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99 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What charges do cations have
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positive
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183
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what charges do anions have
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negative
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183
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What is the major cation in ECF
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sodium Na+
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183
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Keeping Na+ levels different in ECF and ICF is vital for
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muscle contractions, cardiac contractions, nerve transmission, normal osmolarity, and volume of the ECF
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184
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Sodium Na+ range and functions
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136-145 mEq/L
maintenance of plasma and interstitial osmolarity, generation and transmission of action potentials, maintenance of acid-base balance, maintenance of electroneutrality |
184
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Potassium K+ range and functions
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3.5-5.0 mEq/L
regulation of intracellular osmolarity, maintenance of electrical membrane excitability, maintenance of plasma acid-base blance |
184
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Calcium Ca2+ range and functions
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9.0-10.5 mg/dL
cofactor in blood-clotting cascade, excitable membrane stabilizer, adds strength/density to bones and teeth, essential element in cardiac, skeletal, and smooth muscle contraction |
184
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Chloride Cl- range and functions
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98-106 mEq/L
maintenance of plasma acid-base balance, maintenance of plasma electroneutrality, formation of hydrochloric acid |
184
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Magnesium Mg2+ range and functions
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1.3-2.1 mEq/L
excitable membrane stabilizer, essential element incardiac, skeletal, and smooth muscle contraction, cofactor in blood-clotting cascade, cofactor in carbohydrate metabolism, cofactor in DNA and protein synthesis |
184
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Phosphorus P range and function
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3.0-4.5 mg/dL
activation of B-complex vitamins, formation of adenosine triphosphate and energy substances, cofactor in carbohydrate, protein, and lipid metabolism |
184
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hyponatremia
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Na+ level below 136 mEq/L
osmolarity of ECF is lower than ICF. This causes water to move into the cell and swelling. |
184
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common causes of hyponatremia
*actual and relative |
ACTUAL
excessive diaphoreisis, diuretics, wound drainage, decreased secretion of aldosterone, hyperlipidemia, renal disease, NPO, low-salt diet RELATIVE excessive ingestion of hypotonic fluids, psychogenic polydipsia, freshwater submersion accident, renal failure, irrigation with hypotonic fluids, syndrome of inappropriate antidiuretic hormone secretion, hyperglycemia, heart failure |
184
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Hyponatremia cerebral changes
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most obvious problems
confusion LOC |
185
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Hyponatremia neuromuscular
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general weakness
deep tendon reflexes diminish |
185
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Hyponatremia intestinal changes
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increased motility
nausea, diarrhea, ab cramping hyperactive bowel sounds |
185
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Hyponatremia cardiovascular changes
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hypovolemia (decreased plasma volume)-
rapid, weak, thready pulse decreased BP orthostatic hypotension |
185
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Hyponatremia interventions
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drug therapy- severe hyponatremia may be treated with small volume infusions of hypertonic (2-3%) saline through a pump
hyponatremia with fluid excess- osmotic diuretics that promote excretion of water not sodium (mannitol, Osmitrol, conivaptan, Vaprisol) caused by inappropriate secretion of ADH- agents that antagonize ADH such as lithium and demeclocycilne (Declomycin) nutritional therapy- increasing oral sodium intake, restricting oral fluid intakes |
186
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Hypernatremia
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serum sodium level over 145 mEq/L
irritablity- excitable tissues more easily excited- excitable tissues over-respond to stimuli water moves from cells into ECF to dilute hyperosmolar ECF dehydrated excitable tissues may no longer be able to respond to stimuli |
186
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Common causes of hypernatremia
actual and relative |
ACTUAL
hyperaldosteronism, renal failure, corticosteroids, cushing's syndrome, excessive oral sodium ingestion, excessive administration of sodium containing IV fluids RELATIVE NPO, increased rate of metabolism, fever, hypeventilation, infection, excessive diaphoresis, watery diarrhea, dehydration |
186
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hypernatremia nervous system changes
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altered cerebral function
short attention span confusion about recent events |
186
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hypernatremia skeletal muscle changes
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muscle twitching
irregular muscle contractions deep tendon reflexes reduced |
186
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hypernatremia cardiovascular changes
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decreased contractility because slow movement of calcium into the heart cells
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186
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hypernatremia interventions
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drug therapy- hypotonic IV
diuretics that promote sodium loss (Lasix, Furoside) nutrition therapy- sodium restriction |
187
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What is the major cation of intracellular fluid?
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Potassium K+
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187
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Potassium- range and controllers
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3.5 - 5.0 mEq/L
The main controller of ECF potassium level is the sodium-potassium pump within the membranes of all body cells potassium control also occurs through kidney function, because 80% of potassium removed from the body occurs via the kidney |
187
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Hypokalemia
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serum potassium level below 3.5 mEq/L
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187
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Where is 98% of total body potassium
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inside the cells
so, minor changes in ECF potassium levels cause major changes |
187
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common causes of hypokalemia
actual and relative |
ACTUAL
inappropriate or excessive use of drugs (diuretics, digitalis, cortiocosteriods), increased secretion of aldosterone, cushings syndrome, diarrhea, vomiting, wound drainage, prolonged nasogastric suction, heat-induced excessive diaphoresis, renal disease impairing absorption of K, NPO RELATIVE alkalosis, hyperinsulinism, hyperalimentation, total parenteral nutrition, water intoxication, IV therapy with potassium-poor solutions |
187
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hypokalemia respiratory changes
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Respiratory has to be assessed first because skeletal muscle weakness results in shallow respirations.
respiratory insufficiency is a major cause of death |
188
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hypokalemia cardiovascular changes
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pulse is thready, weak, easily blocked with light pressure
dysrthymia may be present give digoxin |
188
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hypokalemia intestinal changes
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decreased smooth muscles contractions in intestinal tract leads to decreased peristalsis
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188
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hypokalemia musculoskeletal changes
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skeletal muscle weakness
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188
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hypokalemia interventions
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drug therapy- potassium is given IV for severe hypokalemia. It is a high alert warning as a concentrated electrolyte solution. A dilution of no more than 1 mEq/10 mL. Max recommended infusion rate is 5-10 mEq/hr. Never exceed 20mEq/hr. Never given IV push, IM, or subcutaneous injection. If burning at site, stop IV immediately.
Potassium sparing diuretics- spironolactone (Aldactone, Nova-Spiroton), triamterene (Dyrenium), and amiloride (Midamor) |
189
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hyperkalemia
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serum potassium level higher than 5.0 mEq/L
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190
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What is the most serious complications of hyperkalemia?
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altered cardiac function
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190
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Common causes of hyperkalemia
actual and relative |
ACTUAL
over ingestion of potassium-containing foods or medications (salt substitutes, potassium chloride), transfusions of whole blood or packed cells, adrenal insufficiency, renal failure, potassium sparing diuretics RELATIVE tissue damage, acidosis, hyperuricemia, uncontrolled diabetes mellitus |
190
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hyperkalemia cardiovascular changes
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bradycardia, hypotension,
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190
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hyperkalemia neuromuscular changes
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skeletal muscle twitches and paresthesia in early stages
then muscle weakness and flaccid paralysis |
190
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hyperkalemia intestinal changes
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increased motility, bowel sounds hyperactive
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190
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hyperkalemia interventions
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drug therapy- potassium excreting diuretics like furosemide
To move potassium from ECF into ICF, insulin increases activity of sodium potassium pumps. Cardiac monitoring- monitory for dysrthymias, compare ECG tracings |
191
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Foods rich in potassium
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meats, dairy, dried fruits, bananas, cantaloupe, kiwi, oranges, avacados, broccoli, dried beans/peas, lima beans, mushrooms, potatoes, seaweed, soybeans, spinach
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191
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foods poor in potassium
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eggs, breads, butter, cereals, sugar, apples, apricots, berries, cherries, grapefruit, peaches, pineapples, cranberries, alfalfa sprouts, cabbage, carrots, cauliflower, celery, eggplant, green beans, lettuce, onions, peas, peppers, squash
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191
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Calcium is a mineral with functions closely related to
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phosphorus and magnesium
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191
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Calcium is important for
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bone strength and density, activating enzymes, allowing skeletal and cardiac muscle contractions, controlling nerve impulse transmission, and allowing blood clotting
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191
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Calcium enters the body by
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dietary intake and absorption through the intestinal tract
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191
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calcium is stored in the
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bones
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191
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When more calcium is needed ___ is released
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Parathyroid hormone (PTH)
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191
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When excess calcium is present,__ secretion is increased by the thyroid gland and PTH is inhibited
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thyrocalcitonin (TCT)
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191
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TCT causes plasma calcium level to __ by ___
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decrease by inhibiting bone resorption of calcium, inhibiting Vit D associated intestinal uptake of calcium, and increasing kidney excretion of calcium in the urine
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191
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Hypocalcemia
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serum calcium level below 9.0 mg/dL
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191
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common causes of hypocalcemia
actual and relative |
ACTUAL
inadequate oral intake of calcium, lactose intolerance, malabsorption syndromes (celiac sprue, chrohn's disease), inadequate intake of vit D, end stage kidney disease, renal failure, diarrhea, steatorrhea, wound drainage RELATIVE hyperproteinemia, alkalosis, calcium chelators or binders, citrate, mithramycin, penicillamine, sodium cellulose phosphate, aredia, acute pancreatitis, hyperphosphatemia, immobility, removal or destruction of parathyroid glands |
192
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hypocalcemia neuromuscluar changes
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occur first in hands
paresthesias at first progressing to muscle twitching, painful cramps, and spasms. assess for Trousseau's sign and Chvostek's sign |
192
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How to test for Trousseau's sign
What is a positive sign |
place a blood pressure cuff around the upper arm, inflate the cuff to greater than the patient's systolic pressure, and keep the cuff inflated for 1-4 minutes. Under these hypoxic conditions, a positive sign occurs when the hand and fingers go into spasm in palmar flexion.
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192
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How to test for Chvostek's sign
What is a positive sign |
tap the face just below and in front of the ear (over facial nerve) to trigger facial twitching of one side of the mouth, nose, and cheek
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192
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hypocalcemia cardiovascular changes
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weak, thready pulse
severe hypocalcemia causes hypotension and ECG changes |
192
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hypocalcemia intestinal changes
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increased peristaltic activity
hyperactive bowel sounds painful ab cramping and diarrhea |
192
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hypocalcemia skeletal changes
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most common
osteoporosis - loss of bone density bones break easily vertebrae become more compact and may bend causing overall loss of height |
193
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hypocalcemia interventions
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drug therapy- calcium replacement (oral and IV) and drugs that enhance absorption, such as aluminum hydroxide and vit D.
nutritional- high calcium diet environment-Reduce stimulation because excitable membranes of the nervous system and skeletal system are overstimulated. seizure precautions |
193
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hypercalcemia
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serum calcium level above 10.5 mg/dL
excitable tissues less sensitive faster blood clotting times |
193
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common causes of hypercalcemia
actual and relative |
ACTUAL
excessive oral intake of calcium, excessive oral intake of vit D, renal failure, use of thiazide diuretics RELATIVE hyperparathyroidism, malignancy, hyperthyroidism, immobility, use of glucocorticoids, dehydration |
194
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manifestation of hypercalcemia are related to
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its severity and how quickly the imbalance occurred.
rapidly occurring is worse |
194
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hypercalcemia cardiovascular changes
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most serious and life threatening
increased heart rate increased BP severe- depresses electrical conduction which slows heart rate assess blood flow- cyanosis and pallor examine ECG for dysrhythmias |
194
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hypercalcemia neuromuscluar changes
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muscle weakness
decreased deep tendon reflexes without paresthesia altered LOC |
194
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hypercalcemia intestinal changes
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first- decreased peristalsis
constipation, anorexia, nausea, vomiting, ab pain bowel sounds hypoactive abdominal size increases |
194
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hypercalcemia interventions
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IV and drugs with calcium stopped (Ringer's lactate, calcium based antacids, thiazide diuretics)
fluid volume replacement with normal saline Lasix, Furoside diuretics to excrete calcium drugs that inhibit calcium resorption from bone- phosphorus, calcitonin (Calcimar, bisphosphonate (etidronate), adn prostoglandin synthesis inhibitors (aspirin, NSAIDS) dialysis-severe (hemodialysis or blood ultrafiltration) cardiac monitoring- identify dysrhythmias and decreased cardiac output |
194
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What is the major anion in ICF?
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phosphorus
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194
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Most phosphorus can be found in the
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bones
80% |
194
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Phosphorus is needed for
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activating vitamins and enzymes, forming adenosine triphosphate (ATP) for energy, and assisting in cell growth and metabolism. Also functions with acid/base and calcium homeostasis.
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194
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A change in plasma phosphorus results in an equal and opposite change in plasma ___
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calcium
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194
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the regulation of ECF phosphorus occurs through activity of ___.
When it increases phosphorus __ |
parathyroid hormone (PTH)
When PTH increases phosphorus decreases, and vice versa |
194
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hypophosphatemia
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serum phosphorus level below 3.0 mEq/L
body functions are not usually impaired by rapid wide changes, but chronic hypophosphatemia |
194
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Three main processes of hypophosphatemia are
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decreased absorption of phosphorus, increased excretion of phosphorus, and intracellular phosphorus shift
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195
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common causes of hypophosphatemia
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malnutrition, starvation, use of aluminum hydroxide based antacids, use of magnesium based antacids, hyperparathyroidism, hypercalcemia, renal failure, malignancy, hyperglycemia, hyperalimentation, respiratory alkalosis, uncontrolled diabetes mellitus, alcohol abuse
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195
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hypophosphatemia cardiac changes
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decreased stroke volume
decreased cardiac output peripheral pulses easily blocked, slow |
195
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hypophosphatemia musculoskeletal changes
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weak skeletal muscles that may progress to muscle break down (rhabdomyolysis)
paresthesias usually not present can affect respiratory chronic- bone density decreased |
195
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hypophosphatemia central nervous system changes
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not apparent to severe
first is irritability then progress to seizure and coma |
195
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hypophosphatemia interventions
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oral replacement of phosphorus and vit D
IV phosphorus only when levels below 1mg/dL and pt has serious manifestations intake phosphorus rich while decreasing calcium rich foods |
195
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foods you may eat if hypophosphatemia
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fish, beef, chicken, pork, organ meats, nuts, whole-grain breads and cereals
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195
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foods you should avoid if hypophosphatemia
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milk, cheese, yogurt, collard greens, rhubarb
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195
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hyperphosphatemia
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serum phosphorus levels above 4.5 mEq/L
problems arise because of the hypocalcemia it causes- increased membrane excitability |
195
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common causes of hyperphosphatemia
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decreased renal excretion resulting from renal insufficiency
tumor lysis syndrome increased intake of phosphorus hypoparathyroidism |
195
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Magnesium Mg2+
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mineral that forms a cation when dissolved in water
adults have an average of 25 g total body level 60% stored in bones more in the ICF |
195
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Magnesium is critical for
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skeletal muscle contractions, carbohydrate metabolism, adenosine triphosphate ATP formation, vitamin activation, and cell growth. Extracellular magnesium regulates blood coagulation and skeletal muscle contractilty.
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196
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The daily magnesium requirement for adults is
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300 mg
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196
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magnesium regulation occurs through
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the kidney and intestinal tract
exact mechanisms not known |
196
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hypomagnesemia
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serum magnesium level below 1.3 mEq/L
effects are caused by increased membrane excitability and the accompanying serum calcium and potassium imbalances |
196
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hypomagnesemia is caused by decreased absorption of dietary magnesium or increased renal magnesium excretion caused by...
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malnutrition, starvation, diarrhea, steatorrhea, celiac disease, crohn's disease, drugs, citrate, ethanol ingestion
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196
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hypomagnesemia neuromuscular changes
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hyperactive deep tendon reflexes
numbness and tingling painful muscle contractions positive Chvostek's and Trousseau's sign may be present because of hypocalcemia tetany, seizures |
196
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hypomagnesemia central nervous system changes
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psychological depression, psychosis, and confusion
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196
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hypomagnesemia intestinal changes
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decreased intestinal smooth muscle contractions
reduced motility anorexia nausea constipation abd distention |
196
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interventions for hypomagnesemia
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correct magnesium and calcium imbalance
IV- magnesium sulfate |
196
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hypermagnesemia
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serum magnesium levels above 2.1 mEq/L
membranes less excitable |
196
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hypermagnesemia is from increased intake of magnesium and decreased renal excretion caused by...
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magnesium containing antacids and laxatives
IV magnesium replacement renal insufficiency |
196
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hypermagnesemia cardiac changes
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bradycardia, peripheral vasodilation, hypotension
DANGER FOR CARDIAC ARREST |
196
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hypermagnesemia central nervous system changes
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drowsy
lethargic coma |
196
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hypermagnesemia neuromuscular changes
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deep tendon reflexes reduced
voluntary become weaker then stop when respiratory muscles are weak- resp insufficiency |
196
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hypermagnesemia interventions
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oral/parenteral magnesium stopped
when renal failure is not present- magnesium free IV fluids high ceiling (loop) diuretics- furosemide (Lasix, Furoside) cardiac problems severe- calcium |
197
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What is the major anion of ECF and works with sodium to maintain ECF osmotic pressure?
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chloride Cl-
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197
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chloride is important in the formation of
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hydrochloric acid in the stomach
|
197
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