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Med-Surg Exam 1: Fluid and Electrolyte Imabalances
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Terms in this set (46)
IV Fluids
Used to maintain oral intake when intake is not adequate
Replace fluid when losses have occurred
IV Fluids: Isotonic
Expands the ECF-keeps fluid in the intravascular volume
Help expand the fluid in the ECF
Examples: .9NS, LR, D5W
Common Uses: Replace fluid loss, maintenance fluid, hypovolemic shock
What to watch for:
Fluid overload
Heme dilution by overexpansion of intravascular compartment
IV Fluids: Hypotonic
Shifts fluid from the intravascular to the tissue cells
Hydrate the cells and decrease the amount of fluid in the circulatory system
Example: 0.45%NS
Common uses: Lower NA levels, hydrate cells
What to watch for:
NA levels
May lower BP
IV Fluids: Hypertonic
Shifts fluids into the blood plasma by moving fluid from the tissue cells
Restore circulating volume
Example: D5W 0.45%NS, D5W.9%NS
Common uses: hypovolemia, hyponatremia
What to watch for:
Wet breath sounds
Increase in BP
Serum NA levels
Fluid and Electrolyte Imbalances
Disruption to normal homeostasis
Caused by:
Illness or disease (burns, HF)
Therapeutic measures (IVF, diuretics)
Post op patients (oral fluid restrictions, GI prep, blood volume loss, fluid shifts)
Sodium (Na)136-145 mEg/L
Plays a major role in:
Maintaining concentration of volume of ECF
Generation and transmission of nerve impulses
Regulation of acid-base balance
GI tract absorbs Na from food:
Exceeds daily requirements
Excreted through urine, sweat, and feces - kidneys regulate the ECF concentration of Na by excreting or retaining water
Hypernatremia Na >145 mEq/L: Causes
*M-Medications, meals
O-Osmotic diuretics
D-Diabetes Insipidus
E-Excessive H2O loss
L- Low H2O intake
Impaired level of consciousness
Decreased kidney response to ADH
Hyperglycemia
Excessive hypertonic saline administration
Excessive oral intake of Na, Concentrated enteral tube feeding
Hypernatremia Na >145 mEq/L: Manifestations S/S
F-fever, flushed
R-restless, confused
I-Increased fluid, bp
E-Edema
D-Decreased urine
Dehydration of brain cells- intense thirst, lethargy, agitation seizures, coma
Postural hypotension, weakness, lethargy, weight loss, decreased skin turgor
Hypernatremia Na >145 mEq/L: Nursing Interventions
Treat the cause
Push PO fluids
D5W
Restrict dietary Na intake
**Na levels must be reduced gradually-rapid correction can result in cerebral edema and long term cognitive defects.
Hyponatremia Na <136 mEq/L: Causes
Excessive hypotonic IVF
Excessive PO water intake
SIADH
Loss from GI tract, kidneys or skin
Diuretics
Hyponatremia Na <136 mEq/L: Manifestations S/S
Fluid shifts into the brain cells- irritability, confusion, seizure, and coma
In severe cases irreversible brain damage and death
Hyponatremia Na <136 mEq/L: Nursing Interventions
Treat cause
Fluid restriction
Daily weight, I/O
Vital signs
In severe cases slow infusion of 3% NaCl
Potassium (K) 3.5-5.2 mEq/L
Critical for cellular and metabolic functions:
Transmission and conduction of nerve and muscle impulses
Cellular grown
Maintenance of cardiac rhythms
Acid-base balance
K is needed daily from dietary intake
90% of daily ingested K is excreted by the kidneys
Also lost in sweat and stool
Sources of Potassium
Bananas, oranges, dark green leafy vegetables, raisins, salt substitutes
All-bran cereals, potatoes, dried beef
Hyperkalemia K > 5.2 mEq/L: Causes
*Renal failure
*M-Meds (ACE, ARB, NSAIDS, K Sparing diuretics)
A-Acidosis
C-Cellular destruction (burns)
H-Hypoaldosteronism
I-Intake excessive
N-Nephrons (RF)
E-Excretion impaired
Hyperkalemia K > 5.2 mEq/L: Manifestations S/S
*M-Muscle weakness
U-Urine decreased
R-Resp distress
D-Deceased cardiac contractility
E-ECG changes
R-Reflexes hyper/areflexia
Leg cramps, weakness, paralysis of skeletal muscles
Cardiac muscle irritability-widening
QRSV Fib, Vtach, PVC, and asystole
Hyperkalemia K > 5.2 mEq/L: Nursing Interventions
Treat the cause
Eliminate or decrease PO/parenteral intake
Cardiac monitoring is needed in severe hyperkalemia
Increase elimination-diuretics, kayexalate
Increase fluid intake (if appropriate)
IV insulin followed by IV glucose
IV calcium-decrease the excitability of cardiac muscle
Hypokalemia K < 3.5 mEq/L: Causes
Loss via the kidneys or GI tract-diarrhea, laxative abuse, vomiting, ileostomy drainage
Elevated aldosterone levels
Metabolic alkalosis
Treatment of DKA
Hypokalemia K < 3.5 mEq/L: Manifestations S/S
Increased negative charge in the cells-reduced excitability
Lethal ventricular dysrhythmias
May have increased digoxin toxicity
Skeletal muscle weakness and paralysis (usually in the legs)
Severe- respiratory arrest
Hypokalemia K < 3.5 mEq/L: Nursing Interventions
Treat the cause
Potassium Chloride supplements (IV or PO)
Increase PO intake of K
Cardiac monitoring is needed in severe hypokalemia
**IV KCL IS NEVER GIVEN IV PUSH
Calcium (Ca) 8.8-10.4mg/dL
Obtained from ingested foods
Functions:
Transmission of nerve impulses
Muscle and myocardial contraction
Blood clotting
Formation of teeth and bones
Common Sources of Calcium
Diary produces
Fortified Juices
Dark green, leafy vegetables
Hypercalcemia Ca > 10.4 mg/dL: Causes
Hyperparathyroidism (2/3)
Malignancy-breast, lung (1/3)
Increased Ca intake
Immobility
Hypercalcemia Ca > 10.4 mg/dL: Manifestations S/S
Reduced excitability of muscles and nerves
Decreased memory, confusion, disorientation, fatigue
Hypercalcemia Ca > 10.4 mg/dL: Nursing Interventions
Treat cause
Promote excretion
Loop diuretic with hydration (Isotonic IVF or 3000-4000ml po intake)
Low calcium diet
Increase activity
Administer calcitonin
Hypocalcemia Ca < 8.8 mg/dL: Causes
Decreased production of PTH
Surgical removal of the parathyroid gland
Low dietary intake of Ca
Hypocalcemia Ca < 8.8 mg/dL: Manifestations S/S
*C-convulsions, confusion
A-arrhythmias
T-tetany
S-spasm
Increased nerve excitability-tetany
Decreased cardiac contractility may result in ventricular tachycardia
Hypocalcemia Ca < 8.8 mg/dL: Nursing Interventions
Treat cause
Increase oral intake
PO calcium supplements
Severe-IV calcium gluconate
Test for hypocalcemia, Chvostek's sign, Trousseau's sign
Monitor ECG, Vitals
Tests for Hypocalcemia
Chvostek's sign is contraction of facial muscles in response to a light tap over the facial nerve in front of the ear
Trousseau's sign is a carpal spasm induced by inflating a blood pressure cuff above the systolic pressure for a few minutes
Phosphate (PO4),Phosphorus (P)3-4.5 mg/dL
Essential to function of muscle, red blood cells, and nervous system
Deposited with calcium for bone and tooth structure
Involved in acid-base buffering system, ATP production, and cellular uptake of glucose
Has a reciprocal relationship with calcium - High PO4 leads to low Ca
Sources of Phosphorus
Milk, cheese, and eggs
Meat, fish, poultry, nuts, and dried fruit
Hyperphosphatemia PO4 > 4.5 mg/dL: Causes
Acute or chronic renal failure
Chemotherapy
Excessive intake of milk or phosphate containing laxatives
Large intake of Vit D
Hyperphosphatemia PO4 > 4.5 mg/dL: Manifestations S/S
Calcified deposits in the joints, arteries, skin, kidneys and corneas
Neuromuscular irritability
Hyperphosphatemia PO4 > 4.5 mg/dL: Nursing Interventions
Treat cause
Limit high PO4 foods (dairy)
Hydration
Correct hypocalcemia
Hypophosphatemia PO4 < 3 mg/dL: Causes
Malnourished
Malabsorption
Alcohol withdrawal
Hypophosphatemia PO4 < 3 mg/dL: Manifestations S/S
Mild-often asymptomatic
Severe-decreased cellular function-death
CNS depression- confusion, mental changes
Muscle weakness, pain, dysrhythmias, cardiomyopathy
Hypophosphatemia PO4 < 3 mg/dL: Nursing Interventions
Treat cause
PO intake
Oral supplements
Severe- Iv sodium phosphate or potassium phosphate
Monitor replacement closely for symptomatic hypocalcemia
Magnesium (Mg)1.8-2.6 mEq/L
50% to 60% contained in bone
Coenzyme in metabolism of protein and carbohydrates
Factors that regulate calcium and potassium balance also influence magnesium balance
Important for normal cardiac function
Sources of Magnesium
Vegetables
Broccoli, spinach, squash, avocados, and potatoes
Whole grains, nuts, and seeds
Tap water
Bananas and oranges
Peanut butter and chocolate
HypermagnesemiaMg > 2.6 mEg/L: Causes
Acute or chronic renal failure
Increased ingestion or intake of Mg containing products
HypermagnesemiaMg > 2.6 mEg/L: Manifestations S/S
Lethargy, drowsiness, N/V
Deep tendon reflexes are lost, somnolence
Ultimate respiratory and cardiac arrest
HypermagnesemiaMg > 2.6 mEg/L: Nursing Interventions
Treat cause
Emergency treatment - IV administration of calcium chloride or calcium gluconate to oppose effects of Mg on cardiac muscle
Fluids to promote urination
Diuretics if not contraindicated
Dialysis for ESRD patient
Monitor ECG, Vitals
Hypomagnesemia Mg < 1.8mEq/L: Causes
Prolonged fasting or starvation
Chronic alcoholism
Fluid loss from GI tract
Prolonged parenteral nutrition without supplement
Diuretics
Hypomagnesemia Mg < 1.8mEq/L: Manifestations S/S
Neuromuscular and CNS hyperirritability
Confusion, hyperactive deep tendon reflexes, tremors, seizures, cardiac dysrhythmias
Hypomagnesemia Mg < 1.8mEq/L: Nursing Interventions
Treat cause
Oral supplements
Increase dietary intake (green vegetables, nuts, bananas, oranges, peanut butter, chocolate)
Severe-IV magnesium sulfate
Rapid administration of Mg can lead to cardiac and respiratory arrest
Monitor ECG, vitals
K and Mg
Closely monitored in cardiac patients
Often supplemented if
K < 4
Mg < 2
Check your hospital policy
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