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F&E Nclex & nur 265

F & E Nclex & nur 265

Causes of hypervolemia *Heart Failure *Renal Failure *Alka-Seltzer, Fleet enema, IVF with Na (lots of sodium)
what is the action of aldosterone and where is it found when blood volume gets low (vomiting, blood loss, etc), aldosterone is secreted which makes you RETAIN Na and WATER and you retain fluids. It's made in the adrenal glands
what is the action of Atrial Natiuretic Peptide (ANP) and where is it found Inverse relationship to aldosterone, which causes you to SECRETE Na and WATER. Found in the atria of the heart. released with bedrest.
Anti-diuretic Hormone (ADH) THINK, three letter=H20. Makes you retain WATER. It'sfound in the pituitary
Disease(s) with too much Aldosterone Cushings Disease Conn's Syndrome
Disease(s) with too little Aldosterone Addison's Disease
SIADH too many letters, too much water! Urine is concentrated, blood is dilute. Remember, Soggy SID!!
think of potential ADH problem in what cases craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy or any condition that could lead to increased ICP
Diabetes Insipidus low ADH causes you to have FVD, dilute urine and concentrated blood. You're worried about shock.
When concentrated, what three things do you expect to go UP and what three things that when dilute, go DOWN Specific Gravity, Sodium, & Hematocrit
synthetic ADH meds for diabetes insipidus vasopressin (Pitressin)desmpressin acetate (DDAVP)
S/S of Hypervolemia - distended neck veins/peripheral veins (vessels are full) - peripheral edema, 3rd spacing (vessels can't hold any more so they start to leak), CVP goes up, lungs sound wet, polyuria, pulse and BP and weight increase (not fat)
Tx of Hypervolemia - Low sodium diet/restrict fluids - I&Os & daily weights - diuretics (lasix, thiazide, aldactone (K+ sparing) - give IVFs with caution to the elderly
Hypovolemia fluid volume deficit THINK SHOCK
Causes of Hypovolemia ) - loss of fluids from anywhere (thoracentisis, paracentisis, vomiting, diarrhea, hemorrhage, suction) - Third spacing (burns, ascites) - diseases with polyuria (polyuria > oliguria > anuria > renal failure
S/S of hypovolemia - weight, urine output and turgor decreases, dry MM, - B/P and CVP decreases, pulse increases - Neck veins/ peripheral veins vasoconstrict (cool extremities), urine spec. gravity and pulse increase
Tx of hypovolemia - prevent further loss - replace fluids (mild deficit: PO fluids, severe deficit: IV fluids) - safety precautions: at higher risk for falls, monitor for overload
Isotonic Solutions do what and give examples 'I'sotonic Solutions "Stay where 'I' put it" TRICK TO REMEMBER - causes B/P to increase (NS, LR, D5W, D5 1/4 NS) CRYSTALLOID
Uses Isotonic Solutions when: pt has lost fluids through N/V, burns, sweating, trauma
Isotonic Solutions CAUTION when pt has hypertension, cardiac disease, or renal disease(they can cause FVE, hypernatremia)
Hypotonic Solutions Hyp'O'tonic solutions "Go 'O'ut of the vessel" TRICK go into the vascular space then shift out into the cells to replace cellular fluid - rehydrate but do not cause B/P to increase (they do not stay in the vascular space) types: 1/4 DW, 0.33% NS, D 2.5 W
Use Hypotonic Solutions when: pt has hypertension, renal or cardiac disease and needs fluid volume replacement because of N/V, burns, hemorrhage, etc - also use for dilution when a pt has hypernatremia and for cellular dehydration
Hypertonic Solutions action and name some "'E'nter the vessel" TRICK TO REMEMBER - volume expanders that will draw the fluid into the vascular space (D10W, 3% NS, 5% NS, D5LR, D51/2 NS, D5NS, TPN, Albumin) COLLOID dangerous - acts like a SPONGE-THINK packed with particles
Use Hypertonic Solutions when: if pt has hyponatremia or has shifted large amounts of vascular volume to a 3rd space, or has severe edema, burns, or ascites.
Hypertonic Solutions Alert: watch for FVE because can happen quickly. Usually would be monitored in an ICU setting where you can watch B/P, pulse, and CVP.
causes of Hypermagnesemia - renal failure - Excessive Administration of MG IV Excessive use of antacids with MG containing antacids Severe dehydration
S/S of hypermagnesemia Hypotension, heart block, flushing, bradycardia , depression, respiratory depression
Tx of hypermagnesemia: Medical mgmt - discontinue all forms of MG salts - calcium gluconate IV, Loop diuretics and .45% NaCL IV if there is adequate renal functioning ECG,neuro checks, vital signs
what is the anedote for Mg toxicity? calcium gluconate IV
S/S of Hypercalcemia - brittle bones, kidney stones, decreased DTRs - possible arrythmias - decreased LOC, pulse, RR
Tx of Hypercalcemia - move, fluids (also prevent kidney stones) - give Phospho Soda or Fleet enema, steroids, add phosphorus diet (anything with protein), safety precautions, must have Vit D - calcitonin (decreases serum Ca)
Magnesium and/or Calcium must remember They act like sedatives! Think muscles first!
Causes of Hypomagnesemia 1. Malnutrition 2. Malabsorption Symptoms 3. Metabolic acidosis with renal failure 4. Alcoholism 5. Loop and thiazide diuretic use/tetany/Muscular excitability and tremors
Mg is excreted through... kidneys and lost through the GI tract
S/S of Hypomagnesemia Increased neuromuscular ability Difficulty swallowing Paralytic ileus ECG changes Psychological changes
Tx of Hypomagnesemia Dietary Supplementation Drug Therapy-Magnesium Sulfate IV Check Magnesium, Calcium, and Potassium levels
S/S of Hypocalcemia - rigid and tight muscles, poss. seizures, stridor/laryngospasm, positive Chvostek's sign: Tap cheek & twitches, positive Trousseau's sign: pump up B/P cuff and hand tremors - possible arrhythmias and swallowing problems due to heart/ esoph. smooth muscle
Tx of Hypocalcemia - vitamin D - Phosphate binders: Renagel, PhosLo, Os-Cal - give IV Ca slowly & make sure pt is on a heart monitor (widens QRS complex & decreases heart rate)
Causes of Hypernatremia Dehydration - too much Na, not enough water - hyperventilation (insensible fluid loss) - heat stroke - DI
Causes of Hyperkalemia - kidney trouble - aldactone
S/S of Hyperkalemia - begins with muscle twitching to weakness to flaccid paralysis and finally life-threatening arrhythmias
Tx of hyperkalemia - dialysis, calcium gluconate, glucose and insulin Any time you give IV insulin, worry about hypokalemia and hypoglycemia) *insulin carries glucose and K into the cell. -Kayexalate (sodium polystyrene) (Na/K have inverse relationship)
Causes of Hypokalemia - vomiting - NG suction (lots of this in our stomach) - diuretics or not eating
S/S of Hypokalemia muscle cramps - weakness - arrhythmias
Tx of Hypokalemia - give K - aldactone (makes them retain K) - Eat more potassium
IV potassium rules *Assess urine output * always put on a pump NEVER IV PUSH, MIX WELL. It will burn during infusion
steps of orthostatic hypotension measuring lie down flat for 3 minutes, V/S lying, sitting, standing, record BP and pulse with the positions noted
Bedrest causes: (4) things r/t dehydration. Explain Diuresis (ANP increase and ADH decrease), possible dehydration risk, ileus, thick blood-DVT risk Dehydration also causes thickened lung secretions, pneumonia PUSH fluids
CVP measured where right atrium
sodium deficit or excess, expect what system changes neuro. It is the only electrolyte that cares about water.
Hypophosphatemia(Causes): Decreased intestinal absorption; increased renal excretions via kidneys; Conditions:alcoholism, insulin IV, Hyperparathyroidism; A lack of phosphate interferes with oxygen transported by RBC’s and energy metabolism
S/S Hypophosphatemia acute: acute: confusion, seizures, and coma; difficulty speaking, weakness of respiratory muscles; Decreased myocardial contractility with decreased cardiac output and blood pressure possible bleeding
S/S Hypophosphatemia:chronic: neuro memory loss and lethargy strength: lethargy, weakness, joint stiffness
ADH=Anti-diuretic Hormone is produced in the hypothalmus;stored and released by the Pituitary gland;ADH makes the body retain water
Aldosterone is released by adrenal cortex;helps the body conserve sodium, sodium retention leads water retention;acts as a volume regulator
When is renin released in the body? blood flow or pressure to the kidney decreases
Magnesium range 1.2-2.1mg/dl
Nursing mgmt of hypermagnesemia: Monitor VS, ECG strips, and urine output, report abnormal findings; Monitor serum magnesium levels as well as potassium; Teach the patient to avoid prolonged use of antacids and laxatives that contain magnesium; Increase po fluid intake
Medical mgmt of Hypophosphatemia Serum phosphate levels; Vitamin D Supplements; Phosphorous IV/oral/enteral tube feedings;Check serum calcium levels; Vital signs; Strict I&O
Hyperphosphatemia causes Dietary Changes-(Oral/IV); Hypoparathyroidism(lack of PTH; Renal Insufficiency-ESRD; Acidosis(either respiratory or metabolic)
S/S of Hyperphosphatemia Tetany-Trousseau & Chvostek; Hyperreflexia/Seizure activity; Flaccid Paralysis; Muscular Weakness; Tachycardia; Nausea, diarrhea, abdominal cramps
Medical mgmt of hyperphosphatemia Serum phosphate levels; Administering phosphate-binding gels;Restricting dietary phosphate; Dialysis; correcting the calcium deficiency through the use of Calcium supplements and agents that bind with phosphate in the GI tract.
Hypochloremia range 90-110MEQ/LITER
Hypochloremia causes Salt-restricted diets; GI tube drainage; Severe vomiting and diarrhea
S/S of Hypochloremia Hyponatremia, hypokalemia; Metabolic alkalosis-hyperexcitability, tetany, weakness, twitching, muscle cramps, shallow breathing; Decrease B/P
Medical mgmt of hypochloremia IV .9% NACL OR .45%NACL; Foods high in chloride-tomato juice, salty broths, processed meats, fruits;Ammonium Chloride; ABG’s
Nursing mgmt of hypochloremia Monitor I&O, ABG’s, Serum electrolytes; Monitor the patient’s LOC; Assess muscle strength and movement; Teach the patient in regards to foods high in chloride content
hyperchloremia causes Administration of 3%/5% Saline Solutions IV; Dietary intake with too much chloride content;Metabolic acidosis
S/S of hyperchloremia Neuromuscular abnormalities-weakness, lethargy, unconsciousness; Respiratory problems-deep, rapid, vigorous breathing
Medical mgmt of hyperchloremia Lactacted Ringers IV; Diuretics; Sodium and chloride po or IV may be restricted; Sodium Bicarbonate IV
Nursing mgmt of hyperchloremia Monitor vital signs, ABG’s, and I&O; Assess for respiratory, neurologic, and cardiac symptoms; Diet teaching
Created by: 597389573
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