Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
56 Cards in this Set
- Front
- Back
|
Serum Sodium Levels
|
135meq/ml - 145meq/ml
|
|
|
Causes of HYPOnatremia (11)
|
-Diaphoresis
-Diuretics -Wound Drainage -Hyperglycemia -Decreased Aldesterone -Fresh water drowning -Congestive Heart Failure -Excessive use of Hypotonic Fluids -Renal Disease or failure -Low sodium diet -NPO |
|
|
Symptoms of HYPOnatremia
|
Normovolemic: Increased Pulse, steady BP
Hypovolemic: Thready, weak, increased pulse, decreased or steady BP and CVP, Flat veins Hypervolemic: Bounding increased pulse, increased BP and CVP Shallow Respirations Headache, personality changes Weakness, worse in extremities Decreased Deep Tendon Reflexes Decreased Bowel sounds Increased urine output Decreased Specific Gravity |
|
|
Intervention for HYPOnatremia (4)
|
- If hypovolemic, IV SALINE infusion
- If hypervolemic; Osmotic diuretics to eliminate water instead of Na - If the cause is increased Antidiuretic Hormone --> adm LITHIUM or DEMECLOCYCLINE (Monitor lithium levels) - Increase Na intake |
|
|
Causes of HYPERnatremia (7)
|
- Increased Na Intake
- Hyperaldesteronism - Use of corticosteroids - Cushing's Syndrome - Renal Failure - NPO - Water loss |
|
|
Symptoms of HYPERnatremia (10)
|
- HR and BP responds to volume
- With hypervolemia, pulmonary edema may occur - Early stage: Twitches, contractions - End Stage: Muscle weakness, decreased DTRs - Altered cerebral function - Normo or Hypovolemic: Agitation, confusion, seizures - Hypervolemic: Lethargy, Coma - Dry, flushed skin with low grade fever - Intense thirst - Edema depending on the volume |
|
|
Interventions for HYPERnatremia
|
- Restrict Na and water intake
- Administer Diuretics that excrete Na - If the cause is fluid loss, adm IV fluids |
|
|
Serum Potassium Levels
|
3.5 - 5.1
|
|
|
Causes of HYPOkalemia (10)
|
- Increased use of Diuretics or Corticosteroids
- Increased Aldesterone due to Cushings Syndrome - Vomiting, Diarrhea - Wound Drainage - Prolonged Nasogastric Suction - Diaphoresis - Renal Disease that causes impaired reabsorption of K -NPO - K shift from extracellular to intracellular: Alkalosis, Hyperinsulinizm - Dilution of K: Water intoxication |
|
|
Symptoms of HYPOkalemia (9)
|
- Flat or inverted T wave, Prominent U wave, Depressed ST segment
-Thready weak irregular Pulse, arrhythmias, - Orthostatic BP drop - Shallow Resp, Diminished Breath sounds - Decreased Bowel Sounds, Nausea, Vomiting, Distention, Constipation - Decreased DTRs - Weakness, cramps, numbness, leg weakness, paralysis, paresthesias - Fatigue, Confusion, Coma - Increased Urine Output - Decreased Sp. Gravity |
|
|
Interventions for HYPOkalemia (6)
|
- Cardiac Monitor
- Oral adm K: Give with juice or water and food. Discontinue if: Abdm. Pain, nausea, distention or gastric bleeding occur. - IV adm K: no more than 1meq/10ml - Safety measures for weakness - K losing diuretic should be changed to K spearing diuretics - increase the intake of K |
|
|
Potassium Containing Foods
|
Avacado, Bananas, Nuts, Spinach, Orange, Carrots, Meats, Cantalope, Fish, Mushrooms, Potatoes, Raisins, Strawberries, Tomatoes
|
|
|
Administering Potassium through IV, What to look for???
|
- Never IV push, IM or SC
- Dilution no more than 1meq/10ml - Max infusion 5 to 10 meq/hr - Dont exceed 20 meq/hr in no circumstances - Client receiving 10meq/hr should be on cardiac monitor and infusion pump - Shake the bag before adm - K infusion can cause phlebitis, assess IV site frequently - Assess renal function BEFORE and DURING (I/O) K administration |
|
|
Causes of HYPERkalemia (8)
|
- Tissue Damage
- Hypercatabolism - Overingestion of K or Salt substitute - Increased infusion of K including IV solutions - K spearing diuretics - Renal Ds - Addisons Disease - K shifting intracellular to extracellular: Acidosis, Hyperuricemia |
|
|
Symptoms of HYPERkalemia (5)
|
- Tall T wave, wide QRS complex, Prolonged PR int, flat P
- Slow, weak, irregular pulse, arrhytmias like bradycardia first, then tachycardia - Resp failure caused by muscular weakness - Early: Muscle twitches, cramps Late: profound weakness, ascending flaccid paralysis on arms n legs - Hyperactive Bowel sounds, diarrhea |
|
|
Interventions for HYPERkalemia (8)
|
- KAYEXALATE adm if the renal function is impaired
- Cardiac Monitor - Adm K excreting diuretics - Adm IV GLUCOSE and REGULAR INSULIN to move K to the cells - Monitor Renal Function - Dialysis if K is too high - Avoid salt substitute - If blood transfusion needed use fresh blood |
|
|
Serum Magnesium Level
|
1.6 - 2.6
|
|
|
Causes of HYPOmagnesemia
|
- Alcholism
- Malnutrition - Vomiting, diarrhea - Malabsorption: Celiac or Chorns Disease - Diuretics - Intracellular movement of Mag: Hyperglycemia, insulin adm, Sepsis |
|
|
Symptoms of HYPOmagnesemia
|
- Tall T wave, Depressed ST segment
- Increased BP and HR - Decreased Bowel Sounds - Anorexia, nausea, abdm distention - Twitches, parasthesias - Positive Trausseau's and Chvostek's sign, increased DTRs - Hyperflexia - Tetany - Iritability, confusion |
|
|
Interventions of HYPOmagnesemia
|
- Hypocalcemia follows Hypomagnesemia, restore Cal levels as well.
- Administer MAGNESIUM SULFATE IV in severe cases - Seizure precautions - Monitor Red. DTRs for Hypermagnesemia - Oral Mag can cause diarrhea that can cause more Mag loss - Increase Mag. intake |
|
|
Magnesium containing foods
|
Avacado
Canned Tuna Cauliflower Cooked rolled oats Low Fat yogurt Milk Peanut Butter Green leafy veggies Meats Potatoes Raisins |
|
|
Causes of HYPERmagnesemia
|
- excessive mag intake
- infusion of mag containing IV fluids - Decreased renal excretion of Mag due to Renal Insufficiency |
|
|
Symptoms of HYPERmagnesemia
|
- Prolonged PR interval, Wide QRS
- Bradycardia, disrithmias - Decreased BP - Resp insufficiency (muscular weakness) - Decreased DTRs - Muscle weakness - Drowsiness, Lethargy, coma |
|
|
Interventions for HYPERmagnesemia
|
- CALCIUM CHLORIDE and CALCIUM GLUCONATE may be prescribed to reverse the effects of the magnesium on heart muscle
- Mag restriction - No Mag containing laxatives |
|
|
Serum Calcuim Levels
|
8.6 - 10
|
|
|
Causes of HYPOcalcemia
|
- Decreased Ca intake
- Lactose Int. - Malabsorption (Celiac or Chorn's Dis) - Decreased Vit D intake - End Stage Renal Dis. - Increased Ca Excreetion Renal Flr (Polyuric Phase) Diarrhea Staetorrhea Wound Drainage (esp GI) - Conditions that decrease ionized fraction of Ca Hypoprotenimia Alkalosis Acute Pencreatis Hyperphosphatemia IMMOBILITY HYPOparathyroid synd. Ca Chelators or Binders |
|
|
Symptoms of HYPOcalcemia
|
-Prolonged ST and QT int
- DECREASED BP, DECR HR - Twitches, Tetany, Cramps, Seizures - Parathesias, numbness on lips, nose and ears - INCREASED DTRs - INCREASED Bowel sounds, abnormal cramping, diarrhea - Anxiety, irretibility |
|
|
Interventions for HYPOcalcemia
|
- Administering Ca supplements
IV infusion: Warm the solution to body temp. Administer slow, observe ekg and infiltration - Administer meds that increase Ca absorption ALUMINUM HYDROXIDE (reduces the phosphorus) and VIT D - Provide quite environment - Seizure precautions - Fracture precautions - Keep Ca Gluconate 10% - Consume Ca inc food |
|
|
Ca Including Foods
|
Cheese
Collard Greens Milk, Soy Milk Rhubarb Spinach Sardines Tofu L/F Yogurt |
|
|
Causes of HYPERcalcemia
|
- Excessive oral intake
- Decreased Ca excreation: Renal Failure, Thiazide Diuretics - Increased bone Resorption HYPERPARATHYROIDSM HYPERTHYROIDSM Malignancy Immobility GLUCOCORTICOIDS - Hemoconcentration Dehydration Use of LITHIUM Adrenal Insufficiency |
|
|
Symptoms of HYPERcalcemia
|
- Short ST, Wide T wave
- INCREASED BP, INCREASED HR in early phase, ARREST in late. Bounding Peripheral Pulses - Ineffective Respirations due to muscle weakness - DECREASED DTRs - INCREASED Urine Output can cause dehydration and Renal Calculi - DECREASED Bowel Sounds Anorexia, nausea, abdominal distention, constipation |
|
|
Interventions for HYPERcalcemia
|
- Discontinue:
Oral or IV adm of Vit D or Cal Discontinue Thiazide Diuretics and replace with diuretics that excrete Cal - Administer: Meds help bone reabsorption Phosphorus CALCITONIN Biophosphonates (ETIDRONATE) Prostoglandin synthesis inhibitors (Asprin, NSAIDs) - Severe case might require Dialysis - Assess for fractions - Check for urinary stones, flank abd. pain - instruct to avoid Cal |
|
|
Serum Phosphorus Levels
|
2.7 - 4.5
|
|
|
Causes of HYPOphosphatemia
|
(Remember DECREASED Phosphate --> INCREASED Cal)
- Malnutrition, starvation - HYPERPARATHYROIDSM - Renal Failure - Use of ALUMINUM HYDROXYDE and MAGNESIUM based Antacids - Intracellular Shift HYPERGLYCEMIA Resp. ALKALOSIS |
|
|
Symptoms of HYPOphosphatemia
|
- Decreased Contractability and cardiac output
- Slowed Peripheral Pulses - Shallow Respirations - DECREASED DTRs - Weakness - Rhabdomyolysis - Decreased Bone Density - Irretibility, Confusion, Seizures - Decreased Platelet aggregation --> Increased Bleeding - Immunosuppretion |
|
|
Interventions for HYPOphosphatemia
|
- Monitor Cardiac, Resp, Hemo responses
- Discontinue meds that cause the situation - Adm Phosphate along with Vit D - IV Phosphate only serum level drops 1 meq/dl, Assess renal func before adm. - Move client carefully - Increase Phosphate intake |
|
|
Foods include Phosphate
|
Fish
Organ Meats Nuts Pork, Beef, Chicken Wholegrain bread, cereals |
|
|
Causes of HYPERphosphatemia
|
(Remember INCREASED Phosphorus --> DECREASED Cal)
- Decreased Renal excreation --> Renal insufficiency - TUMOR LYSIS SYNDROME - Phosphate containing Laxatives - HYPOPARATHYROIDSN |
|
|
Symptoms of HYPERphosphatemia
|
Same as HYPOcalcemia
|
|
|
Interventions for HYPERphoshatemia
|
- Mostly manage Hypocalcemia
- Adm. Phosphate binding meds (should be given with meals or immediately after meals) - Avoid phosphate containing laxatives and enemas - Avoid Phosphate intake |
|
|
EKG changes and Vital signs for HYPOcalcemia
|
Prolonged ST interval
Prolonged QT interval DECREASED HR DECREASED BP DECREASED Peripheral Pulses |
|
|
EKG Changes and Vital signs for HYPERcalcemia
|
Short ST segment
Wide T wave INCREASED HR (early) ARREST (late) INCREASED BP INEFFECTIVE RESP |
|
|
EKG changes and Vital signs for HYPOkalemia
|
ST depression
Shallow, Flat or Inverted T wave Prominent U wave Thready, Weak, Irregular Pulse (arrhythmias) Orthostatic HYPOTENTION Shallow Respirations Diminished Breath Sounds |
|
|
EKG changes and Vital Signs for HYPERkalemia
|
Tall T wave
Flat P wave Widened QRS interval Prolonged PR interval Slow, weak, irregular HR (arrhythmias bradycardia followed by tachycardia) DECREASED BP Respiratory failure due to muscle weakness |
|
|
EKG Changes and Vital Signs for HYPOmagnesemia
|
Tall T wave
Depressed ST segment INCREASED BP INCREASED HR SHALLOW RESP |
|
|
EKG changes and Vital Signs for HYPERmagnesemia
|
Prolonged PR interval
Wide QRS complex Arrhythmias, Bradycardia DECREASED BP Resp Insufficiency (Muscular) |
|
|
DTRs and Bowel sounds for HYPOnatremia
|
DECREASED DTR
DECREASED bowel sounds INCREASED urine output |
|
|
DTRs and Bowel sounds for HYPERnatremia
|
- Early: INCREASED DTR
Late: DECREASED DTR - DECREASED urine output |
|
|
DTRs and Bowel sounds for HYPOkalemia
|
- DECREASED DTR
- DECREASED Bowel Sounds - INCREASED Urinary Output |
|
|
DTRs and Bowel sounds for HYPERkalemia
|
- Early: INCREASED DTR
Late: Profound weakness - INCREASED Bowel Sounds |
|
|
DTRs and Bowel sounds for HYPOmagnesemia
|
- INCREASED DTR (+Trausseau's and +Chvostek's sign)
- DECREASED Bowel Sounds |
|
|
DTRs and Bowel sounds for HYPERmagnesemia
|
- DECREASED DTR
|
|
|
DTRs and Bowel sounds for HYPOphosphatemia
|
- DECREASED DTR
- DECREASED Bowel Sounds |
|
|
DTRs and Bowel sounds for HYPERphosphatemia
|
- INCREASED DTR
- INCREASED Bowel Sounds |
|
|
DTRs and Bowel sounds for HYPOcalcemia
|
- INCREASED DTR
- INCREASED Bowel Sounds |
|
|
DTRs and Bowel sounds for HYPERcalcemia
|
- DECREASED DTR
- DECREASED Bowel Sounds - INCREASED Urine Output |
