Adult Pop Exam 1

In what situation would isotonic/normal saline be administered?

• hydration

• to stabilize a pt

• increase BP

In what situation would a hypertonic solution be administered?

• hyponatremia

• increase BP

In what situation would a hypotonic solution be administered?

• hypernatremia

What can happen if hypotonic solution is administered too rapidly or too long?

• FVD

• hypotension

Watch for edema

Peripheral Venous Catheter

The tip of the catheter ends in a small peripheral vein

Examples of Peripheral Venous Catheter

• saline lock

• midline catheter

Central Venous Catheters

The tip of the catheter ends in the large, central vein—superior vena cava

Examples of Central Venous Catheters

• PICC

• Port-a-cath (implanted)

S/S of FVD

• Pulmonary edema (SOB, tachypnea, dyspnea, crackles, wheeze)

• Peripheral edema

• Delayed recovery of the GI function (can lead to ileus)

• Dilutional anemia r/t hemodilution

• Coagulopathy

• Delayed wound healing

• Abdominal compartment syndrome (increased abdominal girth, N/V, syncope, dyspnea, melena)

• Intraabdominal hypertension
  
  

S/S of Cellular Lysis or Shrinkage

neurological symptoms

Hyperchloremic metabolic acidosis (from a lot of normal saline)

• kidney injury d/t decreased kidney perfusion

• altered mental status

• tachycardia & tachypnea

• muscular weakness

• arrhythmias

• murmurs

• wheezing, rales, or rhonchi

Thrombosis

blood clot d/t damage to vessel/tissue

Phlebitis

Inflammation of the vein from medications, catheter, trauma, or prolonged use of the same IV

Infiltration

leakage of non-vesicant solution into the tissue

Extravasation

leakage of vesicant solution into the tissue

Sodium is directly related to

chloride

What body system does sodium affect?

neurological system

Function of Sodium

• blood volume

• ECF osmolarity

• nerve impulse transmission

• muscle & cardiac contraction

What body system does potassium affect?

• cardiac

• GI

• musculoskeletal

• respiratory

Potassium is directly related to

magnesium

Function of Potassium

• physiological processes of body

• depolarization & action potential for muscle function

• transmit nerve & cardiac impulses

Calcium is inversely related to

phosphorus

Function of calcium

• skeletal & cardiac muscle contractions

• controls nerve impulse transmission

• excitable membrane stabilizer

• bone density & strength

• part of coagulation cascade

• activates enzymes

What body system does calcium affect?

• neuromuscular

• musculoskeletal

• cardiac

• GI

Function of Magnesium

• lowers BP/vascular resistance

• blocks neuromuscular transmission

• bronchodilator for asthma

What body system does magnesium affect?

• neuromuscular

• musculoskeletal

• cardiac

• GI

What body system does phosphorus affect?

• neuro

• musculoskeletal

Normal Range for Sodium

136 - 145

Normal Range for Potassium

3.5 - 5.0

Normal Range for Calcium

9.0 - 10.5

Normal Range for Phosphorus

3.0 - 4.0

Normal Range for Magnesium

1.3 - 2.1

Normal Range for Chloride

98 - 106

Causes of hyponatriemia

prolonged use of diuretics

S/S of hyponatremia

• asymptomatic

• cerebral changes

• muscle weakness

• cardiac

Analysis of hyponatremia

ineffective tissue perfusion r/t fluid changes

Potential Injuries from hyponatremia

• cerebral edema

• reduced response to stimuli

• fluid changes

Nursing care for hyponatremia

• monitor for

  • response to treatment

  • hypernatremia

  • fluid overload

  • neuro status

  • I&O

• seizure precautions

Drug therapy of hyponatremia with hypervolemia

• restrict fluids

• ADH receptor antagonist (tolvaptan or conivaptan) - removes water, keeps Na

• lithium & demeclocycline - for SIADH

• furosemide - increase renal water secretion

Drug therapy of hyponatremia with hypovolemia

• hold/reduce diuretics

• normal saline (unless symptomatic then hypertonic)

Causes of hypernatremia

inadequate fluid intake

S/S of hypernatremia

• fluid volume deficit

• cerebral, cardiac, & skin

Analysis of hypernatremia

ineffective tissue perfusion r/t fluid changes

Potential Injuries for hypernatremia

• cerebral dehydration

• increased response to stimuli

• fluid changes

Nursing care for hypernatremia

• monitor for

  • response to treatment

  • hyponatremia

  • dehydration

  • neuro status

  • I&O

• seizure precautions

Drug therapy of hypernatremia with hypervolemia

• restrict fluids

• loop diuretics

Drug therapy of hypernatremia with hypovolemia

• isotonic solution to stabilize

• Once BP is stable, hypotonic, D5W, or D51/2NS

Causes of hypokalemia

• inadequate intake

• increased excretion

• shifting into ICF

Pts who are at higher risk of hypokalemia

• CHF

• taking diuretics

Result of Hypokalemia

• impaired electrical activity → muscle weakness & alters respiratory function

• dysrhythmia

• changes in conduction & BP

• U wave

• severe

  • respiratory failure

  • cardiac arrhythmia

EKG Rhythm of Hypokalemia

• depressed ST-segment

• flat or inverted T wave

• U wave

S/S of hypokalemia

• leg cramps

• constipation

• tingling in peripherals

• dizziness

Severe S/S of hypokalemia

paralytic ileus

Analysis of hypokalemia

• impaired cardiac function r/t low K

• ineffective tissue perfusion r/t cardiac dysrhythmias

• risk of impaired gas exchange r/t respiratory weakness

• potential for injury d/t digoxin toxicity, respiratory failure, & paralytic ileus

Patient Safety for Hypokalemia

• adequate oxygenation

• fall & injury precaution

• monitor response to therapy

• Monitor for hyperkalemia, metabolic alkalosis, cardiac status, respiratory status, muscle weakness, intestinal status, and VS

• check mag level (low)

Intervention to reduce K loss

• discontinue diuretics/laxatives

• use antiemetics & antidiarrheals

• use H2 blockers (if on nasogastric suctioning)

How do you administer IV potassium?

5 - 10 mEq/hr (no higher than 20)

When to give potassium supplements?

during or after meals to prevent N/V

Side effects of oral potassium

bowel lesions (abd distention, pain, GI bleeding)

What pts are at a higher risk for hyperkalemia?

• renal dysfunction

• chronically ill

• elders taking K sparing diuretics

EKG of Hyperkalemia

• prolonged PR

• absent P wave

• widened QRS

• peaked T wave

S/S of hyperkalemia

• asymptomatic

• muscle fatigue

• weakness

Analysis of Hyperkalemia

• impaired cardiac function r/t high K

• ineffective tissue perfusion r/t cardiac dysrhythmia

• potential for injury r/t cardiac arrest

How do you manage severe symptomatic hyperkalemia?

1. cardiac toxicity 🡪 give IV calcium

2. remove K source

3. increase K cell uptake (IV glucose & insulin)

4. increase K excretion (IV fluid therapy, loop diuretics)

What risks are common with hypomagnesemia?

• hypertension

• atherosclerosis

Common causes of hypomagnesemia

• inadequate intake

• diuretic use

EKG Rhythm changes with Hypomagnesemia

• prolonged QT intervals

• PVCs

• atrial & ventricular fibrillation

• torsade de pointes

Confirmation tests for hypocalcemic-hypomagnesemia

• Trousseau sign (hand spasms)

• Chvostek's sign (facial twitch)

Common S/S

• cardiovascular & neuromuscular changes

• paralytic ileus

Analysis of Hypomagnesemia

• impaired cardiac function

• ineffective tissue perfusion r/t cardiac dysrhythmias

• ineffective neuromuscular function r/t overstimulation of nerves & muscles

• potential injury r/t digoxin toxicity & paralytic ileus

Side effect of Mg Supplement

diarrhea

Side effects of IV MgSO4

• hypotension

• decreased neuromuscular response

Most common cause of hypermagnesemia

renal failure

EKG Rhythm changes with hypermagnesemia

• bradycardia

• heart blocks

• hypotension

S/S of Hypermagnesemia

• decreased DTR

• lethargy

• muscle weakness → respiratory weakness

Life threatening S/S of hypermagnesemia

• cardiac changes

• hypotension w/ N/V

Analysis of Hypermagnesemia

• Impaired cardiac function

• Ineffective Tissue Perfusion r/t cardiac dysrhythmias and low blood pressure

• Potential for Injury r/t to cardiac arrest and respiratory failure

What effects calcium?

• albumin

• acid/base balance

Why are postmenopausal women more at risk for hypocalcemia?

• reduced weight bearing activities

• decreased estrogen levels

Risk of bleeding related to delayed clotting is due to?

hypocalcemia

EKG Rhythm Changes from Hypocalcemia

prolonged QT intervals

Confirmation Tests for hypocalcemia

• Trousseau sign

• Chvostek’s sign

Analysis of Hypocalcemia

• Impaired cardiac function r/t low Ca²⁺

• Ineffective Tissue Perfusion r/t cardiac dysrhythmias

• Ineffective neuromuscular function r/t overstimulation of nerves and muscles

• Potential for Injury r/t fractures, falls, and bleeding

Side effects of IV Calcium replacement

• bradycardia

• hypotension

• cardiac arrest

Highest risk from Hypercalcemia

cardiovascular changes

What is more predisposed from hypercalcemia?

blood clots

Common causes of Hypercalcemia

• hyperparathyroidism

• malignancy

EKG Rhythm Changes from Hypercalcemia

shortened QT intervals

Common S/S of Hypercalcemia

• painful bones

• renal stones

• abdominal groans

• psychic moans

Analysis of Hypercalcemia

• Impaired cardiac function r/t high Ca²⁺

• Ineffective Tissue Perfusion r/t cardiac dysrhythmias and fluid volume deficit

• Potential for Injury r/t cardiac arrest, hypercalcemic crisis, and clotting

Management of Hypercalcemia

1. volume repletion (NS)

2. remove source (thiazide diuretic, supplements)

3. reduce Ca level

   1. excretion (loop diuretic)

   2. inhibit bone reabsorption (bisphosphonates, calcitonin, denosumab)

4. monitor cardiac toxicity

Common Causes of Hyphosphatemia

• malnutrition

• treatment of DKA

• refeeding syndrome

• hyperparathyroidism

• chronic alcoholism

• malabsorption syndrome

• Vit D deficiency

Common causes of Hyperphosphatemia

• renal failure (main)

• tumor lysis syndrome

• hypoparathyroidism

• severe hypomagnesemia

• Vit D intoxication

• Rhabdomyolysis

• acute hemolysis

• acute acidosis.

S/S of Hyperphosphatemia

Hyperparathyroidism

S/S of hypophosphatemia

asymptomatic

Sever S/S of hypophosphatemia

• weakness

• altered mental status

• HF

• respiratory failure

• osteomalacia

• rhabdomyolysis

S/S of Hyperphosphatemia

• asymptomatic

• hypocalcemia

• uremia

• cataracts

• cardiac & neuro (life threatening)

Analysis of Hyperphosphatemia

• Impaired cardiac function r/t hypocalcemia associated with high Phos

• Ineffective Tissue Perfusion r/t cardiac dysrhythmias and low blood pressure associated with hypocalcemia

• Ineffective neuromuscular function r/t overstimulation of nerves and muscles.

• Potential for Injury r/t cardiac arrest, vascular calcification, renal osteodystrophy, and calciphylaxis

Analysis of Hypophosphatemia

• Impaired cardiac function r/t low Phos associated with ATP depletion

• Ineffective Tissue Perfusion r/t decreased cardiac contractility associated with ATP depletion

• Ineffective neuromuscular function r/t ATP depletion

• Potential for injury r/t muscle weakness, altered mental status, respiratory failure, heart failure, and bone fracture

Hypochloremia is associated with

metabolic alkalosis