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33 Cards in this Set
- Front
- Back
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Magnesium normal range
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1.7-2.2
Interdependent with calcium |
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Hypomagnesemia- S/S
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Increased neuromuscular irritability
Tremors Tetany Hyperactive deep tendon reflexes Seizures Dysrhythmias especially if hypokalemia present Disorientation Confusion |
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Hypomagnesemia-Causes
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Alcoholism
GI suction Diarrhea Intestinal fistulas Poorly controlled diabetes mellitus Malabsorption syndrome |
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Hypomagnesemia-Nursing Interventions
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-Increased intake of dietary Mg— green vegetables, nuts, bananas, oranges, peanut butter, chocolate
-Parenteral administration of supplements— magnesium sulfate: 1) Monitor cardiac rhythm 2) Keep self-inflating breathing bag, airways, and oxygen at bedside in case of respiratory emergency Oral— long-term maintenance with oral magnesium IV— assess renal function Monitor for digitalis toxicity Seizure precautions Safety measures for confusion Test ability to swallow before PO fluids/ food because of dysphagia |
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Hypermagnesemia- S/S
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Depresses the CNS
Depresses cardiac impulse transmission Cardiac arrest Facial flushing Muscle weakness Absent deep tendon reflexes Paralysis Shallow respirations |
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Hypermagnesemia- Causes
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Renal failure
Excessive magnesium administration (antacids, cathartics) |
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Hypermagnesemia- Nursing Interventions
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Discontinue oral and IV Mg
Emergency 1) Support ventilation 2) IV calcium gluconate Hemodialysis Monitor reflexes Teach regarding over-the-counter drugs containing Mg Monitor respiratory status Monitor cardiac rhythm; have calcium preparations available to antagonize cardiac depressant |
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Potassium normal range
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3.5-5.0
Main intracellular ion; involved in cardiac rhythm, nerve transmission |
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Hypokalemia-S/S
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Anorexia, nausea, vomiting
Weak peripheral pulses Muscle weakness, paresthesias; decreased deep tendon reflexes Impaired urine concentration Ventricular dysrhythmias Potential for digitalis toxicity Shallow respirations |
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Hypokalemia-Causes
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Vomiting
Gastric suction Prolonged diarrhea Diuretics and steroids Inadequate intake |
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Hypokalemia-Nursing Interventions
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Administration of oral potassium supplements— dilute in juice and give with meals to avoid gastric irritation
Increase dietary intake— raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery IV supplements— 20– 40 mEq/ L usual concentration; cannot give concentration greater than 1 mEq/ 10mL into peripheral IV, or without cardiac monitor; do not exceed 20 mEq/ h infusion rate; stop solution immediately if burning occurs. Assess renal function prior to administration Risk for digitalis toxicity |
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Hyperkalemia-S/S
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EKG changes– peaked T waves, wide QRS complexes
Dysrhythmias, ventricular fibrillation, heart block Cardiac arrest Muscle twitching and weakness Numbness in hands and feet and around mouth Nausea Diarrhea |
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Hyperkalemia-Causes
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Renal failure
Use of potassium supplements Burns Crushing injuries Severe infection Potassium-sparing diuretics ACE inhibitors |
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Hyperkalemia-Nursing Interventions
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Restrict dietary potassium and potassium-containing medications or IV solutions
Sodium polystyrene sulfonate (Kayexalate) 1) Orally— dilute to make more palatable 2) Rectally— give in conjunction with sorbitol to avoid fecal impaction In emergency situation 1) Calcium gluconate given IV 2) Sodium bicarbonate given IV IV administration of regular insulin and dextrose shifts potassium into the cells Peritoneal or hemodialysis Diuretics |
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Calcium normal ranges
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8.5-10.5
Need for blood clotting, skeletal muscle contraction Regulated by the parathyroid hormone and vitamin D, which facilitates reabsorption of calcium from bone and enhances reabsorption from the GI tract |
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Hypocalcemia-S/S
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Nervous system becomes increasingly excitable Tetany
1) Trousseau’s sign— inflate BP cuff on upper arm to 20 mm Hg above systolic pressure, carpal spasms within 2– 5 min indicate tetany 2) Chvostek’s sign— tap facial nerve 2 cm anterior to the earlobe just below the zygomatic arch; twitching of facial muscles indicates tetany Hyperactive reflexes Confusion Paresthesias Irritability Seizures |
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Hypocalcemia-Causes
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Hypoparathyroidism
Pancreatitis Renal failure Steroids and loop diuretics Inadequate intake Post-thyroid surgery |
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Hypocalcemia-Nursing Interventions
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Orally— calcium gluconate or calcium chloride; administer with orange juice to maximize absorption
Parenterally— calcium gluconate 1) Effect is transitory and additional doses may be necessary 2) Caution with digitalized patients because both are cardiac depressants 3) Calcium may cause vessel irritation and should be administered through a long, stable intravenous line 4) Administer at a slow rate to avoid high serum concentrations and cardiac depression 5) Seizure precautions 6) Maintain airway 7) Safety needs due to confusion 8) Increase dietary intake of calcium 9) Calcium supplements 10) Regular exercise 11) Administer phosphate-binding antacids, calcitriol, vitamin D |
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Hypercalcemia-S/S
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Lack of coordination
Anorexia, nausea, and vomiting Confusion, decreased level of consciousness Personality changes Dysrhythmias, heart block, cardiac arrest |
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Hypercalcemia-Causes
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Malignant neoplastic diseases
Hyperparathyroidism Prolonged immobilization Excessive intake Immobility Excessive intake of calcium carbonate antacids |
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Hypercalcemia-Nursing Interventions
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IV administration of 0.45% NaCl or 0.9% NaCl Encourage fluids
Lasix Calcitonin— decreases calcium level Mobilizing the patient Dietary calcium restriction Prevent development of renal calculi 1) Increase fluid intake 2) Maintain acidic urine 3) Prevent urinary tract infection Injury prevention Limit intake of calcium carbonate antacids Surgical intervention may be indicated in hyperparathyroidism (cause of hypercalcemia) 1) Preoperatively— directed toward preventing dangerously high serum calcium levels 2) Postoperatively a) Observe for signs of hypocalcemia (reverse of preop) b) Due to calcium drop postop, large quantities of calcium salts may be required c) Encourage early ambulation to aid in recalcification of bones |
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Hypotonic solutions
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5% dextrose in water (is isotonic but becomes hypotonic when glucose is metabolized)
0.45% NaCl |
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Isotonic Solutions
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0.9% NaCl
Ringer’s solution Lactated Ringer’s |
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Hypertonic Solutions
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10– 15% dextrose in water
3% NaCl Sodium bicarbonate 5% 5% dextrose in 0.9% saline |
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IV Amin Sets
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Macrodrip— can deliver 10, 12, or 15 drops per milliliter; should be used if rapid administration is needed
Microdrip— delivers 60 drops per milliliter; should be used when fluid volume needs to be smaller or more controlled, e.g., patients with compromised renal or cardiac status, patients on “keep-open” rates, and pediatric patients |
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Respiratory Acidosis
What is it? |
Decreased ph (<7.35) and Increased PC02 (>45)
Bicarb (HC03) normal (22-26) |
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Respiratory Acidosis-Causes
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COPD
Hyperventilation Pneumonia Guillain-Barre syndrome Chest wall trauma Pulmonary edema Atelectasis Pneumothorax Drug Overdose |
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Respiratory Acidosis-S/S
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Increased B/P, R <12
Drowsiness Disorientation Hypotension Hypoventilation Warm flushed skin H/A's Dysrhythmias Hypoxia seizures Coma |
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Respiratory Acidosis-Nursing Interventions
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Institute safety measures and assist patient with positioning
Maintain hydration Maintain patent airway Monitor vital signs Health history Identify the underlying cause Lab results-monitor the pH, PaCO2, PaO2, and HCO3 |
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Respiratory Alkalosis
What is it? |
Increased ph (>7.45) and Decreased PC02 (<35)
Bicarb (HC03) normal (22-26) |
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Respiratory Alkalosis-Causes
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Pulmonary Causes: severe hypoxemia, pneumonia, pulmonary vascular disease and acute asthma.
Nonpulmonary Causes: anxiety, fever, aspirin toxicity, metabolic acidosis, pregnancy. |
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Respiratory Alkalosis-S/S
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Nausea and vomiting
Muscle twitching Deep rapid breathing Lightheadedness Lethargy & confusion Tachy Hyperventilation Tingling of extremities |
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Respiratory Alkalosis-Nursing Interventions
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Encourage the anxious patient to verbalize fears
Administer sedation as ordered to relax the patient Keep the patient warm and dry Health history Identify the underlying cause Encourage the patient to take deep, slow breaths or breathe into a brown paper bag Monitor vital signs Lab results |
