Fluid and Electrolytes Flashcards
1
Q
Water content varies with
A
age
gender
and Fat content
2
Q
What are the TWO main BODY Fluid compartments?
A
Intracellulat Fluid (ICF)
and
Extracellular Fluid (ECF)
3
Q
How much of INTRACELLULAR Fluid COMPARTMENT (space) is located in the CELL?
A
2/3 of space is located WITHIN the cell.
4
Q
Extracellular Fluid (ECF) is made up of 3 types.
Name them.
A
- interstitial spaces: b/T cells
- Intravascular: Plasma portion of blood
- Transcellular: (CSF, synovial, intra-ocular, etc) It is found in the lumen of structures lined by epithelium.
5
Q
How many Liters of PLASMA are in the human body?
A
3 L
6
Q
How many Liters of INTERSTITIAL FLUID (IF) is in the human body?
A
10 L
7
Q
How many Liters of INTRACELLULAR FLUID is in the human body?
A
28 L
8
Q
Name the FLUID parts:
A
a. Intracaellular fluid (IF)
b. Interstitial Fluid
c.Plasma
d. Lymph
e. Transcellular fluid
f. Extracellular fluid
g. Body Cell MEMBRANE
9
Q
Fluid Shifts:
Plasma-to-interstitial fluid shift results in Edema.
What 3 things contribute to this?
A
- Salt intake
- Infection
- Lymph system obstruction
10
Q
Fluid Shifts:
Interstitial fluid to plasma decreases edema.
What two things contribute tho this?
A
- Albumin Administration (protein in body)
- Compression stockings
11
Q
What is TED HOSE?
A
ThromboEmbolism-Detterrent hose
Stockings that prevent embolisms
12
Q
How many FLUID SPACINGs are there?
A
THREE
13
Q
First Fluid spacing is:
A
- fluid being where it is supposed to be.
- Fluid inside cells and fluid inside blood vessels (normal)
A NORMAL DISTRIBUTION.
14
Q
Second Fluid spacing consists of
A
- ABNORMAL fluid accumulation in the INTERSTITIAL SPACE.
- this is considered EDEMA
- 2nd spacing is still “in contact” with the areas its SUPPOSED to be in…. so that the fluid can easily move back into the 1st spacing areas IF body conditions change.
15
Q
Some factors that EFFECT 2nd spacing are:
A
- hydrostatic pressure
- diffusion
- osmosis.
16
Q
Third fluid spacing consists of
A
- Fluid accumulation in part of body where it is NOT easily exchanged with ECF.
- This is TRAPPED fluid.
- Fluid is in a place in body where it is difficult or impossible for it to move BACK INTO THE CELLS or blood vessels WITHOUT medical intervention.
17
Q
What is Ascites?
A
Ascites is a type of edema in which fluid accumulates in the peritoneal cavity (abdomen area)
The patient commonly reports shortness of breath and a sense of pressure because of pressure on the diaphragm.
18
Q
How does the body regulate Water Balance
2 types of losses.
A
- “insensible” water losses (unable to be measured)
- “sensible” water losses (can be measured)
19
Q
What is considered INSENSIBLE water losses?
A
- invisible vaporization from lungs and skin
- loss of approximately 600-900 mL/day
- No electrolyte loss.
20
Q
What is considered SENSIBLE water losses?
A
- Caused by exercise, urination and defecation
- May lead to large losses of water and electrolytes.
21
Q
What causes FLUID & ELECTROLYTE IMBALANCES?
A
- Illness or disease (burns or heart failure)
- Result of therapeutic measures (IV fluid replacement or diuretics.
22
Q
ECF volume deficit is called
A
hypovolemia
23
Q
What causes EXTRACELLULAR fluid volume imbalances?
A
- Abnormal LOSS of normal body fluids
- Inadequate intake
- Plasma-to-interstitial fluid shift (plasma leaving blood vessels and entes space in tissues- called INTERSTITIAL fluid.
- Clinical manifestations related to loss of vascular volume as well as CNS effects.
24
Q
What tx is used for ECF volume deficits?
A
Replace water and electrolytes with balanced IV solutions.
25
Fluid Volume Deficit (FVD) Manifestations (signs):
* Restlessness, drowsiness, lethargy, confusion
* Thirst, dry mouth
* LOW skin turgor (remains elevated)
* LOW capillary refill
* LOW urine output, concentrated urine (dark)
* Hypotension (Low BP)
* HIGH PR
* HIGH Respiratory Rate
* Weakness, dizziness
* Acute Weight loss
* Seizures, coma
26
Fluid Volume Deficit (FVD) LABS include
* Elevated Hct./Hgb.
* Elevated BUN
* Urine osmolality & specific gravity increase
* Serum osmolality: increased
--> Measures the concentration of particles in a solution. It refers to the fact that the same amt. of solute is present, but the amount of solvent (fluid) is decreased. Therefore, the blood can be considered “more concentrated”.
**FVD= High labs**
27
PRIORITY HEALTH PREVENTION for **Fluid Volume Deficit** is
PREVENT SHOCK!!!
s/s include:
* low BP
* Increase HR
* Increase RR
28
To PREVENT SHOCK the goal is to
INCREASE **VASCULAR** VOLUME
29
WHAT CAN THE NURSE DO TO **INCREASE Vascular Volume**?
* **Start IVF** (intravenous fluids)
* **Keep Warm** (vasoDILATES-Helps incr. blood flow; improves circulation)
* **Elevate legs** (doesnt let fluids accumulated peripherally)
* **O2 if indicated** (assists RBCs)
* **Monitor V/S & I/Os**
30
Nursing Management for Fluid Volume Deficit (FVD)
*goals for patient*
* Explain the reason for the required intake and the amount needed
* Establish **24-hour** plan for ingesting fluids
* Set **short-term** goals
* Identify fluids the client likes and use those
* Help clients select **foods that become liquid at ROOM temperature**
* Supply cups, glasses, straws
* Serve fluids at proper temperature
* Encourage participation in recording intake
* Be alert to cultural implications
31
*FVD SKIN ASSESSMENT & CARE*:
In fluid volume deficit:
skin turgor diminished, may be
dry/wrinkled
32
*FVD SKIN ASSESSMENT & CARE*:
In fluid volume deficit:
Oral mucous membranes will show
**KNOW**
dry tongue; may be furrowed
33
*FVD SKIN ASSESSMENT & CARE*:
In fluid volume deficit:
Client often complains of
THIRST
34
*FVD SKIN ASSESSMENT & CARE*:
In fluid volume deficit:
Oral care is
CRITICAL!
35
Fluid volume EXCESS is called
HYPERvolemia
36
What causes FLUID VOLUME EXCESS?
* Excessive intake of fluids
* abnormal retention of fluids
* Interstitial-to-plasma fluid shift
* Clinical manifestations related to excess volume
37
Tx for Fluid Volume Excess (hypervolemia)
**Remove** fluid WITHOUT changing electrolyte composition or osmolality of ECF
38
Fluid Volume EXCESS (FVE) manifestations (signs) include
* HA, confusion, lethargy
* Peripheral edema
* Distended neck veins
* Bounding pulse, High BP
* Polyuria (w/normal renal function)
* Dyspnea, crackles (rales), pulmonary edema
* Muscle spasm
* Weight gain
* Seizures, coma
39
Labs for Fluid Volume Excess (FVE)
* HCT: low (FVE lowers % of RBCs)
* Hgb: normal - low
* BUN: low
* Urine specific gravity <1.010
**FVE= LOW labs**
40
Nursing Management For Restricting Fluid Intake
* Explain reason and amount of restriction
* Help client establish ingestion schedule
* Identify preferences and obtain
* Set short term goals; place fluids in small containers
* Offer ice chips and mouth care
* Teach avoidance of ingesting chewy, salty, sweet foods or fluids
* Encourage participation in recording intake
41
*FVE SKIN ASSESSMENT & CARE*:
In Fluid Volume Excess (FVE):
Edematous skin (edema) may feel
* cool
* can stretch the skin- causing it to feel taut and hard
42
*FVE SKIN ASSESSMENT & CARE*:
In fluid volume excess:
Assess soft tissues overlying a bone, areas such as
* tibia, fibula, and sacrum
* patient is turned at regular intervals- **edematous tissue is MORE PRONE to skin break down** than normal tissue.
43
*FVE SKIN ASSESSMENT & CARE*:
In fluid volume excess:
Edema is assessed by pressing with
thumb or forefinger over the edematous area
--> 1+ slight edema= 2mm indention to 4+ pitting edema= 8mm indention
44
Neurological Effects with **FVD (HYPOVOLEMIA)** include
* Lethargy
* Coma
* Fever
45
Neurological Effects with **FVE (HYPERVOLEMIA)** include
* Altered LOC
* HA
* Visual disturbances
* Muscle weakness (?)
* Paresthesias (tingling, numbess or pins/needles)
46
Cardiovascular effects with **FVD (HYPOVOLEMIA)** include
* Hypotension
* Tachycardia (high HR)
* Weak, thready Pulse (+1)
* Postural hypotension (orthostatic hypotension)
* Flat neck & hand veins
47
Cardiovascular effects with FVE (HYPERVOLEMIA)
* Hypertension with decrease pulse pressure
* Tachycardia (high HR)
* Full, bounding pulse (+3)
* Distended neck & hand veins
48
Respiratory Effects with FVD (hypovolemia)
* **Rapid, deep** respirations
* Will see this in shock, also a sign of impending shock
49
Respiratory Effects with FVE (hypervolemia)
* **Rapid shallow** respirations
* Dyspneic on exertion
* Orthopnea: shortness of breath when lying down)
* Moist crackles
50
Gastrointestinal Effects with FVD (hypovolemia)
* Decreased GI motility
* Diminished bowel sounds
* Constipation
* Thirst
51
Gastrointestinal Effects with FVE (hypervolemia)
* Increased GI motility
* Ascites
52
Integumentary Effects with FVD (hypovolemia)
* Dry, scaly skin
* Inelastic turgor with tenting (skin stays up)
* Mouth & tongue dry
* Dry mucous membranes
53
Integumentary Effects with FVE (hypervolemia)
* Skin pale & cool
* Dependent pitting edema
* Diffuse profound edema, late sign, possible in shock at this point
54
Lab Values for FVD will show:
* Elevated Hct.
* Elevated Hgb.
* Elevated BUN
* Urine specific gravity > 1.030 (dehydration=concentrated)
* They have hemoconcentration (incr. rbc resulting from **loss of plasma or water** from bloodstream)
55
Lab values for FVE will show :
* HTC: Low
* Hgb: Normal to Low
* BUN
* Urine specific gravity <1.010
* Values usually decrease due hemodilution
56
Nursing diagnosis for HYPOVOLEMIA
(Signs Nurse will find)
* Deficient fluid volume
* Decreased cardiac output
* Risk for deficient fluid volume
* Potential complication: Hypovolemic shock
57
Nursing diagnosis for HYPERVOLEMIA
(Things you will see)
* Excess fluid volume
* Impaired gas exchange
* Risk for impaired skin integrity (due to edema)
* Activity intolerance
* Disturbed body image
* Potential complications: Pulmonary edema, ascites.
58
Nursing Management for **Fluid Imbalances**
(Things nurse should do)
* I & O (detailed, to the mL)
* Monitor cardiovascular changes
* Assess respiratory changes
* Neurologic changes
* Daily weights (1L of water = 1 kg or 2.2 lbs)
* Skin assessment
59
What are the TWO MAIN GOALS for TREATING FVD (HYPOVOLEMIA)
1. Correct underlying cause
2. Replace both water and any needed electrolytes
60
What are the Nursing Implementations for FVD?
* Balanced IV solutions( like Lactated Ringers (LR)- usually given)
* Isotonic (0.9%) NACL used when rapid volume replacement is indicated
* Blood is administered when volume loss is due to blood loss
61
What is the MAIN Goal Treatment for FVE (HYPERVOLEMIA).
removal of fluid w/o producing abnormal changes in the electrolyte composition or osmolality of ECF
62
What are the Nursing Implementations for FVE?
(Implementation= Nurse care plan in ACTION)
* Identify and treat the primary cause
* **Diuretics and fluid restriction** are PRIMARY forms of therapy
* May restrict Na+ (sodium)
63
What is the PURPOSE of IV Fluids?
1. **Maintenance**
- When oral intake is not adequate
2. **Replacement**
- When losses have occurred
64
______: the ability of an **EXTRACELLULAR SOLUTION** to make **water move INTO or OUT of a cell** by OSMOSIS.
TONICITY
65
Tonicity commonly pertains to _____ solutions.
intravenous (IV)
66
Tonicity most commonly refers to the ______ content of the SOLUTION.
NaCl (also known as table salt)
67
The tonicity of a solution is **determined** by how it compares to physiologic fluid which is _________.
0.9% NaCl
68
MOVEMENT 0f water is EITHER from
ICF --> ECF
**or**
ECF--> ICF
69
The tonicity of a solution can be used to drive water movement between compartments to change the state of ___ and ___.
cellular hydration AND cell size.
70
What are the THREE **TYPES OF FLUIDS** (categorized by tonicity)
1. Hypertonic
2. Isotonic
3. Hypotonic
71
EFFECTS OF WATER STATUS ON RBC:
NAME THIS TYPE OF SOLUTION (water enters cell)
**HYPOTONIC** SOLUTION
-remember Hippo= hypo (fat and round)
72
EFFECTS OF WATER STATUS ON RBC:
NAME THIS TYPE OF SOLUTION (IMAGE)
**ISOTONIC** SOLUTION
73
EFFECTS OF WATER STATUS ON RBC:
NAME THIS TYPE OF SOLUTION (H2O leaves the cell)
**HYPERTONIC** SOLUTION
74
Type of FLUID (SOLUTION) that contain LESS SOLUTE (sodium chloride concentration) BUT MORE WATER than the bloodstream.
HYPOTONIC SOLUTION
75
IV HYPOTONIC SOLUTIONS can be used to move WATER from the ______ INTO the ________.
ECF INTO the ICF by osmosis.
76
**IV HYPOTONIC solutions** can be used to ________ a patient as they contain hIGH WATER CONCENTRATIONS.
HYDRATE.
(Treats cellular dehydration)
**Usually, maintenance fluids**
77
IV Hypotonic Fluids contain mORE WATER than ____.
electrolytes (solutes).
**Note: Pure water lyses RBC**
78
What should the NURSE monitored when using IV Hypotonic Fluids?
Monitor for changes in mentation (mental).
79
TYPE of FLUID (SOLUTION) that has SAME sodium and chloride concentration and SAME WATER concentration as the bloodstream
ISOTONIC SOLUTIONS.
80
IV **ISOTONIC** SOLUTIONS have NO NET LOSS OR GAIN FROM ________ compartment.
ICF
81
IV ISOTONIC solutions are used to EXPAND the _______
ECF Volume
82
**Isotonic** fluids are ideal to REPLACE
ECF VOLUME deficit.
83
What should the nurse monitor when administering **ISOTONIC** IV Fluids?
Watch for S/S of **fluid overload**
(Since it increases ECF VOLUME)
84
Type of FLUID (SOLUTION) composed of GREATER concentration of NaCl (solute) and LESS WATER compared to blood.
HYPERTONIC SOLUTION.
85
IV HYPERTONIC SOLUTION can be infused into the bloodstream to PULL WATER from the ___ iNTO___.
ICF into the ECF.
86
IV HYPERTONIC SOLUTION:
The movement of water from ICF to ECF will cause________ of the cells.
dehydration (shrinking)
87
IV **HYPERTONIC** SOLUTION:
The dehydration of cells is useful in disorders of severe________; particularly ________ , which requires IMMEDIATE treatment.
edema
cerebral edema
88
IV HYPERTONIC SOLUTION:
Name THREE examples of solutes capable of affecting water movement from ICF to ECF (from cell to outside of cell).
1. Sodium
2. Glucose
3. Mannitol-diuretic
89
IV HYPERTONIC SOLUTION:
Out of the **THREE solutes** capable of affecting water movement from ICF to ECF... Which **solute** can be used to move water RAPIDLY?
MANNITOL
(nonresorbable sugar alcohol)
90
IV HYPERTONIC fluids initially ______ the osmolality of ECF.
expands/raises
91
IV Hypertonic fluids Draws (pulls) fluid into the ______ space, expanding plasma volume.
INTRAVASCULAR
92
IV HYPERTONIC fluids require frequent monitoring of
1. Blood pressure
2. Lung sounds
3. Serum sodium levels
93
D5W stands for
5% dextrose in water (D5W)
94
D5W is what kind of Fluid Solution?
ISOTONIC SOLUTION
95
What is FREE WATER?
distilled water that is FREE of any solutes.
96
D5W provides _____ cal/L and FREE WATER to aid in ________ exertion of solutes!
170
Renal.
97
D5W Free water moves into the ____ space.
ICF
98
D5W Prevents _____ associated with starvation.
ketosis
(Metabolic state where body Burns fat instead of glucose (carbs))
99
D5W is used to replace ______ .
water losses
(Remember- goes into ICF space, into cell)
100
D5W is also used to TREAT _____
hypernatremia.
(High sodium)
101
Does D5W provide any electrolytes?
no.
102
Normal Saline (NS) is also known as
0.9% Sodium Chloride.
103
What kind of solution is NS (0.9% Sodium Chloride)
ISOTONIC
104
NS has mORE ____ than ECF.
NaCL
105
NS Expands IV ____
volume
106
NS is the Preferred fluid for
IMMEDIATE response
107
Bc NS expands IV volume, patient has higher risk for
Fluid overload.
108
What should the nurse monitor for when giving NS?
hyperchloremic acidosis
And fluid overload
109
What DOESNT NS include?
no Free water
no calories
no additional electrolytes
110
Is NS compatible with BLOOD products?
yes.
ONLY solution that can be given with BLOOD PRODUCTS.
111
Is NS compatible with MOST medications?
yes.
112
NS ( 0.9% NaCl ) has SIMILAR TONICITY to
PLASMA.
113
FLUID SOLUTION that has SIMILAR composition to plasma but lacks Mg++
LACTATED RINGER'S SOLUTION
114
LACTATED RINGERS SOLUTION PROVIDES ____ cal/L
9 cal/L
115
What ELECTROLYTES does Lactated Ringers solution include?
*K
*Ca
*Cl
*lactate (metabolized to bicarbonate- HCO3)
** does not contain Mg++**
116
What does Lactated Ringer's solution do to ECF?
Expands EFC
117
Lactated Ringers Solution is contraindicated with
HYPERKALEMIA
and
Lactic Acidosis
118
Lactated Ringers Solution should nOT be used with kidney injury because
it contains potassium and can cause HYPERkalemia
119
Lactated Ringers Solution Tonicity is similar to
plasma
120
Lactated Ringers Solution is used for
*hypovolemia
*burns
*fluid lost as bile or diarrhea
121
What DOESN'T Lactated Ringer's Solution have?
No free water
no calories
122
D5 (1/2) NS stands for
0.45% NaCl
(HALF-STRENGHT SALINE)
123
D5 (1/2) NS is what kind of fluid (solution?
Hypertonic
124
D5 (1/2) NS is a common ______ fluid.
maintenance
125
What is D5 (1/2) NS is used to treat
dehydration- Replaces fluid loss.
126
D5 1/2 NS:
_____ added for maintenance or replacement.
KCL
127
D10W stands for
Dextrose 10% in water.
128
D10W is what kind of fluid (solution)
Hypertonic.
129
D10W provides _____ kcal/L
340
Double of D5W
130
D10W provides _____ but NO _____
FREE WATER
NO ELECTROLYTES
131
D10W:
Limit of dextrose concentration may be infused_____
peripherally
132
What am I?
* solutions (agents) used for temporary maintenance of blood volume in emergency situations.
* have relatively HIGH molecular weight and BOOST the plasma volume by INCREASING osmotic pressure.
PLASMA VOLUME EXPANDERS.
133
Where do you find PLASMA EXPANDERS?
Stay in vascular space and increases osmotic pressure
134
Main type of *Plasma volume expanders* are called:
Colloids (larger insoluble molecules)
135
Example that fall under the Colloids Plasma Expanders are:
*Plasma
*albumin
*comercial plasmas
*dextran
*hetastarch
*Blood
136
Name the THREE fluids that fall under ISOTONIC SOLUTIONS?
*NS
*Lactated Ringers Solution
*D5W
137
WHAT TWO fluids fall under HYPERTONIC solution
*D5(1/2) NS
*D10W
138
Name the Cations in PLASMA
NA+
K+
CA2+
MG2+
139
ELECTROLYTE that Plays a major role in water balance and neuromuscular activity.
Sodium (Na)
140
Sodium effects water distribution between the ___ and ____.
ECF and ICF.
141
_____ cells are very sensitive to changes in serum sodium levels.
Cerebral
142
think ____ with Sodium (Na)
BRAIN
143
Elevated serum sodium occurring with water loss or sodium gain
WHAT AM I?
HYPERNATREMIA
(high levels of sodium (Na))
144
Hypernatremia:
Causes_______, leading to **cellular dehydration**
hyperosmolality
145
Primary protection for Hypernatremia is______ from the hypothalamus
thirst
146
What are some manifestations for HYPERNATREMIA
* Thirst (hypothalmus)
* lethargy
* agitation
* seizures
* coma
* Impaired LOC
* Symptoms of fluid volume deficit
**think BRAIN**
147
Remember
FRIED SALT for Hypernatremia S/S
148
Nursing Management for HYPERNATREMIA
* Treat underlying cause
If Excess sodium, dilute with ______ and promote______.
sodium-free IV fluids and promote excretion with diuretics.
149
Nursing Management for HYPERNATREMIA:
Primary water deficit- replace fluid orally or IV with ___- or______ fluids.
isotonic or hypotonic fluids
150
Nursing Management for HYPERNATREMIA:
Reduce serum_______ levels gradually
sodium
151
Nursing Management for HYPERNATREMIA:
Restrict dietary ______ intake
Na+
152
Results from loss of ‘sodium-containing fluids’ and/or from water excess.
What am I?
HYPONATREMIA
(low sodium levels)
153
Manifestations of Hyponatremia
*Confusion
*irritability
*headache
*seizures
*coma
154
Hyponatremia Nursing Management:
If caused by water excess what is needed?
fluid restriction
155
Hyponatremia Nursing Management:
Severe symptoms include
seizures!
(low sodium)
156
If patient suffers from Hyponatremia, what type of Fluid (solution) should be given?
Give SMALL amount of IV hypertonic saline solution (3% NaCl)
157
HYPONATRemIA Nursing implementations:
If patient suffers from ABNORMAL fluid loss, give Fluid replacement with _________ sollution
sodium-containing solution.
158
HYPONATRemIA Nursing implementations:
Drugs that BLOCK vasopressin (antidiuretic hormone-ADH) include
*Conivaptan (Vaprisol)
*Tolvaptan (Samsca)
159
HYPONATREMIA:
REMEMBER "SALT LOSS"
s- stupor/coma
a-anorexia, N&V
L- lethargy
T- tendon reflexes decreased
L-limp muscles (weakness)
O-orthostatic hypotension
S- seizures /headache
S-stomach cramping
160
*Major ICF cation (+)
*Necessary for:
- Transmission and conduction of nerve and muscle impulses
- Cellular growth
- Maintenance of cardiac rhythms. (Think Heart)
- Acid-base balance
Potassium (K+)
161
Where can you get Potassium?
*Fruits and vegetables (bananas and oranges)
*Salt substitutes
*Potassium medications (PO, IV)
*Stored in the blood
162
Potassium is Regulated by the _____.
* kidneys
* 80% of potassium is excreted daily through the kidneys.
163
HYPERKALEMIA: (high potassium)
High serum potassium caused by
(3 causes)
* Impaired renal excretion
* Shift from ICF to ECF
* Massive POTASSIUM intake
164
Hyperkalemia is most common in
renal failure.
165
Hyperkalemia can be common in massive ______.
cell destruction
(burns, crush injury, tumor lysis)
166
HYPERKALEMIA manifestations include
*Cramping leg pain
*Weak or paralyzed skeletal muscles
167
Hyperkalemia Nursing Implementations:
Eliminate ORAL and PARENTERAL _____ intake.
K+
168
Hyperkalemia Nursing Implementation:
Increase elimination of
_____.
K+
ex: diuretics, dialysis, sodium polystyrene sulfonate-Kayexalate
169
Hyperkalemia Nursing Implementation:
Force K from ECF to ICF by giving
IV insulin or sodium bicarbonate
170
Hyperkalemia Nursing Implementation:
Reverse membrane effects of elevated ECF potassium by administering
calcium gluconate IV
171
For HYPERkalemia (high potassium) remember MURDER
M- muscle cramps
U-Urine
R- Respiratory distress
D- Decreased cardiac contractility
E- Ekg changes
R-reflexes
172
What causes LOW serum POTASSIUM (HYPOKALEMIA)
1. Increased loss of K+ via the kidneys or gastrointestinal tract
2. Increased shift of K+ from ECF to ICF
3. Dietary K+ deficiency (rare)
4. Magnesium deficiency
5. Metabolic alkalosis
6. Certain medications (digoxin, IV insulin, diuretics)
173
Hypokalemia Nursing Implementation:
Provide ______ supplements orally or IV
KCl
174
What are Hypokalemia Manifestations?
1. Cardiac- **most serious**
2. Skeletal muscle weakness (legs)
3. Weakness of respiratory muscles
4. Decreased gastrointestinal motility
5. Impaired regulation of arteriolar blood flow
6. Hyperglycemia
175
HYPOkalemia Nursing Implementation:
IV KCl should always be
diluted
176
Hypokalemia Nursing Implementation:
NEVER give KCl via IV ____ OR as a _____.
IV PUSH
BOLUS (RAPID administration of a concentrated dose)
177
Hypokalemia Nursing Implementation:
KCl supplement SHOULD NOT exceed ________ mEq/hr to prevent ________ and _______.
* 10 mEq/hr
* hyperkalemia and cardiac arrest
178
REMEMBER THE 6 L's for HYPOKALEMIA
* LETHARGY
* LEG CRAMPS
* LIMP MUSCLES
*LOW, SHALLOW RESPIRATIONS
* LETHAL CARDIAC DYSRYTHMIAS
* LOTS OF URINE.
179
What are the Functions of CALCIUM
1. Formation of teeth and bone
2. Blood clotting
3. Transmission of nerve impulses
4. Myocardial contractions
5. Muscle contractions
180
How is Calcium obtained?
Obtained from ingested foods
181
What Vitamin is needed for Vitamin C to be ABSORBED.
VITAMIN D
182
Present in 3 forms: Ionized calcium is biologically active
???
183
What changes in _____ and ______ affect CALCIUM levels.
PH and serum albumin
184
CALCIUM balance is controlled by
1.Parathyroid hormone
2. Calcitonin
185
What causes HYPERCALCEMIA?
1. Hyperparathyroidism (two thirds of cases)
2. Malignancy
3. Prolonged immobilization
4. Vit D overdose
186
HYPERCALCEMIA MANIFESTATIONS (upcoming symptoms)
1. Lethargy, weakness, stupor, coma
2. Depressed reflexes
3. Decreased memory
4. Confusion, personality changes, psychosis
5. Anorexia, nausea, vomiting
6. Bone pain, fractures, nephrolithiasis
7. Polyuria, dehydration
187
Hypercalcemia Nursing Implementation include
1. Excretion of Ca with loop diuretic
2. Hydration with isotonic saline infusion
3. Low calcium diet
4. Mobilization
5. Synthetic calcitonin
6. Bisphosphonates
188
HYPOCALCEMIA is caused by
1. Decreased production of PTH
2. Acute pancreatitis
3. Multiple blood transfusions
4. Alkalosis
5. Increased calcium loss
6. Hyperphosphatemia (renal failure
7. Prolonged NG suctioning
189
What are 2 testS done TO TEST for HYPOCALCEMIA?
1. Chvostek’s Sign
- Contraction of facial muscles in response to a light tap over the facial nerve in front of the ear
2. Trousseau’s Sign
- Palmar flexion (carpal spasm) after BP cuff is pumped up > the client’s systolic pressure AND left pumped for 1-4 minutes
190
Chvostek's sign
191
Trousseau's Sign
192
Hypocalcemia Manifestations (upcoming symptoms)
1. Positive Trousseau’s or Chvostek’s sign
2. Laryngeal stridor
3. Dysphagia
4. Tingling around the mouth or in the extremities
5. Cardiac dysrhythmias
193
REMEMBER CATS FOR HYPOCALCEMIA
C-CONVULSIONS
A-ARRHYTHMIAS
T-TETANY
S-SPASMS AND STRIDOR.
194
Hypocalcemia Nursing Implementation:
1. Treat cause
2. Oral or IV calcium supplements
Not IM to avoid local reactions
3. Rebreathe into paper bag
4. Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis
195
Essential to function of muscle, red blood cells, and nervous system
WHO AM I?
phosphate
196
Phosphate is Involved in
1. acid-base buffering system
2. ATP production
cellular uptake of glucose
metabolism of
3. carbohydrates, proteins, and fats
197
PHOSPHATE is the Primary anion in
ICF
198
Phosphate Serum levels controlled by ______ hormone
parathyroid hormone.
199
Phosphate:
Maintenance requires adequate
renal functioning
200
Phosphate:
Reciprocal relationship with
calcium
201
HYPERphosphatemia
is HIGH SERUM PO4(3-) caused by
1. Acute kidney injury or chronic kidney disease (Seen frequently at TMC, 4th Floor – Renal)
2. Chemotherapy
3. Excessive ingestion of phosphate or vitamin D
202
HYPERphosphatemia Manifestations (upcoming symptoms)
1.Neuromuscular irritability and tetany (hypocalcemia)
2. Calcified deposition in soft tissue such as joints, arteries, skin, kidneys, and corneas (can cause organ dysfunction)
203
How to MANAGE HYPERphosphatemia
1. Identify and treat underlying cause
2. Restrict foods and fluids containing phosphorus
3. Phosphate-binding agents
4. Adequate hydration and correction of hypocalcemic conditions
5. Hemodialysis, IV insulin and glucose
204
HYPOphosphatemia:
Low Serum of PO43- is caused by
1.Malnourishment/malabsorption
2. Alcohol withdrawal
3. Use of phosphate-binding antacids
4. During parenteral nutrition with inadequate replacement
205
HYPOphophatemia Manifestations include
1. CNS depression
2. Confusion
3. Muscle weakness and pain
4. Dysrhythmias
5. Cardiomyopathy
206
HYPOPHOSPHATEMIA:
When PO4 is down, the patient experiences the
skeletal and cardiac muscle-relaxing effect of increased MgSO4.
207
HYPOPHOSPHATEMIA:
What causes the problem:
the high magnesium or the low phosphate?
HIGH MAGNESIUM causes the problem.
208
HYPOPHOSPHATEMIA MANAGEMENT INCLUDES
1. Oral supplementation
2. Ingestion of foods high in phosphorus
3. IV administration of sodium or potassium phosphate
209
Coenzyme in metabolism of protein and carbohydrates
Required for nucleic acid and protein synthesis
Acts directly on myoneural junction
WHO AM I?
MAGNESIUM
210
MAGNESIUM helps maintain balance of
calcium and potassium
211
MAGNESIUM is necessary for
sodium-potassium pump
212
Magnesium is important for nORMAL _____function
cardiac
213
How much of Magnesium is contained in the bone?
50-60%
214
Magnesium is ABSORBED IN the
GI tract
215
magnesium is Excreted by the
Kidneys
216
HYPERmagnesemia:
High serum Mg is caused by
1. Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present
2. Excess intravenous magnesium administration
217
MANIFESTATIONS FOR HYPERMAGNESEMIA
1. Lethargy
2. Nausea and vomiting
3. Impaired reflexes
4. Somnolence(sleepy)
5. Respiratory and cardiac arrest
218
Nurse management for HYPERmagnesemia.
1. Prevention first—restrict magnesium intake in high-risk patients
2. Emergency treatment
- IV CaCl or calcium gluconate
3. Fluids and IV furosemide to promote urinary excretion
4. Dialysis
219
HYPOMAGNESEMIA:
LOW SERUM Mg is Caused by
1. Prolonged fasting or starvation
2. Chronic alcoholism
3. Fluid loss from gastrointestinal tract
4. Prolonged parenteral nutrition without supplementation
5. Diuretics
6. Hyperglycemic osmotic diuresis
220
HYPOmagnesemia manifestations include
1. Confusion
2. Hyperactive deep tendon reflexes
3. Muscle cramps
4. Tremors
5. Seizures
6. Cardiac dysrhythmias
7. Corresponding hypocalcemia and hypokalemia
221
HYPOmagnesemia management
1. Treat underlying cause
2. Oral supplements
3. Increase dietary intake
4. Parenteral IV or IM magnesium when severe
222
What causes Ascites?
it results from:
*heart failure
*nephrotic syndrome
*cirrhosis
*Some malignant tumors.
