Fluid and electrolyte imbalance Flashcards
Fluid and electrolyte imbalance Risk factors
Old, young, malnourished, acute illness, severe burns, serious injury or trauma, chronic kidney disease, major surgery
Nutrition Considerations for older adults
at risk due to age-related organ changes, less total body than younger adults, more likely to be taking drugs that affect, impaired nutrition, decreased thirst drive
Calcium
9-10.5, in ECF and blood as ionized calcium(free/active), enters through diet and absorption through intestinal tract (active form of vitamin D), mostly stored in bones
Common causes of hypocalcemia: Actual
calcium deficits: not enough intake, lactose intolerance, malabsorption syndrome (Crohn’s/Celiac), not enough vitamin D, end-stage kidney disease, diarrhea, steatorrhea, Gi wound drainage
Common causes of hypocalcemia: relative/physiological
calcium deficits: hyperproteinemia, alkalosis, calcium binders, acute pancreatitis, hyperphosphatemia, immobility, removal or destruction of parathyroid glands
Hypocalcemia assessment: nutrition
ask about intake of dairy products and calcium supplements
Hypocalcemia assessment: procedures
recent orthopedic surgery, or bone healing, thyroid surgery, therapeutic irradiation of upper middle chest and neck, recent anterior neck injury, paresthesia
Hypocalcemia assessment: cardiac changes
Slower or slightly faster HR, weak thready pulse and ECG changes like prolonged ST and QT interval
Hypocalcemia assessment: intestinal changes
increased peristalsis, hyperactive bowel sounds, abdominal cramping, diarrhea
Hypocalcemia assessment: skeletal muscle changes
osteoporosis, more fragile bones, can lead to loss of height, look for spinal curvatures and any unusual bumps
Hypocalcemia drug therapy
oral or IV calcium replacement, also vitamin D to aid in absorption, drugs that decrease nerve and muscle responses may also be needed
Hypocalcemia nutrition therapy
calcium rich diet, collaborate with registered dietician
Hypocalcemia environmental management interventions
Needed due to excitable membranes being overstimulated. Keep room quiet, limit visitors, adjust lighting, use soft voice
Hypocalcemia injury prevention
Priority!
Use lift sheet rather than pulling, observe range of motion and unusual bumps or depressions over bony prominences (fracture)
Common causes of hypercalcemia: Actual
excessive oral intake of calcium and/or vitamin D, kidney failure, thiazide diuretics
Common causes of hypercalcemia: relative
Hyperparathyroidism, malignancy, hyperthyroidism, immobility, use of glucocorticoids, dehydration
Hypercalcemia assessment: cardiovascular changes
The most serious and life-threatening problems, first causes increased HR and BP, severe or prolonged depresses electrical conduction which slows HR, poor perfusion, ECG for dysrhythmias especially shortened QT interval, blood clotting more likely in lower legs and pelvic region, assess abdominal girth with tape measure
Hypercalcemia assessment: neuromuscular changes
severe muscle weakness, decreased deep tendon reflexes without paresthesia
Positive Chvostek sign
(ipsilateral movement upon tapping skin over facial nerve) Hypocalcemia
Hypercalcemia or hypomagnesemia peristalsis
Paralytic ileus because it can increase or stop peristalsis
Magnesium toxicity
First warning is loss of patellar reflex. D/C magnesium immediately
Calcium function
Maintains bone strength, cardiac muscle, and blood clotting
Hypomagnesemia risk factors: medications
Loop and thiazide diuretics
Severe hypermagnesemia nursing considerations
Increased risk for cardiac arrest. Pt. should have tele and crash cart near by.
Hypomagnesemia risk factors
Starvation, malnutrition, Crohn’s disease, and diuretics
Hypercalcemia interventions
Common cause is dehydration. Increasing fluids can bring serum calcium level back to normal. Furosemide is a better diuretic option.
Hypercalcemia intestinal changes
constipation, anorexia, nausea, vomiting, abdominal distention
Hypomagnesemia: cardiovascular changes
Increased risk for hypertension, atherosclerosis, hypertrophic left ventricle, variety of dysrhythmias (premature contractions, atrial fibrillation, ventricle fibrillation, long QT intervals)
Hypomagnesemia: Neuromuscular changes
Hyperactive deep tendon reflexes, numbness/tingling, painful muscle contractions, may have tetany and seizures
Hypomagnesemia: intestinal changes
Decreased intestinal smooth muscle contraction, reduced motility, anorexia,nausea, constipation, abdominal distention
Common causes of hypomagnesemia
malnutrition, starvation, diarrhea, steatorrhea, celiac disease, crohn’s, certain medications, citrate (blood products), ethanol ingestion
Common causes of hypermagnesemia
Increased magnesium intake, magnesium-containing antacids and laxatives, IV magnesium replacement, decreased kidney excretion of magnesium resulting from kidney disease
Hypomagnesemia interventions
Correct imbalance, manage causative problem, also correct hypocalcemia, drugs that promote magnesium loss like loop/thiazide/osmotic diuretics, aminoglycoside antibiotics, and drugs containing phosphorus are D/C’d, magnesium replaced IV with magnesium sulfate when severe, assess deep tendon reflexes at least hourly w/IV
Hypermagnesemia cardiac changes
bradycardia, peripheral vasodilation, hypotension, with magnesium increase PR interval with widened QRS complex, bradycardia can be severe and cardiac arrest is possible, hypotension is severe, diastolic lower than normal
Hypermagnesemia CNS changes
Drowsy or lethargic, coma may may occur if imbalance is prolonged or severe
Hypermagnesemia neuromuscular changes
reduced or absent deep tendon reflexes, voluntary skeletal muscle contractions become progressively weaker and finally stop
Hypermagnesemia interventions
When kidney failure is not present can give magnesium-free fluids to reduce levels, when cardiac problems are severe, giving calcium may reverse cardiac effects of hypermagnesemia
Isotonic solutions
NS, 0.9% Na+ Cl,LR (blood loss),
Hypotonic solutions
DKA, HHNS (cellular dehydration), 1/2 NS, D5 1/2 NS
Magnesium
1.3-2.1, required for calcium and vitamin D absorption
Hypermagnesemia cardiac
Calm and quiet, heart block, prolonged QT intervals, bradycardia, hypotension,
Hypermagesemia deep tendon reflexes
Calm and quiet, hyporeflexia, decreased DTR
Hypermagnesemia lungs
Calm and quiet, deep/ shallow respirations
Hypermagnesemia GI
Calm and quiet, hypoactive bowels
Hypomagnesemia cardiac
Buck wild, EKG: ST depression, T wave inversion, tornadoes de pointes, severe=v fib, tachycardia
Hypomagnesemia deep tendon reflexes
Buck wild, hyperreflexia, increased DTR
Hypermagnesemia eyes
Buck wild, abnormal eye movements (nystagmus)
Hypermagnesemia GI
Buck wild, diarrhea
Hyperglycemia s/s
Swollen and slow- moans, groans, and stones: constipation, bone pain, kidney stones, decreased DTR, severe muscle weakness
Hypocalcemia S/S
Trousseau’s signs, Chvostek’s signs, diarrhea, circumoral tingling
