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F&E imbalances

Normal value for Sodium 135-145
Normal Value for Chloride 98-106
Normal Value for Potassium 3.5-5
Normal Value for Phosphorus 3-4.5
Normal Value for Magnesium 1.3-2.1
Normal Value for Calcium 9-10.5
What is Hypovolemia? loss of fluid and solutes in body
Causes of Hypovolemia Abdominal surgery, Diabetes, excessive diuretics and laxatives, excessive sweating, fever, hemorrhage, NG drainage, Renal failure with increased urination. V&N
Signs and Symptoms of Hypovolemia increased heart rate ortho. HYPOtension restlessness and anxiety decreased urine output weight loss confusion dizziness, nausea, extreme thrist Decreased Blood Pressure
Diagnostic Test for Hypovolemia Normal or high sodium Decreased Hgb and HCT Elevated BUN and Creatinine Increased USG Increased osmolality
Treatment for Hypovolemia Replace lost fluids isotonic fluids given to increase circulating volume fluid bolus at first Treatment also depends on cause
Nursing Interventions for Hypovolemia Patent Airway and IV Admin oxygen if needed Admin fluids Monitor VS and Mental Status Monitor Peripheral pulses Fluid PO Ascultate breath sounds for FVE Daily Weights Skin care I/O
What is hypervolemia excess of fluid in body.
Causes of hypervolemia excess intake too much sodium Fluid and Sodium retention Heart failure cirrhosis of liver kidney issues corticosteriod therapy HYPERaldosterone BURNS- 3rd Spacing!
Signs and Symptoms of Hypervolemia Rapid bounding pulse increase blood pressure Edema pulmonary edema
Diagnostic test for hypervolemia Low HCT- hemodilution normal NA levels low k+ and BUN levels decreased osmolality low oxygen level pulmonary congestion
Treatments for Hypervolemia NO NA Meds- diuretics Treat the cause Renal failure- hemodialysis
Nursing Interventions for hypervolemia Montior VS and IV Monitor JVD I/O Monitor labs restrict fluids give meds daily weights Skin care
Sodium Imbalances Hypovolemic-Na and water decreased but NA decreases more Hypervolemic- Na and water increase but water increases more Isovolemic- Water increases but sodium remains stable
Causes of hyponatremia inadequate intake Too much water loss or gain
Signs and symptoms of hyponatremia Poor skin turgor dry muscos membranes N&V Anorexia disorientation MUSCLE TWITCHING/ TREMORS/ WEAKNESS Changes in LOC
diagnostics for Hyponatremia osmolality below 280 (low) USG less that 1.010 (low) Elevated HCT and plasma protein
Treatment for Hyponatremia hypervolemic and isovolemic- restrict fluid and give Na Hypovolemic- give isotonic fluids Critical level- hypertonic solution -3% NaCH
Nursing Interventions for Hyponatremia Montior VS and IV Neurologic status Skin turgor Safety restrict fluids
Causes of Hypernatremia water loss low intake of water excessive sodium intake Diabetes Insipidus Always correct this problem SLOWLY-CE
Signs and Symptoms of hypernatremia Agitation confusion flushed skin lethargy thirst MUSCLE twitching Weakness
Diagnostic test for hypernatremia USG above 1.030 (except DI) osmolality greater than 300
treatment for hypernatremia treat the cause
Diabetes Insipidus deficiency in ADH Results in Large water loss Caused by damage to the pituitary gland or head trauma
Nursing interventions for diabetes insipidus monitor patients with pituitary surgery
Nursing interventions for hypernatremia monitor VS and IV fluids and site I/O maintain oral hygiene safety Monitor labs
causes of Hypochloremia poor intake salt restricted diet excessive GI, skin, kidney losses sodium and potassium deficiency metabolic alkalosis DKA addisons disease diuretics removal of ascitic fluid heart failure
S&S of hypochloremia hyperactive DTR muscle hypertonicity and cramps tetany
Diagnostic test for hypochloremia sodium less than 135 pH-greater than 7.45 Bicarb- greater than 26
treatment for hypochloremia treat cause replacement fluid oral supplementation IV supple
Nursing interventions for hypochloremia monitor VS, IV, LOC, Resp monitor muscle strength Monitor cardiac rhythm Use NS instead of tap water to flush NG tube I/O safety
Causes of hyperchloremia increase intake decreased water intake decreased absorption in intestines
Medications that increase hyperchloremia Ammonium Chloride - Rollaids Cortisone- steriod Salicylates- aspirn Sodium polystyrene sulfonate - laxative
S&S of hyperchloremia tachypnea lethargy weakness changes in cog arrythmias kussmaul resp decreased cardiac output decreased LOC
Diagnostic test for hyperchloremia Na greater than 145 pH less than 7.35 bicarb less than 22
treatment for hyperchloremia correct underlying cause diuretics IV fluids
Nursing Interventions for hyperchloremia Monitor VS , IV Monitor Cardiac rhythm assess neurologic, cardiac, resp Assess muscle strength Restrict fluids with Na Cl I/O
Causes Hypokalemia prolonged intestinal suctioning excessive vomitting and diarrhea laxative abuse excessive sweating ileostomy cushings, hyperaldosteronism
meds that lower potassium antibiotics cisplatin corticosteriods diuretics insulin
S&S of hypokalemia Skeletal muscle weakness U wave Constipation Toxicity Irregular and weak pulse Othrostatic hypotension Numbness
Diagnostic Test for Hypokalemia increased urine potassium level elevated pH and Bicarb elevated glucose decreased mag level increased digoxin
Treatment for hypokalemia high K+ diet oral supple IV K+ Potassium sparing diuretics- aldactone (spironolactone)
Nursing interventions for Hypok+ Monitor VS, IV Monitor Cardiac monitor assess resp I/O SLOWLY infuse Potassium
Causes of Hyperkalemia excessive intake Renal insuffiency Addisons disease meds-beta blockers, antibodies, chemotherapy, ACE inhibitors, NSAIDS
Signs and symptoms of hyperkalemia stomach cramping diarrhea Tall T waves HYPOtension irregular pulse Irritability Muscle weakness Nausea Numbness Bradycardia
Diagnostic Tests for hyperkalemia decreased pH Cardiac monitor
Treatment for hyperkalemia loop diuretics K free diet kayexalate Renal Disease- Hemodialysis
Severe hyperkalemia treatment Calcium gluconate Bicarb Insulin Glucose Kayexalate Dialysis
Nursing interventions for hyperkalemia Monitor VS, IV access Monitor EKG changes (Tall T waves) Monitor for hypoglycemia Admin meds CHeck dig levels safety
Causes for Hypomagnesemia Poor intake poor GI absorption increased loss form GI or Urinary tract
Meds that cause low mag levels Laxatives insulin loop diuretic
S&S of hypomagnesemia Ataxia confusion Depression Vertigo Hyperactive DTR Chvostek and trousseaus arrhythmias rapid heart rate vomiting
Diagnostic tests for hypomagnesemia possible low albumin low k+ and calcium EKG changes increased dig level
Treatment for hypomagnesemia change in diet oral or IV mag check renal function
nursing interventions for hypomag assess vs and IV assess neuromuscular assess dysphagia cardiac monitor I/O assess dig level safety give meds
Causes of hypermagnesemia uncommon (Renal pt) addisons disease adrenocortical issues untreated DKA
S&S for hypermag decreased muscle and nerve activity hypoactive DTR weakness. lethargy, drowsiness facial numbness N&V slow and shallow respirations resp arrest EKG changes Vasodilation
Diagnostic test for hypermag EKG changes (Tall T waves)
treatment for hypermag oral or IV fluids no mag products mechanical vent hemodialysis calicum gluconate for emergencies
Nursing interventions for Hypermag monitor VS and IV Mental status flushed skin and sweating neuromuscular system cont cardiac monitoring mechanical ventilation
causes of Hypocalcemia HYPOALBUMINEMIA poor dietary intake malabsorption pancreatitis parathyroid/thyroid surgery kidney failure hypomag hyperphos alkalosis
S&S of hypoclacemia tetany chvostek and Trousseus confusion decreased cardiac output EKG changes Fractures Muscle cramps, tremors, twitching Numbness of face, fingers, and toes
Diagnostic tests for hypocalcemia low albumin level EKG changes
Treatment for Hypocalcemia IV calcium gluconate or Calcium Chloride mg supple increase intake treat the cause
nursing interventions for hypocalcemia Monitor VS and IV cont cardiac monitor check airway monitor for arrhythmias iv supple safety reorient
causes hypercalcemia METABOLIC EMERGENCY hyperparathyroidism cancer
S&S of hypercalcemia confusion altered mental status muscle weakness hyporeflexia bone pain Stomach pain and constipation polyuria extreme thirst
Diagnostic test hypercalcemia digoxin tox X-rays (patho fractures) EKG changes
Treatment for hypercalcemia hydration decrease calcium intake diuretics, corticosteriods, bisphonates hemodialysis or dialysis
nursing interventions for hypercalcemia Monitor VS, IV, airway Monitor arrhythmias Neurological function I/O PO fluids Strain Urine Mobilize safety
causes of hypophosphatemia malabsortion excessive use of anatacids laxative diuretics DKA Hyperglycemia hyperparathyroidism hypercalcemia extensive burns
S&S of hypophosphatemia slurred speech dysphagia hypotension decreased cardiac output rhabdomylosis cyanosis resp failure
diagnostic test for hypophosphatemia elevated creatinine X-rays (skeletal changes) Abnormal electrolytes
Treatment for hypophosphatemia diet high in phosphatemia Eggs, nuts, whole grains, organ meats, fish, milk products supplements
Nursing interventions for hypophosphatemia Monitor VS, IV, airway evidence of heart failure assess muscle strength supplements Assist with ADL
causes of hyperphosphatemia usually caused by renal excretion hypoparathyroidsim DKA Necrosis Heat stroke infection
S&S of hyperphosphatemia (hypocalcemia) hyperreflexia decreased urine output cataracts impaired vision
Diagnostic test for hyperphosphatemia Na->8.5 skeletal changes increased BUN and Creat levels
treatment for hyperphosphatemia reduce phos intake drug therapy to reduce absorption treat underlying cause IV Hemodialysis
nursing interventions for hyperphosphatemia monitor VS, IV, airway s&s of hypocalcemia low phos diet
Created by: BrookeGildon
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