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Electrolytes & A/B

Fluid/Electrolyte & Acid/Base Balance

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