Fluid and Electrolytes Quiz

• Sodium is a major electrolyte found in the extracellular fluid (ECF).
• Sodium is essential for acid-base balance, fluid balance, active/passive transport, nerve-muscle tissue conduction, and irritability.
• Normal sodium (Na) levels are 135-145 mEq/L.
• Increased sodium levels often correlate with decreased potassium levels.

Hypernatremia

• Hypernatremia is indicated by increased sodium levels.
• Symptoms of hypernatremia can be remembered with the mnemonic "fried salt."
• Symptoms include flushed skin, restlessness, anxiety, confusion, irritability, increased blood pressure, fluid retention, edema, decreased urine output, skin that is flushed and dry, agitation, low grade fever, and thirst.
• Hypernatremia risk factors comprise excess administration of IV fluids with sodium, hypertonic IV fluids, loss of fluids, fever, watery diarrhea, diabetes insipidus, excessive sweating, infection, decreased sodium excretion, and kidney problems.
• Interventions for hypernatremia involve administering IV infusions if caused by fluid loss.
• Interventions for hypernatremia involve giving diuretics that promote sodium loss if caused by inadequate renal excretion.
• Interventions for hypernatremia involve restricting sodium and fluid intake as prescribed.

Hyponatremia

• Hyponatremia is indicated by decreased sodium levels.
• Symptoms of hyponatremia can be remembered with the mnemonic "salt loss."
• Symptoms comprise stupor, coma, anorexia, nausea, vomiting, lethargy, weakness, fatigue, tachycardia, thready pulse, limp muscles, muscle weakness, orthostatic hypotension, seizures, headache, and stomach cramping with hyperactive bowels.
• Risk factors for hyponatremia include increased sodium excretion 4D's, diaphoresis (high fever), drains (NGT suction), diuretics, SIADH, adrenal insufficiency, fasting, NPO, low-salt diet, kidney disease, and heart failure.
• Interventions for hyponatremia can be remembered with the mnemonic "ADD SALT."
• Interventions involve administering IV sodium chloride infusions for hypovolemia, administering diuretics for hypervolemia, and monitoring daily weights.
• Interventions for hyponatremia also include ensuring safety to avoid falls, airway protection for lethargic clients, limiting water intake for hypervolemic hyponatremia, and teaching about sodium-rich foods.

Potassium

• Potassium plays a vital role in cell metabolism and the transition of nerve impulses.
• Potassium is key to the functioning of cardiac, lung, and muscle tissues, along with acid-base balance.
• Normal potassium levels are 3.5-5 mEq/L.

Hyperkalemia

• Hyperkalemia is indicated by increased potassium levels.
• Hyperkalemia symptoms can be remembered using the mnemonic "murder."
• The symptoms include muscle cramps, weakness, urine abnormalities, respiratory distress, decreased cardiac contractility, elevated heart rate, elevated blood pressure, ECG changes (tall peak T wave, flat P waves), widened QRS complexes, prolonged PR intervals and reflexes with increased DTR.
• Risk factors for hyperkalemia include medications, potassium-sparing diuretics, ACE inhibitors, NSAIDs, excessive potassium intake, kidney disease/dialysis, decreased potassium excretion, adrenal insufficiency, tissue damage, and acidosis.
• Interventions for hyperkalemia are to monitor EKG, discontinue IV/PO potassium, initiate a potassium-restricted diet, supply potassium-excreting diuretics, prepare the client for dialysis and for administration.
• Prepare for administration of IV calcium gluconate and IV sodium bicarbonate, and to avoid salt substitutes or potassium-containing substances.

Hypokalemia

• Hypokalemia is indicated by decreased potassium levels.
• Symptoms include weak contractions, thready/weak/irregular pulse, orthostatic hypotension, shallow respirations, anxiety, lethargy, confusion, coma, paresthesias, hyporeflexia, hypoactive bowel sounds, constipation, nausea, vomiting, abdominal distention, ECG changes, ST depression, shallow or inverted T waves, and prominent u waves.
• Risk factors for hypokalemia comprise actual total body potassium loss, inadequate potassium intake, fasting, NPO, movement of potassium from the extracellular to intracellular fluid, alkalosis, dilution of serum potassium, water intoxication, and IV therapy with potassium deficient solutions.
• Interventions for hypokalemia include oral potassium supplements, liquid potassium chloride, and potassium-sparing diuretics.
• Potassium must never be administered by IV push or IM/SubQ routes.
• IV potassium must always be diluted and administered using an infusion device.

Calcium

• Calcium is found in the body's cells, bones, and teeth.
• The element is needed for proper functioning of cardiovascular, neuromuscular, and endocrine systems, blood clotting, and teeth formation.
• Normal calcium levels are 9.0–11.0 mg/dl.

Hypercalcemia

• The condition indicates increased calcium levels.
• Symptoms of hypercalcemia can be remembered using the mnemonic "BACKME."
• Manifestations include bone pain, arrhythmias, cardiac arrest/bounding pulses, kidney stones, muscle weakness, and excessive urination.
• Risk factors for hypercalcemia include increased calcium absorption, decreased calcium excretion, kidney disease, thiazide diuretics, increased bone resorption of calcium, hyperparathyroidism, hyperthyroidism, malignancy, bone destruction from metastatic tumors, and hemoconcentration.
• Interventions for hypercalcemia involve discontinuing IV or PO calcium and thiazide diuretics.
• Further interventions include administering phosphorus, calcitonin, bisphosphonates, prostaglandin synthesis inhibitors, and avoiding foods high in calcium.

Hypocalcemia

• The condition indicates decreased calcium levels.
• Symptoms can be recalled with the mnemonic "CATS GO NUMB."
• Symptoms include convulsions, arrhythmias, tetany, spasms, stridor, and numbness in fingers/face/limbs.
• Positive Chvostek's and Trousseau's sign indicate hypocalcemia.
• Risk factors for hypocalcemia include inhibition of calcium absorption from the GI tract, increased calcium excretion, kidney disease, diuretic phase, diarrhea, steatorrhea, wound drainage, and conditions decreasing the ionized fraction of calcium.
• Interventions for hypocalcemia include administering calcium PO or IV, warming it before, and administrating slowly.
• Further interventions include administering aluminum hydroxide and Vitamin D, initiating seizure precautions, administering 10% calcium for acute deficits, and consuming high calcium foods.

Magnesium

• Magnesium and calcium levels often correlate. Any increase in one can indicate an increase in the other.
• Most of the magnesium in the body is found in the bones.
• Magnesium regulates blood pressure, blood sugar, muscle contraction, and nerve function.
• Normal magnesium levels are 1.5-2.5 mg/dL.

Hypermagnesemia

• Hypermagnesemia indicates elevated Magnesium levels.
• Manifestations include decreased energy, drowsiness, coma, decreased bradycardia, decreased blood pressure, hypotension, decreased heart rate, bradypnea, shallow respirations, and bowel sounds, and deep tendon reflex.
• Risk factors for hypermagnesemia include increased magnesium intake, magnesium-containing antacids/laxatives, excessive administration of magnesium IV, renal insufficiency, increased renal excretion of magnesium, and DKA.
• Interventions consist of administering diuretics, IV calcium chloride or calcium gluconate, restricting dietary magnesium, having the patient avoid antacids and laxatives containing magnesium, and hemodialysis.

Hypomagnesemia

• Hypomagnesemia indicates decreased magnesium levels.
• Symptoms include tachycardia, hypertension, hyperreflexia, shallow respirations, twitches, paresthesias, tetany, seizures, and confusion.
• Positive Chvostek's and Trousseau's signs indicates hypomagnesemia.
• Risk factors for hypomagnesemia include insufficient magnesium intake, malnutrition, vomiting, diarrhea, malabsorption syndrome, celiac/Crohn's disease, increased magnesium excretion, diuretics, chronic alcoholism, intracellular movement of magnesium, hyperglycemia, insulin admin, and sepsis.
• Intervetions are the same as hypocalcemia and include administering magnesium sulfate IV or PO, seizure precautions, and advising the client to consume magnesium-containing foods.

IV Solutions

Isotonic Solutions

• Have the "same" salt concentration as the body's cells.
• Cells maintain their size as water and salt are balanced.
• Isotonic solutions are administered for dehydration and to maintain blood pressure.
• Examples of isotonic solutions include normal saline (0.9% NaCl) and lactated ringer's.
• They are are useful for car accidents, big injuries, vomiting, diarrhea, and everyday dehydration.
• Electrolyte imbalances that need isotonic solutions: hypercalcemia, hypomagnesemia, hypokalemia, and hyperkalemia.

Hypotonic Solutions

• The solutions have "too little" salt and "more water" relative to the body's cells.
• Water moves into the cells, causing them to swell.
• Hypotonic solutions are given when cells are dehydrated, such as in diabetic ketoacidosis.
• A common hypotonic solution is 0.45% NaCl (half-normal saline).
• They are useful for high-salt problems, very dry cells, and correcting high sodium.
• Electrolyte imbalances that need hypotonic solutions: hypernatremia and hypermagnesemia.

Hypertonic Solutions

• The solutions have "too much" salt and "less water" than the body's cells.
• Water leaves the cells causing them to shrink.
• They are useful for brain swelling; very low salt in the blood; and critical situations in the ICU.
• An eample of a hypertonic solution is 3% NaCl.
• Electrolyte imbalances that need hypertonic solutions: hyponatremia and hypocalcemia.

Test your knowledge of fluid and electrolyte balance with these multiple-choice questions. Learn about hypernatremia, hyponatremia, hypotonic and hypertonic solutions. Questions cover symptoms, risk factors, and nursing interventions.