Module 5

Dehydration Cues

Thirst, low urine output, dark urine, poor skin turgor, dizziness, confusion, fatigue, dry mouth/mucous membranes, sunken eyes/cheeks, weak thready pulse, hypotension, tachycardia, and possible laxative abuse.

Dehydration Causes

Diabetes, hot or dry environment, heavy sweating from physical activity, diarrhea, vomiting, fever, and certain medications.

Dehydration Non-Pharm Treatment

Encourage oral fluids (water, Pedialyte, electrolyte drinks), avoid soda/caffeine/sugary drinks, offer water-rich foods (watermelon, cucumber, broth), monitor daily weight and I&O, observe urine color, allow rest and avoid strenuous activity.

Dehydration Pharmacologic Treatment

Administer IV fluids ($0.9\%$ NS, D5W, Lactated Ringer’s), electrolyte supplements as ordered, and treat underlying cause with antibiotics, antipyretics, antiemetics, or antidiarrheals.

Dehydration Short-Term Goal

Patient will maintain adequate hydration by taking frequent small sips (about 8 oz total per day or as ordered) and show improving hydration status by the end of the week.

Dehydration Long-Term Goal

Patient will establish healthy hydration habits, maintain adequate fluid intake to prevent dehydration, and verbalize strategies for balanced fluid intake within one month.

Overhydration Signs and Symptoms

Nausea, vomiting, edema, bloating, headache, muscle weakness, drowsiness, underactive bladder, lethargy, dizziness, disorientation, increased BP, bounding pulse, JVD, tachycardia, weight gain, shortness of breath, rapid/crackles in lung sounds.

Overhydration Causes

Overconsumption of water (water toxicity), drinking >2 L rapidly, endurance exercise, extreme heat, low body mass, use of Molly/Ecstasy, psychogenic polydipsia, antidepressants/antipsychotics, and risk factors like CKD, liver disease, CHF, and NSAID overuse.

Overhydration Non-Pharm Treatment

Fluid restriction, sodium restriction, daily weights, strict I&O, leg elevation and compression socks, semi- or high-Fowler’s position, oxygen PRN, skin care, and close monitoring of lung sounds, BP, JVD, edema, breathing, and mental status.

Overhydration Pharmacologic Treatment

Use diuretics such as loop diuretics (furosemide/Lasix for rapid fluid removal), thiazide diuretics (HCTZ for maintenance and watch glucose), and potassium-sparing diuretics (spironolactone which retains potassium).

Overhydration Short-Term Goal

Patient will move toward fluid balance within 24–48 hours as evidenced by more stable vitals, improving lab values, and intake and output trending toward equilibrium.

Overhydration Long-Term Goal

Patient will maintain long-term fluid balance, preserve cardiovascular and renal function, implement lifestyle changes (low-sodium diet, limited alcohol, stable daily weights), and know when to call the provider.

Sodium Normal Range

Normal serum sodium level is $135–145 mEq/L$.

Hyponatremia Definition

Low sodium level in the blood (Na <135 mEq/L).

Hypernatremia Definition

High sodium level in the blood (Na >145 mEq/L).

Hyponatremia Signs and Symptoms

Confusion, headache, lethargy, weakness, nausea/vomiting, muscle cramps or twitching, seizures (severe), and poor skin turgor.

Hypernatremia Signs and Symptoms

Thirst, dry mucous membranes, confusion, restlessness, irritability, decreased urine output, and seizures or coma in severe cases.

Sodium Food Sources

Table salt, processed foods, canned soups, frozen meals, snack foods (chips/pretzels), pickles, sauces, soy sauce, lunch meats, cured meats, and cheese.

Hyponatremia Causes

Excess water intake, heart failure, kidney disease, thiazide diuretics, GI losses (vomiting/diarrhea), SIADH (water retention diluting Na), and adrenal insufficiency.

Hypernatremia Causes

Dehydration, excess sodium intake (diet or IV), diabetes insipidus, fever, sweating, burns, and inadequate water intake (common in older adults).

Hyponatremia Nursing Interventions

Monitor neurological status and seizure risk, replace sodium as ordered (oral or IV NS), and restrict free water if caused by dilution (e.g., SIADH, overhydration).

Hypernatremia Nursing Interventions

Encourage oral fluids or give hypotonic IV fluids as ordered, monitor neuro status and seizure risk, track I&O and daily weights, and correct underlying dehydration.

Potassium Normal Range

Normal serum potassium level is about $3.5–4.5 mEq/L$.

Hypokalemia Definition

Low potassium level in the blood (K+ below normal).

Hyperkalemia Definition

High potassium level in the blood (K+ above normal).

Potassium Signs and Symptoms (High and Low)

Muscle weakness, numbness/tingling, abdominal cramps, irregular heartbeat, weak pulse, and ECG changes such as peaked T waves in hyperkalemia or flattened T waves in hypokalemia.

Potassium Food Sources

Potatoes, tomatoes, spinach, avocados, beans, bananas, oranges/orange juice, nuts, and dried fruits.

Hyperkalemia Causes

Kidney failure, potassium-sparing diuretics (spironolactone), burns/trauma causing cell lysis, ACE inhibitors, and excess K+ intake from diet or supplements.

Hypokalemia Causes

Vomiting, diarrhea, NG suction, potassium-wasting diuretics (furosemide, thiazides), poor intake, and insulin therapy (shifts K+ into cells).

Hyperkalemia Nursing Interventions

Stop potassium intake, give medications like insulin with glucose, calcium gluconate, or Kayexalate to remove K+ in stool, and monitor heart rhythm on ECG.

Hypokalemia Nursing Interventions

Administer potassium PO or via IV pump (never IV push), increase dietary potassium, monitor heart rhythm, and watch closely if patient is on digoxin.

Magnesium Normal Range

Normal serum magnesium level is $1.3–2.3 mEq/L$.

Hypermagnesemia Definition

High magnesium level in the blood above normal range.

Hypomagnesemia Definition

Low magnesium level in the blood below normal range.

Hypermagnesemia Signs and Symptoms

Muscle weakness, decreased deep tendon reflexes, slow heart rate, low blood pressure, drowsiness, and severe respiratory depression.

Hypomagnesemia Signs and Symptoms

Muscle cramps, increased reflexes, fast heart rate, high blood pressure, and seizures.

Magnesium Food Sources

Salmon, tofu, chia seeds, bananas, spinach, cashews, potatoes with skin, avocado, raisins, prunes, beans, and dark chocolate.

Hypomagnesemia Causes

NG suctioning, diarrhea, chronic alcohol use, tube feedings or TPN, sepsis, and burns.

Hypermagnesemia Causes

Renal failure with decreased excretion and excessive magnesium intake (antacids or laxatives).

Hypermagnesemia Nursing Interventions

Use diuretics to increase Mg excretion if kidneys work, avoid magnesium-containing antacids/laxatives, and monitor for hypoactive bowel movements and decreased reflexes.

Hypomagnesemia Nursing Interventions

Monitor for arrhythmias and seizures, institute seizure precautions, monitor respiratory rate and pattern, and replace magnesium as ordered.

Calcium Normal Range

Normal serum calcium level is $8.6–10.2 mg/dL$.

Hypercalcemia Definition

High calcium level in the blood above normal range.

Hypocalcemia Definition

Low calcium level in the blood below normal range.

Hypercalcemia Signs and Symptoms

Severe thirst, frequent urination, upset stomach, constipation, bone pain, lethargy, confusion, and slurred speech.

Hypocalcemia Signs and Symptoms

Numbness and tingling around mouth, fingers, and feet, tetany, muscle cramps/spasms, and seizures.

Calcium Food Sources

Low-fat milk, fat-free yogurt, reduced-fat cheese, cooked collard greens, spinach, bok choy, kale, mustard greens, canned sardines, canned salmon with bones, fortified $100\%$ grapefruit or orange juice, and unsweetened almond or rice milk.

Hypocalcemia Causes

Inadequate calcium intake, inadequate vitamin D intake, impaired absorption, and excess calcium loss via stool, urine, or vomiting.

Hypercalcemia Causes

Cancers, hyperparathyroidism, excess vitamin D, high calcium intake, frequent bone injury/breakdown, and kidney stones.

Calcium Nursing Interventions

Adjust diet (increase Ca for hypocalcemia, limit high-Ca foods for hypercalcemia), educate about calcium-rich foods and vitamin D for absorption, administer IV fluids or diuretics to promote Ca excretion in hypercalcemia, give IV calcium or supplements for hypocalcemia, and monitor respiratory and neuromuscular status.

Phosphate Normal Range

Normal serum phosphate level in adults is $2.5–4.5 mg/dL$.

Hyperphosphatemia Definition

High phosphate level in the blood above normal range.

Hypophosphatemia Definition

Low phosphate level in the blood below normal range.

Hyperphosphatemia Signs and Symptoms

Muscle cramps, dry skin, memory problems, seizures, arrhythmias, irritability, brittle nails, and tingling in lips, tongue, fingers, and feet.

Hypophosphatemia Signs and Symptoms

Muscle weakness and pain, seizures, decreased reflexes, heart failure, altered mental status, dysarthria, and often asymptomatic until severe.

Phosphate Food Sources for Hyperphosphatemia (Eat Less)

Dairy (milk, cheese), meats (chicken, turkey), beans, nuts, seeds (almonds, peanut butter), and some fresh fruits and vegetables.

Phosphate Food Sources for Hypophosphatemia (Eat More)

Fish (salmon, sardines), yogurt, cottage cheese, oats, and brown rice.

Hyperphosphatemia Causes

Chronic kidney disease, acute kidney injury, and hypoparathyroidism.

Hypophosphatemia Causes

Vitamin D deficiency, malabsorption, malnutrition, chronic diarrhea, hyperparathyroidism, end-stage renal disease, and chronic alcoholism.

Hyperphosphatemia Nursing Interventions

Administer phosphate binders as ordered, monitor for signs of hypercalcemia, provide comfort measures, and educate about limiting high-phosphate foods.

Hypophosphatemia Nursing Interventions

Administer phosphate supplements as ordered, educate on causes (poor diet, excess alcohol), and monitor vital signs and lab values to maintain or correct phosphate balance.

Chloride Normal Range

Normal serum chloride level is $98–106 mEq/L$.

Hyperchloremia Definition

High chloride level in the blood above normal.

Hypochloremia Definition

Low chloride level in the blood below normal.

Hypochloremia Signs and Symptoms

Dehydration, weakness, fatigue, muscle pain, shortness of breath, frequent diarrhea or vomiting, low blood pressure, and tachycardia.

Hyperchloremia Signs and Symptoms

Dehydration, kidney disease, nausea, vomiting, fatigue, and metabolic acidosis (acid buildup in the body).

Chloride Food Sources (Increase Intake)

Table salt and sea salt (NaCl), processed/packaged foods, olives, seaweed, rye, cheese, cured meats, and canned soups/broths.

Chloride Diet for High Levels (Eat More Low-Salt Foods)

Fresh fruits (apples, grapes, berries, bananas), vegetables (spinach, carrots, broccoli), low- or no-salt products, fresh unseasoned poultry/fish, whole grains, and eggs.

Hyperchloremia Causes

Dehydration, metabolic acidosis (e.g., diarrhea, renal failure), excess saline IV fluids, kidney dysfunction, hyperparathyroidism, and certain medications (corticosteroids, carbonic anhydrase inhibitors).

Hypochloremia Causes

Prolonged vomiting or NG suction, diarrhea, metabolic alkalosis, loop or thiazide diuretics, adrenal insufficiency (Addison’s), and excess water intake (dilutional).

Hypochloremia Nursing Interventions

Replace chloride with NS or PO supplements, monitor electrolytes (Na, K, HCO₃, ABGs), watch for muscle twitching and irritability, and prevent ongoing losses by reducing suction and treating vomiting.

Hyperchloremia Nursing Interventions

Monitor and correct acid–base balance, avoid chloride-heavy IV fluids by switching to balanced solutions (LR) as ordered, promote hydration, monitor I&O and daily weights, watch renal function (BUN/creatinine), and encourage PO fluids if appropriate.

Cholesterol Level Test Purpose

Blood test that measures total cholesterol to assess cardiovascular disease risk and evaluate response to lipid-lowering therapy.

Cholesterol Normal Range

Total cholesterol ideally less than $200 mg/dL$ in adults.

Cholesterol Pre-Test Care

May require 9–12 hours of fasting and review of medications that affect lipid levels.

Cholesterol Post-Test Care

Resume normal diet/meds unless instructed, review results, and discuss CVD risk and lifestyle changes.

Triglyceride Level Purpose

Measures circulating triglycerides to assess fat metabolism, pancreatitis risk, and cardiovascular risk.

Triglyceride Normal Range

Optimal fasting triglyceride level is less than $150 mg/dL$.

Triglyceride Pre-Test Care

Fast 12 hours, avoid alcohol 24 hours before, and review meds.

Triglyceride Nursing Teaching

Limit alcohol, reduce sweets and refined carbs, control diabetes, and maintain a healthy weight and low-fat diet.

LDL Cholesterol Purpose

Measures low-density lipoprotein (“bad cholesterol”) that contributes to arterial plaque and atherosclerosis.

LDL Normal Range

Optimal LDL is under $100 mg/dL$, or under $70 mg/dL$ for high-risk patients.

HDL Cholesterol Purpose

Measures high-density lipoprotein (“good cholesterol”) that carries cholesterol away from arteries and helps protect the heart.

HDL Normal Range

Men should have >40 mg/dL, women >50 mg/dL, and >60 mg/dL is cardioprotective.

Statins Medication Class

Cholesterol-lowering drugs (e.g., atorvastatin, simvastatin, rosuvastatin, pravastatin) that reduce LDL and triglycerides, slightly raise HDL, and lower risk of MI and stroke.

Statins Key Nursing Interventions

Check baseline and periodic liver function, monitor for muscle pain/weakness and rhabdomyolysis, review drug interactions, usually administer in evening, and reinforce lifestyle changes.

Statins Patient Teaching

Take as prescribed (often at bedtime), avoid grapefruit juice, report unexplained muscle pain or dark urine, and continue heart-healthy diet and exercise.

Cardiac Enzymes CK-MB and Myoglobin Purpose

Blood tests used to detect heart muscle damage and help diagnose or rule out myocardial infarction.

CK-MB and Myoglobin Normal Ranges

CK-MB is about $0–5 ng/mL$ and myoglobin $0–85 ng/mL$.

Cardiac Enzymes Pre-Test Care

No fasting required; explain blood draw and possible serial testing.

Cardiac Enzymes Post-Test Care

Monitor puncture site for bleeding and expect repeat labs every 6–8 hours to track trends.

Cardiac Enzymes Nursing Interventions

Assess chest pain, vitals, and ECG, notify provider if levels rising, and prepare MONA (morphine, oxygen, nitroglycerin, aspirin) as ordered.

Troponin I and T Purpose

Highly specific markers used to detect heart muscle injury and diagnose MI (best cardiac damage indicator).

Troponin Normal Range

Troponin I less than $0.04 ng/mL$; critical levels are greater than $0.40 ng/mL$.

Troponin Nursing Interventions

Obtain serial troponin levels and 12-lead ECG, monitor symptoms, give oxygen if needed, and notify provider immediately if elevated.

PT/INR Test Purpose

Measures clotting time and monitors warfarin therapy to keep anticoagulation levels safe and therapeutic.

PT/INR Normal Ranges

PT is about $11–15 seconds$, INR $0.8–1.1$ normally, $2–3$ therapeutic for most warfarin patients, and $2.5–3.5$ for mechanical heart valves.

PT/INR Nursing Interventions

Review meds, hold warfarin if INR too high, prepare vitamin K if ordered, and teach bleeding precautions (soft toothbrush, no NSAIDs or alcohol).

aPTT Test Purpose

Measures intrinsic clotting time and monitors unfractionated heparin therapy.

aPTT Normal and Therapeutic Range

Normal aPTT is about $25–35 seconds$ and therapeutic for heparin is about $60–80 seconds$.