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Quarter 3 > Chapter 11 Assessment and Care of Patients With Problems of Fluid and Electrolyte Balance > Flashcards

Chapter 11 Assessment and Care of Patients With Problems of Fluid and Electrolyte Balance Flashcards

1
Q

FLUID AND ELECTROLYTE BALANCE

A

Keeping this balance within normal ranges is part of homeostasis.

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2
Q

homeostatic mechanisms

A

many control actions to prevent dangerous changes

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3
Q

(extracellular fluid [ECF]

A

the fluid outside the cells

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4
Q

(intracellular fluid [ICF]

A

the fluid inside the cells

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5
Q

The ECF includes

A

interstitial fluid (fluid between cells, “third space”); blood, lymph, bone, and connective tissue water; and the transcellular fluids

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6
Q

Transcellular fluids include

A

cerebrospinal fluid, synovial fluid, peritoneal fluid, and pleural fluid

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7
Q

Water delivers

A

dissolved nutrients and electrolytes to all organs, tissues, and cells

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8
Q

Changes in either the amount of water or the amount of electrolytes in body fluids:

A

can reduce the function of all cells, tissues, and organs.

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9
Q

solvent

A

is the water portion of fluids.

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10
Q

Solutes

A

are the particles dissolved or suspended in the water.

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11
Q

electrolytes

A

When solutes express an overall electrical charge

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12
Q

Filtration

A

is the movement of fluid (water) through a cell or blood vessel membrane because of water pressure (hydrostatic pressure) differences on both sides of the membrane.

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13
Q

hydrostatic pressure

A

“water-pushing” pressure, because it forces water outward from a confined space through a membrane

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14
Q

Permeable

A

porous membrane separates the two spaces.

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15
Q

equilibrium

A

hydrostatic pressure is the same in both fluid spaces

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16
Q

disequilibrium

A

If the hydrostatic pressure is not the same in both spaces

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17
Q

(gradient)

A

graded difference

one space has a higher hydrostatic pressure than the other.

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18
Q

filtration

A

When a gradient exists, water movement until they are at equilibrium again

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19
Q

filters

A

water moving across gradient from high to low pressure

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20
Q

Blood pressure

A

moves whole blood from the heart to capillaries where filtration can occur to exchange water, nutrients, and waste products between the blood and the tissues.

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21
Q

hydrostatic pressure difference: blood

A

between the capillary blood and the interstitial fluid determines whether water leaves the blood vessels and enters the tissue spaces.

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22
Q

pores

A

Large spaces in the capillary membrane

water filters freely when a hydrostatic pressure gradient is present

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23
Q

Edema

A

(excess tissue fluid)

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24
Q

when does edema form

A

changes in hydrostatic pressure differences between the blood and the interstitial fluid such as in right-sided heart failure

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25
Q

right-sided heart failure

A

the volume of blood in the right side of the heart increases because the right ventricle is too weak to pump blood well into lung blood vessels. As blood backs up into the venous and capillary systems, the capillary hydrostatic pressure rises until it is higher than the pressure in the interstitial space. Excess filtration from the capillaries into the interstitial tissue space then forms visible edema.

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26
Q

Diffusion

A

is the movement of particles (solute) across a permeable membrane from an area of higher particle concentration to an area of lower particle concentration

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27
Q

concentration gradient

A

when two fluid spaces have different concentrations of the same type of particles.

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28
Q

Diffusion- how

A

Any membrane that separates two spaces is struck repeatedly by particles. When the particle strikes a pore in the membrane that is large enough for it to pass through, diffusion occurs

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29
Q

steepness

A

degree of difference

larger the concentration difference between the two sides, the steeper the gradient

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30
Q

selective

A

permit diffusion of some particles but not others.

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31
Q

impermeable

A

closed

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32
Q

glucose

A

cannot cross some cell membranes without the help of insulin. Insulin binds to insulin receptors on cell membranes, which then makes the membranes much more permeable to glucose.

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33
Q

facilitated diffusion

A

Diffusion across a cell membrane that requires a membrane-altering system

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34
Q

Osmosis

A

is the movement of water only through a selectively permeable (semipermeable) membrane.

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35
Q

Osmolarity

A

is the number of milliosmoles in a liter of solution

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36
Q

osmolality

A

is the number of milliosmoles in a kilogram of solution.

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37
Q

normal osmolarity value for plasma and other body fluids

A

270 to about 300 mOsm/L

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38
Q

isosmotic /isotonic

A

Having the same osmotic pressures.

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39
Q

hyperosmotic, or hypertonic

A

Fluids with osmolarities greater than 300 mOsm/L

tend to pull water from the isosmotic fluid space into the hyperosmotic fluid space until an osmotic balance occurs

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40
Q

hypo-osmotic, or hypotonic

A

Fluids with osmolarities of less than 270 mOsm/L are

water is pulled from the hypo-osmotic fluid space into the isosmotic fluid spaces of the interstitial and ICF fluids.

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41
Q

thirst mechanism

A

The feeling of thirst is caused by the activation of cells in the brain that respond to changes in ECF osmolarity.

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42
Q

thirst mechanism steps

A
  1. loses body water but most of the particles remain
  2. ECF volume is decreased, and its osmolarity is increased (is hypertonic)
  3. cells in the thirst center shrink as water moves from the cells into the hypertonic ECF.
  4. shrinking of these cells triggers an adult’s awareness of thirst and increases the urge to drink
  5. Drinking replaces the amount of water lost through sweating and dilutes the ECF osmolarity, restoring it to normal.
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43
Q

Sodium (Na+)

Elevated:

A

Hypernatremia; dehydration; kidney disease; hypercortisolism

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44
Q

Sodium (Na+) Low:

A

Hyponatremia; fluid overload; liver disease; adrenal insufficiency

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45
Q

Potassium (K+) high

A

Hyperkalemia; dehydration; kidney disease; acidosis; adrenal insufficiency; crush injuries

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46
Q

Potassium (K+) low

A

Hypokalemia; fluid overload; diuretic therapy; alkalosis; insulin administration; hyperaldosteronism

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47
Q

Calcium (Ca2+) high

A

Hypercalcemia; hyperthyroidism; hyperparathyroidism

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48
Q

Calcium (Ca2+) low

A

Hypocalcemia; vitamin D deficiency; hypothyroidism; hypoparathyroidism; kidney disease; excessive intake of phosphorus-containing foods and drinks

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49
Q

Chloride (Cl−) high

A

Hyperchloremia; metabolic acidosis; respiratory alkalosis; hypercortisolism

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50
Q

Chloride (Cl−) low

A

Hypochloremia; fluid overload; excessive vomiting or diarrhea; adrenal insufficiency; diuretic therapy

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51
Q

Magnesium (Mg2+) high

A

Hypermagnesemia; kidney disease; hypothyroidism; adrenal insufficiency

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52
Q

Magnesium (Mg2+) low

A

Hypomagnesemia; malnutrition; alcoholism; ketoacidosis

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53
Q

Skin change

A

Loss of elasticity

Decreased turgor

Decreased oil production

Results in:
Skin becomes an unreliable indicator of fluid status, especially the back of the hand

Dry, easily damaged skin

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54
Q

kidney change

A

Decreased glomerular filtration

Decreased concentrating capacity

Results in:
Poor excretion of waste products

Increased water loss, increasing the risk for dehydration

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55
Q

muscle change

A

Decreased muscle mass

Results in:
Decreased total body water

Greater risk for dehydration

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56
Q

Neurologic change

A

Diminished thirst reflex

Results in:
Decreased fluid intake, increasing the risk for dehydration

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57
Q

endocrine change

A

Adrenal atrophy

Results in:
Poor regulation of sodium and potassium, increasing the risk for hyponatremia and hyperkalemia

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58
Q

muscle vs fat cells

A

Muscle cells contain mostly water, and fat cells have little water

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59
Q

sensation of thirst

A

A rising blood osmolarity or a decreasing blood volume triggers

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60
Q

fluid daily

A

2300 mL

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61
Q

obligatory urine output

The minimum amount of urine per day needed to excrete toxic waste products

A

400 to 600 mL

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62
Q

if obligatory urine output is not met

A

lethal electrolyte imbalances, acidosis, and a toxic buildup of nitrogen.

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63
Q

insensible water loss

A

no mechanisms control it

about 500 to 1000 mL/day.

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64
Q

Aldosterone

A

is secreted by the adrenal cortex whenever sodium levels in the extracellular fluid (ECF) are low.

Aldosterone prevents both water and sodium loss.

acts on the kidney nephrons, triggering them to reabsorb sodium and water from the urine back into the blood

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65
Q

Antidiuretic hormone (ADH),

A

or vasopressin, is released from the posterior pituitary gland in response to changes in blood osmolarity.

retains just water

acts on kidney nephrons, making them more permeable to water.

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66
Q

Natriuretic peptides (NPs)

A

are hormones secreted by special cells that line the atria of the heart (atrial natriuretic peptide [ANP]) and the ventricles of the heart

secreted in response to increased blood volume and blood pressure, which stretch the heart tissue. NP binds to receptors in the nephrons, creating effects that are opposite of aldosterone.

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67
Q

The Renin-Angiotensin II Pathway

A

kidneys monitor blood pressure, blood volume, blood oxygen levels, and blood osmolarity

When the kidneys sense that any one of these parameters is getting low, they begin to secrete a substance called renin that sets into motion a group of hormonal and blood vessel responses to ensure that blood pressure is raised back up to normal

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68
Q

Anything that reduces blood volume (e.g., dehydration, hemorrhage) below a critical level:

A

always lowers blood pressure.

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69
Q

Renin

A

activates angiotensinogen 1 to 2

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70
Q

Angiotensin II``

A

starts several actions to increase blood volume and blood pressure

  • decrease urine output
  • aldosterone secretion
  • increases peripheral resistance and reduces the size of the vascular bed
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71
Q

low sodium for hypertension

A

high sodium intake raises the blood level of sodium, causing more water to be retained in the blood volume and raising blood pressure.

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72
Q

ACE inhibitors”

A

disrupt the renin-angiotensin II pathway by reducing the amount of angiotensin-converting enzyme (ACE) made so less angiotensin II is present. With less angiotensin II, there is less vasoconstriction and reduced peripheral resistance, less aldosterone production, and greater excretion of water and sodium in the urine

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73
Q

Dehydration cause

A
  • Hemorrhage
  • Vomiting
  • Diarrhea
  • Profuse salivation
  • Fistulas
  • Ileostomy
  • Profuse diaphoresis
  • Burns
  • Severe wounds
  • Long-term NPO status
  • Diuretic therapy
  • GI suction
  • Hyperventilation
  • Diabetes insipidus
  • Difficulty swallowing
  • Impaired thirst
  • Unconsciousness
  • Fever
  • Impaired motor function
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74
Q

Fluid Overload cause

A
  • Excessive fluid replacement
  • Kidney failure (late phase)
  • Heart failure
  • Long-term corticosteroid therapy
  • Syndrome of inappropriate antidiuretic hormone (SIADH)
  • Psychiatric disorders with polydipsia
  • Water intoxication
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75
Q

dehydration

A

fluid intake or retention is less than what is needed to meet the body’s fluid needs, resulting in a deficit of fluid volume, especially plasma volume.

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76
Q

older adult dehydration risks

A

decreased thirst sensation
difficulty moving
less total body water
drugs that increase fluid excretion

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77
Q

hypovolemia

A

Circulating blood volume is decreased leads to reduced perfusion

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78
Q

Isotonic dehydration

A

Fluid is lost only from the extracellular fluid (ECF) space

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79
Q

Mild dehydration

A

corrected or prevented easily by matching fluid intake with fluid output

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80
Q

history questions

A

Ask specific questions about food and liquid intake.

Collect specific information about exact intake and output volumes and obtain serial daily weight measurements.

Ask specific questions about prescribed and over-the-counter drugs

Ask about the presence of kidney or endocrine diseases.

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81
Q

Cardiovascular changes

A
  • Heart rate increases
  • Peripheral pulses are weak, difficult to find, and easily blocked
  • Blood pressure also decreases
  • Hypotension is more severe with the patient in the standing position than in the sitting or lying position
  • neck and hand veins are flat, even when the neck and hands are not raised above the level of the heart.
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82
Q

Respiratory changes

A

increased respiratory rate is a compensatory mechanism that attempts to maintain oxygen delivery when perfusion is decreased.

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83
Q

Skin changes

A
  • dehydration skin turgor is poor
  • The skin is dry and scaly.
  • The tongue surface may have deep furrows.
  • oral mucous membranes may be dry and covered with a thick, sticky coating and may have cracks and fissures
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84
Q

Neurologic changes

A

changes in mental status and temperature with reduced PERFUSION in the brain.

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85
Q

Kidney changes

A

affect urine volume and concentration

Urine output below 500 mL/day for a patient without kidney disease is cause for concern.

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86
Q

laboratory findings with dehydration show

A

elevated levels of hemoglobin, hematocrit, serum osmolarity, glucose, protein, blood urea nitrogen, and electrolytes because more water is lost and other substances remain, increasing blood concentration

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87
Q

hemoconcentration

A

increasing blood concentration

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88
Q

The priority problems for the patient who has dehydration are:

A
  1. Dehydration due to excess fluid loss or inadequate fluid intake
  2. Potential for injury due to blood pressure changes and muscle weakness
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89
Q

Indicators patient is not dehydrated anymore

A
  • Blood pressure at or near his or her normal range
  • Daily urine output within 500 mL of total daily fluid intake (or at least 30 mL per hour)
  • Moist mucous membranes
  • Normal skin turgor
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90
Q

focus of management for the patient with dehydration

A

prevent further fluid loss, to increase fluid volumes to normal, and to prevent injury.

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91
Q

The Patient With Dehydration interventions

A
  • When possible, provide oral fluids that meet the patient’s dietary restrictions (e.g., sugar-free, low-sodium, thickened).
  • Collaborate with other members of the interprofessional team to determine the amount of fluids needed during a 24-hour period.
  • Ensure that fluids are offered and ingested on an even schedule at least every 2 hours throughout 24 hours.
  • Teach unlicensed assistive personnel to actively participate in the hydration therapy and not to withhold fluids to prevent incontinence.
  • Infuse prescribed IV fluids at a rate consistent with hydration needs and any known cardiac, pulmonary, or kidney problems.
  • Monitor the patient’s response to fluid therapy at least every 2 hours for indicators of adequate rehydration or the need for continuing therapy, especially:
  • Pulse quality
  • Urine output
  • Pulse pressure
  • Weight (every 8 hours)
  • Monitor for and report indicators of fluid overload, including:
  • Bounding pulse
  • Difficulty breathing
  • Neck vein distention in the upright position
  • Presence of dependent edema
  • Assess the IV line and the infusion site at least hourly for indications of infiltration, extravasation, or phlebitis (e.g., swelling around the site, pain, cordlike veins, reduced drip rate).
  • Administer drugs prescribed to correct the underlying cause of the dehydration (e.g., antiemetics, antidiarrheals, antibiotics, antipyretics).
92
Q

Coordinate with unlicensed assistive personnel (UAP) by teaching:

A

offer 60 to 120 mL of fluid every hour to patients who are dehydrated or who are at risk for dehydration.

withholding fluids due to incontinence is not appropriate

record amount of fluids ingested

93
Q

Crystalloids

A

IV fluids that contain water, minerals (electrolytes), and sometimes other water-soluble substances such as glucose

most useful when dehydration includes both the intracellular and extracellular compartments

94
Q

Colloids

A

are IV fluids that contain larger non–water-soluble molecules that increase the osmotic pressure in the plasma volume.

most useful in helping to maintain plasma volume with a lower infused volume

95
Q

The two most important areas to monitor during rehydration

A

pulse rate and quality and urine output.

96
Q

Antidiarrheal drugs

A

are prescribed when diarrhea causes dehydration.

97
Q

Antimicrobial

A

therapy may be used in patients with bacterial diarrhea.

98
Q

Antiemetics

A

may be used when vomiting causes dehydration

99
Q

Antipyretics

A

to reduce fever are helpful when fever makes dehydration worse.

100
Q

patient with dehydration is at risk for falls because

A

orthostatic hypotension, dysrhythmia, muscle weakness, and possible confusion.

101
Q

Indications that the patient’s underlying cause of dehydration is well managed

A
  • Maintains a daily fluid intake of at least 1500 mL (or drinks at least 500 mL more than his or her daily urine output)
  • Can state the indications of dehydration
  • Starts fluid replacement at the first indication of dehydration
  • Correctly follows treatment plans for ongoing health problems that increase the risk for dehydration
102
Q

Fluid overload, also called overhydration,

A

is an excess of body fluid. fluid intake or retention is greater than the body’s fluid needs.

103
Q

response to mild or moderate fluid overload

A

especially increased urine output, and edema formation.

104
Q

when overload is severe or occurs in an adult with poor cardiac or kidney function:

A

it can lead to heart failure and pulmonary edema.

105
Q

Dilution of sodium and potassium

A

can lead to seizures, coma, and death.

106
Q

Fluid Overload

Cardiovascular Changes

A
  • Increased pulse rate
  • Bounding pulse quality
  • Elevated blood pressure
  • Decreased pulse pressure
  • Elevated central venous pressure
  • Distended neck and hand veins
  • Engorged varicose veins
  • Weight gain
107
Q

Fluid Overload

Respiratory Changes

A
  • Increased respiratory rate
  • Shallow respirations
  • Shortness of breath
  • Moist crackles present on auscultation
108
Q

Fluid Overload

Skin and Mucous Membrane Changes

A
  • Pitting edema in dependent areas

* Skin pale and cool to touch

109
Q

Fluid Overload

Neuromuscular Changes

A
  • Altered level of consciousness
  • Headache
  • Visual disturbances
  • Skeletal muscle weakness
  • Paresthesias
110
Q

Fluid Overload

Gastrointestinal Changes

A
  • Increased motility

* Enlarged liver

111
Q

Fluid Overload labs

A

Usually serum electrolyte values are normal; but decreased hemoglobin, hematocrit, and serum protein levels

112
Q

hemodilution

A

excessive water in the vascular space

113
Q

pulmonary edema and fluid overload

A

Assess the patient with fluid overload at least every 2 hours to recognize pulmonary edema
If indications of worsening fluid overload are present (bounding pulse, increasing neck vein distention, presence of crackles in lungs, increasing peripheral edema, reduced urine output), respond by notifying the health care provider.

114
Q

skin breakdown

A

turn every two hours and use pressure reducing things

115
Q

Diuretics

A

are used for fluid overload if kidney function is normal.

116
Q

drug therapy assessment

A

Monitor the patient for response to drug therapy, especially weight loss and increased urine output. Observe for indications of electrolyte imbalance, especially changes in electrocardiogram (ECG) patterns. Assess sodium and potassium values every 8 hours or whenever they are drawn.

117
Q

Drug therapy

A

focuses on removing excess fluid.

118
Q

Nutrition therapy for the patient with chronic fluid overload

A

may involve restrictions of both fluid and sodium intake.

119
Q

Monitoring intake and output and weight

A

provides information on therapy effectiveness.

120
Q

Fluid retention may not be visible, may show as:

A

Rapid weight gain is the best indicator of fluid retention and overload.

121
Q

Each pound (0.5 kg) of weight gained (after the first half pound) equates:

A

to about 500 mL of retained fluid.

122
Q

Electrolytes, or ions,

A

are substances dissolved in body fluid that carry an electrical charge.

123
Q

Cations

anions

A

have positive charges;

have negative charges.

124
Q

Sodium (Na+)

A

is the major cation (positively charged particle) in the extracellular fluid (ECF) and maintains ECF osmolarity.

125
Q

sodium in charge of

A

vital for muscle contraction, cardiac contraction, and nerve impulse transmission.

126
Q

Sodium levels and movement influence water balance because:

A

“where sodium goes, water follows.” The ECF sodium level determines whether water is retained, excreted, or moved from one fluid space to another

127
Q

Low serum sodium levels

A

inhibit the secretion of ADH and NP and trigger aldosterone secretion.

128
Q

High serum sodium levels

A

inhibit aldosterone secretion and stimulate secretion of ADH and NP.

129
Q

Hyponatremia

A

LOW SODIUM

is an electrolyte imbalance in which the serum sodium (Na+) level is below 136 mEq/L (mmol/L).

130
Q

hyponatremia what happens and whats the result

A

SODIUM FOLLOWS WATER LOW SODIUM IN ECF CAUSES WATER TO GO INTO CELLS

osmolarity of the ECF is lower than that of the intracellular fluid (ICF). As a result, water moves into the cell, causing swelling.

can reduce cell function or cause cell to burst

131
Q

Hyponatremia can result from

A

the loss of total body sodium, the movement of sodium from the blood to other fluid spaces, or the dilution of serum sodium from excessive water in the plasma.

132
Q

problems of hyponatremia

A
  • Cerebral changes CONFUSION CAN BE SUDDEN
  • Neuromuscular changes are seen as general muscle weakness.
  • Intestinal changes include increased motility, causing nausea, diarrhea, and abdominal cramping.
  • Cardiovascular changes are seen as changes in cardiac output.
133
Q

cardiac responses to hyponatremia with hypovolemia (decreased plasma volume)

A
  • rapid, weak, thready pulse.
  • Peripheral pulses are difficult to palpate and are easily blocked.
  • Blood pressure is decreased, and the patient may have severe orthostatic hypotension, leading to light-headedness or dizziness. -The central venous pressure is low.
134
Q

cardiac responses to hyponatremia occurs with hypervolemia (fluid overload)

A

-full or bounding pulse with normal or high blood pressure. -Peripheral pulses are full and difficult to block

sometimes hard to palpate due to edema

135
Q

priorities for nursing care of the patient with hyponatremia

A

monitoring the patient’s response to therapy and preventing hypernatremia and fluid overload.

136
Q

Drug therapy hyponatremia fluid deficit

A
  • reducing the doses of any drugs that increase sodium loss such as most diuretics
  • IV saline infusions for fluid deficit
  • small-volume infusions of hypertonic saline in severe cases (3%)
137
Q

Drug therapy hyponatremia- fluid excess

A

-drugs that promote the excretion of water rather than sodium (such as conivaptan (Vaprisol) or tolvaptan (Samsca)

138
Q

mild hyponatremia

A

nutrition therapy

increasing oral sodium intake and restricting oral fluid intake

139
Q

Drug therapy for hyponatremia caused by inappropriate secretion of antidiuretic hormone (ADH)

A

may include lithium (Carbolith, Lithane image) and demeclocycline (Declomycin).

140
Q

Hypernatremia

A

HIGH SODIUM

is a serum sodium level over 145 mEq/L (mmol/L).

141
Q

irritability

A

More sodium is present to move rapidly across cell membranes during depolarization, making excitable tissues more easily excited.

142
Q

Hypernatremia LEADS TO:

A

cell shrinkage more water in ECF than ICF

Eventually the dehydrated excitable tissues may no longer be able to respond to stimuli.

143
Q

Symptoms of hypernatremia first

A

excitable membrane activity, especially nerve, skeletal muscle, and cardiac function.

144
Q

Nervous system changes In hypernatremia with normal or decreased fluid volumes

A

the patient may have a short attention span and be agitated or confused.

145
Q

Nervous system changes in hypernatremia with fluid overload

A

the patient may be lethargic, stuporous, or comatose.

146
Q

Skeletal muscle changes Mild

hypernatremia

A

cause muscle twitching and irregular muscle contractions

147
Q

Skeletal muscle changes moderate

hypernatremia

A

muscles and nerves are less able to respond to a stimulus, and muscles become progressively weaker

148
Q

Skeletal muscle changes late

hypernatremia

A

deep tendon reflexes are reduced or absent.

149
Q

Cardiovascular changes

hypernatremia

A

include decreased contractility because high sodium levels slow the movement of calcium into the heart cells.

150
Q

Nursing care priorities for the patient with hypernatremia

A

include monitoring his or her response to therapy and ensuring patient safety by preventing hyponatremia and dehydration.

151
Q

Hypernatremia caused by reduced kidney sodium excretion drug therapy

A

diuretics that promote sodium loss

152
Q

Drug therapy is used to restore fluid balance when hypernatremia is caused by fluid loss

A

Isotonic saline (0.9%) and dextrose 5% in 0.45% sodium chloride are most often prescribed

153
Q

Nutrition therapy to prevent or correct mild hypernatremia involves :

A

ensuring adequate water intake, especially among older adults

154
Q

Potassium (K+)

A

is the major cation of the intracellular fluid (ICF). The normal plasma potassium level ranges from 3.5 to 5.0 mEq/L (mmol/L)

155
Q

The normal ICF potassium level is

A

about 140 mEq/L (mmol/L)

156
Q

large difference in potassium concentration between the ICF and the extracellular fluid (ECF) is critical for:

A

excitable tissues to depolarize and generate action potentials.

157
Q

sodium-potassium pump

A

in all body cells

moves extra sodium ions from the ICF and moves extra potassium ions from the ECF back into the cell. In this way the serum potassium level remains low, and the cellular potassium remains high

158
Q

Hypokalemia

A

is a serum potassium level below 3.5 mEq/L (mmol/L)

It can be life threatening because every body system is affected.

159
Q

Actual potassium depletion

A

occurs when potassium loss is excessive or when potassium intake is not adequate to match normal potassium loss.

160
Q

Relative hypokalemia

A

occurs when total body potassium levels are normal but the potassium distribution between fluid spaces is abnormal or diluted by excess water.

161
Q

urine and Hypokalemia

A

urine concentrating ability decreases with aging, which increases potassium loss

162
Q

drugs and Hypokalemia

A

diuretics, corticosteroids, and beta-adrenergic agonists or antagonists, can increase potassium loss through the kidneys.

163
Q

disease and Hypokalemia

A

Disease can lead to potassium loss.

164
Q

respiration changes Hypokalemia

A

Respiratory changes occur because of respiratory muscle weakness, resulting in shallow respirations.

CHECK RESP STATUS EVERY TWO HOURS

165
Q

Musculoskeletal changes Hypokalemia

A

skeletal muscle weakness.

166
Q

Cardiovascular changes

Hypokalemia

A

pulse is usually thready and weak. Palpation is difficult, and the pulse is easily blocked. Pulse rate ranges from very slow to very rapid, and an irregular heartbeat (dysrhythmia)

hypotension

167
Q

Neurologic changes from hypokalemia

A

include altered mental status.

168
Q

Intestinal changes occur with hypokalemia:

A

GI smooth muscle contractions are decreased, which leads to decreased peristalsis. Bowel sounds are hypoactive, and nausea, vomiting, constipation, and abdominal distention are common.

169
Q

paralytic ileus

A

absence of peristalsis

170
Q

Hypokalemia causes ECG changes in the heart including:

A

ST-segment depression, flat or inverted T waves, and increased U waves.

171
Q

The priorities for nursing care of the patient with hypokalemia

A

ensuring adequate gas exchange, patient safety for falls prevention, prevention of injury from potassium administration, and monitoring the patient’s response to therapy

172
Q

The Patient With Hypokalemia

A
  • Question the continued use of drugs that increase excretion of potassium (e.g., thiazide and loop diuretics).
  • Give prescribed oral potassium supplement, well diluted and with a meal or just after a meal or snack to prevent nausea and vomiting.
  • Prevent accidental overdose of IV potassium by checking and re-checking the concentration of potassium in the IV solution, ensuring that the maximum concentration is no greater than 1 mEq (mmol)/10 mL of solution.
  • Establish an IV access in a large vein with a high volume of flow, avoiding the hand.
  • Assess the IV access for placement and an adequate blood return before administering potassium-containing solutions.
  • Use a controller for solution delivery, maintaining an infusion rate not faster than 5-10 mEq (mmol) of potassium per hour.
  • Assess the IV site hourly.
  • Stop the infusion immediately if the patient reports pain or burning or if any sign of infiltration occurs.
  • If possible, monitor electrocardiography continuously.
  • Monitor patient responses every 1-2 hours to determine therapy effectiveness and the potential for hyperkalemia.
  • Indications of therapy effectiveness:
  • Respiratory rate is greater than 12 breaths/min.
  • Oxygen saturation is at least 95% (or has returned to the patient’s normal baseline).
  • The patient can cough effectively.
  • Hand-grasp strength increases.
  • Deep tendon reflexes are present.
  • Bowel sounds are present and active.
  • Pulse is easily palpated and regular.
  • Systolic blood pressure when standing remains within 20 mm Hg of the systolic pressure obtained when the patient is sitting or lying down.
  • ST segment returns to the isoelectric line.
  • T waves increase in size and are positive.
  • U waves decrease or disappear.
  • Patient’s cognition resembles his or her prehypokalemic state.
  • Serum potassium level is between 3.5 and 5.0 mEq/L (mmol/L).
  • Indications of hyperkalemia:
  • Heart rate is less than 60 beats/min.
  • P waves are absent.
  • T waves are tall.
  • PR intervals are prolonged.
  • QRS complexes are wide.
  • Deep tendon reflexes are hyperactive.
  • Bowel sounds are hyperactive.
  • Numbness or tingling is present in the hands and feet and around the mouth.
  • The patient is anxious.
  • Serum potassium level is above 5.0 mEq/L (mmol/L).
  • Keep patient on bedrest until hypokalemia resolves or provide assistance when out of bed to prevent falls.
173
Q

Drug therapy for management and prevention of hypokalemia

A

includes additional potassium and drugs to prevent potassium loss

174
Q

Potassium warning

A

Potassium is a severe tissue irritant and is never given by IM or subcutaneous injection.

Tissues damaged by potassium can become necrotic, causing loss of function and requiring surgery.

175
Q

If infiltration of solution containing potassium occurs

A

stop the IV solution immediately, remove the venous access, and notify the health care provider or Rapid Response Team.

176
Q

potassium-sparing diuretic

A

increase urine output without increasing potassium loss

177
Q

Diuretics that increase the kidney excretion of potassium:

A

can cause hypokalemia, especially high-ceiling (loop) diuretics

178
Q

hypokalemia Nutrition therapy involves

A

collaboration with a dietitian to teach the patient how to increase dietary potassium intake

179
Q

hypokalemia Respiratory monitoring

A
  • performed at least hourly for severe hypokalemia.
  • check oxygen saturation by pulse oximetry to determine breathing effectiveness.
  • Assess respiratory muscle effectiveness by checking the patient’s ability to cough.
  • Examine the face, oral mucosa, and nail beds for pallor or cyanosis
180
Q

hypoxemia

A

decreased blood oxygen levels

181
Q

hypercapnia

A

increased arterial carbon dioxide levels

182
Q

Hyperkalemia

A

is a serum potassium level higher than 5.0 mEq/L (mmol/L). Even small increases above normal values can affect excitable tissues, especially the heart.

183
Q

Those at greatest risk for Hyperkalemia

A

chronically ill patients, debilitated patients, and older adults

people with damaged kidneys

184
Q

Cardiovascular changes Hyperkalemia

A

are the most severe problems from hyperkalemia and are the most common cause of death in patients with hyperkalemia

185
Q

Hyperkalemia s/s

A

palpitations, skipped heartbeats, or other cardiac irregularities; and muscle twitching leg weakness, or unusual tingling or numbness in the hands, feet, or face

186
Q

paresthesia

A

tingling and burning sensations followed by numbness in the hands and feet and around the mouth

187
Q

Neuromuscular changes Hyperkalemia

A

skeletal muscle twitches up to muscle weakness and flaccid paralysis

188
Q

Intestinal changes Hyperkalemia

A

include increased motility with diarrhea and hyperactive bowel sounds.

189
Q

Hyperkalemia caused by kidney failure labs

A

occurs with elevated serum creatinine and blood urea nitrogen, decreased blood pH, and normal or low hematocrit and hemoglobin levels.

190
Q

Hyperkalemia caused by dehydration labs

A

levels of other electrolytes, hematocrit, and hemoglobin also are elevated.

191
Q

The priorities for nursing care of the patient with hyperkalemia

A

are assessing for cardiac complications, patient safety for falls prevention, monitoring the patient’s response to therapy, and health teaching.

192
Q

Drug therapy hyperkalemia

A

can restore potassium balance by enhancing potassium excretion and promoting the movement of potassium from the extracellular fluid (ECF) into the cells

193
Q

Cardiac monitoring hyperkalemia

A

allows for the early recognition of dysrhythmias and other symptoms of hyperkalemia on cardiac muscle.

194
Q

Critical Rescue hyperkalemia

A

Assess anyone who has or is at risk for hyperkalemia to recognize cardiac changes. If the patient’s heart rate falls below 60 beats/min or if the T waves become spiked, both of which accompany hyperkalemia, respond by notifying the Rapid Response Team.

195
Q

hyperkalemia teaching

A

includes diet, drugs, and recognition of the indicators of hyperkalemia.

196
Q

Nutritional Management of Hyperkalemia

A

You Should Avoid

  • Meats, especially organ meat and preserved meat
  • Dairy products
  • Dried fruit
  • Fruits high in potassium:
  • Bananas
  • Cantaloupe
  • Kiwi
  • Oranges
  • Vegetables high in potassium:
  • Avocados
  • Broccoli
  • Dried beans or peas
  • Lima beans
  • Mushrooms
  • Potatoes (white or sweet)
  • Seaweed
  • Soybeans
  • Spinach

You May Eat

  • Eggs
  • Breads
  • Butter
  • Cereals
  • Sugar
  • Fruits low in potassium (fresh, frozen, or canned):
  • Apples
  • Apricots
  • Berries
  • Cherries
  • Cranberries
  • Grapefruit
  • Peaches
  • Pineapple
  • Vegetables low in potassium:
  • Alfalfa sprouts
  • Cabbage
  • Carrots
  • Cauliflower
  • Celery
  • Eggplant
  • Green beans
  • Lettuce
  • Onions
  • Peas
  • Peppers
  • Squash
197
Q

Calcium (Ca2+)

A

is an ion having two positive charges (divalent cation) that exists in the body in a bound form and an ionized (unbound or free) form.

198
Q

PTH increases serum calcium levels by:

A
  • Releasing free calcium from bone storage sites (bone resorption of calcium)
  • Stimulating vitamin D activation to help increase intestinal absorption of dietary calcium
  • Inhibiting kidney calcium excretion
  • Stimulating kidney calcium reabsorption
199
Q

Hypocalcemia

A

is a total serum calcium (Ca2+) level below 9.0 mg/dL or 2.25 mmol/L. Because the normal blood level of calcium is so low, any change in calcium levels has major effects on function.

200
Q

Patient-Centered Care:Postmenopausal women are at risk for chronic calcium loss

A

This problem is related to reduced weight-bearing activities and a decrease in estrogen levels. As they age, many women decrease weight-bearing activities such as running and walking, which allows osteoporosis to occur at a more rapid rate. In addition, the estrogen secretion that protects against osteoporosis diminishes. Teach older women to continue walking and other weight-bearing activities.

201
Q

indicator of hypocalcemia

A

report of frequent, painful muscle spasms (“charley horses”) in the calf or foot during rest or sleep

202
Q

hypocalcemia Neuromuscular changes

A

often occur first in the hands and feet. Paresthesias occur at first, with sensations of tingling and numbness. If hypocalcemia continues or worsens, muscle twitching or painful cramps and spasms occur

203
Q

hypocalcemia cardio changes

A

The heart rate may be slower or slightly faster than normal, with a weak, thready pulse. Severe hypocalcemia causes severe hypotension and ECG changes of a prolonged ST interval and a prolonged QT interval

204
Q

hypocalcemia Intestinal changes

A

include increased peristaltic activity

painful abdominal cramping and diarrhea.

205
Q

hypocalcemia skeletal changes

A

bones are less dense, more brittle, and fragile and may break easily with slight trauma. Vertebrae become more compact and may bend forward, leading to an overall loss of height.

206
Q

Assess for hypocalcemia by testing for:

A

Trousseau’s and Chvostek’s signs.

207
Q

hypocalcemia Drug therapy

A

includes direct calcium replacement (oral and IV) and drugs that enhance the absorption of calcium such as vitamin D.

208
Q

hypocalcemia Nutrition therapy

A

involves a calcium-rich diet for patients with mild hypocalcemia and for those who are at continuing risk for hypocalcemia

209
Q

hypocalcemia environmental management

A

Reduce stimulation by keeping the room quiet, limiting visitors, adjusting the lighting, and using a soft voice.

210
Q

Hypercalcemia

A

is a total serum calcium level above 10.5 mg/dL or 2.62 mmol/L.

211
Q

Hypercalcemia cardio changes

A

Mild hypercalcemia at first causes increased heart rate and blood pressure. Severe or prolonged calcium imbalance depresses electrical conduction, slowing heart rate.

Assess for slowed or impaired PERFUSION.

212
Q

Hypercalcemia Neuromuscular changes

A

severe muscle weakness and decreased deep tendon reflexes without paresthesia. The patient may be confused and lethargic.

213
Q

Hypercalcemia Intestinal changes

A

Constipation, anorexia, nausea, vomiting, abdominal distention, and pain are common. Bowel sounds are hypoactive or absent.

214
Q

Hypercalcemia drug therapy

A

preventing increases in calcium and drugs to lower calcium levels.

Fluid volume replacement

Thiazide diuretics are discontinued and replaced with diuretics that enhance the excretion of calcium such as furosemide

215
Q

Hypercalcemia Cardiac monitoring

A

needed to identify dysrhythmias and decreased cardiac output.

216
Q

Magnesium (Mg2+) is a cation mostly stored in bones and cartilage.

A

important for skeletal muscle contraction, carbohydrate metabolism, generation of energy stores, vitamin activation, blood coagulation, and cell growth.

217
Q

Hypomagnesemia

A

is a serum magnesium (Mg2+) level below 1.8 mEq/L or 0.74 mmol/L.

218
Q

Hypomagnesemia cardio changes

A

increase the risk for hypertension, atherosclerosis, hypertrophic left ventricle, and a variety of dysrhythmias

219
Q

Hypomagnesemia Neuromuscular changes

A

increase impulse transmission from nerve to nerve or from nerve to skeletal muscle. The patient has hyperactive deep tendon reflexes numbness and tingling, and painful muscle contractions.

patient may have tetany and seizures as hypomagnesemia worsens.

220
Q

Hypomagnesemia Intestinal changes

A

Reduced motility, anorexia, nausea, constipation, and abdominal distention are common.

221
Q

Hypermagnesemia

A

is a serum magnesium level above 2.6 mEq/L or 1.07 mmol/L.

membrane stabilizer

222
Q

Hypermagnesemia Cardiac changes

A

include bradycardia, peripheral vasodilation, and hypotension.

223
Q

Hypermagnesemia Central nervous system changes

A

Patients may be drowsy or lethargic. Coma may occur if the imbalance is prolonged or severe.

224
Q

Hypermagnesemia Neuromuscular changes

A

include reduced or absent deep tendon reflexes. Voluntary skeletal muscle contractions become progressively weaker and finally stop.

225
Q

Hypermagnesemia resp. risk

A

respiratory muscles are weak, respiratory insufficiency can lead to respiratory failure and death.

226
Q

Interventions for hypermagnesemia

A

focus on reducing the serum level and correcting the underlying problem that caused the imbalance.

When cardiac problems are severe, giving calcium may reverse the cardiac effects of hypermagnesemia.

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