Exam #4 Flashcards
What 2 hormones and glands regulate calcium
What is needed for Ca+ absorption
How does it work
- Thyroid secretes calcitonin when Ca+ is too high to increase resorption in bones and decrease absorption in kidneys and intestines
Parathyroid hormone: stimulates the renal conversion of vitamin D into calcitriol which increases calcium and phosphorus release from the bones and increases reabsorption from intestine and kidneys (excretes phosphorus in the process) - Vitamin D is needed for calcium absorption and Mg+ (for PT to secrete PTH)
How is calcium in the body
What does calcium do for the body (3)
99% of calcium is found in the bones (1% in plasma and body cells)
- Serum calcium= free ionized + albumin bound (bound to albumin and phosphorus)
- Free ionized calcium is biologically active and is used for
Nerve impulse transmission, muscle and myocardial contractions, cross linking of fibrin threads (clot formation)
Hypocalcemia causes (8)
Vitamin D deficiency/ impaired absorption (need calcitriol to absorb Ca+)
Kidney disease (need kidneys to convert Vit D to calcitriol)
Hypoparathyroidism (d/t cancer/ neck surgery)
Hypoalbuminemia (Ca+ is bound to albumin in bone)
Hyperphosphatemia (calcium is excreted d/t increase relationship
Hypomagnesmia (my is needed for PT gland to release PTH)
Diuretics (excrete electrolytes)
Chronic alcohol use (malnutrition)
Hypocalcemia symptoms (4) and nursing implications (5)
SYMPTOMS: Hyperreflexia
Tetany (Chvostek/ trousseau)
Numbness and tingling extremities and around the mouth
Cardiac dysrhythmias
Nursing implications
Increase vitamin D and Ca+ intake
Monitor post op thyroid/ neck surgery
Hold diuretics
Assess sensation, reflexes, cardiac rhythm
Monitor vitamin D, calcium, Phosphorus, mg+ and albumin (possibly PTH)
Hypercalcemia
Causes 3
Symptoms 4
NI 6
Hyperparathyroidism
Cancer with bone metastasis and other cancers
Excess Ca+ intake and antacids (made of Ca+)
Symptoms:
Hypoflexia
Muscle weakness
Lethargy, confusion, cardiac dysrhythmias
Kidney stones
NI:
maintain adequate hydration
Low Ca+ diet
Increase weigh bearing exercises
Assess mentation, reflexes and cardiac rhythm
Filter urine if needed
Monitor Ca+
Phosphate
What kind of electrolyte is it
What hormone/ gland regulates it?
What is required for balance of this electrolyte
Source
Primary anion found in the ICF
PTH maintains serum phosphate levels and balance
If PTH is low, phosphate excretion is low
Balance requires adequate renal function
Attained from intake of food
Phosphate functions 4
85% bound with calcium in teeth and bones
Helps convert carbs, proteins and fat into energy
Essential for muscle function RBCs and nervous system
Acid bas buffering system
Hypophosphatemia causes 5
Inadequate intake/ malabsorption issues
Chronic diarrhea
Vitamin D deficiency
Increased use of phosphate binding anti acids (mg, albumin and calcium)
Hyperparathyroidism
Hypophosphatemia symptoms
Similar to hypercalcemia
Confusion
Muscle weakness
Respiratory muscle weakness
Cardiac dysrhythmias
Hyperphosphatemia causes 3
Renal failure
Hypoparathyroidism
Chronic use of phosphate enemas
Symptoms of Hyperphosphatemia 4
Hyperreflexia
Tetany (Chvostek/ trousseau)
Numbness and tingling to extremities and around the mouth
Cardiac dysrhythmias
(Similar to Hypocalcemia)
BUN
What function does it indicate
What causes elevated levels and decreased levels 3 each
Measures the amount of urea nitrogen in the blood
Indication of kidney and liver function
Elevated: d/t increase protein intake, kidneys disease, dehydration
Decreased levels: liver disease, low protein diet, fluid volume excess
Creatinine
What does it measure/ indicate
Elevated levels d/t 4, low levels d/t 1
Waste product from protein digestion and normal muscle breakdown
Sensitive indicator of kidney function (excreted only by kidneys)
Elevated d/t: kidney damage, MI, high protein intake dehydration
Decreased d/t: low protein intake
Magnesium functions: 6
Transmission of nerve impulses
Needed for PTH secretion
Needed to maintain K+ levels via renal channels (membrane potential)
Regulation of insulin secretion by pancreatic cells
Stimulate glucose uptake from skeletal muscle
Muscle contraction and relaxation
3 causes of Hypomagnesmia
Chronic alcoholism
Inadequate intake/ diarrhea
Diuretics
Symptoms of Hypomagnesmia 4+
Resemble Hypocalcemia
Urinary excretion of K+
Decreased insulin sensitivity and secretion
Increased BP, HR and dysrhythmias
Causes of hypermagnesemia 2
Renal failure
IV/PO and Mg containing meds
Hypermagnesmia symptoms 4
Resembles hypercalcemia
Lethargy
Muscle weakness
Dininished deep tendon reflexes
Decrease BP and HR
Decreases heart condition
Causes of hypoglycemia (3)
Insufficient food intake
Excessive physical exertion
Hypoglycemic agents
Hyperglycemia causes 5
Excessive glucose intake
Insulin deficiency
Emotional. Physical stressors
Corticosteroid use
Parenteral therapy
Hypoglycemia signs and symptoms 8
Shakey
Sweaty
Dizzy
Confused and difficulty speaking
Hungry
Weak or tired
Headache
Nervous or upset
Symptoms of high blood sugar 6
Very thirst
Need to pee often
Very hungry
Sleepy
Blurry vision
Infections or injuries heal more slowly
Symptoms of anemia (low hemoglobin and hematocrit)9
Fatigue
Weakness,
Pale skin
SOB
Dizziness
Lightheadedness
Irregular HR
Chest pains
Headache
Purposes for parenteral therapy 3
resuscitation
Replacement
Maintenance
Hypertonic, isotonic and hypotonic solutions number of average osmolality
375, 290, 250
Do isotonic fluids affect blood pressure?
Yes, they will have a higher blood pressure d/t increased intravascular volume
When could isotonic solutions be used 6
Resuscitation (NS), replacement, increased volume, maintenance
Mild hyponatremia, hypercalcemia
(NOT LR b/c it has calcium)
When to use LR 2
Where is lactate metabolized
When is it contraindicated
Replacement and maintenance (SURGERY)
In the liver into HCO3
No not use if pt has liver disease or alkalosis
Precautions for Hypervolemia cause by isotonic fluids
3
Pulmonary edema
Hemodilution
Peripheral edema
When to use hypotonic fluids 2
Hypernetremia
Hyperosmolar hyperglycemia (to dilute solute concentration in the blood
Which solution starts as isotonic and becomes hypotonic
When to use it
5% dextrose
Becomes isotonic when metabolized (water shifts from ECF to ICF
Hypernatremia
What should use assess for/ be aware of when administering hypotonic solutions 3
Increased cerebral swelling (cerebral edema)
May worsen hypovolemia/ hypotension
Assess urine output
When to use hypertonic fluids 4
Severe hyponatremia, expand intravascular volume, cerebral edema, maintain/ replace electrolytes
What to be cautious of with hypertonic solutions
3
Risk for foluid voluem overload
Caution in cardiac or renal patients
Administer short term
(Pulmonary edema)
What does albumin do ( it is a colloid)
Increase colloidal oncotic pressure (pulling force) draws fluid from the interstitial to intravascular space
Used mostly in the ICU as a plasma volume expander
When is albumin used 3
Fluid volume deficit ( to increase BP)
Low albumin levels (low albumin levels leads to decrease oncotic pressure and can lead to fluid leaking out of the blood vessel and causing edema)
For patients who cannot tolerate large infusion
What to be careful with for albumin
2
Assess for pulmonary edema and do not use if pt has HF
(Fluid volume overload)
What pressure cause edema 3
increase venous hydrostatic pressure (hf, iv fluids)
Decreased plasma oncotic pressure (low plasma protein)
Increased interstitial oncotic pressure (accumulation of protein in the interstitial space)
What symptoms would be present with edema 6
Peripheral edema
Increased BP
Polyuria
Weight gain
Crackles is lungs and
Dyspnea (SOB)
What to assess with edema 6
Extremities
Lungs and heart sounds
Blood pressure
I&O
Urine color quantity and concentration
Labs
What is third spacing
Fluid accumulation in non- functional areas between cells
What are the causes of third spacing 4
Liver disease
Burns, trauma and sepsis
Signs and symptoms of third spacing 3
Hypotension
Edema
Low urine output
What is the body’s reaction to dehydration
(Receptors and hormones secreted)
Osmoreceptors arestimulates by increased osmolality
Osmoreceptors should signal thirst to hypothalamus
Osmoreceptors signal posterior pituitary to secrete antidieutic hormone (vasopressin)
ADH increases H20 reabsorption in the DCT and CD
Causes of dehydration 3
Increased plasma osmolality
Excessive fluid loss
Lack of ADP production
Signs and symptoms of dehydration 7
Tachycardia,
Orthostatic hypotension
Thirst
Dry mucous membranes
Poor skin turgor
Oliguria
Weight loss
What to assess for dehydration 5
Skin turgor and mucous membranes
Intake and output
Urine quantity and color
Specific gravity
Labs
How often should you assess urine output
6-8 hours
