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Pathophysiology Midterm #2 > Sodium/Potassium/and Volume Imbalances > Flashcards

Sodium/Potassium/and Volume Imbalances Flashcards

1
Q

Hyponatremia

A

results from loss of sodium-containing fluids or from water excess
causes hypo osmolality with shift of water into cells
- dilute urine

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2
Q

Clinical Manifestations of Hyponatremia

- CCNVS

A 
C- confusion 
C - coma
N - nausea
V - vomiting
S - seizures
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3
Q

Causes of hyponatremia (11)

A
  • diuretics
  • vomiting/diarrhea
  • nasogastric suctioning
  • burns
  • water retention (high levels of ADH)
  • dilution
  • CHF
  • Liver disease
  • Renal failure
  • Hormone imbalances
  • Syndrome of inappropriate antidiuretic hormone
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4
Q

causes of Hypernatremia

A
  • excessive IV fluid with saline
  • IV sodium bicarb
  • Severe water loss
  • Severe vomiting or diarrhea
  • Heat stroke - losing water
  • Osmotic diuresis
  • Diabetes insipidus
  • Disease that influences RAA system
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5
Q

Collaborative Care of Hyponatremia (5)

A
  1. fluid restriction - not allowing them to drink a high amount of water or other fluids
  2. reduce sodium loss - antiemetic
  3. Dietary replacement
  4. IV hypertonic solution - only given in very severe cases. have to add sodium slowly.
  5. monitoring I & O and monitoring for neurologic changes
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6
Q

Collaborative care of hypernatremia (5)

A
  1. treat underlying cause
  2. give oral or IV fluid replacement
  3. diuretics - depending on if they have the volume
  4. dietary sodium restriction
  5. monitor for CNS changes
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7
Q

Hypovolemia

A

abnormal loss of normal body fluids (diarrhea, fistula drainage, hemorrhage), inadequate intake, or plasma-to-interstitial fluid shift)

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8
Q

Causes of hypovolemia

A
  • fever, diaphoresis, hyperglycemia, gastrointestinal suction, burns, blood loss, hyperventilation
  • diseases: hyperthyroidism, diabetes, addison’s disease, renal failure
  • third - space fluid shifts (intravascular dehydration even through TBW is elevated)
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9
Q

Manifestations of hypovolemia

  • I/O
  • body weight
  • VS
  • Skin
  • CNS
  • Lab values
A
  • I/O - decrease urine output; increased specific gravity
  • body weight - decreased
  • VS - decreased BP, postural hypotension, decreased CVP (central venous pressure), increased pulse
  • Skin - dry mucous membrane, decreased skin turgor & soft, sunken eyes
  • CNS - apprehension, restlessness & headache -> hallucinations & confusion, coma
  • Lab values - increased or decrease Na+, increased hematocrit, increase Hgb, increased BUN, increased urine specific gravity
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10
Q

Nursing Care of Hypovolemia (6)

A
  1. address the problem
  2. Rehydration therapy: replace water and electrolytes - careful how much you give over how much time. patient may not be able to handle rapid rehydration. can give orally, IV or NG tube
  3. frequent oral care
  4. ensure safety - fall risk increased
  5. frequently assessing lab values, VS, signs of JVD, urine output, cap refill, I & O
  6. assessing for possibility of third spacing
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11
Q

Hypervolemia

A

Excessive intake of fluids, abnormal retention of fluids (CHF), or interstital-to-plasma fluid shift
- vascular system, third spacing

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12
Q

Causes of hypervolemia

A
  • circulatory problems -CHF –> hypertension –> pulmonary & peripheral edema
  • renal disease - decreased excretion of body fluids
  • liver - third-spacing –> spaces that don’t normally have fluid
  • Lymphatic obstruction - tumour –> pressure on lymph nodes –> local edema
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13
Q

Manifestations of Hypervolemia

  • respiratory
  • circulatory
  • neurologic
  • lab values
A
  1. fluid in alveolar sacs -> coughing, dyspnea, crackles, hypoxia (pallor, cyanosis, decreased O2 sat)
  2. JVD, increased BP, peripheral edema, weight gain, bounding pulses, ascites
  3. confusion & headache -> lethargy, seizures, coma
  4. decreased Na+, decreased BUN, hematocrit and urine specific gravity
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14
Q

Interventions for hypervolemia

A
  1. sodium and fluid restriction
  2. diuretics
  3. Bi-pap
  4. Facilitate oxygenation and reduce cardiac workload
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15
Q

Nursing Implementation: sodium & volume imbalances (5)

A
  1. intake and output
  2. monitoring for cardiac changes
  3. Assessing respiratory status and monitoring for changes
  4. daily weights
  5. skin changes
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16
Q

Potassium

A
  • Major ICF cation
  • necessary for: (transmission and conduction of nerve impulses, maintenance of cardiac rhythms, skeletal & smooth muscle contraction, Acid-base balance)
  • 90% of daily intake eliminated by kidneys - rest lost in sweat or stool
  • inverse relationship between Na+ and K+
17
Q

Normal values of potassium

A

3.5-5 mmol/L

18
Q

Inverse relationship between Na+ and K+

A

factors that cause Na+ retention cause K+ loss in urine such as low blood volume - and increased aldosterone.
- ability of the kidneys to conserve K+ is weak (even if body stores are depleted)

19
Q

Hyperkalemia

A

high serum potassium

20
Q

Causes of hyperkalemia (6)

A
  1. renal failure
  2. massive intake
  3. shift from intracellular fluid to extracellular fluid (severe cellular dehydration due to hyperglycemia)
  4. massive cell destruction
  5. catabolic state
  6. transfusion of aged blood
21
Q

Manifestations of Hyperkalemia

A
  • weak or paralyzed skeletal muscles - may experience cramping leg pain
  • ventricular fibrillation or cardiac status
  • abdominal cramping or diarrhea
22
Q

Hypokalemia causes (6)

A
  1. abnormal losses via the kidneys or the GI tract
  2. shift from the extracellular to the intracellular
  3. inadequate intake
  4. diuretic use
  5. magnesium deficiency
  6. metabolic acidosis
23
Q

Manifestations of severe hypokalemia (< 2.5) (6)

A
  1. most serious are cardiac
  2. skeletal muscle weakness & paralysis
  3. muscle cramping & muscle cell breakdown
  4. decreased GI motility
  5. Diuresis (kidneys are filtering too much fluid)
  6. Hyperglycemia - reduces insulin secretion
24
Q

Nursing Management of hypokalemia

A
  1. potassium supplements - give very carefully because it is irritating to veins, never give IV flush.

Pathophysiology Midterm #2 (9 decks)

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