
- Neoplasms
- Zollinger-Ellison Syndrome
- Excessive Vitamin A
- Excessive Vitamin D
- Sarcoidosis
2 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
3 mins
Hypercalcemia Treatments
- Treat Underlying Disorder
- Hydration
- Dialysis
- Calcium Restriction
- Bisphosphonates
- Calcitonin
- Cinacalcet
- Glucocorticosteroids
- Denosumab
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)
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
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
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
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
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