Assessment and Care of Patients with Fluid and Electrolyte Imbalances Flashcards
Sodium Levels
136-145
Potassium Levels
3.5-5.0
Calcium Levels
9.0-10.5
Magnesium Levels
1.3-2.1
Phosphorus Levels
3.5-4.5
Signs & Symptoms of Hyponatremia
Vital Signs: Hypothermia, tachycardia, rapid thready pulse, hypotension, orthostatic hypotension
Neuromusculoskeletal: Headache, confusion, lethargy muscles weakness to the point of respiratory compromise, fatigue, decreased DTRs, seizures
GI: Increased motility, hyperactive bowel sounds, abdominal cramping, nausea
Signs & Symptoms of Hypernatremia
Vital Signs: Hyperthermia, tachycardia, orthostatic hypotension
Neuromusculoskeletal: Restlessness, irritability, muscle twitching to muscle weakness, including respiratory compromise, decreased to absent DTRs, seizures, coma
GI: Thirst, dry mucous membranes, increased motility, hyperactive bowel sounds, abdominal cramping, nausea
Other signs: Edema, warm flushed skin, oliguria
Risk Factors for Hyponatremia
- Vomiting, nasogastric suctioning, diarrhea, tap water enemas, GI obstructions
- Diuretics, kidney disease, adrenal insufficiency
- Excessive diaphoresis, burns, wound drainage, ascites
- Excessive oral water intake
- Heart failure, cirrhosis, nephrotic syndrome
- Excessive hypotonic IV fluids
- Inadequate sodium intake (NPO, older adults)
Risk Factors for Hypernatremia
- Water deprivation (NPO)
- Excessive sodium intake
- Excessive sodium retention d/t kidney failure, aldosteronism, or some medications (glucocorticosteroids)
- Fluid losses - fever, diaphoresis, burns, diarrhea
Signs and Symptoms of Hypokalemia
- Weak irregular pulse; hypotension; respiratory distress
- Weakness to the point of respiratory collapse and paralysis, muscle cramping, decreased muscle tone and hypoactive reflexes, paresthesias, mental confusion
- Decreased motility, abdominal distention, constipation, ileus, nausea, vomiting, anorexia
- Polyuria
Signs and Symptoms of Hyperkalemia
- Slow, irregular pulse; hypotension
- Restlessness, irritability, weakness to the point of ascending flaccid paralysis, paresthesias
- Nausea, vomiting, increased motility, diarrhea, hyperactive bowel sounds
- Oliguria
Risk Factors of Hypokalemia
- Abnormal GI losses: vomiting, NG suctioning, diarrhea, excess laxative use
- Kidney losses: excess use of diuretics
- Skin losses: diaphoresis
- Insufficient potassium r/t inadequate dietary intake (rare)
- Intracellular shift r/t metabolic alkalosis, during periods of tissue repair, TPN
Risk Factors of Hyperkalemia
- Potassium supplementation, salt substitute
- Extracellular shift r/t decreased insulin, acidosis, tissue catabolism
- Uncontrolled diabetes mellitus
- Decreased excretion of potassium d/t kidney failure, severe dehydration, potassium-sparing diuretics, ACE inhibitors, NSAIDs, adrenal insufficiency
Function of Sodium
Major electrolyte found in ECF
Essential for maintaining acid-base balance, active and passive transport mechanisms, and irritability and conduction of nerve and muscle tissue
Function of Potassium
Major cation in ICF
Plays a vital role in cell metabolism; transmission of nerve impulses; functioning of cardiac, lung, and muscle tissues; and acid-base balance
Potassium has a reciprocal action with sodium
Function of Calcium
Important for maintain bone strength and density, activating enzymes, allowing skeletal and cardiac muscle contraction, controlling nerve impulse transmission, and allowing blood clotting
Signs and Symptoms of Hypocalcemia
- “Charley horse”
- Tingling and numbness sensations in hands
- Muscle twitching or painful cramps and spasms
- Trousseau’s and Chvostek’s sign
- Heart rate may be decreased or increased with a weak, thready pulse
- Prolonged ST interval
- Prolonged QT interval
Risk Factors of Hypocalcemia
- Inadequate oral intake of calcium
- Lactose intolerance
- Malabsorption syndromes
- Inadequate intake of vitamin D
- End-stage kidney disease
- Diarrhea
- Wound drainage
Signs and Symptoms of Hypercalcemia
- Increased heart rate and BP
- Cyanosis or pallor may be present
- Shortened QT interval
- Slowed or impaired blood flow
- Blood clots to form more easily
- Severe muscle weakness
- Decreased DTRs
- Confusion and lethargy
- Decreased peristalsis
- Hypoactive bowel sounds
Risk Factors of Hypercalcemia
- Excessive intake of calcium or vitamin D
- Kidney failure
- Use of thiazide diuretics
Function of Phosphorus
Needed for activating vitamins and enzymes, forming energy supplies, and assisting in cell growth and metabolism.
Also functions in acid-base balances and calcium homeostasis
Signs and Symptoms of Hypophosphatemia
- Weak skeletal muscles that may progress to acute muscle breakdown
- Respiratory failure if muscle weakness is profound
- Bone density is decreased
- Irritability
- Seizures
- Coma
Risk Factors of Hypophosphatemia
- Malnutrition
- Starvation
- Use of aluminum hydroxide-based antacids
- Use of magnesium-based antacids
- Hyperparathyroidism
- Hypercalcemia
- Kidney failure
- Hyperglycemia
- Respiratory alkalosis
- Uncontrolled DM
- Alcohol abuse
Signs and Symptoms of Hyperphosphatemia
- Increased serum phosphorus levels
- Similar to symptoms of hypocalcemia
Risk Factors of Hyperphosphatemia
- Decreased kidney excretion resulting from kidney disease
- Tumor lysis syndrome
- Increased intake of phosphorus
- Hypoparathyroidism
Function of Magnesium
Important for skeletal muscle contraction, carbohydrate metabolism, generation of energy stores, vitamin activation, blood coagulation, and cell growth
Regulation of magnesium occurs through the kidney and the intestinal tract
Signs and Symptoms of Hypomagnesemia
- Increased impulse transmission from nerve to nerve or from nerve to skeletal muscle
- Hyperactive DTRs
- Numbness and tingling
- Painful muscle contraction
- Positive Chvostek’s and Trousseau’s sign may be present
- Reduce motility, anorexia, nausea, constipation, abdominal distention
Risk Factors of Hypomagnesemia
- Malnutrition
- Starvation
- Diarrhea
- Celiac Disease
- Crohn’s Disease
- Drugs - diuretics
- Citrate (blood products)
- Ethanol ingestion
Signs and Symptoms of Hypermagnesemia
- Bradycardia, peripheral vasodilation, and hypotension
- Prolonged PR interval with widened QRS complex
- Drowsy or lethargic
- Reduced or absent DTRs
- Voluntary skeletal muscle contractions become progressively weaker and finally stop
Risk Factors of Hypermagnesemia
- Increased magnesium intake
- Decreased kidney excretion of magnesium resulting from kidney disease
Homeostasis
Proper functioning of all body systems; requires fluid and electrolyte balances
Filtration
Movement of fluid through cell or blood vessel membrane because of differences in water pressure
Hydrostatic Pressure
“Water-pushing pressure”
Force that pushes water outward from a confined space through a membrane
Ex: Blood pressure
Diffusion
Free movement of particles (solute) across permeable membrane from area of higher to lower concentration
Osmosis and Filtration
Act together at capillary membranes to maintain normal ECF and ICF volumes
Ex: Thirst mechanism
Aldosterone
Hormone secreted by the adrenal cortex whenever sodium levels in the ECF are decreased. It prevents both water and sodium loss.
Prevents excessive kidney excretion of sodium and blood potassium levels from becoming too high
Antidiuretic Hormone (ADH)
Released from the posterior pituitary gland in response to changes in blood osmolarity
Natriuretic Peptides (NPs)
Hormones secreted by special cells that line the atria and ventricles of the heart
Secreted in response to increased blood volume and blood pressure which stretch the heart tissue
How much does 1 L of water weigh?
2.2 lbs or 1 kg
What does weight change of 1 lb equal in mL?
Fluid volume change of about 500 mL
