Fluid And Electrolytes!!!!

  1. 0
    We just started the second semester of 5 on Monday, well we have our first test on Tuesday IV Therapy and the dreaded Fluid and Electrolytes !!!

    My question is for all of you who have taken the course; is there a simple way to remember the normal lab values, and how did you learn your ABG's???

    Any help will be greatly appreciated.

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  2. 11 Comments...

  3. 34
    Fluid and Electrolytes and Acid-Base balance can be particularly tricky! It was one of our hardest tests. I don't think there is really any simple way to remember anything, its alot of just memorized fact.

    Some key concepts to remember:

    Electrolytes found inside the cells are small numbers (like K+ 3.5-5.0 vs Na+ 135-145)

    Since potassium is normally found inside the cell, anytime you have tissue damage (cellular contents spill out) then serum K+ (potassium levels in the blood) will rise

    Mg and K+ can only be excreted by the kidneys so if urine output is decreased you have to monitor these levels closely and decrease any dietary intake (including antacids, etc.) they contain them

    Na+ levels are a good indicator of hydration. A high Na+ means dehydration, or fluid volume deficit, and a low sodium means fluid overload, or fluid volume excess.

    Mg and Phos are inversely proportional. If one goes up, the other goes down. Therefore hypermagnesiemia is the same as hypophosphatemia.

    In Respiratory Acidosis/Alkalosis...the lungs are the problem and can only be fixed by the kidneys

    In Metablolic Acidosis/Alkalosis...the kidneys are the problem and can only be fixed by the lungs

    The lungs only have one compound to fix an acid base imbalance and that is CO2, which is an acid, and it will either be excreted (hyperventilation) to correct metabolic acidosis or retained (hypoventilation) to fix metabolic alkalosis. The effects are immediate.

    The kidneys can excrete HCO3(base) or H+(acid) to correct respiratory problems but this usually takes at least three days to become effective.

    The result of the 'problem being fixed' by the lungs/kidneys is only the body's attempt to restore a normal pH. It doesn't actually mean the problem is fixed, just the pH. That's where you get compensated acid base problems. You still have an abnormal ABG with an acid-base imbalance, however, you have a normal pH because the body has compensated.


    Just a few concepts that I felt I didn't grasp entirely at first. I am studying for my NCLEX now so I am having to go back over all this stuff lol!
    sonias, smicco, Cupcakes321, and 31 others like this.
  4. 6
    ROME - Respiratory opposite, Metabolic equal. If it's a respiratory problem the pH and the bicarb/co2 go in opposite directions. If it's metabolic, they go the same direction.
    plbengtson, Eamlizzie, tinyjojo4, and 3 others like this.
  5. 15
    Quote from soon_2_be_rn
    we just started the second semester of 5 on monday, well we have our first test on tuesday iv therapy and the dreaded fluid and electrolytes !!!

    my question is for all of you who have taken the course; is there a simple way to remember the normal lab values, and how did you learn your abg's???
    it kinda makes you wonder what semester three, four and five are going to be like, doesn't it? the only way to remember this stuff is to hunker down and work at it. try to do it in short sessions. if making lists or tables (of the the normal abgs and respiratory/metabolic acidosis/alkalosis) helps you in some way, then do it to help you learn it. i'm listing a whole bunch of internet links to this information as well as some older allnurses threads that i thought had some good information you could use.

    you are going to see the mnemonic rome used to describe respiratory and metabolic acidosis and alkalosis in some of the allnurses threads. this is what that mnemonic means:
    the mnemonic rome means the following:
    respiratory opposite
    • ph elevated pco2 diminished = alkalosis (respiratory)
    • ph diminished pco2 elevated = acidosis (respiratory)
    metabolic equal
    • ph elevated hco3 elevated = alkalosis (metabolic)
    • ph diminished hco3 diminished = acidosis (metabolic)
    make sure you check http://allnurses.com/forums/f205/pat...es-145201.html the pathophysiology/ a & p/ fluid & electrolyte resources thread on the nursing student assistance forum (it's a sticky). some of the links below may also be listed in that thread.

    http://www.the-abg-site.com/ - the abg site. how to accurately interpret arterial blood gases from ed4nurses.

    http://maagnursing.com/abg/ - this is an abg and acid/base balance tutorial. you do not have to register to go through the tutorial.

    http://www2.norwich.edu/mwalker/nr312/abg.htm - "interpretation of abgs: the battle of bicarb vs. carbon dioxide

    http://web.indstate.edu/mary/abgdemo.html - an abg and abg analysis tutorial by a nursing instructor at indiana state university. http://www-isu.indstate.edu/mary/abgpract.htm - this is a quiz to test what you learned (includes answers).

    http://www.rnceus.com/course_frame.a...directory=abgs - "interpretation of abgs: a four step method". from rnceus.com. discusses the authors four step method for interpreting abg values along with patient case studies and examples.

    http://www.madsci.com/manu/indexgas.htm - blood gas basics from mad scientist software

    http://instructors.butlercc.edu/nr20...abgs/abgs.html - abg tutorial from butler community college nursing program. includes questions and case scenarios. not sure if all answers to questions are on the site.

    http://www.nurse-center.com/studentnurse/abgs.html - this is an abg review. it has 20 sets of abgs for you to interpret. the answers are at the bottom of the page.

    http://medi-smart.com/cc-gas.htm - blood gas analysis downloadable pamphlet of normal abgs parameters and brief explanation of abnormal results and what they can mean. great to put on your clipboard!

    http://www.acid-base.com/ - the home page of an interactive acid-base tutorial for medical students by professor alan grogono at tulane university, but there are things in it that are useful for nursing students. click on buttons throughout the presentation for more specific information. you might want to click on the "alphabetical index" at the left side to get a listing of the subjects covered on this site to save time. also, check out the "links" for more acid-base tutorial sites.

    http://www.usyd.edu.au/su/anaes/lect.../acidbase.html - acid-base balance by professor michael j. bookallil from the royal prince alfred hospital of the university of sydney. includes information on respiratory/metabolic acidosis and alkaloses as well as their treatment and conditions related to them: cardiac arrest, and ketoacidosis

    http://flightline.highline.edu/drydb..._imbalance.htm - a one page chart showing compensated and uncompensated metabolic and respiratory acidosis and alkalosis

    http://www.spjc.edu/spg/science/lanc...ctrolytes.html - body fluids, electrolytes and ph balance. a very nice presentation from a professor at st. petersburg college. there are links at the top of the page to an a&p textbook online learning resource (check out the weblinks), sample quizzes (for that particular instructor) and internet tutorials. nice review of fluid of electrolytes!
    http://www.indstate.edu/mary/fluidlytecf/index.htm - a slide show presentation on fluid and electrolytes. covers sodium, potassium and calcium and treatment including iv fluids.

    http://www.indstate.edu/mary/n205.htm - this is the home page for the above site. the link to the above is at the bottom of this page. there are more links there to information on fluids and electrolytes including lecture note outlines


    http://learn.sdstate.edu/nursing/laboratory.html - thumbnail sketches of lab values, signs and symptoms of increased and decreased levels of the following electrolytes: sodium, potassium, calcium, magnesium. also includes glucose, respiratory and metabolic acidosis and alkalosis, and arterial blood gas values.

    http://www.medicinenet.com/hyperkalemia/article.htm - a fairly thorough explanation of hyperkalemia from medicinenet.com

    http://www.clevelandclinicmeded.com/.../hcalcemia.htm - here's everything you could possibly want to know about hypercalcemia from an online medical textbook. this is just an overview page. there are lots of links to more specific information if you dare to look!

    http://www.clevelandclinicmeded.com/...al/hypocal.htm - here's everything you could possibly want to know about hypocalcemia from an online medical textbook. this is just an overview page. there are lots of links to more specific information if you dare to look!

    http://enw.org/electrolytes.htm - "maintaining the internal seas in harmony: common electrolyte disturbances in the ed" good discussion of dehydration and sodium and potassium electrolyte disturbances. includes discussion of how they occur, signs and symptoms, labs, as well as nursing actions

    some older threads on allnurses about abgs, fluids and electrolytes and acid/base balance:
    Zz SN, Eamlizzie, nursemich, and 12 others like this.
  6. 1
    Get the book Fluid and Electrolytes Made Incredibly Easy.

    This book also helped me understand heart and kidney failure.
    ChrissyRN74 likes this.
  7. 1
    I am a RT today, nurse next week, and blood gases are really pretty simple when you consider "compensated" and "base excess" and even more so when you start at PH, go to PCO2 if abnormal, to bicarb if abnormal, and remember PO2 and SaO2 have nothing to do with acid/base, except of course chronic lungers, who have inverse drive, yadayadayada, and please, please give as much oxygen as needed. (gasp) COPDs' drive cuts out only on VERY high O2 on a vent, ie, >60%, for prolonged times. That hypoxic person on a NC should receive your merciful 4-6 liters if a pulse ox hangs below 70%. just remember that chronic lungers may never go above 76-80%. use your old fashioned assessment skills and liters per minute, pulse oximeters, and the scant coverage of oxygen "safety" you learned be dammed. (whoa, that felt good!)
    and oxygen causes a fire to grow. it doesn't explode. the old man you read about in the nursing home fire died because he couldn't get out of the way. the fire didn't blow up on him...(felt good, too) john
    Eamlizzie likes this.
  8. 1
    I was hoping for a higher grade but I am happy for the 78. I realize that many people don't do well in this section.
    Last edit by calledtodo on Aug 2, '09
    Cristina417 likes this.
  9. 1
    I absolutely love this post. Thanks for this!! I have my F&E exam tomorrow and this really simplified things. Kudos!!!
    Eamlizzie likes this.
  10. 0
    Quote from TruDivaRN
    We just started the second semester of 5 on Monday, well we have our first test on Tuesday IV Therapy and the dreaded Fluid and Electrolytes !!!

    My question is for all of you who have taken the course; is there a simple way to remember the normal lab values, and how did you learn your ABG's???

    Any help will be greatly appreciated.
    I typed all the normal lab values, ABGs on a table, printed it out and put it by the toilet, refrigerator, bedroom..all over the house so these numbers are in my head
  11. 0
    Quote from TruDivaRN
    We just started the second semester of 5 on Monday, well we have our first test on Tuesday IV Therapy and the dreaded Fluid and Electrolytes !!!

    My question is for all of you who have taken the course; is there a simple way to remember the normal lab values, and how did you learn your ABG's???

    Any help will be greatly appreciated.
    Nurse4theplanet wrote that Magnesium and Phosphorus are inversely proportionate or something of the sort. It is actually Calcium and Phosphorus.


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