NCLEX Archer Fluids and Electrolytes study Guide 2024

NCLEX Archer Fluids and Electrolytes study Guide 2024 Sodium important to - brain, nerves, muscle cells euvolemic hypernatremia (high Na) - slight low water, normal sodium may be caused by hyperventilation, excess sweating, fever, diabetes insipidus hypovolemic hypernatremia - low water AND sodium but MORE water loss may be caused by dehydration, NPO, diarrhea, vomiting, burns, diuretics hypervolemic hypernatremia - Increased sodium AND water... but MORE sodium! may be caused by ● Hypertonic IVF ● Sodium bicarbonate ● Increased sodium intake ● Corticosteroids ● Cushing's ● Hyperaldosteronism causes of hypernatremia-- MODELS - medications osmotic diuretics DI excess water loss low water intake sodium intake too high hypernatremia symptoms--FRIED and SALTED - THINK NEURO Fever Restless, agitation Increased fluid retention Edema Dry mouth Skin flush Altered LOC Low urine output Thirst Elevated BP (if hypervolemic) Decreased energy treatment for euvolemic hypernatremia - free water replacement treatment for hypovolemic hypernatremia - Replace H20 deficit w/ NS (relatively hypotonic to body during hypernatremia) treatment for hypervolemic hypernatremia - find cause-- then loop diuretics, free water administration when treating sodium level... - do slow! monitor neuro status r/t risk for cerebral edema management for hypernatremia FLAG - Free water administration Loop diuretics Agent cause (remove) Give fluids IV (except euvolemic) euvolemic hyponatremia - water slightly increases but sodium level stays the same may be caused by SIADH Adrenal insufficiency Addison's Polydipsia Excessive hypotonic IVF Low sodium intake hypervolemic hyponatremia - water increases, dilutes sodium may be caused by CHF Kidney failure Nephrotic syndrome Liver failure water intoxication hypovolemic hyponatremia - Water and sodium are both lost, but unequally, with the sodium loss being greater. may be caused by V/D NG suction diuretics burns excess sweating hyponatremia causes MOBS Fail - - Meds - diuretics - Oral gastric tube suctioning - Burns - SIADH - Failure: Heart, kidney, liver hyponatremia symptoms LOW SODIUM - THINK NEURO LOC alter Orthostatic hypotension Weak muscles + cramps Seizures Osmolality low Diarrhea Increased ICP Urine osmolality high More bowel sounds euvolemic hyponatremia treatment - bring water slightly down, salt slightly up restrict free water, osmotic diuretics, sodium tablets, high salt diet hypervolemic hyponatremia treatment - bring water way down and salt way up restrict free water, osmotic diuretics, sodium tablets, high salt diet hypovolemic hyponatremia treatment - restore water and salt 0.9-3% NS chloride inversely related to - sodium bicarbonate normal chloride - 96-108 Hyperchloremia causes - fluid loss, steroids (cushing's, excess steroid), excess chloride administration IVF (NS) hyperchloremia signs and symptoms - mirrors hypernatremia hyperchloremia treatment - ● Treat the underlying cause ● Correct the imbalance ○ Bicarbonate administration ○ Discontinue any sodium containing meds ○ No NS for IVFs - consider LR instead ● Monitor all electrolytes - it's usually not the only imbalance!