Fluid, electrolyte, and acid-base regulation Exam 3

what are electrolytes?

Minerals found in urine, blood, tissues as well as other body fluids

what are the major electrolytes?

calcium, potassium chloride, magnesium, sodium

While electrolytes occur naturally in the body where can they also be found?

food, drink, and supplements

what are electrolytes responsible for?

-balancing the amt of water in the body, balancing body PH (acid-base level)

-Moving waste out of the body cells

-Moving nutrients into body cells

-Allowing the body muscles, heart, nerves, and brain to function properly

-Conducting electrical charges

Normal value for Potassium (K+)

3.5-5.0

Normal value for Sodium (Na+)

136-145

Normal value for Calcium (Ca++)

9-10.5

Normal value for magnesium (Mg++)

1.3-2.1

what are some contributing factors for electrolyte disturbance?

-Dehydration

-Overhydration

-Certain medications

-Heart, Kidney, or liver disorders

-IV fluids

-Feedings (Tube feed, TPN, poor diet

causes for hyPOkalemia

-Loop Dieuretics

-amphotecierne B, penicillin

-prolonged N/V/D

-chronic laxative use

s/s of hyPOkalemia

-muscle weakness (can be profound)

-Cardiac arrhythmias

-constipation

-fatigue

-paralytic ileus

-hypotension

-rhabdomyolysis

-hypotension

cause for hyPERkalemia

-Renal failure

-dehydration

-Diabetes mellitus

-Trauma/burns

-Excessive K+ intake (diet, supplements, IV solutions)

-PRBC transfusion

-sepsis, acidosis

s/s for hyPERkalemia?

-N/V

- cardiac arrythmias

-Myalgias/muscle weakness

-Paralysis

-heart failure

IV Potassium is a high alert med (true or false)

true

checks for IV potassium

-must be diluted in at least 100 ml of compatible solution

-Never given IV push

-administration rate should not exceed 10-20 mEq/hr

-total dose should typically not exceed 40 mEq at a time

-Requires continuous cardiac monitoring

-re-check of K level is required

hyPOnatremia (low sodium) causes

-meds (thiazide diuretics)

-chronic severe NV/D (lose sodium)

-water intoxication

-excessive alcohol use

-heart, kidney, or liver problems (fluid retention)

-severe burns due to (fluid shifts)

hyPERnatremia (high sodium) causes

-excessive sweating

-severe NV/D (lose water)

-prolonged suction

-burns due to (fluid shifts)

-impaired thirst (brain injury)

-meds/IVFs

s/s of both hypo and hypernatremia

-muscle twitching

-restlessness

-irritability

-confusion

-headache

-seizures

-coma

-death

how do you fix a sodium issue?

by fixing the underlying problem slowly

hypertonic

3% and give if PT has low sodium

isotonic

0.9% sodium chloride and given if PT is dehydrated

hypotonic

o.45% sodium chloride and given if PT has too much sodium

if too much or too little sodium intake you should take a combo of both (true or false)

true

hyPOcalemia (low calcium) causes

-meds (anything that decreases absorption)

-low vitamin D, Mg, Albumin levels

-kidney disease

-menopause

-hypoparathyroidism
-sepsis

s/s of hyPOcalcemia

-CV: CP/syncope/HF/dysrhytmias

-Resp: wheezing, spasm of the lower larynx

-MS: muscle cramps/spasm, bone loss

-Neuro: confusion/psychosis/memory/loss/seizures

-skin and hair changes

-dental problems

-Chovteks’s and trousseaus sign

hyPERcalemia causes

-cancer

-hyperparathyrodism

-Prolonged bedrest (bone reabsorbtion)

-kidney failure

-meds (vit A/D supplements in excess, thiazides)

s/s of hyPERcalemia

-Abdominal groans (contipation, NV)

-Painful Bones

-Kidney stones

-Groans (lethargy, malaise)

-Neurologic moans (confusion, delirium, psychosis, coma)

trousseaus sign

carpopedal spasm

chvosteks sign

facial twitching ipsilateral

hyPOmagnesemia causes

-meds

-poor dietary intake

-decreased ABSORBTION (chrons, celiac)

-DM (decreased urination)

-Burns

-Excessive alcohol intake

s/s of hypomagnesemia

-NV, anorexia

-weakness and fatigue

-muscle cramps/spasm/tetany

-increased DTR (deep tendon reflexes)

-seizure

-cardiac dysrythmias

-numbness and tingling

hyPERmagesemia causes

-kidney disease (acute and chronic)

-meds (laxative like mag citrate, MOM)

-Trauma

-Hypothyroidism (increased tubular reabsorption)

s/s of hypermagnesemia

-confusion and lethargy

-muscle weakness, flaccid paralysis

-decreased DTR (deep tendon reflexes)

-flushing

-hypotension/bradycardia/dysrhythmias

what kind of nursing interventions would you do in a hypermagnesemia pt?

put them on fall precautions

hyPOvolemia causes

-excessive sweating

-large burns

-inadequate fluid intake

-increased urination

-excessive N/V, fever

-Trauma

early s/s of hyPOvolemia

- thrist

-dry mucous membranes

-loss of elastic skin turgor

-decreased urine output

worsening s/s hyPOvolemia

-lethargy/weakness/confusion

-CP/palpitations

-hypotension, tachycardia, thready pulses, tachypnea

what happens in hyPOvolemia

blood vessels constrict in the extremities to preserve blood flow for vital organs (heart, brain and kidneys)

If hypovolemia goes untreated, serious symptoms may develop including:

-blue discoloration of the lips

-change in alertness or level on consciousness

-chest pain, tightness, or pressure

-palpitations

-decreased or no urine production(oliguria)

-decreased blood pressure

-weak pulse

-hypovolemic shock

hypovolemic shock

loss of 20% or 1/5 circulating blood/fluid supply

Hypovolemic shock treatment

Treatment that is aimed at controlling fluid or blood loss, replacing those componets, and restoring overall circulation in the body so that adequte perfusion of organs can occur

hyPERvolemia causes

-heart failure, kidney failure, liver failure (cirrhosis), pregnancy, excessive IVFs, meds which cause NA/H2O retention

s/s of hypervolemia

-pitting edema, HTN, JVD, bounding pulses, crackles, SOB, weight gain

treatment for hypervolemia

diuretics, low Na diet, fluid restriction, treat underlying cause

what are crystalloid solutions?

small particles that can easily pass from the bloodstream into cells and tissues

Each crystalloid solution is categorized by its what?

Tonicity or abilty to make water move in or out of cells via osmosis

What solutions move water from extracellular space into cells

Hypotonic

What solutions cause water to leave the cells?

Hypertonic

There is NO movement between extracelluluar and intracellular fluids in what solutions?

isotonic

what are RBCs known as and what are they used for?

Erythrocytes and can be used to restore blood levels without substantially increasing the clients overall blood volume

Whole blood contains what?

White cells, red cells, and platelets suspended in blood plasma. Trauma and surgery causing a signifigant blood loss are common uses for whole blood

What is the liquid portin of blood?

Plasma, which is where the platelets and red and white blood cells are suspended as they travel throughout the body

what stops or prevents bleeding?

platelets or thrombocytes

albumin

most commonly used for albumin replacement and interstitial edema

what is dextran most commonly used for?

shock

what is hetastarch most commonly used for?

hypovolemia

transfusion reactions

-circulatory overload(hypervolemia)

-hemolytic reaction(blood types aren’t mixing)

-febrile reaction

-allergic reaction

-anaphylaxis

-transfusion-related acute lung injury

-delayed reactions

transfusion reactions s/s

-fever

-chills

-altered blood pressure (elevated or decreased)

-respiratory difficulty (wheezing and dyspnea)

-pain in the chest, abdomen, low back or flank pain

-NV

-Skin manifestations including pruritus, urticaria, flushing, edema (localized), and rash

-jaundice

-urinary changes including oliguria, anuria, and hematuria

what should you do if a transfusion reaction occurs?

STOP TRANSFUSING

-switch tubing and fluids to normal saline

-stay with client and call MD

-blood and tubing will go back to blood bank for testing

what is intake?

anything taken in by client (PO, IV, TFs)

what is output?

anything produced/put out by the body of a client (urine, bowel movements, emesis, drainage, EBL, etc.)

net fluid volume

difference in total intake and total output

complications of IV therapy

-infiltration(administration of fluid into the tissue surrounding an IV site due to displacement of the catheter tip)

-extravasation (inadvertent administration of a vesicant fluid into tissues surrounding an IV cannula)

-phlebitis (inflammation of the inner lining of the vein)

-infection

-embolism(construction of a vessel by air)

-bleeding

Respiratory system (lungs) will try to compensate for any what?

metabolic issue

Renal system (kidneys) will try to compensate for any what?

Respiratory issue

cells only functon well at a neutral pH (true or false)

true

must know value of pH

7.35 - 7.45

must know value of pCO2

35 -45 (acid)

must know value of HCO3-

22 - 26 (base)

common causes of metabolic acidosis

-kidney disease; lose the ability to retain/ excrete H+ and HCO3- normally

-lactic acidosis; severe illness causing hypotension→ low perfusion, strenuous exercise

-diabetic ketoacidosis; ketones build up when diabetes is uncontrolled

-severe dehydration; hypotension leading to poor perfusion, same as LA

-severe diarrhea; loss of too much sodium bicarbonate in liquid stool

common causes of metabolic alkalosis

-loss of potassium or sodium

• overuse of diuretics or laxatives affects kidney reabsorption

-excessive vomiting

• loses stomach acid

-ingestion of bicarbonate

• baking soda, Alka-Seltzer, TUMS

-alcohol abuse

• vomiting

-heart, kidney, or liver failure

• diuretic use

common causes of respiratory acidosis

-central nervous system depression

• Opioids, oversedation, anesthesia

-spinal cord/brain injury

• loss of nerve innervation to the respiratory system

-pulmonary disorder

• COPD, atelectasis, pneumonia

-anything that inhibits ability to breath normally

• EX; chest wall, injury/deformity, ascites, OSA without using CPAP/BiPAP

common causes for respiratory alkalosis

-anything that cause hyperventilation

-severe pain

-anxiety/stress/ panic attack

-pregnancy

-several medical illness causing tachypnea

-sepsis, infection, trauma, fever

respiratory acidosis s/s

-hypoventilatio and hypoxia

-rapid shallow respirations

-low bp

-skin and mucosa pale to cyanotic

-HA

-hyperkalemia

-dysrhytmias

-drowsiness, dizzy, disoriented

-muscle weakness/hyperflexia

respiratory alkalosis s/s

-seizures

-deep rapid breathing

-hyperventilation

-tachycardia

-decreased or normal bp

-hypokalemia

-numbness and tingling of extremeites

-lethargy and confsuon

-light headed

-NV

metabolic acidosis s/s

-HA

-low bp

-muscle twitching

-warm flushed skin

-NV

-decreased muscle tone

-decreased reflexes

-kussmaul respirations

metabolic alkalosis s/s

-restlessness

-dysrhytmias (tachy)

-compensatory hypoventilation

-confusion

-NV and D

-tremors, muscle cramps, tingling of fingers and toes

-hypokalemia