Fluid and electrolyte imbalances can occur when fluid intake and output are not equal. Hypovolemia is a decreased fluid volume, while hypervolemia is an increased fluid volume. Symptoms of hypovolemia include thirst, low blood pressure, and decreased skin turgor. Treatment involves oral or IV fluid replacement depending on severity. Hypernatremia is a high serum sodium level over 145 mEq/L usually due to too much sodium or too little water. It can cause neurological symptoms and death. Treatment focuses on lowering the sodium level through infusion of hypotonic fluids and use of diuretics.
if you like this kindly give your comment and share to others for a education purpose. and follow to my account on slide share to know the update. i tried to give the all information in this slide in detailed. in hope its helpful for you all.
Back care consists of cleaning and massaging back (from shoulder to lower level of the buttocks) by using scientific form of required strokes for maximizing cutaneous stimulation, comfort and emotional relaxation as well.
if you like this kindly give your comment and share to others for a education purpose. and follow to my account on slide share to know the update. i tried to give the all information in this slide in detailed. in hope its helpful for you all.
Back care consists of cleaning and massaging back (from shoulder to lower level of the buttocks) by using scientific form of required strokes for maximizing cutaneous stimulation, comfort and emotional relaxation as well.
Last year by end of the lecture Dr Medinna gave cases to solve for Fluid and electrolytes....
He had a seperate slide for the cases..
Lecture slides are taken from Schwartz Textbook of surgery....
THIS SEMINAR GIVES THE BASIC OVERVIEW THAT HOW YOU CAN MANAGE THE PATIENT WHO COMES TO YOU A FLUID AND ELECTROLYTE IMBALANCE . AND BASIC MECHANISM OF HOMEOSTASTIS
What is an electrolyte imbalance?
An electrolyte imbalance means that the level of one or more electrolytes in your body is too low or too high. It can happen when the amount of water in your body changes. The amount of water that you take in should equal the amount you lose. If something upsets this balance, you may have too little water (dehydration) or too much water (overhydration). Some of the more common reasons why you might have an imbalance of the water in your body include:
1. Certain medicines
2. Severe vomiting and/or diarrhea
3. Heavy sweating
4. Heart, liver or kidney problems
5. Not drinking enough fluids, especially when doing intense exercise or when the weather is very hot
6. Drinking too much water
fluid and electrolyte disturbance in human bodybhartisharma175
it explain about definition of fluid and electrolyte disturbance, causes and different types of fluid disturbance. diagnostic evaluation and their emergent management along with supportive management.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
fluid and electrolyte imbalance
1. Name: laxmi thapa &
ravisha pokhrel
B.sc nursing 3rd
year
College of medical
sciences, bharatpur
2. Help maintain body
temperature and
cell shape
Helps transport
nutrients gases
and wastes
3.
4.
5.
6.
7. The desirable amount of fluid intake and loss in adults ranges from
1500 to 3500 mL each 24 hours. Ave= 2500 mL
Normally INTAKE = OUTPUT
FLUID IMBALANCEFLUID IMBALANCE
• Changes in ECF volume = alterations in sodium balance
• Change in sodium/water ratio = either hypoosmolarity or hyperosmolarity
• Fluid excess or deficit = loss of fluid balance
• As with all clinical problems, the same pathophysiologic change is not of
equal significance to all people
• For example, consider two persons who have the same viral syndrome with
associated nausea and vomiting
8. It is an abnormally decreased or
increased fluid volume or rapid shift
from one compartment of body fluid
to another
Hypovolemia
Hypervolemia
9. • May occur as a result of:May occur as a result of:
• Reduced fluid intakeReduced fluid intake
• Loss of body fluidsLoss of body fluids
• Sequestration (compartmentalizing) of body fluidsSequestration (compartmentalizing) of body fluids
PathophysiologyPathophysiology
DECREASED FLUID VOLUMEDECREASED FLUID VOLUME
Stimulation ofStimulation of
thirst center inthirst center in
hypothalamushypothalamus
Person complains ofPerson complains of
thirstthirst
↑↑ ADH SecretionADH Secretion
↑↑ Water resorptionWater resorption
↓↓ Urine OutputUrine Output
Renin-Angiotensin-Renin-Angiotensin-
Aldosterone SystemAldosterone System
ActivationActivation
↑↑ Sodium andSodium and
Water ResorptionWater Resorption
↑↑ Urine specific gravity exceptUrine specific gravity except
with osmotic diuresiswith osmotic diuresis
11. • Fluid Management
• Oral rehydration therapy – Solutions
containing glucose and electrolytes. E.g.,
Pedialyte, Rehydralyte.
• IV therapy – Type of fluid ordered depends on
the type of dehydration and the clients
cardiovascular status.
• Diet therapy – Mild to moderate dehydration.
Correct with oral fluid replacement.
12. Monitor & measures fluids at least
every 8 hours and sometimes hourly
Monitor daily body weight
Monitor vital signs
Observe for weak, rapid pulse and
orthostatic hypotension
Monitor urine concentration by
measuring urine specific gravity
Assess degree of oral and mucous
membrane moisture
13. To prevent hypovolemia, the nurse
identifies patient at risk and takes
measures to minimize fluid loss. For
ex: the patient has diarrhoea,
measures should be implemented to
control diarrhoea and replacement
fluid administered. This includes
antidiarrheal medication and small
volume of oral fluids at frequent
intervals
14. It refers to an isotonic expansion of
the ECF caused by abnormal
retention of water and sodium in
approximately the same proportion
in which they normally exist in the
ECF.
It is most often secondary to an
increase in total body water.
16. Signs/Symptoms
Increased BP
Weight gain
Bounding pulse
Venous distention
Pulmonary edema
Dyspnea
Orthopnea (diff. breathing when
supine)
crackles
17. Pharmacological therapy
Diuretics such as thiazide diuretics and loop
diuretics
Thiazide diuretics: hydrochlorothiazide
Loop diuretics: furosemide, torsemide
Potassium supplement
18. I/O chart at regular intervals to identify
excessive fluid retention
Breath sound are assessed at regular
intervals in at risk patient particularly if
parenteral fluid are being administered
Monitor the degree of edema in most
dependent parts of body such as feet &
ankles
19. If renal function is so severely impaired
that pharmacologic agents cannot act
efficiently, other modalities are
considered to remove sodium and fluid
from the body. Haemodialysis or
peritoneal dialysis may be used to remove
nitrogenous wastes and control potassium
and acid base balance and to remove
sodium and fluid. Continuous renal
replacement therapy may also be
required
20. IF it is important to detect FVE before the
condition become severe. Intervention
include promoting rest, restricting sodium
intake , monitoring parenteral fluid therapy
and administering appropriate medications
Regular rest periods may be beneficial
because bed rest favours diuresis of fluid
Sodium and fluid restriction should be
instituted as indicated
Fowlers position should be maintain to
promote lung expansion
21.
22.
23.
24. • Controls and regulates volume of body fluidsControls and regulates volume of body fluids
• Its concentration is the major determinant of ECF volumeIts concentration is the major determinant of ECF volume
•Participates in the generation and transmission of nerveParticipates in the generation and transmission of nerve
impulsesimpulses
• Eliminated primarily by the kidneys, smaller in fecesEliminated primarily by the kidneys, smaller in feces
• Salt intake affects sodium concentrationsSalt intake affects sodium concentrations
• Sodium is conserved through reabsorption in the kidneys, aSodium is conserved through reabsorption in the kidneys, a
process stimulated by aldosteroneprocess stimulated by aldosterone
• Normal value: 135-145 mEq/LNormal value: 135-145 mEq/L
25. Refers to the serum sodium concentration less than 135 mEq/L
Common with thiazide diuretic use, but may also be seen with
loop and potassium-sparing diuretics as well
Occurs with marked sodium restriction, vomiting and diarrhea,
SIADH, etc. The etiology may be mulfactorial
May also occur postop due to temporary alteration in
hypothalamic function, loss of GI fluids by vomiting or suction,
or hydration with nonelectrolyte solutions
Postoperative hyponatremia is a more serious complication in
premenopausal women. The reasons behind this is unknown
Therefore monitoring serum levels is critical and careful
assessment for symptoms of hyponatremia is important for all
postoperative patients
26. Sodium loss from the intravascular compartmentSodium loss from the intravascular compartment
Diffusion of water into the interstitial spacesDiffusion of water into the interstitial spaces
Sodium in the interstitial space is dilutedSodium in the interstitial space is diluted
Decreased osmolarity of ECFDecreased osmolarity of ECF
Water moves into the cell as a result of sodium lossWater moves into the cell as a result of sodium loss
Water moves into the cell as a result of sodium lossWater moves into the cell as a result of sodium loss
Extracellular compartment is depleted of waterExtracellular compartment is depleted of water
CLINICAL SYMPTOMSCLINICAL SYMPTOMS
30. Interventions/Treatment
Restore Na levels to normal and prevent further
decreases in Na.
Drug Therapy –
(FVD) - IV therapy to restore both fluid and Na.
If severe may see 2-3% saline.
(FVE) – Administer osmotic diuretic (Mannitol)
to excrete the water rather than the sodium.
Increase oral sodium intake and restrict oral fluid
intake.
31. • A serum sodium level above 145 mEq/L is termedA serum sodium level above 145 mEq/L is termed
hypernatremiahypernatremia
• May occur as a result of fluid deficit or sodiumMay occur as a result of fluid deficit or sodium
excessexcess
• Frequently occurs with fluid imbalanceFrequently occurs with fluid imbalance
• Develops when an excess of sodium occurs without aDevelops when an excess of sodium occurs without a
proportional increase in body fluid or when waterproportional increase in body fluid or when water
loss occurs without proportional loss of sodiumloss occurs without proportional loss of sodium
• Risk Factors: excess dietary or parenteral sodiumRisk Factors: excess dietary or parenteral sodium
intake, watery diarrhea, diabetes insipidus, damageintake, watery diarrhea, diabetes insipidus, damage
to thirst center, too young, too old, those withto thirst center, too young, too old, those with
physical or mental status compromise, and peoplephysical or mental status compromise, and people
with hypothalamic dysfunctionwith hypothalamic dysfunction
32. Increased Sodium concentration in ECFIncreased Sodium concentration in ECF
Osmolarity risesOsmolarity rises
Water leaves the cell by osmosis and entersWater leaves the cell by osmosis and enters
the the extracellular compartmentsthe the extracellular compartments
Dilution of fluids in ECFDilution of fluids in ECF Cells are water depletedCells are water depleted
Suppression of aldosteroneSuppression of aldosterone
secretionsecretion
Sodium is exreted in theSodium is exreted in the
urineurine
CLINICAL SYMPTOMSCLINICAL SYMPTOMS
34. Assessment findings:
Neuro - Spontaneous muscle twitches.
Irregular contractions. Skeletal muscle
wkness. Diminished deep tendon reflexes
Resp. – Pulmonary edema
CV – Diminished CO. HR and BP depend on
vascular volume.
GU – Dec. urine output. Inc. specific gravity
Skin – Dry, flaky skin. Edema r/t fluid
volume changes.
35. Interventions/Treatment
Drug therapy
Lowering of serum sodium level by infusion of
hypotonic electrolyte solution
Diuretics also may be prescribed to treat
sodium gain
Desmopressin acetate to treat diabetes
insipidus if it is cause of hypernatremia
Diet therapy
Mild – Ensure water intake
36. The nurse should assess for abnormal looses of
water or low water intake and for large gains of
sodium as might occur with ingestion of OTC
medication that have high sodium content
The nurse should obtain a medication history,
because some prescription medications have a
high sodium content
The nurse also notes the patients thirst or
elevated body temperature and evaluates it in
relation to other clinical sign and symptoms
37. The more K, the less Na. The less K, the more NaThe more K, the less Na. The less K, the more Na
• Plays a vital role in such processes such as transmission ofPlays a vital role in such processes such as transmission of
electrical impulses, particularly in nerve, heart, skeletal,electrical impulses, particularly in nerve, heart, skeletal,
intestinal and lung tissue; CHON and CHO metabolism; andintestinal and lung tissue; CHON and CHO metabolism; and
cellular building; and maintenance of cellular metabolism andcellular building; and maintenance of cellular metabolism and
excitationexcitation
• Assists in regulation of acid-base balance by cellularAssists in regulation of acid-base balance by cellular
exchange with Hexchange with H
•Sources: bananas, peaches, kiwi, figs, dates, apricots,Sources: bananas, peaches, kiwi, figs, dates, apricots,
oranges, prunes, melons, raisins, broccoli, and potatoes, meat,oranges, prunes, melons, raisins, broccoli, and potatoes, meat,
dairy productsdairy products
•Normal value: 3.5 – 5 mEq/LNormal value: 3.5 – 5 mEq/L
38. Serum level is below 3.5 meq/l (3.5
mmol/L) usually indicates a deficit in
potassium store
39. = Action Potential= Action Potential
Nerve and Muscle ActivityNerve and Muscle Activity
LowLow
ExtracellularExtracellular
K+K+
Increase inIncrease in
restingresting
membranemembrane
potentialpotential
The cellThe cell
becomes lessbecomes less
excitableexcitable
40. Sodium is retained in the body through resorption by theSodium is retained in the body through resorption by the
kidney tubuleskidney tubules
Potassium is excretedPotassium is excreted
Aldosterone is secretedAldosterone is secreted
Use of certain diuretics such as thiazides and furosemide, and corticosteroidsUse of certain diuretics such as thiazides and furosemide, and corticosteroids
Increased urinary outputIncreased urinary output
Loss of potassium in urineLoss of potassium in urine
41.
42. Administration od 40- 80 meq/day of
potassium is adequate in adult if there
are no abnormal losses of potassium
Dietary intake of potassium in average
adult is 50-100meq/day
When dietary intake is inadequate for any
reason, oral or IV potassium supplements
may be prescribed
43. The nurse needs to monitor for its early
presence in patients at risk
Fatigue, anorexia, muscle weakness,
decreased bowel motility, paraesthesia
and dysrhythmias are signal that warrant
assessing the serum potasium
concentration
44. Interventions
Assess and identify those at risk
Encourage potassium-rich foods
K+ replacement (IV or PO)
Monitor lab values
D/c potassium-wasting diuretics
Treat underlying cause
45. Serum potassium level greater than
5meq/L
Less common than hypokalaemia , but it
is usually dangerous
46. Contributing factors:
Increase in K+ intake
Renal failure
K+ sparing diuretics
Shift of K+ out of the cells
47.
48. In non acute situations, restriction of dietary
potassium and potassium containing
medications may correct the imbalance
Administration either orally or by retention
enema of cation exchange resins
EMERGENCY PHARMACOLOGIC THERAPYEMERGENCY PHARMACOLOGIC THERAPY
If serum potassium level are dangerously
elevated, it may be necessary to adm. IV
calcium gluconate
Monitor blood pressure
49. Patients at risk for potassium excess need
to be identified and closely monitored for
signs of hyperkalemia
Nurse should monitor I/O and observe for
signs of muscle weakness and dysrythmias
Serum potassium level as well as BUN ,
creatinine, glucose & arterial blood gas
values are monitored for patient at risk
for developing hyperkalemia
50. Interventions
Need to restore normal K+ balance:
Eliminate K+ administration
Inc. K+ excretion
Lasix
Kayexalate (Polystyrene sulfonate)
Infuse glucose and insulin
Cardiac Monitoring
53. Correcting the cause of hypochloremia
and contributing electrolytes and acid-
base imbalances
Normal saline (0.9% sodium chloride) or
half strength saline(0.45% sodium
chloride) solution is administered by IV to
replace the chloride
54. Monitor the patient I/O, arterial blood gas
values and serum electrolyte levels
Changes in pts level of consciousness,
muscle strength and movement and
reported to the physician promptly
Vital signs are monitored and respiratory
assessment is carried out frequently
Educate the pt about food with high
chloride content which include tomato
juice, banana, eggs, cheese etc
55. Serum level of chloride exceeds 107
meq/L
Hypernatremia, bicarbonate loss and
metabolic acidosis can occur with high
chloride levels
56. Tachypnea
Weakness
Lethargy
Deep and rapid respiration
Hypertension
Dimnished cognitive ability
If untreated it leads to:If untreated it leads to:
Decrease in cardiac output, dysrhythmiasDecrease in cardiac output, dysrhythmias
and comaand coma
57. Correcting the cause of underlying cause of
hyperchloremia and restoring electrolyte
fluid and acid base balance are essential
Hypotonic IV solution may be administered to
restore balance
Lactated ringers solution may be prescribed
to convert lactate to bicarbonate in liver
Diuretics may be administered to eliminate
chloride as well
Sodium chloride and fluid are restricted
58. Monitoring vital sign , arterial blood gas
values and I/O is important to assess the
patients status and the effectiveness of
treatment
Assessment findings related to
respiratory, neurologic and cardiac
systems are documented and changes are
discussed with physician
Educate about the diet
59. More than 90% of body’s calcium is located in
the skeletal system
The normal total serum calcium level is 8.6-
10.2 mg/dl (2.2 to 2.6 mmol/L)
60. The serum calcium value lower than
8.6mg/dl
Occurs in variety of clinical situation
Older people and those with disabilities, who
spend on increased amount of time in bed
have an increased risk of hypocalcaemia
because bed rest increases bone resorption
62. Contributing factors (cont’d):
Acute pancreatitis
Hyperphosphatemia
Immobility
Removal or destruction of parathyroid gland
63. Numbness
Tingling of finger, toes and circumoral region
Anxiety
Hyperactive deep tendon reflex
Bronchospasm
diarrhoea
64. Assessment findings:
Neuro –Irritable muscle twitches.
Positive Trousseau’s sign.
Positive Chvostek’s sign.
Resp. – Resp. failure d/t muscle tetany.
CV – Dec. HR., dec. BP, diminished
peripheral pulses
GI – Inc. motility. Inc. BS. Diarrhea
65.
66.
67. Interventions/Treatment
Drug Therapy
Calcium supplements
Vitamin D
Diet Therapy
High calcium diet
Prevention of Injury
Seizure precautions
68. Status of airway is clearly monitored
Safety precaution to be taken if confusion is
present
Educate the patient about hypocalcemia,
and calcium containing foods like milk,
yogurt, cheese, sea fruit, legumes, fruits
Avoid overuse of laxatives and antacids
69. serum calcium value greater than 10.2
mg/dl
It is a dangerous imbalance when severe
infact, hypercalcemic crisis has a mortality
rate as high as 50% if not treated promptly
72. Assessment findings:
Neuro – Disorientation, lethargy, coma, profound muscle
weakness
Resp. – Ineffective resp. movement
CV - Inc. HR, Inc. BP. , Bounding peripheral pulses,
Positive Homan’s sign.
Late Phase – Bradycardia, Cardiac arrest
GI – Dec. motility. Dec. BS. Constipation
GU – Inc. urine output. Formation of renal calculi
73. Interventions/Treatment
Eliminate calcium administration
Drug Therapy
Isotonic NaCL (Inc. the excretion of Ca)
Diuretics
Calcium reabsorption inhibitors (Phosphorus)
Cardiac Monitoring
74. Increasing patient mobility and encouraging
fluids
Encourage to drink 2.8 to 3.8L of fluid daily
Adequate fiber in diet is encouraged
Safety precaution are implemented
78. Assessment findings:
on lab analysis, serum phosphate level is less
than 2.5 mg/L
Serum magnesium may be decreased due to
increased urinary excretion of magnesium
X-ray may show skeletal changes of rickets
79. MANAGEMENT
Treat underlying cause
Oral replacement with vit. D
IV phosphorus (Severe)
Serum phosphate level should be closely monitored
Diet therapy
Foods high in oral phosphate
80. Identify the patient at risk for
hypophosphatemia
Close monitoring of patient
Vital signs and monitor serum phosphorous
level
Check the level of consciousness
Health education
83. Administration of vit.D such as calcitriol which is
available both oral ( Rocaltrol) & parenteral
( Calajex, paricalcitol forms)
Calcium binding antacids
Administration of amphojel with meals
Restriction of dietary phosphate, forced diuresis
with loop diuretics volume replacement with
saline
84. Surgery may be indicated for removal of
large calcium and phosphorus deposits
Dialysis may also lower phosphorus
85. The nurse monitor patient at risk for
hyperphosphatemia
If low phosphorus diet is prescribed, patient is
instructed to avoid phosphorus rich food such as
hard cheese, cream, nuts, meats etc
Nurse instruct patient to avoid phosphate
containing laxatives and enemas
Monitoring for chnages in urine output
86. HYPOMAGNESEMIAHYPOMAGNESEMIA
Refers to below normal serum magnesiumRefers to below normal serum magnesium
concentration 1.3mg/dl (0.62 mmol/L)concentration 1.3mg/dl (0.62 mmol/L)
It is frequently associated with hypokalemiaIt is frequently associated with hypokalemia
90. Mild magnesium deficiency can be corrected by
diet alone
Magnesium salt can be administered orally in an
oxide or gluonate form
Vital signs must be assessed frequently
Calcium gluconate must be readily available to
treat
IV.mgso4
91. Observe for its sign and symptom
Safety precaution are institued
Due to dysphagia, patient should be screened
Health education
92. Serum magnesium level higher than 2.3
mg/dl
It is a rare electrolyte abnormality because
kidney efficiently excrete magnesium
95. Assessment findings:
serum magnesium level is greater than 2.3mg/dl
creatinine clearance decreases to less than
3.0ml/min
ECG finding: prolonged PR interval
: tall T waves
: widened QRS
96. Administration of magnesium
Ventilatory support
IV calcium gluconate
Administration of loop diuretics and sodium
chloride
Administration of lactated ringers IV solution
97. Risk for hypermagnesemia are identified and
assessed
Monitor vital signs, noting hypotension and
shallow respiration
Observe for decreased deep tendon reflex and
changes in level of consciousness
Caution is essential when preparing and
medicating magnesium containing fluid
parenterally