done-ChA exam 1- presentations Flashcards
1
Q
Body fluid balance
water in-where get 2.5 ml
water out-where 2.5 goes out
A
water in-2.2 food drink, 0.3l metabolism
water out-0.8 insensible loss(inc rr=inc loss), urine 1.5 l, feces .2 l
2
Q
intracellular
A
Water inside the cells
3
Q
extracellular
A
Water outside the cells:
4
Q
interstitial
extracellular
A
Located in spaces between cells
5
Q
intravascular
extracellular
A
plasma
6
Q
trasnecullar
extraceullar
A
Other body fluid such as urine, digestive enzymes, & sweat
7
Q
Osmosis-
process
water goes from
continues
A
primary process between icf and ecf compartments-
water moves from lower concentration to higher concentration
continues until both sides are equal
8
Q
osmolarity
what is
number
A
concentration of a solution
number of solutes per kilogram
9
Q
osmotic pressure
power
A
power of a solution to draw water across a membrane
10
Q
Osmolality is determined by Na+ levels:
high
low
A
High Osmolality = High Na+
Low Osmolality = Low Na+
11
Q
tonicity
effect
A
effect the osmotic pressure has on water movement across the membrane of cells within that solution
12
Q
isotonic
A
same conectrstion as cells in plasma,
cells will not shrink not swell
ns and lr
13
Q
Hypertonic-
A
cells will shrink due to water being drawn out of cell
3%
14
Q
Hypotonic
A
Water moves into cell-cell expands
.45%
15
Q
Diffusion-
A
molecules move from high concentration to low
16
Q
simple diffusion
A
random movement of particles through solution
17
Q
facilitated diffusion
A
uses proteins as carriers across membrane (glucose and amino acids)
18
Q
Filtration-
A
water and dissolved substances move from area of high hydrostatic pressure to low hydrostatic pressure
19
Q
where does filtration occur
A
kidneys
20
Q
Active transport-
A
allows molecules to move across cell membranes and epithelial membranes against concentration gradient
requires ATP
21
Q
Body Fluid Regulation: Thirst
primary
where is thirst center
A
Primary regulation of fluid intake.
Thirst center- hypothalamus
22
Q
when is thirst stimulated
when what decreased
when what increases
A
Thirst is stimulated when blood volume decreases
serum osmolarity (concentration) increases
23
Q
Kidneys functions
e
r
starts what
A
Excretion of water and electolytes
Reabsorption for regulating fluid/ electrolyte balance in body
Starts the Renin-Angiotensin-Aldosterone System
24
Q
what happens in kidney failure
Fluid balance
A
gain more fluid
fluid can go to different parts of body and become overloaded
25
what happens in kidney failure
what goes up
what goes down
high-phosphate, fluid, potassium, magnesium
low-calcium
26
what causes RAAS to start
decreased, decreased, increased
Renin-angiotensin-aldosterone system
Decreased pressure,
decreased sodium delivery
and increased sympathetic delivery causes
27
Nephrons produce what
raas
renin
28
renin does what
goes where
changes to
which converts to _angiotension 1_
, goes to lungs,
changes to _angiotension 2
29
what is angiotensin 2
which does what
which then does what
__- a vasoconstrictor-
which increases BP and thirst,
which increase blood volume
30
angiotensin 2 stimulates what
to release what
and stimulates adrenal gland
to release __aldosterone__
31
aldosterone does what
leading to what
which increases Na and water retention,
leading to increased blood volume
32
RAAS simplified
kidneys
travels
this
Kidneys release Renin, converts Angiotensin I .
Travels to the lungs, meets ACE and change to Angio II (Potent vasoconstrictor).
This (Angio II), stimulates the adrenals to release aldosterone
33
Too much Angio II???
increases _arteries
increases resistance
remodeling of
Increases inflammation in the arteries-inc bp
Increases body's insulin resistance
Remodeling of the heart muscle- the myocardium enlarges and also the conduction system is disrupted
34
what does too much angio 2 cause
hypertension
heart failure
35
Antidiuretic Hormone-
does what to water
reabsorption of water
save water and therefore less urine
36
when in ADH released
stress like pain, surgery, anesthesia
and low bv
37
when is ADH inhibited
a
m
increased
decreased
alcohol,
meds ,
increased blood volume
decreased serum somalaroty
38
Body Fluid Regulator - ANP BNP
opposes
inhibits
blocks
promotes
Opposes renin-angiotensin-aldosterone system
inhibits renin secretion,
blocks the secretion of aldosterone,
promotes Na+ loss and diuresis in the kidneys.
39
What do high levels indicate?
ANP BNP
cardiac stress
BNp could mean heart failure
40
Children
Percentage of water is _____
Metabolic rate is ____
Kidneys
Respirations are ____
Skin-
Risk for dehydration
Percentage of water is high
Metabolic rate is high
Kidneys are immature
Respirations are high
Skin-lose a lot of water from skin
41
FVD causes- Fluid loss examples
loss
h
h
med
__ disorders
GI loss (N/V/D, suction)
Hemorrhage
Heat (Exercise or environment)
Medications (Diuretics, laxatives)
Renal and endocrine disorders
42
FVD causes- poor intake examples
p l
decreased
Physical limitation
Decreased thirst mechanism
43
fvd causes- fluid shift examples
Second or Third spacing
44
FVD causes- older adults
renal
regulation
decreased
undetected
no
med use
renal blood flow decline,
NA, water regulation less efficient ,
decreased perception of thirst
, , undetected fever,
older adults with no air conditioning,
laxative use
45
Hypovolemia-
where is fluid drawn into
not enough fluid in patient
fluid is drawn into vascular compartment from interstitial spaces in attempt to maintain tissue perfusion
46
what fluid will you replace with in FVD
when to give blood in fvd
isotonic and blood
give blood if h/h under 7
47
second spacing
third spacing
what does it mean
-Fluid volume deficit-
2- shift of fluid to interstitial spaces
3-shift of fluid to transcellular spaces
trapped fluid is unable to support cardio/renal function
48
what is third spacing triggered by
increased
decreased
increased vascular permeability
decreased protein levels
49
why can second/third spacing cause fluid volume deficit
renal
leads to
allows
renal blood flow falls
leads to vasodilation
allows fluid to accumulate in interstitial tissues
50
s/s FVD
rapid
skin
tension
neck
rapid weight loss-2% mild,5% moderate, 8% severe
tenting skin turgor
postural/orthostatic hypotension
falt neck veins
51
Compensatory mechanisms to preserve circulation in FVD
cardia
skin
decrease
increase
tachycardia,
pale cool skin (vasoconstrictor )
decreased urine output
increase in specific gravity
52
older adults s/s FVD
changes
MM
increased
temp
cardia
facial
Change in mental status, memory or attention/
/ dry oral mucous membrane
, increased tongue furrows,
subnormal temperature,
tachycardia
pinched facial expression
53
FVD Diagnosis
Electrolytes- in isotonic// in water loss
Serum osmolarity
H&H-
Urine specific gravity-
Central venous pressure-
Electrolytes- in isotonic defeat-only sodium is normal// in water loss- sodium's high
Serum osmolarity if water loss. High osmalarity
H&H-elevated
Urine specific gravity-increased
Central venous pressure-cvd decreased
54
FVD Assessment
assess for what
v
c
p p
daily
/
monitor lab
Assess for the clinical manifestations of FVD
VS-every 4 hours
CVP
Peripheral Pulses
Daily weight
I/O
Monitor Labs-electrolytes, serum omslaity, BUN
55
FVD Treatment: ORal
replace
if mild-
if more severe-
Replace gradually
If FVD is mild-
water
If FVD is more severe-
Water and electrolytes
sports drink, ginger ale or rehydrating
56
FVD Treatment: IV
may need when
what type of iv fluid
if severe and/or unable to drink
Lactated Ringer’s- Na+, K+, Cl-, Ca+, Mg+
0.9% NaCl (NS)
May need to add additional electrolytes
57
FVD- Treatments
Fluid challenge (Bolus)- what adminster
sees if what
Assessments we should be obtaining?
rapid iv infusion of isotonic solution
sees is cardiac/renal or if deficit
if in deficit vs will go back to normal
58
isotonic iv
types
what does
monitor for in all iv
NS, LR
same concentration as normal body
monitor for fluid overload in all iv solutions and disconrinue
59
hypotonic iv
types
what does
0.45 NS
Pulls water into cells
60
hypertonic
type
does what
\-3% NS
, draws fluid from cells.
61
when to not adminster lactated ringers
what monitor with ringers
blood ph
do not administer lactated ringer in liver disease due to acidosis
if ringers are administered, monitor potassium and cardiac rhythm
do not administer if ph of blood is more then 7.5
62
when should d5w not be administered
for at risk cerebral edema
63
When to not administer hypotonic solutions
-do not adminster for at risk intracranial pressure-
do not administer for at risk third space shifts
64
risk for intracranial pressure
trauma, stroke, surgery
65
risk for third spacing shifts
\-burns, trauma, liver disease, malnutrition
66
what to monitor for in hypertonic solutions
monitor for inflammation and infiltration- caused cells to shrink
monitor sodium levels
monitor circulatory overload
67
when to not adminster hypertonic solutions
diabetic ketoacidosis
impaired cardiac or kidney function
68
Nursing Interventions Dx- Deficit Fluid Volume
assess:-
&
assess
daily
administer/monitor
monitor
perfusion
safety issues
I&O-
Assess vital signs, CVP
Daily weight
Administer and monitor fluid intake
Monitor lab values-
Perfusion issues- kidneys, cerebral
Safety issues-change in LOC, dizziness, confusion, restlessness, anxiety
69
reducing risk for injury-
how to reduce orthostatic hypotension-
Fluid volume deficit
reduce risk for injury-safety precautions- bed in low position and slowly raising from supine to sitting/standing
tach how to reduce orthostatic hypotension-
move in stages
avoid prolonged standing
rest in recliner
use assistive devices to pick up
70
how to prevent fluid deficit
avoid
increase
if vomiting
reduce
importance
avoid exercising during heat
increase fluid intake in hot weather
if vomiting, rake small amounts of ice chips or clear liquids,
reduce intake of coffee, tea and alcohol
importance of maintaining fluid
71
when to see HCP
what will nurse do
Children With FVD
see HCP- Severe Vomiting and/or Diarrhea:
Replace fluids and treat the cause of diarrhea to minimize fluid loss.
72
measuring fluid intake in children--breasdtfed, weight
measuring fluid output in child -estimate, diapers
Fluid intake in child- breastfed in measured in minutes, weight before/after feeding,
Fluid output in child- estimate vomit output, diapers can be measured before/after,
73
enteral feeding in children why
Enteral feedings can be used in children because they help preserve stomach mucosa and have no risk of infiltration.
74
Mild dehydration s/s
r
v
t
/
fontanels
has
dehydration in children
restless,
vs,
turgor
, u/o,
fontanels normal,
has tears.
75
Moderate dehydration s/s children
I
l
_tensive
_cardic
_skin_
__mucous membranes
decreased__
__fontanels
irritable,
lethargic,
hypotensive,
tachycardic,
poor skin turgor,
dry MM,
decreased tears,
sunken fontanels.
76
Severe dehydration s/s children
no
no
pulse
- no urine,
no tears,
rapid weak pulse
77
Prevention- dehydration in children
proper
safe
safe
proper clothing,
safe isolette temp,
safe exercise
78
rehydration- in children
types
amounts
ex
avoid
PO or IV
Small, frequent amounts
Ex. Clear liquids, pedialyte
Avoid concentrated simple sugars due to osmotic affects
79
what to do if Diarrhea >24 hour in children
– stool cultures (may need antibiotic)
80
Elderly With FVD
not reliable
tension
mucous
changes in
Skin turgor not a reliable sign
Orthostatic hypotension
Dry mucous membranes
Mental status changes
81
FVE
results when
can lead to
Results when water and sodium are retained in body
can lead to hypervolumia and edema
82
causes of FVE
failure
cirrhosis
failure
disorders
administration
heart failure
liver cirrhosis
renal failure
adrenal gland disorders
corticosteroid administration
83
Nuerlogic manifestations of FVE
4
changes in loc
confusion
headache
seuizures
84
respiratory manifestations FVE
pulmonary congestion-crackle sin lungs
85
cardiosvasular manifestaitons in FVE
incresed x3
presence
cardia
increased bounding pulse
increased bp
increased JVD
presence of s3
tachycardia
86
gi manifestaitons inFVE
anorexia
nausua
87
edema in FVE
dependent pitting edema
88
s/s of FVE
Weight
Respiratory
Urine output
Edema
Altered mental status
Cardiac
89
FVE: Diagnosis
Electrolytes
H/H-
Renal function-
Liver function-
Urine specific Gravity-
Electrolytes- normal
H/H- decreased
Renal function- determani cause
Liver function- determain cause
Urine specific Gravity- decreased
90
complications of FVE
CHF
91
Assessment of FVE: History
Medications
Medical
-Heart failure
-Kidney disease
-Liver failure
Diet
92
medications in FVE
diretics
93
loop diretics
what type
promotes what
works where
-ide" like bumetanide furosemide /
/promote excretion of sodium, chloride, potassium and water-
worls on loop of henle//
94
Thaizade-
ends in what
promotes what
woks where
ends in thiazide-
promote excretion of sodium, chloride, potassium and water by decreasing absorption-
works on dital convoluted tubule
95
potassium sparing-
works where
what drug
promotes what
worls on distal nephron,
spironolocatone,
promotes water echange and inhibits potassium
96
Fluid management- FVE
subtract
palce
offer
give
adminster
subtract required fluid from total daily allowance/
place allowed amounts in small glasses/
offer ice chips/
sugarless chewing gum/
admisnter cautoisly
97
dietary management FVE
avoid------
LOW sodium
avoid lunch meat, bacon, cheese, dry cereal. canned soup. popcorn, ketchup, pickles seafood
98
reduce risk of skin breakdown
assess
reposition. how often
what helps
and oral care how often
- asses bony provinces,
reposition every 2 hours,
egg crate mattress, alternating pressure mattress, foot cradle, heel protector,
Oral Care-e very 2 hours
99
Patient education//Diretics-
dont take
make
avoid
daily
no
always
replace
don’t take at night,
make slow positional changes,
avoid salt,
daily weights,
no salt substatiuts in potassium sparing
reports dizziness
always taken
replace potassium with orange juice and banana
100
management of FVE
daily
assess extent
urine
assess v
assigns lungs
daily wights
assess extent of edema
assess urine output
assess vitals
assess lungs for crackles
101
FVE in children causes
tumor
c
l
failure
adrenal tumor,
CHF,
liver
renal failure
102
FVE s/s children
sudden
edema where
S-sudden wt. gain,
edema in dependent areas (sacrum, genitals)
103
FVE in risk factors children
rapid iv infusion
104
Sodium
major
NA=
critical level
increased sodium=
Major Electrolyte
Na+ = Neuromuscular
critical level is under 120
increased sodium = increased water retention
105
what happens to cells when sodium levels are low
when high
When sodium levels are low (hyponatremia), water is drawn into the cells of the body, causing them to swell. hyponatramia= hypervolemia
In contrast, high levels of sodium in ECF (hypernatremia) draw water out of body cells, causing them to shrink//hypernatramia=hypovolemia
106
How much do we need daily sodium
where is intake most common w/ other sources
500 would meet needs, intake of no more then 2300, with ideal of 1500 mg
Intake:
Most common: dietary
Other sources: meds
107
primary regulator of sodium
kidneys
108
GFR goes up wen
when there's a rise in blood volume
rise in fitler rate
109
when blood volume falls, what is stimulates
RAAS and ADH
110
hyponatrimai patho- from hypovolemia
gi-
skin-
adrenal-
med type
iv solution
GI-N/V/D, NG suction
Skin-sweat, wounds, burns
Adrenal insufficiency-Addisons
Diuretics
Hypotonic IV Solution (Na goes into the cell)
111
hyponatrmia from hypervolemia
excess
S
systemic diseases-
patho
Excessive H2O intake
SIADH-body retains fluid
Systemic diseases- heart failure, renal failure, cirrhosis of liver
112
early manifestations of hyponatramia
3x
gi-4x
muscle cramps
weakness
fatigue
gi- anorexia, nausea, vomiting, abdominal cramping
113
nueroligcal manifestations of hyponatramia (<120)
h
d
duled
changes in
I
L
refelxes
mt
s
headache
depression
dulled sensorium
personality changes
irritibiltiy
lethargy
hyperreflexia
muscle twitching
seizures
114
manifestations of hyponatramia
in decreased ECF volume
in dilutional
decreased ecf volume- s/s FVD-
dilution- s/s of hypervolemia
115
severe loss of sodium leads to what
coma due to cerebral swelling
116
Hyponatremia- Diagnostic tests
serum sodium/osmalarity
24 hr urine-
in increased volume, in loss of fluids
Serum sodium- decreased
Serum osmolarity- decreased
24 hour urine specimen-in increased volume- sodium high,
in loss of fluids- sodium decreased
117
hyponatremia Interventions
hypovolemia
replace
diet
Replace with isotonic solutions
Diet- increase Na+
118
hyponatremia Interventions
hypervolemia
meds
fluids
diet
Diuretics furosemide to get rid of fluid
Fluid Restriction
Diet- increase Na+
119
hyponatremia Interventions
if severely low-110-115
what oral
and what iv fluid
need what if iv
Sodium tablets
3% hypertonic NaCl (Na+ 110-115 mEq/L) – administer cautiously
need central line
120
Clients At Risk hyponatramia
Athletes
Workers
Elderly
Children
121
Nursing Interventions for Imbalanced Fluid Volume
monitor
daily
24
could be
hyponatramia
Monitor I & O,
daily weight,
24 hour fluid balance
could be FVE or FVD
122
Nursing Interventions for Imbalanced Fluid Volume
iv fluids-monitor for wgat
bp
c
h
r
d
c
what if ordered
carefully monitor for Fluid volume excess
Hypertension
, CVP
, HR
, RR,
Dyspnea,
crackles
Fluid restriction if ordered
123
Nursing Interventions for Imbalanced Fluid Volume
Monitor for s/s of ineffective cerebral tissue perfusion-
na 115-120
na 110-115
assess neurologic changes and muscle strength
Na+ 115-120- Headache, lethargy
Na+110-115- Seizures, coma
124
hyponatramia education
fluids
manifesations
older adults
increase fluids containing sodium
manifestaitons to report to hcp,
older adults have increased risk from medications.
125
Hypernatremia causes MODEL
M- Medication
O- Osmotic diuresis
D- Diabetes Insipidus
E- Excessive water loss
L- low water intake
126
hypernatramia also caused by
excess
h/b
excess
excess iv fluids and food
hyperventilation/burns
excess water loss from watery diarrhea, fever
127
Patho of Hypernatremia
Hyperosmolarity-
Cells shrink cell dehydration
128
initial s/s hypernatramia
first-
if not releived- primary manifestations are
l
w
i
thirst,
if not releived
lethargy,
weakness
irritable
129
prolonged s/s hypernatramia
s
c
d
potentially complications
seizures,
coma,
death
130
brain cell
both
na
Brain cell dehydration leads to bleeding.
Both high or low N+ lead to cognitive issues.
131
Hypernatremia: S/S
increased
decreased
dry
h
r
s
cardia
tension
Increased thirst
Decreased urine output
Dry skin and mucous membranes
Headache,
restlessness
Seizures
Tachycardia
Hypotension
132
Diagnosis of Hypernatremia
Serum sodium level- over 145
Serum osmolarity- high
133
Hypernatremia Assessment
health history
physical
diagnostic tests
Health history-
precipitating factors, current medications, perception of thirst
Physical-
Vitals
LOC
I&Os
Diagnostic tests-
Na+, osmolality
134
Medication Treatments hypernatrmia
'
main treatment?
how fast
what iv fluids-
what meds-
Main treatment: replacing with fluids
SLOWLY
What type of IV fluids? hypotonic
Diuretics? Can increase sodium excretion-add fluids
135
Interventions for Risk for Injury hypernatramia
monitor/maintain
monitor _function
institute
re
monitor for
Monitor and maintain fluid replacement
Monitor neurologic function
Institute safety precautions as necessary- keep bed low and side rails up
Reorient
Monitor for Seizures-
136
hypernatramia education
importance of
following
importance
Impirtance of responding to thirst and consuming adequate fluids,
following a low soidum diet,
imprtance of monitoring levels
137
Potassium-
major
essential
ompacts
Major electrolyte within the cells
Essential for cardiac and neuromuscular function
Impacts pH
138
potassium foods
Must be obtained in food daily
bananas
iranges
avocados
spinach
potatoes
meat
seafood
milk
139
potassium regualtion-High K+ in serum
Increase the Aldosterone release
Kidneys increase K+ excretion
140
potassium regulation low k
Nothing happens: Kidneys do not conserve K+ well
141
Renal Failure and K+
impaired renal excretion of potassium is primary cause of hyperkalemia
142
Hypokalemia causes
excess
losses
meds-3
loss
reduced
Excessive loss of K+
GI losses- diarrhea, ileostomy drainage
Medications- Diuretics-corticosteropids, antibiotics
Renal Loss
Reduced K intake
143
Manifestations of Hypokalemia
ECG changes-
Muscles-
secretion//high
urine
ECG changes-depressed ST, U waves
Muscles- leg cramps
decreased Insulin secretion-glucose is high
dilute urine
144
urinary 3
manifestations of hypokalemia
-dilute urine,
polyuria, -excess urine production
polydipsia-excess thirst
145
gi
/
a
d
bowel sounds
i
manifestations of hypokalemia
n/v
anorexia
diarrhea
decreased bowel sounds
lieus
146
musculoskeletal
f
cramps where
m w
poor
hypokalemia
fatigue
leg cramps
muscle wekaness
poor muscle tone
147
cardiovascular
d
pulse
p h
risk
hypokalemia
dysthymia's
irregular weak pulse
postural hypotension
increased risk of dig toxicity
148
Diagnosis of Hypokalemia
Serum potassium-
mild
moderate
severe
ABGs-
Renal function studies-
ECG
Serum potassium-
3-3.5- mild
2.5-3- moderate
< 2.5mEq/L- severe
ABGs- alkalosis-pH increased >7.45
Renal function studies- check creatinine and BUN, GFR
ECG--depressed ST, U waves
149
complications of hypokalemia
resp arrest
cardiac arrest
150
Hypokalemia - Assessment
health history
physical
test
assess for causes
Health history-
current manifestations, duration, current meds, diet
Physical-
LOC changes, VS, pulse, decreased BS, muscle weakness, nausea, vomiting, abdominal pain
Diagnostic tests
Assess for causes-
diuretics, prolonged N/V/D or chronic
151
Assessments for Hypokalemia
monitor what
assess ecg-what looks like
how is pulse
check levels of what
muscle strength
bowel sounds
pain where
Monitor serum K levels
Assess VS and ECG- depressed ST, U waves
- thready pulse, weak
Check digoxin levels
Muscle strength weak
Bowel sounds hypoactive
Abdominal pain
152
oral supplements
dilute
give-why
give
Hypokalemia IMMEDIATE Interventions
dilute oral in vegetable juice/
/ give oral with food-can cause gi upset
give chilled
153
iv supplements -potassium chloride
infuse rate
no
no
monitor
give where if possible
Hypokalemia IMMEDIATE Interventions
infuse at rate slower then 10 meq//
no iv push
no undiluted
cardiac monitoring
give in cvad is possible
154
hypokalemia
digitalis toxicity
- fatigue,
weakness,
hypotension,
nausua
155
Hypokalemia Long Term Interventions
dont take what in potassium sparing diuretics
when to take potassium supplements
diet
do not w/ tablets
Do not take potassium supplements or salt substitutes if also taking potassium sparing diertic,
take potassium suplemetns woth meals,
high potassium diet,
do not chew coated tablets,
156
Hyperkalemia- causes
main
disease
inadequate
meds 3x
a
rapid
Main: Renal failure/Impaired excretion
Addison disease
Inadequate aldosterone
Medications- Potassium sparring diuretics- ACE(pril) I- ARBs(artan)
Acidosis
rapid iv administration
157
early manifestations of hyperkalemia
d
cramps where
a
p
I
m t
t
diahhrea ,
colic-ab cramping-pain in waves
anxiety
parestheasas
irritability
muscle tremors
twitching
158
later s/s of hyperkalemia
muscle//progresing
(what's affected first)
hr
muscle weakness progressing to paralysis
lower extremities affected first
hr bradycardia and irregular
159
what do t waves look like in hyperkalmia
tall t waves
tombstone t
160
Diagnosis of Hyperkalemia
serum electrolytes
ABG
ECG
Serum electrolytes- potassium over 5.3, low calcium and sodium
ABGs- determnain acidosis
ECG- peaked t waves,prolonged pr and qrs
161
Hyperkalemia complications
dysrtymias
162
Medications to Correct Hyper K+
what helps for 1 hr
what rapidly lowers levels
s
d
Calcium gluconate-helps for 1 hr
Insulin, glucose, sodium bicarb IV- montor bradycardia
Sodium polystyrene sulfonate-monitor sodium and poop
Diuretics-furosemide
163
when do you give diuretics in hyperkalemia
only if real function is normal
164
when dialysis in hyper kalmia
When renal function is severely impaired and other measures are ineffective.
165
what education in hyperkalemia
monitor repose
diet
avoid
Monitor response to iv calcium gluconate- calcium can increase digitalis toxocity
Diet and restrict salt substituts and high potassium foods
Avoid fitness and over the coutner supplements
166
Calcium Imbalance
sources
where is calcium
Sources-
99% of all body calcium is in skeleton
167
what % in body// where bound to
bones
bound extraceullar
ionized extracellular
bones -99%/phosphorus
bound extraceullar ions.5% proteins
ionized extracellular .5% nothing
168
Calcium helps with:
stablizes
muscle
function
blood
Stabilizes cell membranes
Muscle contractions
Cardiac function
Blood clotting
169
parathyroid gland
when ca is what
increases reabsorption where
increase absorption where
increase what reabsorption
increase what levels
Balance of Calcium in Body
When Ca is low:
Increases bone reabsorption (release to blood)
Increases GI absorption
Increases tubular reabsorption
Increases serum calcium levels
170
calcitonin
when ca is what
released by
oposes
decerases absoption
increases mineralization
promotes
decreases what
Balance of Calcium in Body
When Ca is high:
Released by thyroid gland
Opposes parathyroid hormone
Decreases GI absorption
Increases bone mineralization
Promotes renal excretion
Decreases serum calcium levels
171
Balance of Calcium in Body Calcitriol
metabolite of what
increase bone
increase absorption
increase reapportion
increase levels
treats low calcium in what
vit d metabolite
Increases bone release to blood
Increases GI absorption
Increases tubular reabsorption in kidneys
Increases serum calcium levels
treats low calcium in kidney disease
172
Hypocalcemia-causes
H
acute
: hypoparathyroidism,
acute pancreatitis
173
Hypocalcemia- risk factors
p
intoleracne
adults
a
med
: parathyrodectomy ,
lactose intolerance,
older adults,
alcoholism
diuretic usage
174
neurological manifestations hypocalcemia
most serious-2
What/where
dtr
+
most serious -tetany/convulsions
Numbness and Tingling - Face (mouth Hands and feet
dtr hyperactive-
positive C/t
175
cardiovascular manifestations hyocalcemia
tension
cardia
vd
hypotension
bradycadia
ventrilar dystrymias
176
CATS of Hypocalcemia
C-convlusions
A-arrhythmias
T-tetany
S-spasms and stridor
177
complications of hypocalcemia
ao
vd
ECG
ca
airway obstruction- largyngospasm (emergency
ventricular dystrymias
prolonged qt intervals
cardiac arrest
178
Diagnosis of Hypocalcemia
Total serum calcium-
Serum albumin-
Serum magnesium-
Serum phosphate-
Parathyroid hormone-
ECG-
Total serum calcium- low
Serum albumin-low
Serum magnesium-low
Serum phosphate-high
Parathyroid hormone-low
ECG-prolonged qt
179
Interventions for Hypocalcemia tetany
provide a quiet environment
institute seuizure precautions
airway at bedside
180
Oral calcium hypocalcemia
administer when
give with
also give
administer 1-1.5 hours after meals and at bedtime
/ give with water and not milk
also give vit d
181
IV calcium hypocalcemia
why is it used
given how fast
adminster where
do not adminster with
used to prevent life threatening airway obstruction
may be given by slow iv push
, adminster in largest vein,
do not admisnter with sodium bicarb
182
potential problems with iv calcium
if infiltrated
if too rapid off drug administration
Iv calcium can cause necrosis and sloughing of tissue if infiltrated into subcutaneous
Rapid drug administration can lead to bradycardia and possible cardiac arrest due to overcorrection
183
hypocalcemia education
maintain
calcium carb can cause
, maintain adequate vit d intake,
calcium carbonate can cause constipation -eat high fiber diet.
184
Hypercalemia- > causes
2most common
hyper
m
rest
failure
increased
excessive
2 most common
Hyperparathyroidism
malignancies
Bed rest
Renal failure-
Increased Vit. D intake
Excessive intake (antacids)
185
Muscle- Manifestations of Hypercalcemia
2
muscle weakness
fatigue
186
GI Manifestations of Hypercalcemia
-anorexia
nausea
vomitong
consitaption
187
CNS Manifestations of Hypercalcemia
5
-difficulty concentrating
confusion
lethargy
behavior changes
coma
188
Cardiac--Manifestations of Hypercalcemia
3
dysrthmias
ecg changes
hypertension
189
complications of hypercalcemia
disease
p
excess
kindey
peptic ulcer disease
pancreatitis
excess calcium
kindly stones
190
Diagnosis of Hypercalcemia
serum calcium
serum PTH
ECG
why bone density
Serum electrolytes- high calcium
Serum Parathyroid hormones-high
ECG- shortened st
Bone density-monitor bone reaboption
191
Medications/ Fluid Management hypercalcemia
main one
diretic// when
emergency reversal
what iv fluid
Calcitonin-
Diuretics- furosmemide// in acute
IV sodium or potassium phosphate- emergency reversal
isotonic iv fluid
192
what drugs are used in malignant hypercalcemia
"ate" drugs
bisisophanates-
pamidronate
etidroante
193
hypercalcemia
diet
type of iv fluid
drink what
Low calcium diet
Isotonic IV fluid
drink cranberry juice
194
what puts them at Risk for injury- hypercalcemia
c
precutions-when
w/
caution-why
confusion,
safety precautions if changes in mental status
weak/ fatigued
caustion with turning postioning and ambulating- have weak bones in reabsorption
195
Risk for excess fluid volume- hypercalcemia
in what//whose at risk
+
sounds
__up
meds
-renal failure
, I+O,
heart and lung sounds,
HOB up,
diuretics
196
education in hypercalcemia
avoid
increase
maintain
hypercalcemia can cause
avoid intake of calcium rich foods/antacids
increase fluid intake to 3-4
maintain weight bearing physical activity
Hypercalcemia can cause bradycardia, cardiac arrest,
197
function of mamgensium
reactions
synthesis
where is most
enzyme reactions
synthesis of proteins and nucleic acids
in the bone
198
dietary sources magnesium
green vegetables
seafood//meats
nuts
milk
199
Hypomagnesemia- < 1.8 mg/dL
common problem for who
may be caused by//deficent, excessive,
d
d
Common problem for critically ill
May be caused by deficient intake, excessive losses or shift from extracellular to intracellular
dka
diretics
200
hypomagnesemia risk factors
loss
e
m
d
loss of gi fluid
ETOH
malnutrition
diuretics
201
Neuro muscular
-Manifestations of Hypomagnesemia
6
tetany,
seizures
hyperactie reflexes,
positive chovestek and trousseau ,
nystagmus-twitching og eyeball
-tremors,
202
cardiac Manifestations of Hypomagnesemia
2
hypertension
tachycardia
203
cns Manifestations of Hypomagnesemia
4
confusion
mood changes
hallucinations
possibl;e psychoses
204
treatment hypomagnesemia
mild deficiency treated with what
mild- oral magnesium and diet of high magnesium
205
diagnosis hypomagnesemia
prolonged pr interval,
widened qrs complex,
depression of st
206
treatments hypomagensmia if manifestations
treated with
what to do before that
adminster im where
treated with parenteral magnesium sulfate-
evaluate renal function prior to administration-
administer im into ventral gluteal and monitor neurologic status
207
Hypermagnesemia-
how common
develops when
with what meds
less common
renal failure
laxatives
208
lower levels-
/
tension
face
s
feeling
Manifestations of Hypermagnesemia
n/v,
hypotension
, facial flushing,
sweating
, feeling of warmth
209
as levels increase
hypermagnesemia
lethargic
drowsiness
weka/absent dtr
210
marked elevation of magnesium
potential complications -3
hypermagnesemia
resp distress
coma
compromised cardiac function
211
Hypermagnesemia Interventions
stop
d
iv what
Stop magnesium containing medications
Dialysis
IV calcium gluconate-reverses neuromuscular and cardiac effets
212
monitor for
decrease-may need
ineffective-may need
risk
Hypermagnesemia Interventions iv calcium gluconate
decreased cardiac output (may need pacer)
ineffective breathing patterns (may need vent)
risk for injury
213
Phosphate Imbalance
essential for what
and formation
__function/metabolism
Essential for intracellular processes like ATP-
RBC formation,
nervous system and muscle function and metabolism
214
calcium and phosphate relationship
as one goes down one must go up
215
Hypophosphatemia- < 3 mg/dL causes
syndrome
meds
a
ventilation
a
refeeding syndrome
meds like iv glucose
alchohism
hyperventilation-
alcohol
216
CNS Manifestations of Hypophosphatemia
I
a
w
p
lck
c
s
c
irritability,
apprehension,
weakness,
paresthesias,
lack of coordination
, confusion,
seizures,
coma.
217
Hematologic
cardiac
gi-decreased,anv.
Manifestations of Hypophosphatemia
Hemolytic anemia (excessive RBC destruction) may develop due to lack of ATP -
cardiac-chest pain -dystrhmias
gi- anorexias, nausua/ vomiting, decreased bowel sounds
218
Musculoskeletal- Manifestations of Hypophosphatemia
weakness
release
acute
muscle weakness,
release of CPK,
acute rhabdomylosis
219
Interventions hypophophatemia
Dietary
Medications
Monitor for?
Dietary - high phosphate
Medications oral phospahte
Monitor for? seizures and coma
220
foods high in phphate
meat
dairy
nuts
221
Hyperphosphatemia- causes
failure of
rapid
shift of
altered- excess
Acute or chronic renal failure-
Rapid administration of phosphate containing solutions
Shift of phosphate from intracellular to extracellular
Altered calcium levels- excess vit d
222
Manifestations Hyperphosphatemia
5
muscle cramps and pain,
paresthesias,
tingling around the mouth,
muscle spasms,
tetany)
223
Interventions hyperphosphatemia
treat
monitor
treat underlying disorder
monitor for hypocalcemia
224
Chloride
cellular
works with
part of
n
is apart of
imbalance is caused by
Extracellular
Works with sodium
Part of HCL
Normal
Cl- is part of salt
Imbalance caused by other imbalances like Na+ and corrected by fixing the other imbalance
225
Diabetes Insipidus
Result
renal tubules
neurogenic
nephrogenic
Result of ADH insufficiency
renal tubules are not sensitive to ADH
neurogenic is cause from hypothalamus and nephrogenic is caused from renal tubules not being sensitive
226
Who is at risk for developing?
brain
surgery
accidents
failure
closed
Diabetes Insipidus
-- brain tumors /infections,
pituitary surgery,
cerebrovascular accidents,
renal/organ failure.
closed head trauma w/increased intracranial pressure
227
Diabetes insidious manifestations
large
p
d w/
large amounts of dilute urine(12)L,
polydipsia-extreme thirst and drinks large water,
dilute w/ low specific gravity urine
228
diabetes insidious
What diagnostic tests would be performed?What results would be expected?-
sodium
serum osmolarity
specific gravity
hypernatremia,
high serum osmolarity,
low specific gravity
229
What are the potential complications? diabetes insidious
If patient is unable to replace water loss they get dehydrated and hypernatremic,
230
What treatments/interventions would be used to treat (including diet and medications)?-
initally
replacing
what iv if high sodium
what do if high sodium
initially correcting fluid deficits,
and replacing ADH with vasopressin
hypotonic solutions are used if sodium is high
seizure precautions id sodium is is high
231
Syndrome of Inappropriate Anti-diuretic Hormone-
high levels
water
urine
high levels of ADH
water retention
small amounts of concentrated urine output
232
Syndrome of Inappropriate Anti-diuretic Hormone-
l/h
injury
disease
adverse reaction
whose at risk
lukemia and hodkpngs lymphona
heda injury
pulmonary disease
adverse reaction of sari
233
Syndrome of Inappropriate Anti-diuretic Hormone-
diagnostics
sodium
osmoloarity
specific gravity
low sodium,
low osmolarity,
high specifc gravity
234
Syndrome of Inappropriate Anti-diuretic Hormone- manifestations
urine- output/c
natramia
fluid w/
changes
wt w/
Hyponatremia-
fluid retention with thirst ,
decreased urine output and concentrated urine,
mental status/personality Changes,
Weight gain w/ no edema
235
Syndrome of Inappropriate Anti-diuretic Hormone-What are the potential complications?
too rapid
what if hyponatramia
Too rapid replacement of sodium can case demyelination of central nervous system
seizures if hyponatremia is severe leading to cerebral edema
236
Syndrome of Inappropriate Anti-diuretic Hormone-interventions
restrict
keep
med
iv fluid
Restrict fluids,
keep patient safe /
/ loop diuretics-excretion of fluid volume//
iv hypertonic solution if severe
237
Adult with Gastroenteritis
Who is at risk for developing?
Goes in body through food, no real risks for anyone
238
Adult with Gastroenteritis manifestations
a
n
d
ab
bowel//and
sounds
Anorexia/ n/v,
diarrhea
abdominal discomfort,
bowel distention and tender,
loud and hyperactive sounds
239
Adult with Gastroenteritis- diagnostics
lab testing
sigmoidoscopy why
lab testing to causative organism and to assess fluid electrolyte imbalance. ,
sigmoidoscopy to differentiae ibd from infections
240
Adult with Gastroenteritis- complications
electrolyte imbalances- hypos
hypovoemiv shock
241
Adult with Gastroenteritis interventions
should
if manifestations
replacing fluids->
precautions
Should resolve on own, so no meds required unless severely ill or prolonged
manifestations- then look for “mycin” antibiotics- need stool culture first. /// antidiarrheal promote comfort
replacing lost fluids-> oral rehydration
iso precautions
242
Adult with Gastroenteritis
if getting culture
importance of
wash
importance of
dont leave
If getting stool culture, use clean bedpan and avoid urine and toilet paper if possible to get best results
importance of hand hygiene,
wash clothing and linens, oral solutions,
, importance of proper food handling
,don’t leave dairy products or egg products at room temperature
243
Metabolic acidosis-
inc
urine
results from
inc respirations,
acidic urine,
results from diahhrea because lots of sodium is lost
244
Metabolic alkalosis-
from
what's lost
respirations
from vomiting,
chl is lost,
slow respirations,
245
why not hypo/hyper fast administration
can cause fluid shifts that will overcorrect
