ZOOM REVIEW EXAM 1 - PATHO II
Fluid & Electrolytes
• Which are the ROUTES BY WHICH WE LOSE ELECTROLYTES:
o SWEAT, URINE, FECES, RESPIRATIONS
o Do we lose sweat via saliva? No we do not
• CELLULAR CHANGES that occur w/electrolyte imbalance:
o Hyperphosphatemia → creates LOW CALCIUM
▪ Relationship between phosphate ions w/ calcium ions → reverse relationship
• Pt. with HEART FAILURE WITH DEPENDENT EDEMA – what is the cause/ideology at the capillary level?
o Why do we have increase fluid in interstitial compartment: we have increased HYDROSTATIC PRESSURE
• FLUID EXCESS: 2lb increase – what are some signs of excess fluid (besides increase in BP):
o Distended jugular veins
o BOUNDING PULSES – increase pulse pressure*
o Edema
o SOB
o Cardiac wise – increase heart rate, bounding/increase pulse pressure, elevated BP
• AGE RELATED CHANGES W /FLUID VOLUME :
o Fluid electrolyte imbalance → confusion, presence of tenting
▪ Deficit – decreased urine output
o Serum lab values are the best indicators of electrolyte imbalance
o Intake/output – decrease kidney function
• HEALTHY ADULT: S/S OF DEHYDRATION that is not present with the older adult? → INCREASED THIRST (elderly will
not have that)
• Pt takes THIAZIDE → what will happen as far as sodium is concerned? → WILL GO DOWN = hyponatremia
o Potassium? WILL GO DOWN – hypOkalemia
▪ What do we normally prescribe for that low potassium → POTASSIUM SUPPLEMENT
• Pt has FEVER = HYPERNATREMIA → losing fluids via kidneys – losing fluids but Na is staying behind
• Pt has NG TUBE TO CONTINUOUS WALL SUCTION – what will happen to electrolytes? Potassium, Sodium will go
DOWN
o Acid base wise → losing HYDROGEN ION
▪ High wall suction = DECREASED K, NA, HYDROGEN ION
• Pt has SEVERE HYPERNATREMIA → what is the worst thing ? = SEIZURES – can become comatose as well
• Pt is on HYPERTONIC ENTERAL FEEDINGS , what do we monitor for? → HIGH SODIUM
o Enteral feedings can cause fluid deficit because we do not give enough water
o HYPERTONIC FEEDINGS = HIGH SODIUM
• Pt has HYPOKALEMIA: abdominal distention, CARDIAC dysthymia – put on cardiac monitor, & hypotension
o How can you tell? → PULSE will be WEAK & IRREGULAR
• Pt with CHRONIC KIDNEY FAILURE – what ELECTROLYTE IMBALANCE are they at risk for → hypernatremia,
hyperkalemia, high phosphate
o HIGH PHOSPHATE & HIGH CALCIUM – because of renal failure
• Pt on DIURETIC = depletion hyponatremia – low sodium
• HYPOCALCEMIA – what is a good assessment for hypocalcemia?
o Chvostek sign
o Trousseau → carpal pedal spasms (like a cobra)
o What can happen with THYROIDECTOMY → calcium will GO LOW – because they took parathyroid gland
▪ Post of care of thyroidectomy – what S/S YOU WOULD MONITOR OF HYPOCALCEMIA :
• Paresthesia – pins & needles
• Chvostek & Trousseau
• Muscle cramps
• Increased deep tendon reflexes - hyperreflexia
Fluid & Electrolytes
• Which are the ROUTES BY WHICH WE LOSE ELECTROLYTES:
o SWEAT, URINE, FECES, RESPIRATIONS
o Do we lose sweat via saliva? No we do not
• CELLULAR CHANGES that occur w/electrolyte imbalance:
o Hyperphosphatemia → creates LOW CALCIUM
▪ Relationship between phosphate ions w/ calcium ions → reverse relationship
• Pt. with HEART FAILURE WITH DEPENDENT EDEMA – what is the cause/ideology at the capillary level?
o Why do we have increase fluid in interstitial compartment: we have increased HYDROSTATIC PRESSURE
• FLUID EXCESS: 2lb increase – what are some signs of excess fluid (besides increase in BP):
o Distended jugular veins
o BOUNDING PULSES – increase pulse pressure*
o Edema
o SOB
o Cardiac wise – increase heart rate, bounding/increase pulse pressure, elevated BP
• AGE RELATED CHANGES W /FLUID VOLUME :
o Fluid electrolyte imbalance → confusion, presence of tenting
▪ Deficit – decreased urine output
o Serum lab values are the best indicators of electrolyte imbalance
o Intake/output – decrease kidney function
• HEALTHY ADULT: S/S OF DEHYDRATION that is not present with the older adult? → INCREASED THIRST (elderly will
not have that)
• Pt takes THIAZIDE → what will happen as far as sodium is concerned? → WILL GO DOWN = hyponatremia
o Potassium? WILL GO DOWN – hypOkalemia
▪ What do we normally prescribe for that low potassium → POTASSIUM SUPPLEMENT
• Pt has FEVER = HYPERNATREMIA → losing fluids via kidneys – losing fluids but Na is staying behind
• Pt has NG TUBE TO CONTINUOUS WALL SUCTION – what will happen to electrolytes? Potassium, Sodium will go
DOWN
o Acid base wise → losing HYDROGEN ION
▪ High wall suction = DECREASED K, NA, HYDROGEN ION
• Pt has SEVERE HYPERNATREMIA → what is the worst thing ? = SEIZURES – can become comatose as well
• Pt is on HYPERTONIC ENTERAL FEEDINGS , what do we monitor for? → HIGH SODIUM
o Enteral feedings can cause fluid deficit because we do not give enough water
o HYPERTONIC FEEDINGS = HIGH SODIUM
• Pt has HYPOKALEMIA: abdominal distention, CARDIAC dysthymia – put on cardiac monitor, & hypotension
o How can you tell? → PULSE will be WEAK & IRREGULAR
• Pt with CHRONIC KIDNEY FAILURE – what ELECTROLYTE IMBALANCE are they at risk for → hypernatremia,
hyperkalemia, high phosphate
o HIGH PHOSPHATE & HIGH CALCIUM – because of renal failure
• Pt on DIURETIC = depletion hyponatremia – low sodium
• HYPOCALCEMIA – what is a good assessment for hypocalcemia?
o Chvostek sign
o Trousseau → carpal pedal spasms (like a cobra)
o What can happen with THYROIDECTOMY → calcium will GO LOW – because they took parathyroid gland
▪ Post of care of thyroidectomy – what S/S YOU WOULD MONITOR OF HYPOCALCEMIA :
• Paresthesia – pins & needles
• Chvostek & Trousseau
• Muscle cramps
• Increased deep tendon reflexes - hyperreflexia
