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Class 17 Objectives

Key Concepts:

Terms in this set (122)

Signs & Symptoms of Hyponatremia:
~ Lethargy/Confusion
~ Muscle Cramps/Twitching
~ Seizures
~ Coma
~ Anorexia, Nausea, Vomiting
~ Elevated Pulse, Decreased Blood Pressure

Nursing Actions for Hyponatremia
~ Monitor Labs: Serum, Na+, Cl-, K+, Urine Na+, and urine specific gravity.
~ Monitor fluid status & V/S
~ Monitor Neurologic Status: - Seizure Precautions
~ Teach patient to eat foods high in salt: canned foods, lunch meat, pork, pickles, chips, cola

Signs & Symptoms of Hypernatremia:
~ Thirst!
~ Increased Temp
~ Sticky Mucous Membranes, Swollen Tongue
~ Mental Changes
~ Seizures and Coma
~ Pulmonary Edema
~ Elevated Pulse and Blood Pressure

Nursing Actions for Hypernatremia:
~ Monitor Labs: Serum, Na+, Cl-, K+, Urine Na+ and specific gravity.
~ Monitor Fluid Status & V/S
~ Teach patient to avoid foods high in salt.
~ Identify drugs that retain sodium
~ Give sufficient water with tube feedings.

Signs & Symptoms of Hypokalemia:
~ Muscle weakness, cramps
~ Cardiac arrhythmia and possible cardiac arrest
~ Polyuria, dilute urine
~ Paresthesia
~ Glucose intolerance
~ Decreased bowel motility

Nursing Actions for Hypokalemia:
~ Monitor Labs: Serum, K+, Mg+, Cl-
~ Monitor EKG: Bradycardia
~ Teach patients to eat foods high in potassium: fresh fruit, fruit juice, dry fruit, vegetables, meats, nuts, cola, cocoa.
~ Talk to MD re: switch to potassium sparing diuretic.

Signs & Symptoms of Hyperkalemia:
~ Cardiac arrhythmia
~ Irregular pulse
~ Muscle weakness and parathesias
~ Flaccid muscle paralysis
~ Intestinal cramping
~ Irritability & anxiety
~ Double check that blood specimen was not hemolyzed.

Nursing Actions for Hyperkalemia:
~ Monitor Labs: Serum, K+, Mg+, Cl-
~ Monitor EKG
~ Teach patient to avoid foods high in potassium: Fresh fruit, fruit juice, dry fruit, vegetables, meats, nuts, cola, cocoa.
~ Monitor U.O. Must have good output before giving K+ supplements
~ Maintain IV access

Signs & Symptoms of Hypercalcemia:
~ Numbness/cramps/tingling/muscle spasms/ seizures.
~ Hyperreflexia - Chvostek's and Trousseau's Signs
~ ECG changes
~ Mental status changes: depression, anxiety, and confusion
~ Laryngeal spams

Nursing Actions for Hypocalcemia:
~ Monitor labs: Serum, Ca++ & ionized Ca++
~ Monitor ECG: Dysrhythmias
~ Teach patient to eat foods high in calcium and vitamin D: meats & dairy
~ IV infiltrate will cause tissue sloughing

Signs & Symptoms of Hypercalcemia:
~ Muscle weakness/lack of coordination
~ Decreased reflexes
~ ECG changes and cardiac arrest
~ anorexia/ nausea, vomiting, constipation
~ Severe thirst
~ Lethargy/coma, memory
~ Bone pain and fractures

Nursing Actions for Hypercalcemia:
~ Monitor Labs: Serum Ca++ and Ionized Ca++, Serum phosphate
~ Monitor ECG
~ Teach patient to limit foods high in calcium and vitamin D: meats and dairy
~ Handle bedridden patients gently
~ Encourage 3000-4000 mL/day of fluid

Signs & Symptoms of Hypophosphatemia:
~ Muscle weakness/numbness/seizures
~ Impairs oxygen delivery to tissues
~ Respiratory muscles so weak as to impair ventilation.
~ Mental status: seizures, coma, confusion

Signs & Symptoms of Hyperphosphatemia:
~ Tetany
~ Hypocalcemia
~ Calcium-phosphate precipitates in kidneys, joints, arteries, skin and cornea.

Signs & Symptoms of Hypomagnesemia:
~ Neuromuscular irritability weakness, tremors, writhing movements, laryngeal stridor - seizures
~ Cardiac arrhythmia
~ Mental Status: delirium, hallucinations

Nursing Actions for Hypomagnesemia:
~ Monitor Labs: Serum Mg+, K+, Ca++
~ Seizure precautions
~ Teach patient to eat foods high in magnesium: peanut butter, chocolate, nuts, legumes, green leafy vegetables, whole grains, seafood, bananas, oranges.
~ Slow IV administration- too fast - cardiac or respiratory arrest.
Treatment of Hyponatremia:
~ Free water restriction to 800 mL/24hrs
~ PO sodium
~ If PO is not tolerated Lactated Ringers IV or isotonic sodium IV
~ Neurological symptoms are present, small amounts of hypertonic solution may be administered 3% or 5 % sodium chloride

Treatment of Hypernatremia:
~ Reduce sodium levels gradually
~ Infuse hypotonic saline solution (0.45%) or an Isotonic non-saline solution ie. (D5W)
~ Diuretics
~ Nursing: Seizure Precautions

Treatment of Hypokalemia:
~ Increase dietary potassium
~ Salt substitutes
~ Oral replacement
~ IV replacement - peripheral amount should be no greater than 40 mEq and given no faster than 10 mEq/hr.

Treatment of Hyperkalemia:
~ EKG monitoring
~ Restriction of dietary potassium and/or potassium containing medications.
~ Kayexalate given PO or as an enema
~ IV calcium gluconate
~ IV sodium bicarbonate
~ Hypertonic dextrose solution causes a shift of potassium into the cells - follow with insulin.
~ Beta-2 agonists
~ Dialysis

Treatment of Hypocalcemia:
~ IV calcium administration - calcium gluconate (watch for postural hypotension).
~ Vitamin D for increased absorption in the gut.
~ Oral calcium supplements.

Treatment for Hypercalcemia:
~ Administer IV fluids
~ Restrict dietary calcium
~ IV phosphate
~ Calcitonin IM
~ Treat underlying cause - cancer, hyperparathyroidism.

Treatment of Hypophosphatemia:
~ Focus is on prevention.
~ Add phosphorus to IV solution.
~ Increase dietary intake
~ Neutra Phos capsules or Fleets Phospho soda PO
~ Monitor calcium levels

Treatment for Hyperphosphatemia:
~ Treat underlying disorder
~ Phosphate- binding gels or antacids
~ Restriction of dietary phosphate: dairy, meat, dried beans, whole grains, cola
~ Dialysis

Treatment of Hypomagnesemia:
~ Increased dietary intake
~ PO magnesium - watch for diarrhea
~ Magnesium sulfate IV

Treatment of Hypermagnesemia:
~ Double check blood was not hemolyzed in lab specimen.
~ Discontinue medications containing magnesium.
~ Loop diuretics and 0.45% NS increase excretion in kidneys.
~ IV calcium gluconate to antagonize effects of hypermagnesemia on the heart.
Metabolic Acidosis:
~ Blood pH < 7.35
~ HCO3 <22
~ Usually due to an increase in acids other than carbonic acid.
~ Compensation + lungs hyperventilate

Signs & Symptoms of Metabolic Acidosis:
~ Drowsiness
~ Increased respiratory rate and depth
~ Flushed Skin
~ Nausea/Vomiting
~ Decreased blood pressure, cold clammy skin
~ Dysrrhythmia

Causes of Metabolic Acidosis:
~ Diabetic ketoacidosis
~ Diarrhea
~ Renal Failure
~ Cardiac Arrest

Nursing Actions for Metabolic Acidosis:
~ Monitor and treat abnormal ABG
~ Monitor renal, neuro, and cardiac status
~ Promote adequate ventilation
~ Fluids
~ Oral Hygiene
~ Admnister sodium bicarbonate

Metabolic Alkalosis
~ Blood pH > 7.45
~ HCO3 is > 26 mEq/L
~ Usually due to a loss of acids
~ Compensation: Lungs hypoventilate

Signs & Symptoms of Metabolic Alkalosis:
~ Dizziness
~ Tingling in fingers and toes
~ Hypertonic muscles
~ Decreased respirations
~ Tachycardia
~ Decreased GI motility

Causes of Metabolic Alkalosis:
~ Upper GI losses
~ Hypokalemia

Nursing Actions for Metabolic Alkalosis:
~ Monitor and treat abnormal ABG
~ Monitor fluid balance, neuro status
~ Promote adequate ventilation
~ Seizure precautions if severe
~ Fluids

Respiratory Acidosis
~ pH < 7.35
~ PaCO2 > 45 mm Hg
~ Caused by retention of CO2 d/t pulmonary insufficiency
~ Very dangerous

Signs & Symptoms of Respiratory Acidosis:
~ Mental cloudiness
~ Unconsciousness
~ Increased pulse, blood pressure, and respiratory rate.
~ Abnormal EKG & ABG
~ Increased intracranial pressure

Causes of Respiratory Acidosis:
~ COPD - Chronic
~ Acute - pulmonary edema, atelectasis, sleep apnea, pneumonia, ARDS
~ Neuromuscular disease - muscular dystrophy, myasthenia gravis
~ Over sedation

Nursing Actions for Respiratory Acidosis:
~ Monitor and treat abnormal ABGs
~ Monitor RR, effort, work of breathing, lung sounds, SaO2, neuro, cardiac status.
~ Titrate O2 to keep SaO2 between 93-99%
~ Monitor response to bronchodilators and corticosteroids.
~ Raise head of bead
~ Encourage cough, turn, and deep breath
~ Encourage fluids
~ Small, easy to eat meals if not NPO

Respiratory Alkalosis
~ Always due to hyperventilation
~ pH > 7.45
~ PaCO2 < 35 mm Hg

Signs & Symptoms of Respiratory Alkalosis
~ Lightheadedness/unconsciousness
~ Elevated pulse > palpitations
~ Numbness and tingling
~ Tinnitus

Causes of Respiratory Alkalosis
~ Extreme anxiety
~ High Fever
~ Pain
~ Salicylate poisoning
~ Excessive mechanical ventilation

Nursing Actions for Respiratory Alkalosis
~ Monitor ABG, V/S, Neuro status, ventilator
~ Provide reassurance and a calm, quiet environment
~ Assist patient w/ development of coping strategies
~ Assess/treat anxiety, pain, over-ventilation
~ Teach patient to breathe through paper bag.