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med surg exam 2
Terms in this set (37)
Significance of elevated Na:
Normal range: 135-145
Hypernatremia; dehydration, kidney disease, hypercortisolism.
Hyponatremia: fluid overload, liver disease, adrenal insufficiency.
Significance of elevated K
Normal range: 3.5-5
Hyperkalemia: dehydration, kidney disease, acidosis, adrenal insufficiency, crush injuries.
Hypokalemia: fluid overload, diuretic therapy, alkalosis, insulin admin, hyperaldosteronism
Significance of elevated Ca:
Hypercalcemia: hyperthyroidism, hyperparathyroidism
Hypocalcemia: vitamin D deficiency, hypothyroidism, hypoparathyroidi9sm, kidney disease, excessive intake of phosphorus-containing foods and drinks.
Significance of elevated Cl:
Hyperchloremia: metabolic acidosis, resp alk, hypercortisolism.
Hypochloremia: fluid overload, excessive vomiting or diarrhea, adrenal insufficiency, diuretic therapy.
Significance of elevated Mg:
Hypermagnesemia: kidney disease, hypothyroidism, adrenal insufficiency.
Hypomagnesemia: malnutrition, alcoholism, ketoacidosis.
3 hormones that control fluid and electrolyte balance:
aldosterone, ADH, NP
Aldosterone is secreted when Na is ____:
Prevents loss of what 2 things:
What organ does it act on and what does it make this organ do:
Promotes excretion of what other electrolyte:
Na and water.
Kidneys; trigger them to reabsorb Na and water.
ADH is released in response to changes in:
Acts on organ?
What does it retain:
kidney; make them more permeable to water.
NPs are the opposite to what hormones:
Inhibits reabsorption of what electrolyte?
_______ output is increased d/t release of NPs.
Blood volume and osmolarity are increased or decreased after the excretion of NPs?
RAAS system and angiotensin II does what to blood volume and blood pressure?
Arteries / veins?
Causes adrenal glands to secrete:
aldosterone so that kidneys reabsorb water and Na.
Hypovolemia nursing interventions:
Match intake w/ output.
Drink fluids and avoid caffeine and alcohol.
increased HR, weak peripheral pulses, decreased B/P, flat neck and hand veins, increased resp rate, tenting skin, dry scaley skin, change in LOC, low grade fever
Hypervolemia nursing interventions
Supportive care, prevent future fluid overload, diuretics, nutrition therapy.
S&S Include: bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, w/ a urine specific gravity < 1.010;
Hyponatremia priority symptoms
Cerebral, neuro mm., intestinal, CV, confusion, seizures, coma, death, mm weakness, INCREASED intestinal motility. N/D. Abd. cramping, rapid, weak, thread pulse, decrease BP.
drug therapy, nutrition therapy, monitor pt, IV saline infusions, if severe 3 or 5% saline. Vasopressin receptor antagonists. Li and demeclocycline. Asseess pt hourly.
Hypernatremia priority symptoms
excitable membrane activity overall: twitching and irregular mm contractions. Hypotension, alter LOC.
Drug therapy (0.9% saline or D5.45NaCl, diretics).
Assess pt hourly. Restrict Na intake and ensure water intake
Hypokalemia priority symptoms
resp mm weakness --> shallow resps.
skel mm weak.
weak thready pulse. dysrhythmias. (ST depression, flat inverted T waves, increased U waves).
Hypotension. Altered LOC. Decrease peristalsis. N/V, constipation, abd distention.
ensure gas exchange (provide O2).
Use K sparing diuretics. Increase K intake.
CV- most common cause of death. Bradycardia, hypotension, tall Peaked T waves, long Pr, flat or no P waves, wide QRS. V fib/asystole.
numbness in hands feet and around the mouth.
Mm weakness -- flaccid paralysis.
increased intentional mobility.
insulin tx, IV fluids w/ glucose and insuiline.
Chvostek's sign, Trousseau's Sign
mm twitching, cramps, tatanty.
tingly nose and lips.
HHR and ECG changes, weak thready pulse, hypotension, prolonged ST and QT, increased peristaltic activity. Osteoporosis.
Drug therapy- oral and IV Ca and Vit d.
Ca rich diet.
INcreased HR and BP.
Severe = slow HR.
poor perfusion. blood clotting. mm weakness. decreased DTRs.
confused and lethargic.
Drug therapy(stop Iv fluids like LR that has Ca, oral drugs w/ Ca stopped like antacids, no more vit D, give normal saline.
Neuromuscular manifestations such as tetany, Chvostek's sign, Trousseau's sign
ECG changes similar to those of hypokalemia (U wave)
More serious manifestations: respiratory muscle paralysis, complete heart block, and coma
stop drug that promotes Mg loss (diretuics)
bradycardia, can lead to cardiac arrest.
ECG- prolonged PR, wide QRS
drowsy, lethargic, coma
reduced / absent DTRs
weak mms. since weak muscles, watch resps.
oral and parental mag stopped. IV fluids, loop diuretics. If there are cardiac problems give Ca to reverse.
Metabolic acidosis symptoms
HA, decreased BP, hyperkalemia, mm twitching, warm flushed skin, N/V/D, changes in LOC, Kussmaul.
Respiratory acidosis symptoms
hypoventilation/hypoxia. Rapid shallow resps. Decreased BP. HA, hyperkalemia, dysrhythmias, drowsy and disoriented, mm weakness.
Metabolic acidosis intervetions
Hydration, treat underlying issue, antidiarrheal, give bicarb, cardiac monitor, ABGs
respiratory acidosis interventions
drug therapy, oxygen therapy, pulm hygiene, vent support.
metabolic alkalosis symptoms
N/V, diaphoretic, shallow breathing, EKG changes, lethargy, tetany, muscle cramps, tingling in extremities. Hypokalemia, confusion, tachycardia.
hyperventilation, tachycardia, decreased or normal BP, hypokalemia, numbness and tingling, seizures, anxiety.
prevent further losses, restore fluid balance. modify/stop treatments like gastric suctioning. replacement therapy. antiemetic drugs.
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