fluid electrolytes chapter 27
Terms in this set (59)
renin angiotensin aldosterone system
LOW SODIUM LOW WATER
in response to low bp or low serum sodium RAAS kicks in to help.
compensate for that.
The liver produces and releases the hormone ANGIOTENSINOGEN, (a plasma protein) into the blood. This makes the kidney produce the enzyme RENIN. the Renin and angiotensinogen react and make ANGIOTENSIN 1.
Angiotensin 1 is now traveling along the blood stream and reaches the lungs, so the lungs respond to this by producing ACE (angiotensin converting enzyme)
ACE and ANGIOTENSIN 1 react and make ANGIOTENSIN 2
this reaches the adrenal glands and gets to the adrenal cortex within the adrenal glands.
The adrenal cortex reacts to the ANGIOTENSIN 2 and produces ALDOSTERONE. Angiotensin also causes vasoconstriction, thus increasing bp
ALDOSTERONE stimulates the kidneys to reabsorb/retain sodium in the tubules. (putting more sodium out into the system) Water will follow that, so the vascular pressure goes up hense bp goes up
Aldosterone also decreases potassium, so if someone is producing aldosterone there will be more potassium in their urine
Main function of RAAS
this is triggered when RENIN is released from the kidneys when:
there is a drop in bp
decrease in sodium levels
increase in potassium levels
RAAS helps us keep homeostasis in these 3 areas above by
the kidneys will reabsorb more sodium so you urinate less sodium, water follows salt, your bp goes up.
in reference to potassium RAAS causes the potassium to be peed out so if you start to get Hyperkalemia the RAAS system will try to help.
the adrenal glands
The adrenal glands secrete aldosterone, a mineralocorticoid hormone that helps the body conserve sodium, helps save chloride and water, and causes potassium to be excreted
Thyroxine, released by the thyroid gland, increases blood flow in the body, leading to increased renal circulation and resulting in increased glomerular filtration and urinary output.
The parathyroid glands secrete parathyroid hormone, which regulates the level of calcium and phosphorus. Parathyroid hormone draws calcium into the blood from the bones, kidneys, and intestines. It also facilitates the movement of phosphorus from the blood to the kidneys, where it is excreted in the urine.
Atrial natriuretic peptide
it is a cardiac hormone does the opposite, it stops RAAS
this is released by the atrium of the heart if the atrium is stretched from fluid overload. ANP then decreases fluid retention by blocking the secretion and action of aldosterone. It also inhibits renin secretion.
thirst control center, it is stimulated by intracellular dehydration and a decrease in blood volume
Antidiuretic hormone is produced in the hypothalamus then stored and released via the posterior pituitary gland into the systemic circulation. ADH acts on the distal tubules to increase the re-absorption of water back into the body.
only makes the kidneys retain water, so it is different from aldosterone which is part of the RAAS system
fluid volume facts
The average adult daily fluid source is: 1,300 mL from ingested water, 1,000 mL from ingested food, and 300 mL from metabolic oxidation, totaling 2,600 mL fluid.
We lose approx 300-400ml per day to insensible fluid loss.
Young children, elderly people, and people who are ill are especially at risk for hypovolemia. Fluid volume deficit can rapidly result in a weight loss of 5% in adults and 10% in infants. A 5% weight loss is considered a pronounced fluid deficit; an 8% loss or more is considered severe. A 15% weight loss caused by fluid deficiency usually is life threatening.
fluid homeostasis is maintained by all of these:
• Active transport
osmosis, diffusion, filtration
OSMOSIS = water from dilute concentration to more concentrated area
movement of ions and molecules from higher to lower.
water and solutes move due to pressure, ie greater pressure at the arterial capillary bed pushes fluid into the interstitial space via the capillary veins
moves from lower concentration to higher, ie sodium potassium pump needs ATP energy to do this
its the amount of particles desolved in a solution.
remember serum is your intravascular spaces.
is determined by the amount of volume and amount of particles ie, sodium, bicarbonate, proteins, glucose, and urea in the extracellular fluid compartments.
why does the body need fluid
• Facilitates cellular metabolism
• Helps maintain normal body temperature
• Acts as a solvent for electrolytes
Water in the body functions primarily to provide a medium for transporting nutrients to cells and wastes from cells; provide a medium for transporting substances such as hormones, enzymes, blood platelets, and red and white blood cells throughout the body; facilitate cellular metabolism and proper cellular chemical functioning; act as a solvent for electrolytes and nonelectrolytes; help maintain normal body temperature; facilitate digestion and promote elimination; and act as a tissue lubricant. Water does not, by itself, provide hydrogen or glucose
insensible fluid loss
The fluid lost through insensible loss is about 300 to 400 mL/day. Insensible water loss occurs when water molecules move from an area of higher concentration, such as the body, to an area of lower concentration, like the atmosphere.
lab values you must know for test
electrolytes in Serum
Sodium (Na+) 135-145mEq/L
or 4.3-5.3 mEq/L
phosphate (HPO4, H2PO4)
1.7 - 2.6mEq/L
bicarbonate (HcO3) 22-26 mEq/L
2.5 to 4.5 mg/dL
substances with solutes in them
intravascular volume = in the blood vessels plasma capillaries, arteries, and veins.
interstitial fluid = found between the mainly contains sodium, chloride, protein, bicarbonate.
in the actual cell, 70% of total body fluid. mainly water
CELL MEMBRANES SEPARATE
intracellular and extracellular spaces
CAPILLARY MEMBRANES SEPARATE
intravascular and interstitial spaces
Iv fluids crysalloids
fluids that are clear, contain a little sodium and chloride to assist with fluid volume. help maintain hydration, blood pressure, and electrolyte balance.
Either isotonic, hypotonic, hypertonic depending on how close they are to osmolarity which is normal serum 275-300mosm/L as dehydration occurs your osmolality goes up.
testing for dehydration
osmolality test serum
look for concentration in fluid
urine specific gravity should be 1.010 to 1.025, if it is higher it means the urine is concentrated and you are dehydrated. Lower means too dilute.
use dip stick.
do BUN =10-20 if higher maybe dehydrated
Creatinine =7-1.4mg/L best indicator of how our kidneys are functioning, above 1.4 we are holding onto fluid, not producing urine
hematocrit =42%-52% men
35%-47% women if it is elevated you could be dehydrated.
is the pressure it takes to prevent osmosis, it is proportional to the osmolality
isotonic solution has the same osmotic pressure as blood so no movement.
if an isotonic iv bag is given to patient the liquid will stay in the extracellular compartments
have lower osmotic pressure than the blood, this forces fluid from the extracellular spaces into the cells, because the extracellular space is now overly concentrated with fluid and has less particles than the cell so the water will move to the area where there are more particles/salt, water follows salt.
have higher osmotic pressure than the blood, more solute, so the fluid leaves the cell and goes into the extracellular spaces.
(D5W) is used in fluid loss, dehydration and hypernatremia, and should not be used in excessive volumes because it does not contain any sodium.
Isotonic solution IV fluids
Normal saline (0.9% NaCl)
lactated ringer solutions
5% dextrose in water (D5W)
only used for fluid recovery, dehydration, and hypernatremia.
isotonic by giving this fluid will stay in the intravascular and interstital fluid not going into the cell. it increases intravascular volume.
give to patients needing intravascular volume increase due to hemoraging, vomiting, heavy drainage suctioning from gi and wounds.
treat for shock, mild hyponatremia, metabolic acidosis like diabetes ketoacidosis. hypercaclemia,
resuscitation efforts. careful with people with cardia or renal disease for overload.
Great for hypotension, hypovolemia in dehydration.
Don't give to a patient with CHF, liver or renal failure because isotonic solution fills intravascular space
isotonic = the same osmotic pressure as in the cell. Isotonic solutions will not pull fluid in or out of the cell. neutral, same concentration as our cells. Be careful not to over hydrate as fluid will go to compartments, excessive fluid volume/overload
Examples of isotonic solution are
(0.9% NaCl) and lactated ringers,
0.9% NaCl (normal saline) and Lactated Ringer's solution are isotonic solutions that have a total osmolality close to that of the ECF and help replace the ECF in the treatment of hypovolemia
hypotonic fluids IV
0.45% NaCl half strength saline
0.45% sodium chloride
2.5% Dextrose in water (D2.5W)
Dextrose is typically isotonic but once absorbed becomes hypotonic
Administer when patient needs cellular hydration, their cells are dehydrated. such as patients with diabetics, ketoacidosis, and hyperosmolarity.
patients with hypernatremia, if D5W doesnt work
By giving hypotonic solution the cell will swell, by giving hypotonic solution you are diluting the intrastitial fluid and then eventually the cell will become more concentrated and fluid will leave the intravascular space and go into the intracellular space.
Be careful not to give too much, say a person has edema or traumatic brain injury by giving hypotonic solution you will make it worse. Cells can burst into the plasma
Examples of hypotonic solutions are
One-half normal saline =(0.45NaCl)
2.5% dextrose in water is your 1/4 normal saline.
anything under .9% ie could be .33%
0.45% NaCl (½-strength normal saline) is a hyptonic solution that provides Na+, Cl−, and free water and is used as a basic fluid for maintenance needs.
isotonic prior to administering but once metabolized in the system becomes hypotonic.
Hypertonic Iv fluid solutions
5% NaCl anything above .9%
5% dextrose in normal saline solution=
5% dextrose in lactated ringer solution= (D5LR) it has become hyper due to the 5%
Give to someone who has brain swelling
give when you need water pulled out of the cell, intracellular.
Fluid is removed from the cell, the cell fluid goes down and fluid goes into the blood vessel to give more intravascular volume.
Examples of hypertonic iv solutions
3% saline and 5% saline administer slowly to pevent circulatory overload.
should be kept separate from other iv fluids.
5% dextrose in 0.9% NaCl is a hypertonic solution that can temporarily be used to treat hypovolemia if plasma expander is not available. 10% dextrose in water (D10W) is a hypertonic solution that is used in peripheral parenteral nutrition.
hypovolemia only blood volume is low
dehydration occurs when both blood volume is reduced and intracellular volume is low.
loss of extra cellular fluid that exceeds the intake, loosing fluid from the intravascular space.
An increase in pulse rate of more than 20 beats per minute indicates ECF volume deficit in the client.
Hypovolemia due to:
mainly losing fluid
reduced intake, not normally
lack of water supplement when receiving concentrated tube feeding.
reduce ability to sense taste.
infants have a higher risk
FLUID SHIFT OUT OF VASCULAR SPACE
fluid volume deficit. not enough fluid in the blood, diminished blood volume caused by fluid loss, lack of fluid intake, or fluid shifts out of the vascular spaces.
what causes hypovolemi
it is dehydration
Main cause is fluid loss.
FLUID SHIFT OUT OF VASCULAR SPACE
acute intestinal obstruction
pancreatitis occurs when loss of ECF (ISF+IVF) volume exceeds, the intake of fluid. losing too much ECF
too many diuretics
symptoms of hypovolemia
regular hypotension/low bp
increased pulse rate/trachycardia
pulse rapid and thready/weak
diminished peripheral pulses
flattened neck veins
poor skin turgor
dry skin and mucous membrane
decreased dark urine output
if severe hypovolemic shock due to decrease in preload to the heart.
Treatments for hypovolemia
treatment ususally consists of isotonic or hypotonic IV solution.
Figure out underlying cause
give oral or parenteral fluids, isotonic
blood transfusion if hemorage
antidiarrheals if diarrhea
antiemetrics if vomiting
if in hypovolemic shock
monitor fluid balance=
I/O, daily weight,
perform frequent vital signs b/p
assess skin turgor
an isotonic expansion of the ECF caused by the abnormal retention of water and sodium in approx the same proportions in which they normally exist in the ECF, water stuck in the Interstitial space and intravascular space
Hypervolemia, or fluid volume excess (FVE), refers to fluid excess in the intravascular space.
increase fluid intake, renal disease.
you may see edema.
EDEMA with hypervolemia is
fluid excess in intrastitial space:
localized edema= due to trauma or inflammation.
general edema= the whole body,
ANASARCA= severe generalized edema.
extracellular fluid excess in other body compartments
ie Ascites, fluid in abdomen peritoneal
pleural effusion in the lung pleural space.
fluid can also get trapped in soft tissue following burns or trauma
causes of hypervolemia
due to increase of sodium and water retention, or just an excessive increase in sodium and water intake, or from fluid shifting from the intracellular space to the extracellular fluid spaces:
people with CHF, kidney disease=renal failure, and liver failure=cirrhiosis are at risk for this because mechanisms for dealing with sodium are not working correctly.
also eating too much sodium, iv solution, blood transfusions,
symptoms of hypervolemia
edema sacral, feet, hands etc
rapid bounding pulses
rapid weight gain.
shortness of breath/dyspnea
crackles in lungs, wet, moist skin
pulse ox will be lower.
Third spacing like, Ascites in abdomen area if it gets compartmentalized.
Treatment for hypervolemia
include diuresis and fluid and sodium restrictions. if the patient is struggling with thirst avoid salty, sweet foods.
Gum and candy temporarily help but then 15-30 min later even dryer.
rinse mouth with only water.
oxygen therapy, morphine, iv diuretics, mechanical ventilation
assess for edema
Monitoring respiratory status for signs and symptoms of pulmonary complications.
fluid overload signs
Engorged neck veins, increased blood pressure, and dyspnea
nursing diagnosis for fluid imbalance
deficient in fluid volume
excess fluid volume
best practices for iv bags
Aseptic technique must be maintained when handling any of the IV solutions or containers to decrease the chance of infection. The nurse then clamps the tubing to allow for filling of the drip chamber to the half way mark, uncaps the spike, and insert the spike into entry site. The tubing is then primed to eliminate all air by removing the cap at end of the tubing, releasing the clamp, and allowing fluid to move through tubing prior to initiating fluid flow into the patient's IV cannula. A label is then applied to identify when the next change of tubing is required.
Following preparation of the IV solution and tubing, stept to selecting a site and palpating a vein to start an IV infusion
The appropriate IV site should be chosen based on several factors, including length of therapy and condition of the patient's veins. The tourniquet ends should be away from the site to maintain asepsis, and the radial pulse must be present to ensure the tourniquet is not too tight. Having the patient hold the arm below the heart level helps fill the veins with blood by using gravity so that they are palpable, allowing for easier insertion of the IV. A low-Fowler's position permits either arm to be used and allows for good body alignment. The tourniquet should be 3 to 4 inches above the planned insertion site to better distend the vein. Opening and closing the first encourages contraction of the muscles of the forearm, forcing blood into the veins, thereby distending them further.
Monitoring IV tubing
• Maintain aseptic technique when opening sterile packages and IV solution.
• Clamp tubing, uncap spike, and insert into entry site on bag as manufacturer directs.
• Remove cap at end of tubing, release clamp, and allow fluid to move through tubing.
• Apply label to tubing reflecting the day/ date for next set change, per facility guidelines.
problems with administering iv
• Swelling, pain, coolness, or pallor at the insertion site may indicate infiltration of the IV.
• Redness, swelling, heat, and pain at the site may indicate phlebitis.
• Local or systemic manifestations may indicate an infection is present at the site.
Redness, swelling, heat, and pain at the site may indicate.
infiltration of the IV
Indicated by: Swelling, pain, coolness, or pallor at the insertion site
Infection at the IV site
Indicated by: Local or systemic manifestations
slightly chemically charged
sodium potassium, calcium, phosphorus
*ions-electrically charged particles
*balance the plus and minuses (cations=+ and Anions=-)
*hooking up with hydrogen
*insiders and outsiders some are in and out of cell.
*balance each other, ie if calcium goes up phosphorus goes down and visa versa
sodium should be 135-145mEq/L
Sodium is a MAJOR CATION in the extracellular fluid often has chloride.
1.Sodium responsible for osmotic pressure of the ECF compartments
(fluid from and to intravascular & interstitial fluid) thus deals with water distribution
2. Sodium aids in nerve and muscle transmission.
3. influences the concentration of potassium and chloride in the body
it is excreted from the body mostly via the kidneys, so the kidneys are the main regulator of the sodium.
ADH and aldosterone regulate sodium balance
Sodium primarily regulates extracellular fluid volume and plays a role in muscle contraction and transmission of nerve impulses, really affects the brain. It also influence ICF volume. The daily suggested intake of sodium is not more than 2,300mg/day or no more than 1,500mg/day for persons 51 years of age and older.
Na+ less than 135mEq/L Na+<135mEq/L
*it could be because too excessive sodium loss or excessive water intake.
*too much fluid and sodium is deluted = delusional hyponatremia
*frequent tap water enemas
*sweating and drinking too much water.
*excessive admin of hypotonic saline.
too much water shifts from the exctracellular space into the cells.
sodium can also be lost via the kidneys, gi tract, or skin.
Aggressive use of diuretics
patient could be vomiting, diarrhea, muscle cramps, lethargy, stooper, coma.
Treatment from the nurse will be
*MAIN thing to do is figure out why.
*fluid intake restrictions
*administer hypertonic solution like 3% sodium chloride slowly, an order could look like (250ml of 3% NaCL intravenously at 25ml/h)
*watch cns is changing so watch for
* watch cardio
eat salt, processed food and meat, bread and dairy
Na+ exceeding 145mEq/L caused by a gain of sodium in excess of water or by a loss of water, so your interstitial fluid has way too much sodium & because water follows salt too much water shifts out of the cell and vascular space to the interstitial fluid causing cellular dehydration and intravascular volume depletion.
Sodium pulls water out of cells, the kidneys excrete the water then hypvolemia
This can happen via
*ingesting too much salt without water
*iv infusion of hypertonic saline, sodium bicarbonate, or isotonic saline.
*trauma to the thirst center.
*hypertonic tube feeding
Excessive diarrhea can cause hypernatremia if you loose more water than salt
increased insensible loss, sweating and heavy breathing.
and for any reason you cant consume water.
Symptoms you will see
headache, neuro disoriented, confused
maybe seziour, coma, this is because of cellular changes in the brain
Treatment by nurse
gradually lower sodium level.
*give hypotonic solution, ie, 0.45 NaCl or 0.3%NaCl, hypotonic solution so the sodium will come out of the vascular space into the cell again.
*if diabetes insipidus is the issue you may give desmopressins or vasopressins.
*monitor fluid and electrolytes
Remember both severe hypo and hyper natremia can cause coma/death
Calcium should be 8.5-10.5mg/dL
calcium assists in
*bone and teeth formation, 90%
*found in blood
* contraction of skeletal and cardiac muscles
*transmission of nerve impulses
*coagulation of blood
*normal cell membrane permeability
Calcium works by
is is supplied via diet.
you need vitamin d so that calcium can be absorbed in the gi tract
this increases excretion of phosphorus via the kidneys, if you have low phosphorus you get high calcium.
if we need calcium PTH is released to break down bone to release the calcium from the bone to the circulatory system. It also tells the intestines and kidneys to reabsorb calcium
If we have too much calcium the the thyroid gland releases calcitonin to decrease calcium levels in the blood by stopping bone absorption into the blood.
HYPOCALCEMIA less than 8.5%
*maybe a parathyroid removal, hypoparathyroidism.
*vitamin D deficiency
*Hypocalcemia or low serum calcium levels can affect clotting. the nurse should take extra care to check for bruising or bleeding, so patient doesnt bleed out
symptoms will be mainly:
*numbness and tingling in face and fingers, around the mouth, pins/needles
*trousseaus (spasms doing bp check)
*hyperactive deep tendon reflexes
*decreased myocardial contractions
*EKG shows shortened QT intervals.
Treatment for hypocalcemia are:
*oral replacement diet, or calcium supplement.
*increase vitamin D
*iv calcium replacement
For hypocalcemia the nurse should monitor and be concerned about:
cardiac decreased status, arrhythmia.
nurse will treat via:
iv calcium or oral calcium
educate on diet to eat:
low fat dairy like milk, cheese, yoghurt,
along with leafy green vegetables
loss in muscle tone and
nephrolithiasis (forming kidney stone)
*It can cause increase in cardiac contractions, and decrease in cardiac rate.
Hypercalcemia in the gi causes *anorexia,
*think malignancy and parathyroid problem, overproduction
main things for nurse to watch for:
Vital signs, high bp
muscle weakness Cardiac is huge
are they alert and oriented.
On EKG it will show as
a wide T wave
Treatment for hypercalcemia are:
identify and remove cause
iv fluids with diuretics
relates to calcium, opposite
phosphorus should be 2.5-4.5mg/dL
major intracellular anion
85% of phosphorus is in bone
the rest is mostly intracellular
we need phosphorus for
*bodies metabolic processes like
metabolism of carbs, lipids, and proteins
*helps maintain acid-base balance
*component in our ATP and DPG
we get phosphorus through diet, mainly in protein.
the kidneys regulate phosphorus via overflow mechanism. If phosphorus serum is low then the kidneys reabsorb what it needs from the tubules. If it is high you urinate it out.
increased PTH increases renal excretion.
phosphorus issues relate mostly to renal impairment.
can happen due to:
*decrease due to intestinal absorption
*increase in renal elimination
Symptoms you will see are:
neuro and muscular symptoms inverse to calcium. so because phosphorus is low your calcium will be high, you will have the same symptoms as hypercalcemia.
*identify underlying cause
* replacement therapy po or iv
*eat low fat dairy, green leafy vegetables
* a shift into the cells
*excessive use of phosphate laxatives
so calcium will be low and you will have the same symptoms as hypocalcemia
you may see
*ECG will show shortened QT intervals
*identify underlying cause
*calcium based phosphate binders.
potassium should be 3.5 to 5meq/L
major Cation in body fluid (K)
major mineral in all cells
potassium is moved by the sodium potassium pump
the potassium pump keeps hemeostasis in the skeletal, cardiac, and smooth muscle function.
It also plays a role in glucose for energy, ie glucose to glycogen.
It also plays a role in amino acids to protein.
Kidneys regulate potassium levels, potassium completely filtered by the glomelurus and almost completely reabsorbed via the proximal tubules.
then whats left is excreted out via the distal tubules.
HYPOKALEMIA= most serious issue is cardiac.
Hypokalemia can be caused by insufficient intake or its not being reabsorbed via kidneys,
causing a loss of potassium via urine, losing potassium through the body.
or potassium moving out of serum, ECF into the cell.
*diuretics, too much
*prolonged gastric suctioning
*hyperalimentation, too many nutrients via iv feeding
your patient will show these symptoms:
nausea, weakness, fatigue, muscle cramps, breathing slowly
cardiac, respiratory, and neuro issues.
Abdominal distention, vomiting, and paralytic ileus
nurse should worry about
are they throwing PVCs
PVCs are preventricular contractions
If you see PVC check potassium levels
for HYPOKALEMIA YOU WILL SEE
hypotonic bowel sounds
For CARDIAC ECG with hypokalemia you will see:
falttened T wave
prolonged PR intervals
Large U waves.
treatment via nurse
Dietary the best
no iv replacement, or injections
if using iv therapy don't infuse more than 10Meq/L per hour and if it goes through peripheral line it burns.
Eat bananas, melons, oranges, apricots, broccli, raisins, dates and green leafy vegetables
AFFECTS resting membrane potential.
most serious issue CARDIAC
*normally kidney failure. Kidneys not excreting potassium.
could be too many potassium supplements either oral or iv.
*Or the body is unable to excrete the excess potassium from the body via the kidneys.
*Acidosis causes potassium to shift out of cells.
Anuria, due to kidney failure, renal impairment which prevents them from excreting potassium, so it gets released into ECF.
Or trauma and potassium has leaked out of the cell into the intravascular space.
*Hyperkalemia compromises the function of the sodium potassium pump so cardiovascular dysrhythmia can be fatal
symptoms you will see:
diarrhea, anxiety, irritability, muscle weaknesses, dyspnea
Nurse worry about
cardiovascular system arrhythmia.
high or low worry about arrhythmia.
CARDIAC CHANGES WITH ECG
*tall peaked T wave
*widening QRS complex
nurse will treat with:
insullin can attach to it and pull it out of the intravascular space and put back into cell.
less salt. Give calcium chloride gluconate this will help with the heart being affected by the hyperkalemia
for mild hyperkalemia
reduce high K food intake
stop potassium sparing diuretics
give Kayexalate, po
administer 50% glucose with insulin iv
magnesium should be 1.5-2.5mg/dL
major intracellular cation
mostly stored in soft tissue, muscle and bone. Very little in the blood
it affects cardiovascular, neurological, and respiratory systems
*magnesium activates many enzymes
* active role in electrical conduction of nerves and cardiac tissue
*assists with protein and carb metabolism.
*essential for protein and DNA synthasis
magnesium obtained via diet.
the pth regulates absorption and excretion in the intestines, same as calcium. if calcium increases magnesium decreases
HYPOMAGNESEMIA caused by:
*insufficient intake, due to malnutrition or alcoholism
*inadequate absorption due to chronic diarrhea
*renal function, renal loss due to diuretics.
*ADH secretion problems
symptoms will look like:
significant neuromuscular issues
and cardiovascular issues similar to hypercalcemia.
HYPOMAGNESEMIA AND HYPERCALCEMIA USUALLY HAPPEN AT THE SAME TIME
abnormal eye movement,
convulsions, fatigue, muscle spasms. deep tendon
Nurse should worry about cardiac system and neurological system, also protein and carbohydrate metabolism can be affect
Test it via BUN
or CMP complete metabolic panel
magnesium via iv, mouth
iv calcium to pull the magnesium out
eat green leafy vegetables, nuts and seeds, fish, soybeans,
rare and usually caused by
*renal failure, volume decifits with decrease renal perfussion.
*traumatic soft tissue injury.
symptoms can cause
serious cardiac problems
neuromuscular problems include:
*respiratory depression, bradypnea
Hold off on seafood
don't give milk of magnesium for constipation.
chloride balance and imbalance
Chloride is a major/cheif ion of the ECF
normal range is 95-105mEq/L
often combines with sodium to form sodium chloride=salt
*Chlorides role is to maintain
acid base balance
*just like sodium, chloride helps maintain osmotic pressure in the intravascular system
*acidity of gastric secretions
The kidneys regulate your chloride
when the kidneys reabsorb sodium ions chloride/bicarbonate ions are automatically reabsorbed with the sodium.
if there is acidosis going on more chloride/bicarbonate binds to the sodium to try and buffer it, due to this more chloride is excreted in the urine
serum chloride below 95%
due to a loss of hydrochloric acid via
When chloride is low the kidneys retain bicarbonate
serum chloride above 105%
*decreased excretion of chloride
3.5-5 mEq/L - CARDIAC A/Dysrhythmias
8.5-10.5 mEq/L - (Low) Muscle tetany/ Paresthesias/ tingling/ numbness or (high) opposite (weakness, confusion, pain, fatigue, thirst, etc...)
Force fluids ordered (by physician)
help the client drink greater than average amounts of fluids. Begin by explaining to the client in understandable terms the rationale for the increased fluids and the specific goal of taking the daily amount of fluids prescribed
Fluid intake should match urine output (e.g. i drink 2,000 ml so i should pee 2,000 ml)
A pounding headache, fainting, rapid pulse rate, increased blood pressure, chills, back pains, and dyspnea occur when fluids are administered too rapidly
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