Exam 2 Nursing 113

A pediatric patient is experiencing a high fever. The nurse must assess closely for: 1. FVD 2. Increased interstitial fluid 3. FVE 4. Increased intracellular fluid

Fluid Volume Deficit

FVE (Fluid Volume Excess) HYPERVOLEMIA

Fluid intake or retention exceeds the body's fluid needs Also called overhydration, fluid overload, circulatory overload. Involves retention of both water and electrolytes (especially sodium). There is usually an increase in the serum sodium which causes water retention.

The nurse is caring for a client with a suspected diagnosis of hypercalcemia. Which sign/symptom would be an indication of this electrolyte imbalance?

Generalized muscle weakness. Generalized muscle weakness is seen in clients with hypercalcemia. Twitching, positive Trousseaus sign, and hyperactive bowel sounds are signs of hypocalcemia.

A nurse is reviewing the patients ABG results and realized that the patient is at risk for acidosis based on the following lab results? 1. CO2 40 2. pH 7.52 3. PaCO2 92

HCO3 14

Which best describes a hypertonic IV fluid? 1. Has less water and more electrolytes than found in plasma. 2. Has more water and fewer electrolytes than found in plasma. 3. Has roughly the same concentration of water and electrolytes as found in plasma.

Has less water and more electrolytes than found in plasma.

A 40 year old patient with FVE might experience the following signs/symptoms: Select one or more 1. High sodium levels 2. Concentrated urine 3. Palpated full bounding pulse 4. Flat neck veins when sitting upright 5. Increase in weight gain

Increase in weight gain High sodium levels Palpated full bounding pulse

The patient is diagnosed with hypervolemia so they should avoid sweet or dry foods because they can 1. Lead to weight gain 2. Obstruct water elimination 3. Cause dehydration 4. Increase the patients desire to consume fluid

Increase the patients desire to consume fluid

FVE management/treatment

limnit fluid intake, using clinical situation as guide diuretics to promote fluid and sodium loss restrict sodium intake to reduce thirst

Hypomagnesemia causes

malnutrition diarrhea celiac disease crohns disease alcoholism prolonged gastric suctioning ileostomy, colostomy, or intestinal fistulas acute pancreatitis diabetic ketoacidosis eclampsia chemotherapy sepsis

Hyperkalemia signs and symptoms

muscle weakness paresthesia hypotension diarrhea hyperactive bowel sounds flat P waves; widened QRS complex; prolonged PR interval; and tall, peaked T waves

Hyperphosphatemia signs and symptoms

neuromuscular irritability muscle weakness hyperactive reflexes tetany positive chvosteks or trousseaus sign

Hypermagnesia causes

overuse of antacids or laxatives that contain magnesium renal insufficiency and kidney failure treatment of preeclampsia with magnesium

The registered nurse reviews the results of the ABG values with the LPN and tells the LPN that the client is experiencing respiratory acidosis. The LPN would expect to note which on the lab result report? 1. pH 7.50, PCO2 52mm Hg 2. pH 7.35, PCO2 40 mm Hg 3. pH 7.25, PCO2 50 mm Hg 4. pH 7.50, PCO2 30 mm Hg

pH 7.25, PCO2 30 mm Hg In respiratory acidosis, the pH is down, and the PCO2 is up.

ABGs

pH 7.35-7.45 <acid >base | metabolic HCO3 22-26 <acid >base | metabolic PACO2 35-45 <base >acid | respiratory acid = acidosis base = alkalosis

Hyponatremia signs and symptoms

rapid, thready pulse postural blood pressure changes weakness abdominal cramping poor skin turgor muscle twitching and seizures apprehension confusion

Metabolic Acidosis (low pH low HCO3) causes

severe diarrhea renal failure sepsis shock diabetic ketoacidosis salicylate OD

Aldosterone

synthesized and secreted by the adrenal cortex increases the levels of sodium ions secreted into the bloodstream from the urine stimulates the absorption of sodium by the nephron to regulate water and salt balance

Hypocalcemia signs and symptoms

tachycardia hypotension paresthesia twitching cramps tetany positive Chvostek's or Trousseau's sign Diarrhea hyperactive bowel sounds prolonged QT interval; prolonged ST segment

Hypomagnesemia signs and symptoms

twitching parenthesia hyperactive reflexes irritability confusion positive Chvosteks or Trousseaus sign shallow respiration tetany seizure tachycardia tall T waves and depressed ST segment

FVD signs and symptoms

urine output <30mL/hr Thirst poor skin turgor and dry mucous membranes increased HR, thready pulse, dyspnea, and postural hypotension weight loss flat neck or hand veins dizziness or weakness decrease in urine volume and dark, concentrated urine increased specific gravity of the urine confusion increased hematocrit level

Hypokalemia Causes

use of potassium losing diuretics diarrhea vomiting inadequate intake of potassium excessive gastric suction excessive fistula drainage Cushings syndrome (increased secretion of aldosterone) chronic use of corticosteroids or laxatives kidney disease parenteral nutrition uncontrolled diabetes alkalosis

FVD causes

vomiting and/or diarrhea blood loss reduced fluid intake continuous GI irrigation GI suctioning Ileostomy or colostomy drainage Draining wounds, burns, or fistulas Increased urine output from the use of diuretics

Magnesium

1.8-2.6 ICF < 1.8 = hypomagnesium > 2.6 = hypermagnesium

Sodium

135-145 ECF < 135 = hyponatremia > 145 = hypernatremia

Which regulatory mechanism of acid-base balance works the quickest in an attempt to maintain homeostasis? 1. the renal system. 2. the body's buffers 3. the GI tract 4. the lungs

The body's buffers

Phosphorus

3.0mg/dL-4.5mg/dL ICF < 3.0 = hypophosphatemia >4.5 = hyperphosphatemia

Potassium

3.5 - 5.0 ICF < 3.5 = hypokalemia > 3.5 = hyperkalemia

Which clients would the nurse determine to be at risk for development of metabolic alkalosis? Select all that apply. 1. Client with emphysema. 2. Client who is hyperventilating. 3. Client with chronic kidney disease. 4. Client admitted with aspirin overdose. 5. Client who has been vomiting for 2 days. 6. Client receiving oral furosemide 40 mg daily.

4 & 6. Metabolic alkalosis is cause by any condition that created the acid-base imbalance through either an increase in based or a deficit of acids, such as the client who has been vomiting for 2 days and the client receiving furosemide daily.

Calcium

9 mg/dL-10.5 mg/dL ECF < 9 = hypocalcemia > 10.5 = hypercalcemia

The lab serum sodium level reading is 175 mEq/L. The nurse would restrict which of the following foods? 1. A banana and iced tea 2. Citrus fruit plate 3. A fresh green salad with cucumbers and carrots 4. A canned vegetable soup with melted cheese.

A canned vegetable soup with melted cheese.

The nurse is caring for a client with respiratory insufficiency. The ABG results indicate a pH of 7.50 and a PCO2 of 30mm Hg, and the nurse is told that the client is experiencing respiratory alkalosis. Which additional lab value would the nurse expect to note? 1. A sodium level of 145 mEq/L 2. A potassium level of 3.0 mEq/L 3. A magnesium level of 1.3 mEq/L 4. A phosphorus level of 3.0 mg/dL

A potassium level of 3.0 mEq/L. Signs/symptoms of respiratory alkalosis include tachypnea, change in mental status, dizziness, allow around the mouth, spasms of the muscles of the hands, and hypokalemia.

Which best describes hydrostatic pressure? 1. An inward pulling pressure exerted by electrolyte in a solution. 2. A pushing pressure exerted by a fluid in a compartment. 3. An inward pulling pressure exerted by proteins in a solution.

A pushing pressure exerted by a fluid in a compartment.

ADH vs Aldosterone

ADH and Aldosterone are secreted under low blood pressure too increase the blood pressure while producing concentrated urine by increasing water reabsorption from the nephron

A person that lives in an area of high altitude experiences a panic attack and starts to hyperventilate. The nurse knows that these conditions could lead to: 1. Acidosis 2. Hypovolemia 3. Alkalosis 4. Full neck vein distention

Alkalosis

The nurse who is caring for a client with renal failure notes that the client is dyspneic and crackles are heard when listening to breath sounds in the lungs. Which additional sign/symptom would the nurse expect to note in this client?

An increase in blood pressure. Impaired cardiac or renal function can result in fluid volume excess. Findings associated with FVE include cough, dyspnea, crackles, tachypnea, tachycardia, an elevated BP, bounding pulse, elevated central venous pressure, weight gain, edema, neck and hand vein distention, and altered level of consciousness, and a decreased hematocrit level.

Metabolic Alkalosis (high pH high CO3) causes

Antacids Overuse of Antacids potassium wasting diuretics (increased loss of H+) loss of gastric juices severe vomiting excessive GI suctioning excessive NaHCO3

The nurse is told that the arterial blood gas (ABG) results indicate a pH of 7.50 and a PCO2 of 32 mm Hg. The nurse determines that these results are indicative of which acid-base disturbance?

Respiratory alkalosis. The normal pH is 7.35 to 7.45. If respiratory condition exists, an opposite relationship will be seen between the pH and the PCO2.

The nurse is assessing a patient with FVE or overload. Which assessment is important to do first? 1. Auscultate the lung sounds and check respiratory rate of the patient. 2. Check a urine sample from the patient. 3. Check the patient weight. 4. Check the patient BP

Auscultate the lung sounds and check respiratory rater of the patient.

Potassium (K) food sources

Avocados, Bananas, Cantaloupe, Oranges, Strawberries tomatos, potatoes, raisins carrots, mushrooms, spinach fish, pork, beef, and veal

A patient presents to the ER with FVD. Which assessment is a priority assessment? 1. Weight 2. Blood pressure 3. Intake and Output 4. Lung sounds

Blood Pressure

The nurse is instructing a client on how two decrease the intake of calcium in the diet. The nurse would tell the client that which food item is least likely to contain calcium?

Butter. Butter comes from milk fat and does not contain significant amounts of calcium. Milk, spinach, and collard greens are calcium-containing foods and must be avoided by the client on a calcium-restricted diet.

In interpreting an ABG for acid-base balance, which results is the respiratory portion of the ABG result? 1. HCO3 2. O2 3. pH 4. CO2

CO2

The nurse is caring for a client with hyperparathyroidism and notes that the client serum calcium level is 13 mg/dL. Which prescribed medication would the nurse plan to assist in administering to the client?

Calcitonin. The normal serum calcium level is 9 to 10.5 mg/dL. The client is experiencing hypercalcemia. Calcium gluconate. and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreased the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

The LPN is observing the client cardiac rhythm on the monitor screen and notes that there is an additional prominent wave following each T wave and suspects the presence of U waves. What actions would the LPN take?

Cardiac changes in hypokalemia include impaired depolarization, resulting in the emergence of prominent U waves. Therefore, hypokalemia is suspected. The incidence of potentially lethal ventricular dysrhythmias is increased in hypokalemia. The nurse must immediately notify the RN and check the patients vital signs, cardiac status, and signs of hypokalemia. The nurse needs to stay with the client while the RN checks the client most recent serum potassium level, contacts the PHCP to report the findings, and obtains prescriptions to treat the hypokalemic state.

Which electrolyte is a major anion in body fluid? 1. Sodium 2. Chloride 3. Calcium 4. Potassium

Chloride

Orthostatic hypotension

Decrease in systolic blood pressure of 20mm Hg or a decrease in diastolic blood pressure of 10mm Hg within 3 minutes of standing when compared with blood pressure from the sitting or supine position Also known as postural hypotension

FVD (Fluid Volume Deficit) HYPOVOLEMIA

Dehydration occurs when the body fluid intake is not sufficient to meet the body's fluid needs. Reduction of circulating blood volume. Not the same as dehydration. The body will attempt to conserve water and sodium to increase the circulating blood volume, but the low volume that exists will result in the common symptoms of FVD.

Respiratory Acidosis (low pH high CO2) causes

Drug overdose pulmonary edema chest trauma neuromuscular disease COPD airway obstruction anesthesia pneumonia atelectasis

A child has been admitted to the pediatric unit with a serum albumin of 2.0 g/dL. The nurse will plan to assess for: 1. Pallor 2. Edema 3. Poor skin turgor 4. Decreased apical pulse

Edema low serum protein levels cause a decrease in plasma antic pressure and allow fluid to remain in interstitial tissues and body cavities, causing edema and ascites.

A client has the following lab values: a pH of 7.55, an HCO3 level of 22 mEq/L, and a PCO2 of 30 mm Hg. Which action would the nurse plan to take?

Encourage the client to slow down breathing. The client is experiencing respiratory alkalosis based on the lab results of a high pH and a low PCO2 level. Interventions for respiratory alkalosis are the voluntary holding of breath or slowed down breathing and the rebreathing of exhaled CO2 by methods such as using a paper bag or a rebreathing mask as prescribed.

The nurse assists to perform an Allen's test on a client scheduled for an arterial blood gas (ABG) draw from the radial artery. During release of pressure from the ulnar artery, color in the hand returns after 20 seconds. The nurse would take which actions?

Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury to the hand if damage to the radial artery occurs with arterial puncture. Upon release of pressure on the ulnar artery, if pinkness fails to return within 6-7 seconds, the ulnar artery blood flow to the hand is insufficient, indicating that the radial artery should not be used for obtaining a blood specimen. Another site would need to be selected for the arterial puncture. The nurse would report this finding to the RN, and the PHCP should also be notified of the finding.

The nurse is caring for a client who has been taking diuretics on a long-term basis. Which finding would the nurse expect to note as a result of this long-term use?

Increased specific gravity of the urine. Clients taking diuretics on a long-term basis are at risk for FVD. Finds of FVD include increased respiration and heart rate, decreased central venous pressure, weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of urine, dark-colored and odorous urine, and increased hematocrit level, and an altered level of consciousness. Gurgling respirations, increased blood pressure, and decreased hematocrit as a result of hemodilution are seen in clients with FVE.

The nurse is caring for a client with a diagnosis of hyperparathyroidism. Lab studies are performed and the serum calcium level is 12.0 mg/dL. Based on this lab value, the nurse would take which action?

Inform the RN of the lab value. The normal serum calcium level ranges from 9 to 10.5 mg/dL. The client is experiencing hypercalcemia and the nurse would inform the RN of the lab value.

Which is true regarding antidiuretic hormone? 1. It causes water retention. 2. It causes potassium retention. 3. It causes sodium excretion. 4. It decreases blood pressure.

It causes water retention.

Which best describes a hypotonic IV fluid? 1. It is more concentrated than plasma. 2. It contains the same ration of water. to electrolytes as found in plasma. 3. It is less concentrated than plasma.

It is less concentrated than plasma.

The nurse observes that a client with diabetic ketoacidosis is experiencing abnormally deep, regular, rapid respirations. How would the nurse correctly document this observation in the medical record?

Kussmaul's respirations. Abnormally deep, regular, and rapid respirations observed in the client with diabetic ketoacidosis are documented as Kussmaul's respirations.

A patient in the ER has overdosed on aspirin. The places the patient at higher risk for ? 1. Respiratory Alkalosis 2. Metabolic Acidosis 3. Metabolic Alkalosis 4. Respiratory Acidosis

Metabolic Acidosis

The nurse is caring for a client with sever diarrhea. The nurse monitors the client closely, understanding that this client is at risk for developing which acid-base disorder?

Metabolic acidosis. Intestinal recreations high in bicarbonate may be lost through enteric drainage tubes, an ileostomy, or diarrhea. The decreased bicarbonate level created the actual base deficit of metabolic acidosis.

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client closely for which acid-base disorder that is most likely to occur in this situation?

Metabolic alkalosis. The loss of gastric fluid via nasogastric suction or vomiting causes a metabolic condition. This also results in an alkaloid condition as a result of the loss of hydrochloric acid through GI fluid losses.

The nurse reviews a clients electrolyte result and notes that the potassium level is 5.4 mEq/L. What would the nurse look for on the cardiac monitor as a result of the laboratory value?

Narrow, peaked T waves. A serum potassium level of 5.4 mEq/L is indicative of hyperkalemia. Cardiac changes include a flat P wave; a prolonged PR interval; a widened QRS complex; and narrow, peaked T waves.

FVE Causes

Overhydration with IV fluids Kidney damage Heart failure Long-term use of corticosteroids Excessive sodium ingestion Syndrome of inappropriate antidiuretic hormone Irrigation of wounds or body cavities with hypotonic fluids Cirrhosis of the liver Cushing's syndrome

The nurse is caring for a client with leukemia and notes that the client has poor skin turgor and flat neck and hand veins. The nurse suspects hyponatremia. Which sign/symptom would the nurse expect to note in this client if hyponatremia is present?

Postural blood pressure changes. Postural blood pressure changes occur in the client with hyponatremia. Intense thirst and dry mucous membranes are seen in clients with hypernatremia. A slow, bounding pulse is not indicative of hyponatremia. In a client with hyponatremia, a rapid, thready pulse is noted.

Which electrolyte is a major cation in body fluid? 1. Bicarbonate 2. Phosphate 3. Potassium 4. Chloride

Potassium

The nurse reviews the clients serum calcium level and notes that the level is 8.0 mg/dL. The nurse understands that which condition would cause this serum calcium level?

Prolonged bed rest. The normal serum calcium level is 9 to 10.5 mg/dL. A client with a serum calcium level of 8.0 mg/dL is experiencing hypocalcemia. The excessive ingestion of Vitamin D, adrenal insufficiency, and hyperparathyroidism are causative factors associated with hypercalcemia. Although immobilization can initially cause hypercalcemia, the long-term effect of prolonged bed rest is hypocalcemia.

The nurse is caring for a client with a diagnosis of COPD. The nurse would monitor the client for which acid-base imbalance?

Respiratory acidosis. Respiratory acidosis most often occurs as a result of primary defects in the function of the lungs or changes in normal respiratory patterns from secondary problems. Chronic respiratory acidosis is most commonly caused by COPD. Acute respiratory acidosis also occurs in clients with COPD when superimposed respiratory infection or concurrent respiratory disease increases the work of breathing.

The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at risk for potassium deficit?

The client receiving a nasogastric suction. Potassium-rich GI fluids are lost through GI suction, which places the client at risk for hypokalemia. The client with intestinal obstruction, Addisons disease, and metabolic acidosis is at risk for hyperkalemia.

The nurse is reading the PHCP's progress notes in the client record and sees that the PHCP has documented "insensible fluid loss of approximately 800 mL daily." Which client is at risk for this loss?

The client with a fast respiratory rate. Sensible losses are those that a person is aware of, such as those that occur through wound drainage, gastrointestinal tract losses, and urination. Insensible losses occur daily through the skin and the lungs.

The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is the least likely risk for the development of third-spacing?

The client with diabetes mellitus. Fluid that shifts into the interstitial space and remains there is referred to as third-space fluid. Common sites for third-spacing include the abdomen, pleural cavity, peritoneal cavity, and pericardial sac. Third-spacee fluid is physiologically useless because it does not circulate to provide nutrients for the cells. Risk factors include live or kidney disease, major trauma, burns, sepsis, wound healing, major surgery, malignancy, malabsorption syndrome, malnutrition, alcoholism, and older age.

The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at risk for fluid volume deficit?

The client with ileostomy. Causes of a FVD include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient IV fluid replacement, draining fistulas, and ileostomy. A client with cirrhosis, heart failure, or decreased kidney function is at risk for FVE.

The nurse reviews electrolyte values and notes a sodium level of 130 mEq/L. The nurse expects that this sodium level would be noted in a client with which condition?

The client with the syndrome of inappropriate secretion of antidiuretic hormone. Hyponatremia is serum sodium level less than 135 mEq/L. Hyponametria can occur secondary to syndrome of inappropriate secretion of antidiuretic hormone. The client with inadequate daily water intake, watery diarrhea, or diabetes insidious is at risk for hypernatremia.

A nurse administers digoxin (Lanoxin) and furosemide (Lasix) to a patient diagnosed with FVE related to heart failure. The nurse identified that this patient is at risk for digoxin toxicity based on which rationale? 1. The potassium-depleting effect of the loop diuretic increased the effect of digoxin. 2. The sodium-depleting effect of the loop diuretic decreased the effect of digoxin. 3. The administration of a loop diuretic decreased the amount of digoxin filtered by the kidney and excreted in the urine. 4. The administration of digoxin decreased the effect of the loop diuretic, causing retention of fluid and retention of digoxin.

The potassium-depleting effect of the loop diuretic increased the effect of digoxin.

The nurse reviews a client electrolyte results and notes a potassium level of 5.5 mEq/L. The nurse understands that a potassium value at this level would be noted with which condition?

Traumatic burn. A serum potassium level that exceeds 5.0 mEq/L is indicative of hpyerkalemia. Clients who experience the cellular shifting of potassium, as in the early stages of massive cell destruction (i.e., trauma, burns, sepsis, or metabolic or respiratory acidosis), are at risk for hyperkalemia. The client with Cushings syndrome or diarrhea and the client who has been overusing laxatives are at risk for hypokalemia.

A client is scheduled for blood to be drawn from the radial artery for an ABG determination. The nurse assists with performing an Allen's test before drawing the blood two determine the adequacy of which?

Ulnar circulation. Before performing a radial puncture to obtain a specimen for ABG values, an Allen's test should be performed to determine adequate ulnar circulation. Failure to assess collateral circulation could result in ischemic injury to the hand if radial artery occurs with arterial puncture.

ADH (anti-diuretic hormone)

also known as vasopressin synthesized in the hypothalamus stored in and secreted by the posterior pituitary gland makes the tubules of the nephron more permeable to water prevents the production of dilute urine

Sodium (Na) food sources

bacon, hot dogs, lunch meat butter, cheese, and milk ketchup, mustard processed, canned, and snack foods table salt soy sauce

Magnesium (Mg) food sources

canned white tuna green leafy greens (broccoli & spinach) cauliflower peanut butter, almonds peas soybeans chicken pork and beef oatmeal wheat bran yogurt avocados, milk, potatoes, raisins

ICF (Intracellular fluid) contains:

cations are positively charged (+) anions are negatively charged (-) potassium (K+)(3.5-5 mEq/L) phosphorus (P-)(2.5-4.5 mg/dL) magnesium (Mg+)(1.3-2.1 mEq/L) calcium (Ca+)(8.5-10.5 mg/dL)

ECF (Extracellular fluid) contains:

cations are positively charged (+) anions are negatively charged (-) sodium (NA+) (135-145mEq/L) chloride (C1-)(98-108 mEq/L) calcium (Ca+)(8.5-10.5mg/dL

Hypertonic Fluids

causes cell shrinking/dehydration D10W (10% Dextrose in water) D5 1/2 NS D5NS D5LR usually given cautiously in ICU via central line because there are hard on the veins and cause phlebitis and the pt's condition can change quickly if not monitored closely can cause fluid overload with pulmonary edema treats cerebral edema by removing fluid off the brain treats hyponatremia by pulling sodium back into intravascular system

Hypotonic Fluids

causes cell swelling/hydration 1/2 NS (0.45% Normal Saline) cell lysis is possible if the cell swells too much can deplete circulatory system fluid (hypovolemic) lower osmolality than blood serum used to hydrate the cell (cells expand)(DKA & hyperosmolar hyperglycemia) used to correct dehydration DONT give to pt's with increase cranial pressure because fluid will shift to brain tissue and cause brain swelling DONT give to pt's with burns and trauma because they are already hypovolemic

Serum Osmolality

concentration of solutes in body fluids/blood/intravascular space sodium, glucose, and urea determine serum osmolality normal serum osmolality consists primarily of sodium and its accompanying anions. main regulator of ADH

Hypophosphatemia signs and symptoms

confusion seizure weakness decreased deep tendon reflexes shallow respiration increased bleeding tendency immunosuppression bone pain

FVE signs and symptoms

cough and dyspnea lung crackles increased respirations and heart rate increased blood pressure and bounding pulse pitting edema weight gain, increased abdominal girth neck and hand vein distention increased urine output if kidneys can compensate; decreased if kidney damage is the cause confusion decreased hematocrit level

Hypophosphatemia causes

decreased nutritional intake of phosphorus and malnutrition use of magnesium-based or aluminum hydroxide-based antacids kidney failure hyperparathyroidism malignancy hypercalcemia alchohol withdrawal diabetic ketoacidosis respiratory alkalosis

Hypernatremia causes

decreased water intake fever excessive perspiration dehydration hyperventilation watery diarrhea enteral nutrition and parenteral nutrition deplete the cells of water diabetes inspidus Cushings syndrome impaired kidney function use of corticosteroids excessive administration of sodium bicarbonate

FVD management/treatment

determine renal function (may use fluid challenge test) isotonic electrolyte solutions (LR), followed by a hypotonic solution (1/2NS) continue with fluids, evaluate lung sounds and blood pressure

Hypernatremia signs and symptoms

dry mucous membranes loss of skin turgor thirst flushed skin elevated temperature oliguria muscle twitching fatigue confusion seizure

Isotonic Fluids

equal concentration inside and outside the cell; cell neither shrinks nor swells NS (0.9% Normal Saline) D5W (5% Dextrose in water) LR (Lactated Ringers) used for maintenance or replacement (expands extracellular volume) used to increase extracellular fluid volume that was lost through blood loss, dehydration (vomiting, diarrhea), or surgery especially used to expand circulating (intravascular) volume same osmolality as blood

Hyperphosphatemia causes

excessive dietary intake of phosphorus overuse of phosphate-containing laxatives or enemas vitamin D intoxication hypoparathyroidism renal insufficiency chemotherapy

Hypercalcemia causes

excessive intake of calcium supplements, milk, and antacid products that contain calcium* excessive intake of vitamin D* increased bone resorption or destruction from conditions such as bone tumors, fractures, osteoporosis*, and immobility decreased excretion of calcium renal disease use of thiazide diuretics hyperparathyroidism use of lithium* use of glucocorticoids* adrenal insufficiency*

Hypermagnesia signs and symptoms

hypotension bradycardia weak pulse sweating and flushing respiratory depression loss of deep tendon reflexes prolonged PR interval and widened QRS complexes

Hypocalcemia causes

inadequate dietary intake of calcium inhibited absorption of calcium from the intestinal tract inadequate vitamin d consumption diarrhea excessive gastrointestinal losses from diarrhea or wound draining end-stage kidney disease calcium-excreting medications such as diuretics, caffeine, anticonvulsants, heparin, laxatives, and nicotine decreased secretion of parathyroid hormone acute pancreatitis crohns disease excessive administration of blood

Hyponatremia causes

inadequate sodium intake (nothing by mouth) gastrointestinal suction excessive intake of water irrigation of gastrointestinal tubes with plain water diuretics increased perspiration draining skin lesion(s) burn(s) nausea and vomiting diabetic ketoacidosis syndrome of inappropriate antidiuretic hormone secretion retention of fluid, such as with kidney or heart failure

Hypercalcemia signs and symptoms

increased heart rate and BP bounding pulse bradycardia (late stage) muscle weakness (hypotonicity) diminished deep tendon reflexes nausea and vomiting constipation abdominal distention confusion, lethargy, and coma shortened QT interval and widened T wave

Respiratory Alkalosis (high pH low CO2) causes

initial stages of pulmonary emboli hypoxia fever pregnancy high altitudes anxiety mechanical ventilation hyperventilation

Hyperkalemia causes

kidney failure intestinal obstruction cell damage excessive oral or parenteral administration of potassium; potassium-retaining (sparing) diuretics Addison's disease excessive use of potassium-based salt substitutes transfusion of stored blood (the breakdown of older red blood cells releases potassium) acidosis

Hypokalemia signs and symptoms

leg and abdominal cramps lethargy and weakness shallow respirations and thready pulse confusion decreased or absent reflexes hypoactive bowel sounds and ileus orthostatic hypotension shallow, flat or inverted T waves; depressed ST segment and prominent U waves