Acid-base, electrolytes, respiratory, disaster Flashcards Preview

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Flashcards in Acid-base, electrolytes, respiratory, disaster Deck (54):
1

Potassium lab range

3.5 - 5.0

2

Sodium lab range

135 - 145

3

Calcium lab range

9.0 - 10.5

4

Chloride lab range

96 - 106

5

Magnesium lab range

1.7 - 2.2

6

Phosphorus lab range

2.5 - 4.5

7

The role of sodium in the body

  • Regulates ICF and ECF water

8

Causes of hyponatremia

  • Evolemic hyponatremia: H2O increases but Na stays the same: SIADH, DI, Adrenal insufficiency, Addison's, freshwater drowning.  No edema!
  • Hypovolemic hyponatremia
    • Dehydration, vomiting, diarrhea, Overuse of diuretics, Excessive diaphoresis, Wound drainage (esp. GI), NPO status, burns, kidney disease, Hyperglycemia (polyurea)
  • Hypervolemic Hyponatremia (both water and Na increase leading to volume overload) -- edema present
    • Heart failure, Overhydration or irrigation with hypotonic fluids, Kidney failure, liver failure
  • Low Na diet

9

Signs and symptoms of 

Hyponatremia

  • Remember SALT LOSS
  • Seizures & stupor
  • Abdominal cramps and attitude changes
  • Lethargy
  • T endon reflexes diminishes, trouble concentrating
  • Loss of urine and appetite
  • Orthostatic HoTN, overactive bowels
  • Shallow respirations
  • Spasms

10

Treatment of 

Hyponatremia

  • Monitor I&O, weights, VS, LOC
  • Drug
    • w/fluid deficit: IV saline, 3 - 5% saline hypertonic soln
    • w/fluid excess: promote H2O excretion - conivaptan, tolvaptan, lithium, demeclocycline
  • Maintain airway
  • Seizure precautions

11

Causes of

Hypernatremia

  • Hyperaldosteronism
  • Cushing's syndrome
  • Corticosteroids
  • Kidney failure
  • Inc. oral ingestion
  • Excessive intake of Na-containing fluids
  • Relative excess
    • NPO status
    • Inc. metabolism
    • hyperventilation (w/acidosis!!!)
    • fever
    • infection
    • excessive diaphoresis
    • watery diarrhea
    • dehydration
    •  

12

Signs and Symptoms of

Hypernatremia

  • Primarily effects: nervous, skeletal muscles, cardiovascular
    • Nervous
      • w/fluid deficit: excitability, short attention span, agitation, confusion
      • w/fluid excess: lethargy, stupor, coma
    • Muscle
      • twitching and irregular contractions
      • weakness
      • dc or absent deep tendon reflexes
    • Cardio
      • dc contractility
      • regular, inc or dec pulse and BP depending of fluid status
      • OHoTN

13

Treatment of

Hypernatremia

  • Monitor I&O, daily weights, VS, LOC
  • Drug:
    • Normal saline, dextrose 5% in 0.45% saline, diuretics
  • Nutrition
    • adequate intake, Na reduction, read labels
  • Safety
    • skin protection and monitoring
  • Maintain airway
  • Seizure precautions

14

Causes of

Hypokalemia

  • Excessive use of diuretics, digitalis, or corticosteroids
  • Inc secretion of aldosterone, Cushing's
  • Metabolic alkalosis (Wound drainage, NG suctioning, Diarrhea, Vomiting)
  • Heat-induced diaphoresis
  • Kidney disease
  • NPO status
  • hyperinsulinism
  • TPN therapy
  • Water Intoxication
  • IV therapy with K-poor soln

15

Signs and symptoms of 

Hypokalemia

  • Primarily effects: respiratory, cardiovascular, neurological, musculoskeletal, and intestinal systems
  • Respiratory: resp. weakness and shallow resp.
  • Cardio: Thready peripheral pulses, brady or tachycardia, OHoTN
    • ECG - depressed ST seg, flat/inverted T waves, ic U waves
  • Neurologic: mental status change, fatigue, lethargy, irritability, agitation, confusion, coma
  • Muscle: weakness, Dc reflexes, flaccid paralysis
  • Intestinal: hypoactive bowel, paralytic ileus, N, V, C, ab distension, 

16

Treatment of

Hypokalemia

  • Adequate O2, maintain airway, fall prevention, IV injury prev., 
  • Assess LOC, strength
  • Oral K - admin with meal
  • Nutrition: inc. K intake
  • Continuous ECG
  • Monitor for hypoxemia, hypercapnia

17

Causes of

Hyperkalemia

  • Ingestion of K
  • Transfusions (K stored in RBC)
  • Adrenal insufficiency (Addison's)
  • Kidney failure
  • K-sparing diuretics
  • ACE inhibitors
  • Tissue damage
  • Acidosis
  • Hyperuricemia
  • Uncontrolled DM

18

Signs and Symptoms of 

Hyperkalemia

  • Primarily affects Cardiovascular, Neuromuscular, and intestinal
    • Cardiovascular: brady cardia, HoTN
      • ECG: Tall, peaked T waves, prolonged PR inv, flat-absent P waves, wide QRS, ectopic beats, complete heart block, asystole, vfib

19

Treatment of 

Hyperkalemia

  • Priorities: cardiac complications, fall precautions, monitoring, teaching
  • Drug: Stop K intake, diuretics, Kayexalate w/ kidney disease, dialysis, IV fluids containing glucose & insulin
  • ECG continuous monitoring
  • Treat dysrhythmias
  • Health teaching

20

What is the role of calcium in the body?

  • Plays a huge role in
    • bones/ teeth
    • muscle/nerve fx
    • blood clotting
  • It is absorbed in the GI system

21

Causes of

Hypocalcemia

  • Remember "LOW CALCIUM"
    • Low parathyroid
    • Oral intake inadequate
    • Wound drainage
    • Celiac's disease
    • Acute pancreatitis
    • Low vitamin D intake
    • Chronic kidney disease
    • Increased phosphorus level
    • Using medications (magnesium supplements, loop diuretics, Ca binders, laxatives)
    • Motility issues

22

Signs and symptoms of 

Hypocalcemia

  • Remeber CRAMPS
  • Confusion
  • Reflexes hyperactive
  • Arrhythmias (prolonged QT and ST intvs)
  • Muscle spasms in calves/feet, tetony, seizures
  • Postive Trousseau's sign
  • Sign of Chvestok's

23

Treatment of 

Hypocalcemia

  • Safety risk for bone fx
  • watch for laryngeal spasms
  • admin IV Ca2+ (10% calcium gluconate)
    • give slowly, watch rhythm, central line, infiltration/phlebitis, digoxin (toxicity)
  • Oral Ca w/ vitamin D (after meal or before bed w/ full glass)
  • Admin aluminum hydroxide sodium for hyperphosphorus (TUMS)
  • Diet education

24

Causes of

Hypercalcemia

  • Remember "HIGH CAL"
    • Hyperparathyroidism (in parathyroid hormone causes too much Ca release)
    • Increased intake (excessive Ca2+ or vitamin D supplements)
    • Glucocorticoids (suppresses Ca2+ absorption)
    • Hyperthyroidism
    • Calcium excretion decreased (w/ thiazide diuretics, renal failure, bone cancer)
    • Adrenal insufficiency (Addison's disease)
    • Lithium (affects parathyroid and causes dc phosphorus → in calcium)

25

Signs and symptoms of 

Hypercalcemia

  • Remember "The body is too WEAK"
    • Weakness of muscles
    • Ekg changes (short QT interval, prolonged ST interval)
    • Absent reflexes, absent minded, disoriented, abdominal distension from constipation
    • Kidney stone fm

26

Treatment of 

Hypercalcemia

  • Keep hydrated (dc kidney stone fm)
    • Strain urine
  • Safety (falls/injuries)
  • Monitor cardiac, GI, renal, LOC
  • Complaints of flank pain, ab pain
  • Decrease Ca-rich foods and thiazide diuretics, supplements of ca and vit D
  • Administer calcium reabsorption inhibitors (calcitonin), biphosphorates, prostaglandin synthesis inhibitors (aspirin, NSAIDS)
  • Dialysis for severe cases

27

Foods rich in calcium

 

  • Remember: Young Sally's Calcium Serum Continues to Randomly Mess-up!
    • Yogurt
    • Sardines
    • Cheese
    • Spinach
    • Collard greens
    • Rhubarb
    • Milk

 

 

28

What is the role of magnesium in the body?

  • roles in
    • cell function - transferring and storing of energy)
    • regulates parathyroid hormone (affects Ca levels)
    • Metabolizes carbs, lipids, and proteins
    • Regulates blood pressure
  • Absorbed in the small intestines!
  • Excreted via kidneys

29

Causes of 

Hypomagnesemia

  • Remember "LOW MAG"
    • Limited intake (starvation)
    • Other e- issues (hypOkalemia, hypOcalcemia)
    • Wasting Mg+ via kidneys (loop or thiazide diuretics) cyclosporines
    • Malabsorption issues (celiac, chrones, vomiting, PPIs -protonix, prilosec drugs ending in prazole)
    • Alcohol 
    • Glycemic issues (DKA, insulin)

30

Signs and symptoms of 

Hypomagnesemia

  • Remember "TWITCHING"
    • Trouessou's sign (w/coinciding hypocalcemia)
    • Weak respirations
    • Irritability
    • Torsades de pointes, T etany
    • Cardiac changes (tall T waves, depressed ST seg, prolonged PR and QT intv. with wide QRS complex) 
    • Hypertension, Hyperreflexia
    • Involuntary movements
    • Nausea
    • GI issues (dc bowel sounds & motility)

31

Treatment of 

Hypomagnesemia

  • Monitor cardiac, GI, respiratory, LOC, and ECGs
  • Oral K supplements: 
  • Oral Ca supplements with vitamin D
  • Magnesium sulphate monitor mag levels (check DT reflexes)
  • Seizure precautions
  • Oral magnesium (diarrhea!)

32

Foods containing Magnesium

  • Remember Always Get Plenty Of Foods Containing Large Numbers Of Magnesium
    • Avacado
    • Green leafy veggies
    • Peanut butter, P ork  
    • O atmeal
    • Fish
    • Cauliflower, Chocolate, dark
    • Legumes
    • N uts
    • Oranges
    • Milk

33

Causes of Hypermagnesemia

  • Remember MAG
    • Magnesium containing antacids & laxatives, or correction of hypomagnesemia
    • Addison's disease (adrenal insufficiency)
    • Glomerular filtration insufficiency (renal failure, <30mL/min)

34

Signs and symptoms of 

Hypermagnesemia

Remember "LETHARGIC"

  • Lethargy (profound)
  • Ekg changes (PR and QT interval prolonged & QRS complex wide)
  • Tendon reflexes absent/diminished
  • Hypotension
  • Arrhythmias (bradycardia, heart blocks)
  • Respiratory arrest
  • GI issues (N/V)
  • Impaired breathing (due to skeletal muscle weakness)
  • Cardiac arrest 

35

Treatment of 

Hypermagnesemia

  • Monitor cardiac, respiratory, neuro, GI, renal status
    • Put on EKG
  • Safety: fall precautions
  • Prevention!
  • MD order diuretics wastes Mg (loop & thiazides) except for renal failure
  • Renal failure prep for dialysis
  • IV Ca to reverse side effects of low mag
    • watch for infiltration/phlebitis...arterial line preferred

36

Acids in the body

  • carbonic acid - carbohydrates metabolism
  • sulfuric acid - protein metabolism
  • keto acids - fatty acids
  • lactic acid - incomplete anaerobic breakdown of glucose
  • ECF and free hydrogen - cell breakdown.

37

Bases in the body

  • bicarbonate - GI absorption, pancreatic production, kidney reabsorption

38

Buffers in the body

  • Chemical buffers
    • bicarbonate (ECF & ICF)
    • phosphate (ICF)
  • Protein buffers
    • albumin (ECF)
    • globulins (ECF)
    • hemoglobin (ICF)

39

Kidney control actions and mechanisms

  1. Kidney movement of bicarbonate to inc. pH
    1. produced in the body
    2. produced in the kidneys
  2. Formation of acids
    1. excretion to inc. pH
  3. Formation of ammonium to inc. pH

40

Patients at greatest risk for acidosis are

  • Those with impaired breathing
  • Older adults with chronic health problems

41

Causes of Metabolic Acidosis

  • Overproduction of hydrogen ions
    • excessive oxidation of fatty acids: DKA, starvation
    • hypermetabolism: heavy exercise, seizure, fever, hypoxia, ischemia
    • excessive ingestion of acids: ethanol or methanol intoxication, salicylate intoxication
  • Underelimination of hydrogen ions with kidney failure
  • Underproduction of bicarbonate
    • Kidney failure
    • pancreatitis
    • Liver failure
    • Dehydration
  • Overelimination of bicarbonate: diarrhea

42

Causes of Respiratory Acidosis

  • Underelimination of hydrogen ions
    • respiratory depression: drugs, electrolyte imbalance
    • Inadequate chest expansion: muscle weakness
    • Airway obstruction
    • Alveolar-capillary block

43

Combined metabolic and respiratory acidosis

uncorrected acute respiratory acidosis leads to poor oxygenation and lactic acidosis

ex. DKA with COPD

44

Assessment of acidosis

  • History:
    • Age, diet & nutrition, comorbidities
    • drug therapies (esp diuretics & aspirin)
    • cardiac, kidney, pulmonary impairments
  • Cardio
    • early: inc HR, inc CO
    • late: dec HR, tall peaked T waves, wide QRS complex, dec. peripheral pulses, HoTN
  • CNS: Behavior changes, depressed CNS, lethargy, confusion, coma, 
  • Neuromuscular: Decreased strength and DT reflexes
  • Respiratory: depends on cause
    • If metabolic: Kussmaul respirations
    • If respiratory: dec. respirations
  • Skin: depends on cause
    • if metabolic: vasodilation causes warm, dry, pink skin and mucous membranes
    • If respiratory: skin and mucous membranes pale to cyanotic

45

Lab assessment of acidosis

  • ABS pH < 7.35
  • Metabolic:
    • low bicarb <21
    • PaO2 normal
    • PaCO2 normal or slightly dec
    • Serum K often high
  • Respiratory​
    • PaO2 low 
    • PaCO2 high
    • bicarb variable depending on compensation
    • serum K may be elevated with acute, or normal or low with chronic

46

Interventions for metabolic acidosis

  • hydration and drugs
  • treatments to control/correct the problem causing
  • bicarbonate is administered only if levels are low
  • Nursing priorities: monitor for changes, cardiovascular changes, muscle changes, ABGs

47

Interventions for Respiratory acidosis

  • Priority interventions: ventilation and oxygenation, maintaining airway.
    • drug therapy, oxygen therapy, pulmonary hygiene (positioning, breathing techniques), vent support, prevention of complications
  • Drug therapy: bronchodilators, antiinflammatories, mucolytics

48

Causes of metabolic alkalosis

  • Increase of base components
    • Oral ingestions of bases (antacids)
    • TPN
    • Blood transfusion
    • Sodium bicarbonate IV
  • Decrease of acid components
    • Prolonged vomiting
    • NG suctioning
    • Hypercortisolism
    • Hyperaldosteronism (Cushing's)
    • Thiazide diuretics

49

Causes of Respiratory alkalosis

  • Excessive loss of CO2
    • Hyperventilation, fear, anxiety
    • Mechanical ventilation
    • Salicylate toxicity
    • High altitudes
    • Shock
    • Early-stage acute pulmonary problems

50

Effects of alkalosis

  • Many symptoms are similar to that of hypocalcemia and hypokalemia
  • CNS: overexcitement causing dizziness, agitation, confusion, hyperreflexia, and seizures; positive Chvostek's or Trousseau's signs
  • Neuromuscular: muscle cramps, twitching, tetany, decreased strength (inc. respiratory muscles)
  • Cardiovascular: inc. HR, thready pulse, inc. sensitivity to digoxin with hypokalemia
  • Respiratory: may be increased if causatory   

51

Interventions for alkalosis

  • Treat cause
  • Prevent further degradation
  • Discontinue drug or other therapies which lead to the condition
  • Antiemetic drugs for nausea
  • Monitor electrolytes daily
  • PREVENT FALLS

52

Hyponatremia mnemonic

  • Remember No Na+
  • Na+ excretion inc w/renal problems, NG suctioning, vomiting, diuretics, sweating, DI, aldosertone secretion
  • overload of fluids
  • na+ intake low through low salt diet or NPO status
  • antidiuretic hormone oversecreted (addison's)

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