FLUID AND ELECTROLYTES Flashcards
1
Q
(MAINTAINING BALANCE)
How do the kidneys contribute to maintaining electrolyte balance/ homeostasis?
A
Adjust Urine Volume and Excrete Electrolytes
2
Q
(MAINTAINING BALANCE)
How does ADH contribute to maintaining electrolyte balance/ homeostasis?
A
Vasopressin: Controls Water Retention
3
Q
(MAINTAINING BALANCE)
How does RAAS contribute to maintaining electrolyte balance/ homeostasis?
A
Release of Renin
4
Q
(MAINTAINING BALANCE)
How does Aldosterone contribute to maintaining electrolyte balance/ homeostasis?
A
Water Regulator
5
Q
(MAINTAINING BALANCE)
How does Atrial Natruetic Peptide contribute to maintaining electrolyte balance/ homeostasis?
A
ANP reduces fluid volume
6
Q
Name the 5 ways the body maintains electrolyte balance:
A
- The Kidneys
- ADH
- RAAS
- Aldosterone
- ANP
7
Q
The 7 functions of the kidneys are what?
(AWETBED)
A
A: controlling ACID-BASE balance
W: controlling WATER balance
E: maintaining ELECTROLYTE balance
T: removing TOXINS and waste products from the body
B: controlling BLOOD-PRESSURE
E: producing the hormone ERYTHROPOIETIN
D: activating VITAMIN D
8
Q
what is erethropoeitin?
where is it produced?
A
a hormone secreted by the KIDNEYS that increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues.
9
Q
there must be VITAMIN D so what can be absorbed?
A
Calcium
10
Q
what is Anti-Diuretic Hormone?
what is the medication form of this called?
what does this do to BP?
A
- ADH is going to control water retention, by holding onto water (not allowing the release of water via urine).
- also known as VASOPRESSIN.
- ADH is a vasoconstrictor, so its going to RAISE BLOOD PRESSURE
11
Q
(RAAS) Aldosterone’s function is to regulate what?
Aldosterone causes the kidneys to retain what, and excrete what?
A
- Aldosterone is a WATER REGULATOR = regulates Na+ and water
- Aldosterone causes the kidneys to retain Na+ and Water, while excreting K+ (potassium)
Low aldosterone = High K+
High aldosterone = Low K+
12
Q
when is aldosterone released?
A
released when Na+ is low and K+ is high.
Increases RE-ABSORPTION of Na+ (where salt goes, water flows)
13
Q
If you have high aldosterone, how does this affect your BP?
A
High aldosterone (sodium and water retention) = HIGH BP
14
Q
where is ANP produced and stored ?
whats its function?
A
In the ATRIA
stops the action of RAAS
(vasodilation, lowers bp)
15
Q
Hypovolemia vs. Dehydration
A
Hypovolemia: LOW volume in extracellular fluid, results in decreased profusion to tissues. Loss of WATER AND SODIUM.
causes: vomiting, diarrhea, and third spacing.
Dehydration: WATER loss ONLY.
pure water loss from total body water, only 1/3 from ECF.
ALWAYS HYPERNATREMIC.
Treatment: free water admin.
16
Q
what are some symptoms of hypovolemia?
A
increased BP, tachycardia, high respirations due to trying to increase perfusion to tissues.
17
Q
what are the function of electrolytes? (5)
A
- ions found in our body fluids
- conduct electricity, energy
- control body fluids
- maintain homeostasis
- communicate cell to cell, organ to organ, nerve to nerve
18
Q
once electrolytes are dissolved in water what do they do?
A
electrolytes separate into ions (charged particles) when dissolved in water
19
Q
electrolytes that are cations (+ charged) : (4)
electrolytes that are anions
(- charged): (3)
A
CATIONS: Na+, K+, Ca+, Mg+
ANIONS: Cl, HCO3, Phosphate
* cations cannot be in the cell together
* anions can combine with positive charged ions in the cell
20
Q
how can you have a depletion of electrolytes?
(4)
A
think fluid–> where fluid flows, electrolytes go
1. vomiting
2. urination
3. bowel movements
4. sweating
21
Q
6 electrolytes and their normal lab values:
A
Magnesium (Mg+): 1.5-2.5
Phosphorus: 2.4-4.5
Potassium (K+): 3.5-5.0
Calcium (Ca+): 8.5-10.5
Chloride (Cl-): 95-105
Sodium (Na+): 135-145
22
Q
can you give potassium to a patient who has not eaten anything or is NPO?
A
No, this will upset their stomach causing them to vomit
23
Q
Foods that are rich is potassium (K+) : 4
A
fruits, green leafy vegetables, spinach, salt substitutes
24
Q
Foods that are rich in sodium (Na+): 5
A
table salt, cheese, spices, canned food , processed foods (lunch meat)
25
Foods that are rich in magnesium (Mg+): 5
spinach, almonds, yogurt, green vegetables
Dark chocolate = excellent Mg+ source
26
Foods that are rich in calcium (Ca+): 3
milk, cheese, green vegetables
27
Foods that are rich in phosphorus: 3
dairy, meats and beans
28
Foods that are rich in chloride (Cl-) : 7
salty foods and salt substitutes, canned foods,
Vegetables such as tomatoes, lettuce, celery and olives
29
Sodium (135-145)
Functions: (5)
1. maintain blood pressure
2. blood volume
3. pH balance (acid base) in blood
4. controlling nerve impulses
5. stimulating muscle contractions
30
Major electrolyte in ECF?
SODIUM
- big impact on bodys fluid balance
- controls water balance
31
what is sodium regulated by?
ADH & Aldosterone, Na+ K+ pump (sodium, potassium pump)
32
when you hear or see sodium issues THINK what?
think brain: NEURO CHECKS, SAFETY
* if sodium to low or high i will think i need to check brain and neuro status focused neuro assessment
*safety is huge for low or high sodium: confusion affects safety level
33
HYPONATREMIA LAB VALUE:
low sodium: < 135
34
what is the #1 cause of low sodium in the hospital?
SIADH
35
what is SIADH and why does it cause hyponatremia?
Syndrome of inappropriate anti-diuretic hormone secretion.
*impaired water excretion caused by inability to suppress secretion of ADH; water retention causes dilutional hyponatremia
*dilution of sodium
36
what is another major cause of hyponatremia (other than SIADH)?
Hypotonic Fluids:
shifts solutes into the cell (swells) (intracellular)
*dilution of sodium
37
what could fasting/NPO or low Na+ diet cause?
hyponatremia
38
hyponatremia
increased Na+ excretion due to:
1. 4D’s - diarrhea, diuretics, drainage, diaphoresis
2. Vomiting
3. Kidney disease
4. Hypoaldosteronism (Addison’s Disease )
sodium loss and water retention
39
what are the three type of hyponatremia?
1. Euvolemic
2. Hypovolemic
3. Hypervolemic
40
what is euvolemic?
LOW SODIUM BUT ECF IS NORMAL (normal volume) CLASSIC SIADH
41
what is hypovolemic?
Na+ (sodium) loss with ECF volume depletion (ecf volume loss)
42
what is hypervolemic?
Na+ (sodium) loss with increased ECF volume
43
(patient presentation hyponatremia)
Mild symptoms: 3
headache,
nausea/vomiting,
fatigue
44
patient presentation hyponatremia: Moderate symptoms? 3
lethargy,
weakness,
altered LOC
45
patient presentation hyponatremia: severe symptoms? 4
seizures,
brainstem herniation,
respiratory arrest (cardiac arrest follows) ,
death
46
which is worse: slow sodium loss or acute (rapid onset ) sodium loss?
acute sodium loss is by far worse due to irreversible brain damage with acute hyponatremia
47
what fluid should be given to a patient with severe acute hyponatremia?
3% normal saline should be given (this is hypertonic, pull fluid from cerebral tissue to decrease intracranial pressure)
48
Hyponatremia Interventions?
REPLACE SODIUM SLOWLY
- avoid fluid overload due to fluid shifting with sodium
- can lead to neuro damage if given too rapidly
49
when correcting hyponatremia you want to increase no more than how many points, in respect to electrolyte labs, in a 24 hour period?
how frequently do you check Na+ values?
6-12 points
every 2-4 hours
50
when correcting hyponatremia you need to stop sodium wasting diuretics. which diuretics need to be stopped and what should you put the patient on instead?
Loop diuretics; thiazides
may need to switch to spironolactone
51
Hyponatremia Hypovolemic Intervention: 3
(provide iv fluids/meds)
- 0.9% Normal saline to correct fluid volume status & Na+
- 3% normal saline (hypertonic solution) used for extremely low Na+
- give through a central line – highly caustic on veins
52
Hyponatremia hypervolemic: intervention:
(provide iv fluids/meds)
give osmotic diuretics and fluid restriction:
Mannitol – excretes water but not Na+
53
Interventions for severe hyponatremia:
what is the lab value of sever hyponatremia: 5
1. less than 120 mEq/L-->.administer 3% saline IV slowly not increase by more than 6-12 mEq/L in first 24 hours
3. Plan for CVAD (3% saline highly caustic to veins)
4. Insert indwelling catheter for strict intake and output
5. Perform neurologic checks every 2-4 hours & keep on bedrest (safety)
5. Safety is key due to cerebral involvement
54
what happens if you over-correct hyponatremia too quickly?
1. if overcorrected too quickly = demyelination syndrome causing damage to nerve cells in the brain
2. Locked in syndrome: the pt cant talk, move,or blink their eyes, brain is working but they are basically paralyzed
55
SIADH: how does this pertain to hyponatremia?
High levels of ADH : retain water --> Upsets electrolytes, especially SODIUM --> Increased water retention --> Decreased Sodium
56
SIadh:
causes: 3
SOAKED INSIDE (no urination) (low sodium osmoality)
Causes: 3 Ss
1. Small cell lung cancer
2. Severe brain trauma
3. Sepsis infections of brain
57
synthetic ADH:
Desmopressin, Vasopressin
Decreases Urine output
Pressin the BP up
58
SIADH CAUTIONS:
HEADACHES “priority” (can mean the brain is swelling wtf )
Low Na+…..seizures…..DEATH
59
treatment for SIADH? 5
1. Fluid restriction – 800-1000 mL/day (stops dilution of sodium)
2. Demeclocycline –
blocks effect of ADH resulting in more dilute urine
3.Diuretics = medications/caffeine
4. Increase oral sodium intake salt tablets, bacon, processed foods
5. Daily weight & I & O
60
Hypernatremia lab value:
Causes of hypernatremia: 5
hypernatremia lab value more than 145
decreased sodium excretion:
-Corticosteroids: cause kidneys to retain sodium and losing potassium
- Cushing's Syndrome: occurs due to prolonged exposure to glucocorticoids (prednisone) or a tumor producing excessive cortisol by adrenals
Hyperaldosteronism – high sodium and water retention
-Kidney disease
61
severe HYPERnatremia:
it can cause: 4
sodium greater than 160
Causes brain shrinkage : cerebral hemorrhage, cerebral bleeding, permanent brain damage
62
causes of hypernatremia continued: 8
(increased sodium intake)
1.excessive oral sodium ingestion, too many processed foods
2. Hypertonic solutions (3% NS or 5%NS)
3. Alka seltzer, aspirin
(Decreased water intake)
4. fasting / NPO status
(increased water loss; hemoconcentration)
5. dehydration is hypernatremia
6. too much water loss & Na+ gain
7. Infection
8. Diabetes Insipidus: hypernatremia
63
HYPERnatremia Interventions: 10
1. (Bring sodium levels down slowly) : rapid correction can lead to seizures due to rapid
fluid shifts in the brain
2. (provide IV fluids/medication)
Administer IV infusion in case of fluid losses
Hypotonic solutions
½ NS, D5W
3. (Diuretics)
if inadequate renal excretion of sodium, administer
diuretics (thiazides; loop diuretics)
4. Avoid medications that cause hypernatremia
5. Restrict sodium & fluid intake as prescribed
6. Free water intake to help with hemodilution
7. Patient safety – confused & agitated
8. Weigh daily
9. I & O
10. Neurologic precautions: Neuro checks
64
if a patient is presenting mild symptoms of hypernatremia, what would this look like? 3
faint feeling
muscle fatigue
weakness
65
if a patient is presenting moderate symptoms of hypernatremia, what would this look like? 7
(monitor closely)
confusion,
irritability,
swollen and dry red tongue*
hyperreflexia
muscle twitching
edema
thirst*
66
if a patient is presenting severe symptoms of hypernatremia, what would this look like? 4
nausea & vomiting
increased muscle tone
seizures
coma
67
Diabetes Insipidus = Hypernatremia.
what does this look like?
DI= DRY INSIDE = LABS HIGH
increased sodium
diluted urine
ADH DEFICIENCY (PEEING ALOOOT)
polydipsia – extreme thirst
polyuria – excrete dilute urine, > 200 mL/hr
68
causes of diabetes insipidus: 3
damage to brain
tumors
trauma
69
what is a major electrolyte in intracellular fluid?
Potassium (K+)
70
number 1 cause of hyperkalemia?
Renal problem/ Failure
71
what is the function of potassium in the body?
1. Maintains heart & muscle contraction
2. Regulated by kidneys and aldosterone
3. Acid-Base balance:
Increased K+ in the cell----> H+ moves out
Increased H+ in the cell----> K+ moves out
72
main source of potassium :
Diet is main source of K+
73
what are some causes of hypokalemia? 6
(potassium loss) less than 3.5
1. Diuretics:
digoxin toxicity – low K+ causes dig toxicity; caution using, diuretics with digoxin = increased risk for hypokalemia
2. Corticosteroids (water retention causing hemodilution)
3. Increased secretion of aldosterone (Cushings)
Aldosterone = K+ excretion through kidneys; higher
levels of aldosterone cause more K+ excretion
4. GI loss: Vomiting/diarrhea/prolonged NG suction
5. Excessive diaphoresis
6. Kidney disease
73
what are some causes of hypokalemia? 6
(potassium loss) less than 3.5
1. Diuretics:
digoxin toxicity – low K+ causes dig toxicity; caution using, diuretics with digoxin = increased risk for hypokalemia
2. Corticosteroids (water retention causing hemodilution)
3. Increased secretion of aldosterone (Cushings)
Aldosterone = K+ excretion through kidneys; higher
levels of aldosterone cause more K+ excretion
4. GI loss: Vomiting/diarrhea/prolonged NG suction
5. Excessive diaphoresis
6. Kidney disease
74
hypokalemia causes continued:
(inadequate K+ intake)
1. movement of K+ from ECF to ICF
2. excess insulin – moves K+ into the cell
(alkalosis, metabloic)
H+ and K+ located inside the cell
in alkalosis, there is less H+ in blood----> causes
H+ to shift out of cells and K+ to shift into cells
excess insulin – moves K+ into the cell
75
low potassium slows what?
heart rate causes bradycardia
76
severe hypokalemia value:
cardiovascular presentation: 4
severe is less than 2.5
torsades de pointes: lethal dysrythmia
irregular apical HR: bradycardia
lethal dysrhythmias
bradycardia
77
Should check Mg+ level with hypokalemia, why?
If Mg+ is low, it worsens K+ losses; correct Mg+ first to correct K+
78
severe hypokalemia, neuromuscular presentation:
confusion, lethargy
muscle weakness
diminished DTRs
79
severe hypokalemia,
GI presentation:
Constipation
** if bowel sounds are absent, think paralytic ileus – portion of bowel not moving and can lead to small bowel obstruction
80
in general low potassium does what to the body?
SLOWWS EVERYTHING DOWN
81
what do long QT intervals mean?
what can they lead to?
means heart is taking longer
to electrically charge
for the next heartbeat
can lead to torsade de pointes
** fainting is the most common symptom
82
Torsades de pointes in hypokalemia
(twisting of the points):
Lethal dysrythmia
Irregular QRS complexes appearing to wrap around the EKG baseline
IV Mg+ is treatment (slow 2G IVP)
83
hypokalemia intervention: 5
1. Monitor Cardiac and respiratory status
2. Administer K+ supplements orally or IV
- administer K+ SLOWLY & DILUTED – can be lethal when given too fast
3. If patient in taking a diuretic, may need to stop
- Spironolactone (K+ sparing diuretic)
4. K+ rich foods
- if taking orally, must take with food – never give
on an empty stomach
5. Monitor for digoxin toxicity
84
potassium is NEVER administered where/how?
Potassium is never administered IV push, intramuscular,
or subcutaneous routes. IV potassium is always diluted
and administered using an infusion pump
85
hyperkalemia value:
causes: 5
over 5.0
1. Excess K+ intake
2. Decreased K+ excretion
- K+ sparing diuretics (spironolactone)
- Ace inhibitors (lisinopril) : hold onto potassium
- NSAIDs (decrease renal perfusion) (meloxicam)
3. Adrenal insufficiency
- Addison’s--> low aldosterone = retention of K+
hypoaldosteronism causes large amounts of sodium excretion and retains K+ (Addison’s = destruction of adrenal gland)
4. Kidney disease - #1 cause; decrease in urine and increase in K+
5. Traumatic burns
86
what is the #1 cause of hyperkalemia?
Kidney Disease/Renal failure
87
hyperkalemia ----> acidosis, metabolic ?
(H+ and K+ located inside the cell)
in acidosis, there is more H+ in blood---> causes H+ to shift into the cells and K+ to shift out in the cells
88
severe hyperkalemia value :
lethal hyperkalemia value:
severe more than 6.5
lethal more than 8.5
89
(severe,lethal hyperkalemia)
a patient presenting with hyperkalemia could be experiencing?
-cardiovascular,gi and muscle weakness
Cardiovascular
- low blood pressure
- dysrhythmias – V fib and cardiac standstill
GI
- increased motility = hyperactive bowel sounds
- diarrhea
Muscle weakness
- can result in paralysis and respiratory arrest
90
mild hyperkalemia intervention: 6
1. Monitor cardiac rhythm changes
2. Restrict K+ in diet
3. Diuretics
4 Cation exchange resins
= sodium polystyrene sulfate (Kayexalate)
po or rectal* = explosive diarrhea
5. Stop medication causing increase in K+
6. Dialysis
91
Emergency medical treatment for severe hyperkalemia (>6.5)
**more dangerous than hypokalemia: 6
1. Ca+ Gluconate 10% IV
protects heart from myocardial irritability
2. IT DOES NOT LOWER potassium
3. must be given over 3-5 minutes
4. place on monitor for dysrhythmias, monitor BP and HR
5. Hypertonic glucose & insulin (Rapid Acting Insulin ONLY IV) Moves excess K+ into the cells
6. NaHCO3
K+ shifts into the cell and raises pH
92
what might calcium gluconate do?
slow heart rate and help prevent lethal dysrythmia but can cause bradycardia and if this happens stop the infusion
93
calcium lab value: 8.5-10.5
functions: 4
1. Calcium will help with function of Mg+ when Mg+ is low: Ca+ and Mg+ are best friends – when one goes up,The other one follows
2. Keeps the 3 B’s strong
Bone – 90% of body’s calcium
Blood clotting
Beat (heart rate) myocardial contraction
4. Regulated by 3 hormones
parathyroid hormone – parathyroid gland makes and releases when Ca+ levels are low but if too high it stops ca+
calcitonin – regulated by thyroid; released when Ca+ levels are high to lower Ca+ and put back into the bone
calcitriol – Vitamin D analog; controls blood calcium by suppressing release of PTH PTH increases blood calcium levels; calcitonin decreases blood calcium levels
94
causes of hypocalcemia?
lab value associated: 7
less than 8.5
1. Vitamin D deficiency =
required for absorption of Ca+
2. Long-term corticosteroids
3. Hypoparathyroidism →
decrease in parathyroid hormone
removal of parathyroid glands
4. Renal disease
5. Massive diarrhea
6. Hyperphosphatemia – inverse relationship with calcium
7. Medications – diuretics; laxatives; corticosteroids (contribute to bone loss)
95
what is the relationship between calcium and phosphate?
inverse relationship
mag down = phos up
96
patient presenting with hypocalcemia may be experiencing what?
cardiovascular,neuromuscular, GI
Cardiovascular :
hypotension
dysrhythmias (V Tach)
decreased HR
Neuromuscular:
irritable skeletal muscles – twitching, cramps, tetany, seizures, paresthesias
painful muscle spasms in calf or foot positive Trousseau’s and Chvostek’s signs
hyperactive deep tendon reflexes (DTRs)
osteoporosis – body trying to get more calcium
GI:
hyperactive bowel sounds
diarrhea
97
hypocalcemia intervention: 6
1. Replace Calcium (IV or PO)
- IV calcium gluconate 10% over 10 – 20 minutes
- monitor BP, HR & place patient on heart monitor
2. Vitamin D if giving PO
3. Aluminum hydroxide (Tums) calcium supplements
4. Initiate seizure precautions & bleeding precautions
5. Move patient carefully:
- prone to fracture, prone to bleeding, they are a HIGH FALL RISK
osteoporosis: fractures
6. Educate on calcium-rich foods
- dairy, cheese, milk, yogurt
- collard greens, broccoli
98
Hypercalcemia lab value & causes:
greater than 10.5
ONLY 2 THINGS
1. Hyperparathyroidism = Hypercalcemia
2. Malignancies = bone cancer and sometimes breast cancer cause it metastasizes
** Low calcium is more common than a high calcium
99
a pt is presenting with hypercalcemia, what might they be experiencing?
1. Neuromuscular
- EXTREME muscle weakness
diminished or absent DTRs
GI
- hypoactive bowel sounds (constipation)
Renal
- kidney stones
***stones, bones, abdominal moans
THINK: Kidney stones, painful bones, moans
from constipation, nausea & vomiting
100
hypercalcemia interventions: 6
1. Administer IV fluids
- 0.9% saline to get the kidneys to excrete calcium
2. Discontinue calcium
discontinue oral meds with calcium & vitamin
3. Loop diuretics=furosemide
4. Medications=phosphorous
inverse relationship with calcium
- calcitonin
- bisphosphonates
5. Dialysis if medications fail
6. Educate on avoiding calcium rich foods
***IV Normal Saline and loop diuretics = less severe
101
magnesium lab values:
functions: 9
1.5-2.5
1. support muscle and nerve function & energy production
2. Direct relationship with calcium=best friends; when one goes up the other one goes up
3. Inverse relationship with phosphorus
4. Helps to maintain blood glucose control
5. blood pressure
6. skeletal muscle contraction
7. neurologic function
8. ATP formation
9. mmune system – fights inflammation
102
causes of hypomagnesemia? and lab value associated: 4
1. Chronic alcohol use - #1 cause poor diet/malnutrition; starvation malabsorption due to effects of alcohol on GI tract
2. Renal loss – overuse of alcohol increases excretion of Mg
3. GI loss – NG, diarrhea
4. Diuretics
103
a pt is presenting with hypomagnesemia, what could they be experiencing?
Unable to maintain order; everything goes crazy
Neuromuscular:
tetany, twitches, paresthesias
positive Trousseau’s & Chvostek’s signs
(due to direct relationship with Ca+)
Increased DTRs
Laryngeal stridor
Tachycardia
104
Hypomagnesemia interventions:
*Hypocalcemia accompanies hypomagnesemia; interventions aim to restore calcium levels
1. replace Mg+ and Ca+ (IV or PO)
2. when replacing Mg+ IV give slowly (can slow HR)
3. seizure precautions
monitor DTRs – if diminished or absent=hypermagnesemia
4. discontinue medications that cause Mg+ loss
5. Monitor K+ if magnesium is low -----> Secondary K+ depletion
** Treat hypomagnesemia prior to hypokalemia; when the body is in a state of low M+, it is unable to process & absorb K+
105
hypermagnesium causes: lab value associated:
Greater than 2.5
1. Increased Mg+ intake
2. Decreased renal excretion of Mg+
calm and slow**
106
a pt presenting with hypermagnesemia, may be experiencing what? 5
1. Heart – calm & quiet
respirations low and shallow
bradycardia
hypotension
2. Lung
respirations low and shallow
3. GI
hypoactive bowel sounds
4. Neurological
drowsiness, lethargy
5. MS
Diminished or absent DTR’s
107
interventions for hypermagnesemia:
Calcium Gluconate is antidote for magnesium overdose
Diuretics for Mg+ excretion
108
phosphorus lab value:
function: 4
2.4 - 4.5
1. Regulated by parathyroid and calcitriol
2. Helps regulate calcium
- inverse relationship with calcium
- inverse relationship with magnesium
3. Cellular metabolism and energy production through ATP (Adenosine Triphosphate)
4. Essential for bone and teeth
109
causes of hypophosphatemia & lab value associated:
less than 2.4
(Increased phosphorous excretion)
1. hyperparathyroidism – calcium rises; phosphorous drops
2.malignancy
3. diuretics and diarrhea
4. use of magnesium-based or aluminum-based antacids---> increased Ca+ depletes phosphorous
110
pt is presenting with hypophosphatemia, what coul they be experiencing? 6
(Cardiovascular)
1. decreased BP, HR
(GI – )
2. hypoactive bowel sounds
(GU – )
3. kidney stones
(Neurological – )
4. altered LOC decreased DTR
(Musculoskeletal – )
5. severe muscle weakness
6. Bone pain & fractures
111
hypophosphatemia interventions: 2
1. Replace phosphorous IV or PO
- phosphorous slow if severely low
- administer oral phosphorous with Vitamin D
2. Fracture precautions
112
causes of hyperphosphatemia and the lab associated:
greater than 4.5
1. Increased phosphorous intake
2. Overuse of laxative and enemas with phosphorous
3. Decreased excretion of P- due to renal insufficiency
4. Hypoparathyroidism
5. Hypocalcemia : signs and symptoms u would see relating to the inverse relation to calcium
113
a pt is presenting with hyperphosphatemia, what might they be experiencing? 7
(Neuromuscular)
1. irritable skeletal muscles – twitching, cramps, tetany, seizures, paresthesias
2. painful muscle spasms in calf or foot
3. positive Trousseau’s and Chvostek’s signs
4. hyperactive deep tendon reflexes (DTRs)
5. osteoporosis – body trying to get more calcium
(GI)
6. hyperactive bowel sounds
7. diarrhea
114
hyperphosphatemia interventions?
exact same as calcium
115
Chloride lab values
and functions:
95 - 105
1. Major anion of ECF
- Sodium is major cation of ECF
2. Moves in and out of the cell with sodium
3. Involved in regulating acid base balance
4. Inverse relationship to HCO3
5. chloride likes sodium; if Na+ loss = Cl- loss
6. hypochloremia= same s/s as hyponatremia
116
hypochorlemia associated lab values:
causes
s/s:
hypochorlemia < 95
s/s: same a hyponatremia
causes: same as hyponatremia
Acid base imbalance= metabolic alkalosis
