2. F&E 2 Flashcards
Hyponatremia causative factors:
Vomiting, diarrhea, fistulas, sweating
Diuretics, low salt diets, deficiency of aldosterone
Water intoxiction - causes water to move into the cell = ECF volume excess; seen with inappropriate ADH; hyperglycemia, tap-water enema; irrigation of g-tubes with water instead of NS; compulsive water drinker; excessive use of IV Dextrose and Water
-SIADH
SIADH
syndrome of inappropriate ADH, so increase AHD (reabsorbs water and sodium filling up urine)
Leads to inappropriate urination of sodium
Conditions associated w SIADH = oat-cell lunc tumors, head injury, endocrine and pulmonary disorders; physiologic and psychological stress; medications – chemo agents
Hyponatremia s/s
Headache, orthostatic BP, nausea, abdominal cramping, altered mental status, can have seizures that lead to coma, poor skin turgor, dry mucosa, decreased saliva production, Anorexia, muscle cramps, exhaustion; serum sodium below 115 mEq/L; signs of increased intracranial pressure – lethargy, confusion, muscle twitching, focal weakness, hemiparesis, seizures
Hyponatremia treatment
Sodium replacement – by mouth, nasogatric tube, or IV
Water restriction – total 800 ml / 24 hours
Hypernatremia patho
fluid deprivation in unconscious patients who cannot perceive, respond to, or communicate thirst; Very old, very young, cognitively impaired persons
Hypernatremia causative factors:
Fluid deprivation, hypertonic enteral feedings (Adminstration without water supplements); watery diarrhea, hyperventilation, burns, diabetes insipidus (polydispia – increase urination, holding on to salt)
Less common causes: heat stroke, near-drowning in sea water, malfunction of HD or PD systems, IVF – hypertonic saline
Hypernatremia s/s
Neurologic (primarily neurologic – consequence of cellular dehydration – concentrated ECF), diminished DTR, restlessness, weakness, disorientation, delusions, hallucinations; thirst, dry/sticky mucus membrane, red/dry tongue; body temp rises
Hypernatremia treatment
monitor how quick, want gradual change back to normal - Gradual lowering of serum sodium by infusion of hypotonic electrolyte solution – 0.3% sodium chloride) or an isotonic nonsaline solution (D%W) – as indicated when water needs to be replaced without sodium
may give diuretics for fluid overload - to treat sodium gain
may need dialysis
monitor fluid loss
Hypokalemia
o Indicates an actual deficit in total K+ stores
o GI loss most common cause; vomiting and gastric suction may lead to hyokalemia
Hypokalemia causative factors
Diuretics, vomiting, gastric suction, diarrhea, hypersecretion of insulin, dietary, debilitated, elderly, alcoholism, anorexia, bulimia
Hypokalemia s/s
Cardiac or respiratory arrest, dysrhythmia, digitalis sensitivity, flat/inverted T wave on EKG; alkalosis; fatigue, anorexia, N/V; muscle weakness, leg cramps, decreased bowel motility (muscle contractions), paresthesias
- symptoms not likely unless beow 3.0 mEq/L
Hypokalemia treatment
Dietary or IV intake – give potassium by mouth if able, if not then dilute and give by IV - Cannot give undiluted potassium, will kill pt
• Increased intake of dietary K+, or IVF therapy, 40-80mEq/day is adequate in adults
• Foods = fruit – raisins, banana, apricots, organes, vegetables, legumes, whole grains, milk, and meat, Salt substitutes contain 50-60 mEq of K+ per teaspoon
Hyperkalemia
Seldom occurs with normal renal function - is often due to treatments of other conditions
Cardiac arrest more common with elevated K+
Causes of “pseudo” hyperK+ : tight tourniquet around exercising extremity while drawing a blood sample and hemodialysis of sample before analysis
eukocytosis (WBC > 200,000); thrombocytosis (platelets > 1 million); drawing blood above K+ infusion site Measurements should be verified
Hyperkalemia causative factors
Renal failure; deficient adrenal hormones; medications; diet; burns, tissue trauma, may be because of shortening of dialysis
- Major cause: decreased renal excretion of K+ - untreated renal failure; hypoaldosteronism and Addison’s disease (deficient adrenal hormones)
- Medications – KCL, heparin, angiotensin-converting enzyme inhibitors, captopril, nonsteroidal antiinflammatories, K= sparing diuretics
- High dietary intake; K+ supplements; IVF;
Hyperkalemia s/s
- Peaked T waves, widen QRS on EKG; cardiac arrest; acidosis
- Skeletal muscle weakness; numbness, paresthesia, paralysis
- Nausea, colic, diarrhea, abdominal cramping
- cardiac effects not usually significant below 7 mEq/L but almost always present when 8 mEq/L or greater
- Earliest changes – narrow T wave, ST segment depression, shortened QT interval (6 mEq/L) if levels continue to increase, PR interval prolonged – disappearance of P wave; ventricular dysrhythmias, cardiac arrest
Hyperkalemia treatment
- Restrict K+ intake – oral and IV, eliminate salt substitutes
- Retention enema; Kayexalate – orally or retention enema (do not use if paralytic ileus or intestinal perforation can occur)
- EKG to detect changes; repeat serum K+ level from vein
Hypocalcemia causative factors
Hypoparathyroidism, also associate with surgery on thyroid and parathyroid glands and radical neck dissections, Inflammation of pancreas; renal failure; insufficient Vitamin D; Magnesium deficiency; thyroid carcinoma; low albumin, alkalosis, alcohol abuse
Hypocalcemia s/s
Tetany, tingling fingers, mouth, feet; spasms in extremities or face; seizures; mental changes, delirium; prolonged QT interval on EKG, Ventricular tachycardia
- tetany – the entire symptom complex induced by increase neural excitabilty – sx due to spontaneous discharges of both sensory and motor fibers in peripheral nerves
- Trousseau’s sign – inflate bp cuff, carpal spasms (abduction thumb, flexed wrist, fingers together)
- Chvosterk’s sign - tap side of cheek and notice twitching
- seizures may occur – increased irritability of CNS; mental changes – depression, impaired memory, confusion, delirium, hallucination
Hypocalcemia assessment
Serum calcium, albumin Level, arterial pH; PTH level; Magnesium & phosphorus levels
Hypocalcemia treatment
Calcium salts via IVF therapy; Vitamin D therapy; aluminum hydroxide antacids; dietary replacement
- acute symptoms are life-threatening and require prompt treatment with IV calcium
- Parenteral calcium salts – calcium gluconate, calcium chloride, calcium gluceptate
- Too rapid IV admin can cause cardiac arrest – dangerous in patients receiving digitalis-derived meds
- IV calcium should be diluted in D5W –given slow IV bolus or slow IV infusion (0.9% NS should NOT be used with calcium because it increases renal calcium loss)
- Solutions with phosphates or bicarb should NOT be used -> percipitates when calcium is added
- Calcium can cause postural hypotension – keep in bed for IV replacement and monitor BP
- Vit D therapy – increase calcium absorption from GI tract
- Aluminum-hydroxide antacids
- Dietary intake to at least 1000 – 1500 mg/day in adult
- Foods high in calcium = milk products, green leafy vegetable, canned salmon, sardines, fresh oysters
hypercalcemia crisis
17** severe thirst and polyuria; muscle weakness, intractable nausea, abdominal cramps, obstipation or diarrhea, peptic ulcer symptoms, bone pain; lethargy, confusion, and coma – very dangerous condition – may lead to cardiac arrest.
• mortality rate as high as 50% if not treated promptly.
hypercalcemia causative factors
Malignancy, bone cancer, hyperparathyroidsim ; excessive PTH (secretion = increased release of calcium from bones and increased intestinal and renal absorption); immobilization (Bone mineral is lost during immobilization – may cause increase in total calcium); thiazide diuretics (may cause slight elevation – they potentiate the action of PTH on kidneys = reduced urinary calcium excretion); vitamin A & D intoxication, lithium
hypercalcemia s/s
Muscle weakness, depressed DTR, uncoordination; lethargy, confusion, coma, short QT on EKG; renal stones
- hyper ca+ reduces neuromuscular excitability – suppresses activity at myoneural junction
- Muscle weakness, incoordination, anorexia, constipation
- Cardiac standstill may occur when serum calcium is 18mg/dl
- Dig toxicity is aggravated by hypercalcemia
- Anorexia, N/V, constipation; dehydration; abdominal / bone pain; abdominal distention and paralytic ileus; excessive urination; severe thirst; peptic ulcer sx – increased secretion of acid and pepsin by stomach
- Confusion, impaired memory, slurred speech, lethargy, acute psychotic behavior, or coma may occur
hypercalcemia treatment
Treat underlying cause; IVF therapy; mobilize patient; restrict dietary intake
