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adult health I > chapter 10: fluid and electrolyte imbalances > Flashcards

chapter 10: fluid and electrolyte imbalances Flashcards

1
Q

hyperkalemia

A

excessive potassium in the blood (ECF), more than 5

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2
Q

what are the signs and symptoms of hyperkalemia?

A

M: muscle cramps/weakness
U: urine low/absent
R: respiratory distress
D: decreased cardiac (HR, BP)
E: ECG changes (tall peaked T waves)
R: increased reflexes
* dysrhythmias

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3
Q

what are the cause/risk factors for hyperkalemia?

A

C: K movement to ECF
A: adrenal insufficiency (Addison disease)
R: renal failure (dialysis patients)
E: excessive intake
D: drugs (ACE inhibitors, NSAIDS, spironolactone)
others: acidosis, hyperuricemia, hypercatabolism, tissue damage

RF: arrhythmias

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4
Q

nursing interventions for hyperkalemia

A

monitor EKG, respiratory, neuromuscular, GI states
discontinue IV/PO potassium
initiate potassium restricted diet (POTASSIUM)
potassium excreting diuretics: kayexalate (PO/edema, GI sodium absorption= K excretion, hold if their hypokalemia), Lasix (K wasting), furosemide, dextrose (prevents hypoglycemia)
dialysis
administer IV hypertonic solution (glucose/insulin, pulls K into cells)
- calcium gluconate/sodium bicarb
avoid salt substitutes

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5
Q

sodium range

A

135-145

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6
Q

potassium range

A

3.5-5

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7
Q

phosphorus range

A

2.5-4.5

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8
Q

calcium range

A

9-11

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9
Q

magnesium range

A

1.5-2.5

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10
Q

chloride range

A

95-105

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11
Q

hemoglobin (Hgb) range

A

males: 13-18
female: 12-16

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12
Q

hematocrit range

A

female: 36-48%
male: 39-54%

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13
Q

BUN range

A

7-20 mgdl

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14
Q

creatinine range

A

0.6-1.2mg/dl

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15
Q

hypernatremia

A

excess sodium intake (higher than 145)

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16
Q

what are the risk factors/causes for hypernatremia?

A

increased sodium intake (oral ingestion, IV fluid administration with sodium, hypertonic IV fluids)
loss of fluids (fever, diarrhea, diabetes insipidus, excessive diaphoresis, infection)
decreased sodium excretion (kidney problems)

HIGH SALT
H-hypercortisolism (overproduction of aldosterone=retain Na, Cushing syndrome), hyperventilation
I: increased intake
G: GI feeding without adequate H20 intake
H: hypertonic solution (3% saline)

S:decreased Na excretion
A: aldosterone problem
L: loss of fluid
T: impaired thirst
T: loss of fluid

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17
Q

what are the signs/symptoms for hypernatremia?

A

BIG/BLOATED

FRIED SALTS

F: flushed
R: restless, anxious, confused, irritable
I: increased BP/fluid retention
E: edema pitting
D: decreased urine output

S: skin dry
A: agitation
L: low grade fever
T: thirt (dry mucous membrane)

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18
Q

what is the nursing management for hypernatremia?

A

if because of fluid loss–> administer hypotonic/isotonic solutions (0.45% NS slowly to avoid risk of cerebral edema)

if because of inadequate renal excretion –> give diuretics that promote sodium loss

restrict sodium and fluid intake

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19
Q

hyponatremia

A

sodium deficit, less than 135

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20
Q

hypovolemic hyponatremia

A

deficit in fluid and sodium

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21
Q

causes of hypovolemic hyponatremia

A

vomiting, diarrhea, NG sunction, burns, diuretic therapy, excessive therapy

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22
Q

hypervolemic hyponatremia

A

both water and sodium increase
sodium dilutes

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23
Q

causes of hypervolemic hyponatremia

A

CHF, kidney failure, saline infusion, liver failure

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24
Q

euvolemic hyponatremia

A

h20 increases and sodium levels stay the same –> sodium dilutes

C: STADH

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25
Q

S/S of hyponatremia

A

SALT LOSS

S: stupor/coma, shallow respirations
A: anorexia (nausea/vomiting)
L: lethargy (weakness/fatigue), loss of urine /appetite
T: tachycardia (thready pulse)

L: limp muscles, decreased DTR, spasms
O: orthostatic hypotension
S: seizures/headache
S: stomach bowels (hyperactive bowels)

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26
Q

causes of hyponatremia

A

increased sodium excretion (4 D’s)
1. diaphoresis
2, diarrhea/vomiting
3. drains (NG sunction)
4. diuretics (thiazide/loop diuretics)
SIADH
adrenal insufficiency
inadequate sodium intake (fasting, NPO, low-salt diet)
kidney diseases
heart failure (CHF)

27
Q

NM for hyponatremia

A

ADD SALT

A: administer IV sodium chloride infusions (3% hypertonic solutions): only if due to hypovolemia
D: diuretics (if due to hypervolemia)/dialysis
-can cause hemodilution
D: daily weights

S: safety (orthostatic hypertension)
A: airway protection (NPO): don’t give food to a lethargic, confused patient= increased aspiration risk
L: limit water intake
T: teach about foods high in sodium (canned food, packaged/processed meats)

28
Q

hypokalemia

A

potassium deficit, less than 3.5

29
Q

what are the signs and symptoms of hypokalemia?

A

SLOW AND LOW

7 L: lethargic, low shallow rep, lethal cardiac, loss urine, leg cramps, low BP+HR
thready, weak, irregular pulse
orthostatic hypertension, shallow respirations
anxiety, lethargy, confusion, coma
parethesias, decreased DTR
hyporeflexia
hypoactive bowel sounds (constipation)
nausea, vomiting, abdominal distention
ECG changes: ST depression, shallow/inverted T waves, prominent U wave

30
Q

what are the causes/risk factors of hypokalemia?

A

total body potassium loss
inadequate potassium intake: fasting, NPO , anorexia, nausea
movement of K from the ECF to ICF: alkalosis, hyperinsulinism (too much insulin)
dilution of serum K: water intoxication, IV therapy with potassium deficit solutions
DITCH
D: drugs (laxatives, diuretics, corticosteroids)
I: inadequate
T: too much water
C: Cushing syndrome (increased aldosterone)
H: heavy fluid loss (NG sunction. vomiting, diarrhea, sweating)

31
Q

NM for hypokalemia

A

oral potassium supplements with food (2.5-3.5)
liquid potassium chloride
potassium-retaining diuretic: spinola, diazyde,maxide?
never administer via IV push, IM, subcut
always dilute and administered using an infusion device (no more than 20/hr, risk for phlebitis/infiltration)

32
Q

hypercalcemia

A

excessive calcium in the body, more than 11

33
Q

what are the signs/symptoms of hypercalcemia?

A

bone pain, arrythmias, cardiac arrest (bounding pulses, shortened QT interval), kidney stones, muscle weakness (lower DTR), excessive urination, abdominal distention, constipation

34
Q

what are the risk factors/causes of hypercalcemia?

A

glucocorticoids: suppress Ca absorption
increased calcium absorption
decreased calcium excretion
thiazide diuretics:calcium excretion decreased
increased bone resorption of calcium
-hyperparathyroidism (releases too much Ca)/hyperthyroidism
-malignancy
hemoconcentration
lithium usage: causes Ca to increase

35
Q

what are the NM for hypercalcemia?

A

hydration, safety, complaints for flank abdominal pain/strain urine
D/C IV/PO calcium
D/C thiazide diuretics
administer phosphorus, calcitonin, (inhibits reabsorption of calcium), biphosponates, prostagladins synthesis inhibitors (NSAID’s, decrease Ca)
avoid foods high in calcium
dialysis= if too severe

36
Q

hypocalcemia

A

deficit in calcium, less than 9

37
Q

what are the signs/symptoms of hypocalcemia?

A

convulsions, arrythmias, tetany, spasms/stridor, hyperactive DTR, numbness in fingers, face, limbs
positive trosseau’s” carpal spasm caused by inflating a BP cuff
positive chvostek’s signs: contraction of facial muscles w/light tap over 8th CN

38
Q

what are the causes/risk factors for hypocalcemia?

A

inhibitoion of calcium absorption from the GI tract
increased calcium excretion
- kidney disease, diuretic
-diarrhea, steatorrhea
-wound drainage
conditions that decrease calcium

LOW CALCIUM

L: low PTH/thyroidectomy
O: oral intake inadequate
W: wound drainage

C: celiac/Crohns disease
A: acute pancreatitis
L: low vitamin D
C: CKO
I: increased potassium
U: using meds (mg supplements, loop diuretics)
M: mobility issues

39
Q

what are the NM for hypocalcemia?

A

administer calcium PO/IV (10% calcium gluconate= risk for infiltration)
- for IV warm before and administer slowly
administer aluminum hydroxide/ vitamin D after meal
seizure precaustions
consume foods high in calcium: yogurt, sardines, cheese, spinach, tofu, milk
risk for pathological fracture

40
Q

hypermagnesemia

A

magnesium excess, more than 2.5

41
Q

what are ths signs/symptoms of hypermagnesemia?

A

LOW EVERYTHING

low energy (drownsiness/coma)
low HR
low BP (hypotension)
low RR (bradypnea)
low respirations (shallow)
low bowel sounds
low DTR (deep tendon reflexes)
EKG: prolonged PR+QT interval

42
Q

what are the risk factors/causes for hypermagnesemia?

A

MAG
M: magnesium antacids/laxatives (ex: TUMS)
A: Addison diseases
G: glomerular filtration (<30ml/min), keeping too much

diabetic ketoacidosis
renal insufficency (no excretion= more in the blood)

43
Q

what is the NM for hypermagnesemia?

A

diuretics
IV administration of calcium chloride/calcium gluconate: reverses Mg effects
restrict dietary intake of Mg containing foods
avoid the use of laxatives/antacids
hemodialysis

44
Q

hypomagnesemia

A

magnesium deficit, less than 1.5

45
Q

what are the signs/symptoms of hypomagnesemia?

A

HIGH EVERYTHING

high HR
high BP
hyperreflexia
shallow respirations
twitches, parathesia
tetany/seizures
irritability/confusion
Torsades depointes: abnormal heart rhythmn seen in alcohol abuse
EKG: tall T waves, depressed ST
positive Trousseaus’s/Chevstoke’s signs

46
Q

what are the risk factors/causes for hypomagnesemia?

A

LOW MAG

L: limited intake
O: hypokalemia/hypocalcemia
W:wasting via kidneys, loop/thiazide diuretics, cyclosporines

M: malabsorption issues (Crohn, celiac, vomiting)
A: alcohol stimulates wasting
G: glycemic issues

sepsis

47
Q

what are the NM for hypomkagnesemia?

A

oral Ca supplements/ w 10% calcium gluconate
oral K supplements
IV magnesium sulfate (can lead to hypermagnesemia, check DTR)/PO
seizure precauyions
increase magnesium contaning foods

48
Q

do magnesium and calcium go up and down together?

A

yes

49
Q

do calcium and phosphate go up/down together or inverse?

A

inverse

50
Q

do potassium and sodium go up/down together or inverse?

A

inverse

51
Q

hypovolemia/FVD

A

fluid output exceeds intake

52
Q

what are the risk factors for hypovolemia?

A

GI losses (vomiting, diuretics)
hemorrhaging
diabetes insipidus
hyperventilation

53
Q

what are the S/S for hypovolemia?

A

low BP, hypotension, high RR,HR, tachypnea, tachycardia, thirst, oliguria, flattened JV, weak/thready pulse

54
Q

labs for hypovolemia

A

concentrated blood/urine

high hematocrit, serum osmolarity, BUN, USG, UO

55
Q

what is the treatment for hypovolemia?

A

IV fluid replacement (isotonic)

56
Q

what are the NI for hypovolemia?

A

monitor I/O, fall precautions, daily weights

if urine below 30ml= hypovolemic shock

57
Q

hypervolemia/FVE

A

excessive intake of fluid/inadequate excretion

58
Q

what are the risk factor/causes of hypervolemia?

A

kidney dysfunction, heart failure, corticosteroids, cirrhosis

59
Q

what are the S/S of hypervolemia?

A

weight gain, edema, hypertension, bounding pulse, JVD, tachycardia, dyspnea, crackles, tachypnea

60
Q

what are the labs for hypervolemia?

A

diluted, low hemoglobin, hematocrit, SO, USG

61
Q

what is the treatment for hypervolemia?

A

diuretics & paracentesis

62
Q

what are the NI for hypervolemia?

A

weigh on a daily basis, provide O2, skin care, restrict fluid/sodium intake
- gain weight 1/2 lbs in 24 hrs or 3lbs in a week= danger

63
Q

what are complications for hypervolemia?

A

pulmonary edema: backup fluid in the lungs

CHF

adult health I (3 decks)

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