Fluids/Electrolytes I am doomed!

Plucker · Sep 8, 2005

I felt the same way last year. You'll do fine. It's more than knowing lab values as you have already found out. This stuff you just have to know and I promise, you'll see it again in your next semesters. Acronymns worked well for me, GOOD LUCK!! You can do it!

mandrews · Sep 8, 2005

I have a test tomorrow... I have studied my butt off & I don't really think I get it!I know my lab values but I don't think I know what to do for the imbalances. Acid bases I got, overhydration/deyhadration kinda :imbar . If any of you have any tips of any kind on this stuff....I am all ears.

See if these old notes help.

Fluid volume excess:hypervolema - think CHF, aldosterone, ADH or Renal Failure. If CHF then you have decreased cardiac output-decreased kidney output- decreased urine output.

Renal Failure- If blood is not making it to the kidneys you are NOT making urine. Remember IVF with NA, alkaseltzer and fleets are high in Na.

Aldosterone is a steroid that maintains blood volume. When blood volume is low the aldosterone is secreted and you retain water and Na.

*Too much aldosterone: Cushings or hyperaldosteronism.

ADH (antidiuretic hormone)- think "retain"

Too much ADH- water in vascular space. (SIADH) urine decreased and blood is diluted- If blood is diluted your electrolytes are probably going to fall into lower numbers.

*Too little ADH- Think diabetic insipidus- lose or diurese water- start thinking shock- blood becomes concentrated. People with DI will continue to diurese without being given fluids "shocky". start giving them fluids!

s/s: distended neck veins, edema, crackles, pulse-bp-weight increase.

tx: Diuretic: loops watch for hypokalemia, aldactone watch for hyperkalemia, Thiazides watch for hypokalemia.

Bedrest- increases kidney perfusion.

Hypovalemia- think "shocky"

think ascites- 3rd spacing- belly looks like pooh. burns- fluid leaves vascular space. Polyuria "diabetes"

s/s: decreased weight, skin turgor, dry mucous membranes, pulses weak and thready, low BP. Neck veins get tiny, Peripheral perfusion goes to the kidneys trying to save the organs so hands and feet are cold and clammy.

tx: encourage oral fluids. Severe cases give IV fluids.

*** Isotonic solutions are balanced so they will stay in the vascular space better- Lactated Ringers would be your best choice. (I think it has all the electrolytes)

crb613, BSN, RN · Sep 8, 2005

See if these old notes help.
Fluid volume excess:hypervolema - think CHF, aldosterone, ADH or Renal Failure. If CHF then you have decreased cardiac output-decreased kidney output- decreased urine output.
Renal Failure- If blood is not making it to the kidneys you are NOT making urine. Remember IVF with NA, alkaseltzer and fleets are high in Na.
Aldosterone is a steroid that maintains blood volume. When blood volume is low the aldosterone is secreted and you retain water and Na.
*Too much aldosterone: Cushings or hyperaldosteronism.
ADH (antidiuretic hormone)- think "retain"
Too much ADH- water in vascular space. (SIADH) urine decreased and blood is diluted- If blood is diluted your electrolytes are probably going to fall into lower numbers.
*Too little ADH- Think diabetic insipidus- lose or diurese water- start thinking shock- blood becomes concentrated. People with DI will continue to diurese without being given fluids "shocky". start giving them fluids!
s/s: distended neck veins, edema, crackles, pulse-bp-weight increase.
tx: Diuretic: loops watch for hypokalemia, aldactone watch for hyperkalemia, Thiazides watch for hypokalemia.
Bedrest- increases kidney perfusion.
Hypokalemia- think "shocky"
think ascites- 3rd spacing- belly looks like pooh. burns- fluid leaves vascular space. Polyuria "diabetes"
s/s: decreased weight, skin turgor, dry mucous membranes, pulses weak and thready, low BP. Neck veins get tiny, Peripheral perfusion goes to the kidneys trying to save the organs so hands and feet are cold and clammy.
tx: encourage oral fluids. Severe cases give IV fluids.
*** Isotonic solutions are balanced so they will stay in the vascular space better- Lactated Ringers would be your best choice. (I think it has all the electrolytes)

God bless your soul! Yes it helps...Thank you

crb613, BSN, RN · Sep 9, 2005

Thanks for your support/help... I PASSED!!!!! :balloons: I was terrified. Whew glad that is over. Now on to the Endorcine/Diabetes.

Plucker · Sep 9, 2005

Good job!!

DMBFAN4EVR · Dec 10, 2008

Does anybody know what happens with WBC in the case of HYPOvalemic shock? Do they increase or decrease?? Thank You!

avahnel, ASN, RN · Dec 10, 2008

If a pt is losing whole blood, and it is causing hypovolemic shock, the ratio of WBCs should stay the same. So the levels would stay the same. I think?!?

Daytonite, BSN, RN · Dec 10, 2008

does anybody know what happens with wbc in the case of hypovalemic shock? do they increase or decrease?? thank you!

they will decrease slightly, but not significantly. wbcs, either immature or mature, hang out and wait in various places throughout the body including the spleen, thymus gland, lymph nodes and tissues waiting to be called into service. neutrophils, the most common and numerous type of wbc, go into the circulating blood when mature but only live for 6 hours. they can be quickly replaced. monocytes only stay in the circulating blood for 70 hours and then they move into the body tissues where they become macrophages (page 1375, davis's comprehensive handbook of laboratory and diagnostic tests with nursing implications, 2nd edition, by anne m. van leeuwen, todd r. kranpitz and lynette smith). cell generation and maturation is an ongoing 24 hour/7 days a week process. if the wbc count is significantly decreased it is because of bone marrow failure (page 893, mosby's diagnostic and laboratory test reference, 4th edition, by kathleen deska pagana and timothy james pagana).

in clinical situations of hypovolemia (hemorrhage), you will see low rbc counts. rbc and platelets will be replaced. sometimes whole blood may be given as a transfusion, but that is getting very rare. mostly rbcs are given and platelets can be added as well if necessary. whole blood donations are broken down into components these days at blood banks and every component is extracted out and used for a specific purpose. wbcs are only transfused in patients with leukemia or leukopenia as a result of some immune disease or chemotherapy.

chart of commonly transfused blood products.doc

DMBFAN4EVR · Dec 10, 2008

Thanks for taking the time to answer my thread. This is what my actual exam question was: How do you know if somebody has an AAA that has ruptured? Amongst other answers, one of the answers was an increased OR decreased WBC. I have really looked into this and can't seem to find a definite solid answer.

Daytonite, BSN, RN · Dec 10, 2008

Thanks for taking the time to answer my thread. This is what my actual exam question was: How do you know if somebody has an AAA that has ruptured? Amongst other answers, one of the answers was an increased OR decreased WBC. I have really looked into this and can't seem to find a definite solid answer.

What were your other answer choices?

http://www.merck.com/mmpe/sec07/ch079/ch079c.html - Aortic Dissection (this is the medical term for AAA rupture). It includes the signs and symptoms.
http://www.fpnotebook.com/CV/Vessel/ArtcDsctn.htm - includes symptoms and signs of aortic dissection

A ruptured AAA is an acute life threatening event and these people are often whisked off to the OR if they even make it to the ER. I'm not being mean here, but the last thing to do is to be looking at WBC counts. Since you posted this under fluids and electrolytes, look for evidence of the patient having congestive heart failure.

DMBFAN4EVR · Dec 10, 2008

I realize that nobody cares what the WBC is but apparently my instructor thinks it's important. The only two answers that could have been correct included multiple symptoms: decreased BP, pain, decreased H&H. Then, one included increased WBC and the other included decreased WBC.