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101 Cards in this Set
- Front
- Back
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Causes of Hypokalemia (Under 3.5)
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- Diuretics
- Poor intake - GI loss (vomiting, diarrhea, etc.) - Metabolic alkalosis - too much ADH |
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When giving replacement IV Potassium..
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- NEVER IV PUSH!!!!
- Never given IM or SC - Concentration should not exceed 40 mEq/L (80meq/L for severe conditions and cardiac monitoring needed) - Higher concentrations should not be given in peripheral veins (can be irritating) - Do not add K+ to a container in the hanging position - Rotate Bag to ensure distribution of K+ - Assess urinary output (0.5 ml/kg/hr) - Administer no faster than 10 mEq/hour |
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Causes of Hypocalcemia (under 8.6)
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- hypo-PTH
- decreased vitamin D - Chronic Renal Failure - decreased pvo - blood tranfusion |
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Causes of Hyperkalemia (Above 5.0)
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“Pseudohyperkalemia” - Pseudohyperkalemia is a rise in the amount of potassium that occurs due to excessive leakage of potassium from cells, during or after blood is drawn
- CRF (chronic renal failure) - Use of salt substitutes - K+ sparing diuretics - Metabolic acidosis - Burns (massive cell destruction) |
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Clients with "hyperactive bowel sounds, muscle weakness, and diminished deep tendon reflexes" are at risk of what electrolyte imbalance?
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HYPONATREMIA.
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Clients with "tumor lysis, hypoparathyroidism, and renal insufficiency" are at risk of what electrolyte imbalance?
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Hyperphosphatemia.
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Causes of Hypophosphatemia (Under 2.4)..
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Hyperparathyroidism
Thiazide diuretics |
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Causes of Hypercalcemia (Above 10.2)..
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- Hyper PTH
- Immobilization - Overuse of calcium products - Malignancies |
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Clients with "Alcoholism" are at risk of what electrolyte imbalance?
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Hypophosphatemia
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Clients with "decreased CVP" are suspected to have..
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Fluid Volume Deficit
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Clients with "skin trauma, burns, and sepsis" are at risk of what electrolyte imbalance?
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HYPERKALEMIA.
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Clients with "Twitching, deep tendon reflexes, and numbness" are suspected to have what electrolyte imbalance?
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Hypocalcemia (positive trousseaus, Chvostek's are signs too)
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Clients with "colostomies, vomiting and diarrhea" are at risk for..
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Fluid Volume Deficits
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Clients with "renal failure, heart failure, and excess wound irrigation" are suspected to have..
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Fluid Volume Excess
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A client with excess fluid volume will have
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elevated bp, cough, dyspnea, bounding pulse, neck and hand vein distention.
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Causes of Hypermagnesemia (Over 2.5)
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- Renal failure
- Excessive mg+ intake (Maalox) |
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A person getting NG suctioning may get..
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Hypokalemia.
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Causes of Hyponatremia (Na under 135):
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- Overuse of Diuretics
- Too much H20 intake |
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Clients with "cushings, colitis, and "laxative use" are at risk of what electrolyte imbalance?
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Hypokalemia
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Causes of Hypernatremia (Above 145)
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- Renal Failure
- Cushings - Dehydration - Hyperaldosteronism |
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Clients who are taking diuretics are at risk of what electrolyte imbalance?
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HYPONATREMIA
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Causes of Hypomagnesemia (Under 1.5)
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- Alcoholism
- Starvation - Diarrhea - Increased PTH |
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Nuts, Cauliflower, and Peas are good sources of..
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Phosphorus.
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Causes of Hyperphosphatemia (Above 4.4)
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Chronic Renal Failure
Increased intake of phosphorus Hypo PTH |
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Phosphorus Functions:
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Phosphorous: most is in bone and teeth; remaining is metabolically active and essential to the function of muscle, RBCs, and the nervous system
-Acid-Base Buffer, ATP, cellular uptake of glucose, metabolism of carbohydrates, proteins, and fats -Reciprocal with Ca+ Phosphorous: Primary anion in ICF |
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Potassium Function
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Potassium: Resting membrane potential of nerve and muscle cells (cardiac and neuromuscular functions are most often affected)
Promotes Cell Growth Require for glycogen to be deposited in muscle and liver cells Acid-Base balance Major ICF Cation |
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Sodium Function
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Sodium: generation and transmission of nerve impulses, muscle contractility, acid/base balance
Major ECF Cation |
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Calcium Function
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Calcium: blood clotting, transmission of nerve impulses, myocardial contractions, muscle contractions
-Absorption requires active vitamin D -50% if bound to protein (inactive), 40% is free ionized form (active) Major cation in structure of bones and teeth |
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Magnesium Functions:
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cellular processes, activates enzyme systems, coenzyme in metabolism of carbohydrates and protein, required for synthesis of nucleic acids and proteins
-Plays a role in maintain normal calcium and potassium levels -needed for Na+/K+ pump -Neuromuscular excitability and contractility |
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Potassium Function
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Potassium: Resting membrane potential of nerve and muscle cells (cardiac and neuromuscular functions are most often affected)
Promotes Cell Growth Require for glycogen to be deposited in muscle and liver cells Acid-Base balance Major ICF Cation |
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Calcium is also involved in..
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blood clotting, transmission of nerve impulses, myocardial contractions, muscle contractions
-Absorption requires active vitamin D -50% if bound to protein (inactive), 40% is free ionized form (active). |
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Nursing intervention for Hyperkalemia (K above 5.0)
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-Eliminate Oral and parenteral intake
-Increase elimination with diuretics, dialysis, ion-exchange resins -IV administration of insulin (forces K+ from ECF to ICF) -IV gluconate to reverse membrane potential -Monitor ECGs to detect dysrhythmias -Monitor BP b/c Ca+ can cause hypotension -Hemodialysis for renal failure |
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Nursing intervention for Hypokalemia (K under 3.5)
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-Oral or IV KCL and increased K+ food sources (fruits, dried fruits,
vegetables) -Monitor serum levels and urine output -KCl must always be diluted, never give as push or bolus, invert bags to evenly distribute, never add to a hanging bag to prevent accidental bolus (very irriting to vein, assess IV hourly for phlebitis and infiltration) -Monitor cardiac function |
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Nursing intervention for Hypernatremia (Na above 145)
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Treat underlying cause
-oral or IV fluid replacement with isotonic or hypotonic fluids (D5W, 0.45% NaCl NS) -Diuretics to excrete sodium -Monitor Na levels and response (want to avoid rapid shift of water back into cells; cerebral edema and neurologic complications) -Dietary Na+ restriction |
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Nursing intervention for Hyponatremia (Na under 135)
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-Fluid restriction
-small amounts of IV hypertonic saline solution (3% NaCl) can be used if seizure manifests -Increase sodium |
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Nursing intervention for Hypercalcemia (CA above 10.2)
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-Promote urinary excretion using loop diuretic and hydrating patient with isotonic saline
-Intake 3000-4000 mL fluid daily -Diet low in calcium -Increase weight-bearing activity to enhance bone mineralization -Biphosphates (malignancy) -Calcitonin (IM) |
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Nursing intervention for Hypocalcemia (Ca under 8.6)
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-IV calcium (calcium guconate, calcium chloride), increase calcium through diet along with vitamin D
-Measure and promotes CO2 retention to help control muscle spasms -Treat pain and anxiety because they can cause hyperventilation-induced respiratory alkalosis |
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Nursing intervention for Hypermagnesemia (Mg over 2.5)..
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Avoid Foods with Magnesium
(green vegetables, nuts, bananas, oranges, peanut butter, chocolate) -IV administration of CaCl or calcium gluconate to oppose effects on cardiac muscle -Increased fluids and IV furosemide to decrease magnesium levels |
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Nursing intervention for Hypomagnesemia (Mg under 1.5)
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-oral supplements and increased dietary intake
-IV magnesium is severe; monitor vitals and use infusion pump to avoid rapid administration and cardiac/respiratory arrest |
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Nursing intervention for Hyperphosphatemia (Phos. over 4.4)
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-Restrict foods high in phosphorus (dairy products)
-Phosphate-binding agents or gells (calcium carbonate) limit intestinal reabsorption of phosphate -Hemodialysis or an insulin and glucose infusion -Adequate hydration |
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Nursing intervention for Hypophosphatemia (Phos. under 2.4)
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-Ingest foods high in phosphorus (dairy products)
-Sodium-phosphate or potassium-phosphate IV -Monitor calcium and phosphate levels |
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Clinical Manifestations of Hypernatremia (Above 145)
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- Turgor
- Extreme Thirst - Irritability - Lethargy - Twitching - Nausea/Vomiting - Muscle Weakness |
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The 3rd space refers to the..
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interstitial area.
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the majority of fluids are located..
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INTRACELLULAR
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EXTRAcellular fluid includes..
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vascular, interstitial
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how much body fluid do we have?
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we have 40 liters (40,000 ml) of fluid which make up 60% of body weight.
ICF 40% of body weight ECF 20% of body weight |
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Most body fluids are located in the..
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intracellular compartment. (in cells)
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If a person loses a large quantity of blood, from what fluid compartment has the loss occurred?
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Vascular compartment.
Blood is contained in the vascular compartment. |
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If a large quantity of fluid had been lost from the vascular bed, what do you think will happen to the hydrostatic pressure? It will:
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DECREASE.
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If fluid moves from the interstitial space to the blood, what would you expect to find when assessing the skin?
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Dry skin with poor turgor.
If interstitial fluid is lost, the effect will be seen in the skin turgor and degree of hydration. |
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The nephron is the functional unit of the kidney.
It filters the blood plasma to remove: |
- the end products of metabolism
- drugs - any excess water or solutes It reabsorbs water and solutes as needed. It maintains fluid, electrolyte, and acid-base balance. |
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It is in the distal tubule where ADH and aldosterone act to..
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influence water and electrolyte balance.
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the nephron is an important organ in..
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maintaining fluid and electrolyte balance.
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Blood is filtered in the glomerulus, and as the filtrate moves through the tubule system..
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water and electrolytes move in and out, and ADH and aldosterone act to regulate water and sodium.
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Clinical Manifestations of Hyperkalemia (Above 5.0)..
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- Cardiovascular Issues - Bradycardia
- Hypotension - Muscle Twitching - GI Issues |
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Clinical Manifestations of Hyponatremia (Below 135)
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- Confusion
- Weakness Thready Pulse - Nausea and Vomiting - Muscle Weakness |
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Clinical Manifestations of Hypokalemia (Below 3.5)..
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Respiratory Issues: (S.O.B. and Difficulty Breathing)
- Muscle Weakness - GI issues (Nausea,Vomit, Diarrhea) |
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Clinical Manifestations of Hypercalcemia (Above 10.2)..
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- Increased Heart Rate
- Increased BP - Muscle Weakness - Decreased Peristalsis (GI Muscle Contractions) |
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Clinical Manifestations of Hypocalcemia (Under 8.6)
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+Trousseau Sign
+Chvostek Sign |
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Clinical Manifestations of Hypermagnesemia (Above 2.5)
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flushing of skin/warmth,
Nausea/Vomiting dehydration drowsiness decreases reflexes weakness, resp/CV depression |
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Clinical Manifestations of Hypomagnesemia (Under 1.5)
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- increased reflexes
- painful muscle contractions - confusion - tetany (rigidity,spasms) |
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Clinical Manifestations of Hyperphosphatemia (Above 4.4)
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tingling fingers
muscle spasms calcium/phosphate precipitation |
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Clinical Manifestations of Hypophosphatemia (Under 2.4)
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- numbness
- weakness - deacreased Cardiac Output - change in mental status - acute respiratory failure |
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Clinical Manifestations of Hypokalemia (Below 3.5)
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Respiratory Issues: (S.O.B. and Difficulty Breathing)
- Muscle Weakness - GI issues (Nausea,Vomit, Diarrhea) |
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What would a nurse assess in a pt. with a possible isotonic excess..
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Increase in BP, Bounding HR, and possible fluid in the lungs.
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What would you see in a patient with an isotonic deficit?
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(excess fluid loss - both water & electrolytes) leading to..
- increase in HR - increase in BP - Kidneys retaining fluid - concentrated urine |
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To treat hyper-osmolar patients..
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Replace the water (through IV or oral) and eliminate the cause of water loss.
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Being hypo-osmolar involves too few particles or too much water, resulting in cell swelling. It's from..
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Replacing H20 and Na+ loss with only water
Inability to excrete urine (CRF) |
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Treatment for isotonic excess is to..
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restrict fluids, carefully monitor fluids, give diuretics.
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How to treat an isotonic deficit..
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treat the underlying cause and carefully administer isotonic solutions.
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Isotonic excess is when..
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there is excess fluid in the vessels.
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Isotonic dehydration is when..
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the Na+ level is normal but isotonic solutions are lost.
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To treat hypo-osmolar patients..
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- Replace loss with Na+ and H20 (isotonic)
- Utilize oral liquids with electrolytes |
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With Isotonic imbalances..
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- Na+ and H20 increase or decrease together in equal proportions
- Cells do not shrink or swell - Volume of ECF changes but the concentration of the solutes remains the same |
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A patient with hypernatremia and hyperosmolarity would likely have..
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DEHYDRATION SYMPTOMS.
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Fluid Spacing - First Spacing:
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normal distribution of ICF and ECF.
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Fluid Spacing - Second Spacing:
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abnormal accumulation in interstitial space (edema).
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Fluid Spacing - Third Spacing:
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is trapped fluid and basically unavailable. It is distributional is a space that is not easily exchanged with the ECF (e.g. peritonitis).
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Hypernatremia and Hyperosmolarity involve NA increase and water decrease. A nurse would expect to see..
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Headaches, Irrational thinking, loss of fluid, viscous blood, slow blood circulation, rise in body temp and dizziness.
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Nursing intervention for Hypernatremia..
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- restrict sodium intake
- gradually lower sodium to prevent cerebral edema. - monitor changes in behavior |
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Hyponatremia results from cell swelling and happens when..
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the amount of sodium in fluids outside cells drops, water moves into the cells to balance the levels.
This causes the cells to swell with too much water. |
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the amount of sodium in fluids outside cells drops, water moves into the cells to balance the levels.
This causes the cells to swell with too much water. |
•Euvolemic hyponatremia -- total body water increases, but the body's sodium content stays the same
•Hypervolemic hyponatremia -- both sodium and water content in the body increase, but the water gain is greater •Hypovolemic hyponatremia -- water and sodium are both lost from the body, but the sodium loss is greater |
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Hyponatremia can be caused by..
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•Burns that affect a large area of the body
•Diarrhea •Diuretic medicines, which increase urine output •Heart failure •Kidney diseases •Liver cirrhosis •Syndrome of inappropriate antidiuretic hormone secretion (SIADH) •Sweating •Vomiting |
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Common symptoms of Hyponatremia..
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•Confusion
•Convulsions •Fatigue •Headache •Irritability •Loss of appetite •Muscle spasms or cramps •Muscle weakness •Nausea •Restlessness •Vomiting |
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Risk Factors for fluid volume deficit:
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Vomiting
Diarrhea Excessive sweating polyuria fever NASOGASTRIC SUCTION Abnormal drainage or wound losses |
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Insufficent fluid intake could result from..
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nausea
anorexia depression confusion impaired swallowing inability to access fluids (elderly) |
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Clinical manifestations of fluid volume deficit:
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decreased skin turgor
sunken eyeballs dry mucous membranes weak pulse tachycardia decreased BP hypotension |
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nursing interventions for Fluid Volume Excess:
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- assess breath sounds for crackles
- assess for edema - monitor intake/output - place in semi or high fowlers position - restrict fluid intake |
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what causes protein deficiency?
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-inadequate protein intake
-protein losses (caused by certain kidney diseases) -decreased protein synthesis (liver failure) |
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what would a nurse see in a patient with protein deficit?
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-anemia
-weight loss -suppressed immune system -edema -atrophy -decreased RBC -weakness -delayed wound healing -fatigue |
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Interventions for protein deficiency:
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-diet high in CHO (want to give for body to burn and turn into energy, otherwise it will burn up the protein stores which are already low!)
-diet high in protein -tube feeding or IV with amino acids |
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what is dependent edema?
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controlled by gravity (i.e. when a person stands up and they get edema in their feet/ankles)
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What is weeping edema?
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When the fluid leaks through the skin, usually happens when a person has anasarca edema.
anascara edema = generalized edema all over body. |
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Re-mobilization of fluid following burn or trauma:
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When a person is burned, that capillary is destroyed which leads to edema, then we give IV fluids to maintain BP and hydration.
When capillaries heal, fluid in vascular dept is double--- think of a burn blister: after a couple days the fluid goes away back into the vessels. |
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Burns can lead to the Electrolyte imbalance..
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"Hyperkalemia"
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Nursing care for a pt. with hyponatremia includes..
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Fluid Restriction
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The nurse should be alert for which manifestations in a patient receiving a loop diuretic?
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Weak, irregular pulse and poor muscle tone
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Which patient would be at greatest risk for the potential development of hypermagnesemia?
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42-year-old woman with systemic lupus erythematosus and renal failure
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manifestation(s) in a patient who has just undergone a total thyroidectomy..
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Confusion, Positive Chvostek's Sign, Circumoral numbness.
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Lungs act as an acid-base buffer by..
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increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load.
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The typical fluid replacement for the patient with a fluid volume deficit is..
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Lactated ringers
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