Alterations in fluid, electrolyte, + pH Flashcards
extracellular fluid volume excess
too much fluid in vascular + interstitial compartment
-w normal serum Na concentration
possible cause of extracellular fluid volume excess
excessive IV fluids
hypernatremia
loss of water > loss of Na
or
gain of Na > water
hypernatremia
can be from…
- dehydration of breastfed newborn esp at 2-3 day mark
- decr LOC, confusn, lethargy, coma, seizures
- low UOP except in cases of DI
hypernatremia
treatment
treated slowly
w isotonic first then hypotonic
hypernatremia
loss of more water than sodium can be caused by…
- deficient breastfeeding intake w norm output
- diarrhea/vomiting w/o fluid replacmt
- DI
- excessv sweating w/o fluid replacmt
hypernatremia
gain of more Na than water can be caused by…
- inability to comunicate thirst
- limited access to water
- IV HYPERtonic soln
- improper formular prep
water deprivation can lead to ____ and may possibly be caused by ___
hypernatremia
munchausen syndrome by proxy or neglect
to prevent hypernatremia…
extra fluids during hot weather, vomit, diarrhea
hyponatremia
decr osmolality of blood
-fr dilatn of body fluids
hyponatremia
causes
- forced intake of water
- *dilute formula
- excessive swallowing of swimming pool water
hyponatremia
manifestations
lethargy decorticate posturing coma anorexia n/v
hyponatremia
treatment
treated slowly w isotonic fluids
hyperkalemia can be caused by anything that…
kills a lot of cells
hyperkalemia
manifestations
-muscle dysfunction
-hyperactivity of smooth muscles in GI tract
»»cause cramping/diarrhea
-cardiac arrhythmias
hyperkalemia is removed thru…
dialysis, diuretics, + kayexalate
HYPER kalemia
nursing mgmt
- check UO (should be 1-2 mL/kg/hr)
- turn IV soln to mix K
hypokalemia can be caused by…
- *incr K thru GI tract is most common in kids)
- *fad diets
- *nasogastric suctioning can cause K loss
HYPO kalemia
manifestations
slowed GI: ab distentn, constipatn, paralytic ileus
gen muscle weaknss
when administering K via IV,…
may need to dilute or slow down
Calcium is needed for…
- muscle/nerve function
- hormones
- bone formation
- strength
- clotting factors
Ca requires ___ for max efficiency
vitamin D
more calcium during childhood reduces the risk of…
osteoporosis
infants w ___ are at risk for HYPERcalcemia bc…
low birth wt;
inadequate bone phosphorous
most common cause of hyper-calcemia
shift of Ca fr bones to plasma
-fr tumor or hyperparathyroidism
hyper-calcemia
nonspecific symptoms
- fatigue
- weakness
- confusion
- lethargy
- decr attention span
hyper-calcemia
severe symptoms
- cardiac arrhythmias
- death
hyper-calcemia
treatments
hydration
- avoid vit D supplements
- avoid Ca rich food
- avoid TUMS
hypo-calcemia
etiology/common causes
-children w chronic generalized malnutritoin
-fem adolescents trying to lose wt often drop foods high in Ca
»»causes premature bone loss, inadequate bone, risk for osteoporosis
-vitamin D deficienct
hypo-calcemia
nursing mgmt
assess for... -diet -fat/muscle wasting -muscle cramps -stiffness -clumsiness -incr excitability >>CHVOSTEK SIGN >>TROUSSEAU SIGN
hypo-calcemia should dirnk…
3 glasses of nonfat milk per day
most common cause of hypermagnesemia in childten
impaired renal functioning leading to decr Mg excretion
possible cause of hypermagnesemia in newborn
MgSulfate in moms to treat eclampsia before birth
hypermagnesemia
education
avoid milk of magnesia + antacids w magnesium
hypomagnesemia
2 routes of loss
GI loss: diarrhea, malabsorption, small bowel bypass surgery
Renal loss: diuretics, genetic disorder, diabetic ketoacidosis
hypomagnesemia
manifestations
- hyperactive reflex
- muscle cramps
- cardiac arrhythmias
- trousseau + chvostek signs
hypo-Mg can cause…
hypo-Ca
Respiratory Acidosis is caused by
accumulation of CO2 in blood
**any factor that interferes w ability of lungs to excrete CO2 can cause respiratory acidosis
Respiratory Acidosis
education
encourage deep breathing in younger children
- use pinwheel
- blow bubbles thru water
- blow scraps of paper across table
respiratory acidosis
factors affecting the lungs
- epiglottitis
- cystic fibrosis
- pulmonary embolism
respiratory acidosis
factors affecting the neuromuscular pump
- pneumothorax or hemothorax
- hypokalemic muscle weakness
- congenital diaphragmatic hernia
respiratory acidosis
factors affecting the central control of respiration
- sedative overdose
- general anesthesia
respiratory alkalosis
common causes
- hyperventilation
- anxiety
- fear
- pain
if respiratory alkalosis persists for days,
kidneys compensate by
>retaining acid
>excreting bicarbonate
respiratory alkalosis
signs
- light headed feeling
- tingling
- numbness to fingers or toes
- tachypnea
metabolic acidosis
excess of any acid other than carbonic acid
metabolic acidosis
causes
-eat/drink substance w acid like aspirin
-cells make abnorm amt of acid
»>ketoacidosis, starvation fr anorexia/bulimia
metabolic acidosis causes respiratory compensation called..
kussmaul respiration
metabolic alkalosis
too few metab acids
metabolic alkalosis
causes
- excessive intake of bicarb antacids or baking soda
- citrate metabolized into bicarb in blood transfusn
- lose of acid thru severe vomiting, continuous gastric suction
