Exam 1 HCC II (F&E, Nutrition)
How can a nurse help a pt with FVD? (implications)
*ADMINISTER FLUID RESISCITATION -IVF (Hinkle Table 13-5 ; Isotonic are best) -ORAL FLUIDS & REHYDRATION SOLUTIONS -ENTERAL & PARENTERAL FLUIDS *RECORD I&O, DAILY WEIGHTS & VITAL SIGNS *ASSESS FOR SYMPTOMS -Skin And Tongue Turgor, Mucosa, Urine Output, Mental Status Changes *IMPLEMENT MEASURES TO MINIMIZE FLUID LOSS *PERFORM ORAL CARE *PROMOTE PREVENTION (Pedi & Geri Considerations)
How are some ways a nurse can treat a pt with hyponatremia?
*Assess CV, Metabolic, Neuro, GI status *Obtain EKG and monitor telemetry *Measure I&O (document renal function) *Administer potassium carefully (never push, avoid crushing oral supp) *Teach pt about eating K+ rich foods *monitor for constipation (but don't give laxatives that are K+ wasting)
What should a nurse do to help a pt with hypocalcemia?
*Assess CV, Resp, Neuro, Skeletal, Psych, skin status *Encourage weight-bearing exercises *Patient teaching related to diet, medications, exercise *Maintain seizure precautions/fall risk if severe *Administer IV calcium carefully and slowly -monitor for swallowing
What are some causes for hyperkalemia?
*Excessive K+ intake -IV or PO *Renal failure *Tissue trauma (Burns, chemo, gangrene) *Acidosis *Diuretics (K+ sparing) *Some drugs -ACE inhibitors, NSAIDS, Antibiotics *Blood Transfusions (Think lysis of old RBCs)
How is hyponatremia treated?
*Fluid restrictions *Sodium replacement -Isotonic/Hypertonic IV fluids -Sodium Tablets -Dietary sodium
What are some causes of hyponatremia?
*GI losses -vomiting, diarrhea *Severe Diaphoresis *Diuretics *SAIDH (Syndrome of inappropriate antidiuretic hormone) *Hypotonic Tube Feeds *Hypotonic IV fluids
What can cause hypokalemia?
*GI losses (remem GI suct) *Acid-base imbalance *Diuretics/laxative (K+ wasting) *Poor dietary intake *Some drugs -Steroids, antibiotics, digoxin * High glucose concentrations in urine producing osmotic dieresis
Who would be at risk for FVO?
*Pt who receives excessive IVF *Water Intoxication *Poor Water Excretions ex: -Kidney failure -Low cardiac output -Hypertension -CHF
What does Sodium do to the body?
*Regulates Extra Cellular Fluid (ECF) volume and distribution -Where sodium goes, water follows *Maintains blood volume and transmits nerve impulses and muscle contraction *Regulated by ADH, thirst and RAAS *Serum sodium levels evaluate fluid-electrolyte and acid-base balance -and related neuromuscular, renal, and adrenal functions
What is the medical managment of SIADH?
*eliminating the underlying cause, if possible *restricting fluid intake (Because retained water is excreted slowly through the kidneys, the extracellular fluid volume contracts and the serum sodium concentration gradually increases toward normal.) *Diuretic (furosemide [Lasix])
What pts are at risk for hypomagnesemia?
-Alcoholism -Diabetic Ketoacidosis -Sepsis -Burns -Wounds require debridement -Hypothermia -Renal Failure
What are some way a nurse can help a pt with hyponatremia? (implications)
-Assess skin, GI, CV, Neuro status -Administer sodium replacement -Evaluate fluid intake -Measure I&O and maintain fluid restrictions if ordered -Evaluate effects of medications (diuretics, lithium) -Administer hypertonic IVF carefully -Assess for risk factors, especially in the aged
What are some labs or test to test for FVD?
-BUN & Creatinine (normal is 10:1 ; 20:1 depletion) -Hematocrit (elevated due to decreased plasma volume) -Hypo/Hypernatremia -Hypo/Hyperkalemia -UA - Increased urine specific gravity
What kind of labs or test would you run for a pt with FVO?
-BUN decreased due to volume depletion -Hematocrit decreased due to volume depletion
What kind of drugs are associated with hyperkalemia?
-Beta blockers -Penicillin G -ACE inhibitor -NSAIDs
What are some causes for hypermagnesemia?
-Bowel Disorders -Overconsumption of magnesium antacids -Laxative abuse -Renal Insufficiency
What are the S&S or clinical manifestations of hypercalcemia? Resulting from a Serum calcium greater than 11 mEq/L
-CNS changes: LETHARGY, consfusion, depression -heart rhythm disturbances; dysrhythmias -Shortened QT interval -Shortened ST segment -Cardiac arrest -hypertension -bradycardia -Renal calcili -Bone fractures -Faster clotting time -Bone pain -N/V -abdominal pain -constipation -Polyuria -thirst -Muscle weakness; flaccidity -hypoactive DTRs -incoordination
What are some S&S of diabetes insipidus with associated hypernatremia?
-Dehydration (increased serum osmolality) -polyuria -extreme thirst
Who is at risk for FVD?
-Diabetes Insipidus (DI) -Adrenal insufficiency -Osmotic diuresis -Hemorrhage -Coma -Third-space shifts
What is the treatment for a pt who has hypomagnesemia?
-Diet -magnesium sulfate IV or magnesium gluconate orally (caution this can cause diarrhea
What would be some S&S or clinical manifestations of SIADH?
-Dilutional hyponatremia -fluid retention
What are some S&S or clinical manifestations of FVD?
-Dry Mucous Membranes -Increased Hemoglobin & Hematocrit -Thirst -Decreased Urine Output (oliguria) -Weight Loss -Postural Hypotension -Weak, Rapid Pulse
What S&S or clinical manifestation would be present in a pt experiencing hypomagnesemia. Resulting in a serum less than 1.8 mg/L.
-Dysrythmias/arrhythmias -HTN -Tachycardia -Positive Chovstek's and Trousseau's sign -Tentany -Increased tendon reflexs -Tremor -Dyspgagia -CNS changes: LOC, hallucinations, seizures, confusion -N/V, diarrhea -Prolonged PR interval and QRS complex -Prolonged QT interval -Flattened T wave -Ventcricular fibulation -Heart block
What are some S&S or clinical manifestations of FVO?
-Edema -Pitting edema -Weight gain -Ascites -Adventitious Lung Sounds -Tachycardia -Hypertension -JVD
What can put a pt at risk for hyponatremia?
-Excessive NGT Suctioning -Renal Disease -Adrenal Insufficiency -Burns -Heart Failure -Head Trauma
What are the cardiac problems associated with hypokalemia?
-Flattened T wave -depressed ST segment -Presence of a U wave -Irregular, weak pulse
Who is at risk for hypernatremia?
-Fluid Deprivation -Tube Feeds -Hyperventilation -Burns -Heat Stroke -Cushing's Syndrome/hyperaldosteronism
What is the treatment for hypernatremia?
-Fluid replacement either orally or hypotonic/Isotonic IV fluids -restrict sodium intake -give diuretics
What are the functions of calcium?
-Forming bones and teeth -Transmitting nerve impulses -Regulating muscle contractions -Maintain cardiac pacemaker (automaticity) -Blood Clotting -Enzyme activation (lipase)
What is the treatment for hypocalcemia?
-Give IV of calcium salts -Calcium, Mag and vitamin D supplements -Increase dietary calcium -Low phorphate diet (or give aluminum hydroxide; it will bind to the phosphate) -Calcium gluconate or calcium chloride (IV) -Avoid high dose caffeine or smoking -Weight bearing exercise -Be prepared for resuscitation -Have trach care set at bedside
What can cause FVO?
-Heart Failure -Renal Failure -Cirrhosis of Liver -Excessive dietary sodium
What are some causes of hypercalcemia?
-Hyperparathyroidism -Bone Malignancy; or cancer cells invaded the bone squamous cell carcinoma of the lung, myeloma, breast cancer -Bone loss/multi fractures -hyperthyroidism -immobilization -Excessive ingestion of Calcium, Vit A, or Vit D -Drug Toxicity -Thiazide diuretics -lithium, -Vit A&D -digoxin
What can cause hypocalcemia?
-Hypoparathyroidism (remem where it is regulated) -Malabsorption -Prolonged inactivity -Hypoalbuminemia -Hypomagnesemia -Elevated serum phosphorous -Use of Calcitonin and mithramycin -renal failure -inadequate intake, poor absorption, and excess losses -Massive transfusion of citrated blood -Alkalosis
What pts are at risk for developing hyperkalemia?
-Kidney disease -Burns -Adrenal insufficiency (Addison's disease)
What is dehydration?
-Loss of water alone -Serum sodium levels increase -May occur alone or in combination with other imbalances, but often serum electrolyte concentrations remain essentially unchanged
Who is at risk of developing hypercalcemia?
-Malignant Neoplasms -Renal Disease -Prolonged Immobilization -Steroid Use
What can a nurse do for a pt with diabetes insipidus with associated hypernatremia? (implications)
-Measure I&O -Monitor water intake
What are some way to help a pt with FVO? (implications)
-Measure I&O and record daily weights -Assess lung sounds, edema, other symptoms -Administer diuretic therapy and evaluate response -Promote adherence to fluid restrictions if ordered -Evaluate sources of excessive sodium, including medications -Promote rest -Position in Semi-Fowler's for orthopnea -Perform skin care, positioning/turning -Anticipate dialysis with severe renal impairment ; paracentesis with ascities -Perform patient teaching related to sodium, fluid restrictions, edema -Manage IVF administration to prevent overload
How can a nurse help a pt with SIADH?
-Monitor I&O -daily weight -urine and blood chemistries -neurological status -administer diuretics
What can a nurse do to help a pt with hypernatremia?
-Monitor Neurological changes -monitor I&O -daily weights -monitor VS -Monitor IV fluids making sure not to give to pt hyponatremia -Provide patient teaching regarding avoidance of dehydration -Give sufficient water
What should the nurse be aware of when giving potassium?
-NEVER PUSH intramuscular or IV potassium -Give IV over time and dilute -Assess IV site regularly
What pts are at risk for developing hypokalemia?
-NGT Suctioning -Hyperaldosteronism -Bulimia -CHF -nephritis -liver disease -Alcoholism
What is magnesium essential for?
-Neuro Muscular Function -Regulate cardiac function
What would be some treatments for hyperkalemia?
-Obtain ECG ; Monitor Telemetry -Loop diuretics -Dietary potassium restrictions (watch for "salt" substitutes) -Keyexalate -Calcium Gluconate 10% -regular insulin -Hypertonic dextrose IV
What can a nurse do to treat a pt with hypercalcemia?
-Obtain EKF, Monitor Telemetry -Monitor VS closely -Administer medications -Promote prevention through patient education regarding: -Increased mobility -fluids minimum 6 C daily (flush out the Ca+ & prevent renal calculi) -adequate daily fiber
How can a nurse help a pt with hyperkalemia?
-Obtain EKG ; Monitor Telemetry -Dietary potassium restrictions -Pt teaching about potassium rich food and dangers of salt substitutes -Renal failure pts at more of a risk (let them know this) -Give Kayexelate as ordered -Give loop diuretics -Always be prepared for cardiac arrest or respiratory arrest ***Note: Hemolysis of blood specimen or drawing of blood above IV site may result in false result
What are some way a nurse can help a pt with hypomagnesemia? (implications)
-Obtain EKG ; Monitor Telemetry -Monitor for CNS changes and/or seizures -Provide patient teaching related to diet, medications, alcohol use -Administer magnesium sulfate (IV if severe) -Screen for dysphasia -Observe for diarrhea associated with the (mag. glcuonate
What are some S&S or clinical manifestations of hyperkalemia? Resulting from a serum potassium greater than 5.3 mEq/L.
-Peaked T waves -Flattened P wave - Prolonged PR interval -Wide QRS -Depressed ST segment -Heart blocks -Ventricle arrhythmias -asystole (K+ greater than 7.0) -Dysrhythmias -slow irregular pulse -hypotension N/V diarrhea abdominal cramping flaccid metabolic acidosis muscle weakness paresthesias anxiety CRITICAL VALUE: 7 mEq/L Cardiac arrest, paralysis
Why should you not push IV Calicum?
-Rapid infusion can cause cardiac arrest
What is the treatment for hypercalcemia?
-Reduce the dietary intake -Hydration at least 6 glasses a day/isotonic IV prefered (flush out the Ca+) -Loop diuretics -Mithramycin and calcitonin (inhibit the bone resorption) -Corticosteroids given IV -Weight bearing exercise -Bisphosphonate -Treat underlying cause -Malignancies, etc.
Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply.
-Shortness of breath -Crackles in the lung fields -Distended neck veins
What are the drugs that cause hypokalemia?
-Thiazide diuretics -Gentamicin -Carbenicillin -Amphotericin B -Corticosteroids -increased insulin use -digoxin (digitalis toxicity)
Who is at risk for hypocalcemia?
-Thyroidectomy with Parathyroid removal -Renal Disease -Pancreatitis -Burns -Alcoholism (think absorption of vitamins and minerals)
What are the functions of potassium?
-Transmit nerve/electrical impulses -Regulate cardiac impulse transmission -Skeletal & Smooth muscle function -Regulate Acid-Base Balance
What are some S&S or clinical manifestations or hypocalcemia? Resulting from a serum calcium less than 8.5 mEq/L.
-Trousseau's sign, & Chovstek's sign -hyperactive deep tendon reflexes (DTRs_ -Tetany -Circumoral numbness(around the mouth) -Prolonged ST segment -Ventricle tachycardia -Torsades de Pointes -Bradycardia -hypotension -dyspnea -abnormal clotting -CNS changes: anxiety, irritability, seizures -dry skin, hair, nails -Laryngeal and abdominal spasm
What can cause fluid volume deficit?
-Vomiting -Diarrhea -GI suctioning, -sweating, -Decreased intake -Increased metabolic rate -Fever
What are some potassium rich foods?
-bananas -melon -citrus fruits -fresh and frozen vegetables (avoid canned vegetables) -lean meats -milk -whole grains
What causes Hypernatremia?
-excess water loss or deprivation -Impaired thirst mechanism (think brain injury) -hyperventilation -excess sodium from foods, meds, or salt tablets -Diabetes Insipidus -diaphoresis -hypertonic IV solutions
What are the foods high in calcium?
-green leafy vegetables -canned salmon and sardines -fresh oysters.
What foods are high in magnessium?
-green leafy vegetables -nuts /seeds -legumes -whole grains -seafood -peanut butter -cocoa.
What are some cause for hypomagnesemia?
-inadequate intake/ GI losses -Alcoholism -Chronic Laxative/diuretic use; along with other drugs -Enteral/Parenteral feeding deficient in magnesium -Rapid administration of citrated blood -Malabsorption -Burns -Bowel resection -Diabetic ketoacidosis
Which solution is hypotonic?
0.45% NaCl
A client has been diagnosed with a gastrointestinal bleed and the health care provider has ordered a transfusion. At what rate should the nurse administer the client's packed red blood cells?
1 unit over 2 to 3 hours, no longer than 4 hours Packed red blood cells are administered 1 unit over 2 to 3 hours for no longer than 4 hours.
What is the critical level for calcium?
17 mEq/L or greater
How much should urine should a pt excrete every hour?
30mL/hour
Which positioning strategy should be used for the client diagnosed with hypovolemic shock?
A modified Trendelenburg position recommended in hypovolemic shock. Elevation of the legs promotes the return of venous blood and can be used as a dynamic assessment of a client's fluid responsiveness.
A nurse is measuring intake and output for a client who has congestive heart failure. What does not need to be recorded? A. Frozen fluids B. Parenteral fluids C. Fruit consumption D. Sips of water
C. Fruit consumption The amount of water in fruits can not be measured
What is diabetes insipidus associated with hypernatremia?
Chronic excretion of very large amounts of pale urine of low specific gravity
The nurse is caring for a client with heart failure. What procedure should the nurse prepare the client for in order to determine the ejection fraction to measure the efficiency of the heart as a pump?
Echocardiogram
What can SIADH result from?
Excessive ADH secretion from the pituitary gland resulting from: *Malignancies -ex: bronchogenic carcinoma *Serve pneumonia *pneumothorax *Disorders of the CNS -head injuries -Brain surgery or tumor -infection *medications -vincristine [Oncovin] -phenothiazines -tricyclic antidepressants -thiazide diuretics *nicotine
The nurse is caring for a client who has developed diabetes insipidus. The cause is unknown, and the physician has ordered a diagnostic test to determine if the cause is nephrogenic or neurogenic. What test will the nurse prepare the client for?
Fluid deprivation test
What is hypovolemia or fluid volume deficit?
Fluid loss -Occurs when loss of ECF volume exceeds the intake of fluid. -Water and Electrolytes are lost in the same proportion Or -Water alone is lost and electrolytes remain unchanged
How does calcium gluconate 10% help with hyperkalemia?
Give 10ml over 3 minuets will temporarily drive K+ into the cells instead of the bloodstream, will last for about 3 hrs
How does Keyexalate help with hyperkalemia?
Giving via PO, NG tube, or enema pulls the potassium out of the bloodstream into the GI mucosa
What other diagnosis' woukd be in conjuction with hypomagnesemia?
Hypokalemia &Hypocalcemia
What altered serum electrolyte would cause SIADH?
Hyponatremia
What is the cause of diabetes insipidus associated with hypernatremia?
Inadequate output of pituitary antidiuretic hormone.
While reviewing the basic information related to hemodialysis, the professor explains that water molecules move through adjacent phospholipid molecules in the cell membrane by:
Osmosis
What is calcium regulated by?
Parathyroid Hormone (PTH) & Calcitonin
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis?
Peripheral edema, weight gain
What is the primary anion in intracellular fluid?
Phosphorous
What is the treatment for hypokalemia?
Potassium replacement -Dietary -Oral -IV treat underlying cause like changing to a potassium sparing diuretic
What is Hypervolemia or fluid volume overload?
Simple fluid overload -Isotonic expansion of the ECF due to abnormal retention of water. -Serum sodium concentration remains essentially normal.
Where is 99% of calcium stored?
Skeletal system
Which serum electrolyte would be used to evaluate fluid-electrolyte and acid-base balance and related neuromuscular, renal, and adrenal functions?
Sodium
To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body?
Tachycardia Fluid volume deficit, or hypovolemia, occurs when the loss of extracellular fluid exceeds the intake of fluid. Clinical signs include oliguia, rapid heart rate, vasoconstriction, cool and clammy skin, and muscle weakness. The nurse monitors for rapid, weak pulse and orthostatic hypotension.
What do the VS look like for a pt who has hyponatremia related to dilutional hyponatremia (fluid volume overload)?
Tachycardia hypertension Bonding pulse Weight gain
What will the vitals look like on a pt who is hypervolemic?
Tachycardia hypertension Bonding pulse Weight gain
As a representative of the treatment team, a nurse is reviewing results of diagnostic studies with the family of an adolescent with anorexia nervosa. What explanation should the nurse give the family about the client's abnormal blood urea nitrogen (BUN) value?
The BUN is elevated because your daughter is dehydrated."
What is the best indicator for fluid loss?
Weight loss
A 4-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. The nurse should suspect that the child's I.V. fluid intake is excessive if assessment reveals
Worsening dyspnea
How does regular insulin help treat hyperkalemia?
administered IV in 10 units will drive potassium into the cells for up to 6 hours; must be given with high concentrations of dextrose (D10Wor D50W)
What are some S%S or clinical manifestations of hypokalemia? Resuling from a serum potassium less than 3.5 mEq/L.
flat/inverted T on EKG -depressed ST segment and presence of a U wave -hypotension -dysrhythmias -pulse is weak and irregular -skeletal muscle weakness especially in the legs nausea vomiting hypoactive bowel motility glucose intolerance (polyuria) fatigue cramps paresthesia confusion and irritability CRITICAL VALUE: 2.5 mEq/L *Life-Threatening -Cardiac and respiratory arrest
Where is 98% of potassium located?
intracellular
What are some S&S or clinical manifestations of hyponatremia? When the Serum sodium less than 135 mEq/L.
poor turgor dry mucosa nausea/vomiting, abdominal cramps edema, hypotension, tachycardia weakness fatigue dizziness confusion headache muscle twitching CRITICAL VALUE: 120 mg Convulsions, coma, death
How is potassium mainly excreted?
renal exrection
What is SIADH?
syndrome of inappropriate antidiuretic hormone Excessive ADH secretion from the pituitary gland even in the face of subnormal serum osmolality
What are some S&S or clinical manifestations of hypernatremia? When the serum sodium is greater then 135 mEq/L
thirst dry/swollen tongue sticky mucous edema hypertension tachycardia weakness restlessness irritability fever CRITICAL VALUE: 160 mg Hyperreflexia, seizures
What is osteoporosis?
total-body calcium deficit caused by prolonged low intake ; diminished bone mass
What is a marker for fluid volume overload?
weight gain
