Quiz One ch.14&15 Flashcards
Causes for Isotonic fluid loss (8)
Porportional loss of fluid to solute
- hemorrhage
- GI losses
- wound drainage
- fever
- environment
- burns
- diuretics
- third space fluid shifts
what would cause hypertonic fluid loss?
whats the ratio?
more water/NA than solute
- inability to responsd to thirst
- decreased H20 intake
- NPO status
- Diabetes Insipidus
- brain injury
- increased intake of solute
signs and symptoms of FVD (fliuid volume deficit)
Thirst
Concentrated urine
Low urine volume
Dry skin / ↓ turgor
Sunken eyeballs
Sunken or depressed fontanels
Hypotension
Decreased cardiac output
Tachypnea
Low grade fever
Mental status changes
Acute weight loss
what causes isotonic fluid excess? (5)
- Renal failure
- heart failure
- excess intake
- high corticosteroid levels (stress, disease, therapy-)
- high aldosterone levels
What sodium levels in the blood become too low what happens to the cell?
excess water enter cells and cause the cells to swell
Hypotonic fluid excess?
possible causes? (6)
More fluid than solute
- Repeated plain water enemas
- Repeated plain water NG tube or bladder irrigations
- Overuse of hypotonic IV fluids too rapidly
- Overzealous plain water intake
- SIADH
- Heart failure, renal failure, cirrhosis of the liver
Signs of Fluid Volume Excess (FVE)
Peripheral edema
High CVP
Pulmonary edema
Acute rapid weight gain
Altered urine output/concentration
Distended neck veins
Crackles
Tachycardia
Increased weight
Shortness of breath/wheezing
best bed position for a fluid overload?
semi fowlers
Normal sodium (Na) level?
135-145
Normal Potassium (k) level?
3.5-5.5
normal calcium (Ca) level?
8.5-10.2
Normal magnesium (Mg) level?
1.8-2.7
normal phosphorous level
2.5-4.5
Normal chloride (Cl) level
96-108
Normal plasma pH?
7.35-7.45
what is hyponatremia?
abnormally low level of sodium in the blood, less than 135 mEq/L
What are the possible causes of hyponatremia?(7)
What are the signs/symptoms/manifestations?(8)
- Adrenal insufficiency
- Water intoxication
- SIADH
- Vomiting
- Diarrhea
- Sweating
- Diuretics
s/s:
- Poor skin turgor
- Dry mucosa
- Headache
- Decreased salivation
- Decreased BP
- Nausea
- Abdominal cramping
- Neuro changes
how do we manage hyponatremia?
- water restriction
- monitor sodium
- teach effects of medication
What is Hypernatremia?
possibe causes?
s/s manifestations?
how do we manage it?
excess amounts of sodium in the blood, serum sodium greater than 145 meq
- Excess water loss
- Excess Na admin.
- Diabetes insipidus
- Heat stroke
- Hypertonic IV solution
- Thirst
- Elevated temperature
- Dry, swollen tongue
- Sticky mucosa
- Nuero symptoms
- Restlessness
- Weakness
- hypotonic electrolyte soln
- D5W
- assess OTC sources of sodium
- encourage fluids
- H20 via feeding tube
what is hypokalemia?
possible causes?
s/s/m?
management?
low levels of potassium, less than 3.5 meq
- GI losses
- Medications
- Alterations of acid-base balance
- Hyperaldosteronism
- Poor dietary intake
- Fatigue
- Anorexia
- N/V
- Dysrhythmias
- Muscle weakness
- Cramps
- Paresthesias
- Glucose intolerance
- ↓ muscle strength
increase dietary K, D5W, monitor EKG, ABG’s
What is hyperkalemia?
causes?
manifestations, s/s?
Managment?
serum potassium greater than 5.0 mEq/L
- Treatment related
- Impaired renal fx
- Hyperaldosteronism
- Tissue trauma
- Acidosis
- *Other
- Cardiac changes
- Dysrhythmias
- Muscle weakness
- Potential respiratory impairment
- Paresthesias
- Anxiety
- GI manifestations
- Monitor EKG
- limit dietary K
- monitor med effects
- dietary teaching
what is hypocalemia?
Possible Causes?
Manifestations?
Management?
serum calcium less than 8.5 mEq/L
- Hypoparathyroidism
- Malabsorption
- Pancreatitis
- Alkalosis
- Massive transfusion of citrated blood
- Renal failure
- Medications
- Tetany
- Circumoral numbness
- Paresthesias
- Hyperactive DTR’s
- Trousseau’s sign
- Chvostek’s sign
- Seizures
- Respiratory symptoms
- Dyspnea
- IV calcium gluconate
- Calcium
- Vitamin D
- Diet
- Weight bearing exercises
- Patient teaching
- IV calcium administration
What is hypercalemia?
Possible causes?
Manifestations?
Managment?
when serum calcium is greater than 10.2 mEq/L
- Malignancies
- Hyperparathyroidism
- Tumors
- Immobilization
- Thiazide diuretics
- Vitamin A & D intoxication
- Lithium and theophylline toxicity
- Anorexia
- N/V - Dehydration
- Constipation
- Abdominal/bone pain
- Excessive urination
- Severe thirst
- Confusion, impaired memory, slurred speech, lethargy, acute psychotic behavior or coma
- Fluids 3/4 L a day
What is hypomagnesim?
possible causes?
manifestations?
management?
serum magnesium less than 1.8 mg/dl
- Alcoholism
- GI losses
- Enteral/parenteral feeding deficient in Mg
- Medications
- Rapid administration of citrated blood
- Diabetic ketoacidosis
- Sepsis
- Burns/hypothermia
- Neuromuscular irritability
- Muscle weakness
- Tremors
- EKG changes
- Dysrhythmias
- Alterations in mood/LOC
- Athetoid movement
Diet
Oral Mg
MgSO4 IV
Patient teaching
what is hypermagnesium?
possible causes?
manifestations?
management?
serum magnesium greater than 2.7 mg/dl
- Renal failure
- Diabetic ketoacidosis
- Excessive MgSO4
- Flushing
- Lowered BP
- N/V
- Hypoactive reflexes
- Drowsiness
- Muscle weakness
- Depressed respirations
- EKG changes
- Dysrhythmias
- IV calcium gluconate
- Loop diuretics
- Avoid MgS04 meds
- IV NS or RL
- Hemodialysis
- Pt teaching r/t OTC medications with MgSO4
what is Hypophosphatemia?
possible causes
serum phosphate less than 2.5 mg/dl
- ETOH
- Refeeding pts after starvation
- Pain
- Heat Stroke
- Respiratory alkalosis
- Hyperventilation
- Hepatic encephalopathy
- Major burns
- Neuro symptoms
- Confusion
- Muscle weakness
- Tissue hypoxia
- Muscle and bone pain
- ↑ susceptibility to infection
- Oral or IV phosphorus
- Encourage food high with phosphorus
- Gradually introduce calories for malnourished pts on parenteral nutrition
What is hyperphosphatemia?
possible cause?
manifestations?
management?
serum magnesium greater than 4.5 mg/dL
- Renal failure
- Excess phosphorus
- Excess Vitamin D
- Hypoparathyroidism
- Chemo
- Soft tissue calcifications
- Symptoms r/t associated hypocalcemia
Hypochloremia?
possible causes?
manifestations?
management?
serum chloride less than 96 mEq/L
- Addison’s disease
- Reduced chloride intake
- GI loss
- Diabetic ketoacidosis
- Excessive sweating
- Fever/burns
- Medications
- Metabolic alkalosis
- Agitation
- Irritability
- Weakness
- Hyperexcitability of muscles
- Dysrhythmias
- Seizures
- Coma
- Replace Chloride
- IV NS or 0.45% NS
- Avoid free water
- Encourage high-chloride foods
- pt teaching r/t high chloride foods
- Restore electrolyte and fluid balance
- Lactated Ringers
- Sodium bicarbonate
- Diuretics
- Provide pt teaching r/t diet and hydration
what is the normal plasma pH?
7.35-7.45
