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.

aPTT Nursing Interventions:Adjust heparin drip per protocol, hold heparin and give protamine sulfate if too high, and monitor for bleeding at IV sites, gums, and in stool/urine.

Chest X-Ray (CXR) Purpose:Diagnostic imaging that uses a small dose of radiation to view heart, lungs, blood vessels, airways, and chest bones to detect conditions like pneumonia, emphysema, and other lung/cardiac issues.

CXR Pre-Test Care:Have patient wear comfortable clothing, remove metal objects, and inform tech of medical/surgical history and implants, including pregnancy status.

CXR Post-Test Care:No special care needed; patient can resume normal activity.

CXR Nursing Interventions:Educate on holding breath for image, explain the procedure, ensure removal of objects that may obscure the film, and verify pregnancy status in women.

EKG Purpose:Records electrical activity of the heart to check rhythm and detect problems such as electrolyte imbalances, ischemia, or arrhythmias.

EKG Pre-Test Care:Remove metal objects, clean chest skin, place electrodes, and instruct patient to lie still and relax.

EKG Post-Test Care:Remove electrodes, clean skin, send tracing for interpretation, and report abnormal findings.

EKG Patient Teaching:Reassure that test is painless and quick, and remind them to stay still for 5–10 minutes and avoid lotions on chest the day of test.

Echocardiogram Purpose:Noninvasive ultrasound test that uses sound waves to visualize heart valves, chambers, and blood flow to diagnose heart failure, valve problems, and structural issues.

Echocardiogram Nursing Interventions:Monitor HR and BP, assist with positioning, shave chest if needed for better conduction, and provide reassurance about the painless nature of the test.

Stress Test Purpose:Evaluates how the heart responds to exercise or medication-induced stress to detect blood flow changes, ischemia, or arrhythmias.

Stress Test Nursing Interventions:Apply electrodes and BP cuff, monitor heart rhythm, BP, and breathing during treadmill/bike or pharmacologic stress, and monitor recovery afterward.

Stress Test Patient Teaching:Explain that they will exercise or receive a medicine to stress the heart, they may be asked to breathe into a tube, and results will guide further treatment like med changes or procedures.

Cardiac Catheterization Purpose:Invasive procedure where a catheter is inserted via arm or groin artery to the heart to diagnose and sometimes treat cardiac conditions (e.g., stent placement, angioplasty).

Cardiac Cath Pre-Test Care:Obtain CBC, ECG, chest X-ray, signed consent, and check for allergies (especially to contrast/iodine); give local anesthetic at insertion site.

Cardiac Cath Post-Test Care:Nurse monitors pain, uses pressure device/dressing at insertion site, checks for bleeding or hematoma, monitors heart rhythm, pulses, and circulation, and educates on avoiding heavy lifting (10–15 lb) for 7–14 days and when to report complications.

Bronchoscopy Purpose:Procedure using a flexible scope via mouth or nose to view airways and lungs, collect biopsies, remove secretions, or evaluate abnormalities.

Bronchoscopy Pre-Test Care:Obtain chest imaging (X-ray/CT), administer numbing spray and/or sedative, ensure NPO 6–12 hours (fluids until 2–4 hours prior if allowed), and hold certain meds such as blood thinners as ordered.

Bronchoscopy Post-Test Care:Monitor vitals and respiratory status, expect temporary sore throat, cough, or mild fever, and ensure gag reflex has returned before allowing food or drink.

Incentive Spirometer Purpose:Device that provides visual feedback to encourage deep breathing, prevent atelectasis and pneumonia, and promote lung expansion postoperatively.

Incentive Spirometer Nursing Interventions:Place patient in semi-Fowler’s, teach correct technique, assess respiratory status, document highest volume reached, clean device after use, and encourage regular use.

Incentive Spirometer Patient Teaching:Explain that regular use helps prevent lung complications after surgery, encourage slow deep breaths to reach target volume, and praise progress to improve motivation.

Albumin Test Purpose:Blood (or sometimes urine) test measuring albumin, a liver-produced protein that maintains oncotic pressure and transports substances; helps assess liver, kidney function, and nutritional status.

Albumin Normal Range:Normal serum albumin level is about 3.4–5.4 g/dL.

Albumin Nursing Considerations:Review meds that affect albumin (steroids, insulin, birth control, ACE inhibitors), monitor vitals, and educate about causes of low or high levels (liver/kidney disease, malnutrition, dehydration).

Low Albumin Interventions:Address underlying cause such as treating liver or kidney disease or infections, and improve nutrition (adequate protein intake) as ordered.

High Albumin Interventions:Usually indicates dehydration, so administer IV fluids as ordered and monitor fluid balance, vitals, and intake/output.

Total Protein Test Purpose:Measures total proteins (albumin and globulin) in blood to assess liver function, kidney function, and overall nutritional/immune status.

Total Protein Normal Range:Normal total serum protein level is about 6–8.3 g/dL.

Low Protein Level Interventions:Investigate for liver/kidney disease, malnutrition, or malabsorption and address cause (high-protein diet, avoid alcohol in liver disease, weight loss for fatty liver, etc.).

High Protein Level Interventions:Consider infection (HIV, viral hepatitis) or multiple myeloma, treat underlying infection (antivirals) or cancer (chemotherapy) as ordered, and educate patient on follow-up and treatment plan.