Dehydration can occur with loss of what normal body fluids? (5)
diarrhea
vomiting
GI drainage
diuretic overdose
hemorrhage
Give examples of reasons why dehydration may occur: (7)
decreased intake
inadaq. intake
intake with impaired thirst
fever
anorexia
nausea
decrease LOC/cognitive impairment
True or False?
FVD does mean dehydration.
False- does not
Dehydration refers to loss of pure ____ ____ without corresponding to loss of __.
water alone
Na
List some manifestations of dehydration:(4)
restlessness
drowsiness
postural hypotension
increased respiratory rate
When Tx dehydration what is the perfered route:
oral
What are the dangers with rapid replacement of fluids? (2)
stimulates diuresis-(increased excretion of urine)
stimulates hypernatremia
What are the clinical manifestations of hypovolemia/FVD: (15)
1.weight loss
2. hypotension and tachycardia
3. orthostatic hypotension
4. slow capillary refill
5. flat neck veins
6. dry mucous membranes
7. weakness, dizziness, lightheadedness
8. thirst
9. oliguria and concentrated urine
10. fever
11. elevated HTC >55%
12. elevated Na > 145 Eq/L
13. Urine specific gravity > 1.025
14. BUN >25mg/dl
15. plasma osmolarity >295mOsm/kg
What are the 4 Nx DX for FVD?
deficient fluid volume
impaired oral mucous membranes
ineffective health maintenance
potential complication: hypovolemic shock
Deficient fluid volume is r/t what, based on the notes?
excess fluid loss or inadequate fluid intake
Impaired oral mucous membranes is r/t what, based on the notes?
inadequate oral secretions
ineffective health maintenance r/t what, based on the notes:
deficient knowledge regarding prevention of dehydration
Over hydration or fluid overload or fluid volume excess may result from excessive intake of _____, abnormal ________ of fluids.
fluids
retention (such as heart failure, renal failure)
Vascular overload is called what?
hypervolelmia
When dealing with fluid overload the 1st space is and give example:
intravascular space
HTN & hypervolemia
When dealing with fluid overload the 2nd space is what and give an example:
edema in interstitial space
Ascites
When dealing with fluid overload the 3rd space is fluid ___________ in areas in which exchange with thr rest of ____ cannot easily occur such as: (3)
accumulation
ECF
pleural
pericardial
peritoneal space
If fluid accumulation in the 3rd space does not easily occur in the exchange area of ECF what causes it?
(IPI)
mainly due to:
infection
inflammation
perotonitis
When FVE is present in the intersitial spaces what is it refered as?
edema
High doses of corticosteroids can cause what?
FVE
What are the major clinical manifestations of FVE in the 3rd space:
moist crackles in the lungs
SOB
cough
peripheral or dependant edema
What are the usual treatments for FVE?
Diurectics and restriction of Na and fluids
What are the Nx for FVE: (3)
Excess fluid volume
Risk for impaired skin integrity
Potential complications: pulmonary edema, ascites
Excess fluid volume is r/t what, based on the notes:
compromised regulatory mechanisms or excess intake or excess retention.
What are the major FVE manifestations:
rapid weight gain
intake > output
full bounding pulse
elevated BP
distended jugular veins
moist crackles on lung auscultation
SOB
Peripheral or dependent edema
When dealing with fluid imbalances what are the major nursing interventions that should be done:
1. I&O; look at trends
2. monitor cardiovascular changes
3. assess respiratory status and monitor changes.
4. daily weights
5. skin assessment
6. neuro assessment
What tool helps to identify if the urine is highly concentrated or dilute?
Urine specific gravity
S/S of ECF imbalances are reflected in what 3 main areas:
BP
pulse force
JVD
An increase of 1kg (2.2lb) = how many mL?
1000mL
When dealing with Fluid imbalance turgor should be assessed over the ______, _______, _______ ______. Execpt in OA which should be done on ________ or below the ________.
sternum
abdomen
forearm
forhead
clavicle
What population is at risk for Electrolyte imbalance:(5)
elderly
endocrine
renal
cognitively impaired
medications (diuretics)
What is the normal levels for Na:
135-145mEq/L
What is the major cation in ECF?
Na
NA determines what in the body?
plasma osmolarity
Hypernatremia is >
145mEq/L
Hypernatremia causes _________ leading to cellular __________. The primary protection is thirst from ___________.
hyperosmolality
dehydration
hypothalamus
Based on the notes what are 2 good nursing Dx for Hypernatremia:
Excess fluid volume r/t...
Risk for injury (falls) r/t...
What are the main causes of Hypernatremia:
inadequate water intake
excess water loss
excess Na intake
renal disease
cushing disease
hyperaldosteronism
Hypertonic IV fluids
DM
What are the major clinical manifestations for Hypernatremia:
thirst
changes in LOC
muscle twitching
changes in V/S
JVD
decrease urine output
increase urine specific gravity
edema
weight gain
dry skin
severe neuro changes
restlessness/agitation
dry swollen tongue
How would you treat/manage Hypernatremia:
treat underlying cause
oral fluids
Diuretics (promotes Na excretion)
When dealing with Hypernatremia if oral fluids cannot be ingested, IV solution of __ ______ in water or _______ ____.
5% dextrose
hypotonic saline
Serum Na levels must be reduced gradually to avoid what?
Cerebral edema
Hyponatremia abnormal level is:
<135mEq/L
What are the major causes of Hyponatremia:
excess loss of Na due to GI, renal, skin loss
FVE
use of diuretics
diarrhea
vomiting
burns
CHF
cirrhosis
nephrotic syndrome (edema)
hypoaldosteronism
Hyponatremia causes the ____ to be especially vulnerable because it cause brain swelling.
CNS
What are the major clinical manifestations of Hyponatremia:
confusion
nausea
increase urine output
generalized muscle weakness
postural Hypotension
weight loss
headache
tremors, seizures, como
muscle spasm
N/V
Based on the notes what is the nursing Dx for Hyponatremia:
Risk for injury (falls)
How would you treat Hyponatremia?
Fluid restriction
Fluid replacement of 3% NaCl
When dealing with Hyponatremia if severe symptoms occur small amount of intravenous _______ _____ ( ) is given.
hypertonic saline
3% NaCl
What are the normal levels of K?
3.5-5.5mEq/L
K is necessary for transmission and conduction of _____ _______. Maintenance of normal ______ _____. _______ muscle contraction and ___-___ balance.
nerve impulses
cardiac rhythms
skeletal
acid-base
List some major sources of k+:
Fruits & vegetables
Salt substitutes
K+ med (PO,IV)
stored blood
What are the major clinical manifestations of Hyperkalemia:
Irregular heart rate, usually bradycardia
Abdominal pain and cramps, diarrhea
muscle twitches or cramps
weakness
cardiac arrest
decrease B/P
EKG changes
What are good interventions for Hyperkalemia:
Eliminate oral and parenteral K intake
Increase elimination of k
How would you eleminate excess K+:
diuretics
dialysis
kayexalate
When dealing with Hyperkalemia a good intervention to put in action would be to force K from ECF by __ ____ or ____ _______ but only if what is present?
IV insulin
sodiun bicarbonate
acidosis
Hyperkalemia is causee by what?
drug containing K (salt sudstitutes)
shift of K out of cell
acidosis
burns, fever
renal dx
ACE inhibitors
Hypokalemia abnormal level is
< 3.5mEq/L
Hypokalemia is caused by:
GI, renal, skin, dialysis
diuretics
hyperaldosteronism
decrease magnesium
increase insulin
tissue repair
What are the clinical manifestations for Hypokalemia:
Resp px (muscle weekness)
*Potentially lethal ventricular arrhythmias
skeletal muscle weakness and paralysis
decrease GI motility, paralytic ileus
increase risk of digitalis toxicity
*anxiety, lethargy, confusion
muscle weakness, leg cramps
irregular pulse, arrhythias
What are three good Nursing Dx for Hypokalemia:
Risk for injury (falls) r/t skeletal muscle weekness.
Potential complication: arrhythmias
constipation r/t smooth muscle atony
What are some good interventions for Hypokalemia:
replace by PO or IV
Always check K levels before giving drug
*Never push IV only IVPB
teach prevention methods
What are the normal Ca ++ levels:
9-11mg/dL
Calcuim is obtained from:
ingested foods
bones
Ca is controlled by:
Parathyroid hormone
Calcitonin
Vitamin D
Hypercalcemia's abnormal level is:
> 11mg/dL
Hypercalcemia causes:
Hyperparathyroidism
malignancy
Vitamin D overdose
*prolonged immobilization
What are the clinical manifestation of Hypercalcemia:
1.Increased HR, BP, bounding pulses, arrythmias
2. Ineffective resp movement r/t profound skeletal muscle weakness
3. Impaired LOC: disorientation, lethargy
4. increaded urine output, dehydration, formation of renal calculi
5. Decreased GI motility, hypoactive bowl sounds, abdominal distention, constipation
When managing hypocalcemia why would you want to treat pain and anxiety:
to prevent hyperventilation-induced respiratory alkalosis
What are the normal levels for Phosphorus :
2.8-4.5mg/dL
Phosphorus is essential for the activation of __-_______ vitamins.
B-complex
Phosphorus is essential in forming and activating _______ ________ ( )
adenosine triphosphate (ATP)
Phosphorus is essential in assisting in ___ ______.
cell division
Phosphorus is essential for _____ homeostasis. Ca and Phosphorus exist in a _______ ________ relationship.
balanced reciprocal
Hyperphosphatemia abnormal level is:
> 4.5 mg/dL
Hyperphosphatemia causes:
Acute or chronic renal failure
chemotherapy?
Excssive ingestion of milk or phosphate containing latatives
large intakes of vitamine D
Results in Hypocalcemia?
When treating Hyperphosphatemia you want to use binding agents such as ______ that binds with phosphorus and removes it via the _____.
Teach pt importance of taking this medication, especially ____ pt.
Renagel
feces
renal
Hypophosphatemia abnormal level is:
<2.8mg/dL
Hypophosphatemia causes:
malnourishment/malabsorption
Hypophosphatemia clinical manifestations are:
1. shallow respirations
2. weakness, decreases reflexes
3. in severe cases; irritability and confusion leading to seizures
4. increased bleeding
What would be good ways to manage Hypophosphatemia?
oral supplementation
ingestion of foods high in phosphorus
may require IV administration of sodium or potassium phosphate
What are the normal ranges for magnesium?
1.5-2.5mEq/L
Magnesium is essential for:
skeletal muscle contraction
carbohydrate metabolism
ATP formation
B-complex vitamin activation
DNA synthesis
protien synthesis
Recommended daily amount of magnesium is?
300mg
Hypermagnesemia abnormal range is ?
> 2.5mEq/dL
Hypermagnesemia causes increased intake or ingestion of products containing ___ when ____ _________ or _____ is present.
Mg
renal insufficiency
failure
What are the main ways to manage hypermagnesemia?
IV CaCl or calciun gluconate
fluids
diuretic
When dealing with Hypermagnesemia you want to teach the pt to avoid excessive consumption of ______ containing ___.
antacids
Mg
Hypomagnesemia abnormal range is:
<1.5 mEq/L
Hypomagnesemia causes:
prolonged fasting or starvation
fluid loss
Clinical manifestations associated with Hypomagnesemia are:
