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58 Cards in this Set
- Front
- Back
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Water Content Of The Body
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Children 70-80 %
Adult 50-60% Elder 45-55% |
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Water Balance in Infants
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Infants & young children
Greater need for water More vulnerable to alterations Infants have greater & more rapid water loss Water & electrolyte disturbances occur more freq & more rapidly Children adjust less promptly to these alterations |
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Water Balances in InfantsBody Surface Area (BSA)
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BSA of premature neonate 5x more than older child or adult, 2-3x more in newborn
Longer GI tract in infancy source of relatively greater fluid loss |
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Water Balances in Infants
Metabolic Rate Kidney Function |
Higher in infancy
Greater production of metabolic wastes Immature at birth Inability to concentrate or dilute urine More likely to become dehydrated or overhydrated |
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Water Balances in Infants
Fluid Requirements |
Ingest & excrete greater amount of fluid/kg of body weight
Maintenance requirements include both water & electrolytes |
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Dehydration in Children
Common Causes |
Diarrhea
Vomiting Gastroenteritis |
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Assessing for Dehydration in Children
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Earliest detectable sign: Tachycardia
Skin & mucous membranes:dry Fontanels: sunken Extremities:Cool Skin elasticity:decreased Capillary refill: > 3 sec Sensorium (irritability to lethargy) Heart rate: increased Eyes: sunken Urine output:decreased 30 ml BP : hypotension Pedi kidney function: 1-2ml/kg/hr |
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Nursing Responsibilities in Children with Dehydration
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Assessment
Accurate I&O 1 gm wet diaper weight = 1 ml urine Oral rehydration management Parenteral fluid therapy |
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Water Intoxication in Children
How CM |
Can occur during
Acute intravenous (IV) water overloading Feeding of incorrectly mixed formula Excess water ingestion Manifestations: Irritability Somnolence HA Vomiting Diarrhea Seizures |
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Gerontologic Considerations in Fluid & Electrolyte Balance
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Structural changes in kidneys
Hormonal changes Loss of subcutaneous tissue Reduced thirst mechanism |
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Fluid and Electrolyte Imbalances
Extracellular Fluid Volume (ECF) Imbalances |
Fluid volume deficit (hypovolemia)
Fluid replacement (isotonic) blood transfus. Fluid volume excess (hypervolemia) Remove fluid (diuretics) Fluid restriction |
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Sodium
Characteristics |
135-145
Plays a major role in ECF volume and concentration Generation and transmission of nerve impulses Acid–base balance |
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Sodium Imbalances: Hypernatremia
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Elevated serum sodium
Causes hyperosmolality cellular dehydration hypothalamus says drink |
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Sodium Imbalances: Hypernatremia
Manifest |
nuerologic: restless, agitation, anorexia, nausea, vomting
weakness, lethargy, confusion, seizures, and coma |
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Sodium Imbalances: Hypernatremia
Causes |
antacids w/ bicarbs
antibiotics Na bicarb injections |
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Nursing Management Hypernatremia
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Treat underlying cause
If oral fluids cannot be ingested, IV solution of 5% dextrose in water or hypotonic saline Diuretics Reduce level gradually |
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Sodium Imbalances: Hyponatremia
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Results from loss of sodium-containing fluids or from water excess
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Sodium Imbalances: Hyponatremia
manifest |
Neurologic: headache, disorientation, seizures, coma
Nausea, vomiting weakness |
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Nursing Management Hyponatremia
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Caused by water excess
Fluid restriction is needed Severe symptoms (seizures) Give small amount of IV hypertonic saline solution (3% NaCl) |
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Potassium
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Major ICF cation
Necessary for 3.5-5 Transmission and conduction of nerve and muscle impulses Maintenance of cardiac rhythms Acid–base balance |
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Potassium sources
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Banana, oranges, salt substitutes
diuretic-K retention stored blood inverse relationship with Na |
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Potassium Imbalances: Hyperkalemia
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High serum potassium caused by
Massive intake Impaired renal excretion Shift from ICF to ECF Common in massive cell destruction Burn, crush injury, or tumor lysis |
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Potassium Imbalances: Hyperkalemia
CM |
Nueromuscular: cramping, weakness, respiratory failure, hyperactive smooth muscle (GI tract).
Cardiac: V-fib, dysrhythmia |
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Nursing Implementation: Hyperkalemia
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Eliminate oral and parenteral K intake
Increase elimination of K Force K from ECF to ICF by IV insulin or sodium bicarbonate Reverse membrane effects of elevated ECF potassium by administering calcium gluconate IV Kayexalate |
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Potassium Imbalances: Hypokalemia
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Low serum potassium caused by
Abnormal losses of K+ via the kidneys or gastrointestinal tract Magnesium deficiency Metabolic alkalosis |
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Potassium Imbalances: Hypokalemia
CM |
dysrhythmia, V-fib
muscle weakness, decreased GI motility digoxic toxicity |
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Nursing Management Hypokalemia
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KCl supplements orally or IV
Should not exceed 10 to 20 mEq/hr To prevent hyperkalemia and cardiac arrest |
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Calcium 1
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Cardiac
Obtained from ingested foods Inverse relationship with phosphorus Blocks sodium transport Stabilizes cell membrane |
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Calcium 2
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Functions
Transmission of nerve impulses Myocardial contractions Blood clotting Formation of teeth and bone Muscle contractions Balance controlled by Parathyroid hormone Calcitonin Vitamin D |
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Calcium Imbalances Hypercalcemia
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High serum calcium levels caused by
Hyperparathyroidism (two thirds of cases) Malignancy Vitamin D overdose Prolonged immobilization |
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Calcium Imbalances: Hypercalcemia
CM |
confusion
lethargy depression muscle weakness dysrhyhmia deep tendon reflexes digoxin toxicity |
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Nursing Implementation: Hypercalcemia
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Excretion of Ca with loop diuretic
Hydration with isotonic saline infusion Synthetic calcitonin Mobilization |
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Calcium Imbalances: Hypocalcemia
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Low serum Ca levels caused by
Decreased production of PTH Acute pancreatitis Multiple blood transfusions Alkalosis Decreased intake |
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Calcium Imbalances: Hypocalcemia
CM |
Manifestations
Positive Trousseau’s or Chvostek’s sign-tetany Laryngeal stridor Dysphagia Tingling around the mouth or in the extremities |
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Nursing Diagnoses Hypocalcemia
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Risk for injury
Potential complication: fracture or respiratory arrest |
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Nursing Management: Hypocalcemia
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Treat cause
Oral or IV calcium supplements Not IM to avoid local reactions Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis |
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Phosphate
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Primary anion in ICF
Essential to function of muscle, red blood cells, and nervous system Deposited with calcium for bone and tooth structure Involved in acid–base buffering system, ATP production, and cellular uptake of glucose Maintenance requires adequate renal functioning Essential to muscle, RBCs, and nervous system function |
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Phosphate Imbalances: Hyperphosphatemia
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High serum PO43- caused by
Acute or chronic renal failure Chemotherapy Excessive ingestion of phosphate or vitamin D |
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Phosphate Imbalances: Hyperphosphatemia
CM |
Manifestations
Positive Trousseau’s or Chvostek’s sign-tetany Laryngeal stridor Dysphagia Tingling around the mouth or in the extremities |
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Nursing Mangement: Hyperphosphatemia
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Identify and treat underlying cause
Restrict foods and fluids containing POh3- Adequate hydration and correction of hypocalcemic conditions |
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Phosphate Imbalances: Hypophosphatemia
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Low serum PO43- caused by
Malnourishment/malabsorption Alcohol withdrawal Use of phosphate-binding antacids During parenteral nutrition with inadequate replacement |
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Hypophosphatemia: Manifestations
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CMS depression
weak muscle cardiac dysrhythmias respiratory muscle fatigue |
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Nursing Management: Hypophosphatemia
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Oral supplementation
Ingestion of foods high in PO43- IV administration of sodium or potassium phosphate |
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Magnesium
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50% to 60% contained in bone
Coenzyme in metabolism of protein and carbohydrates Factors that regulate calcium balance appear to influence magnesium balance Acts directly on myoneural junction Important for normal cardiac function |
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Magnesium Imbalances: Hypermagnesemia
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High serum Mg caused by
Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present |
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Magnesium Imbalances: Hypermagnesemia
CM |
hypoactive DTR
decr. muscle activity weakness nausea and vomiting hypotension slow respirations |
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Nursing Management: Hypermagnesemia
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Prevention
Emergency treatment IV CaCl or calcium gluconate Fluids to promote urinary excretion |
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Magnesium Imbalances: Hypomagnesemia
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Low serum Mg caused by
Prolonged fasting or starvation Chronic alcoholism Fluid loss from gastrointestinal tract Prolonged parenteral nutrition without supplementation Diuretics |
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Hypomagnesemia: Manifestations
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incr. neuro excite
tetany hyperactive DTR dysrhythmia digoxin toxicity |
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Nursing Management: Hypomagnesemia
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Oral supplements
Increase dietary intake Parenteral IV or IM magnesium when severe |
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Ca excess
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Hypercalcemia
Thirst CNS deterioration Increased interstitial fluid digoxin toxicity |
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Ca deficit
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Hypocalcemia
Tetany Chvostek’s, Trousseau’s signs Muscle twitching CNS changes ECG changes |
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Mg excess
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Hypermagnesemia
Loss of deep tendon reflexes (DTRs) Depression of CNS Depression of neuromuscular function |
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Mg deficit
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Hypomagnesemia
Hyperactive DTRs CNS changes digoxin toxicity |
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Na excess
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Hypernatremia
Thirst CNS deterioration Increased interstitial fluid |
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Na deficit
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Hyponatremia
CNS deterioration |
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K excess
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Hyperkalemia
Ventricular fibrillation ECG changes CNS changes |
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K deficit
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Hypokalemia
Bradycardia ECG changes CNS changes digoxin toxicity |
