module 5 - acid/base imbalance, fluid status, and electrolyte imbalances

what causes fluid volume excess

increased Na or H2O intake; decreased Na or H2O elimination

what causes increased Na or H2O intake

high Na diet

psychogenic polydipsia

hypertonic IV fluid

free water / enteral feeds

what causes decreased Na or H2O elimination

syndrome of inappropriate antidiuretic hormone (SIADH)

hyperaldosteronism

cushing's syndrome

organ failure - kidney, heart, liver

what occurs with weight, blood pressure, pulse, respiratory rate, and U/O in FVE

increases; pulse bounding

what occurs in the lungs in FVE

dyspnea, labored breathing, coughing, crackles

what other manifestations are involved in FVE

JVD, edema - pinning

what happens to urine specific gravity in FVE

low - <1.005

interventions of FVE and FVD

treat underlying cause

daily weight

input and output

what is the most accurate intervention with FVE and FVD

daily weight

causes of FVD

inadequate fluid intake, excessive fluid losses

what are causes of inadequate fluid intake

poor PO intake, insufficient IV replacement, decreased thirst mechanism

what are causes of excessive fluid losses

diabetes insipudis, hemorrhage, gastrointestinal, burns, excessive diuretic use

how does weight, BP, respiratory, and U/O change in FVD

decrease; BP ortho hypotension

how does pulse change in FVD

increases; weak and thready

what are other manifestations presented in FVD

capillary refill slow, thirst, poor skin turgor, dry mucous membranes

how does urine specific gravity change in FVD

increase - >1.030

hyponatremia

sodium not plentiful extracellular

causes of hyponatremia

deficient sodium, excessive water

what causes deficient sodium

loss of sodium (V, D)

hypoaldosteronism

diet sodium restrictions

what causes excessive water

hyperglycemia

excessive water ingestion

dilution of blood (FVE): renal failure, HF, SIADH

neuromuscular manifestations of hyponatremia

HA, confusion, muscle weakness, seizures

GI manifestations of hyponatremia

N,V,D

hypovalemia manifestations of hyponatremia

thirst, dry mucous membranes, hypotension, decreased U/O

hypervolemia manifestations of hyponatremia

HTN, edema, weight gain, increased u/o

causes of hypernatremia

excessive sodium, deficient water

causes of excessive sodium

increased Na intake

hold onto Na: cushing's, hyperaldosteronism

causes of deficient water

water loss (V, D, diabetes insiputis, diuretic use)

loss of thirst / inability to drink water

nauromuscular manifestations of hypernatremia

HA, confusion, muscle cramps, seizures

hypovalemia manifestations of hypernatremia

thirst, dry mucous membranes

more manifestations of hypernatremia

decreased u/o trying to reach homeostasis

hypotension, tachycardia

hypokalemia causes

excessive K+ loss, deficient K+ intake, things that cause a shift of K+ in body

what causes excessive K+ loss

GI loss - V, D, NGT suctioning, laxitives

kidney loss - K=losing diuretics, Cushing's

what causes deficient K+ intake

malnutrition, extreme dieting, alcoholism

what are things that cause a shift of K+ in the body in hypokalemia

k+ from blood to cells - alkalosis, too much insulin

cardiac manifestations of hypokalemia

flattened t waves, presence of u wave (small bump after T)

weak and irregular pulse

GI manifestations of hypokalemia

decreased GI motility - N, C, decreased bowel sounds, abdominal distention

neuromuscular manifestations of hypokalemia

paresthesia, muscle weakness, muscle cramps, confusion

causes of hyperkalemia

deficient K+ excretion

excessive K+ intake

things that cause a shift of K+ in body

what causes deficient K+ excretion

renal failure, ACE inhibitors, K-sparing diuretics (gets rid of fluids but holds onto K+)

what causes excessive K+ intake

increase in K+: PO or IV

what are things that cause a shift of K+ in the body in hyperkalemia

K= from cell into blood - trauma or MI causing cell death, DKA, acidosis

cardiac manifestations of hyperkalemia

tall peaked t waves, bradycardia

gi manifestations of hyperkalemia

increased GI motility - N, D

neuromuscular manifestations of hyperkalemia

paresthesia, flaccid paralysis, muscle weakness, muscle cramps, anxiety

what causes hypocalcemia

deficient Ca+ intake or release from bone

excessive Ca+ losses

what causes deficient Ca+ intake or release from bone in hypocalcemia

renal failure

alcoholism

absorption disorders

what causes excessive Ca+ losses in hypocalcemia

hypoparathyroidism

renal failure

D, laxatives

what are the manifestations of hypocalcemia

trousseau's sign

chvostek's sign

d

decreased bone density

increased deep tendon reflexes

prolonged QT interval

what are causes of hypercalcemia

excessive Ca+ intake or release from bone

deficient Ca+ excretion

what are the causes of excessive Ca+ intake or release from bone in hypercalcemia

immobility - bones release Ca if they are not in use

calcium antacids/supplements

renal failure

hyperparathyroidism

manifestations of hypercalcemia

muscle weakness

N,V,C

polyuria

renal calculi - kidney stones

decreased deep tendon reflexes

short QT interval

what causes hypomagnesemia

deficient Mg+ intake

excessive Mg+ excretion

what causes deficient Mg+ intake in hypomagnesemia

alcoholism

malnutrition

preeclampsia

what causes excessive Mg+ excretion in hypomagnesemia

diuretics

diarrhea

manifestations of hypomagnesemia

hypocalemia

what causes hypermagnesemia

excessive Mg+ intake

deficient Mg+ excretion

what causes excessive Mg+ intake in hypermagnesemia

excessive antacid use

what causes deficient Mg+ excretion

renal failure

excessive laxative use

manifestations of hypermagnesemia

hypercalcemia

what are causes of hypophosphatemia

causes of hypercalcemia

what are manifestations of hypophosphatemia

manifestations of hypercalcemia

what are causes of hyperphosphatemia

causes of hypocalcemia

what are manifestations of hyperphosphatemia

manifestations of hypocalcemia

lung compensation in metabolic alkalosis

decreased RR

retain CO2

lung compensation in metabolic acidosis

increase RR

expel CO2

lung compensation in respiratory alkalosis/acidosis

no lung compensation

kidney compensation in metabolic alkalosis/acidosis

no kidney compensation

kidney compensation in respiratory alkalosis

retain hydrogen ions

excrete bicarbonate

kidney compensation in respiratory acidosis

excrete hydrogen ions

retain bicarbonate

causes of metabolic alkalosis

vomiting

NG suctioning

diuretic therapy

hypokalemia

why does hypokalemia cause metabolic alkalosis

low K - pulls K out of cell -> hydrogen goes into cell -> hydrogen blood levels drop

causes of metabolic acidosis

diarrhea*

DKA* - anaerobic metabolism

lactic acidosis*

renal failure

shock

starvation

causes of respiratory alkalosis

hyperventilation

*pain

*anxiety

*fever

liver failure

causes of respiratory acidosis

hypoventilation

respiratory depression (narcotics)

airway obstruction

asthma/copd

sleep apnea

manifestations of metabolic alkalosis

decreased respirations

dizziness

hypertonic muscles

tetany

parasthesias

dysrhythmia

manifestations of metabolic acidosis

vital signs: bradycardia, weak pulses, hypotension, tachypnea

kussmaul respirations

hyperkalemia

warm flushed skin

manifestations of respiratory alkalosis

tachypnea

palpitations

chest pain

parasthesias

syncope

manifestations of respiratory acidosis

muscle twitching

dizziness

palpitations

interventions of metabolic alkalosis/acidosis

treat underlying cause

administer fluids and electrolytes

interventions of respiratory alkalosis

reduce oxygen therapy

reduce anxiety/pain

rebreathing techniques

interventions of respiratory acidosis

maintain patent airway

bronchodilators

reversal agents (narcotics) - narcan

normal pH value

7.35 - 7.45

acidotic pH

<7.35

alkalotic pH

>7.45

normal PaCO2

35-45

acidotic PaCO2

>45

alkalotic PaCO2

<35

normal HCO3

22-26

acidotic HCO3

<22

alkalotic HCO3

>26

what are levels of metabolic acidosis

low pH

normal PCO2

high HCO3

what are levels of metabolic alkalosis

high pH

normal PCO2

high HCO3

what are levels of respiratory acidosis

low pH

high PCO2

normal HCO3

what are levels of respiratory alkalosis

high pH

low PCO2

normal HCO3

uncompensated ABG

2 are abnormal

partial compensated ABG

if all three are abnormal

fully compensated ABG

2 are abnormal and pH has returned to normal