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34 Cards in this Set

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Magnesium:
Normal Value and Use
1.6-2.6 mg/dl
Required for :
-Use of Adenosine Triphosphate
-Carbohydrate metabolism
-Protein Synthesis
-Regulates neuromascular activity.
Sodium:
Normal Value and Use
135-145 mEq/dl
-Maintains Osmotic Pressure
-Transmits nerve impulses
Sodium:
Hypernatremia Causes and Treatments
-Excessive intake of Na
-HYPERaldosteronism/Conn's
-Cushing’s Disease
-Decreased Water Intake
-Diaphoresis
-Diabetes Insipidus
-Diarrhea
a. IV Normal Saline for Hypernatremia caused by caused by fluid loss.
b. Furosemide (Lasix) - for Hypernatremia caused by Inadequate Renal Secretion
Sodium:
Hyponatremina Causes and Treatments
-Inadequate Na Intake
-Addison’s
-Hypoaldosternonism
-Vomiting
-Diarrhea
-Fever
-Renal Failure
-Excessive Sweating
-Thiazide Diuretics
-Low salt diet
-SIADH (treated with Declomycin, an ADH Antagonist)
-CHF
a. Hypovolemic Hyponatremia – Little H20 and Na. IV NaCl to restore Na and Fluid.
b. Hypervolemic Hyponatremia – More H20, Lesser Na. Potassium-Sparing Diuretics (Spirinolactone)
Calcium:
Normal Value and Use
8.6-10.0 mg/dl
-Mineral for bone formation
-Coagulation of blood
-Excitation of cardiac and skeletal muscles
-Regulation of endocrine and exocrine glands
Calcium:
Hypercalcemia Causes and Symptoms
-Excessive oral intake of Ca and Vit D
-Hyperparathyroidism
-Bone Destruction
- ECG Sign: Short ST, Wide -
- Disorrientation
- Lethargy
- Coma
Calcium:
Hypocalcemia Causes and Symptoms
-Lactose Intolerance
-Inadequate intake of Calcium and Vit D
-Celiac Sprue or Crohn’s Disease
-Hyperphosphatemia
-Parathyroidectomy
- ECG Sign: Prolonged ST QT
- TROUSSEAU’S Sign (carpall spasm)
- Chvostek Sign (facial spasm)
- Twitches
- Cramps
- Tetany
Potassium:
Normal Value and Use
3.5-5.1 mEq/dl
- Primary fluid in interstitial compartment
- For blood gas exchange
- Nerve conduction and muscle function
- 5-10 mEq/h infusion rate.
- Needs cardiac monitor
- Cannot be administered vua IM, SQ and IV Push
- No Pee, No K.
Potassium:
Hyperkalemia Causes and Treatment
- Addison’s
- Excessive Intake of K
- Spirinolactone
- K Supplements
- Calcium Gluconate
- Sodium Bicarbonate
- Kayexalate
- Dialysis
Potassium:
Hypokalemia Causes and Symptoms
- Cushing’s
- Hyperaldosteronism
- Inadequate intake of K
- Fluid shift from Extra to Intra
- Renal Failure
- Vomiting
- Diarrhea
- NG Suction
- Corticosteroids
- Wound drainage
- Sweating
- Early: Muscle Twitches, Cramps
- Late: Paralysis
Phosphorus:
Normal Value and Use
2.7-4.5 mg/dl
- Required for bone formation
- Metabolism of glucose and lipids
- Maintenance of acid-base balance.
Phosphorus:
Hyperphosphatemia Causes and Treatments
- Excessive intake of Phosphate-containing laxative and enema
- Tumorlysis syndrome caused by chemo
- Hypoparathyroidism
- Oral Phosphate Binders such as Aluminum Hydroxide (Amphojel)
Phosphorus:
Hypophosphatemia Cause and Treatments
- Insufficient Phosphorus Intake
- Malnutrition
- Starvation
- Increased phosphorus excretion caused by Hyperparathyroidism
- Increased Phosphorus Intake along with Vit D.
- If Serum Phosphorus is <1 mg/dl, administer Phosphorus through Slow IV.
IV Fluids:
Isotonic Description and Solutions
Two solutions separated by permeable membrane with equal concentration.
a. D5W, 5% Dextrose in H2O
b. NaCl, .9% in Cl
c. LR, Lactated Ringer's
IV Fluids:
Isotonic, Dextrose 5% in water (D5W) Uses and Considerations
- Fluid loss
- Dehydration
- Hypernatremia
- Use cautiously in renal and cardiac patients
- Can cause fluid overload
IV Fluids:
Isotonic, 9% Sodium in Cl (NaCl) Uses and Considerations
- Shock
- Hyponatremia
- Blood transfusions
- Resuscitation
- Fluid challenges
- DKA
- Can lead to overload
- Use with caution in patients with heart failure or edema
IV Fluids:
Isotonic, LaIV Fluids:ctated Ringers
- Dehydration
- Burns
- Lower GI fluid loss
- Acute blood loss
- Hypovolemia due to third spacing
- Contains potassium, don’t use with renal failure patients
- Don’t use with liver disease, can’t metabolize lactate
IV Fluids:
Hypotonic Description and Solutions
Contains lower concentration of
Salt
0.45% sodium chloride (1/2 normal saline)
IV Fluids:
Hypotonic, 0.45% sodium chloride (1/2 normal saline) Uses and Considerations
- Water replacement
- DKA
- Gastric fluid loss from NG or vomiting
- May cause cardiovascular collapse
- May Increase intracranial pressure
- Don’t use with liver disease, trauma, or burns
IV Fluids:
Hypertonic Description and Solutions
Have high concentration solutes.
- Dextrose 5% in ½ normal saline
- Dextrose 5% in normal saline
- Dextrose 10% in water
IV Fluids:
Hypertonic, Dextrose 5% in ½ normal saline Uses and Consideration
Later in DKA treatment
Use only when blood sugar falls below 250 mg/dL
IV Fluids:
Dextrose 5% in normal saline Uses and Considerations
Temporary treatment for shock if plasma expanders aren’t available
Addison’s crisis
Don’t use in cardiac or renal patients
IV Fluids:
Dextrose 10% in water Uses and Considerations
Water replacement
Conditions where some nutrition with glucose is required
Monitor blood sugar levels
Dehydration and Overhydration:
DEHYDRATION Signs and Interventions
1.CARDIOVASCULAR SIGNS: Increased Pulse Rate, HTN, Orthostatic Hypotension, Flat Neck Veins
2. SKIN: Poor Skin Turgor, Tenting, Dry Mouth, Dry Skin
3. RENAL: Decreased Urine Output, Increased Urine Specific Gravity
4. LAB FINDINGS: Increased Serum Osmolality, Increased Hematocrit, Increased BUN, Hypernatremia
a. IV Fluid Infusion
b. Increased Fluid Intake
c. ISOTONIC with Isotonic, HYPERTONIC with Hypotonic, HYPOTONIC with HYPERTONIC
Dehydration and Overhydration:
OVERDHYDRATION Signs
1. RESPIRATORY: Crackles, Tachypnia, Dyspnea
2. SKIN: Cool, Pale Skin; Pitting Edema
3. CARDIOVASCULAR: Tachycardia, Jugular Venous Distention, Hypertension
Dehydration and Overhydration:
ISOTONIC. Definition and Isotonic Fluid Samples
Contains equal amount of Water and Electrolytes
Lactated Ringer’s Solution
5% Dextrose in 0.225% Saline
5% Dextrose in Water
Dehydration and Overhydration:
ISOTONIC DEHYDRATION Definition and Causes
a. Water and Electrolytes are lost at an equal Value
b. HYPOVOLEMIC/Hypovolemia
Fluid Shift
Inadequate intake of Fluids and Solutes
Dehydration and Overhydration:
ISOTONIC Overhydration Definition, Causes and Symptoms
a. Water and Electrolyte are gained at the same value
b. HYPERVOLEMIC/Hypervolemia
c. c. Can cause Circulatory Overload, Peripheral Edema and Pulmonary Edema
CAUSES
- Corticosteroid Therapy
- Renal Failure
- Excessive IV Therapy

SYMPTOMS
- Hepatomegaly
- Ascites
Dehydration and Overhydration:
HYPOTONIC. Definition and Hypotonic Fluid Samples
Contains more Water than Na
- 22% NaCl
- 33% NaCl
- 45% NaCl
Dehydration and Overhydration:
HYPOTONIC DEHYDRATION Definition and Causes
Electrolyte loss is greater than Water loss causing HYPONATREMIA
Excessive fluid replacement with Hypertonic, malnutrition
Dehydration vs Overhydration:
HYPOTONIC OVERHYDRATION Definition and Causes
Results from water intoxication
Excessive Hypotonic Infusion
Renal Failure
CHF
SIADH secretion
Dehydration vs Overhydration:
HYPERTONIC. Definition and Hypertonic Fluid Samples
Have higher concentration of Solutes than Water
3% NaCl
5% NaCl
10% Dextrose in Water
5% Dextrose in Ringer’s
Dehydration vs Overhydration:
HYPERTONIC DEHYDRATION Definition and Causes
loss exceeds Electrolytes causing HYPERNATREMIA
Vomiting
Diarrhea
Excessive Sweating
Ketoacidosis
Diabetes Insipidus.
Dehydration vs Overhydration:
HYPERTONIC OVERHYDRATION Causes
Excessive Na intake
Rapid infusion on IV Saline