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(Low sodium levels)
Causes: Water intoxication (Dilutional Hyponatremia), vomiting, diarrhea, sweating, diuretics, adrenal insufficiency
Can occur as a result of FVE or FVD
Clinical Manifestations depends on the underlying cause
FVD: poor skin turgor, dry mucosa, headache, orthostatic hypotension, nausea, abdominal cramping
FVE: edema, crackles, ascites,
neurological symptoms (ms changes, headache, lethargy, muscle twitching, hemiparesis & seizures) occur with acute hyponatremia
May necessitate water restriction or sodium replacement
Nurse must monitor:
- Fluid I&O
- Daily body weight
- Monitor GI manifestations & central nervous system changes
- Effects of medications
Confusion may be overlooked with elderly patients (Low Potassium Levels)
K+ level of <3.5 mEq/L from active losses of potassium or insufficient intake
Conditions causing increased output of K+
- Diuretics, vomiting, diarrhea, gastric suction
Conditions causing decreased intake of K+
- NPO, anorexia, vomiting
Redistribution of K+
- Metabolic alkalosis, insulin administration
Clinical manifestations: fatigue, anorexia, nausea, vomiting, dysrhythmias, muscle weakness & cramps, paresthesias, decreased muscle strength
Treatment is oral or IV replacement therapy
Nursing treatment focuses on assessment of cardiac and motor signs and symptoms
• Severe hypokalemia is life-threatening
• Monitor EKG, dietary potassium, I&Os, nursing care related to IV potassium administration (High Potassium Levels)
K+ level >5 mEq/L resulting from increased intake, medication effects, musculoskeletal injury, or decreased renal excretion of potassium
Clinical Manifestations: cardiac changes & dysrhythmias, muscle weakness, paralysis, anxiety, nausea, diarrhea
Medical Management: EKG monitoring, Dialysis
• Medications include regular insulin, Kayexelate, IV sodium bicarbonate
Nursing Management: Monitor potassium levels, monitor medication affects, dietary potassium restriction, observe for symptoms • Caused by an absence of or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein & fat
• Without insulin, the amount of glucose entering the cells is reduced, and production & release of glucose by the liver is increased
- This leads to hyperglycemia
• Kidneys excrete excess glucose causing an osmotic diuresis
• Free fatty acids are converted into ketones
• Causes of DKA:
- Missed doses of insulin
- Stress
- Illness or infection
• Primary clinical features
- hyperglycemia, ketosis, dehydration, electrolyte loss & acidosis
• Clinical Manifestations
- polyuria, polydipsia, weakness, signs of dehydration, anorexia, nausea, vomiting, abdominal pain, acetone breath, Kussmaul respirations, MS changes
• Occurs in Type 1 Diabetics • Blood glucose less than 50 to 60 mg/dL
• Can be caused by too much insulin or oral hypoglycemic agents, too little food, or excessive physical activity
• Usually treated with 15 g of a fast-acting concentrated source of carbohydrate (ex. 4-6 oz. of juice)
• Educate the patient to carry a source of carbohydrate at all times
- prepared glucose tablets, hard candies
• Glucagon injection
• 50% Dextrose in water
• Autonomic Nervous System symptoms
- sweating, tremors, tachycardia, palpitations, anxiety, & hunger
• Central Nervous System symptoms
- inability to concentrate, headache, lightheadedness, confusion, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational behavior, double vision, & drowsiness
- Severe hypoglycemia: symptoms include MS changes, seizures, difficulty arousing, & LOC • A typically reversible clinical syndrome in which there is an abrupt loss of kidney function and GFR over a period of hours to days
• Clinical Manifestations (Multisystem)
- Oliguria (UO<500ml/day) or Anuria (<50ml/day) with azotemia
- Acidemia
- Fluid excess, Electrolyte abnormalities
- Hematuria, N/V, headache, lethargy
- Failure of BP regulation & erythropoiesis resulting in anemia
• Prerenal ARF:
- Caused by reduced blood flow to the kidney with decreased GFR & low UO
- Causes include volume depletion, impaired cardiac deficiency & vasodilation
• Intrarenal ARF
- The result of damage to the glomeruli or kidney tubules
- Causes include medications (NSAIDs)
• Postrenal ARF: The result of an obstruction
- Causes may be renal calculi or benign prostatic hyperplasia (BPH)
- Pressure in the kidneys rises with a decrease GFR
• Four clinical phases of ARF
- 1. Initiation or onset
- 2. Oliguric
- 3. Diuretic
- 4. Recovery
• Prevention (Assess patients at risk)
- Adequate hydration, Assess medications, Assess labs, I&Os
• Interventions include:
- Treat underlying cause
- Medications, Nutritional promotion, Bed rest, Infection control, Skin care • A progressive and irreversible deterioration in renal function taking place over months to years
• The end products of protein metabolism, normally excreted in urine, accumulate in the blood
• Major risk factors include diabetes, hypertension, proteinuria, family history, and increasing age
• The greater the buildup of waste products, the greater the symptoms
• Virtually every body system is affected by chronic renal failure
• Neuro: altered LOC, agitation, confusion, peripheral neuropathy
• Cardio: HTN, heart failure, pulmonary edema, Cardiovascular disease is the predominant cause of death
• GI: N/V, anorexia, Ammonia breath
• Skin: Pruritus
• Hematologic: Anemia
• GFR decreases, BUN & Creatinine increase
• Medications include phosphate-binding agents, calcium supplements, antihypertensive and cardiac medications, antiseizure medications, and erythropoietin.
• Patients require nutritional support and dialysis
• Limit protein, sodium, potassium, phosphate
• May require a fluid restriction • Occurs when the normal liver tissue is replaced by fibrotic tissue in response to damage to liver cells
• Classified as either Compensated or Decompensated
• Compensated is typically asymptomatic
• Decompensated results in the development of jaundice, ascites, esophageal varices,
• Nursing assessment focuses on precipitating factors, particularly long-term alcohol abuse, hepatotoxic medications, IV drug abuse dietary intake and changes in mental status
• Nursing interventions include promoting rest and nutrition, skin care, and reducing risk of hemorrhage, fluid excess, and hepatic encephalopathy 