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133 Cards in this Set
- Front
- Back
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Active transport |
Movement of ions against osmotic pressure to an area of higher pressure Requires energy |
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Diffusion |
Passive movement of electrolytes or other particles down the concentration gradient (from higher to lower concentration) |
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Osmosis |
Movement of water (or other solute) from an area of lesser to one of greater concentration |
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Filtration |
Movement across a membrane, under pressure, from higher to lower pressure |
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Intracellular Fluid |
Fluid within cells 2/3 of total body water |
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Extracellular Fluid |
Fluid outside of cells 1/3 total body water |
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Interstitial Fluid |
Fluid outside the blood vessel (in tissues) |
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Intravascular Fluid |
Fluid circulating inside blood vessels (plasma) |
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Transcellular Fluid |
Fluid that isn't really collected in large amounts (synovial fluid, eyeball fluid, cerebrospinal fluid) Doesn't really affect fluid and electrolyte balance |
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Regulators of Water Balance |
Fluid intake Fluid distribution Hormonal Influences Fluid Output |
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Fluid Intake |
Thirst regulates fluid intake ~2300 mL/day |
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Fluid distribution |
Extracellular (vascular and interstitial) Intracellular |
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Hormonal Influences |
Antidiuretic hormone Renin-angiotensin-aldosterone mechanism Atrial natriuretic peptides |
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Fluid Output |
Through kidneys, skin, lungs and GI tract Insensible Loss Sensible Loss |
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Thirst |
Regulated by mechanisms in the brain that are stimulated when blood volume decreases |
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Adequate output |
At least 30cc / hr |
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Normal Serum Osmolality |
280-300mOsm/kg H20 |
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Normal Serum Sodium (Na+) |
135-145 mEq/L |
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Normal Serum Potassium (K+) |
3.5-5.0 mEq/L |
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Normal Serum Total Calcium (Ca++) |
8.4-10.5mg/dL |
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Normal Serum Magnesium (Mg++) |
1.5-2.5 mEq/L |
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Normal Serum Phosphate (PO4) |
2.7-4.5mg/dL |
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Lab value for Hypernatremia |
Greater than 145 mEq/L |
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Lab value for Hyponatremia |
Less than 135 mEq/L |
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What percentage of body potassium is intracellular? |
98% of body potassium is intracellular |
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What is the lab value for Hyperkalemia |
Greater than 5.0 mEq/L |
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Lab value for Hypokalemia |
Less than 3.5 mEq/L |
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What is the primary determinant of ECF osmolality? |
Sodium |
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Functions of calcium? |
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Lab value for Hypercalcemia |
Over 10.5 mg/dL |
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Lab value for Hypocalcemia |
Less than 8.4 mg/dL |
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Sensible Loss
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Fluid loss that can be measured (urine, etc)
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Insensible loss
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Fluid loss that cannot be measured (sweat, incontinence, etc.)
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Concepts related to Fluid and Electrolyte Balance |
Elimination Nutrition Mobility Acid-Base Balance (very closely related) Gas Exchange / Perfusion Cognition |
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Divisions of Extracellular Fluid |
Interstitial Intravascular Transcellular |
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Types of Imbalances |
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Types of Osmolality Imbalances |
High/hypertonic; hypernatremia; "water deficit" Low/hypotonic; hyponatremia; "water excess" |
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Causes of Water Deficit |
Strokes Burns Severe dehydration Alcoholism Hyperglycemia |
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Causes of water excess |
Too much water intake Low sodium Acute Renal Failure Some medications |
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Chemicals that affect osmolality |
Sodium Chloride Bicarbonate Proteins Sugar |
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What is electrolyte imbalance |
Plasma concentration of electrolytes outside the norm |
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Sites for osmolality checks |
Serum osmolality (blood) Urine osmolality |
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What is hypervolemia |
Fluid volume excess Fluid intake or fluid retention exceeds the needs of the body |
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Potential causes for hypervolemia |
Congestive Heart Failure End Stage Renal Disease Other disease processes |
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Signs/Symptoms of Hypervolemia |
Cough Dyspnea Crackles Tachypnea Tachycardia Elevated BP Bounding pulses Weight gain Edema Neck and hand vein distension Altered LOC Decreased hematocrit |
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What is hypovolemia |
Fluid volume deficit |
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What is lost in hypovolemia |
Both fluid and electrolytes |
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What are potential causes of hypovolemia |
Decreased fluid intake Difficulty swallowing Coma Blood loss/hemorrhage Polyuria |
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Signs/Symptoms of Hypovolemia |
Weight loss Flat neck and hand veins Dry mucous membranes Thirst Weak, rapid pulse Change in mental status Hypotension Decreased skin turgor Elevated BUN or hematocrit |
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Who is at risk for fluid imbalances |
Very young Adolescents Older adults Those with output greater than intake and absorption Those with output less than intake and absorption Those with altered fluid and electrolyte distribution |
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Why are the very young at risk for fluid imbalance? |
Fewer reserves Totally dependent on others |
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Why are adolescents at risk for fluid imbalance? |
Decreased fluid intake Fluctuating hormones Wanting to drink other things (than water) High activity levels |
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Why are older adults at risk for fluid imbalance? |
Some restrict fluid to avoid incontinence episodes or cold temperature Decreased thirst mechanism Lower concentration of water in their body |
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Who has more fluid reserve: a lean, muscular person or a large, adipose-heavy person? |
Lean, muscular person |
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What to assess for fluid imbalance |
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What is important to note when taking daily weights? |
Same time, same clothes, same scale |
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Why do you need to monitor signs/symptoms and relevant labs when assessing fluid imbalances? |
To monitor for improvement |
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Other considerations for fluid imbalance? |
IV fluid solutions and rates Presence of NG suction Hydration maintenance |
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Ways to maintain hydration in clients |
Encourage oral intake Add supplementary fluid with tube feeding |
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IV Fluid Types |
Isotonic Hypotonic Hypertonic |
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What are crystalloid fluids? |
Flow easily across semipermeable membranes; easily transfer between bloodstream and body cells/tissues |
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What are isotonic fluids? |
Fluids that have the same concentration as fluid already in the body |
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What are hypotonic fluids? |
Fluids that have a lower concentration that body fluid |
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What do hypotonic fluids do? |
Pull fluid into the cells and cause them to swell |
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What do isotonic fluids do? |
They do not encourage fluid movement into or out of cells |
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What are hypertonic fluids? |
Fluids with higher concentration than body fluid |
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What do hypertonic fluids do? |
Pull fluid out of the cells and causes them to shrink |
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Osmolality of isotonic fluids? |
250-375 mOsm/L (same as normal serum osmolality) |
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Where do isotonic fluids end up? |
Remain within extracellular fluid compartments |
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Examples of Isotonic Fluids |
0.9% sodium chloride (normal saline) Lactated Ringers solution D5W |
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Who would need isotonic fluids? |
Patients with nausea/vomiting Patient hemorrhaging Sweating excessively |
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What do isotonic fluids treat? |
Fluid volume deficit |
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What are some considerations for isotonic fluids? |
Monitoring for hyper or hypo volemia |
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Signs/Symptoms of Hypervolemia |
Hypertension Bounding pulse Crackles Dyspnea Edema JVD Extra heart sounds |
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Considerations for monitoring for hypervolemia? |
Monitor intake and output Elevate HOB to 35-45 degrees |
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Signs/Symptoms for Hypovolemia |
Poor skin turgor Tachycardia Weak, thready pulse Hypotension Urine output less than 0.5mL/kg/hr |
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Osmolality of hypotonic fluids? |
Less than 250 mOsm/L (lower than normal serum osmolality) |
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Use of hypotonic fluids? |
Assist with maintaining daily body fluid requirements Help kidneys excrete excess fluid and electrolytes |
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What is in hypotonic fluids? |
Sodium and chloride No calories! |
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Examples of Hypotonic Fluids |
0.45% sodium chloride (half normal saline) 0.33% sodium chloride (0.33% NaCl) 0.2% sodium chloride (0.2% NaCl) 2.5% dextrose in water |
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Nursing Considerations for Hypotonic Fluids |
Monitor for:
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Contraindications for Hypotonic Fluids |
High risk for increased cranial pressure Liver disease Trauma Burns |
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Osmolality of hypertonic fluids |
Greater than 375 mOsm/L (higher than normal serum osmolality) |
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What do hypertonic fluids do? |
Draw water out of intracellular space, increasing extracellular fluid volume |
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What are hypertonic fluids used for? |
Volume expansion Might be used for brain injury to prevent swelling |
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What concentration of sodium and chloride compared to plasma for hypertonic fluids? |
Higher concentration than plasma |
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Examples of Hypertonic Fluids |
3% sodium chloride (513 mEq/L of sodium chloride) 5% sodium chloride (844 mEq/L of sodium chloride) |
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Nursing Considerations for Hypertonic Fluids |
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Why do hypertonic fluids need to be administered slowly? |
To avoid intravascular fluid overload and pulmonary edema |
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What must you know before administering hypertonic fluids? |
Total volume to be infused Infusion rate Infusion duration Discontinue parameters |
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What are colloids? (in terms of IV fluids) |
Volume or plasma expanders |
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Where do colloids go? |
They remain in the intravascular space They do not pass through cellular membranes |
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What are colloids indicated for? |
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Types of Colloids? |
Albumin Dextran Hydroxyethyl starches: Hetastarch, Hespan |
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Normal Serum Chloride |
96-106 mEq/L |
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Causes of Chloride Deficit |
Addison’s disease, reduced chloride intake or absorption, untreated diabetic ketoacidosis, chronic respiratory acidosis, excessive sweating, vomiting, gastric suction, diarrhea, sodium and potassium deficiency, metabolic alkalosis; loop, osmotic, or thiazide diuretic use; overuse of bicarbonate, rapid removal of ascitic fluid with a high sodium content, IV fluids that lack chloride (dextrose and water), draining fistulas and ileostomies, heart failure, cystic fibrosis |
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Causes of Chloride Excess |
Excessive sodium chloride infusions with water loss, head injury (sodium retention), hypernatremia, renal failure, corticosteroid use, dehydration, severe diarrhea (loss of bicarbonate), respiratory alkalosis, administration of diuretics, overdose of salicylates, Kayexalate, acetazolamide, phenylbutazone and ammonium chloride use, hyperparathyroidism, metabolic acidosis |
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Signs/Symptoms of Chloride Excess |
Tachypnea, lethargy, weakness, deep rapid respirations, decline in cognitive status, ↓ cardiac output, dyspnea, tachycardia, pitting edema, dysrhythmias, coma Labs indicate: ↑ serum chloride, ↑ serum potassium and sodium, ↓ serum pH, ↓ serum bicarbonate, normal anion gap, ↑ urinary chloride level |
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Signs/Symptoms of Chloride Deficit |
Agitation, irritability, tremors, muscle cramps, hyperactive deep tendon reflexes, hypertonicity, tetany, slow shallow respirations, seizures, dysrhythmias, coma Labs indicate: ↓ serum chloride, ↓ serum sodium, ↑ pH, ↑ serum bicarbonate, ↑ total carbon dioxide content, ↓ urine chloride level, ↓ serum potassium |
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Phosphate |
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Causes of Hyperphosphotemia
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Acute kidney injury Chronic kidney disease Chemotherapy Excessive ingestion of milk Large intake of Vitamin D (increases GI absorption of phosphorus) |
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Manifestions of hypophosphatemia |
Mild: asymptomatic Severe: same as hypocalcemia Tetany Muscle cramps Parasthesias Seizures |
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Causes of Hypophosphatemia |
Rare Malnourishment Malabsorption syndrome Alcohol withdrawal Use of phosphate binding antacids |
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Manifestations of hypophosphatemia |
Often symptomatic in mild to moderate CNS depression Changes in LOC Confusion Muscle weakness Pain Dysrhythmias |
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Magnesium |
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Causes of Hypermagnesemia |
Increased intake in renal insufficiency or renal failure IV magnesium replacement in pregnant women w/ eclampsia |
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Manifestations of hypermagnesemia |
Lethargy Nausea and vomiting Loss of deep tendon reflexes Somnolence (sleepiness/drowsiness) Respiratory and cardiac arrest |
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Causes of hypomagnesemia |
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Manifestations of hypomagnesemia |
Confusion Hyperactive deep tendon reflexes Muscle cramps Tremors Seizures Cardiac dysrhythmias |
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Causes of hypernatremia |
excessive sodium intake inadequate water intake excessive water loss disease states |
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Manifestations of hypernatremia |
restlessness agitation twitching seizures coma intense thirst BP/pulse changes |
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Interventions for hypernatremia |
Hypotonic solution will lower sodium levels gradually check patients sodium levels regularly monitor neurologic status encourage to drink water |
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Causes for hyponatremia |
Profuse diaphoresis draining wounds excessive diarrhea or vomiting trauma w/ significant blood loss inappropriate use of hypotonic IV fluids SIADH (syndrome of inappropriate antidiuretic hormone) |
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Manifestations for hyponatremia |
irritability headache confusion seizures coma irreversible neurologic damage death |
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Interventions for hyponatremia |
daily weight monitor I&O monitor neurologic status if confused (move closer to nurse's station) |
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What does potassium do in the body? |
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What is the main source of potassium for the body? |
Diet is the source of potassium (bananas, avocados, others) |
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How is potassium primarily lost? |
Kidneys are primary route for potassium loss |
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Causes for hyperkalemia? |
Increased potassium intake and absorption decreased potassium output shift of K+ from cells into the ECF oliguria |
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Manifestations for hyperkalemia
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muscle weakness cardiac dysrhythmias (peak T-waves) cardiac arrest |
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Interventions for hyperkalemia |
Kayexalate (medication - causes excessive bowel movements) calcium gluconate IV or insulin with glucose IV |
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Causes of hypokalemia |
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Manifestations of hypokalemia |
Leg muscle weakness weakness or paralysis of respiratory muscles decreased airway responsiveness cardiac dysrhythmias |
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Interventions for hypokalemia |
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Changes in Na+ levels are associated with |
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What is required for absorption of calcium? |
Vitamin D |
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What controls serum calcium levels? |
Balance is controlled by parathyroid hormone (PTH) and calcitonin |
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Causes of hypercalcemia |
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Manifestations of hypercalcemia |
lethargy weakness depressed reflexes decreased memory confusion anorexia nausea/vomiting bone pain fractures ECG changes |
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Interventions for hypercalcemia |
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Causes of hypocalcemia |
Decreased production of PTH acute pancreatitis multiple blood transfusions sudden alkalosis laxative abuse malabsorption syndromes |
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Manifestations of hypocalcemia |
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Interventions for hypocalcemia |
a) Calcium carbonate, oral (Give in divided doses) b) Calcium gluconate, IV (May be given slow push for tetany. Also, infiltration causes tissue sloughing.) c) Synthetic parathyroid hormone may be used Foods high in calcium with Vitamin D supplement |
