Nurs 452 Fluid Electrolytes Studyguide

NURS 452 FLUID ELECTROLYTES STUDYGUIDE Sodium (Na+): 135 – 145 mEq/L Most abundant in ECF Function: maintains water balance, transmits nerve impulse, contract muscles HYPERNATREMIA: 145 HYPONATREMIA: 135 Causes Ingestion of large amounts of Na, fluid deprivation, lack of fluid consumption, hyperventilation, burns, corticosteroid use Signs & Symptoms Dry tongue (profound), Polydipsia, Edema, weakness, disorientation, delusion, hallucination, increase HR & BP, pulmonary edema, decrease urine output , increased urinary specific gravity, N/V profound Interventions Monitor cardiovascular, resp, neuro, cerebral, renal, and integumentary status Administer IV infusions if cause is fluid loss Administer diuretics if cause is inadequate renal excretion of Na Restrict Na and Fluid intake Causes GI loss, fistula, sweating, diuretic, vomiting, diarrhea, HF Signs & Symptoms NVD, Hypotension, Confusion, Edema, Weakness and Seizures/Coma, Increased motility and hyperactive bowel sounds, increased urine output, decreased urinary specific gravity Interventions Monitor cardiovascular, resp, neuro, cerebral, renal, and GI status Administer IV NaCl if caused by FVD Administer osmotic diuretics (excretion of H2O rather than Na) if caused by FVE Increase oral intake of Na and diet Monitor Lithium if client is taking it Potassium (K+): 3.5 – 5.0 mEq/L Most abundant in ICF Function: regulates neuromuscular excitability, muscular contraction, acid-base ** NEVER ADMINISTER IV PUSH/SC/IM. Should always be DILUTED and use INFUSION DEVICE ** HYPERKALEMIA: 5.0 HYPOKALEMIA: 3.5 Causes Renal failure, hypoaldosteronism, heparin, potassium chloride, ACE inhibitors, NSAIDS, K sparing diuretics Signs & Symptoms Muscle contractility, skeletal weakness, paralysis (profound), cardiac irregularities, irregular slow pulse  cardiac arrest Causes K wasting diuretics (e.g Lasix), GI losses, poor dietary intake Signs & Symptoms Fatigue, irregular pulse, hypotension, muscle weakness, leg cramps, paresthesia, dysrhythmias This study source was downloaded by from CourseH on :20:38 GMT -05:00 Interventions Monitor cardiovascular, resp, neuromuscular, renal and GI status (Client has to be placed in cardiac monitor) Discontinue IV K, withhold oral K Potassium restricted diet Administer diuretics (potassium excreting) Interventions Monitor cardiovascular, resp, neuromuscular, renal and GI status (Client has to be placed in cardiac monitor) Monitor electrolyte values Administer K supplements oral/IV (oral should be taken with meal, liquid should be diluted w juice or other liquid. Administer K retaining diuretic (e.g Spironolactone) Instruct client about foods high in K (e.g banana, avocado) Calcium (Ca +): 8.6 – 10.2 mg/L total 2 4.5 – 5.1 mg/dL ionized Function: cardiac conduction, bone growth and formation, muscular relaxation HYPERCALCEMIA: 10.2 HYPOCALCEMIA: 8.6 Causes Cancer, hyperparathyroidism, osteoporosis, prolonged immobilization Signs & Symptoms N/V, constipation, bone pain, Polyuria, Polydipsia, confusion, lethargy, slurred speech, muscle weakness, kidney stones (renal calculi), incoordination, decreased DTR Causes Vit. D deficiency, impaired calcium absorption, excessive calcium loss, renal failure Signs & Symptoms Tetany, paresthesia, circumoral numbness, muscle cramp, Trousseau & Chvostek’s sign, seizures, dyspnea, laryngospasm + Magnesium (Mg2 ): 1.3 – 2.3 mEq/L total 2nd most abundant in ICF Function: cardiac conduction, bone growth and formation, muscular relaxation HYPERMAGNESEMIA: 2.3 HYPOMAGNESEMIA: 1.3 Causes Renal failure, excess admin of Mg (e.g antacids and laxatives) Signs & Symptoms N/V, weakness, flushed, lethargy, hypoactive DTR, shallow and slow resp, respiratory arrest, dysrhythmia, cardiac arrest, bradycardia, hypotension Interventions Causes Malnutrition, GI losses, admin of tube feedings/parenteral nutrition, sepsis, burns, withdrawal from Alcohol Signs & Symptoms Muscle tremors, hyperactive DTR, seizures, heart block, dysrhythmia, change in mental status, respiratory paralysis Interventions Monitor cardiac, resp, neuro, CNS, status; place on Cardiac monitor Administer diuretics to increase renal excretion of Mg IV Calcium Chloride or Calcium Gluconate as an antidote Restrict dietary intake of magnesium containing foods Avoid use of laxatives + antacids Monitor cardiac, resp, neuro, CNS, status; place on Cardiac monitor Restore Calcium levels (Mg accompanies Ca) Oral preparations of Mg (can cause diarrhea) Magnesium Sulfate by IV or IM (IM causes pain + tissue damage) Monitor serium mg frequently and DTR Increase intake of foods high in Mg Phosphate (PO4-): 2.5 – 4.5 mg/L total Function: critical element in all of body’s tissues ** A decrease in Phosphate  increase in Calcium (reciprocal) ** HYPERPHOSPHATEMIA: 4.5 HYPOPHOSPHATEMIA: 2.5 Causes Renal failure, hypoparathyroidism, chemo Signs & Symptoms Tetany, anorexia, nausea, weakness and tachycardia Interventions Manage hypocalcemia Administer phosphate binding medications that increase fetal excretion of phosphorus (must be taken with meal) Avoid phosphate containing medications (e.g laxatives and enemas) Instruct to decrease intake of food high in PO4- Causes Admin of calories to malnourished pt, alcohol withdrawal, DKA, hyperventilation, insulin release and diuretics Signs & Symptoms Irritability, fatigue, weakness, paresthesia, muscle + bone pain, confusion, seizures, coma Interventions Monitor cardiovascular, respiratory, neuromuscular, hematological status Discontinue medications that  low level of Phosphate Administer PO4- PO along w Vit D Increase intake of food high in PO4- Move client carefully (high risk fracture bc of increase Ca level) Chloride (Cl-): 97 – 107 mEq/L total Function: major component gastric + pancreatic juices, acid-base HYPERCHLOREMIA: 107 HYPOCHLOREMIA: 97 Causes Increase sodium level in blood, Diabetes Insipidus, hyperparathyroidism, metabolic acidosis, head trauma, increase perspiration Causes GI loss, sweating, high fever, burns, drugs (e.g bicarbonate, corticosteroids, diuretics, laxatives) Signs & Symptoms Tachypnea, weakness, lethargy, decrease cognitive ability, HTN, rapid + deep respirations, dysrhythmia Interventions IV (lactated ringers slowly) Administer diuretics Restrict Na and Cl Signs & Symptoms Tetany, hyperactive DTR, weakness and muscle cramps, dysrhythmia, seizures, coma Interventions Monitor I&O Monitor bicarb and Na level Intake of food high in Cl Respiratory Acidosis ↑ PaCO2 45 ↓ pH 7.35 Occur as a result of respiratory disturbances  alters Carbonic acid Causes Symptoms Respiratory failure, hypoventilation, airway Drowsiness, disorientation, dizziness, H/A, coma obstruction, COPD, PNA, Atelectasis Hypotension, warm flushed skin, seizures, hypoventilation with hypoxia, dysrhythmia Levels pH 7.35 (Normal Values: 7.35 – 7.45) - paCO2 45 mm Hg (Normal Values: 35 – 45) Respiratory Alkalosis ↓ PaCO2 35 ↑ pH 7.45 Occur as a result of respiratory disturbances  alters Carbonic acid Causes Excessive exhalation of CO2 (Hyperventilate), Anxiety, Mechanical Vent Levels pH 7.45 (Normal Values: 7.35 – 7.45) - paCO2 35 mm Hg (Normal Values: 35 – 45) Symptoms Lethargy, confusion, tachycardia, N/V, numbness, hyperreflexia, seizures, hyperventilation Metabolic Acidosis ↓ pH 7.35 ↓ HCO3- 22 Result of metabolic processes. Alters Bicarbonate in the ECF Causes Starvation, DKA, renal failure, diarrhea, drug use, shock Levels pH 7.35 Symptoms Hypotension, hyperkalemia, muscle twitch, hyperventilation (compensatory mechanism), N/V/D, changes in LOC (Normal Values: 7.35 – 7.45) - HCO3 22 mEq/L - (Normal Values: 22 – 26) Metabolic Alkalosis ↑ pH 7.45 ↑ HCO3- 26 Result of metabolic processes. Alters Bicarbonate in the ECF Causes Symptoms Excessive vomiting, prolonged GI suction Restlessness, confusion, N/V/D, dysrhythmia, hypoventilation (compensatory mechanism), hypokalemia (Al K a LO sis) Levels pH 7.45 (Normal Values: 7.35 – 7.45) - HCO3 26 mEq/L - (Normal Values: 22 – 26) Fluid Imbalances FLUID VOLUME EXCESS HYPERVOLEMIA FLUID VOLUME DEFICIT HYPOVOLEMIA Interventions Monitor cardiovascular, resp, neuro, renal and integumentary, GI status Prevent further fluid overload Administer diuretics Restrict fluid and Na intake Monitor I&O Daily weights Monitor electrolytes Interventions Monitor cardiovascular, resp, neuro, renal and integumentary, GI status Prevent further fluid loss Administer antidiarrheal, antiemetic Provide oral rehydration, IV fluid replacement Monitor skin breakdown and good oral care Monitor electrolytes Daily weights Signs & Symptoms Bounding pulse Hypertension Distended neck veins Increased CVP Dyspnea w/ Moist Crackles Increased Urine Output Pale cool skin Diarrhea Increased body weight/ ascites Signs & Symptoms Weak thread pulse Hypotension Flat neck Decreased CVP Dyspnea Decreased Urine Output Poor turgor, dry mouth Constipation Decreased Body Weight Lab Findings (FVE decreases) ↓ serum osmolarity ↓ HCT ↓ BUN ↓ Na level ↓ Urinary Specific Gravity (1.005 – 1.030) Lab Findings (FVD increase) ↑ serum osmolarity ↑ HCT ↑ BUN ↑ Na level ↑ Urinary Specific Gravity (1.005 – 1.030) ↑ Creatinine