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Acid-base, electrolytes, respiratory, disaster Flashcards

1
Q

Potassium lab range

A

3.5 - 5.0

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2
Q

Sodium lab range

A

135 - 145

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3
Q

Calcium lab range

A

9.0 - 10.5

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4
Q

Chloride lab range

A

96 - 106

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5
Q

Magnesium lab range

A

1.7 - 2.2

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6
Q

Phosphorus lab range

A

2.5 - 4.5

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7
Q

The role of sodium in the body

A
  • Regulates ICF and ECF water
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8
Q

Causes of hyponatremia

A
  • Evolemic hyponatremia: H2O increases but Na stays the same: SIADH, DI, Adrenal insufficiency, Addison’s, freshwater drowning. No edema!
  • Hypovolemic hyponatremia
    • Dehydration, vomiting, diarrhea, Overuse of diuretics, Excessive diaphoresis, Wound drainage (esp. GI), NPO status, burns, kidney disease, Hyperglycemia (polyurea)
  • Hypervolemic Hyponatremia (both water and Na increase leading to volume overload) – edema present
    • Heart failure, Overhydration or irrigation with hypotonic fluids, Kidney failure, liver failure
  • Low Na diet
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9
Q

Signs and symptoms of

Hyponatremia

A
  • Remember SALT LOSS
  • Seizures & stupor
  • Abdominal cramps and attitude changes
  • Lethargy
  • T endon reflexes diminishes, trouble concentrating
  • Loss of urine and appetite
  • Orthostatic HoTN, overactive bowels
  • Shallow respirations
  • Spasms
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10
Q

Treatment of

Hyponatremia

A
  • Monitor I&O, weights, VS, LOC
  • Drug
    • w/fluid deficit: IV saline, 3 - 5% saline hypertonic soln
    • w/fluid excess: promote H2O excretion - conivaptan, tolvaptan, lithium, demeclocycline
  • Maintain airway
  • Seizure precautions
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11
Q

Causes of

Hypernatremia

A
  • Hyperaldosteronism
  • Cushing’s syndrome
  • Corticosteroids
  • Kidney failure
  • Inc. oral ingestion
  • Excessive intake of Na-containing fluids
  • Relative excess
    • NPO status
    • Inc. metabolism
    • hyperventilation (w/acidosis!!!)
    • fever
    • infection
    • excessive diaphoresis
    • watery diarrhea
    • dehydration
      *
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12
Q

Signs and Symptoms of

Hypernatremia

A
  • Primarily effects: nervous, skeletal muscles, cardiovascular
    • Nervous
      • w/fluid deficit: excitability, short attention span, agitation, confusion
      • w/fluid excess: lethargy, stupor, coma
    • Muscle
      • twitching and irregular contractions
      • weakness
      • dc or absent deep tendon reflexes
    • Cardio
      • dc contractility
      • regular, inc or dec pulse and BP depending of fluid status
      • OHoTN
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13
Q

Treatment of

Hypernatremia

A
  • Monitor I&O, daily weights, VS, LOC
  • Drug:
    • Normal saline, dextrose 5% in 0.45% saline, diuretics
  • Nutrition
    • adequate intake, Na reduction, read labels
  • Safety
    • skin protection and monitoring
  • Maintain airway
  • Seizure precautions
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14
Q

Causes of

Hypokalemia

A
  • Excessive use of diuretics, digitalis, or corticosteroids
  • Inc secretion of aldosterone, Cushing’s
  • Metabolic alkalosis (Wound drainage, NG suctioning, Diarrhea, Vomiting)
  • Heat-induced diaphoresis
  • Kidney disease
  • NPO status
  • hyperinsulinism
  • TPN therapy
  • Water Intoxication
  • IV therapy with K-poor soln
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15
Q

Signs and symptoms of

Hypokalemia

A
  • Primarily effects: respiratory, cardiovascular, neurological, musculoskeletal, and intestinal systems
  • Respiratory: resp. weakness and shallow resp.
  • Cardio: Thready peripheral pulses, brady or tachycardia, OHoTN
    • ECG - depressed ST seg, flat/inverted T waves, ic U waves
  • Neurologic: mental status change, fatigue, lethargy, irritability, agitation, confusion, coma
  • Muscle: weakness, Dc reflexes, flaccid paralysis
  • Intestinal: hypoactive bowel, paralytic ileus, N, V, C, ab distension,
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16
Q

Treatment of

Hypokalemia

A
  • Adequate O2, maintain airway, fall prevention, IV injury prev.,
  • Assess LOC, strength
  • Oral K - admin with meal
  • Nutrition: inc. K intake
  • Continuous ECG
  • Monitor for hypoxemia, hypercapnia
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17
Q

Causes of

Hyperkalemia

A
  • Ingestion of K
  • Transfusions (K stored in RBC)
  • Adrenal insufficiency (Addison’s)
  • Kidney failure
  • K-sparing diuretics
  • ACE inhibitors
  • Tissue damage
  • Acidosis
  • Hyperuricemia
  • Uncontrolled DM
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18
Q

Signs and Symptoms of

Hyperkalemia

A
  • Primarily affects Cardiovascular, Neuromuscular, and intestinal
    • Cardiovascular: brady cardia, HoTN
      • ECG: Tall, peaked T waves, prolonged PR inv, flat-absent P waves, wide QRS, ectopic beats, complete heart block, asystole, vfib
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19
Q

Treatment of

Hyperkalemia

A
  • Priorities: cardiac complications, fall precautions, monitoring, teaching
  • Drug: Stop K intake, diuretics, Kayexalate w/ kidney disease, dialysis, IV fluids containing glucose & insulin
  • ECG continuous monitoring
  • Treat dysrhythmias
  • Health teaching
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20
Q

What is the role of calcium in the body?

A
  • Plays a huge role in
    • bones/ teeth
    • muscle/nerve fx
    • blood clotting
  • It is absorbed in the GI system
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21
Q

Causes of

Hypocalcemia

A
  • Remember “LOW CALCIUM”
    • Low parathyroid
    • Oral intake inadequate
    • Wound drainage
    • Celiac’s disease
    • Acute pancreatitis
    • Low vitamin D intake
    • Chronic kidney disease
    • Increased phosphorus level
    • Using medications (magnesium supplements, loop diuretics, Ca binders, laxatives)
    • Motility issues
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22
Q

Signs and symptoms of

Hypocalcemia

A
  • Remeber CRAMPS
  • Confusion
  • Reflexes hyperactive
  • Arrhythmias (prolonged QT and ST intvs)
  • Muscle spasms in calves/feet, tetony, seizures
  • Postive Trousseau’s sign
  • Sign of Chvestok’s
23
Q

Treatment of

Hypocalcemia

A
  • Safety risk for bone fx
  • watch for laryngeal spasms
  • admin IV Ca2+ (10% calcium gluconate)
    • give slowly, watch rhythm, central line, infiltration/phlebitis, digoxin (toxicity)
  • Oral Ca w/ vitamin D (after meal or before bed w/ full glass)
  • Admin aluminum hydroxide sodium for hyperphosphorus (TUMS)
  • Diet education
24
Q

Causes of

Hypercalcemia

A
  • Remember “HIGH CAL”
    • Hyperparathyroidism (in parathyroid hormone causes too much Ca release)
    • Increased intake (excessive Ca2+ or vitamin D supplements)
    • Glucocorticoids (suppresses Ca2+ absorption)
    • Hyperthyroidism
    • Calcium excretion decreased (w/ thiazide diuretics, renal failure, bone cancer)
    • Adrenal insufficiency (Addison’s disease)
    • Lithium (affects parathyroid and causes dc phosphorus → in calcium)
25
Signs and symptoms of Hypercalcemia
* Remember "The body is too **WEAK**" * **W**eakness of muscles * **E**kg changes (short QT interval, prolonged ST interval) * **A**bsent reflexes, absent minded, disoriented, abdominal distension from constipation * **K**idney stone fm
26
Treatment of Hypercalcemia
* Keep hydrated (dc kidney stone fm) * Strain urine * Safety (falls/injuries) * Monitor cardiac, GI, renal, LOC * Complaints of flank pain, ab pain * Decrease Ca-rich foods and thiazide diuretics, supplements of ca and vit D * Administer calcium reabsorption inhibitors (calcitonin), biphosphorates, prostaglandin synthesis inhibitors (aspirin, NSAIDS) * Dialysis for severe cases
27
Foods rich in calcium
* Remember: **Y**oung **S**ally's **C**alcium **S**erum **C**ontinues to **R**andomly **M**ess-up! * **Y**ogurt * **S**ardines * **C**heese * **S**pinach * **C**ollard greens * **R**hubarb * **M**ilk
28
What is the role of magnesium in the body?
* roles in * cell function - transferring and storing of energy) * regulates parathyroid hormone (affects Ca levels) * Metabolizes carbs, lipids, and proteins * Regulates blood pressure * Absorbed in the small intestines! * Excreted via kidneys
29
Causes of Hypomagnesemia
* Remember "**LOW MAG**" * **L**imited intake (starvation) * **O**ther e- issues (hyp**O**kalemia, hyp**O**calcemia) * **W**asting Mg+ via kidneys (loop or thiazide diuretics) cyclosporines * **M**alabsorption issues (celiac, chrones, vomiting, PPIs -protonix, prilosec drugs ending in prazole) * **A**lcohol * **G**lycemic issues (DKA, insulin)
30
Signs and symptoms of Hypomagnesemia
* Remember "**TWITCHING**" * **T**rouessou's sign (w/coinciding hypocalcemia) * **W**eak respirations * **I**rritability * **T**orsades de pointes, **T** etany * **C**ardiac changes (tall T waves, depressed ST seg, prolonged PR and QT intv. with wide QRS complex) * **H**ypertension, **H**yperreflexia * **I**nvoluntary movements * **N**ausea * **G**I issues (dc bowel sounds & motility)
31
Treatment of Hypomagnesemia
* Monitor cardiac, GI, respiratory, LOC, and ECGs * Oral K supplements: * Oral Ca supplements with vitamin D * Magnesium sulphate monitor mag levels (check DT reflexes) * Seizure precautions * Oral magnesium (diarrhea!)
32
Foods containing Magnesium
* Remember **A**lways **G**et **P**lenty **O**f **F**oods **C**ontaining **L**arge **N**umbers **O**f **M**agnesium * **A**vacado * **G**reen leafy veggies * **P**eanut butter, **P** ork * **O** atmeal * **F**ish * **C**auliflower, **C**hocolate, dark * **L**egumes * **N** uts * **O**ranges * **M**ilk
33
Causes of Hypermagnesemia
* Remember **MAG** * **M**agnesium containing antacids & laxatives, or correction of hypomagnesemia * **A**ddison's disease (adrenal insufficiency) * **G**lomerular filtration insufficiency (renal failure, \<30mL/min)
34
Signs and symptoms of Hypermagnesemia
Remember "**LETHARGIC**" * **L**ethargy (profound) * **E**kg changes (PR and QT interval prolonged & QRS complex wide) * **T**endon reflexes absent/diminished * **H**yp**o**tension * **A**rrhythmias (bradycardia, heart blocks) * **R**espiratory arrest * **G**I issues (N/V) * **I**mpaired breathing (due to skeletal muscle weakness) * **C**ardiac arrest
35
Treatment of Hypermagnesemia
* Monitor cardiac, respiratory, neuro, GI, renal status * Put on EKG * Safety: fall precautions * Prevention! * MD order diuretics wastes Mg (loop & thiazides) except for renal failure * Renal failure prep for dialysis * IV Ca to reverse side effects of low mag * watch for infiltration/phlebitis...arterial line preferred
36
Acids in the body
* carbonic acid - carbohydrates metabolism * sulfuric acid - protein metabolism * keto acids - fatty acids * lactic acid - incomplete anaerobic breakdown of glucose * ECF and free hydrogen - cell breakdown.
37
Bases in the body
* bicarbonate - GI absorption, pancreatic production, kidney reabsorption
38
Buffers in the body
* Chemical buffers * bicarbonate (ECF & ICF) * phosphate (ICF) * Protein buffers * albumin (ECF) * globulins (ECF) * hemoglobin (ICF)
39
Kidney control actions and mechanisms
1. Kidney movement of bicarbonate to inc. pH 1. produced in the body 2. produced in the kidneys 2. Formation of acids 1. excretion to inc. pH 3. Formation of ammonium to inc. pH
40
Patients at greatest risk for acidosis are
* Those with impaired breathing * Older adults with chronic health problems
41
Causes of Metabolic Acidosis
* Overproduction of hydrogen ions * excessive oxidation of fatty acids: DKA, starvation * hypermetabolism: heavy exercise, seizure, fever, hypoxia, ischemia * excessive ingestion of acids: ethanol or methanol intoxication, salicylate intoxication * Underelimination of hydrogen ions with kidney failure * Underproduction of bicarbonate * Kidney failure * pancreatitis * Liver failure * Dehydration * Overelimination of bicarbonate: diarrhea
42
Causes of Respiratory Acidosis
* Underelimination of hydrogen ions * respiratory depression: drugs, electrolyte imbalance * Inadequate chest expansion: muscle weakness * Airway obstruction * Alveolar-capillary block
43
Combined metabolic and respiratory acidosis
uncorrected acute respiratory acidosis leads to poor oxygenation and lactic acidosis ex. DKA with COPD
44
Assessment of acidosis
* History: * Age, diet & nutrition, comorbidities * drug therapies (esp diuretics & aspirin) * cardiac, kidney, pulmonary impairments * Cardio * early: inc HR, inc CO * late: dec HR, tall peaked T waves, wide QRS complex, dec. peripheral pulses, HoTN * CNS: Behavior changes, depressed CNS, lethargy, confusion, coma, * Neuromuscular: Decreased strength and DT reflexes * Respiratory: depends on cause * If metabolic: Kussmaul respirations * If respiratory: dec. respirations * Skin: depends on cause * if metabolic: vasodilation causes warm, dry, pink skin and mucous membranes * If respiratory: skin and mucous membranes pale to cyanotic
45
Lab assessment of acidosis
* ABS pH \< 7.35 * Metabolic: * low bicarb \<21 * PaO2 normal * PaCO2 normal or slightly dec * Serum K often high * Respiratory​ * PaO2 low * PaCO2 high * bicarb variable depending on compensation * serum K may be elevated with acute, or normal or low with chronic
46
Interventions for metabolic acidosis
* hydration and drugs * treatments to control/correct the problem causing * bicarbonate is administered only if levels are low * Nursing priorities: monitor for changes, cardiovascular changes, muscle changes, ABGs
47
Interventions for Respiratory acidosis
* Priority interventions: ventilation and oxygenation, maintaining airway. * drug therapy, oxygen therapy, pulmonary hygiene (positioning, breathing techniques), vent support, prevention of complications * Drug therapy: bronchodilators, antiinflammatories, mucolytics
48
Causes of metabolic alkalosis
* Increase of base components * Oral ingestions of bases (antacids) * TPN * Blood transfusion * Sodium bicarbonate IV * Decrease of acid components * Prolonged vomiting * NG suctioning * Hypercortisolism * Hyperaldosteronism (Cushing's) * Thiazide diuretics
49
Causes of Respiratory alkalosis
* Excessive loss of CO2 * Hyperventilation, fear, anxiety * Mechanical ventilation * Salicylate toxicity * High altitudes * Shock * Early-stage acute pulmonary problems
50
Effects of alkalosis
* Many symptoms are similar to that of hypocalcemia and hypokalemia * CNS: overexcitement causing dizziness, agitation, confusion, hyperreflexia, and seizures; positive Chvostek's or Trousseau's signs * Neuromuscular: muscle cramps, twitching, tetany, decreased strength (inc. respiratory muscles) * Cardiovascular: inc. HR, thready pulse, inc. sensitivity to digoxin with hypokalemia * Respiratory: may be increased if causatory
51
Interventions for alkalosis
* Treat cause * Prevent further degradation * Discontinue drug or other therapies which lead to the condition * Antiemetic drugs for nausea * Monitor electrolytes daily * PREVENT FALLS
52
Hyponatremia mnemonic
* Remember No Na+ * **Na+ excretion inc w/renal problems, NG suctioning, vomiting, diuretics, sweating, DI, aldosertone secretion** * **overload of fluids** * **na+ intake low through low salt diet or NPO status** * **antidiuretic hormone oversecreted (addison's)**
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Complex Med Surg (5 decks)

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