Fluid And Electrolyte/acid-Base Balance

Front 1

What is the normal pH range?

Back 1

7.35-7.45

Front 2

What range of pH is compatible for life?

Back 2

6.8-7.8

Front 3

The two major buffer systems in the body are:

Back 3

lungs and kidneys

Front 4

The function on acids and bases:

Back 4

regulate the body's hydrogen ion (H+)

Front 5

Acids

Back 5

produce (promote) H+ (holding on)

Front 6

Bases

Back 6

eliminate (neutralize) H+

Front 7

Respiratory buffer response

Back 7

CO2 dissolved in H2O turns into carbonic acid (H2CO3). Lungs control CO2 and H2CO3

Front 8

Respiratory acidosis causes:

Back 8

RR increase and causes elimination of CO2

Front 9

Respiratory alkalosis causes:

Back 9

RR decreases and causes CO2 to be retained

Front 10

What is the normal range for CO2?

Back 10

35-45 mmHg

Front 11

Renal buffer response

Back 11

kidneys excrete or retain bicarbonate

Front 12

Metabolic alkalosis causes

Back 12

kidneys retain H+ and excrete HCO3 through the urine

Front 13

Metabolic acidosis causes

Back 13

kidneys excrete H+ and retain HCO3

Front 14

Normal range for HCO3

Back 14

19-26

Front 15

What is the pH and PaCO2 of a patient in respiratory acidosis?

Back 15

pH < 7.35
PaCO2 > 45mmHg

Front 16

What causes respiratory acidosis?

Back 16

an accumulation of CO2 caused by pneumonia, lung collapse, pneumothorax, aspiration, flail chest, spinal cord injury, chest trauma, sleep apnea, OD on sedatives

Front 17

What are s&s of respiratory acidosis?

Back 17

dyspnea, shallow resp., HA, confusion, tachycardia, anxiety, tachypnea, decreased BP, dysrhythmias, hyperkalemia, drowsiness, dizziness, disorientation, hypoxia, muscle weakness, hyperreflexia

Front 18

Treatment of respiratory acidosis consist of:

Back 18

increasing ventilation (elevate HOB), treating the root cause, medications such as bronchodilators (bronchospasm), antibiotics (respiratory infection) and anticoagulants (pulmonary emboli), pulmonary hygiene, hydration, supplemental O2 (not the final treatment)

Front 19

What is the pH and PaCO2 of a patient with respiratory alkalosis?

Back 19

pH > 7.45
PaCo2 < 35mmHg

Front 20

What causes respiratory alkalosis?

Back 20

caused by any condition causing hyperventilation such as anxiety, fear, pain, fever, sepsis, pregnancy

Front 21

What are the s&s of respiratory alkalosis?

Back 21

light headedness, lethargy, confusion, seizures, deep rapid breathing, tachycardia, decreased or normal BP, hypokalemia, numbness, tingling of extremities, nausea, vomiting, hyperventilation

Front 22

Treatment of respiratory alkalosis:

Back 22

treat root cause, monitor closely for respiratory muscle fatigue, breathe in a paperbag, use venturi mask

Front 23

What are the HCO3 and pH levels of a patient with metabolic acidosis?

Back 23

HCO3 < 19-22mEq/L
pH < 7.35

Front 24

What causes metabolic acidosis?

Back 24

renal failure, diabetic ketoacidosis, starvation, salicylate intoxication, severe diarrhea, shock

Front 25

What are the s&s of metabolic acidosis?

Back 25

HA, confusion, decreased BP, hyperkalemia, changes in LOC, Kussmaul respirations, restlessness progressing to coma, dysrhythmias, nausea, vomiting, warm flushed skin, peripheral vasodilation, decreased cardiac output

Front 26

Treatment of metabolic acidosis:

Back 26

give sodium bicarbonate, treat root cause, dialysis for renal failure

Front 27

What are the HCO3 and pH levels of a patient with metabolic alkalosis?

Back 27

HCO3 > 26mEq/L
pH > 7.45
This is either an excess of base or loss of acid

Front 28

What causes metabolic alkalosis?

Back 28

ingestion of antacids, excess us of bicarbonate (excess base) or gastric suctioning, vomiting, use of lactate in dialysis, excess admin of diuretics (loss of acid)

Front 29

What are the s&s of metabolic alkalosis?

Back 29

dizziness, lethargy, disorientation, dysrhythmias (tachycardia), weakness, compensatory hypoventilation, muscle twitching, muscle cramps, NVD, seizures, coma, hypokalemia, tingling of fingers and toes

Front 30

Treatment of metabolic alkalosis:

Back 30

monitor I&O, treat root cause, initiate seizure precautions, give Tagament for suctioning

Front 31

What is the normal range of PaCO2 in ABGs?

Back 31

35-45mmHg

Front 32

What is the normal range of PaO2 in ABGs?

Back 32

70-100mmHg

Front 33

Acid Base Mnemonic

Back 33

Respiratory
Opposite
Metabolic
Equal

Front 34

What is the normal lab value for Calcium?

Back 34

9-11 mg/dL

Front 35

What does Ca+ do in the body?

Back 35

found in bone/teeth, aids in blood clotting, transmits nerve impulses, increased absorption in GI tract and reabsorbs in kidney tubes

Front 36

What causes hypocalcemia?

Back 36

primary and surgical hypoparathyroidism, thyroid surgery, renal failure, inadequate Vit D consumption, ETOH abuse

Front 37

What are the clinical manifestations of hypocalcemia?

Back 37

numbness and tingling of fingers and toes, + Trousseau's sign and Chvostek's sign, seizures, anxiety, impaired clotting time, tetany, irritability, hyperactive DTRs

Front 38

What are treatments for hypocalcemia?

Back 38

IV admin of calcium (gluconate) diluted with D5W and given as a slow bolus or an infusion pump, can cause dig toxicity in patients on digitalis

Front 39

Nursing interventions for hypocalcemia:

Back 39

increase dietary intake of Ca+, vitamin D therapy, initiate seizure precautions if severe, caution patients regarding high intake of ETOH, caffeine, and overuse of laxatives and antacids containing phosphorus (decreases Ca+ absorption), ask patient about diet

Front 40

Who is at an increased risk for hypocalcemia?

Back 40

Elderly and those with disabilities that spend an increased amount of time in bed (bedrest increases bone resorption)

Front 41

What causes hypercalcemia?

Back 41

malignancies and hyperparathyroidism, immobilization

Front 42

Clinical manifestations of hypercalcemia:

Back 42

muscular weakness, NV, constipation, anorexia, confusion, impaired memory, slurred speech, flank pain, plydispsia, kidney stones, coma (levels > 16), ECG changes

Front 43

Treatment of hypercalcemia:

Back 43

treat undelying cause, restrict dietary intake of Ca+, administer fluids to dilute serum Ca levels and promote renal excretion, Lasix and IV phosphate, NS may be given to drop levels (use extreme caution with IV phosphate therapy-can cause severe calcification in tissues, hypotension, tetany, and ARF)

Front 44

Nursing interventions for hypercalcemia:

Back 44

monitor Ca levels, instruct clients to avoid foods high in Ca, increase fluid intake if not contraindicated, administer meds as ordered

Front 45

What are the normal lab values for Potassium?

Back 45

3.5-5.3 mEq/L

Front 46

What can increase potassium in the blood?

Back 46

K+ sparing diuretics, K+ supplements, blood products, ACE inhibitors, Beta adrenergic blockers, NSAIDs, heparin

Front 47

What causes hyperkalemia?

Back 47

seldom occurs in patients with normal renal function, decreased renal excretion on K+, rapid administration of K+, and movement of K+ from ICF to ECF compartment

Front 48

What are the clinical manifestations of hyperkalemia?

Back 48

dysrhythmias, irritability, parasthesias, cramps, cardiac arrest

Front 49

Treatment of hyperkalemia:

Back 49

EKG obtained, Kayexelate PO or enema (pulls K+ and H2O into intestines), IV calcium gluconate to counteract effect of K+ on heart muscle, loop diuretic, IV sodium bicarb, restrict dietary K+

Front 50

Nursing interventions for hyperkalemia:

Back 50

monitor EKG continuously, caution salt substitute, monitor lab values, teach about dietary management

Front 51

What does potassium do in the body?

Back 51

influences skeletal and cardiac muscle action, kidneys is primary regulator of potassium

Front 52

What causes hypokalemia?

Back 52

diarrhea, prolinged intestinal suctioning, recent ileostomy, intestina tumors, people who do not eat a normal diet at risk (alcoholics, anorexics, bulimics, debilitated elderly)

Front 53

What are the clinical manifestations of hypokalemia?

Back 53

weakness, fatigue, NV, parasthesias, decreased BP, leg cramps, irregular pulse, anorexia, polyuria, you may see on EKG flattened T waves, ST depression, prolonged PR interval and prominet U waves

Front 54

Treatment for hypokalemia:

Back 54

oral or IV replacement, foods high in K+ such as bananas, meat, baked potatoes, coffee, tea, cocoa, milk, eggs

Front 55

Oral potassium supplements can produce what?

Back 55

small bowel lesions. Assess for and caution about abd distention, pain and GI bleeding

Front 56

Nursing interventions for hypokalemia:

Back 56

closely monitor, place on cardiac monitor if replacing K+ via IV infusion, monitor for dig toxicity in patients taking digitalis

Front 57

How is potassium given?

Back 57

PO, IV infusion. K+ IS NEVER ADMINISTERED IV PUSH OR IM!!!

Front 58

Examples of K+ supplements:

Back 58

Chlorcon
K-door

Front 59

Why should aged (stored) blood not be administered to patients with impaired renal function?

Back 59

Serum potassium concentration of stored blood increases due to red blood cell deterioration

Front 60

What is the normal lab values for Sodium?

Back 60

135-145 mEq/L

Front 61

What causes hyponatremia?

Back 61

vomiting, diarrhea, diaphoresis, use of diuretics, aldosterone deficiency, low sodium diet

Front 62

What are the clinical manifestations of hyponatremia?

Back 62

anorexia, NV, HA, dizziness, confusion, muscle cramps, dry skin and mucosa, increased pulse, low BP, shallow breathing, dyspnea, convulsion and death may result

Front 63

Treatment of hyponatremia:

Back 63

treat cause first, fluid and dietary management, increase dietary sodium, restrict fluid intake to a total of 800mL/day, replace fluid with LR or isotonic NS, hypertonic solutions if neuro symptoms severe

Front 64

Nursing interventions for hyponatremia:

Back 64

strict I&O, daily wts, monitor serum sodium, urine sodium and specific gravity, monitor FVO when admin fluids, identify and monitor patients at risk for

Front 65

What are the causes of hypernatremia?

Back 65

fluid deprivation, diabetes insipidus, heat stroke, near drowning in sea water, admin of IV hypertonic saline, malfunction of hemodialysis or peritoneal dialysis systems

Front 66

What are the clinical manifestions of hypernatremia in a patient

Back 66

thirst, fever, sticky mucous membranes, pulmonary edema, increased pulse, increased BP, lethargy, irritable, restless, circulatory overload, shock, resp distress, renal failure, permanent brain damage can occur

Front 67

Treatment of hypernatremia:

Back 67

decrease Na intake, promote Na excretion with diuretics, hypotonic or nonsaline isotonic solutions, monitor S/S of hypernatremia and LOC changes, restore balance

Front 68

Nursing interventions for hypernatremia:

Back 68

accurate I&O, daily wts, assess pt's response to fluids, observe for changes in neurologic signs, teach dietary management of low Na diet

Front 69

What are the normal lab values for phosphorus?

Back 69

2.5-4.5 mg/dL

Front 70

What are foods high in phosphate?

Back 70

beef, pork, turkey, milk, whole grains

Front 71

What does phosphate do in the body?

Back 71

essential to the function of muscle and RBCs, forms ATP, maintenance of acid-base balance, as well as the nervous system, provides structural support to bones and teeth

Front 72

What are the causes of hypophosphatemia?

Back 72

intracellular shift of PO4 from serum into cells, increased urinary excretion of PO4, severe protein-calorie malnutrition, overabundance of simple carb intake, chronic alcoholism

Front 73

What are the clinical manifestations of hypophosphatemia?

Back 73

muscle weakness, parasthesias, confusion, seizures, coma, tissue hypoxia, bone pain, resp failure, increased risk for infection (depresses activity of granulocytes), chest pain, tenderness

Front 74

What is the goal of treatment for hypophosphatemia?

Back 74

PREVENTION

Front 75

What are treatments for hypophosphatemia?

Back 75

oral or IV replacement, increase PO4 in patients receiving TPN
Be careful in IV replacement-can cause tetany from hypocalcemia and calcifications in tissues from hyperphosphatemia

Front 76

Nursing interventions for patients with hypophosphatemia?

Back 76

identify those patients with or at risk for, monitor them closely, prevent infection, monitor PO4 levels, increase foods rich in PO4

Front 77

What are the causes of hyperphosphatemia?

Back 77

most common cause is renal failure. Others include increased intake, decreased output or a shift from ICF to ECF.

Front 78

A high serum phosphate tends to cause?

Back 78

low serum calcium concentrations

Front 79

What are the clinical manifestations of hyperphosphatemia in a patient?

Back 79

tetany, tachycardia, anorexia, NV, muscle weakness, soft tissue calcifications of the lungs, heart, kidneys and cornea, s/s of hypocalcemia

Front 80

What are treatments for a patient with hyperphosphatemia?

Back 80

treat underlying disorder when possible, restrict dietary phosphate, loop diuretics, volume replacement with saline, dialysis, Calcitrol given to bind phosphorus in GI tract

Front 81

Nursing interventions for patients with hyperphosphatemia:

Back 81

monitor I&O (decreased urinary output can increase PO4 and MD should be notified), consume foods low in PO4, educate to avoid phosphate containing substances such as laxatives and enemas

Front 82

What are the normal lab values for magnesium?

Back 82

1.5-2.5 mEq/dL

Front 83

What does magnesium do in the body?

Back 83

plays a role in carb and protein metabolism, important for neuromuscular function, act peripherally to produce vasodilation and decrease peripheral resistance, predominantly found in bone and soft tissue and eliminated by the kidneys

Front 84

What are good sources of magnesium in food?

Back 84

green leafy veggies, nuts, seeds, legumes, whole grains, seafood, PB

Front 85

What are the causes of hypomagnesemia?

Back 85

ETOH withdrawal, admin of tube feedings and TPN, loss may occur through diarrhea, fistulas or NG suction. Any small bowel disrupt

Front 86

What are the clinical manifestations of hypomagnesemia in a patient?

Back 86

neuromuscualr irritability, + Trousseau's and Chvostek's signs, insomnia, mood changes, seizures, delirium, hallucinations, psychoses, ECG changes, laryngeal stridor

Front 87

What are the treatments for a patient with hypomagnesemia?

Back 87

diet, IV Mg via an infusion pump, can also be given orally or added to TPN

Front 88

A bolus dose of Mg given too rapidly can produce?

Back 88

alterations in cardiac conduction leading to heart block or asystole

Front 89

Nursing interventions for hypomagnesemia:

Back 89

assess VS during IV admin of Mg, seizure precautions if severe, eat a diet rich in Mg, counseling regarding ETOH abuse

Front 90

What are the causes of hypermagnesemia?

Back 90

rare imbalance, usually caused by renal failure, untreated DKA, admin of Mg, Addison's disease, execessive use of antacids, laxatives, lithium toxicity, use of opioids and anticholinergics

Front 91

What are the clinical manifestations of hypermagnesemia in a patient?

Back 91

flushing, hypotension, muscle weakness, drowsiness, depressed resp, cardiac arrest, coma, ECG changes

Front 92

What are the treatments for patients with hypermagnesemia?

Back 92

loop diuretic for those with adequate renal function, NaCl or LR can be given IV, IV calcium gluconate reverses effects in emergency situations, always have calcium gluconate available for pregnant client on Mg sulfate for PIH

Front 93

Nursing interventions for hypermagnesemia:

Back 93

monitor VS, note hypotension and shallow resp, don't admin Mg containing meds to pts with renal failure or insufficiency, use caution when admit parentally

Front 94

Nursing interventions for a patient with a diagnosis of hyponatremia includes all othe following except:
a. assessing for symptoms of nausea and malaise
b. encouraging the intake of low-sodium liquids, such as coffee or tea
c. monitoring neuroligic status
d. restricting tap water intake

Back 94

B. encouraging the intake of low-sodium liquids, such as coffee or tea

Front 95

The nursing assessment for a patient with metabolic alkalosis includes evaluation of laboratory data for all of the following except:
a. hypocalcemia
b. hypoglycemia
c. hypokalemia
d. hypoxemia

Back 95

b. hypoglycemia