EXAM 2: F&E Flashcards
1
Q
What are electrolytes?
A
substances that dissociate in solution to form a charged particle; electrically charged ions
2
Q
What are some examples of electrolytes?
A
K, Na, Cl, Ca, Mg, PO
3
Q
What are the body fluid compartments?
A
intracellular: body cells and blood cells have water
extracellular: plasma and interstitial spaces
4
Q
This occurs when too much fluid moves from the intravascular space (blood vessels) into the interstitial or “third” space:
A
third spacing (potential space)
5
Q
Third spacing fluid is:
A
- trapped in one of the several possible extracellular (transcellular) spaces
- cannot be used for normal function within the body
6
Q
How do you relieve fluid in third spacing?
A
letting (cardiocentesis)
7
Q
What are some examples of third spacing?
A
- ascites
- pleural effusion
- cardio effusion
8
Q
This condition results in abdominal fluid build up and is associated with right side heart failure
A
ascites
9
Q
This condition results in fluid (bleeding) and air collecting in the pleural space with s/sx such as SOB and cyanosis and can be caused by trauma and cancer:
A
pleural effusion
10
Q
What is the normal value for pleural effusion?
A
4 mL (just enough to separate membranes)
11
Q
What is edema?
A
accumulation of excess interstitial fluid in the extracellular space
12
Q
What is generalized edema referred to as?
A
anasarca
13
Q
Where is edema most common?
A
in the feet and legs
14
Q
This occurs when edema appears in the face, throat, and eyes:
A
anaphylaxis
15
Q
What are the causes of edema?
A
- increased hydrostatic pressure
- lowered plasma oncotic pressure
- increased capillary permeability
- lymphatic channel obstruction
16
Q
What is the lowered plasma oncotic pressure due to?
A
decreased amounts of plasma proteins (albumin)
17
Q
What reduces the ability to suck fluid from interstitial space back into the capillary?
A
decreased capillary colloidal osmotic pressure
18
Q
What causes the solutes to leave the capillary, increase the interstitial osmolality and draw more water in the interstitial spaces (causing edema)?
A
increased capillary permeability
19
Q
What kind of obstruction can be caused by cancer or surgery?
A
lymphatic channel obstruction
20
Q
What are the functions of body fluids?
A
- transport gases, nutrients, and wastes
- help generate the electrical activity needed to power body functions
- take part in the transformation of food into energy
- maintain the overall function of the body
21
Q
What population is at higher risks for function issues?
A
elderly and babies
22
Q
Fluid intake can be achieved via:
A
oral, IV/IM etc.
23
Q
Fluid outtake can be achieved via:
A
- sweating
- respiratory
- urinary
- GIT
24
Q
This consists of fluid contained within all the cells in the body and is the larger of the two compartments:
A
intracellular compartment (ICF)
25
The ICF holds how much of the body's water in healthy adults?
2/3
26
The ICF has a high concentration of which electrolyte?
K
27
This contains the remaining 1/3 of body water and contains all the fluids outside the cells (interstitial + tissue spaces + blood vessels)
extracellular compartment (ECF)
28
The ECF has a high concentration of which electrolyte?
Na
29
This is pushing force exerted by a fluid:
hydrostatic pressure
30
This is pulling force of plasma proteins that cannot pass through the capillary membrane:
colloidal osmotic pressure
31
What does colloidal osmotic pressure assist with?
the movement of fluid back into the capillary
32
What is the total arterial capillary pressure?
30 mm Hg
33
What is the total venous capillary pressure?
10 mm Hg
34
What contributes to outward movement of fluid from the capillary?
interstitial fluid that has a negative hydrostatic pressure of about - 3 mm Hg
35
The composition of the ECF, plasma, and interstitial fluid consists of:
- large amounts of sodium and chloride (and some bicarbonate)
36
The composition of intracellular fluids (ICF) consists of:
large amounts of potassium (with some magnesium)
37
What is the concentration gradient?
the difference in concentration over a distance
38
This is the movement of charged or uncharged particles along a concentration gradient from an area of higher concentration to one of lower concentration:
diffusion
39
This is the movement of water across a semipermeable membrane going from a low to high solute concentration:
osmosis
40
What path does water follow during osmosis?
water goes from the side of the membrane having a lesser number of particles and greater concentration of water TO the side with the greater number of particles and lesser concentration of water
41
What is osmolarity?
the amount of sodium and other solutes in the blood (majority is sodium)
42
What is the main source of fluid intake?
water
43
What is the main source of fluid output?
urine
44
What mechanisms maintain proper balance?
homeostatic mechanisms
45
Small amounts of urine results in:
| High amounts of urine results in:
```
highly concentrated urine (too much ADH)
diluted urine (too little ADH) > results in thirst
```
46
What is the osmolarity of the blood plasma (serum) largely determined by?
the amount of sodium contained in the plasma
47
A patient with an elevated sodium serum will have hyper-osmolarity. In this case, what fluid movement would you expect to happen?
an increase in plasma sodium (plasma osmolality) attracts water out of the cell, leading to shrinkage of the intracellular volume
48
This is the tension or effect that the effective osmotic pressure of a solution with impermeable solutes exerts on cell size because of water movement across the cell membrane:
tonicity
49
In obligatory urine output, how much cc's are required per 24hours?
300-500 cc's
50
An hourly urine output assessment is to:
1. increase blood flow by increasing water reabsorption in kidney tubules
2. increase systemic vascular resistance - vasoconstriction of blood vessels
51
How can solutions be classified?
according to whether or not they cause cells to shrink
52
These cells neither shrink nor swell and there is an equal loss of water and sodium:
isotonic
53
These cells swell (become lysed) and more Na is lost than water (serum Na is low):
hypotonic
54
These cells shrink (shrivel) and more water is loss than sodium:
hypertonic
55
What is the proper term for dehydrated?
fluid volume deficit
56
Vomiting, diarrhea or misuse of diuretics/lasix's is an example of what kind of fluid volume deficit?
isotonic
57
Osmotic diuresis, excessive sweating, loss of thirst and being unable to drink fluids is an example of what kind of fluid volume deficit?
hypertonic
58
Excess renal losses of Na and aldosterone deficiency is an example of what kind of fluid volume deficit?
hypotonic
59
What is the recommended treatment for isotonic fluid volume deficit?
IV fluid replacement using NS (0.9%)
60
Who usually suffers from hypertonic fluid volume deficit due to large glucose molecules drawing out fluids while Na ions are maintaining normal filtration levels
diabetics
61
What is the recommended treatment for hypertonic fluid volume deficit?
drinking plain water or IV of dextrose 5% in water (D-5-W)
62
What is the recommended treatment for hypotonic fluid volume deficit?
IV of NS or a 3% solution of Na IV
63
What are some s/sx of a fluid volume deficit?
- dry skin and mucous membranes (tongue)
- poor skin turgor
- decrease urine output
- babies have a decreased fontanel and their eyes appears sunken
- BP may be decreased with increased HR (orthostatic hypotension)
64
What are some physiological consequences of fluid volume deficit?
inadequate renal perfusion (blood flow)
65
What mechanisms protect extracellular fluid volume?
1. alterations in hemodynamic variables
| 2. alterations in sodium and water balance
66
Alterations in hemodynamic variables results in:
vasoconstriction and an increase in heart rate
67
Alterations in sodium and water balance results in:
- isotonic contraction or expansion of ECF volume
| - hypotonic dilution or hypertonic concentration of extracellular sodium brought about by chances in extracellular water
68
What are the different types of edema?
- pitting edema (due to extra water, responds well to elevation and diuretics)
- nonpitting edema (caused by factors other than just fluid, making drainage more difficult)
- brawny edema (swelling of subcutaneous tissues that cannot be indented easily by compression)
69
What physiologic mechanisms contribute to edema?
- increase in capillary filtration pressure
- decrease in capillary colloidal osmotic pressure
- increase in capillary permeability
- obstruction to lymph flow
- localized, general and dependent edema
70
How can you assess a patient for edema?
- daily weight
- visual assessment
- measurement of the affected part
- application of finger pressure to assess for pitting edema
71
These physiological mechanisms assist in regulating body water:
>This is primarily a regulator of water intake:
>This is primarily a regulator of water output:
- thirst
| - ADH
72
Both physiological mechanisms respond to changes in:
extracellular osmolarity and volume
73
What regulates effective volume?
baroreceptors
74
The rate of sodium is coordinated by the:
- SNS
- angiotensin II
- aldosterone
75
Water and Na balance modulate:
SNS outflow and ADH secretion
76
How is water and Na gained?
- oral intake and metabolism of nutrients
| - foods
77
How much sodium is required per day?
<16-18/day
78
How is water and Na loss?
- kidneys
- skin
- lungs
- GIT
79
What is the main regulator for sodium?
the kidneys
80
The kidneys monitor arterial pressure, retaining sodium when arterial pressure is ________ and eliminating it when arterial pressure is ________
decreased; increased
81
________ may also regulate sodium excretion by the kidney:
atrial natriuretic peptide (ANP)
82
What results when serum sodium levels decreases?
there is an excess amount of water, which causes:
- serum osmolarity to fall <280 mOsm/kg
- thirst to diminish
- ADH release suppressed
- renal water excretion increases
- serum osmolality normalizes
83
What do you assess when assessing body fluid loss in a patient?
- their history of conditions that predispose to Na and water losses and weight loss
- heart rate
- BP
- venous volume/filling
- capillary refill rate
84
What are the V1 receptors of ADH?
vasoconstriction
85
What are the V2 receptors of ADH?
- control water reabsorption
| - aquaporins
86
What are some disorders of ADH expression?
- diabetes insipidus
| - SIADH
87
These patients have a deficiency or decrease response to ADH and are unable to concentrate urine during periods of water restriction causing them to excrete large volumes of urine
diabetes insipidus
88
These patients have a failure of the negative feedback system that regulates the release and inhibition of ADH
SIADH (resulting from surgery, pain, stress or temperature changes)
89
Neurogenic diabetes insipidus results from:
head injury or surgery
90
Central diabetes insipidus results from:
a defect in synthesis or release of ADH
91
What is the goal of treatment to restore fluid volume excess?
to restore fluid balance, correct electrolyte imbalances and eliminate or control underlying cause of overload
92
What are the types of fluid volume excesses?
- isotonic over-hydration
- hypertonic over-hydration
- hypotonic over-hydration
93
What is isotonic over-hydration?
when there is excessive fluid in the EFC causing circulatory overload and interstitial edema
94
What is hypertonic over-hydration?
it is rare but may be caused by excessive sodium intake
95
What is hypotonic over-hydration?
it is known as water intoxication and occurs when excessive fluid moves in intracellular space and all body compartments expand
96
What are some causes of fluid volume excess?
* * heart failure and kidney issues **
- inadequate Na and water elimination
- excessive Na intake in relation to output
- excessive fluid intake in relation to output
- inadequately controlled IV therapy
- kidney disease
- long term steroid therapy
- rapid infusion of hypertonic-hypotonic solutions
- excessive sodium bicarbonate therapy
- SIADH
- irrigation of wounds and body cavities with hypotonic fluids
97
What assessment findings can you expect with fluid volume excess?
* * active weight gain, HTN, bounding pulse, SOB, JVD, edema **
- tachycardia, HTN, distended neck veins
- tachypnea, moist crackles
- altered LOC
- pitting, dependent edema, diarrhea, ascites
- polyuria
98
What interventions should be used when treating fluid volume excess?
- administer diuretics
- restrict Na and fluid intake
- monitor electrolyte values
99
This drug decreases fluid volume
diuretics
100
What are the different types of diuretics?
- furosemide (lasix): works in the loop of henle in the kidneys
- hydrochorothiazide (HCTZ): a thiazide diuretic (gives to AA)
- spironolactone (aldactone): an aldosterone receptor antagonist that is potassium sparing when K is too low
101
Isotonic fluid volume excess results in:
isotonic expansion of the ECF compartment with increases in both interstitial and vascular volumes, increases in total body sodium that is accompanied by proportionate increase in water
102
What are some causes of decreased Na and water elimination?
- renal function
- heart failure
- liver failure
- corticosteroid excess
103
When water and electrolytes are lost in equal proportions, what results?
isotonic dehydration
104
When electrolyte loss exceeds water loss, what results?
hypotonic dehydration
105
When water loss exceeds electrolyte loss, what results?
hypertonic dehydration
106
What are some causes of fluid volume deficits?
- inadequate intake of fluids and solutes
- excessive perspiration
- hyperventilation, ketoacidosis
- prolonged fever, vomiting and diarrhea
- end stage kidney disease, diabetes insipidus
- excessive fluid replacement, kidney disease, chronic malnutrition
107
How is isotonic dehydration caused and treated?
- vomiting, diarrhea and misuse of diuretics
| - RX: IV fluid replacement w/isotonic (0.9% saline aka normal saline)
108
How is hypertonic dehydration caused and treated?
- osmotic diuresis, excessive sweating, loss of thirst sensation or being unable to obtain or drink fluids
- RX: drinking plain water or IV dextrose 5% in water (D5W)
109
How is hypotonic dehydration caused and treated?
- excess renal losses of Na, aldosterone (saves or retains Na) deficiency
- RX: if mild, IV of 0.9 Saline but if severe, a 3% solution of sodium might be ordered
110
What assessment findings can you expect with fluid volume deficit?
- tachycardia, hypotension, tachypnea
- lethargy to coma state
- oliguria
- nonelastic skin turgor, dry skin and mucous membranes
- decreased bowel sounds, constipation
- thirst
111
What interventions should be used when treating fluid volume deficit?
- rehydrate client
| - administer medications to correct causes
112
What is hematocrit?
a blood test that shows the % or proportion of RBCs to the plasma (in dehydrated people, Hct is increased)
113
What is normal hematocrit levels for males and females?
males: 42%-52%
females: 37%-47%
114
What does the urine specific gravity test measure?
the weight of urine compared to the density of water
115
What is the normal range for USG in adults?
1.010-1.025
116
A low USG is seen in what kind of urine?
dilute
117
A high USG is seen in what kind of urine?
concentrated
118
Dehydration will results in what kind of USG result?
high specific gravity (hypertonic urine)
119
What is increased USG caused by?
glucose or proteins in the urine (making urine more dense)
120
T/F SG doesn't change in pt. where the kidneys are unable to concentrate the urine adequately. If the SG is low, it indicates an adequately hydrated pt. due to it being dilute and not
containing solutes.
true
121
What is the intracellular concentration of potassium and the extracellular concentration?
intracellular: 140-150 mEq/L
extracellular: 3.5-5.0 mEq/L
122
What is body stores of K related to and where is K derived from?
- related to body size and muscles mass
| - derived from dietary sources
123
What two mechanisms are plasma K regulated through?
- renal mechanisms that conserve or eliminate K
| - a transcellular shift b/w the ICF and ECF compartments
124
What are noneletrolytes?
substances that don’t dissociate into charged particles (glucose)
125
During interstitial fluid exchange, what occurs when capillary filtration pressure is pushing fluid out?
- the tissue hydrostatic pressure is acting against the interstitial space
- if you have a lot of water in the IS space, it will push into the vascular space
126
During interstitial fluid exchange, what occurs when capillary colloidal (albumin) osmotic pressure is pushing fluid back into the blood stream?
water is pulled from IS space back into the capillary
127
Interstitial Pressure opposes the movement of water out of the capillary, resulting in:
the arterial end being higher pressure than venous end of capillaries
> 120 mmHg in the LV and pushes the blood all the way to the capillaries (it is at its lowest point the rt. atrium)
128
This reflects the kidneys ability to produce concentrated/dilute urine
osmolality
129
How is osmolality measured?
by serum osmolality and the need for water conservation/excretion
130
Why do diuretics cause a "hypo" electrolyte imbalance?
because water follows sodium (therefore water is loss)
131
What are the causes of hyponatremia?
```
○ Increase in Na secretion
○ Inadequate intake
○ Diluted serum Na
○ Excess ADH
○ Vomiting
○ Hypotonic irrigations (enemas)
○ Excessive water intake
○ Near drowning (freshwater)
```
132
What are the s/sx of hyponatremia?
○ Change in pulse and BP
○ Shallow respirations
○ Inc. GI motility (hyperactive bowel sounds)
○ Polyuria (dec SG)
○ Diminished deep tendon reflexes
○ Muscle/abdominal cramping and weakness
○ N/V
○ Suppression of thirst reflex
○ HA, confusion, lethargy, seizures, coma, death
**most sxs. Are manifestations from the brain!!!***
Neuro sxs
133
What drug can cause hyponatremia?
Diuretics because it induces sodium loss to reduce water concentrations
134
How is hyponatremia diagnosed?
○ Serum sodium level = below 135
○ Serum osmolality below 280
○ Urine Specific Gravity below 1.010
○ Elevated Hct & plasma proteins
135
How is hyponatremia treated?
○ Treat the underlying cause and monitor systems related to impact
○ If client taking lithium, monitors levels (can cause diminished lithium excretion resulting in toxicity)
○ Fluid restriction
○ Oral or IV of saline solution (NS)
○ Eat high sodium foods
136
How is severe hyponatremia treated?
▪ Neurological symptoms such as seizures (serum sodium <110)
▪ Treated with hypertonic solution (3-5%) to increase sodium levels and return to normal
> Too much treatment with hypertonic solution can cause a rapid shift of water out of the
brain cells and cause permanent brain damage (Karev)
137
This condition results in sodium levels above 145 mEq/L and serum osmolality about 295
Hypernatremia
138
What are the causes of hypernatremia?
```
○ Dec. Na secretion
○ Inc. Na intake
○ Dec. H2O intake
○ Inc. H2O loss
○ Tube feedings
▪ Some of the canned foods for tube feedings are high in sodium (need to dilute them)
○ Watery diarrhea
○ IV infusion of hypertonic solution
○ Near drowning (salt water)
○ Inability to respond to thirst
▪ They are relatively hypernatremic due to low fluid levels
```
139
What are the s/sx of hypernatremia?
```
○ Changes in pulse and BP
○ Irregular muscle contraction
○ Diminished to absent deep tendon
○ Altered cerebral function
○ Thirst
○ Oliguria (inability to form urine)
○ Decrease in skin turgor, salivation and moisture
Neuro sxs:
▪ HA, agitation, poor reflexes, seizures, coma, death
```
140
How do you assess for hypernatremia?
Inspect for drugs containing sodium bicarbonate or IV NaCl
141
What are the nursing interventions for hypernatremia?
▪ Monitor neuro status, seizures, I&O, and Vitals
▪ Instruct to avoid high Na+ foods
▪ Administer IV fluids (if due to fluid loss)
▪ Administer diuretics
142
How is hypernatremia diagnosed?
○ Serum sodium above 145
○ Serum osmolality above 295/300
○ Urine specific gravity will be high (dehydrated) = 1.025+
143
How is hypernatremia treated?
○ Treat the underlying CAUSE
○ Replace fluids, slowly and carefully
▪ Can be done orally or IV but gradually to avoid Cerebral Edema
144
Some examples of high sodium foods include?
- bacon
- butter
- canned foods
- luncheon meats
- table salt
145
What are the normal potassium levels?
3.5 - 5.0
146
What are good food sources of potassium?
* Fruits (think bananas, oranges, etc.)
* Meats
* Vegetables
147
What causes hypokalemia?
```
○ Inadequate Dietary Intake:
(also due to poor eating habits -> anorexia, NPO, unbalanced diet)
○ Excess Renal, GI, Skin losses
○ Movement of K from ECF to ICF
○ Dilution of serum K
```
148
What are considered potassium wasting diuretics?
- lasix
| - thiazides
149
What are GI secretions high in and what occurs during hypokalemia?
GI secretions are high in K+, therefore unusual wasting can cause hypokalemia
150
What are the s/sx of hypokalemia?
○ Thready, weak pulse and orthostatic hypotension
○ Changes in ECG (ST depression and flat or inverted T wave)
○ Shallow respirations
○ Lethargy to coma state
○ Skeletal muscle weakness, deep tendon hyporflexia
○Polyuria, decreased urine specific gravity
○ GI, Neuromuscular, renal, & Cardiovascular systems are mostly effected
151
What effect does hypokalemia have on the cardiovascular system?
Due to K+ acting on the electrical activity of excitable tissues, heart dysrhythmias occurs causing a decreased T-wave
152
What effect does hypokalemia have on the GI system?
It causes abdominal distention, constipation, and diminished bowel sounds (abnormal peristalsis) due to the K+ deficiency acting on the bowels' contractility
153
What effect does hypokalemia have on the neuromuscular system?
- muscles weakness
| - paralysis
154
How is hypokalemia diagnosed?
```
> By lab results such as:
▪ Urine specific gravity
▪ K+ serum level
▪ Serum osmolality
> Presence of T-wave depression
```
155
How do we treat hypokalemia?
○ Place client on a heart monitor
○
○ High K+ foods, oral supplements, or IV (take precaution)
○ Using the drugs K-Dur & IV Potassium Chloride
○ Patient can NOT take oral K supplements on a empty stomach
156
What must be done before giving a potassium IV and why?
K+ must be diluted when given IV or it will stop the heart. It also needs to be infused not pushed
157
What are some food sources for potassium?
- Fruits (oranges, bananas, apricots and cantaloupe)
- Meats
- Vegetables
- Dried fruit, nuts and seeds
- Chocolate
158
What causes hyperkalemia?
○ MOST COMMON CAUSE IS DECREASED RENAL FUNCTION
○ Excess IV administration of K+ or excessive oral ingestion of supplements
○ Decreased excretion due to K+ sparing diuretics (spironolactone)
○ Shift of K+ from intracellular to extracellular (ICF -> ECF)
159
How does hyperkalemia cause a decrease in renal function?
Because the kidney is unable to excrete potassium into urine like normal
160
The shift of potassium from intracellular to extracellular ICF -> ECF is due to things such as:
▪ Crushing injuries or burns that cause cell death and release K into the ECF
161
What are the s/sx of hyperkalemia?
○ First symptom is paresthesia (numbness/tingling)
○ HEART DYSRHYTHMIAS (cardiac conduction is blocked which is shown through the peaked/elevated T-waves, widened QRS complexes and prolonged PR intervals)
○ Slow/weak pulse/hypotension
○ Muscle twitching changes to weakness, and decreased neuromuscular excitability
○ Respiratory failure (SOB)
○ Inc. GI motility
162
How is hyperkalemia diagnosed?
by looking at lab values, medical history (renal failure, etc.), & EKG findings
163
How is hyperkalemia treated ?
○ Limit IVs, supplements & sparing meds (spironolactone)
○ Administer medications that will remove K from body by renal excretion
○ Education client to avoid foods high in K
○ Need to monitor EKG for hypokalemia (flattened T-wave, etc.)
○ Inc. cellular uptake
164
What medications will remove K from the body?
▪ Sodium polystyrene (Kaexalate)
| ▪ Calcium gluconate
165
What does sodium polystyrene (Kaexalate) do?
It is a resin drug that exchanges potassium for sodium, lowering the K+ level
166
What does calcium gluconate do?
Calcium antagonizes the reduced membrane excitability caused by excess K+, and returns excitability/membrane potential to normal. It is a short-lived solution and thus combined with something that can reduce the ECF concentrations of K+ (insulin)
167
In severe cases of hyperkalemia, what can be used in severe cases in those with renal failure?
hemodialysis
168
What effect does sodium bicarbonate have on K disorders?
it will cause K to move to ICF
169
What effect does insulin have on K disorders?
it will decrease ECF K concentration
170
What is the normal range for calcium?
8.6-10.2 mg/dl
171
What is the most common cause of hypocalcemia? What are some other causes?
```
○ Lactose intolerance
○ Inadequate oral intake or intake of vitamin D
○ Immobility
○
○ Most common cause is Renal Failure
○ Hypoparathyroidism
○ Pancreatitis which causes fat necrosis
○ GI wound drainage/Chronic diarrhea (inhibits ability to absorb Ca++ from the GIT)
```
172
Why is renal failure a cause of hypocalcemia?
```
Because of the decreased production of activated Vitamin D and hyperphosphatemia
□ Vitamin D is activated in
the Kidneys
□ Without active Vitamin D,
calcium cannot be absorbed
from the GIT
□ Phosphate and Calcium
have an inverse relationship
□ Increased phosphate
(hyperphosphatemia) results
in hypocalcemia
```
173
What is normally the first s/sx of hypocalcemia?
NEURO/MUSCLE PROBLEMS (Increased Neuromuscular Excitability)
174
What are some other s/sx of hypocalcemia?
```
▪ Prolonged ST interval
▪ Inc. GI activity
▪ Neuromuscular irritability
▪ Cramping
▪ Hyperactive reflexes
▪ Paresthesia
▪ Tetany (spasms in face, hands, feet)
▪ Heart dysrhythmias Heart dysrhythmias
```
175
How is hypocalcemia diagnosed?
```
○ Chvostek Sign
▪ Stimulating facial nerve
by tapping and observing
for tetany
○ Trousseau Sign
▪ Inflating BP cuff to 10 mm
above systolic and
watching for tetany in
hands/fingers
```
176
How is hypocalcemia treated?
○ Calcium chloride (IV)
▪ warm injection to body temp. prior to administering
▪ administer slowly
▪ monitor for ECG changes
▪ observe for infiltration
▪ monitor for signs of hypercalcemia
○ Calcium gluconate (10%) - restores functional integrity of the neuromuscular sys.
○ Reduce environmental stimuli
○ Initiate seizure precautions
○ Monitor for s/sx of fractures ○ Eat more cheese, milk, soy, sardines, spinach, tofu, low fat yogurt
177
What is the cause of hypercalcemia?
```
○ Overconsumption of Vitamin D
▪ Results in excessive
absorption of Calcium and
increased serum Ca++ levels
○ Hyperparathyroidism
▪ Excess release of PTH,
thus excessive Ca++ release
from bones
○ Bone tumors can also cause increased Ca++ release from bones
○ Hemoconcentration
○ Immobility
```
178
What are the s/sx of hypercalcemia?
```
○ Early signs = Tachycardia and shortened ST interval
○ Impaired respiratory movement
○ Renal calculi formation
○ Hypoactive bowel sounds
○ Decreased neural excitability & impaired cardiac and smooth muscle fxn
○ Muscle weakness
○ Neuromuscular-
▪ Headache, stupor, fatigue
○ Anorexia, constipation, N/V
▪ Think of the decreased
smooth muscle ability
○ Cardiac dysrhythmias (ventricular)
▪ Ca++ is the primary ion
responsible for cardiac
conduction… too much
causes deadly
Ventricular Arrhythmias
```
179
How is hypercalcemia treated?
○ Correct the underlying cause of the serum Ca++ excess
○ Promote urinary excretion of Ca++
▪ The excretion of Na+ is
accompanied by Ca++
▪ Diuretics!!
○ Calcitonin- decrease osteoclast activity/calcium release from bone
○ Position and monitor mobility
○ Monitor for signs of renal calculi and pathological fractures
180
What is the normal range for magnesium?
1.5-2.5 mg/dl
181
What is the cause of hypomagnesemia?
○ Malnutrition and chronic alcoholism
○ Diabetic Ketoacidosis
○ Diuretic therapy
○ Hyperparathyroidism
○ Vomiting, diarrhea, celiac disease, chrohns disease
○ Hyperglycemia, insulin administration, sepsis
182
What is the s/sx of hypomagnesemia?
```
○ Hyperactive NEUROMUSCULAR activity
Tetany
▪ Nystagmus- following the
finger back and forth with
pupil (tracking without
fluttering)
▪ Choreiform movements
(dyskinesia)
▪ Positive Trousseau and
Chvosteks signs
▪ + Babinski test- reflex and
the bottom of the foot
○ Peaked T wave, depressed ST segment
○ Shallow respirations
○ Personality changes
```
183
How is hypomagnesemia treated?
○ Initiate seizure precautions
○ Monitor for reduced deep tendon flexes
○ Magnesium replacement
▪Magnesium hydroxide
(Milk of Magnesia)
▪ Magnesium sulfate
* Route of administration depends on the severity of the hypomagnesemia *
184
What is the cause of hypermagnesemia?
```
○ Renal Disease/failure
○ Excessive intake of drugs containing magnesium
▪ IV administration
▪ P.O. meds- antacids,
supplements, laxatives
```
185
What are the neuromuscular and cardiac s/sx of hypermagnesemia?
○ Muscle weakness / hyporeflexia
▪ Due to magnesium
decreasing the
acetylcholine release at
the neuromuscular
junction
○ Lethargy, confusion, coma
○ Cardiac arrest, arrhythmias, hypotension (prolonged PR interval)
▪ Due to the Calcium channel blocking effect of magnesium
○ Respiratory arrest, complete heart block, and cardiac arrest (think of the lack of muscular excitability)
186
How is the hypermagnesemia treated?
○ Stop administration of magnesium
○ Administer calcium chloride or gluconate (direct antagonist of magnesium)
○ Administer dieuretics
○ Restrict magnesium in the diet
○ Educate client to avoid laxatives and antacids containing magnesium
187
What is the normal range for potassium?
3.5-5.0
188
What is the normal range for chloride?
98-106
189
What is the normal range for sodium bicardbonate?
24-31
