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Exam 2 > Fluid and electrolyte imbalance > Flashcards

Fluid and electrolyte imbalance Flashcards

1
Q

Fluid and electrolyte imbalance Risk factors

A

Old, young, malnourished, acute illness, severe burns, serious injury or trauma, chronic kidney disease, major surgery

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2
Q

Nutrition Considerations for older adults

A

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

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3
Q

Calcium

A

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

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4
Q

Common causes of hypocalcemia: Actual

A

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

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5
Q

Common causes of hypocalcemia: relative/physiological

A

calcium deficits: hyperproteinemia, alkalosis, calcium binders, acute pancreatitis, hyperphosphatemia, immobility, removal or destruction of parathyroid glands

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6
Q

Hypocalcemia assessment: nutrition

A

ask about intake of dairy products and calcium supplements

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7
Q

Hypocalcemia assessment: procedures

A

recent orthopedic surgery, or bone healing, thyroid surgery, therapeutic irradiation of upper middle chest and neck, recent anterior neck injury, paresthesia

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8
Q

Hypocalcemia assessment: cardiac changes

A

Slower or slightly faster HR, weak thready pulse and ECG changes like prolonged ST and QT interval

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9
Q

Hypocalcemia assessment: intestinal changes

A

increased peristalsis, hyperactive bowel sounds, abdominal cramping, diarrhea

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10
Q

Hypocalcemia assessment: skeletal muscle changes

A

osteoporosis, more fragile bones, can lead to loss of height, look for spinal curvatures and any unusual bumps

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11
Q

Hypocalcemia drug therapy

A

oral or IV calcium replacement, also vitamin D to aid in absorption, drugs that decrease nerve and muscle responses may also be needed

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12
Q

Hypocalcemia nutrition therapy

A

calcium rich diet, collaborate with registered dietician

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13
Q

Hypocalcemia environmental management interventions

A

Needed due to excitable membranes being overstimulated. Keep room quiet, limit visitors, adjust lighting, use soft voice

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14
Q

Hypocalcemia injury prevention

             Priority!
A

Use lift sheet rather than pulling, observe range of motion and unusual bumps or depressions over bony prominences (fracture)

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15
Q

Common causes of hypercalcemia: Actual

A

excessive oral intake of calcium and/or vitamin D, kidney failure, thiazide diuretics

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16
Q

Common causes of hypercalcemia: relative

A

Hyperparathyroidism, malignancy, hyperthyroidism, immobility, use of glucocorticoids, dehydration

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17
Q

Hypercalcemia assessment: cardiovascular changes

A

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

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18
Q

Hypercalcemia assessment: neuromuscular changes

A

severe muscle weakness, decreased deep tendon reflexes without paresthesia

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19
Q

Positive Chvostek sign

A

(ipsilateral movement upon tapping skin over facial nerve) Hypocalcemia

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20
Q

Hypercalcemia or hypomagnesemia peristalsis

A

Paralytic ileus because it can increase or stop peristalsis

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21
Q

Magnesium toxicity

A

First warning is loss of patellar reflex. D/C magnesium immediately

22
Q

Calcium function

A

Maintains bone strength, cardiac muscle, and blood clotting

23
Q

Hypomagnesemia risk factors: medications

A

Loop and thiazide diuretics

24
Q

Severe hypermagnesemia nursing considerations

A

Increased risk for cardiac arrest. Pt. should have tele and crash cart near by.

25
Q

Hypomagnesemia risk factors

A

Starvation, malnutrition, Crohn’s disease, and diuretics

26
Q

Hypercalcemia interventions

A

Common cause is dehydration. Increasing fluids can bring serum calcium level back to normal. Furosemide is a better diuretic option.

27
Q

Hypercalcemia intestinal changes

A

constipation, anorexia, nausea, vomiting, abdominal distention

28
Q

Hypomagnesemia: cardiovascular changes

A

Increased risk for hypertension, atherosclerosis, hypertrophic left ventricle, variety of dysrhythmias (premature contractions, atrial fibrillation, ventricle fibrillation, long QT intervals)

29
Q

Hypomagnesemia: Neuromuscular changes

A

Hyperactive deep tendon reflexes, numbness/tingling, painful muscle contractions, may have tetany and seizures

30
Q

Hypomagnesemia: intestinal changes

A

Decreased intestinal smooth muscle contraction, reduced motility, anorexia,nausea, constipation, abdominal distention

31
Q

Common causes of hypomagnesemia

A

malnutrition, starvation, diarrhea, steatorrhea, celiac disease, crohn’s, certain medications, citrate (blood products), ethanol ingestion

32
Q

Common causes of hypermagnesemia

A

Increased magnesium intake, magnesium-containing antacids and laxatives, IV magnesium replacement, decreased kidney excretion of magnesium resulting from kidney disease

33
Q

Hypomagnesemia interventions

A

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

34
Q

Hypermagnesemia cardiac changes

A

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

35
Q

Hypermagnesemia CNS changes

A

Drowsy or lethargic, coma may may occur if imbalance is prolonged or severe

36
Q

Hypermagnesemia neuromuscular changes

A

reduced or absent deep tendon reflexes, voluntary skeletal muscle contractions become progressively weaker and finally stop

37
Q

Hypermagnesemia interventions

A

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

38
Q

Isotonic solutions

A

NS, 0.9% Na+ Cl,LR (blood loss),

39
Q

Hypotonic solutions

A

DKA, HHNS (cellular dehydration), 1/2 NS, D5 1/2 NS

40
Q

Magnesium

A

1.3-2.1, required for calcium and vitamin D absorption

41
Q

Hypermagnesemia cardiac

A

Calm and quiet, heart block, prolonged QT intervals, bradycardia, hypotension,

42
Q

Hypermagesemia deep tendon reflexes

A

Calm and quiet, hyporeflexia, decreased DTR

43
Q

Hypermagnesemia lungs

A

Calm and quiet, deep/ shallow respirations

44
Q

Hypermagnesemia GI

A

Calm and quiet, hypoactive bowels

45
Q

Hypomagnesemia cardiac

A

Buck wild, EKG: ST depression, T wave inversion, tornadoes de pointes, severe=v fib, tachycardia

46
Q

Hypomagnesemia deep tendon reflexes

A

Buck wild, hyperreflexia, increased DTR

47
Q

Hypermagnesemia eyes

A

Buck wild, abnormal eye movements (nystagmus)

48
Q

Hypermagnesemia GI

A

Buck wild, diarrhea

49
Q

Hyperglycemia s/s

A

Swollen and slow- moans, groans, and stones: constipation, bone pain, kidney stones, decreased DTR, severe muscle weakness

50
Q

Hypocalcemia S/S

A

Trousseau’s signs, Chvostek’s signs, diarrhea, circumoral tingling

51
Q
A

Exam 2 (3 decks)

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