QZLT Medical Surgical Nursing II: Acid-Base Balance & Fluid-Electrolyte Balance

Blood and plasma are which type of fluid?

intravascular

Kussmaul respirations

very deep, labored breathing (usually associated with diabetic acidosis and renal failure)

Body's compensation for metabolic acidosis

Daily Weights

best indicator of fluid loss or retention

Tx for hyperkalemia

restricting potassium intake, loop diuretics, IV insulin +glucose(which forces K into the cells), Kayexelate(which binds to K), calcium gluconate through IV(which reduces membrane potential), or dialysis

food sources of calcium

-Milk

-Milk products

-Dark green leafy vegetables

-Salmon

-Calcium-fortified foods such as breads and cereals

signs of hyponatremia

Anorexia, nausea, cramps, fatigue, lethargy, muscle weakness, headache, confusion, seizures, decreased blood pressure

risk factors for hypocalcemia

smoking, lack of exercise, high alcohol consumption, anorexia, estrogen or testosterone deficiency, poor nutrition, obesity, post-menopausal women

antidiuretic hormone (ADH)

Hormone produced by the neurosecretory cells in the hypothalamus that stimulates water reabsorption from kidney tubule cells into the blood and vasoconstriction of arterioles.

Secreted to prevent further dehydration and encourage kidneys to retain fluids

Hypertonic

Having a higher concentration of solute than blood

Isotonic

Having the same solute concentration as blood.

Hypotonic

Having a lower concentration of solute than blood

Signs of hypocalcemia

-paresthesias followed by numbness

-hyperactive deep tendon reflexes

-a positive Trousseau's or Chvostek's sign

-neuromuscular excitability

-muscle cramps

-twitching

-tetany

-seizures, irritability, and anxiety

-increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.

sensible fluid losses

Measurable

Ex: from urination, defecation, & wounds

insensible fluid losses

Immeasurable

Ex: through the skin (affected by humidity & body surface area) & lungs (affected by respiratory rate and depth)

causes of hyponatremia

Fluid overload: heart failure, cirrhosis

Excessive water ingestion

Excessive infusion of D5W

SIADH

Dehydration

Trousseau sign

Spasmodic contractions caused by pressing the nerve supplying a muscle; seen in tetany

Chvostek's sign

Cheek, facial spasm when Cheek is tapped associates with hypocalcemia

signs of hypovolemia

tachycardia, hypotension, weak pulse, loss of skin turgor, tachypnea, sunken eyes, orthostatic hypotension

treatment of hypovolemia

replace water and electrolytes with balanced IV solutions

Vitamin required to absorb calcium in the GI tract

Vitamin D

Electrolyte caused by hyperparathyroidism

hypercalcemia

Contraindications for IV fluid replacement

Heart Failure

possibly ESRD

food sources of potassium

Bananas

Oranges

Apricots

Figs

Dates

Carrots

Potatoes

Tomatoes

Spinach

Dairy products

Meats

Hypomagnesmia

lower than 1.5

causes: inadequate magnesium intake and absorption, increased excretion due to hypercalcemia or drugs such as furosemide, chronic alcoholism, malnutrition

signs/symptoms: lethargy, tremor, tetany, hyperreflexia, seizures, arrhythmias, *Torsades de pointes*

treatment: magnesium replacement

Hypermagnesmia

greater than 2.5

causes: acute renal failure, excess Mg/Al antacids

signs/symptoms: neuro and cardiac depression, drowsiness, hyporeflexia, decreased respiratory rate, cardiac arrest

treatment: saline and loop diuretics, possible hemodialysis

Hypercalcemia treatment

Treat underlying cause. Hydration, increasing salt intake, and forced diuresis (careful to prevent potassium or magnesium depletion), bisphosphonates and calcitonin

Edema is a sign of what fluid imbalance?

fluid volume overload

Interventions for fluid-volume overload

Raise head of bed

Stop IV fluid

Call doctor and get an order for Lasix ( furosemide)

Normal dose 20-40

Daily Weights

Interpret the ABGs and determine the Acid-Base Imbalance:

pH 7.46

pC02 31

pHC03 24

Respiratory Alkalosis

Interpret the ABGs and determine the Acid-Base Imbalance:

pH 7.30

pC02 47

pHC03 22

Respiratory Acidosis

Interpret the ABGs and determine the Acid-Base Imbalance

pH 7.49

pCO2 44

pHC03 29

Metabolic Alkalosis

Interpret the ABGs and determine the Acid-Base imbalance

pH 7.32

pC02 43

pHCO3 19

Metabolic Acidosis

causes of hypokalemia

Actual total body potassium loss

~excessive use of meds such as diuretics and corticosteroids

~increased secretion of aldosterone (Cushing's Syndrome)

~Vomiting, diarrhea

~Wound drainage (gastrointestinal)

~Prolonged nasogastric suction

~Excessive diaphoresis

~Renal disease impairing reabsorption of potassium

Inadequate intake of potassium: NPO

Movement of potassium from the extracellular fluid to intracellular fluid

~alkalosis

~hyperinsulinism

Dilution of serum potassium

~Water intoxication

~IV therapy with potassium poor solutions

sources of sodium in diet

Processed foods have the most sodium and reduced potassium

Fresh fruits and vegetables have the least sodium

care for a patient with potassium imbalances

should always include a cardiac monitor

high risk of arrhythmia

Causes of respiratory acidosis

decreased respiratory stimuli (anesthesia, drug overdose), COPD, pneumonia, atelectasis

Causes of metabolic acidosis

Starvation, dehydration, diarrhea, shock, renal failure, and diabetic ketoacidosis.

Causes of respiratory alkalosis

hyperventilation (anxiety, PE, fear), mechanical ventilation

Causes of metabolic alkalosis

Loss of gastric juices, potassium wasting diuretics, overuse of antacids

Administration of potassium

-oral- DO NOT CRUSH

-IV (must be diluted)- DO NOT PUSH

-potassium chloride is most common

food sources of potassium

Bananas

Oranges

Apricots

Figs

Dates

Carrots

Potatoes

Tomatoes

Spinach

Dairy products

Meats

causes of hyperkalemia include

potassium supplements, ace inhibitors, renal failure, excessive loss from cells, potassium-sparing diuretics, burns, trauma, metabolic acidosis, infections

Hyperkalemia in DKA explanation

Acid in the blood is buffered by being drawn into cells, antiporting with potassium

Overall, though, the total body potassium is low, because it is lost in the urine, even though there is hyperkalemia in the blood