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234 Cards in this Set
- Front
- Back
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Water is serving as:
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A medium for metabolic reactions within cells ¦
Atransporter for nutrients, waste products, and other substances ¦ A lubricant ¦ An insulator and shock absorber ¦ A means of regulating and maintaining body temperature. |
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The body’s fluid is divided into two major compartments
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intra-cellular and extracellular
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- Intracellular fluid ( ICF)
- total body volume? |
is found within the cells of the body. It constitutes approximately two thirds of the total body fluid in adults
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Extracellular fluid ( ECF) is found
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outside the cells and accounts for about one third of total body fluid
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2 main ECF compartments
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intravascular and interstitial
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Intravascular fluid
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(plasma) accounts for approx-imately 20% of ECF and is found within the vascular system
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Interstitial fluid
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accounting for approximately 75% of ECF, surrounds the cells
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other compartments of ECF
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the lymph and transcellular fluids
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other compartments of ECF
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the lymph and transcellular fluids
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Examples of transcellular fluid include
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cerebrospinal, pericardial, pancreatic, pleural, intraoc-ular, biliary, peritoneal, and synovial fluids
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Examples of transcellular fluid include
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cerebrospinal, pericardial, pancreatic, pleural, intraoc-ular, biliary, peritoneal, and synovial fluids
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Intracellular fluid is vital to
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normal cell functioning
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Intracellular fluid is vital to
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normal cell functioning
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Intracellular fluid contains solutes such as
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oxygen, electrolytes, and glucose
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Intracellular fluid contains solutes such as
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oxygen, electrolytes, and glucose
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Intracellular fluid provides a medium in which
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metabolic processes of the cell take place.
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Intracellular fluid provides a medium in which
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metabolic processes of the cell take place.
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Interstitial fluid trans-ports wastes from cells by way of the
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lymph system, as well as directly into the blood plasma through capillaries
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Interstitial fluid trans-ports wastes from cells by way of the
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lymph system, as well as directly into the blood plasma through capillaries
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Composition of Body Fluid Extracellular and intracellular fluids contain
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oxygen from the lungs, dissolved nutrients from the gastrointestinal tract, excre-tory products of metabolism such as carbon dioxide, and charged particles called ions.
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Composition of Body Fluid Extracellular and intracellular fluids contain
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oxygen from the lungs, dissolved nutrients from the gastrointestinal tract, excre-tory products of metabolism such as carbon dioxide, and charged particles called ions.
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Examples of cations are
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sodium ( Na ), potassium ( K ), cal-cium ( Ca2 ), and magnesium ( Mg2 )
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Examples of cations are
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sodium ( Na ), potassium ( K ), cal-cium ( Ca2 ), and magnesium ( Mg2 )
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Examples of anions include
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chloride ( Cl ), bicarbonate HCO3 , phosphate HPO4 2–, and sulfate SO4 2–.
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Examples of anions include
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chloride ( Cl ), bicarbonate HCO3 , phosphate HPO4 2–, and sulfate SO4 2–.
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The term milliequivalent refers to
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the chemical combining power of the ion, or the capacity of cations to combine with an-ions to form molecules
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The term milliequivalent refers to
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the chemical combining power of the ion, or the capacity of cations to combine with an-ions to form molecules
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primary cations present in ICF
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K + ( then Mg)
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primary cations present in interstitial
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Na+
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primary cations present in plasma
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NA+
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primary anions present in ICF
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phosphate
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primary anions present in plasma and interstitial
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chloride
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primary cations present in ICF
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K + ( then Mg)
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primary cations present in interstitial
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Na+
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primary cations present in plasma
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NA+
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primary anions present in ICF
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phosphate
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primary anions present in plasma and interstitial
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chloride
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Selectively permeable
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cell membranes that allow substances move across them with varying degrees of ease
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Small particles that move easily across these membranes,
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oxygen, and carbon dioxide
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larger molecules that have difficulty moving between fluid compartments.
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glucose and proteins
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solute
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substance dissolved in a liquid
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Crystalloid
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salt that dissolves readily into true solution
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Colloid
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substance that doesn't readily dissolve into true solution
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Osmolality
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total solute concentration within a fluid compartment
measured as parts of solute per kg of water |
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Isotonic
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the same osmolality as ECF. Normal saline, 0.9% sodium chloride, is an example of an isotonic solu-tion
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The term tonicity may also be used to refer to the
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osmolality of one solution in relation to another solution
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Hypertonic
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such as 3% sodium chloride, have a higher osmolality than ECF
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Hypotonic solutions
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0.45% sodium chloride, have a lower osmolality than ECF
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Osmotic pressure
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the power of a solution to pull water across a semipermeable membrane
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Colloid osmotic pressure/oncotic pressure
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plasma proteins exert this pressure which holds water in plasma or pulls water from interstitial space to the vascular compartment when necessary
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Diffusion
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The movement of molecules through a semipermeable membrane from area of higher concentration to lower concentration
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Osmosis
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water molecules move from less concentrated area to the more concentrated area to equalize concentration of the solutions on either side of the membrane
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Filtration
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fluid and solutes move together across a membrane from an area of higher pressure to an area of lower pressure.
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filtration pressure
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The pressure that results in the movement of the fluid and solutes out of a compartment
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Hydrostatic pressure
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is the pressure exerted by a fluid within a closed system on the walls of the container in which it is contained.
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The hydrostatic pressure of blood is the force ex-erted by
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blood against blood vessel walls.
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Active Transport
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movement of solutes across cell membranes from a less concentrated solution to a more concentrated one
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in active transport each molecule requires
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specific carrier
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sodium concentrations are higher in
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ECF
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potassium concentrations are higher in
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ICF
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Average daily fluid intake
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2,500 mL
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Average daily fluid output
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2,300-2,600 mL
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Routes of fluid output (4)
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urine 1400 - 1500
feces 100-200 noticeable loss thru skin 100 insensible losses 350-400 |
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daily intake (source and amount)
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Oral fluids 1,200 to 1,500
Water in foods 1,000 Water as by- product of food metabolism 200 |
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Insensible fluid loss
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fluid loss that is not perceptible to the individual
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Obligatory losses
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essential fluid losses required to maintain body functioning
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Importance of electrolytes
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maintain fluid balance
contribute to acid-base regulation facilitate enzyme reactions transmitting neuromuscular reactions |
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Antidiuretic Hormone ADH
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regulates water excre-tion from the kidney, is synthesized in the anterior portion of the hypothalamus and acts on the collecting ducts of the nephrons.
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When serum osmolality rises, ADH is
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produced, causing the collecting ducts to become more permeable to water.This increased permeability allows more water to be reabsorbed into the blood. As more water is reabsorbed, urine output falls and serum osmolality decreases because the water dilutes body fluids.
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if serum osmolality decreases, ADH is
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suppressed, the collecting ducts become less permeable to water, and urine output increases. Excess water is excreted, and serum osmolality returns to normal
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factors also affect the production and release of ADH
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blood volume, temperature, pain, stress, and some drugs such as opiates, barbiturates, and nicotine
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The renin- angiotensin-aldosterone system is
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neuroendocrine control mecha-nism that contributes to maintaining fluid balance. Specialized receptors in the kidneys respond to changes in renal perfusion, stimulating the renin- angiotensin- aldosterone system.
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If blood flow or pressure to the kidney decreases, renin is
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released.
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Renin causes the conversion of
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angiotensinogen to angiotensin I
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Atrial natriuretic factor ( ANF) is released from
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cells in the atrium of the heart in response to ex-cess blood volume and stretching of the atrial walls.
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Acting on the nephrons, ANF promotes
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sodium wasting and acts as a potent diuretic, thus decreasing blood volume.
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ANF also inhibits thirst by
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reducing fluid intake.
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Sodium ( Na ) regulation
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Renal reabsorption or excretion
¦ Aldosterone increases Na reabsorption in collecting duct of nephrons |
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Sodium ( Na ) function
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Regulating ECF volume and distribution ¦
Maintaining blood volume ¦ Transmitting nerve impulses and contracting muscles |
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K+ regulation
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Renal excretion
¦ Aldosterone increases K excretion ¦ Movement into and out of cells ¦ Insulin helps move K into cells; tissue damage and acidosis shift K out of cells into ECF |
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K+ function
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Maintaining ICF osmolality
¦ Transmitting nerve and other electrical impulses ¦ Regulating cardiac impulse transmission and muscle contraction ¦ Skeletal and smooth muscle function ¦ Regulating acid– base balance |
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Ca regulation
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Redistribution between bones and ECF
¦ Parathyroid hormone and calcitriol increase serum Ca2 levels; calcitonin decreases serum levels |
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Ca function
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Forming bones and teeth
¦ Transmitting nerve impulses ¦ Regulating muscle contractions ¦ Maintaining cardiac pacemaker ( automaticity) ¦ Blood clotting |
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Mg regulation
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Conservation and excretion by kidneys
¦ Intestinal absorption increased by vitamin D and parathyroid hormone |
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Mg function
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Intracellular metabolism
¦ Operating sodium- potassium pump ¦ Relaxing muscle contractions |
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CL function
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Excreted and reabsorbed along with sodium in the kidneys
¦ Aldosterone increases chloride reabsorption with sodium |
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Cl regulation
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HCl production
¦ Regulating ECF balance and vascular volume ¦ Regulating acid– base balance ¦ Buffer in oxygen- carbon dioxide exchange in RBCs |
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Phosphate function
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Excretion and reabsorbed along with sodium in the kidneys
¦ Parathyroid hormone decreases serum levels by increasing renal excretion ¦ Reciprocal relationship with calcium: increasing serum calcium decreases phosphate levels; decreasing serum calcium increases phosphate |
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Phosphate regulation
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Forming bones and teeth
¦ Metabolizing carbohydrate, protein, and fat ¦ Cellular metabolism; producing ATP and DNA ¦ Muscle, nerve, and RBC function ¦ Regulating acid– base balance ¦ Regulating calcium levels |
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bicarbonate regulation
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Excretion and reabsorption by the kidneys
¦ Regeneration by kidneys |
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bicarbonate function
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Major body buffer involved in acid– base regulation
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bicarbonate regulation
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Excretion and reabsorption by the kidneys
¦ Regeneration by kidneys |
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bicarbonate function
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Major body buffer involved in acid– base regulation
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potassium Rich foods vegetable
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Avocado
Raw carrot Baked potato Raw tomato Spinach |
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Potassium rich foods meats
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Beef
Cod Pork Veal |
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POtassium rich foods fruits
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Dried fruits
( e. g., raisins and dates) Banana Apricot Cantaloupe Orange |
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POtassium rich foods drinks
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Milk
Orange juice Apricot nectar |
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ECF calcium is regulated by
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a complex interaction of parathyroid hormone, calcitonin ( a hormone produced by the thyroid), and calcitriol ( a metabolite of vitamin D).
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When calcium levels in the ECF fall,
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parathyroid hormone and calcitriol cause calcium to be released from bones into ECF and increase the absorption of calcium in the intestines, thus raising serum calcium levels.
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calcitonin stimulates the deposition of calcium in bone, reducing the
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concentration of calcium ions in the blood.
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Magnesium ( Mg2 ) is found primarily in the
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skeleton and ICF, where it is the second most abundant intracellular cation.
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Magnesium also is important for
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for protein and DNA synthesis within the cells, for intracellular metabolism, particularly in the production and use of ATP.
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Magnesium In ECF is involved in
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regulating neuro-muscular and cardiac function.
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Chloride ( Cl ) is the major anion of
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ECF
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Chloride functions with sodium to regulate
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serum osmolality and blood volume.
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The concentration of chloride in ECF is regulated secondarily to
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sodium (it follows sodium)
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Chloride is a major component of
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gastric juice as hydrochloric acid ( HCl) and is involved in regulating acid– base balance. It also acts as a buffer in the exchange of oxygen and carbon dioxide in RBCs.
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Phosphate ( PO4 ) is found in
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ECF, bone, skeletal muscle, and nerve tissue.
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Phosphate is involved in
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many chemical actions of cells, and is essential for functioning of muscles, nerves, and red blood cells. It is also involved in the metabolism of protein, fat, and carbohydrate.
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Phosphate is absorbed from the
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intestine
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Bicarbonate ( HCO3 ) is present in both
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ICF and ECF
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Bicarbonate pri-mary function is
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regulating acid– base balance as an essential component of the body’s buffering system.
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Extracellular bicar-bonate levels are regulated by the
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kidneys
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if more Bicarbonate is needed
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the kidneys both regenerate and reabsorb bicarbonate ions.
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bicarbonate are produced through
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metabolic processes.
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Sodium levels
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135-145 mEq/L
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Potassium levels
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ICF levels 125-140 mEq/L
serum K levels 3-5 mEq/L |
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normal pH
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7.35-7.45
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Pa O2
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80-100 mmHg
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Pa CO2
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35-45- mmHg
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HCO3
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22-26 mEq/L
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normal O2 sat
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95-98%
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Calcium levels
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4.5-5.5 mEq/L
8.5 - 10.5 mg/dL |
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Magnesium Levels
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1.5-2.5 mEq/L
1.6-2.5 mg/dL |
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Chloride Levels
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95-108 mEq/L
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Phosphate levels
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1.8-2.6 mEq/L
2.5-4.5 mg/dL |
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Bicarbonate levels
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22-26 mEq/L
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Bases
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(alkalis) have low hydrogen ion concentration and can accept hydrogen ions in solution
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Buffers
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prevent excessive changes in pH by removing or releasing hydrogen ions
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Acidosis
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a condition that occurs with increases in blood carbonic acid or with decreases in blood bicarbonate; blood pH below 7.35
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Alkalosis
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a condition that occurs with increases in blood bicarbonate or decreases in blood carbonic acid; blood pH above 7.45
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Respiratory alkalosis
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a state of excessive loss of carbon dioxide from the body
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The lungs help regulate acid– base balance by
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eliminating or re-taining carbon dioxide ( CO2), altering the rate and depth of respirations
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powerful stimulator of the respiratory center in the brain
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Carbon dioxide
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the ultimate long- term regulator of acid– base balance
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kidneys
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kidneys are slower or faster then lungs?
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Slower, it takes hours to correct imbalance (p1458)
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factors affecting body fluid, electrolytes, and Acid - Base Balance
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age, sex and body, environmental temperature, lifestyle
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Infants are at high risk for fluid and electrolyte imbalance because:
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Their immature kidneys cannot concentrate urine.
¦ They have a rapid respiratory rate and proportionately larger body surface area than adults, leading to greater insensible losses through the skin and respirations. ¦ They cannot express thirst, nor actively seek fluids. |
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Older adults are at high risk for fluid and electrolyte imbalance because of decreases in:
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Thirst sensation
¦ Ability of the kidneys to concentrate urine ¦ Intracellular fluid and in total body water Response to body hormones that help regulate fluid and electrolytes ¦ Use of diuretics for hypertension and heart disease ¦ Decreased intake of food and water, especially in older adults with dementia or who are dependent on others to feed them and offer them fluids ¦ Preparations for diagnostic tests that include being NPO for long periods of time, laxatives, or contrast dyes ¦ Impaired renal function, for example in older adults with diabetes. |
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Fluid volume deficit (FVD)
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hypovolemia) loss of both water and electrolytes in similar proportions from the ECF
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Fluid volume excess (FVE) proportions to normal ECF
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(hypervolemia) retention of both water and sodium in similar
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third space syndrome
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fluid shifts from the vascular space into an area where it is not readily accessible as extracellular fluid
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Hypovolemia
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an abnormal reduction in blood volume
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Hypervolemia
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increased blood volume
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FVD generally occurs as a result of
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( a) abnormal losses through the skin, gastrointestinal tract, or kidney;
( b) decreased intake of fluid; ( c) bleeding; ( d) movement of fluid into a third space. |
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Third spacing has two distinct phases:
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loss and reabsorption.
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The client with third space syndrome during the loss phase has an
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isotonic fluid deficit.
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During the reabsorption phase, tissues begin
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to heal and fluid moves back into the intravascular space
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FVE is always
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secondary to an increase in the total body sodium content, which leads to an increase in total body water.
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causes of FVE include
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( a) excessive intake of sodium chloride;
( b) administering sodium- containing infusions too rapidly, particularly to clients with impaired regulatory mechanisms; and ( c) disease processes that alter regulatory mechanisms, such as heart failure, renal failure, cirrhosis of the liver, and Cushing’s syndrome. |
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Isotonic Fluid Volume Deficit Risk factors:
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Loss of water and electrolytes from
¦ Vomiting ¦ Diarrhea ¦ Excessive sweating ¦ Polyuria ¦ Fever ¦ Nasogastric suction ¦ Abnormal drainage or wound losses Insufficient intake due to ¦ Anorexia ¦ Nausea ¦ Inability to access fluids ¦ Impaired swallowing ¦ Confusion, depression |
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Isotonic Fluid Volume Deficit Clinical manifestation
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Complaints of weakness and thirst Weight loss
¦ 2% loss mild FVD ¦ 5% loss moderate ¦ 8% loss severe Fluid intake less than output Decreased tissue turgor Dry mucous membranes, sunken eyeballs, decreased tearing Subnormal temperature Weak pulse; tachycardia Decreased blood pressure Postural ( orthostatic) hypotension ( significant drop in BP when moving from lying to sitting or standing position) Decreased capillary refill Decreased central venous pressure Decreased urine volume ( 30 mL/ hr) Increased specific gravity of urine ( 1.030) Increased hematocrit Increased blood urea nitrogen ( BUN) |
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Isotonic Fluid Volume Deficit Nursing interventions
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Assess for clinical manifestations of FVD.
Monitor weight and vital signs, including temperature. Assess tissue turgor. Monitor fluid intake and output. Monitor laboratory findings. Administer oral and IV fluids as indicated. Provide frequent mouth care. Implement measures to prevent skin breakdown. Provide for safety, e. g., provide assistance for a client rising from bed or chair. |
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Isotonic Fluid Volume Excess Risk Factors
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Excess intake of sodium- containing IV fluids
Excess ingestion of sodium in diet or medications ( e. g., sodium bicarbonate antacids such as Alka- Seltzer or hypertonic enema solutions such as Fleet’s) Impaired fluid balance regulation related to ¦ Heart failure ¦ Renal failure ¦ Cirrhosis of the liver |
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Isotonic Fluid Volume Excess Risk Factors
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Weight gain
2% gain mild FVE ¦ 5% gain moderate ¦ 8% gain severe Fluid intake greater than output Full, bounding pulse; tachycardia Increased blood pressure and central venous pressure Distended neck veins Moist crackles ( rales) in lungs; dyspnea, shortness of breath Mental confusion |
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Isotonic Fluid Volume Excess Risk factors
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Assess for clinical manifestations of FVE.
Monitor weight and vital signs. Assess for edema. Assess breath sounds. Monitor fluid intake and output. Monitor laboratory findings. Place in Fowler’s position. Administer diuretics as ordered. Restrict fluid intake as indicated. Restrict dietary sodium as ordered. Implement measures to prevent skin breakdown. |
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Pitting edema
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edema in which firm finger pressure on the skin produces an indentation (pit) that remains for several seconds
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Overhydration occurs when
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water is gained in excess of electrolytes, resulting in low serum osmolality and low serum sodium levels, also known as hypo-osmolar imbalance or water intoxication
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Hypo-osmolar
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overhydration
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hyperosmolar
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dehydration
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Hypernatremia
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an excess of sodium in the blood plasma
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Hyponatremia
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deficiency of sodium in the blood plasma
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Respiratory acidosis
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a state of excess carbon dioxide in the body
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hypercapnia
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Respiratory acidosis
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Respiratory alkalosis
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a state of excessive loss of carbon dioxide from the body
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Metabolic alkalosis a condition characterized by
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an excess of bicarbonate ions in the body in relation to the amount of carbonic acid in the body; the pH rises to greater than 7.45
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Metabolic acidosis a condition characterized by
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a deficiency of bicarbonate ions in the body in relation to the amount of carbonic acid in the body, in which the pH falls to less than 7.35
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hematocrit ( Hct), measures
(part of CBC) |
the percentage of the volume of whole blood that is composed of RBCs. Hematocrit is a measure of the volume of cells in relation to plasma and is, therefore, affected by changes in plasma volume; hematocrit increases with dehydration and decreases with overhydration.
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Serum electrolyte levels is
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test for electrolyte and acid– base imbalances.
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Serum osmolality is a measure of
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fluid balance. An increased urine osmolality indicates a fluid volume deficit; a decreased urine osmolality reflects a fluid volume excess.
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Specific gravity is an indicator of
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rine concentration that correlates with urine osmolality
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Arterial blood gas
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test performed to evaluate the client's acid-base balance and oxygenation
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Metabolic alkalosis a condition characterized by
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an excess of bicarbonate ions in the body in relation to the amount of carbonic acid in the body; the pH rises to greater than 7.45
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Metabolic acidosis a condition characterized by
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a deficiency of bicarbonate ions in the body in relation to the amount of carbonic acid in the body, in which the pH falls to less than 7.35
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hematocrit ( Hct), measures
(part of CBC) |
the percentage of the volume of whole blood that is composed of RBCs. Hematocrit is a measure of the volume of cells in relation to plasma and is, therefore, affected by changes in plasma volume; hematocrit increases with dehydration and decreases with overhydration.
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Serum electrolyte levels is
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test for electrolyte and acid– base imbalances.
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Serum osmolality is a measure of
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fluid balance. An increased urine osmolality indicates a fluid volume deficit; a decreased urine osmolality reflects a fluid volume excess.
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Specific gravity is an indicator of
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rine concentration that correlates with urine osmolality
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Arterial blood gas
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test performed to evaluate the client's acid-base balance and oxygenation
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Hyponatremia risk factors
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Loss of sodium ¦ Gastrointestinal fluid loss
¦ Sweating ¦ Use of diuretics Gain of water ¦ Hypotonic tube feedings ¦ Excessive drinking of water ¦ Excess IV D5W ( dextrose in water) administration Syndrome of inappropriate ADH ( SIADH) ¦ Head injury ¦ AIDS ¦ Malignant tumors |
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Hyponatremia clinical manifestation
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Lethargy,
confusion, apprehension Muscle twitching Abdominal cramps Anorexia, nausea, vomiting Headache Seizures, coma Laboratory findings: Serum sodium below 135 mEq/ L Serum osmolality below 280 mOsm/ kg |
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Hyponatremia NIC
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Assess clinical manifestations. Monitor fluid intake and output. Monitor laboratory data ( e. g., serum sodium). Assess client closely if administering hypertonic saline solutions. Encourage food and fluid high in sodium if permitted ( e. g., table salt, bacon, ham, processed cheese). Limit water intake as indicated.
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Hypernatremia Risk Factors
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Loss of water
¦ Insensible water loss ( hyperventilation or fever) ¦ Diarrhea ¦ Water deprivation Gain of sodium ¦ Parenteral administration of saline solutions ¦ Hypertonic tube feedings without adequate water ¦ Excessive use of table salt ( 1 tsp contains 2,300 mg of sodium) Conditions such as ¦ Diabetes insipidus ¦ Heat stroke |
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Hypernatremia Clinical manifestation
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Thirst
Dry, sticky mucous membranes Tongue red, dry, swollen Weakness Severe hypernatremia: ¦ Fatigue, restlessness ¦ Decreasing level of consciousness ¦ Disorientation ¦ Convulsions Laboratory findings: Serum sodium above 145 mEq/ L Serum osmolality above 300 mOsm/ kg |
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Hypernatremia NIC
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Monitor fluid intake and output.
Monitor behavior changes ( e. g., restlessness, disorientation). Monitor laboratory findings ( e. g., serum sodium). Encourage fluids as ordered. Monitor diet as ordered ( e. g., restrict intake of salt and foods high in sodium). |
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Hypokalemia Risk Factors
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Vomiting and gastric suction
¦ Diarrhea ¦ Heavy perspiration ¦ Use of potassium- wasting drugs ( e. g., diuretics) ¦ Poor intake of potassium ( as with debilitated clients, alcoholics, anorexia nervosa) ¦ Hyperaldosteronism |
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Hypokalemia Clinical manifestation
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Muscle weakness,
leg cramps Fatigue,lethargy Anorexia, nausea, vomiting Decreased bowel sounds, decreased bowel motility Cardiac dysrhythmias Depressed deep- tendon reflexes Weak, irregular pulses Laboratory findings: Serum potassium below 3.5 mEq/ L Arterial blood gases ( ABGs) may show alkalosis |
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Hypokalemia NIC
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Monitor heart rate and rhythm.
Monitor clients receiving digitalis ( e. g., digoxin) closely, because hypokalemia increases risk of digitalis toxicity. Administer oral potassium as ordered with food or fluid to prevent gastric irritation. Administer IV potassium solutions at a rate no faster than 10– 20 mEq/ hr; never administer undiluted potassium intravenously. For clients receiving IV potassium, monitor for pain and inflammation at the injection site. Teach client about potassium- rich foods. Teach clients how to prevent excessive loss of potassium ( e. g., through abuse of diuretics and laxatives). |
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Hyperkalemia Risk Factors
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Decreased potassium excretion
¦ Renal failure ¦ Hypoaldosteronism ¦ Potassium- conserving diuretics High potassium intake ¦ Excessive use of K containing salt substitutes ¦ Excessive or rapid IV infusion of potassium ¦ Potassium shift out of the tissue cells into the plasma ( e. g., infections, burns, acidosis) |
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Hyperkalemia Clinical manifestation
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High potassium intake
Gastrointestinal hyperactivity, diarrhea Irritability, apathy, confusion Cardiac dysrhythmias or arrest Muscle weakness, areflexia ( absence of reflexes) Decreased heart rate Irregular pulse Paresthesias and numbness in extremities Laboratory findings: Serum potassium above 5.0 mEq/ L |
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Hyperkalemia NIC
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Closely monitor cardiac status and ECG.
Administer diuretics and other medications such as glucose and insulin as ordered. Hold potassium supplements and K conserving diuretics. Monitor serum K levels carefully; a rapid drop may occur as potassium shifts into the cells. Teach clients to avoid foods high in potassium and salt substitutes. |
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Hypocalcemia Risk Factors
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surgical removal of the parathyroid glands
Conditions such as ¦ Hypoparathyroidism ¦ Acute pancreatitis ¦ Hyperphosphatemia ¦ Thyroid carcinoma Inadequate vitamin D intake ¦ Malabsorption ¦ Hypomagnesemia ¦ Alkalosis ¦ Sepsis ¦ Alcohol abuse |
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Hypocalcemia clinical manifestation
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Numbness, tingling of the extremities and around the mouth
Muscle tremors, cramps; if severe can progress to tetany and convulsions Cardiac dysrhythmias; decreased cardiac output Positive Trousseau’s and Chvostek’s signs ( see Table 52– 8 and Figure 52– 13) Confusion, anxiety, possible psychoses Hyperactive deep- tendon reflexes Laboratory findings: Serum calcium less than 8.5 mg/ dL or 4.5 mEq/ L ( total) |
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Hypocalcemia NIC
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Closely monitor respiratory and cardiovascular status.
Take precautions to protect a confused client. Administer oral or parenteral calcium supplements as ordered. When administering intravenously, closely monitor cardiac status and ECG during infusion. Teach clients at high risk for osteoporosis about ¦ Dietary sources rich in calcium. ¦ Recommendation for 1,000– 1,500 mg of calcium per day. ¦ Calcium supplements. ¦ Regular exercise. ¦ Estrogen replacement therapy for postmenopausal women. |
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Hypercalcemia Risk Factors
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Prolonged immobilization Conditions such as
¦ Hyperparathyroidism ¦ Malignancy of the bone ¦ Paget’s disease |
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Hypercalcemia clinical manifestation
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Lethargy, weakness
Depressed deep- tendon reflexes Bone pain Anorexia, nausea, vomiting Constipation Polyuria, hypercalciuria Flank pain secondary to urinary calculi Dysrhythmias, possible heart block Laboratory findings: Serum calcium greater than 10.5 mg/ dL or 5.5 mEq/ L ( total) |
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Hypercalcemia NIC
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Increase client movement and exercise.
Encourage oral fluids as permitted to maintain a dilute urine. Teach clients to limit intake of food and fluid high in calcium. Encourage ingestion of fiber to prevent constipation. Protect a confused client; monitor for pathologic fractures in clients with long- term hypercalcemia. Encourage intake of acid– ash fluids ( e. g., prune or cranberry juice) to counteract deposits of calcium salts in the urine. |
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Hypomagnesemia Risk Factors
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Excessive loss from the gastrointes-tinal tract ( e. g., from nasogastric suction, diarrhea, fistula drainage)
¦ Long- term use of certain drugs ( e. g., diuretics, aminoglycoside antibiotics) Conditions such as ¦ Chronic alcoholism ¦ Pancreatitis ¦ Burns |
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Hypomagnesemia clinical manifestation
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Neuromuscular irritability with tremors Increased reflexes, tremors, convulsions
Positive Chvostek’s and Trousseau’s signs ( see Table 52– 8 and Figure 52– 13) Tachycardia, elevated blood pressure, dysrhythmias Disorientation and confusion Vertigo Anorexia, dysphagia Respiratory difficulties Laboratory findings: Serum magnesium below 1.5 mEq/ L |
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Hypomagnesemia NIC
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Assess clients receiving digitalis for digitalis toxicity.
Hypomagnesemia increases the risk of toxicity. Take protective measures when there is a possibility of seizures. ¦ Assess the client’s ability to swallow water prior to initiating oral feeding. ¦ Initiate safety measures to prevent injury during seizure activity. ¦ Carefully administer magnesium salts as ordered. Encourage clients to eat magnesium- rich foods if permitted ( e. g., whole grains, meat, seafood, and green leafy vegetables). Refer clients to alcohol treatment programs as indicated. |
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Hypermagnesemia Risk Factors
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Abnormal retention of magnesium, as in
¦ Renal failure ¦ Adrenal insufficiency ¦ Treatment with magnesium salts |
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Hypermagnesemia Clinical Manifestation
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Peripheral vasodilation, flushing
Nausea, vomiting Muscle weakness, paralysis Hypotension, bradycardia Depressed deep- tendon reflexes Lethargy, drowsiness Respiratory depression, coma Respiratory and cardiac arrest if hypermagnesemia is severe Laboratory findings: Serum magnesium above 2.5 mEq/ L |
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Hypermagnesemia NIC
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Monitor vital signs and level of consciousness when clients are at risk.
If patellar reflexes are absent, notify the primary care provider. Advise clients who have renal disease to contact their primary care provider before taking over- the- counter drugs. |
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Chvostek’s sign is a
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contraction of the facial muscles in response to tapping the fa-cial nerve in front of the ear ( Figure 52– 13, A ¦ );
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Trousseau’s sign is a
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carpal spasm in response to inflating a blood pressure cuff on the upper arm to 20 mmHg greater than the systolic pressure for 2 to 5 minutes
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Serious lung diseases? - causes of respiratory acidosis
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asthma and chronic obstructive pulmonary disease ( COPD)
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respiratory acidosis risk factors
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Acute lung conditions that impair alveolar gas exchange ( e. g., pneumonia, acute pulmonary edema, aspiration of foreign body, near- drowning)
Chronic lung disease ( e. g., asthma, cystic fibrosis, or emphysema) Overdose of narcotics or sedatives that depress respiratory rate and depth Brain injury that affects the respiratory center Airway obstruction |
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respiratory acidosis clinical manifestation
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Increased pulse and respiratory rates
Headache, dizziness Confusion, decreased level of consciousness ( LOC) Convulsions Warm, flushed skin Chronic: Weakness Headache Laboratory findings: Arterial blood pH less than 7.35 PaCO2 above 45 mmHg HCO3 normal or slightly elevated in acute; above 26 mEq/ L in chronic |
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respiratory acidosis NIC
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Frequently assess respiratory status and lung sounds.
Monitor airway and ventilation; insert artificial airway and prepare for mechanical ventilation as necessary. Administer pulmonary therapy measures such as inhalation therapy, percussion and postural drainage, bronchodilators, and antibiotics as ordered. Monitor fluid intake and output, vital signs, and arterial blood gases. Administer narcotic antagonists as indicated. Maintain adequate hydration ( 2– 3 L of fluid per day). |
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respiratory alkalosis risk factors
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Hyperventilation due to
¦ Extreme anxiety ¦ Elevated body temperature ¦ Overventilation with a mechanical ventilator ¦ Hypoxia ¦ Salicylate overdose Brainstem injury Fever Increased basal metabolic rate |
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respiratory alkalosis clinical manifestation
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Complaints of shortness of breath, chest tightness
Light- headedness with circumoral paresthesias and numbness and tingling of the extremities Difficulty concentrating Tremulousness, blurred vision Laboratory findings ( in uncompensated respiratory alkalosis): Arterial blood pH above 7.45 PaCO2 less than 35 mmHg |
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respiratory alkalosis NIC
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Monitor vital signs and ABGs.
Assist client to breathe more slowly. Help client breathe in a paper bag or apply a rebreather mask ( to inhale CO2). |
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Metabolic Acidosis risk factors
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Conditions that increase nonvolatile acids in the blood ( e. g., renal impairment, diabetes mellitus, starvation)
Conditions that decrease bicarbonate ( e. g., prolonged diarrhea) Excessive infusion of chloride- containing IV fluids ( e. g., NaCl) Excessive ingestion of acids such as salicylates Cardiac arrest |
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Metabolic Acidosis clinical manifestation
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Kussmaul’s respirations ( deep, rapid respirations)
Lethargy, confusion Headache Weakness Nausea and vomiting Laboratory findings: Arterial blood pH below 7.35 Serum bicarbonate less than 22 mEq/ L PaCO2 less than 38 mmHg with respira-tory compensation |
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Metabolic Acidosis NIC
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Monitor ABG values, intake and output, and LOC.
Administer IV sodium bicarbonate carefully if ordered. Treat underlying problem as ordered. |
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Metabolic Alkalosis Risk Factors
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Excessive acid losses due to
¦ Vomiting ¦ Gastric suction Excessive use of potassium- losing diuretics Excessive adrenal corticoid hormones due to ¦ Cushing’s syndrome ¦ Hyperaldosteronism Excessive bicarbonate intake from ¦ Antacids ¦ Parenteral NaHCO3 |
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Metabolic Alkalosis clinical manifestation
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Decreased respiratory rate and depth
Dizziness Circumoral paresthesias, numbness and tingling of the extremities Hypertonic muscles, tetany Laboratory findings: Arterial blood pH above 7.45 Serum bicarbonate greater than 26 mEq/ L PaCO2 higher than 45 mmHg with respiratory compensation |
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Metabolic Alkalosis NIC
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Monitor intake and output closely.
Monitor vital signs, especially respirations, and LOC. Administer ordered IV fluids carefully. Treat underlying problem |
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Common Risk Factors for Fluid, Electrolyte, and Acid– Base Imbalances
CHRONIC DISEASES AND CONDITIONS |
Chronic lung disease ( COPD, asthma, cystic fibrosis)
¦ Heart failure ¦ Kidney disease ¦ Diabetes mellitus ¦ Cushing’s syndrome or Addison’s disease ¦ Cancer ¦ Malnutrition, anorexia nervosa, bulimia ¦ Ileostomy |
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Common Risk Factors for Fluid, Electrolyte, and Acid– Base Imbalances
ACUTE CONDITIONS |
Acute gastroenteritis
¦ Bowel obstruction ¦ Head injury or decreased level of consciousness ¦ Trauma such as burns or crushing injuries ¦ Surgery ¦ Fever, draining wounds, fistulas |
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Common Risk Factors for Fluid, Electrolyte, and Acid– Base Imbalances
MEDICATIONS |
¦ Diuretics
¦ Corticosteroids ¦ Nonsteroidal anti- inflammatory drugs |
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Common Risk Factors for Fluid, Electrolyte, and Acid– Base Imbalances
TREATMENTS |
Chemotherapy
¦ IV therapy and total parenteral nutrition ¦ Nasogastric suction ¦ Enteral feedings ¦ Mechanical ventilation |
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Common Risk Factors for Fluid, Electrolyte, and Acid– Base Imbalances
OTHER FACTORS |
Age: Very old or very young
Inability to access food and fluids independently |
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pH is a measure
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of the relative acidity or alkalinity of the blood, and is an inverse measure of the number of hydrogen ions in a solution.
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PaO2 is
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the partial pressure of oxygen dissolved in arterial plasma, and is an indirect measure of blood oxygen content. PaO2 represents one of the two forms in which oxygen is transported in blood, and accounts for only about 3% of the oxygen content of the blood.
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PaCO2 is
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the partial pressure of carbon dioxide in arterial plasma, and is the respiratory component of acid– base deter-mination. Because carbon dioxide is regulated by the lungs, PaCO2 is used to determine if an acid– base imbalance is re-spiratory in origin.
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HCO3 is
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a measure of the bicarbonate dissolved in arterial plasma, and represents the metabolic component of acid– base balance.
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Base excess ( BE) is
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a calculated value of bicarbonate levels, also reflective of the metabolic component of acid base bal-ance. If the number is preceded by a plus sign, it represents a base excess; a BE above 2 indicates alkalosis. If the number is preceded by a minus sign, it represents a base deficit; a BE below – 2 indicates acidosis.
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SpO2 is
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oxygen saturation, which represents the percentage of hemoglobin that is combined ( saturated) with oxygen. SpO2 is the other form in which oxygen is transported in the blood and accounts for about 97% of the oxygen in the blood.
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Base excess values
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– 2 to +2 mEq/ L
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Respiratory acidosis ABG VALUES
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pH <7.35
PaCO2 >45 mmHg ( excess CO2 and carbonic acid) HCO3 Normal ( or >26 mEq/ L with renal compensation) |
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Respiratory alkalosis ABG VALUES
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pH >7.45
PaCO2 <35 mmHg ( inadequate CO2 and carbonic acid) HCO3 Normal ( or <22 mEq/ L with renal compensation) |
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Metabolic acidosis ABG VALUES
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pH <7.35
PaCO2 Normal ( or <35 mmHg with respiratory compensation) HCO3 <22 mEq/ L ( inadequate bicarbonate) |
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Metabolic alkalosis ABG VALUES
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pH >7.45
PaCO2 Normal ( or >45 mmHg with respiratory compensation) HCO3 >26 mEq/ L ( excess bicarbonate) |
