Interpretation of Monitoring Flashcards
Hypernatremia value
> 145
usually hypovolemic
CNS changes, mental status changes,
irritability, hyperreflexia, ataxia, seizures, hypotension
after induction.
signs and symptoms hypernatremia
Treatments for hypernatremia
volume
diuretics if hypervolemic
vasopressors, inotropes
Hyponatremia [more commom] value
Na <135, usually hypervolemic
CNS,lethargy, cramps, decreased reflexes, seizures.
hyponatremia s&s
Na+ <120 associated with
50% mortality rate
treatment hyponatremia
- CHF inotropes
- lasix
- replete Na with 3% saline
Too rapid a correction with 3% saline (hypertonic saline) may lead to
demyelination of pontine neurons and a condition known as central pontine myelinolysis
Hyperkalemia value
> 5.5
f K+ > 6.0, what rhythm changes will you see?
prolonged PR, peaked T waves
significant S&S of high K?
conduction disturbances of the heart
[ESRD, HD, DKA, meds]
treatments of >K?
avoid acidosis, hypoventilation, >ETCO2
Calcium
lasix
glucose/insulin/D10
for every 10 mmHg change in EtCO2 the K+ changes
0.5 mEq
what med should you avoid with >K and why?
avoid succinylcholine, intubating dose ↑’s K+ 0.5 mEq
Hypokalemia value
<3.5
typical causes of
diuretics, N/V, GI losses
muscle weakness, cramps, PVCs, high U waves,
flattened low or even inverted T waves, low ST
segment, worsens digoxin toxicity
S&S
treatment
avoid hypoventilation, alkalosis
glucose
k replacement
what does
prolongs
causes of hypercalcemia
hyperparathyroid, cancer,
*breast cancer alone causes 25-50% of hypercalcemia.
N/V, ↓ deep tendon reflexes, hypotonia,
confusion, lethargy
hypercalcemia S&S
treatment hypercalcemia
Maintain hydration and UOP.
• Loop diuretics (avoid thiazide diuretics, they ↑Ca++
reabsorption)
• Monitor muscle relaxation using nerve stimulator.
Hypocalcemia causes
↓’d PTH, ↓’d Mg+ (causes ↑’d end-organ resistance to PTH)
alkalosis (↑’d pH causes iCa++ bind to protein),
massive blood tx, (citrate binds Ca++),
pancreatitis,
hypoparathyroidism
removal of parathyroid
tetany, twitching, laryngospasm, tingling lips &
fingers. Spontaneous action potentials are generated.
Hypocalcemia
treatment hypocalcemia
Avoid hyperventilation
• Avoid alkalotic conditions, maintain normal to hypercarbic
state (↑EtCO2)
• IV replacement if severe symptomatology.
Hypomagnesemia causes
Poor GI absorption, Dialysis, ETOH
S&S hypomagnesemia
Dysrhythmias, Ventricular
–Muscle weakness/twitching/tetany
–Tetany
Treatment
Supplemental Mg++
–Avoid diuretics Mg++ follows Na+
–Cautious with muscle relaxants
–Mg++ helps treat and correct refractory hypocalcemia and hypokalemia
Hypermagnesemia causes
Rare, infusions for preeclampsia and pheo
S&S hypermagnesemia?
–Lethargy, Loss of deep tendon reflexes, paralysis,
hypotension, heart block
–Acidosis worsens effects
treatments hypermagnesemia?
temporary dialysis
–Loop diuretics
–Reduce muscle relaxants
–Adequate ventilation to prevent acidosis
Measures the degree of systolic dysfunction
Ejection Fraction, normal 55 or greater
Graded Systolic Dysfunction
- Mild 45-54%
- Moderate 30-44%
- Severe less than 30%
Indicator of balance between oxygen delivery &
consumption. Normal range 68-80%. Normal
extraction around 25%
Mixed Venous (SvO2) and Central Venous (ScvO2)
Four primary factors impact SVO2
–Oxygen consumption (VO2)
–Hemoglobin level (hgb)
–Cardiac Output (CO)
–Arterial oxygen saturation (SaO2)
Decreased svo2 causes
- Increased VO2 (Fever, hyperthermia)
- Decreased hgb (anemia, hemolysis)
- Decreased SaO2
- Decreased CO (ex: MI, CHF, hypovolemic states)
increased svo2
• Decreased VO2 (cyanide toxicity, carbon monoxide poisoning, hypothermia, sepsis)
Increased hgb (volume depleted)
• Increased SaO2
•Increased CO (burns, inotropic drugs)
