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NURSADN6 Med Surg > Week 2 Fluid and Electrolytes Balance and Disturbance > Flashcards

Week 2 Fluid and Electrolytes Balance and Disturbance Flashcards

1
Q

Movement of fluid from region of low solute to region of high across semipermeable membrane

A

Osmosis

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2
Q

Changes in water or volume related to water pressure

A

Hydrostatic Pressure

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3
Q

Movement of solutes from area of greater concentration to lesser concentration

Solutes in an intact vascular system are unable to move so diffusion normally should not be taking place

A

Diffusion

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4
Q

Movement of molecules against the concentration gradient and requires ATP as energy; process typically takes place at cellular level and is not involved in vascular volume changes

A

Active Transport

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5
Q

What is the nursing role in Fluid and Electrolyte balance

A

Help prevent, treat fluid and electrolyte disturbances

Understand physiology of F&E and Acid Base balances to anticipate, identify and respond to possible imbalances

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6
Q

The body is approximately how many % of fluid?

A

60%

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7
Q

Intracellular is ?

A

28 L

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8
Q

Extracellular fluid is how many?

A

14L

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9
Q

Extracellular fluid is broken into

A
  1. Intravascular-3-4 L
  2. Interstitial - 10-11 L
  3. Transcellular
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10
Q

Loss of ECF into space that does not contribute to equilibrium

Moves from intravascular to interstitial (Nonfunctional area between cells)

A

Third Spacing

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11
Q

Fluid is not available in the ICF or ECF

Does not contribute to equilibrium between ICF/ ECF

A

Third Spacing

Sign is decreased urine output Hallmark Sign

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12
Q

Third Spacing is seen in what kind of patients

A
  1. Decreased Potassium
  2. Decreased Fe
  3. Severe liver dz
  4. Alcholishm
  5. Hypothyroidism
  6. Malabsorption
  7. Burns
  8. Fluid Volume Overload
  9. Cancer
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13
Q

As volume deficits are detected by the kidneys they retain fluids in an effort to

A

Maintain CO and BP

Examples ascites, pleural effusion, pericardial effusion

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14
Q

Other compensatory signs of Third Spacing includes

A

Increased HR
Decreased BP
Decreased CVP
edema
Increased body wt
Imbalance
I & O’s

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15
Q

Low oncotic pressure exerted by plasma proteins is loss from?

A

IV space

Will result in leakage into the tissues

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16
Q

Name causes of fluid shifts

A

Albumin losses can occur in liver failure, liver dysfunction, and malnutrition
- Albumin losses can lead to fluid shifting into the peritoneum causing ascites
- Destruction of endothelial cells such in bowel surgery can cause fluid to move and be trapped in interstitial spaces

Fluid trapped in the lungs can lead to pulmonary edema

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17
Q

Active chemicals that carry positive and negative charges are

A

Electrolytes
cation= +
anions= -

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18
Q

Name the major cations

A

Sodium
Potassium
Calcium
Magnesium
Hydrogen Ions

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19
Q

Name the major anions

A

Chloride
Bicarbonate
Phosphate
Sulfate
Proteinate

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20
Q

Electrolyte concentrations differ in fluid compartments

A

True

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21
Q

Most in extracellular fluid includes

A

Na
Ci
Osmolality
HCo3

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22
Q

Most in intracellular fluids include

A

Potassium
Mg
Phosphates
Osmolality

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23
Q

How can we regulate fluid?

A

Osmosis
Diffusion
Filtration
Active Transport

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24
Q

Regulation of fluid is movement through capillary walls depends on what?

A

Direction of fluid movement depends on differences of hydrostatic, osmotic pressure

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25
Q

Average intake includes?

A

Metabolism-10%,250 ml
Foods-30%-750ml
Beverages-60%1500ml

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26
Q

Average output includes?

A

Feces- 4%, 100 ml
Sweat- 8%, 200ml
Insensible losses via skin and lungs- 28%, 700ml
Urine-1500ml, 60%

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27
Q

Gain is what?

A

Dietary intake of fluid, food or enteral feeding
Parenteral fluids

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28
Q

Routes of losses includes

A

Kidney : Urine output
Skin loss: Sensible/ insensible losses
-Lungs
- GI tract

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29
Q

As blood flows through the lungs what happens?

A

Co2 removed and 02 is added

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30
Q

What moves in Cells? Out of cells?

A

In cells are nutrients
Out of cells are metabolic wastes move out of cells

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31
Q

Kidneys clear

A

Plasma filtrate of nitrogenous wastes, ion excesses, etc

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32
Q

Name homeostatic mechanisms

A

Kidney
Heart and Blood vessels
Lung
Pituitary
Adrenal
Parathyroid
Baroreceptors

RAAS
ADH
Osmoreceptors
Natriuretic Peptides

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33
Q

Gerontologic Considerations includes

A

Reduced Homeostatic mechanisms, cardiac, renal, and resp. function

Decreased body fluid percentage

Medication use

Presence of concomitant conditions

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34
Q

Imbalance may be subtle
Fluid deficit may cause delirium
Decreased cardiac reserve
Reduced renal function
Dehydration is common
Age - related thinning of skin and loss of strength and elasticity

A

Gerontologic Considerations

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35
Q

Fluid Volume deficit is also known as

A

Hypovolemia

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36
Q

FVE is also known as

A

Hypervolemia

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37
Q

What is the relationship between Volume and osmolarity?

A

Decrease volume, increased Osmol

Decreased Osmol, Increased Volume

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38
Q

This may occur alone or in combination with other imbalances

A

FVD

Hypovolemia

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39
Q

-Loss of extracellular fluid exceeds intake ratio of water

  • Electrolytes lost in same proportion as they exist in normal body fluids
A

Fluid Volume Deficit

  • Hypovolemia
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40
Q

Not the same as FVD

  • Loss of water alone, with increased serum sodium levels
A

Dehydration

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41
Q

-Abnormal Fluid Losses
- Decreased Intake
- Third Space Fluid Shifts
- Additional Causes

A

Causes of FVD

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42
Q

Manifestations of this include

  • Rapid weight loss
  • Decreased skin turgor
  • Oliguria
  • Concentrated urine
  • Postural hypotension
  • Rapid weak pulse
  • Increased temperature
  • Cool clammy skin due to vasoconstriction
  • Lassitude
  • Thirst
  • Nausea
  • Muscle weakness
  • Cramps
A

Fluid Volume Deficit

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43
Q

Lab Data is showing
- Elevated BUN in relation to serum creatinine
- Increased HCT
- Increased serum and urine osmo and specific gravity
- Decreased urine Na

A

FVD

  • Serum Electrolyte changes may occur
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44
Q

Medical Management of FVD

A

Provide fluids to meet body needs

—-Oral Fluids
—-Iv Solutions

FVD

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45
Q

Name the risk for Dehydration or Hypovolemia

A
  1. Diminished kidney function
  2. Elevated Temperature
  3. Highly concentrated tube feedings without enough supplemental water
  4. Young infant with diaper- Inaccurate assessment of output
  5. Diarrhea; diuretic overuse; diabetes
  6. Reduction in body water content; LOC, temp. and fluids= Tachycardia
    –esp. in elderly
  7. ADH production decreases
    8.Thirst mechanism reduced
  8. Increase in serum glucose
  9. Other conditions-N/V
  10. Not able to obtain fluid without help
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46
Q

Concept Map RAAS

A

Slide 29

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47
Q

Regulation of water intake and output

A

Slide 30

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48
Q

Labs are all increased
- HCT
- Serum Osmolality
- Protein level
- BUN
- Na
- Glucose
- Urine Specific Gravity

A

FVD or Dehydration

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49
Q

System Specific assessment

A
  • Decreased moisture of mucous membranes
  • Decrease in vascular volume= Tachycardia
  • Decrease in postural BP= Syncope
  • Decrease in neck vein (Flat)
  • Decrease in UO
  • Decrease BP too much= Shock
  • Decrease in skin turgor- not valid in elderly
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50
Q

What is the normal Serum Osmol?

A

270-300 mOsm/ kg

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50
Q

Fluid replacement is determined based on how the fluid was loss

A

Crystalloids- Small molecules

Colloids- Large molecules

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50
Q

-This is due to fluid overload or diminished homeostatic mechanisms
- Risk factors: Heart failure, renal failure, cirrhosis

A

FVE

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50
Q

Contributing factors includes
- Excessive dietary sodium or sodium containing IV solutions

A

FVE

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51
Q

Manifestations include
- Edema
- Distended Neck Veins
- Abnormal lung sounds( crackles)
-Tachycardia
- Increased Blood pressure
- Pulse pressure and CVP
- Increased weight
- Increased urine output
- SOB
- Wheezing

A

FVE

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51
Q

Medical management includes
- Directed at cause
- Restriction of fluids and sodium
- Administration of diuretics

A

FVE

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51
Q

ANP/ ANF does what?

A

increases
- NaCl concentration
- Blood volume
- Blood Pressure

Then stretches increase of atria
Then increases ANP/ ANF release from cardiac cells in the atria

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52
Q

Then the atria ANP/ ANF

A
  • Decreases suppression of RA system, angiotensin II
  • Decreases Aldosterone release by adrenal cortex
  • Decreases ADH release by posterior pituitary gland
  • Increase GFR and increases Na excretion
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53
Q

With decrease ADH release it increases what?

A

Urine production and water excretion

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54
Q

Increase rate of urine production and water excretion does what?

A

Decreases
- Blood volume
- CVP
- CO
- Arterial Blood pressure
- Preload
- HR

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55
Q

System Specific Assessment of FVE includes

A

Increase Pulse - may be bounding
-Increase BP
- Increase confusion
- Increase in edema
- Increase wt more than 2ILBS/ 24 hr
- Increase in ascites
- Increase crackles in lungs
- Increase RR, dyspnea, orthopnea
- Increase neck veins JVD
- Increase R/F skin breakdown

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56
Q

FVE Labs will show what?

A

Decreased
- HCT
- Protein Level
- Na
- Urine SG
- Serum Osmolality
- BUN
- Glucose

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57
Q

This includes
- Postural hypotension
- Tachycardia
- Absence of JVP
- Decreased skin turgor
- Dry mucosa
- Supine Hypotension
- Oliguria
- Organ Failure

A

Volume Depletion

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58
Q

This includes
- HTN
- Tachycardia
- Raised JVP/ Gallop rhythm
- Edema
- Pleural Effusions
- Pulmonary Edema
- Ascites
- Organ Failure

A

Volume Overload

59
Q

Sodium- Hyponatremia/ Hypernatremia
Potassium- Hypokalemia/ Hyperkalemia
Calcium- Hypocalcemia/ Hypercalcemia
Magnesium- Hypo magnesium/ Hyper magnesium
Phosphorus- Hypophosphatemia/ Hyperphosphatemia
Chloride- Hyperchloremia/ Hypochloremia

A

Electrolyte Imbalances

60
Q

Serum Sodium less than is 135

A

Hyponatremia

61
Q

Causes include Adrenal Insufficiency
- Water intoxication
- SIADH
-Losses by vomiting
- Diarrhea
- Sweating
- Diuretics
- Renal Disease

A

Hyponatremia

  • Na deficit

FVE - Dilutional

62
Q

Name the S/S of hyponatremia

A
  • Poor skin turgor
  • Dry mucosa
  • Headache
  • Decreased salivation
  • Decreased BP
  • Nausea
  • Muscle weakness
  • Abd. cramping
  • Neurologic changes
  • Seizures
63
Q

Name the medical management of Hyponatremia

A
  • Water restriction
  • Sodium replacement
64
Q

What is the nursing management of hyponatremia?

A
  • Assessment and prevention
  • Dietary sodium and fluid intake
  • Identify and monitor at- risk patients
  • Effects of medications - ( diuretics, Lithium)
65
Q

System Specific Assessment Solution Deficit includes

A
  • Decrease in cerebral function
  • Decrease LOC- risk for seizures
  • Decrease muscle strength
  • Decrease DTR
  • Decrease volume= Increase HR
  • Decrease BP; orthostatic
  • Decrease UO
  • Decrease weight
  • Decrease sodium intake
66
Q

System specific assessment solution deficit includes both cause depending on ECF includes

A

Decrease in cerebral function
Decrease LOC risk for seizures
Decrease muscle strength

67
Q

Name system Specific Assessments Dilutional Water excess includes

A
  1. Decrease Cerebral function
  2. Decrease LOC- risk for seizures
  3. Decrease muscle strength
  4. Decrease DTR
  5. Decrease UO
  6. Increase BP
  7. Increase weight
  8. Increase HR
68
Q

Causes of this includes
- Excess water loss, excess sodium administration, DI, heat stroke, Hypertonic IV solutions

A

Hypernatremia more than 145

69
Q

S/S include
- Thirst
- Elevated Temp.
- Dry, swollen tongue
- Sticky mucosa
- Neuro symptoms
restlessness
- Weakness

A

Hypernatremia

70
Q

Thirst may be impaired in the ?

A

Elderly
ill

71
Q

_________________________ occurs in patients with normal fluid volume, FVD, FVE

A

Hypernatremia

72
Q

In hypernatremia what is the serum osmolality

A

Greater than 300mOsm/ kg

73
Q

Increased urine specific gravity and osmolality

A

Hypernatremia

74
Q

Fluid Deficit Dried Specific System Assessments

A
  • Dryness of mucous membranes
    —–Increase concentration in urine/ decrease UO
    -Red Flushed Skin
    —-Increase restless progressing to confusion
  • Increased Temp. ; I &O
    —- Increase concentration in urine/ decrease UO
  • Increase thirst ( may not be present in elderly)
  • Increase risk for seizure
    -Elevated HR
  • Decreased weight, BP, CVP, and UO
75
Q

Name the system specific Assessments “Edema”
- Fluid excess/ Na retention

A
  1. Edema
  2. Decrease in HCT; diet high in Na
  3. Elevated weight; elevated BP and HR
  4. Mentation decreased - Lethargic
  5. A flushing of the skin
76
Q

Interventions for hypernatremia

A

Restrict fluid intake with retention
- restrict foods high in Na

Evaluate for cerebral changes-(HA, nausea, seizure precautions)
- Strict I&0 safety falls
- BP is elevated d/t excess fluid excess. BP is low - Fluid deficit
- Review origin of hypernatremia
- Fluid deficit- hypotonic IV fluids
- Check daily weight; neuro assessments
- The excess fluids removed by diuretics

77
Q

Below normal potassium may occur with normal potassium levels with ALKALOSIS due to shift of potassium into cells

A

Hypokalemia

78
Q

Name the causes of Hypokalemia

A

GI losses/ NGT, medications, alterations of acid- base balance, hyperaldosterism, poor dietary intake

79
Q

Name s/s of hypokalemia

A
  • Fatigue
  • Anorexia
  • Nausea
  • Vomiting
  • Dysrhythmias
  • Muscle weakness
  • Cramps
  • Paresthesias
  • Glucose intolerance
  • Decreased muscle strengths
  • DTRs
80
Q

Medical management of hypokalemia includes

A

Increased dietary potassium
Potassium replacement
IV for severe deficit

81
Q

Nursing Management of hypokalemia

A

Assessment
Severe hypokalemia is life threatening
- Monitor ECG and ABGs
- Dietary potassium
- Nursing care related to IV potassium administration

82
Q

Name foods high in potassium

A
  1. tomatoes
  2. Avocados
  3. Bananas
  4. Orange
83
Q

________ substitutes are ______ in ____

A

Salt; potassium

84
Q

Potassium level higher than 5.0
What are causes of this?

A

Hyperkalemia
1. Usually treatment related
2. Impaired renal function
3. Hypoaldosteronism
4. Tissue Trauma
5. Acidosis

85
Q

Name the S/S of hyperkalemia includes

A
  • Cardiac changes and dysrhythmias
  • Muscle weakness with potential respiratory impairment
  • Paresthesia
  • Anxiety
  • GI manifestations
86
Q

Name the medical management of Hyperkalemia

A
  • Monitor ECG
  • Limitation of dietary potassium
  • Cation exchange resin ( Kayexalate)
  • IV sodium bicarbonate
  • IV calcium gluconate
  • Regular insulin
  • Hypertonic dextrose IV
  • Dialysis
87
Q

Nursing Management of Hyperkalemia

A

Assessment of serum potassium levels
- Ivs containing K
- Monitor medication affects
- Dietary potassium restrictions/ dietary teaching for patient’s at risk

88
Q

________ may result in false lab result positive of hyperkalemia

A

Hemolysis or drawing of blood above IV site

89
Q

______ sub. may contain potassium

90
Q

What may cause elevation of potassium

A

Potassium sparing diuretics

  • Not used in renal DZ
91
Q

-Renal Function deteriorates with age
-Elimination is decreased due to decrease in oral fluid intake
-Note that plasma renin and aldosterone decrease with age
- Alteration in renal blood flow
-Likely to take meds that interfere with K excretion

A

Hyperkalemia in Elderly Adults

92
Q

Hyperkalemia and the EKG

A

Peaked T waves
Flat Ps

93
Q

What is C-BBIG-K?

A

Calcium Gluconate or CaCI- Cardio protective- Prevents deleterious cardiac effects

BBIG- K back into the cell
–B2 agonist
- Bicarb– if acidosis
- I and G- Insulin and glucose together

K - Get rid of the potassium
- Kayexalate
- Diuretics
- Dialysis

94
Q

Hypocalcemia has normal output but low intake/ absorption

A
  • Low Ca rich foods
  • Vit D deficiency
  • Malabsorption Crohns
95
Q

Hypocalcemia increased output not balanced by increase Ca intake and absorption

A
  • Binds Ca in GI secretions in addition to the intake of Ca in diet- steatorrhea
96
Q

Hypocalcemia is serum less than

A

8.6 must be considered in conjunction with serum albumin levels

97
Q

Causes of hypocalcemia

A

Hypoparathyroidism
Malabsorption, Pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure medications

98
Q

S/S neuromuscular Hypocalcemia

A

Tetany
Circumoral numbness
Parethesias
DTRs
Trousseaus
Chovstek’s
Seizures
Resp. symptoms of dyspnea and laryngospasm
- abnormal clotting
- Anxiety

99
Q

Cuff of blood pressure is what sign seen in hypocalcemia

A

Trousseau’s

100
Q

Tapping of the cheek is a sign of what?

A

Hypocalcemia and is known as Chvostek’s sign

101
Q

System Assessments for Hypocalcemia

A

T- Trousseau’s
W- Watch for dysrhythmias
I- Increases bowel sounds/ diarrhea
T- Tetany, twitching, tingling, seizures, spasms at rest can progress to tetany
C- Chvostek’s
H- Hypotension, Hyperactive DTRs

102
Q

First to do priority Interventions Hypocalcemia “SAFE”

A

S- seizure precautions
A- administer Ca supplements
F- foods high in C ( dairy, greens) educate client
E- emergency equipment on standby

103
Q

Name the medical management of Hypocalcemia includes

A
  • IV calcium gluconate
  • Calcium and vitamin D supplements
  • Diet
104
Q

_____________ _____________ is life threatening

A

Severe hypocalcemia

105
Q

What type of exercises one can do to decrease bone calcium loss?

A

Weight Bearing

Also teach patient about related diet and medications

Nursing care is related to IV calcium administration

106
Q

Name the drugs associated with hypocalcemia

A

A- aluminum containing antacids
A- anticonvulsants
B- beta blockers
C- caffeine
C- corticosteroids
D- diuretics (loop)

107
Q

Serum level is above 10.5

A

Hypercalcemia

108
Q

Name the s/s of hypercalcemia

A
  • muscle weakness
  • low coordination
  • anorexia
  • constipation
  • N/V
  • Abd bone pain
  • polyuria
  • thirst
  • ECG changes
  • Dysrhythmias
109
Q

Name the causes of hypercalcemia

A
  • Malignancy
  • Hyperparathyroidism
  • Bone loss related to immobility
110
Q

Medical Management of hypercalcemia

A

-Treat underlying causes
- fluids
- Furosemide
- phosphates
- calcitonin
- bisphosphonates

111
Q

______ normal output, increased Ca and intake and absorption

A

hypercalcemia

112
Q

Decreased output not balanced by decrease Ca intake

A

Thiazide Diuretics

Hypercalcemia

113
Q

Rapid Ca shift from bone to ECF ..

A
  • Hyperparathyroidism
  • Metastatic malignancy that secretes bone resorbing factors
    Padgett’s disease

Chronic immobility

114
Q

System specific Assessment for Calcium includes

A

C- cardiac dysrhythmias ( decrease QT, short ST); CNS is decreased
A- anorexia, nausea, constipation
L- LOC decreased
C- Ca level above 10.5
I- increase in drowsiness
u- Underactive reflexes
M- muscle weakness
F- fat Ca

115
Q

Serum is less than 1.3 mg/ dL and evaluate with serum albumin

A

Hypomagnesemia

116
Q

Name causes of Hypomagnesemia

A
  • Alcoholism
  • GI losses
  • IBS/ IBD medications
  • Rapid administration of citrated blood
  • Contributing causes include DKA
  • Sepsis
  • Burns
  • Hypothermia
117
Q

S/S of hypomagnesemia include

A
  • Neuromuscular irritability
  • Muscle weakness/ fatigue
  • Tremors/ convulsions
  • ECG changes
  • ALOC
  • Nystagmus
118
Q

What is the medical management of Hypomagnesemia?

A

Includes
- Diet
- Oral magnesium
Mag sulfate IV

119
Q

Mg has similar relation to?

120
Q

Assessment for Magnesium

A

TWITCH
T- Trousseau’s
W- watch for dysrhythmias
I- Increase neuromuscular excitability
T- Tetany, twitching ( seizures)
C- Chhvostek’s sign
H- Hypoactive bowel sounds, constipation, hyperactive DTR; HTN

121
Q

Interventions for low mag.

A

SAFE
S- Seizure/ fall precautions
A- Administer Mg sulfate IV per order
F- foods high in Mg
E- Emergency equipment stand by, eliminate drugs that decrease magnesium, Evaluate DTRs

122
Q

What is the nursing management of hypomag.?

A

Assessment
- Ensure safety
- pt teaching related to diet
- medications
- alcohol use
- Nursing care related to IV mag sulfate
- Often accompanied by hypocalcemia
- Dysphagia common in mag. depleted patients

123
Q

Name foods high in Mg

A

Nuts
Dark chocolate
Seafood
Introduce Peas and dry beans
Use whole grain bread and cereal
Meats

124
Q

Rhythm to watch with Mg is

A

Torsades de Pointes

125
Q

Hypermagnesemia is serum above

126
Q

Name causes of Hypermagnesemia

A
  • Renal Failure
  • DKA
  • Excessive administration of mg
127
Q

S/S of Hypermag

A
  • Low BP
  • n/v
  • hypoactive reflexes
  • drowsiness
  • muscle weakness
  • depressed respirations
  • ECG changes
  • Dysrhythmias
128
Q

Medical management of hypermag. includes?

A

IV calcium gluconate, Loop diuretics, IV NS of RL
- Hemodialysis

129
Q

Nursing management of Hypermag.

A
  • Assessment
  • Do not administer medications containing magnesium
  • Pt teaching regarding magnesium containing OTC medications
130
Q

Name the similarities between Ca and Mg

A
  • Both predominantly in bone
  • Assessments are similar
  • Both can twitch
  • Elevated levels, drowsiness, decrease muscle tone, dysrhythmias
  • differences - diarrhea- too much Mg
  • Constipation- too much calcium
131
Q

Below serum of 2.5

A

Hypophosphatemia

132
Q

Name S/S of hypophosphatemia

A
  • Neurologic symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, increased susceptibility to infection
133
Q

What is the nursing management of Hypophosphatemia?

A
  • Assessment
  • Encourage food high in phosphorus
  • Gradually introduce calories for malnourished patients receiving paternal nutrition
134
Q

Name the causes of hypophosphatemia

A
  • Alcoholism, refeeding of patients after starving
  • Pain, heat stroke, resp. alkalosis, hyperventilation
  • DKA
  • Hepatic encephalopathy
  • Major Burns, Hyperparathyroidism
  • Low Mg
  • Low potassium
  • Diarrhea
  • Vitamin D deficiency
  • Use of diuretic and antacids
135
Q

Name the medical management of hypophosph.

A
  • Oral or IV phosphorus replacement
136
Q

Serum above 4.5 is known as

A

Hyperphosphatemia

137
Q

Name the S/S of hyperphosphatemia

A
  • Soft tissue calcifications
  • Symptoms include and associated with hypocalcemia
138
Q

Nursing management of Hyperphosphatemia include ?

A
  • Assessment
  • Avoid high phosphorus foods
  • Pt teaching related to diet
  • Phosphate containing substances and signs of hypocalcemia
139
Q

Name the causes of Hyperphosphatemia

A
  • Renal Failure
  • Excess phosphorus
  • Excess vitamin D
  • Acidosis
  • Hypoparathyroidism
  • Chemotherapy
140
Q

Name the medical management of Hyperphosphatemia

A
  • Treat underlying disorder
  • Vitamin D preparations
  • Calcium Binding antacids
  • Phosphate Binding gels or Antacids
  • Loop Diuretics
  • NS IV
  • Dialysis
141
Q

Hypochloremia is less than

142
Q

Name the causes of hypochloremia

A
  • Addison’s disease
  • Reduced chloride intake
  • GI loss
  • DKA
  • Excessive sweating
  • Fever
  • Burns
  • Medications
  • Metabolic Alkalosis
143
Q

Loss of __________________ occurs with loss of other electrolytes, potassium, sodium

144
Q

S/S of hypochloremia includes

A
  • Agitation
  • Irritability
  • Weakness
  • Hyperexcitability of muscles
  • Dysrhythmias
  • Seizures
  • Coma
145
Q

Medical management of hypochloremia

A
  • Replace chloride IV NS
    or 0.45 NS
146
Q

What is the nursing management of hypochloremia?

A
  • Assessment
  • Avoid free water
  • Encourage high chloride foods
  • Patient teaching related to high chloride foods
147
Q

Serum more than 107 mEQ/ L is

A

Hyperchloremia

148
Q

Name causes of hyperchloremia

A
  • Excess sodium infusions with water loss
  • Head injury
  • Hypernatremia
  • Dehydration
  • Severe diarrhea
  • Resp. Alkalosis
  • Metabolic acidosis
  • Hyperparathyroidism
  • Medications
149
Q

Name the S/S of hyperchloremia

A
  • Tachypnea
  • Lethargy
  • Weakness
  • Rapid deep respirations
  • HTN
  • Cognitive changes
150
Q

Hyperchloremia includes

A

Normal serum anion gap

151
Q

Medical management of hyperchloremia includes

A

Restore electrolyte and fluid balance
- LR
- Sodium Bicarbonate
- Diuretics

152
Q

Name the nursing management of Hyperchloremia

A
  • Assessment
  • Pt teaching r/t diet and hydration

NURSADN6 Med Surg (9 decks)

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