Fundamentals NR 226 Quiz 3 Questions and Answers

Fundamentals NR 226 Quiz 3 Questions and Answers What are the main causes of electrolytes imbalances? Changes in diet GI malfunction Renal problems Medications Procedures Disease process What is considered an isotonic solution? Fluid with the same tonicity as normal blood What is considered a hypotonic solution? More dilute than blood --cell swells What is considered a hypertonic solution? More concentrated than normal blood --cell shrinks Extracellular fluid volume deficit Body Fluids Have Decreased Volume but Normal Osmolality -decreased intake of H20 and salt -Increased GI output -Increased renal output -Loss of blood or plasma -Massive sweating without water and salt intake Extracellular fluid volume excess Body Fluids Have Increased Volume but Normal Osmolality -Excessive administration of Na+ containing isotonic IV fluids or oral intake of salty foods and water -Renal retention of Na+ Signs of mild Extracellular fluid volume excess Swollen ankles and fingers (rings feel tight) and a gain of 2lbs or more Bananas are rich in what type of electrolyte Potassium Foods high in potassium K+ Fruits, potatoes, instant coffee, molasses, brazil nuts, True or false: Cancer can cause major electrolyte imbalances True Calcium-rich foods include dairy products, lentils, fish w/ fine bones, broccoli, oranges, dried fruits, nuts, chocolate, cocoa, Ovaltine Best absorption of calcium rich fluids happens with Vitamin D Undigested fat can prevent ____ and _____ from absorption Calcium and Magnesium Magnesium-rich foods include dark green leafy vegetables, whole grains, magnesium-containing laxatives and antacids Phosphate-rich foods include milk, processed food What can prevent phosphate absorption? Aluminum antacids Hypernatremia Abnormally high sodium concentration in the blood -water deficit What types of patients should you monitor for hypernatremia? Diabetes insipidus Osmotic diuresis -Large amount of perspiration and respiratory water output -Tube feedings, hypertonic parenteral fluids, or salt tablets -Dysfunction of osmoreceptor driven thirst drive Causes of hypernatremia Excessive / rapid IV administration of normal saline, inadequate water intake and kidney disease Normal range for sodium 135-145 mEq/L Signs and symptoms of hypernatremia Confusion, dry mucous membranes, seizures flat neck veins, dry skin, intense thirst, dark urine, skin tenting True or false: a patient with hypernatermia will show very similar signs of dehydration True What blood work is done to look at sodium? Chem 7, cmp Confusion is present in both hypo and hyper_____________ Hyponatermia and hypernatremia Treatment for hypernatremia Weigh patient daily, monitor I/O, check vital signs, check skin turgor, place patient on sodium restricted diet Clinical dehydration ECV deficit and hypernatremia combined What IV drugs do you want to administer for a patient experiencing hypernatremia Hypotonic IV fluids or Isotonic IV fluids Hyponatremia Abnormally low sodium ion concentration in the blood Causes of hyponatremia Decreased sodium intake, increased sodium excretion due to suctioning Signs and symptoms of hyponatremia Confusion, N/V, abdominal cramping, weigh gain, cold clammy skin, SOB, crackles, periorbital edema, Treatment for hyponatremia Provide high sodium foods, auscultate lungs (crackles), monitor body weight and vital signs What IV solutions should be hung to help with hyponatremia? Administer hypertonic IV fluids or Hypotonic IV fluids, Hyperkalemia abnormally high potassium ion in concentration in the blood Whenever potassium is off, what should the nurse be worried about? The heart; dysrhythmias occur in both hypo and hyperkalemia What should you use to help determine if a patient is experiencing a potassium imbalance? Lab: CNP, BMP Test: 12 lead ECG or EKG Causes of hyperkalemia Excessive potassium intake, shift of potassium from cells into the ECF -Renal issues (oliguria) Signs and symptoms of hyperkalemia muscle weakness, cardiac dysrhythmias, numbness, tinging, irritability, flaccid paralysis, N/V/D Treatment for hyperkalemia includes sodium polystyrene and keyaxalate enemas, diet changes, no use of salt supplements Keyaxalate enema Removes excess potassium via the stool Sodium polystyrene Removes excess potassium via bowel Why do you want to monitor acid base balance with hyperkalemia? Too much potassium in the body can cause the blood to become acidic With hyper and hypokalemia what test should be ran? ECG or EKG Hypokalemia Low potassium concentration in the blood Causes of hypokalemia NG tube suctioning, diuretics such as furosemide Signs and symptoms of hypokalemia Cardiac dysrhythmias, thready, rapid, weak pulse, decreased blood pressure, muscle weakness, shallow respiration, weight loss Treatment for hypokalemia Increase potassium-rich foods, administer potassium supplements, monitor ECG, EKG and vital signs Hypercalcemia Abnormally high calcium concentration in the blood Normal calcium levels 8.4-10.5 mg/dL Causes of hypercalcemia Renal problems, certain cancer cells, How do some cancer cells put patients at risk for hypercalemia? Bc some cells secrete chemicals into the blood that are related to parathyroid hormone --one these chemicals reach the bone they shift calcium out into the ECF -weakening the bone Hypercalcemia can cause pathological fractures to occur from the loss of calcium, what are these fractures? Bone breakage caused by the forces that would not break a healthy bone What types of patient might experience hypercalcemia? Patients with immobility, osteoporosis, osteomalacia, and patients that have eaten too much calcium foods Signs and symptoms of hypercalcemia Lethargy, stupor, decreased muscle tone, deep bone pain, headaches, GI symptoms such as N/V, anorexia and constipation Treatment for hypercalcemia Encourage ambulation, reduce calcium intake, administer diuretics to increase excretion of calcium Hypocalcemia Abnormally low calcium concentration in the blood Causes of hypocalcemia Diarrhea, acute pancreatitis, thyroidectomy, hypothyroidism, and lack of calcium in diet Signs and symtpoms of hypocalcemia increased neuromuscular excitability, numbness, tingling in hands and soles of feet, muscle tremors, cramps leading to tetany and convulsions Hypocalcemia may cause numbness around where 24 to 48 hours after surgery? The lips What signs can you test for when a patient has hypocalcemia? Positive Chovestek's signs Positive Trousseau's sign Positive Chovestek's sign Twitching of the facial muscle upon tapping Positive Trousseau's sign Carpal spasms Treatments for hypocalcemia Increase calcium intake For a patient who has hypocalcemia, why might you want to provide padded side rails? In cases where patient has convulsions or seizures What IV solution might be hung for a patient experiencing hypocalcemia IV calcium chloride or gluconate Normal magnesium levels 1.5-2.5 mEq/L When you think of magnesium in the blood you should think of ____ reflexes Hypermagnesmia Abnormally high magnesium concentraion in the blood causes of hypermagnesemia Renal diseases, dehydration, excessive use of magnesium Signs and symptoms of hypermagnesmia Decreased nueromuscular excitability, lethargy, decreased deep tendon reflexes What is the most common side affect of hypermagnesmia? Decreased deep tendon reflexes Treatment of hypermagnesmia Withhold magnesium containing foods, increase fluid intake Hypomagnesemia Abnormally low magnesium concentration in the blood Causes of hypomagnesemia Decreased magnesium intake and absorption, shift of plasma magnesium to its inactive form and increased magnesium output Signs and symptoms of hypomagnesemia Paresthesias, confusion, hallucinations, conclusions, deep tendon reflexes, flushing of face, diaphoresis muscle spasm Treatment for hypomagnesemia Provide good dietary sources of magnesium With dehydration what CMP levels will there be an increase of? Protein, electrolytes and glucose Phosphate normal levels 2.7-4.5 mg/dL Urine specific gravity normal levels 1.005-1.030 Chloride normal levels 98-106 mEq/L Specific gravity of urine test Concentration of urine What kind of patient might experience electrolyte imbalances? All sick patients