Chapter 11 Assessment and Care of Patients With Problems of Fluid and Electrolyte Balance Flashcards

Question

right-sided heart failure

Answer 1

the volume of blood in the right side of the heart increases because the right ventricle is too weak to pump blood well into lung blood vessels. As blood backs up into the venous and capillary systems, the capillary hydrostatic pressure rises until it is higher than the pressure in the interstitial space. Excess filtration from the capillaries into the interstitial tissue space then forms visible edema.

Answer 2

is the movement of particles (solute) across a permeable membrane from an area of higher particle concentration to an area of lower particle concentration

Answer 3

when two fluid spaces have different concentrations of the same type of particles.

Answer 4

Any membrane that separates two spaces is struck repeatedly by particles. When the particle strikes a pore in the membrane that is large enough for it to pass through, diffusion occurs

Answer 5

degree of difference larger the concentration difference between the two sides, the steeper the gradient

Answer 6

permit diffusion of some particles but not others.

Answer 7

cannot cross some cell membranes without the help of insulin. Insulin binds to insulin receptors on cell membranes, which then makes the membranes much more permeable to glucose.

Answer 8

Diffusion across a cell membrane that requires a membrane-altering system

Answer 9

is the movement of water only through a selectively permeable (semipermeable) membrane.

Answer 10

is the number of milliosmoles in a liter of solution

Answer 11

is the number of milliosmoles in a kilogram of solution.

Answer 12

270 to about 300 mOsm/L

Answer 13

Having the same osmotic pressures.

Answer 14

Fluids with osmolarities greater than 300 mOsm/L tend to pull water from the isosmotic fluid space into the hyperosmotic fluid space until an osmotic balance occurs

Answer 15

Fluids with osmolarities of less than 270 mOsm/L are water is pulled from the hypo-osmotic fluid space into the isosmotic fluid spaces of the interstitial and ICF fluids.

Answer 16

The feeling of thirst is caused by the activation of cells in the brain that respond to changes in ECF osmolarity.

Answer 17

1. loses body water but most of the particles remain 2. ECF volume is decreased, and its osmolarity is increased (is hypertonic) 3. cells in the thirst center shrink as water moves from the cells into the hypertonic ECF. 4. shrinking of these cells triggers an adult's awareness of thirst and increases the urge to drink 5. Drinking replaces the amount of water lost through sweating and dilutes the ECF osmolarity, restoring it to normal.

Answer 18

Hypernatremia; dehydration; kidney disease; hypercortisolism

Answer 19

Hyponatremia; fluid overload; liver disease; adrenal insufficiency

Answer 20

Hyperkalemia; dehydration; kidney disease; acidosis; adrenal insufficiency; crush injuries

Answer 21

Hypokalemia; fluid overload; diuretic therapy; alkalosis; insulin administration; hyperaldosteronism

Answer 22

Hypercalcemia; hyperthyroidism; hyperparathyroidism

Answer 23

Hypocalcemia; vitamin D deficiency; hypothyroidism; hypoparathyroidism; kidney disease; excessive intake of phosphorus-containing foods and drinks

Answer 24

Hyperchloremia; metabolic acidosis; respiratory alkalosis; hypercortisolism

Answer 25

Hypochloremia; fluid overload; excessive vomiting or diarrhea; adrenal insufficiency; diuretic therapy

Answer 26

Hypermagnesemia; kidney disease; hypothyroidism; adrenal insufficiency

Answer 27

Hypomagnesemia; malnutrition; alcoholism; ketoacidosis

Answer 28

Loss of elasticity Decreased turgor Decreased oil production Results in: Skin becomes an unreliable indicator of fluid status, especially the back of the hand Dry, easily damaged skin

Answer 29

Decreased glomerular filtration Decreased concentrating capacity Results in: Poor excretion of waste products Increased water loss, increasing the risk for dehydration

Answer 30

Decreased muscle mass Results in: Decreased total body water Greater risk for dehydration

Answer 31

Diminished thirst reflex Results in: Decreased fluid intake, increasing the risk for dehydration

Answer 32

Adrenal atrophy Results in: Poor regulation of sodium and potassium, increasing the risk for hyponatremia and hyperkalemia

Answer 33

Muscle cells contain mostly water, and fat cells have little water

Answer 34

A rising blood osmolarity or a decreasing blood volume triggers

Answer 35

400 to 600 mL

Answer 36

lethal electrolyte imbalances, acidosis, and a toxic buildup of nitrogen.

Answer 37

no mechanisms control it about 500 to 1000 mL/day.

Answer 38

is secreted by the adrenal cortex whenever sodium levels in the extracellular fluid (ECF) are low. Aldosterone prevents both water and sodium loss. acts on the kidney nephrons, triggering them to reabsorb sodium and water from the urine back into the blood

Answer 39

or vasopressin, is released from the posterior pituitary gland in response to changes in blood osmolarity. retains just water acts on kidney nephrons, making them more permeable to water.

Answer 40

are hormones secreted by special cells that line the atria of the heart (atrial natriuretic peptide [ANP]) and the ventricles of the heart secreted in response to increased blood volume and blood pressure, which stretch the heart tissue. NP binds to receptors in the nephrons, creating effects that are opposite of aldosterone.

Answer 41

kidneys monitor blood pressure, blood volume, blood oxygen levels, and blood osmolarity When the kidneys sense that any one of these parameters is getting low, they begin to secrete a substance called renin that sets into motion a group of hormonal and blood vessel responses to ensure that blood pressure is raised back up to normal

Answer 42

always lowers blood pressure.

Answer 43

activates angiotensinogen 1 to 2

Answer 44

starts several actions to increase blood volume and blood pressure - decrease urine output - aldosterone secretion - increases peripheral resistance and reduces the size of the vascular bed

Answer 45

high sodium intake raises the blood level of sodium, causing more water to be retained in the blood volume and raising blood pressure.

Answer 46

disrupt the renin-angiotensin II pathway by reducing the amount of angiotensin-converting enzyme (ACE) made so less angiotensin II is present. With less angiotensin II, there is less vasoconstriction and reduced peripheral resistance, less aldosterone production, and greater excretion of water and sodium in the urine

Answer 47

* Hemorrhage * Vomiting * Diarrhea * Profuse salivation * Fistulas * Ileostomy * Profuse diaphoresis * Burns * Severe wounds * Long-term NPO status * Diuretic therapy * GI suction * Hyperventilation * Diabetes insipidus * Difficulty swallowing * Impaired thirst * Unconsciousness * Fever * Impaired motor function

Answer 48

* Excessive fluid replacement * Kidney failure (late phase) * Heart failure * Long-term corticosteroid therapy * Syndrome of inappropriate antidiuretic hormone (SIADH) * Psychiatric disorders with polydipsia * Water intoxication

Answer 49

fluid intake or retention is less than what is needed to meet the body's fluid needs, resulting in a deficit of fluid volume, especially plasma volume.

Answer 50

decreased thirst sensation difficulty moving less total body water drugs that increase fluid excretion

Answer 51

Circulating blood volume is decreased leads to reduced perfusion

Answer 52

Fluid is lost only from the extracellular fluid (ECF) space

Answer 53

corrected or prevented easily by matching fluid intake with fluid output

Answer 54

Ask specific questions about food and liquid intake. Collect specific information about exact intake and output volumes and obtain serial daily weight measurements. Ask specific questions about prescribed and over-the-counter drugs Ask about the presence of kidney or endocrine diseases.

Answer 55

- Heart rate increases - Peripheral pulses are weak, difficult to find, and easily blocked - Blood pressure also decreases - Hypotension is more severe with the patient in the standing position than in the sitting or lying position - neck and hand veins are flat, even when the neck and hands are not raised above the level of the heart.

Answer 56

increased respiratory rate is a compensatory mechanism that attempts to maintain oxygen delivery when perfusion is decreased.

Answer 57

- dehydration skin turgor is poor - The skin is dry and scaly. - The tongue surface may have deep furrows. - oral mucous membranes may be dry and covered with a thick, sticky coating and may have cracks and fissures

Answer 58

changes in mental status and temperature with reduced PERFUSION in the brain.

Answer 59

affect urine volume and concentration Urine output below 500 mL/day for a patient without kidney disease is cause for concern.

Answer 60

elevated levels of hemoglobin, hematocrit, serum osmolarity, glucose, protein, blood urea nitrogen, and electrolytes because more water is lost and other substances remain, increasing blood concentration

Answer 61

increasing blood concentration

Answer 62

1. Dehydration due to excess fluid loss or inadequate fluid intake 2. Potential for injury due to blood pressure changes and muscle weakness

Answer 63

* Blood pressure at or near his or her normal range * Daily urine output within 500 mL of total daily fluid intake (or at least 30 mL per hour) * Moist mucous membranes * Normal skin turgor

Answer 64

prevent further fluid loss, to increase fluid volumes to normal, and to prevent injury.

Answer 65

* When possible, provide oral fluids that meet the patient's dietary restrictions (e.g., sugar-free, low-sodium, thickened). * Collaborate with other members of the interprofessional team to determine the amount of fluids needed during a 24-hour period. * Ensure that fluids are offered and ingested on an even schedule at least every 2 hours throughout 24 hours. * Teach unlicensed assistive personnel to actively participate in the hydration therapy and not to withhold fluids to prevent incontinence. * Infuse prescribed IV fluids at a rate consistent with hydration needs and any known cardiac, pulmonary, or kidney problems. * Monitor the patient's response to fluid therapy at least every 2 hours for indicators of adequate rehydration or the need for continuing therapy, especially: * Pulse quality * Urine output * Pulse pressure * Weight (every 8 hours) * Monitor for and report indicators of fluid overload, including: * Bounding pulse * Difficulty breathing * Neck vein distention in the upright position * Presence of dependent edema * Assess the IV line and the infusion site at least hourly for indications of infiltration, extravasation, or phlebitis (e.g., swelling around the site, pain, cordlike veins, reduced drip rate). * Administer drugs prescribed to correct the underlying cause of the dehydration (e.g., antiemetics, antidiarrheals, antibiotics, antipyretics).

Answer 66

offer 60 to 120 mL of fluid every hour to patients who are dehydrated or who are at risk for dehydration. withholding fluids due to incontinence is not appropriate record amount of fluids ingested

Answer 67

IV fluids that contain water, minerals (electrolytes), and sometimes other water-soluble substances such as glucose most useful when dehydration includes both the intracellular and extracellular compartments

Answer 68

are IV fluids that contain larger non–water-soluble molecules that increase the osmotic pressure in the plasma volume. most useful in helping to maintain plasma volume with a lower infused volume

Answer 69

pulse rate and quality and urine output.

Answer 70

are prescribed when diarrhea causes dehydration.

Answer 71

therapy may be used in patients with bacterial diarrhea.

Answer 72

may be used when vomiting causes dehydration

Answer 73

to reduce fever are helpful when fever makes dehydration worse.

Answer 74

orthostatic hypotension, dysrhythmia, muscle weakness, and possible confusion.

Answer 75

* Maintains a daily fluid intake of at least 1500 mL (or drinks at least 500 mL more than his or her daily urine output) * Can state the indications of dehydration * Starts fluid replacement at the first indication of dehydration * Correctly follows treatment plans for ongoing health problems that increase the risk for dehydration

Answer 76

is an excess of body fluid. fluid intake or retention is greater than the body's fluid needs.

Answer 77

especially increased urine output, and edema formation.

Answer 78

it can lead to heart failure and pulmonary edema.

Answer 79

can lead to seizures, coma, and death.

Answer 80

* Increased pulse rate * Bounding pulse quality * Elevated blood pressure * Decreased pulse pressure * Elevated central venous pressure * Distended neck and hand veins * Engorged varicose veins * Weight gain

Answer 81

* Increased respiratory rate * Shallow respirations * Shortness of breath * Moist crackles present on auscultation

Answer 82

* Pitting edema in dependent areas | * Skin pale and cool to touch

Answer 83

* Altered level of consciousness * Headache * Visual disturbances * Skeletal muscle weakness * Paresthesias

Answer 84

* Increased motility | * Enlarged liver

Answer 85

Usually serum electrolyte values are normal; but decreased hemoglobin, hematocrit, and serum protein levels

Answer 86

excessive water in the vascular space

Answer 87

Assess the patient with fluid overload at least every 2 hours to recognize pulmonary edema If indications of worsening fluid overload are present (bounding pulse, increasing neck vein distention, presence of crackles in lungs, increasing peripheral edema, reduced urine output), respond by notifying the health care provider.

Answer 88

turn every two hours and use pressure reducing things

Answer 89

are used for fluid overload if kidney function is normal.

Answer 90

Monitor the patient for response to drug therapy, especially weight loss and increased urine output. Observe for indications of electrolyte imbalance, especially changes in electrocardiogram (ECG) patterns. Assess sodium and potassium values every 8 hours or whenever they are drawn.

Answer 91

focuses on removing excess fluid.

Answer 92

may involve restrictions of both fluid and sodium intake.

Answer 93

provides information on therapy effectiveness.

Answer 94

Rapid weight gain is the best indicator of fluid retention and overload.

Answer 95

to about 500 mL of retained fluid.

Answer 96

are substances dissolved in body fluid that carry an electrical charge.

Answer 97

have positive charges; have negative charges.

Answer 98

is the major cation (positively charged particle) in the extracellular fluid (ECF) and maintains ECF osmolarity.

Answer 99

vital for muscle contraction, cardiac contraction, and nerve impulse transmission.

Answer 100

“where sodium goes, water follows.” The ECF sodium level determines whether water is retained, excreted, or moved from one fluid space to another

Answer 101

inhibit the secretion of ADH and NP and trigger aldosterone secretion.

Answer 102

inhibit aldosterone secretion and stimulate secretion of ADH and NP.

Answer 103

LOW SODIUM is an electrolyte imbalance in which the serum sodium (Na+) level is below 136 mEq/L (mmol/L).

Answer 104

SODIUM FOLLOWS WATER LOW SODIUM IN ECF CAUSES WATER TO GO INTO CELLS osmolarity of the ECF is lower than that of the intracellular fluid (ICF). As a result, water moves into the cell, causing swelling. can reduce cell function or cause cell to burst

Answer 105

the loss of total body sodium, the movement of sodium from the blood to other fluid spaces, or the dilution of serum sodium from excessive water in the plasma.

Answer 106

- Cerebral changes CONFUSION CAN BE SUDDEN - Neuromuscular changes are seen as general muscle weakness. - Intestinal changes include increased motility, causing nausea, diarrhea, and abdominal cramping. - Cardiovascular changes are seen as changes in cardiac output.

Answer 107

- rapid, weak, thready pulse. - Peripheral pulses are difficult to palpate and are easily blocked. - Blood pressure is decreased, and the patient may have severe orthostatic hypotension, leading to light-headedness or dizziness. -The central venous pressure is low.

Answer 108

-full or bounding pulse with normal or high blood pressure. -Peripheral pulses are full and difficult to block sometimes hard to palpate due to edema

Answer 109

monitoring the patient's response to therapy and preventing hypernatremia and fluid overload.

Answer 110

- reducing the doses of any drugs that increase sodium loss such as most diuretics - IV saline infusions for fluid deficit - small-volume infusions of hypertonic saline in severe cases (3%)

Answer 111

-drugs that promote the excretion of water rather than sodium (such as conivaptan (Vaprisol) or tolvaptan (Samsca)

Answer 112

nutrition therapy | increasing oral sodium intake and restricting oral fluid intake

Answer 113

may include lithium (Carbolith, Lithane image) and demeclocycline (Declomycin).

Answer 114

HIGH SODIUM is a serum sodium level over 145 mEq/L (mmol/L).

Answer 115

More sodium is present to move rapidly across cell membranes during depolarization, making excitable tissues more easily excited.

Answer 116

cell shrinkage more water in ECF than ICF Eventually the dehydrated excitable tissues may no longer be able to respond to stimuli.

Answer 117

excitable membrane activity, especially nerve, skeletal muscle, and cardiac function.

Answer 118

the patient may have a short attention span and be agitated or confused.

Answer 119

the patient may be lethargic, stuporous, or comatose.

Answer 120

cause muscle twitching and irregular muscle contractions

Answer 121

muscles and nerves are less able to respond to a stimulus, and muscles become progressively weaker

Answer 122

deep tendon reflexes are reduced or absent.

Answer 123

include decreased contractility because high sodium levels slow the movement of calcium into the heart cells.

Answer 124

include monitoring his or her response to therapy and ensuring patient safety by preventing hyponatremia and dehydration.

Answer 125

diuretics that promote sodium loss

Answer 126

Isotonic saline (0.9%) and dextrose 5% in 0.45% sodium chloride are most often prescribed

Answer 127

ensuring adequate water intake, especially among older adults

Answer 128

is the major cation of the intracellular fluid (ICF). The normal plasma potassium level ranges from 3.5 to 5.0 mEq/L (mmol/L)

Answer 129

about 140 mEq/L (mmol/L)

Answer 130

excitable tissues to depolarize and generate action potentials.

Answer 131

in all body cells moves extra sodium ions from the ICF and moves extra potassium ions from the ECF back into the cell. In this way the serum potassium level remains low, and the cellular potassium remains high

Answer 132

is a serum potassium level below 3.5 mEq/L (mmol/L) It can be life threatening because every body system is affected.

Answer 133

occurs when potassium loss is excessive or when potassium intake is not adequate to match normal potassium loss.

Answer 134

occurs when total body potassium levels are normal but the potassium distribution between fluid spaces is abnormal or diluted by excess water.

Answer 135

urine concentrating ability decreases with aging, which increases potassium loss

Answer 136

diuretics, corticosteroids, and beta-adrenergic agonists or antagonists, can increase potassium loss through the kidneys.

Answer 137

Disease can lead to potassium loss.

Answer 138

Respiratory changes occur because of respiratory muscle weakness, resulting in shallow respirations. CHECK RESP STATUS EVERY TWO HOURS

Answer 139

skeletal muscle weakness.

Answer 140

pulse is usually thready and weak. Palpation is difficult, and the pulse is easily blocked. Pulse rate ranges from very slow to very rapid, and an irregular heartbeat (dysrhythmia) hypotension

Answer 141

include altered mental status.

Answer 142

GI smooth muscle contractions are decreased, which leads to decreased peristalsis. Bowel sounds are hypoactive, and nausea, vomiting, constipation, and abdominal distention are common.

Answer 143

absence of peristalsis

Answer 144

ST-segment depression, flat or inverted T waves, and increased U waves.

Answer 145

ensuring adequate gas exchange, patient safety for falls prevention, prevention of injury from potassium administration, and monitoring the patient's response to therapy

Answer 146

* Question the continued use of drugs that increase excretion of potassium (e.g., thiazide and loop diuretics). * Give prescribed oral potassium supplement, well diluted and with a meal or just after a meal or snack to prevent nausea and vomiting. * Prevent accidental overdose of IV potassium by checking and re-checking the concentration of potassium in the IV solution, ensuring that the maximum concentration is no greater than 1 mEq (mmol)/10 mL of solution. * Establish an IV access in a large vein with a high volume of flow, avoiding the hand. * Assess the IV access for placement and an adequate blood return before administering potassium-containing solutions. * Use a controller for solution delivery, maintaining an infusion rate not faster than 5-10 mEq (mmol) of potassium per hour. * Assess the IV site hourly. * Stop the infusion immediately if the patient reports pain or burning or if any sign of infiltration occurs. * If possible, monitor electrocardiography continuously. * Monitor patient responses every 1-2 hours to determine therapy effectiveness and the potential for hyperkalemia. * Indications of therapy effectiveness: * Respiratory rate is greater than 12 breaths/min. * Oxygen saturation is at least 95% (or has returned to the patient's normal baseline). * The patient can cough effectively. * Hand-grasp strength increases. * Deep tendon reflexes are present. * Bowel sounds are present and active. * Pulse is easily palpated and regular. * Systolic blood pressure when standing remains within 20 mm Hg of the systolic pressure obtained when the patient is sitting or lying down. * ST segment returns to the isoelectric line. * T waves increase in size and are positive. * U waves decrease or disappear. * Patient's cognition resembles his or her prehypokalemic state. * Serum potassium level is between 3.5 and 5.0 mEq/L (mmol/L). * Indications of hyperkalemia: * Heart rate is less than 60 beats/min. * P waves are absent. * T waves are tall. * PR intervals are prolonged. * QRS complexes are wide. * Deep tendon reflexes are hyperactive. * Bowel sounds are hyperactive. * Numbness or tingling is present in the hands and feet and around the mouth. * The patient is anxious. * Serum potassium level is above 5.0 mEq/L (mmol/L). * Keep patient on bedrest until hypokalemia resolves or provide assistance when out of bed to prevent falls.

Answer 147

includes additional potassium and drugs to prevent potassium loss

Answer 148

Potassium is a severe tissue irritant and is never given by IM or subcutaneous injection. Tissues damaged by potassium can become necrotic, causing loss of function and requiring surgery.

Answer 149

stop the IV solution immediately, remove the venous access, and notify the health care provider or Rapid Response Team.

Answer 150

increase urine output without increasing potassium loss

Answer 151

can cause hypokalemia, especially high-ceiling (loop) diuretics

Answer 152

collaboration with a dietitian to teach the patient how to increase dietary potassium intake

Answer 153

- performed at least hourly for severe hypokalemia. - check oxygen saturation by pulse oximetry to determine breathing effectiveness. - Assess respiratory muscle effectiveness by checking the patient's ability to cough. - Examine the face, oral mucosa, and nail beds for pallor or cyanosis

Answer 154

decreased blood oxygen levels

Answer 155

increased arterial carbon dioxide levels

Answer 156

is a serum potassium level higher than 5.0 mEq/L (mmol/L). Even small increases above normal values can affect excitable tissues, especially the heart.

Answer 157

chronically ill patients, debilitated patients, and older adults people with damaged kidneys

Answer 158

are the most severe problems from hyperkalemia and are the most common cause of death in patients with hyperkalemia

Answer 159

palpitations, skipped heartbeats, or other cardiac irregularities; and muscle twitching leg weakness, or unusual tingling or numbness in the hands, feet, or face

Answer 160

tingling and burning sensations followed by numbness in the hands and feet and around the mouth

Answer 161

skeletal muscle twitches up to muscle weakness and flaccid paralysis

Answer 162

include increased motility with diarrhea and hyperactive bowel sounds.

Answer 163

occurs with elevated serum creatinine and blood urea nitrogen, decreased blood pH, and normal or low hematocrit and hemoglobin levels.

Answer 164

levels of other electrolytes, hematocrit, and hemoglobin also are elevated.

Answer 165

are assessing for cardiac complications, patient safety for falls prevention, monitoring the patient's response to therapy, and health teaching.

Answer 166

can restore potassium balance by enhancing potassium excretion and promoting the movement of potassium from the extracellular fluid (ECF) into the cells

Answer 167

allows for the early recognition of dysrhythmias and other symptoms of hyperkalemia on cardiac muscle.

Answer 168

Assess anyone who has or is at risk for hyperkalemia to recognize cardiac changes. If the patient's heart rate falls below 60 beats/min or if the T waves become spiked, both of which accompany hyperkalemia, respond by notifying the Rapid Response Team.

Answer 169

includes diet, drugs, and recognition of the indicators of hyperkalemia.

Answer 170

You Should Avoid * Meats, especially organ meat and preserved meat * Dairy products * Dried fruit * Fruits high in potassium: * Bananas * Cantaloupe * Kiwi * Oranges * Vegetables high in potassium: * Avocados * Broccoli * Dried beans or peas * Lima beans * Mushrooms * Potatoes (white or sweet) * Seaweed * Soybeans * Spinach You May Eat * Eggs * Breads * Butter * Cereals * Sugar * Fruits low in potassium (fresh, frozen, or canned): * Apples * Apricots * Berries * Cherries * Cranberries * Grapefruit * Peaches * Pineapple * Vegetables low in potassium: * Alfalfa sprouts * Cabbage * Carrots * Cauliflower * Celery * Eggplant * Green beans * Lettuce * Onions * Peas * Peppers * Squash

Answer 171

is an ion having two positive charges (divalent cation) that exists in the body in a bound form and an ionized (unbound or free) form.

Answer 172

* Releasing free calcium from bone storage sites (bone resorption of calcium) * Stimulating vitamin D activation to help increase intestinal absorption of dietary calcium * Inhibiting kidney calcium excretion * Stimulating kidney calcium reabsorption

Answer 173

is a total serum calcium (Ca2+) level below 9.0 mg/dL or 2.25 mmol/L. Because the normal blood level of calcium is so low, any change in calcium levels has major effects on function.

Answer 174

This problem is related to reduced weight-bearing activities and a decrease in estrogen levels. As they age, many women decrease weight-bearing activities such as running and walking, which allows osteoporosis to occur at a more rapid rate. In addition, the estrogen secretion that protects against osteoporosis diminishes. Teach older women to continue walking and other weight-bearing activities.

Answer 175

report of frequent, painful muscle spasms (“charley horses”) in the calf or foot during rest or sleep

Answer 176

often occur first in the hands and feet. Paresthesias occur at first, with sensations of tingling and numbness. If hypocalcemia continues or worsens, muscle twitching or painful cramps and spasms occur

Answer 177

The heart rate may be slower or slightly faster than normal, with a weak, thready pulse. Severe hypocalcemia causes severe hypotension and ECG changes of a prolonged ST interval and a prolonged QT interval

Answer 178

include increased peristaltic activity painful abdominal cramping and diarrhea.

Answer 179

bones are less dense, more brittle, and fragile and may break easily with slight trauma. Vertebrae become more compact and may bend forward, leading to an overall loss of height.

Answer 180

Trousseau's and Chvostek's signs.

Answer 181

includes direct calcium replacement (oral and IV) and drugs that enhance the absorption of calcium such as vitamin D.

Answer 182

involves a calcium-rich diet for patients with mild hypocalcemia and for those who are at continuing risk for hypocalcemia

Answer 183

Reduce stimulation by keeping the room quiet, limiting visitors, adjusting the lighting, and using a soft voice.

Answer 184

is a total serum calcium level above 10.5 mg/dL or 2.62 mmol/L.

Answer 185

Mild hypercalcemia at first causes increased heart rate and blood pressure. Severe or prolonged calcium imbalance depresses electrical conduction, slowing heart rate. Assess for slowed or impaired PERFUSION.

Answer 186

severe muscle weakness and decreased deep tendon reflexes without paresthesia. The patient may be confused and lethargic.

Answer 187

Constipation, anorexia, nausea, vomiting, abdominal distention, and pain are common. Bowel sounds are hypoactive or absent.

Answer 188

preventing increases in calcium and drugs to lower calcium levels. Fluid volume replacement Thiazide diuretics are discontinued and replaced with diuretics that enhance the excretion of calcium such as furosemide

Answer 189

needed to identify dysrhythmias and decreased cardiac output.

Answer 190

important for skeletal muscle contraction, carbohydrate metabolism, generation of energy stores, vitamin activation, blood coagulation, and cell growth.

Answer 191

is a serum magnesium (Mg2+) level below 1.8 mEq/L or 0.74 mmol/L.

Answer 192

increase the risk for hypertension, atherosclerosis, hypertrophic left ventricle, and a variety of dysrhythmias

Answer 193

increase impulse transmission from nerve to nerve or from nerve to skeletal muscle. The patient has hyperactive deep tendon reflexes numbness and tingling, and painful muscle contractions. patient may have tetany and seizures as hypomagnesemia worsens.

Answer 194

Reduced motility, anorexia, nausea, constipation, and abdominal distention are common.

Answer 195

is a serum magnesium level above 2.6 mEq/L or 1.07 mmol/L. membrane stabilizer

Answer 196

include bradycardia, peripheral vasodilation, and hypotension.

Answer 197

Patients may be drowsy or lethargic. Coma may occur if the imbalance is prolonged or severe.

Answer 198

include reduced or absent deep tendon reflexes. Voluntary skeletal muscle contractions become progressively weaker and finally stop.

Answer 199

respiratory muscles are weak, respiratory insufficiency can lead to respiratory failure and death.

Answer 200

focus on reducing the serum level and correcting the underlying problem that caused the imbalance. When cardiac problems are severe, giving calcium may reverse the cardiac effects of hypermagnesemia.

Chapter 11 Assessment and Care of Patients With Problems of Fluid and Electrolyte Balance Flashcards

(226 cards)