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NUR 112

F&E lecture notes

QuestionAnswer
Early sign on fluid volume deficit thirst
VS during fluid volume deficit high temperature, tachypnea, hypotension, tachycardic (weak and rapid)
s/s of fluid volume deficit weight loss, tenting skin, anxiety, exhaustion, HA, lethargy, confusion, disorientation, decreased urine output
causes of fluid volume deficit Burns, vomiting, diarrhea, GI suctioning, decreased PO intake, or increased intake of coffee/ alcohol, hemorrhage, diuretics, hyperglycemia, hypoaldosteronism
difference between fluid volume deficit and dehydration no sodium loss with dehydration
how to fix dehydration PO intake of water
what type of fluid to administer for fluid volume deficit lR of 0.9% NS
VS in fluid volume overload normothermic, bounding pulse; muffled heart sounds, hypertensive, increase RR, SOB, dyspnea
s/s of fluid volume overload weight gain, peripheral edema, JVD present, apprehension, diluted urine
what is ascites increase of fluid in the intestinal compartments
how can renal failure cause fluid volume overload fluid retention due to decline in production of urine
causes of fluid volume overload CHF, renal failure, cirrhosis of liver, excess ingestion of sodium, excessive or too rapid IV fluid infusion
specific NI for admin diuretics, restrict fluids, assess breath sounds and breathing pattern, semi-fowlers for dyspnea, skin care
sodium normal levels 135-145
causes of hypernatremia impaired thirst mechanism, profuse sweating, diarrhea, diabetes insipidus, cushings syndrome, inappropriate use of oral electrolytes
s/s of hypernatremia observe for HA, N/V, increased BP, confusion
management of hypernatremia fluid replacement at a moderate rate
causes of hyponatremia diuretic use, renal disease/ adrenal insufficiency, Vomitting, diarrhea, excessive GI suctioning, burns, HF, hypotonic IV fluid replacement
manifestations of hyponatremia edema, muscle cramps, abd cramps, weak/fatigue, anorexia, N/V
when Na is less than 120 what can happen convulsions, coma, death
when Na is more than 160 what can happen seizures
management of hyponatremia safety promotion, sodium containing fluids, sodium containing foods
is sodium extracellular or intracellular extracellular
is potassium extracellular or intracellular intracellular
normal potassium 3.5-5
hyperkalemia causes renal failure, pot-sparing diuretic use, excessive K+ intake, adrenal insufficiency, acidosis, burns/ tissue trauma, starvation
hyperkalemia cardiac manifestations Tall, peaked T waves, widened QRS -dysrhythmias -cardiac arrest
hyperkalemia other manifestations N/V, abd cramping, diarrhea, paresthesia
management of hyperkalemia admin of calcium gluconate, insulin and glucose, polystyrene sulfonate -- diuretics if renal excretion is normal
causes of hypokalemia loop/thiazide diuretics, corticosteroid use, some antibiotics, severe vomiting, GI suctioning, alkalosis, long term IV fluid use without addition of K+
hypokalemia cardiac manifestations dysrhythmias, flat or inverted T-waves
other hypokalemia manifestations anorexia, decreased bowel sounds, ileus, muscle cramps, suppressed insulin secretion, increased risk for digoxin toxicity
management of hypokalemia replacement of potassium salts
chloride normal levels 95-105
chloride extra or intracellular extracellular
causes of hyperchloremia diarrhea, renal failure, overactive parathyroid glands, use of carbonic anhydrase inhibitors, metabolic acidosis, respiratory alkalosis
hyperchloremia manifestations kussmaul respirations, weakness, increased thirst
management of hyperchloremia diuretics, IV fluids, Tx of underlying cause, dialysis
hypochloremia causes loss of body fluid, V/D
manifestations of hypochloremia paresthesia of face/ extremities, muscle spasms/ tetany
management of hypochloremia increase salt in diet, adding chloride to IV fluids, TX of underlying cause
calcium normal levels 9-11
calcium uses Bones, Blood clotting, Beats (muscle contraction)
what controls calcium levels vitamin D, calcitonin, parathyroid hormone
causes of hypercalcemia Hyperparathyroidism Bone malignancy Drug toxicity
manifestations of hypercalcemia Fatigue, weakness Decreased deep tendon reflexes Headache, impaired cognition Anorexia, nausea, vomiting, constipation Lethargy Polyuria Renal calculi Cardiac dysrhythmias Conjunctival calcifications
management of hypercalcemia Partial parathyroidectomy Discontinuation of thiazide diuretics Vitamin and mineral supplements Low-calcium diet
causes of hypocalcemia Transfusion of large volume of citrated blood Decreased parathyroid hormone Elevated serum phosphorus Decreased magnesium levels Hypoalbuminemia Alkalosis
manifestations of hypocalcemia Bradycardia and hypotension Numbness, tingling of fingers Hyperactive reflexes, muscle cramps Laryngeal spasms Tetany Confusion, possible seizures Pathologic fractures Trousseau sign, Chvostek sign
management of hypocalcemia Severe symptoms managed with IV replacement of calcium at moderate rate, 60 mg elemental calcium per minute
magnesium levels 1.5-3.0
causes of hypermagnesmia Bowel disorders Overuse of magnesium-containing antacids Renal insufficiency
manifestations of hypermagnesemia Flaccid muscle tone Decreased response in deep tendon reflexes
management of hypermagnesemia Discontinue any intervention containing magnesium Hemodialysis at very high magnesium levels
causes of hypomagnesemia Malabsorption Renal wasting Poor dietary intake Side effects of medication
manifestations of hypomagnesemia can lead to neurologic, cardiac complications, Muscle cramps, Tremors
management of hypomagnesemia Magnesium salts when symptomatic or persistent
causes of hypophosphatemiac Alcoholism Excessive antacid intake Low vitamin D intake Certain medications Hyperparathyroidism
what to know about hyperphosphatemia Rare Asymptomatic Related to excessive intake
Created by: ginnyfoscue
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