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Electrolytes & A/B
Fluid/Electrolyte & Acid/Base Balance
| Question | Answer |
|---|---|
| Potassium | K+ 3.5-5.5 meq/L - Regulates protein synthesis, glycolysis, and glycogen synthesis |
| Calcium | Ca++ 4.5-5.5 meq/L - Helps with the strength and density of bones and teeth, normal clotting, and muscle contractility |
| Chloride | Cl- 95-105 meq/L - Assists the formation of HCl , maintanance of acid/base balances, and maintaining osmotic pressure. |
| Phosphorus | P+ 2.5-4.5 meq/dl - Assists with activation of B complex, cell development, CHO, fat and protein metabolism, and formation and activation of ATP (adenosine triphosphate - creb cycle) |
| Magnesium | Mg++ 1.4-2.5 meq/dl - Helps with muscle contraction, Dna synthesis, and activation of ATP and B complex |
| Respiratory alkalosis | Related primarily to the excessive blowing off of CO2 through hyperventilation. |
| Respiratory alkalosis - causes | Hypoxia, anxiety, high altitudes |
| Respiratory alkalosis - symptoms | NS: numbness and tingling of hands and feet, tetany, seizures, fainting. RESP: deep, rapid respirations. PSYCH: anxiety, fear, hysteria. |
| Respiratory alkalosis - lab changes | Increased pH, decreased PaCO2, decreased K levels, normal or decreased CO2 levels. |
| Sodium | Na++ 135-145 meq/L - Maintains acid/base balance, extracellular vol, and urine concentration |
| Respiratory alkalosis - treatments | Stress reduction, Sedation, Breathing in a paper bag to facilitate retaining CO2 or using a rebreathing bag. Decreasing the tidal wave vol and rate of ventilator settings. |
| To correct respiratory alkalosis, the nurse must... | the nurse must determine the cause for hyperventilation |
| Some causes for hyperventilation | stress and high altitude |
| Metabolic alkalosis | results from a primary gain in HCO3 (bicarb) or a loss of acid that results in a pH > 7.45 |
| Metabolic alkalosis - causes | * V or NG suction - loss of HCl * Fistulas high in GI tract - loss of HCl * Steroid tx or Cushing's syndrome - Na, H+ and fluid retention. * Ingestion or retention of a base (e.g., Ca antacids or NaHCO3) |
| Metabolic alkalosis - symptoms | NS: fidgetting and twitching tremors related to hypokalemia or hyperkalemia. RESP:slow, shallow resp (attempt retain CO2). CV: atrial tachycardia and depressed T waves r/t hypokalemia. GI: N/V/D - loss of HCl |
| Metabolic alkalosis - lab changes | pH Levels above 7.45, normal or increased CO2, increased NaHCO3. |
| Metabolic alkalosis - care | 1) administer K replacements. 2) observe for dysrhythmias. 3)observe I&O. 4) assess neurological changes. |
| Metabolic acidosis - causes | 1) DM - lack of usable insulin leading to (l/t) hyperglycemia and ketoacidosis. 2) Anorexia - l/t cell starvation. 3) Lactic acidosis - due to muscle and cell trauma, such as MI. |
| Metabolic acidosis | resukts from a primary gain of H2CO3 (carbonic acid) or a loss of bicarbonate HCO3 with a pH < 7.40 |
| Metabolic acidosis - causes (cont) | 4) RF - l/t waste accummulation and elevated levels of CR, BUN, uric acid. All these substances are acidic. 5) Diarrhea - with loss of HCO3. Loss of HCO3 and fluid l/t dehydration. When pt isn dehydrated, acidosis is likely. |
| Metabolic acidosis - causes (cont 2) | 7) Excessive ingestion of aspirin or other acids. 8) Overuse of diuretics - especially nonK-sparing diuretics. 9) Overwhelming systemic infections - sepsis - l/t cell death and nitrogenous waste accummulation. |
| Metabolic acidosis - causes (cont 3) | 10) Terminal stages of Addison's disease - adrenal insufficiency results in a loss of Na and HO2. This l/t decreasein BP and hypovolemic shock. |
| Metabolic acidosis - symptoms | NS: h/a, lethargy, drowsiness, LOC,coma, death. GI: anorexia, N/V/D, fruity breath. RESP: hyperventilation (due to stimulation of hypothalamus). GU:polyuria and increased acid in the urine. |
| Metabolic acidosis - lab values | Decreased pH, decreased PaCO2, decreased serum CO2, often increased K. |
| Metabolic acidosis - care | Treat causative factors: Monitor K+ levels and treat accordingly. 2) Treat diabetes 3) Treat hypovolemia 4) treat lactic acidosis 5) treat Addison's disease |
| Monitor K+ level and treat accordingly | Because K+ is an intracellular cation, changes in K levels commonly occur w/ metabolic acidosis |
| Hyperkalemia - symptoms | malaise, generalised weakness, muscle irritability, flaccid paralysis, N/D |
| Hypokalemia - symptoms | diminished reflexes, weak pulse, depressed U waves on the ECG exam, shallow resp, SOB, V. |
| Treat diabetes | Treat with insulin for hypeglycemia;treat with glucose for hypoglycemia |
| Treat hypovolemia | Treat w/ volume expander and blood transfusion and treat shock. |
| Treat renal failure (RF) | Tx incl dialysis or transplant. The diet for renal failure clients should control protein, Na, and fluid. Supplemental with calories and carbs suggested. |
| Treat lactic acidosis | Tx incl O2 and NaHCO3 (sodium bicarb) |
| Treat Addison's disease | Tx incl cortisone preparations, a high Na diet, and fluids for shock. |
| Respiratory acidosis | occurs when there is a decrease in the rate of ventilation to the amount of carbonic acid production. Hypoventilation l/t CO2 accumulation and pH value < 7.35. |
| Respiratory acidosis (cont) | Loss of the lungs as a buffer system causes the kidneys to compensate. In chronic resp acidosis, the kidneys attempt to compensate by retaining HCO3. |
| Respiratory acidosis - causes | Involve accumulation of carbonic acid (CO2) and/or a lack of O2. 1)Over sedation or anesthesia. 2) Head injury 3) Paralysis of the resp muscles (e.g., Guillian-Barre, myasthenia gravis, or spinal injury). 4) Upper airway obstruction. |
| Respiratory acidosis - causes (cont.) | 5) Acute lung conditions (e.g., pulmonary emboli, pulmonary edema, pneumonia, or atelectasis). 6 COPD 7) Prolonged overbreathing of CO2. |
| Respiratory acidosis - symptoms | NS: dull sensorium, restlessness, apprehension, hypersomnolence, coma. RESP: Initially increased resp rate, perspiration, incr HB;later, slow resp and periods of apnea or Cheyne-Stokes resp with resulting cyanosis. |
| Cheyne-Stokes respirations | Breathing marked by periods of apnea lasting 10-60s followed gradually by hyperventilation. |
| Hypokalemia - causes (diseases & pathological states) | Cushing's syndrome, renal disease, uncontrolled diabetes, burns, alkalosis,D & V |
| Hypokalemia - causes (drugs, diet & med int) | K-wasting diuretics, chronic use of corticosteroids, laxative abuse, inadequate intake of K, excessive gastric & intestinal suction, excessive fistula drainage, TPN (total parenteral nutrition) |
| Hyperkalemia - causes (diseases & pathological states) | RF (renal failure), Addison's disease, intestinal obstruction, cell damage, burns, infections, metabolic acidosis, |
| Hyperkalemia - causes (drugs, diet & med int) | excessive PO or parenteral admin of K, excessive use of K-based salt subtitutes, transfusion of stored blood (breakdown of older RBC release K) |
| Hypokalemia - description | A serum K lebel below 3.5 mEq/L |
| Hyperkalemia - description | A serum K lebel above 5.5 mEq/L |
Created by:
AJJAD