Chronic Exam #1
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| Role of sodium (Na+) | (extracellular) osmolarity, affects water distribution bw ECF and ICF
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| normal Na lab value | 135-145 mEq/L
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| Purpose of potassium (K+) | (intracellular) key role in cardiac, skeletal and sm ms contraction, generation and transmission of nerve impulses
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| normal lab values of K+ | 3.5 - 5.0 mEq/m
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| Na sources | cheeses and ham
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| K sources | spinach, potatos, bananas, nuts, citrus fruits
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| Role of Calcium (Ca+) | (cardiac/neuromuscular function), bl coagulation
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| normal lab values of Ca | 9.0 - 10.5 mg/dL
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| sources of Ca | nuts/seeds, leafy greens, fish, beans
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| oliguria | <30 cc/hr
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| intracellular fluids | fluids within cell membranes, 40% body weight, provides cells with internal aqueous medium necessary for chemical functions
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| extracellular fluids | fluids outside cell membranes, 15-20% body weight, bodys transportaiton system
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| extracellular fluids consists of... | interstitial fluid (fluid in tissues) and intravascular fluid (plasma)
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| 4 means of movement of body fluids | filtration, diffusion, osmosis, active transport
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| Filtration | movement of fluid through a membrane as a result of hydrpstatic pressure differences
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| diffusion | process by which solid, particulate matter moves from an area of higher concentration to an area of lower concentration
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| osmosis | process by which a solvent (water) moves through a semipermeable membrane from a solution of lower concentration to a higher concentration
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| active transport | movement of materials across a cell membrane by the use of metabolic activity and energy expenditure (Na/K pump)
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| Regulation of fluid intake | regulated by thirst mechanism in hypothalamus, thirst stimulated by increased serum osmolarity and decreased bl volume, water acquired from food and oxidation of food during digestion
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| Regulation of fluid output | losses occur through kidneys, GI tract, skin via sweat, lungs
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| sensible loss | perceived by individual
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| insensible loss | continued water loss not perceived by the individual
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| hormones in the regulation of fluid and electrolytes | aldosterone, ADH
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| Aldosterone | mineralcorticoid produced by adrenal cortex, causes kidneys to reabsorb Na and excrete K (increased Na causes increased water retention)
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| ADH | (antidiuretic hormone) rel from post pituitary gland in response to stimulation from the hypothalamus, increases the reabsorption of water by the kidney tubules, rel is increased with a decrease in the bodys fluid volume
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| causes of fluid deficit | excessive sweating, fever, impaired thirst or decreased fluid intake
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| specific causes of fluid deficit | prolonged vomiting/diarrhea, hemorrhage, wound/fistula drainage, burn, diuretic therapy, diabetic ketoacidosis
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| assessment findings of fluid deficit | dry skin and mucous membranes, poor skin turgor, coated tongue, low BP, collapsed veins, weak pulses, oliguria
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| laboratory findings of fluid deficit | increased Hgb and Hct, increased BUN, increased specific gravtiy, increased serum osmolarity
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| Management of fluid deficit | fluid/electrolyte restoration (oral/IV replacement), treat underlying cause
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| monitor for complications of fluid deficit | I and O, vital signs, skin turgor, lab values, assess vein filling, provide oral hygiene, ,monitor daily weights (same time) A pint a pound, the world is round (500cc)
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| causes of fluid excess | increased ingestion, decreased excretion of water (renal failure, inability of heart to circulate fluids)
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| assessment findings of fluid excess | generalized edema, weight gain, crackles, bounding pulse, distended neck veins, headache, decreased orientation, visual changes, seizure, coma, low serum Na level
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| lab findings of fluid excess | decreased Hgb and Hct, decreased BUN, decreased specific gravity, decreased serum osmolarity
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| management of fluid excess | restrict fluids, restrict Na intake, promote increased urine output, improve cardiac function
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| monitor for complications of fluid excess | I and O, daily weights, vital signs, lung sounds, edema, labs
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| ways to mobilize fluids | TED hose, turning, positioning, elevating feet
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| How to prevent shortness of breath | apply oxygen, position in high Fowlers
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| etiology of electrolyte imbalances | decrease intake and availability or increase loss of an electrolyte, increase intake and retention or decrease excretion of kidneys
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| what is used to diagnose electrolyte imbalance? | plasma levels in lab studies and through clinical manifestations
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| lab values for Hyponatremia | <135 mEq/L Na
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| etiology of hyopnatremia | water loss (diuretics, vomiting, diarrhea, excessive sweating), net water excess...intracellular edema due to fluid shofts (results from loss of sodium containing fluids
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| signs of hyponatremia | confusion, nausea, vomiting, seizures, coma
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| management of hyponatremia | restore Na+ levels, fluid restrictions
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| lab values for hypernatremia | Na > 145 mEq/L
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| what is hypernatremia? | elevated serum sodium occuring with water loss or sodium gain, leads to dehydration (excess fluid loss, excess Na intake)... increases myocardial depolarization
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| early symptoms of hypernatremia | thirst, dry flushed skin, dry tongue and mucous membranes, polyuria, anorexia, weakness, restlessness, cramping
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| late symptoms of hypernatremia | agitation, confusion, lethargy, seizures, coma, tremors, muscle twitching, rigid paralysis, discoordination
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| management for hypernatremia | treat underlying cause, 5% dextrose in water, diuretics (excrete sodium)
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| lab values for hypokalemia | K < 3.5 mEq/L
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| causes of hypokalemia | abnormal losses fo K via the kidneys or GI tract, Mg deficiency, metabolic alkalosis
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| signs and symptoms of hypokalemia | most serious are cardiac!!, skeletal ms weakness, respiratory ms weakness, decreased GI motility
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| management of hypokalemia | KCl supplements orally or IV
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| lab values for hyperkalemia | K > 5.0 mEq/L
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| causes of hyperkalemia | massive intake, impaired renal excretion, shift from ICF to ECF
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| signs and symptoms of hyperkalemia | weak or paralyzed skeletal muscles, ventricular fibrillation or cardiac standstill, abdominal cramping, diarrhea
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| management of hyperkalemia | eliminate oral and parenteral K intake, increase elimination of K (diuretics, dialysis)
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| lab values for hypocalcemia | Ca < 9.0 mg/dl
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| causes of hypocalcemia | decreased production of PTH, acute pancreatitis, multiple bl transfusions, alkalosis, decreased intake
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| signs and symptoms of hypocalcemia | positive Trousseau's or Chvosteks sign, laryngeal stridor, dysphagia, tingling around the mouth or extremities
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| management os hypocalcemia | oral or IV calcium supplements, treat pain and anxiety to prevent hyperventilation
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| lab values for hypercalcemia | Ca > 10.5-11 mg/dl
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| causes of hypercalcemia | hyperparathyroidism, malignancy, vitamin D overdose, prolonged immobilization
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| signs and symptoms of hypercalcemia | polyuria r/t osmotic diagnosis, anorexia, constipation, nausea, abdominal distension, fatigue, depression, muscle weakness
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| management of hypercalcemia | excretion of Ca with loop diuretic, hydration with isotonic saline solution, synthetic calcitonin, mobilization
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| phosphate lab values | 2.5-4.5 mg/dl
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| phosphate | primary ICF anion, essential to function of muscle, red blood cells, and nervous system. deposited with Ca for bone and tooth structure, inversely related to calcium
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| lab values for Hypomagnesemia | Mg < 1.5 mEq/L or 1.8 mg/dl
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| causes of hypomagnesemia | related to less intake and absorption
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| signs and symptoms of hypomagnesemia | confusion, hyperactive deep tendon reflexes, tremors, seizures, cardiac dysrhythmias
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| management of hypomagnesemia | oral supplements, increase dietary intake, parenteral IV or IM Mg when severe
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| lab values for hypermagnesemia | Mg > 2.5 mEq/L
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| causes of hypermagnesemia | increased intake or ingestion of products containing Mg when renal insufficiency or failure is present
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| signs and symptoms of hypermagnesemia | lethargy or drowsiness, N/V, impaired reflexes, respiratory and cardiac arrest
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| management os hypermagnesemia | prevention, emergency treatment (IV CaCl or calcium gluconate... Ca inversely related) fluids to promote urinary excretion
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