Are fluids and electrolytes really that hard?

Purple_roses · May 7, 2016

Fluids and Lytes are difficult because there's a lot to memorize. But if you take the time to memorize everything, you'll be absolutely fine. Memorize the lab values. Memorize all the signs and symptoms of a low electrolyte value vs a high electrolyte value. Same thing applies when you get to acid base balance: just commit to memorizing and you'll be fine.

I've noticed that higher semesters at my school like to scare newer students. Every semester, the semester above mine tells us all about how ridiculously hard their semester was and that we're going to struggle. It's NEVER been as hard as they've made it out to be. Don't let the big kids scare you

ETA: But to help you study for them, here are some tips. Take notes in lecture, then read about that section in your text book and fill in the blanks in your notes. Research any physiology that you don't understand, because if you know the physiology, you'll understand why certain symptoms are occurring. Then draw charts comparing the electrolyte imbalances side by side. Use one highlighter to mark similarities between a group and one highlighter to mark the differences. This is what I did. I usually am not a fan of flash cards, but flash cards actually helped me out with this subject.

Then focus on learning what causes those electrolyte imbalances and what you should do, as the nurse, to correct it. A big part of that is learning which foods are high in a particular electrolyte. For instance, if your patient has hyperkalemia (a level above 5.0, which is high) you'll need to educate your patient about which foods to avoid (salt substitutes bananas, oranges, prune juice, cheese, avocado, stored blood, potatoes).

Then after that, focus on prioritizing. This is where I missed a few questions on my tests. Many of the electrolyte imbalances have multiple signs and symptoms, but which ones are the most dangerous? For instance, hyperkalemia symptoms include hyperactive bowel sounds, diarrhea, and ECG changes (including v-fib), just to name a few. If a question asks you what symptom you're going to be monitoring, you need to choose cardiac status. Sure, all of those symptoms are related to hyperkalemia, but cardiac is the most important one to watch out for. So know your priorities.

Hope this helps.

TheCommuter, BSN, RN · May 7, 2016

Moved to Nursing Student Assistance for more replies.

xmilkncookiesx, RN · May 8, 2016

Fluids and Lytes are difficult because there's a lot to memorize. But if you take the time to memorize everything, you'll be absolutely fine. Memorize the lab values. Memorize all the signs and symptoms of a low electrolyte value vs a high electrolyte value. Same thing applies when you get to acid base balance: just commit to memorizing and you'll be fine.
I've noticed that higher semesters at my school like to scare newer students. Every semester, the semester above mine tells us all about how ridiculously hard their semester was and that we're going to struggle. It's NEVER been as hard as they've made it out to be. Don't let the big kids scare you
ETA: But to help you study for them, here are some tips. Take notes in lecture, then read about that section in your text book and fill in the blanks in your notes. Research any physiology that you don't understand, because if you know the physiology, you'll understand why certain symptoms are occurring. Then draw charts comparing the electrolyte imbalances side by side. Use one highlighter to mark similarities between a group and one highlighter to mark the differences. This is what I did. I usually am not a fan of flash cards, but flash cards actually helped me out with this subject.
Then focus on learning what causes those electrolyte imbalances and what you should do, as the nurse, to correct it. A big part of that is learning which foods are high in a particular electrolyte. For instance, if your patient has hyperkalemia (a level above 5.0, which is high) you'll need to educate your patient about which foods to avoid (salt substitutes bananas, oranges, prune juice, cheese, avocado, stored blood, potatoes).
Then after that, focus on prioritizing. This is where I missed a few questions on my tests. Many of the electrolyte imbalances have multiple signs and symptoms, but which ones are the most dangerous? For instance, hyperkalemia symptoms include hyperactive bowel sounds, diarrhea, and ECG changes (including v-fib), just to name a few. If a question asks you what symptom you're going to be monitoring, you need to choose cardiac status. Sure, all of those symptoms are related to hyperkalemia, but cardiac is the most important one to watch out for. So know your priorities.
Hope this helps.

Ahhh thank you so much!

Larry2016 · May 10, 2016

knowing the values are not difficult.

here is what makes it difficult

1) patient condition: some patients are on the higher side of normal.

Examples:

cardio issues may have an elevated potassium but the higher side or slightly elevated from the "norm"

osteoporosis patients may have elevated serum calcium levels on the higher side of normal

now what happens if you have a cardio patient who also has osteoporosis? the elevated calcium could be caused by either.

rule of thumb:where does the patient live? if electrolytes are slightly elevated, will harm result by bringing them down?

2) do the symptoms match the labs?

This is the difficult part that requires very good nursing judgment.

Examples:

hypochloremia: muscle cramps, weakness, tetany, hyper DTRs

hypophosphatemia: tetany, weakness, nausea / vomiting

hypomagnesemia: muscle cramps, tetany, tremors, hyper DTRs

hypocalcemia: tetany, muscle cramps/weakness, numbness

See how VERY similar those are?

Also consider this:

A mental health patient is admitted to your med-surg floor with diabetes mellitus type 2 (new onset). ED admission was due to complications leading toward hyperosmolar nonketoic state. On assessment, the patient appears restless, delusional, and screams out that "The shadow people are coming to get me - there's one now!"

At first, it seems that the comments and initial assessment is related to the mental health status of the patient. An hour later, lab results come back: Sodium level is 185. Hypernatremia carries the neuro symptoms of: Restlessness, disorientation, delusions, hallucinations.

I hope that sheds some light on how difficult it is to pinpoint the exact problem. Memorizing the list of symptoms and lab values are not hard - BUT applying them in the clinical setting can be difficult.

bgxyrnf, MSN, RN · May 11, 2016

Nope, not much math, so don't look to that as your edge.

The topic is difficult because it's multi-factorial and defies a simple algorithmic approach.

firefly22 · May 11, 2016

YouTube videos are very helpful!

cnmbfa · Jun 6, 2016

As a faculty member who teaches this topic, I have found a mostly successful strategy for mastering this. We work in small groups to write a backwards case study. I give them an abnormal lab value, and have them create a story for how it developed (diuretics without eating any K+ rich foods, ran a marathon drank plain water no sodium replacement; borderline renal function using magnesium laxatives, etc) Next they describe the presenting signs/symptoms and the nursing interventions. They end by saying not just what the normal lab values will be, but the other symptoms will resolve. They know they will be handed a lab value and have to create a case on the next quiz. Works well.

Esme12, ASN, BSN, RN · Jun 6, 2016

https://allnurses.com/nursing-student-assistance/med-surg-fluid-804058.html

table of commonly used iv solutions.doc - most commonly used iv solutions; includes tonicity, ph, the ingredients of the solutions, its uses and complications

icufaqs

http://www.merckmanuals.com/professi...scitation.html

http://www.mhprofessional.com/downloads/products/007148986X/hurst_pathophysiology-ch01_986x.pdf

There are 6 major electrolytes. Sodium, potassium, calcium, chloride, magnesium and phosphorus. It is primarily potassium, calcium and sodium that will cause problems when they are out of whack.

hypokalemia
hyperkalemia
hypocalcemia
hypercalcemia
hyponatremia
hypernatremia

When there is a sodium imbalance quite often there will be changes in mental status - confusion, delirium, etc. Often seen with traumatic brain injury where diabetes insipidus (pathological voiding of large amounts of dilute urine) and its opposite SIADH (syndrome of inappropriate antidiuretic hormone - minimal urine output but very concentrated) may occur. Sodium imbalances are also seen with dehydration in some patients (elderly, burn victims, many others) and the blood levels will go up. Very rarely, sodium levels in the blood will go down because of consuming large quantities of fluids.

The other main electrolyte imbalance seen is when potassium is out of whack, and its most serious consequence is cardiac problems that can be life-threatening (you will see T wave changes: depression with hypokalemia, elevation with hyperkalemia, among other changes in the EKG like QRS interval changes).

For these 2 main electrolyte imbalances remember: Sodium equals mentation, and Potassium equals cardiac.

Sodium does affect fluid. In fact, they say sodium always follows water. There are a lot of people with edema related hypernatremia; and a lot of dehydration related to sodium and chloride losses. Potassium tends to affect the heart and in the clinical area you will see dramatic instances of people with hypokalemia and hyperkalemia. Calcium affects the muscles and is not as commonly seen clinically because it is detected because of lab testing.

Sodium - body water balance
Potassium - contraction of skeletal and smooth muscle and nerve impulse conduction
Calcium - formation and structure of bones and teeth, cell structure and function, cell membrane permeability and impulse transmission, the contraction of all muscle types and is necessary in the blood clotting process
Chloride - important in the digestive acids; closely linked to sodium
Magnesium - affects nerve and muscle action by affecting calcium usage, activates enzymes involved in carbohydrate and protein metabolism, helps in the transport of sodium and potassium across cell membranes, and influences the levels of sodium, potassium, calcium and some body hormones (parathyroid hormone)
Phosphorus - formation and structure of bones and teeth, this electrolyte is needed in the following activities: utilization of B vitamins, acid base homeostasis, bone formation, nerve and muscle activity, cell division, the transmission of hereditary traits, metabolism of carbohydrates, proteins and fats
http://www.elmhurst.edu/~chm/vchembook/253fluidkidneys.html

Third-spacing: Where has all the fluid gone?

c-electrolyte-surface-of.gif

table of commonly used iv solutions.doc

IV fluids: Do you know what's hanging and why? | Modern Medicine

http://ww2.rch.org.au/emplibrary/clinicalguide/IVFLUIDCHART.pdf

http://www.med.mun.ca/getdoc/6f26f870-6c78-4a73-80f0-98200858aafd/IntravenousFluids.aspx