Review for Quiz 1 IV Therapy Hondros PN

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my take on need to know info

Sodium

Normal level: 135 to 145 mEq/L

HYPONATREMIA

MUSCLE WEAKNESS
MUSCLE TWITCHING
DECREASED SKIN TURGOR
HEADACHE TREMOR,SEISZURES, COMA

Hypernatremia

THIRST
FEVER
FLUSHED SKIN
OLIGURIA
DISORIENTATION
DRY STICKY MEMBRANES

Potassium

Normal level is 3.5 to 5.0 mEq/L

HYPOKALEMIA

DECREASED GI, SKELETAL MUSCLE,CARDIAC FUNCTION
DECREASED REFLEXES
RAPID, WEAK, IRREGULAR PULSE
DECREASED BLOOD PRESSURE
DECREASED BOWEL MOTILITY
MUSCLE WEAKNESS OR IRRITABILITY

Hyperkalemia

MUSCLE WEAKNESS
NAUSEA & DIARRHEA
OLIGURIA
PARESTHESIA (ALTERED SENSATION) OF THE FACE, TONGUE, HANDS, AND FEET
EKG changes
Vague muscle weakness
Flaccid paralysis
Anxiety
Nausea
Cramping
Diarrhea

Hyperkalemia treatment

Restrict dietary potassium and discontinue K+ supplements
For cardiac symptoms administer calcium gluconate
IV sodium bicarb
Causes alkalinity of the plasma and causes a shift of potassium into the cells (temporary)
Administer regular insulin and a hypertonic solution (D10)
Causes a shift of potassium into the cells
May use peritoneal dialysis or hemodialysis

Chloride

Normal level is 95 to 105 mEq/L

HYPOCHLOREMIA

TETANY,INCREASED MUSCLE EXICITABILITY
DECREASED RESPIRATIONS

HYPERCHLOREMIA

STUPOR
RAPID DEEP BREATHING
MUSCLE WEAKNESS

Calcium

Normal level is 9-11 mEq/L.

Hypocalcemia

Neuromuscular symptoms
Numbness of fingers
Cramps in muscles
Hyperactive deep tendon reflexes
Positive Trousseau's sign and Chvostek's sign
Irritability
Memory impairment
Delusions
Prolonged QT interval
Altered cardiovascular hemodynamics
*****most dangerous symptoms
laryngospasm and tetany-like contractionsMUSCLE CRAMPS
ARRHYTHMIAS
NUMBNESS OR TINGLING OF FINGERS
TONIC-CLONIC SEIZURES

Treatment for Hypocalcemia

Must treat the underlying cause

Calcium gluconate with calcium supplements, 1000 mg/ day
Oral or IV

HYPERCALCEMIA

LETHARGY
HEADACHE
MUSCLE FLACCIDITY
NAUSEA & VOMITING
ANORIXIA
CONSTIPATION HYPERTENSION
POLYURIA

Treatment for Hypercalcemia

Treat underlying cause
Diuresis of calcium levels with 0.45 or 0.9
Organic phosphate salts orally or rectally
Hemodialysis or peritoneal dialysis
Lasix to prevent fluid overload with saline administration
Calcitonin to temporarily lower serum calcium levels
Biphosphonate to inhibit bone reabsorption
Plicamycin to inhibit bone reabsorption

Phosphorus

Chiefly an intracellular anion
Normal level is 3-4 mEq/L.
Dietary intake is usually 800 to 1500 mg per day.

Hypophosphatemia

Can occur from a dietary insufficiency, impaired kidney function, or maldistribution of phosphate
Muscle weakness possible

Hyperphosphatemia

Most commonly occurs as a result of renal insufficiency; also can occur with increased intake of phosphate or vitamin D
Signs and symptoms: tetany, numbness and tingling around the mouth, and muscle spasms

HYPOPHOSPHATEMIA

PARESTHESIA (CIRCUMORAL & PERIPHREAL)
LETHARGY
SPEECH DEFECTS (STUTTERING/STAMMERING)
MUSCLE PAIN AND TENDERNESS

HYPERPHOSPHATEMIA

RENAL FAILURE
ARRHYTHMIAS
MUSCLE TWITCHING

Magnesium

Normal level is 1.5 to 2.4 mEq/L.

Hypomagnesemia

: increased neuromuscular irritability similar to those observed with hypocalcemia
Major causes are increased excretion by the kidneys, impaired absorption from the GI tract, and prolonged malnutrition.

Hypermagnesemia

Major causes are impaired renal function, excess magnesium administration, and diabetic ketoacidosis when there is severe water loss.
An excess of magnesium severely restricts nerve and muscle activity.

Bicarbonate

Normal level is 22 to 26 mEq/L.

Isotonic

0.9NaCL, D5W
Same osmolarity as normal body fluids
Remain in ECF, have no effect on volume of fluid within the cell

Hypotonic

D2.5W, 0.45 NS
Contain less salt than intracellular space, osmolarity <250
Move water into cell, causing cells to swell and burst
Lower the serum osmolarity body fluids, shift out of blood vessels into interstitial tissues and cells
Hydrate cells and deplete circulatory system

Hypertonic

D5and 0.9NaCl, D and Normosol,
Shifts water from a cell to ECF where concentration of salt is greater, causing the cell to shrink, has osmolarity of >375.
Used to replace electrolytes
When used alone they also shift ECF from interstitial tissue to plasma

Signs and Symptoms FVD

Acute weight loss
Complaint of nausea & vomiting
Increased heart rate, decreased blood pressure
Weak peripheral pulses
Changes in mental status, disorientation, lethargy
Dizziness and vertigo
Sunken eyeballs, poor skin turgor
Increased thirst, decreased urine output

Treatment of FVD

Fluid replacement (oral and/or intravenously)
Use isotonic electrolyte solutions (such as 0.9 NaCl, Lactated Ringers)
Extreme caution must be exercised in fluid replacement therapy to avoid fluid overload

Extracellular Fluid Volume Excess Signs and symptoms

Acute weight gain
Changes in mental status
Hypertension, tachycardia, bounding pulse, increased Central Venous Pressure (CVP), jugular venous distention (JVD)
Shortness of breath, tachypnea, dyspnea, cough, crackles
Edema
Hematocrit will be decreased due to hemodilution
Serum sodium and osmolarity will be decreased due to hypervolemia / hemodilution

Treatment of FVE

Directed toward fluid and sodium restriction
Diuretics to increase fluid excretion
Treatment of the underlying cause
Evaluate the patient for potential fluid and electrolyte imbalances due to corrective therapy

The body has three systems that work to keep the pH in the narrow range of normal.

Blood buffers
Lungs
Kidneys

Normal Blood pH
7.35 - 7.45

pH < 7.35 = acidosis pH > 7.45 = alkalosis

Below 6.8 = FATAL Above 7.8 = FATAL

CO2

35 - 45 mmHg

HCO3

22 - 26 mEq/L

If the CO2 is < 35

ALKALOSIS

If the CO2 is > 45

ACIDOSIS

If the HCO3 is <22

ACIDOSIS

If the HCO3 is >26

ALKALOSIS

Clinical manifestations of Respiratory Acidosis

Confusion
Drowsiness
Weakness
Dyspnea
Hyperkalemia (increased K+ >5 mEq/L)

Respiratory Acidosis

This is caused by any condition that impairs normal ventilation.
A retention of carbon dioxide occurs with a resultant increase of carbonic acid in the blood.
As the pH falls, the Pco2 level increases.
Shallow respirations result because of the retained carbon dioxide.
Treatment is aimed at improving ventilation; correcting the primary condition responsible for the imbalance.

Clinical manifestations of Metabolic acidosis

Clinical manifestations include:
Muscle weakness
Malaise
Headache
Hyperkalemia (increased K+ >5 mEq/L)

Metabolic Acidosis

This can result from a gain of hydrogen ions or a loss of bicarbonate: retaining too many acids or losing too many bases.
Without sufficient bases, the pH of the blood falls below normal; the bicarbonate level will also drop.
The effect is hyperventilation, as the lungs attempt to compensate by blowing off carbon dioxide to lower the Pco2 level.
Treatment is the administration of sodium bicarbonate.

Respiratory Alkalosis Clinical manifestations

Mental Status Changes
Pallor around mouth
Tingling fingers
Spasms of hand muscles
Hypokalemia (decreased K+ <3.5 mEq/L)

Respiratory Alkalosis

This is caused by hyperventilation.
Respirations that increase in rate, depth, or both can result in loss of excessive amounts of carbon dioxide with a resultant lowering of the carbonic acid level in the blood.
The pH rises because of the decrease in carbonic acid being blown off with each exhalation.
Treatment is sedation and reassurance; breathing into a paper bag will cause rebreathing of the exhaled carbon dioxide

Metabolic Alkalosis Clinical manifestations include

Disorientation
Lethargy
Convulsions
Hypokalemia (decreased K+ <3.5 mEq/L)

Metabolic Alkalosis

This results when a significant amount of acid is lost from the body or an increase in the bicarbonate level occurs.
The most common cause is vomiting gastric content, normally high in acid.
It can also occur in patients who ingest excessive amounts of alkaline agents, such as bicarbonate-containing antacids.
The central nervous system is depressed.
Treatment is aimed at the cause

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