NCLEX RN COMPREHENSIVE ATI REVIEW
MED SURG SECTION 1
FLUID &ELECTROLTYTES
Intravenous Fluids
• Hypertonic
Higher osmolality than ECF
Use only when
... [Show More] 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 xray 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
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
POTASSIUM (K+)
Hypokalemia Hyperkalemia
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
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+ [Show Less]