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adult health I > chapter 10: fluid and electrolyte imbalances > Flashcards

chapter 10: fluid and electrolyte imbalances Flashcards

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1
Q

hyperkalemia

A

excessive potassium in the blood (ECF), more than 5

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2
Q

what are the signs and symptoms of hyperkalemia?

A

M: muscle cramps/weakness
U: urine low/absent
R: respiratory distress
D: decreased cardiac (HR, BP)
E: ECG changes (tall peaked T waves)
R: increased reflexes
* dysrhythmias

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3
Q

what are the cause/risk factors for hyperkalemia?

A

C: K movement to ECF
A: adrenal insufficiency (Addison disease)
R: renal failure (dialysis patients)
E: excessive intake
D: drugs (ACE inhibitors, NSAIDS, spironolactone)
others: acidosis, hyperuricemia, hypercatabolism, tissue damage

RF: arrhythmias

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4
Q

nursing interventions for hyperkalemia

A

monitor EKG, respiratory, neuromuscular, GI states
discontinue IV/PO potassium
initiate potassium restricted diet (POTASSIUM)
potassium excreting diuretics: kayexalate (PO/edema, GI sodium absorption= K excretion, hold if their hypokalemia), Lasix (K wasting), furosemide, dextrose (prevents hypoglycemia)
dialysis
administer IV hypertonic solution (glucose/insulin, pulls K into cells)
- calcium gluconate/sodium bicarb
avoid salt substitutes

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5
Q

sodium range

A

135-145

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6
Q

potassium range

A

3.5-5

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7
Q

phosphorus range

A

2.5-4.5

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8
Q

calcium range

A

9-11

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9
Q

magnesium range

A

1.5-2.5

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10
Q

chloride range

A

95-105

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11
Q

hemoglobin (Hgb) range

A

males: 13-18
female: 12-16

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12
Q

hematocrit range

A

female: 36-48%
male: 39-54%

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13
Q

BUN range

A

7-20 mgdl

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14
Q

creatinine range

A

0.6-1.2mg/dl

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15
Q

hypernatremia

A

excess sodium intake (higher than 145)

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16
Q

what are the risk factors/causes for hypernatremia?

A

increased sodium intake (oral ingestion, IV fluid administration with sodium, hypertonic IV fluids)
loss of fluids (fever, diarrhea, diabetes insipidus, excessive diaphoresis, infection)
decreased sodium excretion (kidney problems)

HIGH SALT
H-hypercortisolism (overproduction of aldosterone=retain Na, Cushing syndrome), hyperventilation
I: increased intake
G: GI feeding without adequate H20 intake
H: hypertonic solution (3% saline)

S:decreased Na excretion
A: aldosterone problem
L: loss of fluid
T: impaired thirst
T: loss of fluid

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17
Q

what are the signs/symptoms for hypernatremia?

A

BIG/BLOATED

FRIED SALTS

F: flushed
R: restless, anxious, confused, irritable
I: increased BP/fluid retention
E: edema pitting
D: decreased urine output

S: skin dry
A: agitation
L: low grade fever
T: thirt (dry mucous membrane)

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18
Q

what is the nursing management for hypernatremia?

A

if because of fluid loss–> administer hypotonic/isotonic solutions (0.45% NS slowly to avoid risk of cerebral edema)

if because of inadequate renal excretion –> give diuretics that promote sodium loss

restrict sodium and fluid intake

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19
Q

hyponatremia

A

sodium deficit, less than 135

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20
Q

hypovolemic hyponatremia

A

deficit in fluid and sodium

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21
Q

causes of hypovolemic hyponatremia

A

vomiting, diarrhea, NG sunction, burns, diuretic therapy, excessive therapy

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22
Q

hypervolemic hyponatremia

A

both water and sodium increase
sodium dilutes

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23
Q

causes of hypervolemic hyponatremia

A

CHF, kidney failure, saline infusion, liver failure

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24
Q

euvolemic hyponatremia

A

h20 increases and sodium levels stay the same –> sodium dilutes

C: STADH

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25
S/S of hyponatremia
SALT LOSS S: stupor/coma, shallow respirations A: anorexia (nausea/vomiting) L: lethargy (weakness/fatigue), loss of urine /appetite T: tachycardia (thready pulse) L: limp muscles, decreased DTR, spasms O: orthostatic hypotension S: seizures/headache S: stomach bowels (hyperactive bowels)
26
causes of hyponatremia
increased sodium excretion (4 D's) 1. diaphoresis 2, diarrhea/vomiting 3. drains (NG sunction) 4. diuretics (thiazide/loop diuretics) SIADH adrenal insufficiency inadequate sodium intake (fasting, NPO, low-salt diet) kidney diseases heart failure (CHF)
27
NM for hyponatremia
ADD SALT A: administer IV sodium chloride infusions (3% hypertonic solutions): only if due to hypovolemia D: diuretics (if due to hypervolemia)/dialysis -can cause hemodilution D: daily weights S: safety (orthostatic hypertension) A: airway protection (NPO): don't give food to a lethargic, confused patient= increased aspiration risk L: limit water intake T: teach about foods high in sodium (canned food, packaged/processed meats)
28
hypokalemia
potassium deficit, less than 3.5
29
what are the signs and symptoms of hypokalemia?
SLOW AND LOW 7 L: lethargic, low shallow rep, lethal cardiac, loss urine, leg cramps, low BP+HR thready, weak, irregular pulse orthostatic hypertension, shallow respirations anxiety, lethargy, confusion, coma parethesias, decreased DTR hyporeflexia hypoactive bowel sounds (constipation) nausea, vomiting, abdominal distention ECG changes: ST depression, shallow/inverted T waves, prominent U wave
30
what are the causes/risk factors of hypokalemia?
total body potassium loss inadequate potassium intake: fasting, NPO , anorexia, nausea movement of K from the ECF to ICF: alkalosis, hyperinsulinism (too much insulin) dilution of serum K: water intoxication, IV therapy with potassium deficit solutions DITCH D: drugs (laxatives, diuretics, corticosteroids) I: inadequate T: too much water C: Cushing syndrome (increased aldosterone) H: heavy fluid loss (NG sunction. vomiting, diarrhea, sweating)
31
NM for hypokalemia
oral potassium supplements with food (2.5-3.5) liquid potassium chloride potassium-retaining diuretic: spinola, diazyde,maxide? never administer via IV push, IM, subcut always dilute and administered using an infusion device (no more than 20/hr, risk for phlebitis/infiltration)
32
hypercalcemia
excessive calcium in the body, more than 11
33
what are the signs/symptoms of hypercalcemia?
bone pain, arrythmias, cardiac arrest (bounding pulses, shortened QT interval), kidney stones, muscle weakness (lower DTR), excessive urination, abdominal distention, constipation
34
what are the risk factors/causes of hypercalcemia?
glucocorticoids: suppress Ca absorption increased calcium absorption decreased calcium excretion thiazide diuretics:calcium excretion decreased increased bone resorption of calcium -hyperparathyroidism (releases too much Ca)/hyperthyroidism -malignancy hemoconcentration lithium usage: causes Ca to increase
35
what are the NM for hypercalcemia?
hydration, safety, complaints for flank abdominal pain/strain urine D/C IV/PO calcium D/C thiazide diuretics administer phosphorus, calcitonin, (inhibits reabsorption of calcium), biphosponates, prostagladins synthesis inhibitors (NSAID's, decrease Ca) avoid foods high in calcium dialysis= if too severe
36
hypocalcemia
deficit in calcium, less than 9
37
what are the signs/symptoms of hypocalcemia?
convulsions, arrythmias, tetany, spasms/stridor, hyperactive DTR, numbness in fingers, face, limbs positive trosseau's" carpal spasm caused by inflating a BP cuff positive chvostek's signs: contraction of facial muscles w/light tap over 8th CN
38
what are the causes/risk factors for hypocalcemia?
inhibitoion of calcium absorption from the GI tract increased calcium excretion - kidney disease, diuretic -diarrhea, steatorrhea -wound drainage conditions that decrease calcium LOW CALCIUM L: low PTH/thyroidectomy O: oral intake inadequate W: wound drainage C: celiac/Crohns disease A: acute pancreatitis L: low vitamin D C: CKO I: increased potassium U: using meds (mg supplements, loop diuretics) M: mobility issues
39
what are the NM for hypocalcemia?
administer calcium PO/IV (10% calcium gluconate= risk for infiltration) - for IV warm before and administer slowly administer aluminum hydroxide/ vitamin D after meal seizure precaustions consume foods high in calcium: yogurt, sardines, cheese, spinach, tofu, milk risk for pathological fracture
40
hypermagnesemia
magnesium excess, more than 2.5
41
what are ths signs/symptoms of hypermagnesemia?
LOW EVERYTHING low energy (drownsiness/coma) low HR low BP (hypotension) low RR (bradypnea) low respirations (shallow) low bowel sounds low DTR (deep tendon reflexes) EKG: prolonged PR+QT interval
42
what are the risk factors/causes for hypermagnesemia?
MAG M: magnesium antacids/laxatives (ex: TUMS) A: Addison diseases G: glomerular filtration (<30ml/min), keeping too much diabetic ketoacidosis renal insufficency (no excretion= more in the blood)
43
what is the NM for hypermagnesemia?
diuretics IV administration of calcium chloride/calcium gluconate: reverses Mg effects restrict dietary intake of Mg containing foods avoid the use of laxatives/antacids hemodialysis
44
hypomagnesemia
magnesium deficit, less than 1.5
45
what are the signs/symptoms of hypomagnesemia?
HIGH EVERYTHING high HR high BP hyperreflexia shallow respirations twitches, parathesia tetany/seizures irritability/confusion Torsades depointes: abnormal heart rhythmn seen in alcohol abuse EKG: tall T waves, depressed ST positive Trousseaus's/Chevstoke's signs
46
what are the risk factors/causes for hypomagnesemia?
LOW MAG L: limited intake O: hypokalemia/hypocalcemia W:wasting via kidneys, loop/thiazide diuretics, cyclosporines M: malabsorption issues (Crohn, celiac, vomiting) A: alcohol stimulates wasting G: glycemic issues sepsis
47
what are the NM for hypomkagnesemia?
oral Ca supplements/ w 10% calcium gluconate oral K supplements IV magnesium sulfate (can lead to hypermagnesemia, check DTR)/PO seizure precauyions increase magnesium contaning foods
48
do magnesium and calcium go up and down together?
yes
49
do calcium and phosphate go up/down together or inverse?
inverse
50
do potassium and sodium go up/down together or inverse?
inverse
51
hypovolemia/FVD
fluid output exceeds intake
52
what are the risk factors for hypovolemia?
GI losses (vomiting, diuretics) hemorrhaging diabetes insipidus hyperventilation
53
what are the S/S for hypovolemia?
low BP, hypotension, high RR,HR, tachypnea, tachycardia, thirst, oliguria, flattened JV, weak/thready pulse
54
labs for hypovolemia
concentrated blood/urine high hematocrit, serum osmolarity, BUN, USG, UO
55
what is the treatment for hypovolemia?
IV fluid replacement (isotonic)
56
what are the NI for hypovolemia?
monitor I/O, fall precautions, daily weights if urine below 30ml= hypovolemic shock
57
hypervolemia/FVE
excessive intake of fluid/inadequate excretion
58
what are the risk factor/causes of hypervolemia?
kidney dysfunction, heart failure, corticosteroids, cirrhosis
59
what are the S/S of hypervolemia?
weight gain, edema, hypertension, bounding pulse, JVD, tachycardia, dyspnea, crackles, tachypnea
60
what are the labs for hypervolemia?
diluted, low hemoglobin, hematocrit, SO, USG
61
what is the treatment for hypervolemia?
diuretics & paracentesis
62
what are the NI for hypervolemia?
weigh on a daily basis, provide O2, skin care, restrict fluid/sodium intake - gain weight 1/2 lbs in 24 hrs or 3lbs in a week= danger
63
what are complications for hypervolemia?
pulmonary edema: backup fluid in the lungs CHF

adult health I (3 decks)

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