Unit 2 test Acid-base balance--- Electrolyte -- EOD Flashcards
Facts of Potassium
3.5-5.0
Major ICF Cation
Function: some control over ICF osmolarity and volume
regulate protein synthesis , glucose use, and storage
pH balance
nerve conduction
Hypernatremia
sodium level greater then 145
H20 movement from the ICF to the ECF
ICF = dehydration
Causes: increase in Na intake decreases in Na excretion decrease in H20 intake Increase in water loss
Signs and Symptoms of Hypernatremia
Thirsty ICF dehydration Lethargy convulsion pulmonary edema hypotension tachycardia restless irritable oliguria seizures coma warm skin dry mucous membranes
What is convulsion
brain cell dehydration
Nursing interventions for hypernatremia
Monitor CVA, RESP, Renal, Skin status Monitor I&O if d/t fluid loss- admin IV fluid if d/t inadequate renal exertion- administer diuretics May restrict Na+ intake education
Hyponatremia signs and symptoms
Na level under 135 too much H20 decrease osmolatiry tachycardia weak rapid thready pulse hypotension orthostatic hypotension nausea and vomiting diarrhea decreased deep tendon reflexes lethargy headache confusion cramps muscle weakness and fatigue
Nursing Interventions for Hyponatremia
IV fluids - NS or 1/2 NS Osmotic diuretics increase in sodium intake monitor Na levels monitor LOA Safety precautions-- seizures, falls education Monitor I&O Daily weights
Causes of Hypocalcemia
Hypoparathyroidisim malabsorption-- chrones disease hypersecretion of calcitonin deficient serum albumin increase inn serum pH lack of Vit D-- lactose chronic renal failure
Calcium
9.0-10.5 Mostly found in ECF 98% stored in bones Works with Vit.D functions: bone and teeth muscle contraction and relaxation blood clotting Regulated by parathyroid hormone increase in blood calcium by stimulation osteoclasis increase GI aborption and renal retention calcitonin
Signs and symptoms of Hyperkalemia
increase in neromuscular irritability tingling and numbness found in the lips, fingers, and toes restless cardiac dysrthmias -- widen QRS and spiked T wave nausea fatigue little or no urine output decrease in pH acidosis
Interventions for hyperkalemia
Monitor status Monitor EKG monitor renal function d/c KCL medication prepare dialysis if needed education nutrition
Treatment:
Insulin+ glucose— D5W to counteract low blood sugar levels
Sodium Bicarb
Ca++ counter acts effects on heart
Causes of hyperkalemia
end stage renal disease aldosterone defect use of K+ sparing diuretic leakage of ICF K+ into ECF insulin defficient uncontrolled DM multiple blood transfusions
Causes of hypokalemia
diarrhea diuresis w/ diuretic use Increase in aldosterone or glutocosteroids decrease in dietary intake Treatment of DKA w/ insullin Increase in loss of urine increase of K+ into the cells
Interventions of hypokalemia
Monitor status Monitor EKG administer PO K 1st then IV therapy if needed potassium sparing diuretic saftey nutrition education
Normal ABG lab values
pH: 7.35-7.45 CO2 35-45 HCO3 22-26 O2 80-100 anion gap 10-14 albumin 4
Signs and symptoms of hypokalemia
cardiac dysrthmias --> cardiac arrest fatigue and muscle weakness parathesis (sensation anorexia nausea shallow respirations increase in urine output increase in serum pH depressed T wave. forms a U wave
hypertonic solution dehydration
deficit of fluid is greater than the deficit of electrolytes
fluid shifts out of ICF and into ECF space neurologic
Isotonic dehydration
Loss of fluid and electrolyte is balanced most of loss is sustained by ECF
Most Common
hypotonic dehydration
electrolytes deficit is greater then fluid deficit
ECF moves into ICF space
signs of dehydration
tachycardia weak pulse restless flushed dry skin dry mucous membranes decrease in urine output increase in HCT increased Na Increase in hgb , osmolatiry, and specific gravity
Magnesium
1.3-2.1
critical for skeletal muscle contraction, cell growth, ATP formation, and carbohydrate metabolism
Phosphorus
30-4.5
found in bones
activates vitamins and enzymes
assist in cell growth and metabolism
treat with Aluminum Hydroxide
Hypercalcemia signs and symptoms, and Interventions
depressed neuromuscular activity muscle weakness, loss of muscle lethargy cardiac arrest, bradycardia anorexia nausea interffernece with ADH in the renal loss of absorption of H2O = poyuria
Interventions
Monitor status, ca level, and EKG
Causes of hypercalcemia
uncontrolled use of ca+ ions from the bones causes by neoplasms (cancer cells) Immobility hypothyroidism renal disease hyperparathyroid hormone Increase in Ca and Vit D Certain drugs
SIgns of hypocalcemia
Increase neuromuscular stimulation muscle spasm muscle cramps Chvostck sign + Trosseau sign + arrhythmias bradycardia intestinal cramping pain
Common causes of fluid overload
excessive fluid replacement kidney failure heart failure long term corticosteroid use SIADH pysch disorders w/ polydipsia water intoxication
Common causes of dehyrdation
hemorrhage vomit diarrhea profuse salivation fever hyperventilation ileostomy fistulas burns wounds NPO status GI suction diabietes incipidus difficulty swallowing
Fluid Volume Excess Signs and Symptoms
visual changes renal disease ADH secretion is decreased decreased cardiac output decreased blood flow to kidney s low hct low hgb low osmo low Specific gravity headache moist crackles edeam pale cool tachycardia bounding pulse high BP high CVP weight gain
Common causes of hyponatremia
excessive diaphoresis diuretics wound drainage decreased secretion of aldosterone hyperlipidemia kidney disease NPO low salt diet hyperglycemia cirrhosis of liver SIADH heart failure kidney failure
two most important areas to watch for during dehydration
urine output
pulse rate
Metabolic alkalosis
pH: High
HCO3: High
Resp Alkalosis
pH: High
CO2: Low
Resp Acidosis
pH: Low
Co2: High
Interventions for Metabolic Alkalosis
Correct problem KCL replacement replace fluid depletion w/ NS or 1/2 NS intubation if resp related monitor neuros. seizure precautions Monitor I&O status
Interventions for Metabolic Acidosis
Treat the cause
Sodium bicarb infusion
IV Fluid and insulin for DKA cases restoration of fluids and treatment of electrolyte imbalances administer O2 dialysis for renal failure Increase cardiac output treat dysrythmia
Interventions for Resp Alkalosis
sedatives or analagesics treat the cause O2 if needed deep breath breathe in a bag relaxation techniques
Metabolic Acidosis- Causes and S&S
Ph: Low
HCO3: low
Causes: Increase in nonvolatile metabolic acids
decrease in acid secretion by renal
excessive loss of HCO3
DKA, cardiac arrest, diarrhea, antifreeze overdose
SIGNS hyperventilation-- kussmauls resp CNS depression (Coma) N/V abdominal pain dull headache weakness fatigue confusion High Potassium, Chrloide, and Calcium levels
What is Respitory Acidosis Causes and S7S
pH: Low CO2: High Not breathing adqequatley Causes: acute resp depression or airway obstruction chronic COPd Over-sedation narcotic overdose
SIGNS altered LOC tachycardic headache warm skin muscle twitching shallow breathing pale cynotic
Metabolic Acidosis
pH: Low
HCO3: low
Acid Base balance lines of defense
- Chemical and protein buffers; respond quickly
- Resp Buffers: control levels of H+ ions in blood
- Renal Buffesrs; Most effective, slower to respond
Resp Alkalosis; Causes and S&S
pH: high
CO2: Low
Causes:: hyperventalation of any eitology
pyschogenic (fear and or anxiety)
SIGNS numbness and tingling in toes and fingers dizzy seizures tachypnea rapid breathing convulsions confusion low o2 possible
Metaboic Alkalosis Causes and S&S
High pH
High HCO3– too much bicarb not enough acid
Causes: vomiting, NG tube placement
cushings syndrome
K+ deficiency => due to diarrhea or vomitting
mass blood transfusions
Increased use of diuretics
SIGNS ;; related to hypokalemia numbness and tingling N/V diaphoresis shallow breathing confusion hypotensive headache dysrytmias increased QT, sinuc tachy
Interventions for Resp Acidosis
Focus on improving ventalation and O2 maintain patient airway treat the underlying cause Drug therapy Bronchodilators anti-inflam mucolytics O2 therapy Pulm hygiene vent support eleminate excess O2
Forensic nurse examiner
Victims of rape, child abuse, domestic violence advocate
Develops safety plans
how to escape violent situations
document injuries
Traige level ( non-urgent)
Could wait several hours if needed Examples skin rashes strains and sprains "Colds" simple fractures
Triage level Emergent
"life threatening" 1st level Examples Resp distress Chest pain w/ diaphoresis active bleed unstable vitals
Triage level Urgent
Need quick treatment , but not immediate life threatening Examples Sever abdominal pain renal colic displaced or multiple fractures soft tissue injuries pneumonia
Water body weight for babies, adults, and elderly
babies 70-80%
adults 60%
older adults 45-50%
SIADH
too much aldosterone -- not peeing edema weight gain disturbed electrolyte count
Monitor I&O diuretic therapy watch vitals monitor weight Hct, Hgb, Na, Osmo, will be decreased
How is ADH stimulated
when there is a low Na+ level, blood volume, and body fluids are down ( dehydration)
it helps to regulate H2O
Isontonic Solution
same concentration of blood
examples NS, D5W, LR, D5 in 1/4 NS
Hypotonic Solution
lower solute concentration then blood; fluid moves out of cells into intersitial
examples: 1/2 NS
Hypertonic solution
Higher concentration then blood
moves fluid into cell
examples: D10W, D5NS, D5LR
how to measure dehydration levels
adults: mucous membranes
Babies; sunken fontanell
Older adults: Neuro status
diabetes incipidus has not enough what
ADH, cannot concentrate urine, you pee alot, drink alot, and can become hpyotensive
what type of patients need fluid right away
burns
sever fever
very ill
specific gravity of fluid overloaded
will lower then 1.003
how much weight gain to notify provider
1-2 lb weight gain in 24hr period and 3 lbs in a week
addison’s disease is associated with what electrolyte
chloride
An increase in sodium can cause a decrease in what
potassium
diarrhea equals a low what
potassium level
clotting is effected by which electrolyte
calcium; if low can cause an increase in bleeding
parathyroid hormone comes when
there is too low of calcium
calcitonin will be released when
to keep calcium in the bones
an increase in calcium causes an increase in
phosphorus
cancer cells mimic what
parathyroid hormone cells
Third spacing
accumalation of fluid in the intersitial space
common in cirrhosis patients, renal failure, sepsis patients
