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F&E imbalances
| Question | Answer |
|---|---|
| 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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