FLUIDS AND ELECTROLYES IMBALANCES

Question 1

❖ Loss of body fluid causing a decrease in blood volume.

(Fluid Volume Deficit)

Answer 1

HYPOVOLEMIA

Question 2

Fluid losses such as those resulting from:

→ Once FVD develops, kidneys attempt to conserve body fluids resulting:

Answer 2

vomiting, diarrhea, GI suctioning, and sweating; decreased intake, as in nausea or lack of access to fluids; and third-space fluid shifts.

UO of less than 1mL/h

Question 3

is a condition that causes excessive urination, and this is due to the inability of the kidneys to respond to ADH which can increase urine formation causing polyuria.

Answer 3

Diabetes Insipidus

Question 4

❖ DIAGNOSTIC FINDINGS OF HYPOVOLEMIA
→ can occur with GI & renal losses as these organs are major regulators of potassium.

Answer 4

Hypokalemia

Question 4

❖ DIAGNOSTIC FINDINGS OF HYPOVOLEMIA
→ can occur with adrenal insufficiency due to aldosterone deficiency which causes lack of potassium excretion.

▪ Aldosterone deficiency decreases Na reabsorption, leading to increased Na excretion. The relationship between Na and K = when Na is reabsorbed, K is excreted to maintain electrolyte balance. However, due to aldosterone deficiency, both Na excretion and K retention can occur causing hyperkalemia.

Answer 4

Hyperkalemia

Question 4

❖ DIAGNOSTIC FINDINGS OF HYPOVOLEMIA
→ occurs with increased thirst and ADH release, which increases water content of the bloodstream.
▪ Excessive water in the body dilutes the fluids

Answer 4

Hyponatremia

Question 4

ASSESSMENT
S/Sx
Decreased Urine Output (EXPLAIN)

Answer 4

➢ dehydration > hypothalamus will sense it > stimulate PPG to release ADH > ADH prevents kidney from releasing urine by stimulating renal tubules to reabsorb water

Question 5

❖ DIAGNOSTIC FINDINGS OF HYPOVOLEMIA
→ can result from increased insensible water losses and diabetes insipidus,

Answer 5

Hypomagnesemia

Question 6

❖ DIAGNOSTIC FINDINGS OF HYPOVOLEMIA
→ may or may not be present.

▪ NORMAL UO: 1L per day
▪ POLYURIA: increased urination (DM and DI)
▪ OLIGURIA: decreased urination 400–600 mL
▪ ANURIA: only excreting 50mL in 24 hours

Answer 6

Oliguria

Question 7

❖ MEDICAL MANAGEMENT
→ Antidiarrheal

→ Isotonic Electrolyte Crystalloid Solutions

→ Hypotonic Electrolyte Solution

Answer 7

→ Antidiarrheal such as loperamide and bismuth subsalicylate.

→ If not severe, oral route is preferred. If acute or severe, IV route is required.

→ Isotonic Electrolyte Crystalloid Solutions
▪ These are frequently the first-line choice to treat the hypotensive patient with FVD because they expand plasma volume.
▪ e.g., lactated Ringer’s solution or 0.9% sodium chloride

→ Hypotonic Electrolyte Solution
▪ If patient becomes normotensive, this is often used to provide both electrolytes and water for renal excretion of metabolic wastes.
▪ (e.g., 0.45% sodium chloride)

Question 7

HYPERVOLEMIA (Fluid Volume Excess)
❖ Excessive retention of fluid in the body that can increase blood volume.
→ FVE may be related to simple fluid overload or diminished function of the homeostatic mechanisms responsible for regulating fluid balance.

Answer 7

HYPERVOLEMIA

Question 7

❖ NURSING INTERVENTIONS HYPOVOLEMIA

Answer 7

→ Monitor VS every 4 hours. (↓ BP & ↑PR)

→ Promote adequate fluid replacement.
▪ IV fluids
▪ Oral Rehydration Solutions
➢ These provide fluids, glucose, and electrolytes – easily absorbed.
➢ e.g., rehydralyte, elete, and cytomax

→ Monitor and measure I&O to determine when therapy should be slowed to avoid volume overload.
▪ Report if urine output is below 250cc/8hrs.
▪ Normal: 240 to 250 cc per 8 hours

→ Provide oral hygiene several times per day.
▪ Dry mouth causes bad breath (halitosis)
▪ Oral hygiene ᛏ amount of saliva (saliva has plenty of lysosomes which can kill bacteria in the mouth).

→ Routinely check body weight.
▪ Loss of 0.5kg (1.1lb) = 500mL fluid loss
▪ 1L of fluid = 1kg or 2.2lb

→ Monitor lab results such as:
▪ ↑ Blood Urea Nitrogen, creatinine, Hematocrit Blood Test, serum and urine osmolality, and specific gravity; ↓urine
sodium

Question 7

→ This can occur due to increased capillary fluid pressure, decreased capillary oncotic pressure, or increased interstitial oncotic pressure.

▪ Hypervolemia can cause edema due to liver, heart, and lung failure resulting to excess fluids in the body; These fluids will go to the third spaces in the body causing edema

Answer 7

EDEMA

Question 8

❖ NURSING INTERVENTIONS

Answer 8

→ Monitor and measure I&O and daily weight.

→ Assess breath sounds at regular intervals.
▪ Abnormal breath sounds heard in patients with FVE are crackles, wheezing, rhonchi.

→ Monitor the degree of edema (press using thumb); on a scale of 1+ (minimal) to 4+ (severe).

→ Regular rest periods may be beneficial because it supports the body’s diuresis process, helping to reduce the excess fluid load.
▪ In a supine position, the blood in the lower extremity travels more in the abdomen area and more blood will go to the kidneys which increase urine formation = excretion.

→ Advise the patient to avoid foods high in sodium such as sausage, bacons, seafood, fish or poultry, canned goods, pizza, processed cheese, pickles,tomato sauce, breads, and soy sauce.

→ Advise the patient to eat seasoning substitutes such as onion, garlic, and lemon juice to decrease sodium intake.

→ Advise malnourished patients to increase protein intake such as egg, chicken breast, salmon, tuna, beef, cottage cheese, and almonds to increase capillary oncotic pressure; Increased COP will pull fluid out of the tissues into vessels for excretion by
the kidneys.

→ If dyspnea or orthopnea is present, place the patient in a semi-Fowler position to promote lungexpansion.
▪ Orthopnea occurs when patient is having difficulties in breathing while lying and it is relieved by sitting.

→ Reposition the patient at regular intervals because edematous tissue is more prone to skin breakdown than normal tissue.
▪ Epidermis has no vessels while dermis has, epidermis gets nutrients at the dermis. The water will go to the space between the dermis and vessels, causing the epidermis to detach from the dermis or be destroyed resulting to bedsores.

→ Instruct patient to use anti-embolic stockings because this helps improve blood circulation, which can prevent fluid from pooling in the legs and reduce edema.

→ Monitor lab results:
▪ Labs indicate: ↓ BUN, hemoglobin &hematocrit, serum and urine osmolality; and ↑urine sodium and specific gravity

Question 8

Types of Edema
▪ It can be localized (e.g., ankle, rheumatoid arthritis).
▪ It can be generalized (e.g., cardiac failure and kidney injury).
▪ ____ – severe generalized edema

Answer 8

Anasarca

Question 9

→ Functions: (Nervous System)
▪ transmission and conduction of the nerve impulse; contractility of the muscles
▪ attracts fluid and helps preserve the ECF and fluid volume distribution on the body
▪ combines w/ chloride and bicarbonate to regulate acid-base balance
(most abundant in ECF)

Answer 9

❖ SODIUM Na+

Question 10

Foods high in sodium:

Answer 10

▪ Sausage, bacons, seafood, fish or poultry, canned goods, pizza, processed cheese, pickles, tomato sauce, breads, and soy sauce.

Question 11

SODIUM → Normal Value:
▪ ECF: mEq/L
▪ ICF: mEq/L

Answer 11

135-145

10-14

Question 12

→ Sodium level is less than 135 mEq/L.
▪ Plenty of Na is inside the cells and this attracts the water at the ECF to also go inside the cells which causes swelling = rupture; and this can lead to seizures.
▪ This is due to excessive intake of fluids making the sodium diluted

Answer 12

HYPONATREMIA

Question 13

→ Nursing Management: HYPONATREMIA

Answer 13

▪ Monitor vital sings at regular intervals. This condition causes ↑PR and ↓ BP.
▪ Monitor I&O and body weight at regular intervals.
▪ Advice patient to restrict fluid intake and eat sodium rich foods.

▪ If seizures occur:
➢ Immediately protect the head, put a pillow or anything soft.
➢ Side rails up and put pillows at the side of the patients to prevent fall.
➢ Place patient on a side-lying position and turn the head on one side to prevent aspiration.
➢ Don’t put anything in the mouth, because it can push the tongue at the back which can block the airway; it can break the teeth.
➢ Don’t hold the extremities because it can cause fracture or any injury

▪ If patient can’t consume sodium orally, lactated Ringer’s solution or isotonic saline (0.9% sodium chloride) solution may be prescribed.

Question 14

→ Sodium level is greater than 145 mEq/L.

▪ There is high Na level outside the cells which pulls water out of cells causing cell shrinkage (dies). When brain cells lose too much water, they shrink and this can trigger abnormal electrical activity = seizure.

▪ Thirst (mechanism) is the body’s main defense against hyp_rnatremia

▪ Fluid deprivation in patients that can’t drink voluntarily: infants, confused elderly people, and unconscious or cognitive impaired px.
▪ Increased intake of sodium (Oral / IV)

Answer 14

HYPERNATREMIA

Question 15

OTHER REMINDERS FOR HYPERNATREMIA

▪ Enteral feeding without adequate water supplement.
➢ Hypertonic Solution: particles is higher than water
✓ example: osteorized feeding (TPN) – plenty of salt will attract
water

➢ Osteorized Feeding for patients who can’t eat.

Place patient in a sitting position. The doctor will insert a nasogastric tube, instruct patient to do swallowing reflexes while tube is being inserted.

✓ Length of tube: earlobes to the tip of the nose then tip of nose to the xiphoid process.

✓ Dietician makes the osteorized content.

✓ Osteorized can block the tube so flush it with 50cc of water.

➢ Hypernatremia can result from Diabetes Insipidus, where the kidneys fail to respond to ADH. This causes increased water excretion, leading to excessive urination and loss of water from the body.

Answer 15

.

Question 16

→ Nursing Management: HYPERNATREMIA

Answer 16

▪ Monitor vital signs at regular intervals. This condition causes ↑PR, BP, and Temperature.
▪ Advice the patient to increase fluid intakeand avoid foods rich in sodium.
▪ Observe for changes in neurologic status, such as confusion, disorientation, and possible decreased level of consciousness.

Question 17

→ Correcting hypernatremia too quickly could cause water to shift rapidly into the cells and may cause the brain cells to swell.

Answer 17

cerebral edema

Question 18

Functions: (CVS System)
▪ Promotes transmission and conduction of nerve impulses and the contraction of skeletal, cardiac, and smooth muscles.
▪ Assists in the regulation of intracellular osmolality.
▪ Assists in the maintenance of acid-base balance.
➢ K in acid-base balance allows the acid (hydrogen ions) to enter the cells.

Answer 18

❖ POTASSIUM K+

Question 19

Foods rich in potassium:

Answer 19

▪ Banana, cantaloupe, honeydew, orange juice, potato, dried fruits, raisin, milk, citrus, whole grain, avocado, beans, fish, spinach, and peaches

Question 20

Normal Value of Potassium:
▪ ECF: ____ mEq/L
▪ ICF: ____ mEq/L

Answer 20

3.5-5

140-150

Question 21

A serum K level less than 2.5 mEq/L or greater than 7.0 mEq/L may result in _____

Answer 21

cardiac arrest

Question 22

ECG:

Atrial Depolarization (contraction)
➢ Atrium Contraction; AV Valves are open; SV are close; giving blood to the ventricles.

Answer 22

P

Question 23

ECG:

The stimulus travels from SA Node to AV Node; Holds the AV Node to open allowing the blood to be filled in the ventricles.

Answer 23

▪ PR INTERVAL

Question 24

ECG:

Ventricular Depolarization
➢ dapat maliit lang yung Q
➢ Ventricular Contraction; AV Valves close; SV are open

Answer 24

QRS

Question 25

ECG:

Early Ventricular Repolarization
➢ Ventricles are starting to rest

Answer 25

ST

Question 26

ECG:

Ventricular Repolarization (relaxation)
➢ Complete relaxation of ventricles.
➢ Atrium starts contracting again.

Answer 26

T

Question 27

Potassium level is less than 3.5 mEq/L.
▪ Severe Hypokalemia – cardiac arrest or respiratory arrest = death

Answer 27

HYPOKALEMIA

Question 28

FACTORS in Medications

➢ Corticosteroids
➢ Insulin
➢ Steroids

Answer 28

➢ Corticosteroids causes sodium reabsorption therefore potassium is excreted.

➢ Insulin
✓ Its function is to bring glucose into cells for energy and it can take potassium along with it. This can lead to lower K in the blood.

➢ Steroids
✓ This causes sodium retention and causing potassium excretion.
✓ Stress increases the production of steroids in the body which can intensify the sodium-retaining effect and excretion of K.

Question 29

▪ Toxic effects of Digoxin

Answer 29

➢ Function:
✓ (+) Inotropic = CO increases
✓ (-) Chronotropic – HR decreases to allow the AV valves to open for 0.5 seconds allowing more blood to flow in the ventricles. If there is increased HR, the AV valves immediately closes (0.2 or 0.3) which lessens the blood going to ventricles.
✓ (-) Dromotropic

➢ Given if you have Heart Failure.
✓ HF can cause edema because the weakened heart struggles to pump blood effectively, causing increased pressure in veins and fluid leakage into tissues. Therefore, diuretics are prescribed to remove excess fluid causing the patient to urinate frequently and this may result in low K.

➢ Usually given with Furosemide (loop diuretic) and they can increase urination = low K.
✓ To prevent low K, give Potassium-Sparing Diuretics

Question 30

→ Nursing Management: HYPOKALEMIA

Answer 30

▪ Monitor the vital signs at regular intervals.
➢ ↓ BP; orthostatic hypotension
▪ Monitor the I&O at regular intervals.
➢ because 40 mEq of potassium is lost for every liter of urine output
▪ Advice the patient to increase intake of foods high in potassium.
➢ Dietary intake of potassium in the average adult is 50 to 100 mEq/day.
➢ Oral potassium supplements can produce small bowel lesions; therefore, the patient must be assessed for and cautioned about abdominal distention, pain, or GI bleeding.
▪ If oral administration is not feasible, the IV route is indicated.
➢ IV is prescribed for severe hypokalemia
▪ Monitor the ECG.
➢ flattened T waves, increased U waves, ST depression, prolonged PR interval
➢ Most prominent characteristic of Hypokalemia is the presence of U Wave.
✓ Presence of U wave is normal in aged and children

Question 30

→ Potassium level is greater than 5mEq/L.

→ Factors:
▪ Kidney failure
▪ Severe traumatic injury

➢ Burns – cells are destroyed > K goes out > hyperkalemia

➢ Bleeding - less blood circulating > anaerobic metabolism > lactic acid > metabolic acidosis
▪ Blood for transfusion that is 1-3 weeks old.

➢ Old RBC releases K into the blood.
▪ Acidosis. If blood pH decreases K goes out the cells because hydrogen ions go insidethe cells

➢ Sodium Bicarbonate will increase the pH, therefore the K that goes back in the cells.

Answer 30

HYPERKALEMIA

Question 31

→ Complications: HYPERKALEMIA

▪ Respiratory/Metabolic Acidosis
▪ Metabolic Acidosis leads to Hyperkalemia.
▪ Medication (to correct acidosis)

Answer 31

▪ Respiratory/Metabolic Acidosis
➢ hyperkalemia > cardiac dysrhythmia > ᛏ cardiac rate > ᛎ cardiac output > less oxygen & nutrients going to the body > hypoxemia > px will become weak because there is less oxygen > anaerobic metabolism > lactic acid is produced > metabolic acidosis
➢ Anaerobic metabolism - creation of energy through the combustion of carbohydrates in the absence of oxygen > lactic acid is produced.
➢ Patient will be given o2.

▪ Metabolic Acidosis leads to Hyperkalemia.
➢ Anaerobic metabolism > lactic acid is produced > metabolic acidosis > plenty of H+ ions (acid) > plenty H+ ions will be filling the blood > H+ will go into the cells > entrance of H+ will push K outside > hyperkalemia

▪ Medication (to correct acidosis)
➢ Na HCO3 (ᛏ base) – Sodium Bicarbonate neutralizes excess acid bringing the pH closer to normal. As acidosis is corrected, the K that went out goes back in, lowering the K in blood.

Question 32

→ Causes of Metabolic Acidosis:

Answer 32

▪ Damaged kidney impacts the acid-base balance.
➢ Kidneys function in maintaining acid-base balance by excreting waste products like uric acid & urea.
➢ Kidneys produce bicarbonates (base) which neutralizes excess acid.
▪ Damaged lungs increase acidity because they can’t eliminate enough CO2.
▪ Bleeding reduces oxygen supply can lead to the production of lactic acid, increasing acidity.
▪ Diarrhea (removes bicarbonate)

Question 33

→ Nursing Management: HYPERKALEMIA

▪ Monitor the vital signs at regular intervals.
▪ Monitor I&O at regular intervals.
▪ Advice patient to avoid potassium rich foods but still need to eat low K foods.
▪ Monitor K serum levels.
▪ Advice patients who use Na substitute to use them cautiously, as each tsp may contain up to 60 mEq of K.
▪ Monitor the ECG

Answer 33

▪ Monitor the vital signs at regular intervals.
➢ Apical pulse should be taken because high K causes ᛏ CR.

▪ Monitor I&O at regular intervals.

▪ Advice patient to avoid potassium rich foods but still need to eat low K foods.
➢ Low K Foods: Cucumber, apples, cherries coffee, eggplant, onion, grapes, rice, coleslaw, watermelon, and peas.

▪ Monitor K serum levels.
➢ Report values more than 5.3 mEq/L

▪ Advice patients who use Na substitute to use them cautiously, as each tsp may contain up to 60 mEq of K.
➢ Na substitute contains K instead of Na.
➢ Used by patients who need to reduce their sodium intake.

▪ Monitor the ECG

Question 34

HYPERKALEMIA

▪ Monitor the ECG. = _________

➢ ECG Manifestations:
✓ 5.5 – 6.0 mEq/L
✓ 6.0 – 7.0 mEq/L
✓ ᛏ 8.0 mEq/L

Answer 34

• Tall, peaked T waves
• ## Loss of P waves
• Prolonged PR interval
• ## Widened QRS interval
• complete heart block & cardiac arrest

Question 35

→ Medical Management: HYPERKALEMIA
▪ 5.5 – 6.5 mEq/L

to do:

Answer 35

(MILD)

➢ restrict K intake

Question 36

→ Medical Management: HYPERKALEMIA
6.5 – 7.5 mEq/L

to do:

Answer 36

(MOD)

➢ Give Kayexalate or Kalimate (1 sachet in 100cc of water).
✓ Kayexalate lowers the K in the body by binding K in the intestine.
➢ Give diuretics: furosemide
➢ Give beta-2 agonist (salbutamol, albuterol) through nebulization.
✓ causes K to move from ECF to ICF

Question 36

→ Medical Management: HYPERKALEMIA
ᛏ 7.5 mEq/L

to do:

Answer 36

(SEVERE)

➢ Calcium Gluconate (10mL/ampule in 10% solution)
✓ Given for cardiac dysrhythmia.
* slow IV push – rapid administration may cause hypotension
✓ Counteract the adverse effects of high K levels on the heart’s electrical activity, helping to restore a more stable heart rhythm.
✓ Ca ᛎ the irritability of the myocardium resulting from ᛏ K.
✓ Does not promote K loss.

Question 36

→ Medical Management: HYPERKALEMIA

➢ Glucose Insulin (50mL)

Answer 36

✓ It will carry the K to enter the cell.

✓ Since insulin is also a carrier of glucose, the glucose in the blood is also being sent inside the cells, so possible for the px to become hypoglycemic > not good because normal serum glucose is 80-100 mg/dL, glucose is needed by the cells for energy > if you bring it all inside the cell, there will be less sugar > brain will immediately suffer

✓ Brain cells – do not store glucose; depend on the blood circulating in the brain per minute

Question 36

Functions:
▪ muscle contraction, blood clotting process, transmission of nerve impulses, formation of bones

Answer 36

❖ CALCIUM Ca2+

Question 37

Calcium Metabolism:
▪ Vitamin D is

▪ Low Ca:

▪ High Ca:

Answer 37

needed for the absorption of calcium in the small intestine.

➢ Vitamin D that we get from exposure to sunlight or egg yolk, butter, milk, is still inactive and therefore cannot be used yet by the body.

➢ Kidney activates the vitamin D. Once activated, vit. D will be absorbing the calcium we ate (milk, cheese).

▪ Low Ca: Parathyroid is stimulated > PTH is released > release Ca from bones

▪ High Ca: Thyroid is stimulated > Calcitonin is released > inhibits calcium release from bones

Question 38

Foods high in calcium:

Answer 38

▪ Okra, broccoli, cabbage, coconut meat, almonds, pumpkin seeds, avocado, celery, onions, milk, cheese, yogurt, onions, leeks, asparagus, and spinach.

Question 39

→ Normal Values: CALCIUM
▪ ECF: mg/dL
▪ ICF: mEq/L

Answer 39

8.8-10.5

<1

Question 39

❖ CALCIUM and PHOSPHATE.

→ If kidneys are damaged, phosphates level will be high, and calcium will become low.

Answer 39

▪ For calcium to be absorbed, doctors will prescribe an active vitamin D (calcitriol) &Calcium Carbonate to lower phosphate levels.

▪ Aluminum hydroxide, calcium acetate, or calcium carbonate antacids may be prescribed to decrease elevated phosphorus levels before treating hypocalcemia.

➢ High phosphate levels = Ca will not be absorbed

Question 40

Calcium level is less than 8.8 mg/dL.
▪ If with renal failure, calcium will not be absorbed because vitamin D is not activated =

Answer 40

HYPOCALCEMIA

Question 41

If with renal failure, calcium will not be absorbed because vitamin D is not activated = hypocalcemia.
(EXPLAIN)

✓ Avoid falls – side rails up.
➢ PTH will also increase Ca absorption from the GIT (small intestine).

Answer 41

➢ Decrease in calcium will be felt by the parathyroid gland at the back of thyroid gland. The parathyroid gland will release PTH, PTH will order the bones to release calcium because there is less Ca in the blood (bone resorption) causing the bones to be brittle & soft.

Question 42

HYPOCALCEMIA
▪ Early Signs (Tetany)

– twitch or spasms of facial muscles
✓ To assess, tap px’s face below the zygomatic arch. This will trigger twitching of face

Answer 42

Chvostek Sign

Question 43

HYPOCALCEMIA
▪ Early Signs (Tetany)

twitch or spasms of hand/ fingers
✓ To assess, inflate BP cuff on the arm to about 20mmHg above systolic pressure this temporarily decreases blood flow in the arm. Within 2 to 5 mins, twitching of the hand/fingers will occur.

Answer 43

Trosseau Sign –

Question 44

→ Nursing Management: HYPOCALCEMIA

Answer 44

▪ Monitor VS at regular intervals. (↓ BP)

▪ Oral Calcium Supplements:
➢ Administer at least 30 minutes prior to a meal to enhance intestinal absorption.
➢ Advise patient to eat foods rich in calcium, vitamin D, and protein.
➢ Calcium supplements must be given in divided doses of no higher than 500 mg to promote calcium absorption.

▪ Check for prolonged bleeding or reduced clot formation because Ca can cause clotting of the blood.

▪ Advise patient to avoid alcohol and caffeine intake because this limit calcium absorption.

▪ Advise patient to avoid cigarette smoking because this increases urinary excretion of calcium.

▪ Advise patient to avoid laxatives and antacids with phosphorus because they decrease Ca absorption.

▪ Handle the patient gently because patient is suffering from severe bone calcium loss which makes the bone soft and brittle.

➢ side rails up to avoid fall

➢ use bed sheet to lift patient

Question 45

Calcium level is greater than 10.5 mg/dL.
▪ This can cause calculi (stone).
▪ If there’s excess Ca in the blood, the thyroid gland will secrete calcitonin.
➢ Calcitonin lower blood Ca levels by decreasing the release of calcium from bones and promoting its excretion by the kidneys.
➢ Higher calcium levels excreted in the urine due to calcitonin’s action can increase the risk of kidney stone formation (renal calculi).

Answer 45

HYPERCALCEMIA

Question 46

Factors of Hypercalcemia

Answer 46

Hyperparathyroidism.

Question 47

Excessive PTH secretion causes increased release of calcium from the bones and increased intestinal and renal absorption of
calcium.

Answer 47

Hyperparathyroidism

Question 48

→ Nursing Management: HYPERCALCEMIA

Answer 48

▪ Monitor VS at regular intervals. (↓ PR)

▪ Active and passive exercise for bedridden patients.
➢ For conscious px: ambulate
➢ Immobile/lack of exercise = increases bone resorption

▪ Encourage patient to drink 3-4L of fluid daily to remove Ca from kidneys through urine.
➢ Fluids containing sodium should be given because Na assists with Ca excretion.

▪ Advise patient to avoid food rich in Ca.

▪ Advise patient to eat foods high in fiber such as avocado, apple, almond, sweet potatoes, oats, pea, and carrots to prevent constipation.

▪ Encourage foods that increases urine acidity because it can help promote the excretion of excess calcium.
➢ Acid-Ash Diet: meat, cheese, eggs, prune juice, whole grains, and cranberry juice

▪ Provide safe environment: side rails up and position the bed in lowest position.

Question 49

Functions:
▪ Acts as an activator for many intracellular enzyme systems and plays a role in both carbohydrates and protein metabolism.

▪ Produces its sedative effect at the neuromuscular junction, probably by inhibiting the release of the neurotransmitter acetylcholine.
➢ Acetylcholine transmits signals between nerves and muscles leading to muscle contractions and nerve excitability.

▪ Increases the stimulus threshold in nerve fibers by making them less excitable (calm) because the nerves are sensitive due to muscle spasms, seizures, tremors, & anxiety.

▪ Effect in CV (ᛎ BP): acts peripherally to produce vasodilation and decreased peripheral resistance.

▪ Essential for the production and utilization of ATP for energy.

▪ Helps in the contractility of cardiac and skeletal muscles.

Answer 49

❖ MAGENSIUM Mg2+

Question 50

→ Foods high in magnesium:

Answer 50

▪ Almonds, spinach, soybeans, cashews, avocados, potatoes, and brown rice

Question 51

Normal Values: MAGNESIUM
▪ ECF: mg/dL
▪ ICF: mEq/kgb

Answer 51

1.8-3.6

40

Question 52

Magnesium level is lower than 1.8 mg/dL.
▪ ᛎ Mg increases neuromuscular irritability and contractility
▪ Mg levels should be evaluated in combination with albumin levels because 30% of Mg is albumin bounded.

Answer 52

HYPOMAGNESEMIA

Question 53

Factors:
▪ GI: Nasogastric Suction, Diarrhea, Fistula.

▪ Disruption in small bowel function such as intestinal resection and inflammatory bowel disease.

▪ Withdrawal from Alcohol
➢ Chronic alcohol abuse – major cause of symptomatic ᛎ Mg

Answer 53

.

Question 54

Signs and Symptoms:
▪ 3T’s and Hyperactive DTR’s
– (Chvostek Sign and Trousseau Sign)

Answer 54

➢ Tremors, Twitching, Tetany

Question 55

→ Nursing Management: HYPOMAGNESEMIA

→ Medical Management:

Answer 55

▪ Monitor VS at regular intervals. (↑ BP)
▪ Monitor I&O at regular intervals, and notify the physician if UO decreases to less than 100mL over 4 hours.
▪ Advise patient to increase foods high in Mg.
▪ Monitor lab values:
➢ ECG: flat or inverted T waves, depressed ST segment, prolonged PR interval, and widened QRS
—————————————–
▪ Mild magnesium deficiency can be corrected by diet alone.
▪ A magnesium IV solution can be used to counteract seizures due to preeclampsia or eclampsia, cardiac arrhythmia, asthma, and hypertension.

Question 56

→ Magnesium level is greater than 3.6 mg/dL.
▪ ᛏ Mg diminishes the excitability of the muscle cells

Answer 56

HYPERMAGNESEMIA

Question 57

Occur in patients with untreated DKA.

➢ This is due to the breakdown of cells during catabolism, releasing Mg into the bloodstream. However, the excess magnesium cannot be effectively excreted due to severe fluid volume depletion and oliguria

Answer 57

HYPERMAGNESEMIA

Question 58

→ Nursing Management: HYPERMAGNESEMIA

→ Medical Management:

Answer 58

▪ Monitor VS at regular intervals. (ᛎ BP)
➢ tachycardia → bradycardia

▪ Observe for decreased deep tendon reflexes (DTRs), muscle weakness, and changes in the level of consciousness.

▪ Administration of fluids and diuretics are often used in treatment and monitoring of I&O is important.

▪ Hemodialysis for severe hypermagnesemia, particularly if cardiovascular or neurologic manifestations are present.

▪ Monitor lab values:
➢ ECG: prolonged PR interval and QT, tall T waves, and widened QRS
——————————-
▪ Avoiding the administration of magnesium to patients with kidney injury and by carefully monitoring seriously ill patients who are receiving magnesium salts.
▪ Ventilatory support and IV Elemental Calcium are prescribed in emergencies such as respiratory depression or defective cardiac conduction.
▪ Hemodialysis

Question 59

Functions:
▪ provides support for bones and teeth
▪ metabolizes Carbohydrate, Protein, and Fat
▪ produces ATP, DNA, RNA
▪ Muscle, Nerve, and RBC function

➢ It gives energy (ATP) to muscles allowing contraction and movement.
➢ It is involved in sending electrical signals along nerve cells.
➢ It helps RBCs in transporting oxygen.
▪ regulates acid-base balance & Ca levels

Answer 59

❖ PHOSPHORUS HPO4

Question 60

Foods high in Phosphorus:

Answer 60

▪ Dairy foods, beans, nuts, oatmeal, colas, chicken, tuna, low-fat milk, tofu, scallop, squash and pumpkin seeds, garlic,
mushrooms, cashews and beef

Question 61

Normal Values: PHOSPHORUS
▪ ECF: ____ mg/dL

Answer 61

2.5-4.5

Question 62

→ Phosphorus level is lower than 2.5 mg/dL.

Factors:
▪ Heatstroke, hyperventilation, alcohol withdrawal, DKA, respiratory alkalosis, hepatic encephalopathy, and major thermal burns.
▪ GI Malabsorption Disorders. Chronic diarrhea, Crohn’s disease, or celiac disease.
▪ Vitamin D Deficiency. It regulates intestinal absorption of Ca and phosphate ion.
▪ High intakes of Antacids.

Answer 62

HYPOPHOSPHATEMIA

Question 63

→ Nursing Management: HYPOPHOSPHATEMIA

→ Medical Management:

Answer 63

▪ Advise patient to eat phosphorus-rich food.

▪ Administration of IV Solutions are prescribed to avoid rapid shifts of phosphorus into cells for patients who are malnourished and receiving parenteral nutrition.

▪ Vitamin D to enhance absorption of phosphorus and calcium.

▪ Burosumab (Crysvita) is a monoclonal antibody drug used for patients with low phosphorus.

Question 64

→ Phosphorus level is greater than 4.5 mg/dL.
→ Factors:
▪ Kidney injury is the most common.
➢ When renal insufficiency progresses to 40% to 50% = high phosphorus.
▪ Excessive intake of phosphorus, vitamin D excess, respiratory and metabolic acidosis, hypoparathyroidism, DKA, and hemolysis.

Answer 64

HYPERPHOSPHATEMIA

Question 65

→ Nursing Management: HYPERPHOSPHATEMIA

→ Medical Management:

Answer 65

▪ Monitor I&O at regular intervals.
▪ Advise patient to avoid phosphorus-rich foods.
▪ When appropriate, advise patient to avoid phosphate-containing laxatives & enemas.
———
▪ Phosphate binders (Calcium Carbonate or Calcium Citrate) can be given with meals to reduce hyperphosphatemia.
▪ Phosphate Binding Resins that do not contain calcium include sevelamer and lanthanum.
▪ Sucroferric Oxyhydroxide can also be used particularly in patients who require iron supplementation.
▪ Forced Diuresis with a loop diuretic or saline diuresis can be used in patients with normal renal function.

Question 66

Functions:
▪ It maintains cellular integrity by providing water balance and maintains acid–base balance.

▪ Combines with hydrogen to form Hydrochloric Acid (HCl).
➢ helps the body to break down, digest, and absorb nutrients

▪ Chloroid Plexus which secretes CSF depends on Na and Cl to attract water allowing the formation of the fluid portion of
the CSF.

▪ Bicarbonate has an inverse relationship with chloride. As chloride moves from plasma into the RBCs (chloride shift), bicarbonate moves back into the plasma maintaining acid-base balance.

▪ Buffer in Oxygen-Carbon Dioxide exchange in RBCs.
➢ When RBCs pick up CO2, this can cause acidity. The buffering action by Cl helps balance the acidity of the RBCs.

Answer 66

❖ CHLORIDE Cl-

Question 67

→ Foods high in Chloride:

Answer 67

▪ Table salt, salmon, shrimp, seaweed, rye, tomatoes, lettuce, celery, pickles, banana, kimchi, bacon, sausage, and olives

Question 68

Normal Values: CHLORIDE
▪ ECF: mEq/L
▪ ICF: mEq/L

Answer 68

98-106

3-4

Question 69

Chloride level is lower than 98 mEq/L

Answer 69

HYPOCHLOREMIA

Question 70

→ Nursing Management: HYPOCHLOREMIA

→ Medical Management:

Answer 70

▪ Monitor I&O, ABG values, and serum electrolyte levels.
▪ Vital signs are monitored, and respiratory assessment is carried out frequently.
▪ Advise patient to eat chloride-rich foods.
———————–
▪ Normal saline (0.9% sodium chloride) or half-strength saline (0.45% sodium chloride) solution is given by IV to replace the chloride.
▪ If the patient is receiving a diuretic (loop, osmotic, or thiazide), it may be discontinued or another diuretic prescribed.
▪ Ammonium Chloride (acidifying IV agent)may be prescribed to treat metabolic alkalosis; the dosage depends on the patient’s weight and serum chloride level.
➢ This agent is metabolized by the liver, and its effects last for about 3 day

Question 71

→ Chloride level is greater than 106 mEq/L.

Answer 71

HYPERCHLOREMIA

Question 72

→ Nursing Management: HYPERCHLOREMIA

→ Medical Management:

Answer 72

▪ Monitor VS at regular intervals. (↑RR, ↑PR)
▪ Monitor ABG values and I&O.
▪ Advise patients to avoid foods high in sodium and chloride; and maintain adequate hydration.
————————-
▪ Lactated Ringer’s Solution may be prescribed to convert lactate to bicarbonate in the liver, which increases the bicarbonate level and corrects the acidosis.
▪ IV sodium bicarbonate may be given to increase bicarbonate levels, which leads to the renal excretion of chloride ions because bicarbonate and chloride compete for combination with sodium.
▪ Diuretics may be given to eliminate chloride.

Question 73

→ Bicarbonate is formed through the dissolution of CO2 in water, leading to the formation of carbonic acid, which can then dissociate into bicarbonate ions and hydrogen ions.

▪ Bicarbonate ions act as a buffer, helping to neutralize excess hydrogen ions and prevent drastic changes in pH.

▪ Hydrogen ions, on the other hand, are a measure of acidity and can disrupt cellular processes if their concentration becomes imbalanced.

❖ Functions:
→ Major body buffer involved in acid-base regulation.
▪ Blood pH & Respiratory Regulation

→ It helps neutralize the acidic chyme in digestive system.
→ It helps maintain the pH of the ECF, which in turn affects the pH of ICF.

Answer 73

❖ BICARBONATE HCO3

Question 74

❖ Normal Values:
→ ECF: mEq/dL
→ ICF: mEq/

Answer 74

24-31

7-10