-
dyspnea, orthopnea
sign of what imbalance?
shortness of breath
ECV Excess
-
effervescent medications can cause what fluid imbalance?
- ECV Excess
- lots of sodium -> retain fluids
-
what fluid do you give for ECV deficit?
normal saline (isotonic)
-
what solution do you need to treat hypernatremia?
water/d5W
-
in clinical dehydration, what solutions do you use to treat?
- first normal saline (address low blood volume first)
- then address concentration problem with 1/2 normal saline, 1/2 d5w
-
oliguria
low urine output
-
what effect would renal failure have on fluid levels?
decrease Na+/H20 output
-
cirrhosis and congestive heart failure both prompt what hormonal change? What does this do to fluid levels?
- secretion of excessive aldosterone
- decrease Na+/H20 output
-
diuresis
excessive output of urine
-
bedrest can cause what to happen to fluid balances?
diuresis- increased urine output (legs are at same level of heart -> increased renal output)
-
crackles and rales are a a sign of which fluid imbalance?
ECV excess
-
dyspnea/orthopnea are signs of which fluid imblance?
ECV excess
-
lightheadedness may be a sign of which fluid imbalance?
ecv deficit
-
soft, sunken eyeballs and longitudinal furrows in tongue are a sign of which fluid imbalance?
ECV deficit
-
serum sodium concentration reflects osmolality of just blood, or whole body?
just blood/other body fluids
-
diabetes insipidus may cause which fluid imbalance?
- hypernatremia
- lose more water than salt
-
with excess sweating and diarrhea (without replacement), do you lose more water, more salt, or equal amounts of both?
more water than salt -> hypernatremia
-
if an older adult is on diuretic therapy, are they at risk to lose more water, more salt, or equal amounts of both?
lose more salt than water
-
seizures and coma may be a sign of what osmolality imbalance?
hypernatremia AND hyponatremia
-
nausea and emesis: which osmolality imbalance?
hyponatremia
-
why do both hyper and hyponatremia cause confusion and lethargy?
- alter the way neurons function
- hypo: brain cell swells
- hyper: cell shrivels
-
which hormone puts calcium into blood?
parathyroid hormone
-
which hormone removes calcium from blood?
calcitonin
-
is calcium that is bound to albumin in blood physiologically active?
no, needs to be free
-
which electrolyte imbalances are floppy?
- hyperkalemia
- hypokalemia
- hypermagnesemia
- hypercalcemia
-
which electrolyte imbalances are twitchy?
- hypocalcemia
- hypomagnesemia
-
what do you need for optimal absorption of calcium?
vitamin D
-
what can cause a deficit of calcium, potassium or magnesium? (general)
take in less than put out, supply shifts from available form to storage pool
-
what can cause an electrolyte excess? (general)
greater intake than output, supply shifts from storage pool into plasma
-
how does steatorrhea affect calcium levels?
- undigested fats bind to calcium
- may decrease intake/absorption
- may increase output
-
acute diarrhea may lead to which electrolyte imbalance?
hypokalemia (increased excretion)
-
how does pancreatitis affect electrolyte levels?
- can't digest fat -> undigested fat in colon
- calcium and magnesium bind to fat and are excreted
-
what hormone do low magnesium levels affect? What does this cause?
hypomagnesium -> low parathyroid -> calcium does not shift from bone to available blood
-
signs of hypocalcemia
- positive Chvostek sign
- positive Trousseau sign
- muscle twitching, cramping
- grimacing
- carpopedal spasm
- tetany
- laryngospasm
- seizures
- cardiac dysrhythmias
-
signs and symptoms of hypercalcemia
- anorexia
- constipation
- nausea/emesis
- muscle weakness, fatigue
- polyuria
- PERSONALITY AND MOOD CHANGES
-
if hypercalcemia, what should you do to your fluid intake?
drink a lot of fluid to keep urine dilute (prevents renal damage)
-
calcium rich foods
- almonds
- cream of wheat
- chocolate
- fish with bones (salmon, sardines)
- oranges/oj
- oysters
- tofu
- corn tortillas
- DGLV's
-
what 3 things cause potassium to move out of plasma and into cells?
insulin, alkalosis, epinephrine
-
high levels of potassium in the blood stimulate the release of what hormone?
aldosterone
-
factors that decrease K+ intake
- NPO status
- anorexia
- unusual weight-loss diet w/o K+
- IV therapy w/o K+
-
factors that increase K+ intake
- too much/too fast IV with KCl
- insufficient mixing of IV bag
- administration of stored blood
-
cushing's syndrome (glucocorticoid excess) make cause what electrolye imbalance?
increased output of potassium
-
hypomagnesemia may cause increased output of which electrolyte?
- potassium
- (also causes shift of calcium into bone)
-
potassium imbalances affect what?
smooth, skeletal and cardiac muscles
-
bilateral and ascending flaccid paralysis may indicate what?
- hypokalemia
- hyperkalemia (doesn't ascend as far)
-
dysrhythmias caused by _______ are among the potentially most dangerous ones
hyperkalemia
-
abdominal distension, decreased bowel sounds, constipation, polyuria, flaccid skeletal muscle weakness and cardian dysrhythmias
hypokalemia
-
flaccid skeletal muscle weakness, transient intestinal cramping and diarrhea, cardiac dysrhythmias
hyperkalemia
-
salt substitutes put you at risk for which imbalance?
hyperkalemia (contain KCl)
-
potassium rich foods
- apricots
- canteloupe
- dates
- figs
- grapefruit
- kiwi
- oranges/oj
- peaches
- prunes
- raisins
- strawberrys
- aspragus
- beets/green beans
- broccoli
- carrots, cauliflower, celery, potatoes
- pumpkin, squash
- almonds, brazil nuts, cashews, sunflower seeds
- instant coffee
-
chronic alcoholism and magnesium
causes increased output (undigested fats from liver failure?)
-
steatorrhea
unbound fats may bind to magnesium or calcium -> decreased intake/absorption, increased output
-
aspiration of sea water may increase levels of which electrolyte?
magnesium
-
positive chvostek and trousseau sign are signs of what imbalances?
hypomagnesemia, hypocalcemia
-
magnesium imbalances affect what?
neuromuscular excitability, deep tendon reflexes
-
an exaggerated patellar reflex may be a sign of
hypomagnesemia
-
decreased reflex response
hypermagnesemia
-
magnesium rich foods
- cocoa
- coffee
- egg yolk
- DGLV's -> have chlorophyll
- legumes
- milk
- meat
- nuts
- whole grain cereals
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