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Hypotonic Solutions
- Shifts fluid from intravacular to intracellular; expands cells
- 0.45% NS, 0.2% NS, 2.5% Dextrose
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Hypertonic Solutions
- Shifts fluid from intracellular to intravascular to expand blood volume; shrinks cells
- 5% Dextrose in 0.45% NS, 10% Dextrose in water, 3% NS
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Isotonic Solutions
5% Dextrose in water, 0.9% NS, Lactated Ringers
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Types of fluid losses in hypovolemia
- Sensible: diarrhea
- Insensible: tachypnea (through moisture in our expirations)
- Hospital induced: NG suctioning
- Other: vomiting, diuretics, ATN, hyperventilation, wound drainage, burns, diaphoresis
- ATN: all functioning components of tubulars of kidneys won't be able to absorb correctly
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S/S of hypovolemia
- Mental status: anxious, restlessness
- Skin: dry, tenting, decreased tugor
- Mucous membrane: dry
- CV: hypotension
- Urinary: drop off
- Musculoskeletal: cramping in gut, legs, and hands
- Note: if on vent, mouth could look dry when body isn't
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Most dangerous type of 3rd spacing
Cardiac Tamponade; pericardia can't expand anymore and things get squeezed
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Common cause of hypervolemia
Organ failure: Heart, Renal, Liver
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S/S of hypervolemia
- Crackles
- Edema
- JVD
- Weight gain
- HTN
- Localized and Generalized
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What is the one assessment finding that can occur in hypo or hypervolemia?
Low urine output: in hypervolemia the kidneys start to retain fluid because of compensatory mechanism in reaction to increased fluid; renal failure
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HYPOcalcemia Normal Level
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HYPOcalcemia causes
- Hypoparathyroidism (surgery)
- Acute pancreatitis: releasing Ca and being excreted by kidneys
- Citrate ingestion: Ca binds to this and become unusable; from stored blood
- Decreased magnesium and increased phosphorus
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S/S of HYPOcalcemia; start to show at <2.5
- Musculoskeletal: muscle twitching, spasms, tetany, cramps, Chvostecks and Trousseaus signs
- Neuro: irritability; muscles exciting
- Cardiac: decreased CO
- Skeletal: bone fractures
- Hematological: increased clot formations
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HYPOcalcemia Treatment
- First line: IV replacement; calcium gluconate/chloride
- Correct underlying cause
- Nursing care: monitor, PE, and VS
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HYPERcalcemia Normal Level
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HYPERcalcemia Causes
- Mobilization out of bone: BE ACTIVE!
- Malignancy: destruction of bone
- Parathyroid secreting tumors
- Meds: vit D, calcium, thaizide diuretics (not letting Ca out through kidneys)
- Absorption: the slower the gut, the slower time moving things out
- Over supplementation
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S/S of HYPERcalcemia
- Neuromuscular: muscle weakness and general fatigue, exhaustion
- Neuro: depressive state
- Cardiac: primary or secondary block
- Skeletal: bone fractures
- GI: PUD
- Renal: kidney stones
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HYPERcalcemia Treatment
- Increase calcium elimination by the kidneys (IV fluids and diuretics)
- Reduce calcium reabsorption from bone
- Medications
- Nursing care: monitor for dysrythmias, mental status, PE, and VS
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HYPOmagnesemia Normal Level
<1.3
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HYPOmagnesemia Causes
- Decreased intake: nutritional intake (veggies), chronic alcoholism
- Decreased absorption: acute pancreatitis, Chrohns Disease, bariatric surgery pts
- Increased Elimination: burns
- hypoparathyroidism w/ resultant hypocalcemia can cause hypomagnesemia bc the regulatory mechanisms of Mg and Ca are related
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S/S of HYPOmagnesemia
- Neuromuscular: tremors, tetany, Chrosteck and Trouseau
- Cardiovascular: PVCs (can go into VF)
- NEED GOOD MG LEVELS FOR GOOD K+ LEVELS
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HYPOmagnesemia Treatment
- Increase levels: IV (will start, then PO)
- Nursing care: monitor, notify, replace
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HYPERmagnesemia Normal Level
- >2.5
- Rare bc water soluble
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HYPERmagnesemia Causes
- Renal failure: failure to excrete
- Consumption of large quanitities of mag: medications (antacids, laxatives)
- elderly have a lot of reasons to be constipated, so sometimes over do it on laxatives
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S/S of HYPERmagnesemia
- Neuromuscular: lethargy, decreased deep tendon reflexes
- Cardiovascular: hypotension, bradycardia, cardiac arrest
- Respiratory: depression
- Mag has a depressant effect
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HYPERmagnesemia Treatment
- First line: give calcium
- Hold mag rich meds/foods
- Nursing care: monitor VS, PE, notify, administer
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HYPOphosphatemia
- <1.7
- Common imbalance in crititcally ill patients
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HYPOphosphatemia Causes
- Malnourishment
- Hyperparathyroidism
- Some renal tubular defects
- Metabolic acidosis (including DKA)
- Disorders tha cause hypercalcemia
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S/S of HYPOphosphatemia
- Cardiac: decreased CO
- Musculoskeletal: weakness
- GI: N/V
- Neuro: disorientation, seizures
- Hematologic: poor tissue oxygenation
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HYPOphosphatemia Treatment
- IV or PO supplementation
- Treat underlying cause
- Nursing care: monitor respiratory and muscles r/t weakness and fatigue, notify, replace
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HYPERphosphatemia Normal Level
>2.6
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HYPERphosphatemia Causes
- Main: Chronic Renal Failure
- Hyperthyroidism
- Hypoparathyroidism
- Severe catabolic states
- Conditions causing hypocalcemia
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S/S of HYPERphosphatemia
- Cardiac: tachycardia
- GI: diarrhea, N/V, abdominal cramping (#1 complaint)
- Musculoskeletal: weakness, muscle cramps in gut and legs
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HYPERphosphatemia Treatment
- Lower serum levels: binders (absorb phosphorus and get excreted)
- Nursing care: monitor pt and serum lab values
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Sodium and Dilutional Effect
- A major factor in DKA because glucose is increased, and things can't get excreted; fluid shifts
- Water replacement and diuretic use: too much or too little can alter levels but same content
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Acute Treatments of Hyperkalemia
- 10 units of Regular Insulin IV
- Full amp of IV Dextrose 50
- will decrease glucose and push K+ into cells lowering K+ levels
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