9 terms

Chp 14 Fluid & electrolytes

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Fluid volume deficit (hypovolemia)
*Contributing Factors*
loss of water & electrolytes, as in vomiting, diarrhea, fistulas, fever, excess sweating, burns, blood loss, GI suction, & third-space fluid shifts; ↓ intake, as in anorexia, nausea, & inablility to gain access to fluid
*S/S*
acute wt loss, ↓ skin turgor, oliguria, concentrated urine, weak rapid pulse, capillary filling time prolonged, low CVP, ↓ BP, flattened neck veins, dizziness, weakness, thirst, confusion, ↑ pulse, muscle cramps, sunken eyes
*Labs Indicate*
↑ Hgb & Hct, ↑ serum & urine osmolality & specific gravity, ↓ urine sodium, ↑ BUN & creatinine
Fluid volume excess (hypervolemia)
*Contributing Factors*
compromised regulatory mechanisms, such as renal failure, heart failure, & cirrhosis; over-zealous administration of sodium containing fluids; and fluid shifts (tx of burns). Prolonged corticosteroid therapy, severe stress, & hypoaldosteronism augment fluid volume excess
*S/S*
acute wt gain, peripheral edema & ascites, distended jugular veins, crackles, elevated CVP, shortness of breath, ↑ BP, bounding pulse, cough, ↑ resp rate
*Labs Indicate*
↓ Hgb & Hct, ↓ serum & urine osmolaity, ↓ urine sodium & specific gravity
Sodium deficit (hyponatremia) serum sodium <135mEq
*Contributing Factors*
loss of sodium, as in use of diuretics, loss of GI fluids, renal disease, & adrenal insufficiency. Gain of water, as in excess admin of D₅W and H₂O supplements for pt's receiving hypotonic tube feedings; disease states assoc w/SIADH such as head trauma & oat-cell lung tumor; meds assoc w/water retention (oxytocin & tranqs); psychogenic polydipsia. Hyperglycemia & heart failure cause loss of sodium
*S/S*
anorexia, n & v, headache, lethargy, dizziness, confusion, muscle cramps & weakness, muscle twitching, seizures, papilledema, dry skin, ↑ pulse, ↓ BP, wt gain, edema
*Labs Indicate*
↓ serum & urine sodium, ↓ urine specific gravity & osmolality
Sodium excess (hypernatremia) serum sodium >145mEq
*Contributing Factors*
water deprivation in pt's unable to drink at will, hypertonic tube feedings w/o adequate water supplements, diabetes insipidus, heatstroke, hyperventilation, watery diarrhea, burns & diaphoresis. Excess corticosteroid, sodium bicarb, & sodium chloride admin, & salt-water near-drowning victims
*S/S*
thirst, ↑ body temp, swollen dry tongue & sticky mucous membranes, hallucinations, lethargy, restlessness, irritability, focal or grand mal seizures, pulmonary edema, hyperreflexia, twitching, n & v, anorexia, ↑ pulse, ↑ BP
*Labs Indicate*
↑ serum sodium, ↓ urine sodium, ↑ urine specific gravity & osmolality, ↓ CVP
Potassium deficit (hypokalemia) serum potassium <3.5mEq
*Contributing Factors*
diarrhea, vomiting, gastric suction, corticosteroid admin, hyperaldosteronism, carbenicillin, amphotericin B, bulimia, osmotic diuresis, alkalosis, starvation, diuretics, digoxin toxicity
*S/S*
fatigue, anorexia, n & v, muscle weakness, polyuria, ↓ bowel motility, ventricular asystole or fibrillation, paresthesias, leg cramps, ↓ BP, ileus, abd distension, hypoactive reflexes
*ECG*
flattened T waves, prom U waves, ST depression, prolonged PR interval
Potassium excess (hyperkalemia) serum potassium >5.0mEq
*Contributing Factors*
pseudohyperkalemia, oliguric renal failure, use of potassium-conserving diuretics in pt's w/renal insufficiency, metabolic acidosis, Addison's disease, crush injury, burns, stored bank blood transfusions, rapid IV admin of potassium & certain meds such as ACE inhibitors, NSAIDs, cyclosporine
*S/S*
muscle weakness, tacycardia→bradycardia, dysrhythmias, flaccid paralysis, paresthesias, intestinal colic, cramps, abd distension, irritability, anxiety
*ECG*
tall tented T waves, prolonged PR interval & QRS duration, absent P waves, ST depression
Calcium deficit (hypocalcemia) serum calcium <8.5mg/dL
*Contributing Factors*
hypoparathyrodism, malabsorption, pancreatitis, alkalosis, vit D deficiency, massive subcutaneous infection, generalized peritonitis, massive transfusion of citrated blood, chronic diarrhea, decreased parathyroid hormone, diuretic phase of renal failure, ↑ PO₄, fistulas, burns, alcoholism
*S/S*
numbness, tingling of fingers, toes, & circumoral region; positive Trousseau's sign & Chvostek's sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, impaired clotting time, ↓ prothrombin, diarrhea, ↓ BP
*ECG*
prolonged QT interval & lengthened ST
*Labs Indicate*
↓ Mg
Calcium excess (hypercalcemia) serum calcium >10.5mg/dL
*Contributing Factors*
hyperparathyroidism, malignant neoplastic disease, prolonged immobilization, overuse of calcium supplements,vit D excess, oliguric phase of renal failure, acidosis, corticosteroid therapy, thiazide diuretic use, ↑ parathyroid hormone, digoxin toxicity
*S/S*
muscular weakness, constipation, anorexia, n & v, polyuria, polydipsia, dehydration, hypoactive deep tendon reflexes, lethargy, deep bone pain, pathologic fractures, flank pain, calcium stones, hypertension
*ECG*
shortened ST segment & QT interval bradycardia, heart blocks
Magnesium deficit (hypomagnesemia) serum magnesium <1.8mg/dL
*Contributing Factors*
chronic alcoholism, hyperparathyroidism, hyperaldosteronism, diuretic phase of renal failure, malabsorptive disorders, diabetic ketoacidosis, refeeding after starvation, parenteral nutrition, chronic laxative use, diarrhea, acute MI, heart failure, ↓ decreased serum K & Ca, certain pharmacologic agents such as gentamicin, cisplatin & cyclosporine
*S/S*
neuromuscular irritability, positive Trousseau's & Chvostek's signs, insomnia, mood changes, anorexia, vomiting, ↑ tendon reflexes, ↑ BP
*ECG*
PVC's, flat or inverted T waves, depressed ST segment, prolonged PR interval, widened QRS
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