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Na normal level? 135-145
K normal level? 3.5-5
Ca normal level? 8.5-10
Mg normal level? 1.5-2.5
P normal level? 2.5-4.5
Cl normal level? 95-105
S/Sx: poor skin turgor, dry mucosa, HA, decreased salivation, low B/P, N/V, abd cramping, neurologic changes (confusion, change in mental status), seizure hyponatremia
-Medical management: water restriction, replacement of [electrolyte] -Nursing management: assessment and prevention, dietary [electrolyte] and fluid intake, identify and monitor at-risk patients, effects of meds (diuretics, lithium) hyponatremia
-S/Sx: thirst; elevated temp; dry, swollen tongue; sticky mucosa; neurologic symptoms; restlessness; weakness *thirst may be impaired in elderly or the ill hypernatremia
-Medical management: hypotonic electrolyte solution or D5W -Nursing management: assessment and prevention, assess for OTC sources of [electrolyte], offer and encourage fluids to meet pt needs, provide sufficient water with tube feedings hypernatremia
Manifestations: fatigue, anorexia, N/V, dysrhythmias, muscle weakness and cramps, paresthesias, glucose intolerance, decreased muscle strength, depressed DTRs hypokalemia
-Medical management: increased dietary [electrolyte], [electrolyte] replacement, IV for severe deficit -Nursing management: assessment, severe is life-threatening, monitor ECG and ABGs, dietary [electrolyte], nursing care related to IV [electrolyte] adm hypokalemia
Manifestations: cardiac changes and dysrhythmias, muscle weakness with potential respiratory impairment, paresthesias, anxiety, GI manifestations (diarrhea) hyperkalemia
Medical management: monitor ECG, limitation of dietary [electrolyte], cation-exchange resin (Kayexalate), IV sodium bicarbonate, IV calcium gluconate, regular insulin and hypertonic dextrose IV, B-2 agonists, dialysis hyperkalemia
Nursing management: assessment of serum [electrolyte] levels, mix IVs containing [electrolyte] well, monitor med effects, dietary [electrolyte] restriction/dietary teaching for patients at risk hyperkalemia
Manifestations: tetany, circumoral numbness, paresthesias, hyperactive DTRs, Trousseau’s sign, Chovstek's sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety hypocalcemia
-Medical management: IV of Ca gluconate, Ca and Vit D supplements; diet -Nursing management: assessment, severe is life-threatening, weight-bearing exercises to decrease bone Ca loss, pt teaching r/t diet and meds, and nursing care r/t IV Ca hypocalcemia
carpopedal spasm induced by inflating a BP cuff above systolic BP Trousseau’s sign
a contraction of the facial muscles creates a response to a light tap over the facial nerve in front of the ear Chvostek’s sign
Manifestations: muscle weakness, incoordination, anorexia, constipation, N/V, abd and bone pain, polyuria, thirst, ECG changes (shortened ST segment & QT interval), dysrhythmias hypercalcemia
-Medical: treat underlying cause, fluids, furosemide, phosphates, calcitonin, biphosphonates -Nursing: crisis has high mortality, encourage ambulation, fluids of 3-4 L/d, provide fluids containing Na unless contraindicated, fiber for constipation hypercalcemia
Manifestations: neuromuscular irritability, muscle weakness, tremors, athetoid movements, ECG changes (flat or inverted T waves, depressed ST, prolonged PR, widened QRS) and dysrhythmias, alterations in mood and LOC hypomagnesemia
-Medical management: diet, oral [electrolyte], [electrolyte] sulfate IV -Nursing management: assessment, ensure safety, patient teaching r/t diet, meds, alcohol use, and nursing care related to IV [electrolyte] sulfate hypomagnesemia
hypomagnesemia often accompanied by... hypocalcemia
_____ common in magnesium-depleted patients (assess ability to swallow with water before administering food or medications) dysphasia
Manifestations: flushing, lowered BP, N/V, hypoactive reflexes, drowsiness, muscle weakness, depressed resp, ECG changes (tachycardia-->bradycardia, prolonged PR & QRS, peaked T waves), dysrhythmias hypermagnesemia
-Medical management: IV calcium gluconate, loop diuretics, IV NS or LR, hemodialysis -Nursing management: assessment, do not administer medications containing [electrolyte], patient teaching regarding [electrolyte]-containing OTC meds hypermagnesemia
Manifestations: neurologic symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, increased susceptibility to infection hypophosphatemia
-Medical management: oral or IV [electrolyte] replacement -Nursing management: assessment, encourage foods high in [electrolyte], gradually introduce calories for malnourished patients receiving parenteral nutrition hypophosphatemia
Manifestations: few symptoms; soft-tissue calcifications, symptoms occur due to associated hypocalcemia hyperphosphatemia
-Medical: treat underlying disorder, vitamin-D preps, Ca-binding antacids, [electrolyte]-binding gels or antacids, loop diuretics, NS IV, dialysis -Nursing: avoid high-[electrolyte] foods; patient teaching related to diet, [electrolyte]-containing substa hyperphosphatemia
Manifestations: agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma; occurs with loss of other electrolytes (potassium, sodium) hypochloremia
-Medical management: replace [electrolyte] with IV NS or 0.45% NS -Nursing management: assessment, avoid free water, encourage high-[electrolyte] foods, patient teaching related to high-[electrolyte] foods hypochloremia
Manifestations: tachypnea, lethargy, weakness, rapid/deep resp, HTN, cognitive changes hyperchloremia
-Medical management: restore electrolyte and fluid balance, LR, sodium bicarbonate, diuretics -Nursing management: assessment, patient teaching related to diet and hydration hyperchloremia
Normal plasma pH? 7.35 to 7.45
Low pH <7.35 Low bicarbonate <22 mEq/L Most commonly due to renal failure Metabolic Acidosis
S/Sx: HA, confusion, drowsiness, increased resp rate/depth, decreased BP, decreased cardiac output, dysrhythmias, shock; if decrease is slow, pt may be asymptomatic until bicarb is 15 mEq/L or less Metabolic Acidosis
-Correct underlying problem, correct imbalance -Bicarbonate may be administered Metabolic Acidosis
High pH >7.45 High bicarbonate >26 mEq/L Most commonly due to vomiting or gastric suction May also be due to medications, especially long-term diuretic use Metabolic Alkalosis
-Manifestations: Sx r/t decreased calcium, respiratory depression, tachycardia, symptoms of hypokalemia -Correct underlying disorder, supply chloride to allow excretion of excess bicarbonate, restore fluid volume with sodium chloride solutions Metabolic Alkalosis
Low pH <7.35 PaCO2 >45 mm Hg Always due to respiratory problem with inadequate excretion of CO2 Respiratory Acidosis
-Symptoms may be suddenly increased HR/RR/BP, mental changes, feeling of fullness in head -Potential increased intracranial pressure -Treatment aimed at improving ventilation Respiratory Acidosis
-High pH >7.45 -PaCO2 <35mm Hg -Always due to hyperventilation -Manifestations: lightheadedness, inability to concentrate, numbness and tingling, sometimes loss of consciousness -Correct cause of hyperventilation Respiratory Alkalosis
Arterial Blood Gases: normal pH? 7.35–7.45
Arterial Blood Gases: normal PaCO2? 35–45 mm Hg
Arterial Blood Gases: normal HCO3? 22–26 mEq/L
Arterial Blood Gases: normal PaO2? 80–100 mmHg
Arterial Blood Gases: normal oxygen saturation? >94%
Compensation vs Uncompensation? pH normal, PaCO2 and HCO3 abnormal full compensation
Compensation vs Uncompensation? all values abnormal partial compensation
Compensation vs Uncompensation? pH & one other value abnormal uncompensated
Created by: nurse savage