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fluid imbalances, acid-base imbalance

Terms in this set (40)

isotonic FVD or hypovolemia (underlying causes)
Hemorrhage, burns, vomiting, diarrhea, Addison disease, fever, excessive perspiration
hypertonic FVD or dehydration (underlying causes)
Diabetes insipidus, diabetic ketoacidosis; administration of osmotic diuretics, hypertonic enteral tube feedings, or hypertonic intravenous fluids; prolonged vomiting and diarrhea
clinical manifestations of hypovolemia(isotonic fluid volume deficit)
Confusion, thirst, dry mucous membranes, orthostatic hypotension, tachycardia, weak and thready pulse, decreased skin turgor, prolonged capillary refill, and decreased urinary output
clinical manifestation of dehydration(hypertonic fvd)
dry sticky mucous membranes, flushed dry skin, increased body temperature, irritability, convulsions, and coma
interventions for FVD(HYPOVOLEMIA ans DEHYDRATION)
Admin fluids, Monitor vitals, Monitor I&O, Monitor labs hematocrit BUN Urine specific gravity,

and assess neuro changes for dehydration
interventions for ISOTONIC FVE
M,M,M
and assess edema and JVD,
auscultate lung fields
interventions for HYPOTONIC FVE
M,M,M
Assess for neuro changes
underlying causes of isotonic FVE
Congestive heart failure, renal failure, and cirrhosis
UNDERLYING CAUSES OF HYPOtonic FVE
Excessive water intake, prolonged use of hypotonic IV solutions, SIADH
CLINICAL MANIFESTATIONS OF ISOTONIC FVE
Weight gain, edema in dependent areas, bounding peripheral pulses, hypertension, JVD, dyspnea, cough, abnormal lung sounds
CLINICAL MANIFESTATIONS OF HYPOtonic FVE
Symptoms similar to isotonic fluid volume excess plus neurologic changes that indicate cerebral edema, including decreased level of consciousness, coma, and convulsions
SODIUM NORMAL VALUES
135-145
POTASSIUM NORMAL VALUES
3.5-5
CALCIUM NORMAL VALUES
8.5-10.5
MAGNESIUM NORMAL VALUES
1.3-2.1
PHOSPHORUS NORMAL VALUES
1.7-2.6
C/M of hyponatrmia
Lethargy, confusion, weakness
Muscle cramping
Seizures
Anorexia, nausea, vomiting
Serum osmolarity <280 mOsm/kg
c/m of hypernatremia
Thirst, dry sticky mucous membranes, weakness, elevated temperature
Severe causing confusion and irritability, decreased levels of consciousness, hallucinations, and convulsions
Serum osmolarity >300 mOsm/kg
c/m of hypokalemia
Weak, irregular pulse
Fatigue, lethargy
Anorexia, nausea, vomiting
Muscle weakness and cramping
Decreased peristalsis, hypoactive bowel sounds
Paresthesia
Cardiac dysrhythmias
Increased risk of digitalis toxicity
c/m of hyperkalemia
Anxiety, irritability, confusion
Dysrhythmias, including bradycardia and heart block
Muscle weakness, flaccid paralysis
Paresthesia
Abdominal cramping
underlying causes of HYPOKALEMIA
• Vomiting, gastric suction, diarrhea
• Laxative abuse, frequent enemas
• Use of potassium-wasting diuretics
• Inadequate intake seen in anorexia, alcoholism, debilitated patients
• Hyperaldosteronism
Underlying cause of hyperkalemia
Renal failure
Massive trauma, crushing injuries, burns
Hemolysis
IV potassium
Potassium-sparing diuretics
Acidosis, especially diabetic ketoacidosis
hypercalcemia(ex.osteoporosis) c/m
Lethargy, stupor, coma
Decreased muscle strength and tone
Anorexia, nausea, and vomiting
Constipation
Pathologic fractures
Dysrhythmias
Renal calculi
hypocalcemia c/m
Confusion, anxiety
Numbness and tingling of extremities
Muscle cramps that progress to tetany and convulsions
Hyperactive reflexes
Cardiac dysrhythmias
Positive Chvostek and Trousseau signs
u/c hypercalcemia
Prolonged bed rest
Hyperparathyroidism
Bone malignancy
Paget disease
Osteoporosis
u/c hypocalcemia
Hypoparathyroidism
Pancreatitis
Vitamin D deficiency
Inadequate intake of calcium-rich foods
Hyperphosphatemia
Chronic alcoholism
hypomagnesemia u/c
Decreased intake
TPN without magnesium
Decreased absorption
Nasogastric suction
Draining fistulas
Prolonged diarrhea
Laxative abuse
Malabsorption syndrome
Ulcerative colitis
Crohn's disease
Increased renal excretion
Diuresis
Loop and thiazide diuretics
hypermagnesemia u/c
Excessive intake of magnesium- containing antacids or cathartics
TPN with too much magnesium
Prolonged use of intravenous magnesium sulfate
Renal failure
Severe dehydration
Adrenal insufficiency
Leukemia
c/m of hypophosphatemia
Weak pulse
Shallow respirations
Hypotension
Decreased cardiac output
Hemolytic anemia
Bleeding, increased bruising
Muscle weakness
Decreased deep tendon reflexes
Tremors
Bone pain
Anorexia
Increased risk of infection
u/c of hyperphosphatemia
Impaired renal function
Hypoparathyroidism
Acid-base imbalances
Cellular injury
c/m of respiratory acidosis
Headache
Altered level of consciousness, irritability, confusion
Dyspnea
Tachycardia
Muscle twitching
c/m of respiratory alkalosis
Tachypnea (rapid, shallow breathing)
Numbness, tingling of fingers
Muscle cramping
Palpitations
Anxiety, restlessness
ECG changes
c/m of metabolic acidosis
Kussmaul respirations
Hypotension
Headache
Decreased level of consciousness
Weakness
Nausea, vomiting, anorexia
c/m of metabolic alkalosis
Hypotension
Mental confusion
Muscle twitching, tetany
Increased deep tendon reflexes
Numbness, tingling of fingers and toes
Seizures
Anorexia, nausea, vomiting
Polyuria
ph value
(acid)7.35-7.45(base)
PaCO2 value
resPiratory
base35-45acid
HCO3
metabolic
acid22-26base
1 value under normal=UNCOMPENSATED
remaining value not in the normal =partially compensated
assessment of fluid balances is done by:(6)
daily weights, edema, skin turgor,
mucous membrane, diagnostic tests, vital signs
maintaining fluids and electrolyte balance
fluid restriction, pushing fluids, fluid replacement,teaching
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