Fluid & Electrolytes


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  • Fluid & Electrolytes/Acid Base BalanceGoal: Reestablish & maintain normal balance -assess clients likely to develop imbalances -monitor clients for early manifestations -implement collaborative interventions
  • Necessary for cells to be able to carry out their work. Body fluids are in constant motionBody fluids maintain healthy living conditions for body cells
  • nutrients in foodnormal digestive processesnormal volume, composition, distribution, & pH of body fluids
  • Homeostasis involvesDelivery of essential elements such as oxygen and glucose to the cellsRemoval of wastes such as carbon dioxide from the cells
  • Intracellular fluid 40% total body weightEssential for normal cell functionProvides medium for metabolic processes
  • Extracellular fluid 20% total body weightInterstitial fluid: spaces between cellsIntravascular fluid (plasma-arteries, veins, capillaries)Transcellular fluidUrine, digestive secretions, perspirationCerebrospinal, pleural, synovial fluidsIntraocular, gonadal, pericardial fluids
  • 82 year old women
  • Isotonic dehydration, the most common type of fluid deficit, is caused by loss of plasma volume. In this case, the client lost volume by excessive vomiting and diarrhea
  • Urine specific gravity >1.010 Urine volume decreased Serum sodium normal Serum hct & hgb increasedBUN normal or increased Serum osmolality normal
  • Orthostatic hypotension and flat neck veins
  • Increased sympathetic discharge
  • Rapid hydration of IVF
  • D5W
  • Urinary output
  • crackles
  • weight
  • Distended hand and neck veins
  • All except diminished peripheral pulses, thirst, orthostatic hypotension
  • Restrict free water
  • Stop IV
  • Urine output
  • ElectrolytesMaintain fluid balanceRegulate & maintain acid-base balanceContribute to enzyme reactionsEssential for neuromuscular activityMeasured in mEq/L of watermEq-measure of chemical binding power of the ion
  • Heart rhythm
  • Cardiac monitoring
  • Bacon, fresh fruit salad if it contains bananas, cantalope, kiwi, orange) potato, spinach, & dried fruit; salt subsitute
  • Deficit knowledge related to dietary intake of potassium as evidenced by dietary intake of potassium rich foods such as potatoes, bacon, and salt subsitute. Deficit knowledge related to lack of familiarity with information resources as evidenced by inaccurate follow through on instructions for medication and dietary intake of potassium rich foods
  • Loose diarrhea stools. Symptoms are a result of the excess potassium moving from ICF to ECF creating an stimulation of the bowel and resulting in diarrhea.
  • There is no need to clarify the order. GI s/s of hyperkalemia are increased motility, hyperactive bowel sounds and diarrhea. The kayxalate will reduce the potassium levels consequently the intestinal motility decreases if the enema is successful
  • Spironolactone is a potassium sparing diuretic and should be d/c.Teach diet, medications, and recognition of s/s of hyperkalemia. Importance of follow up care
  • Seizure precautions
  • Because of her symptoms and history knowing that dehydration can be characteristic of hypernatremia the sodium level is expected to be elevated. Assessment: CNS, neurovascular, and CV manifestations Treatment fluid replacement with isotonic solution (NaCl) Teaching sodium content in foods and beverages, safety measures (physiologic changes in the elderly, s/s of dehydration to report, prevention of dehydration and hypernatremia by drinking adequate water
  • High Ca can cause constipation, polyuria which causes increased thirst; cardiac arrestLow Ca Lethargy, coma
  • Heart rhythm-dysrhythmias, ECG changes possible HTN, cardiac arrest
  • Severe Low phos affects every major organ
  • Magnesium
  • Fluid & Electrolytes

    1. 1. Fluid & Electrolytes<br />C. Washington RN, MSNEd<br />
    2. 2.
    3. 3. Homeostasis Depends On<br />
    4. 4. Homeostasis Depends on<br />
    5. 5.
    6. 6.
    7. 7.
    8. 8. Fluid Balance<br />
    9. 9.
    10. 10.
    11. 11.
    12. 12. Body Fluid Distribution<br /><ul><li>ICF
    13. 13. Potassium, magnesium, & phosphate
    14. 14. Glucose, oxygen
    15. 15. ECF
    16. 16. Sodium, chloride, bicarbonate, calcium
    17. 17. High Na+ concentration regulates body fluid volume</li></li></ul><li>Body Fluid Movement<br />
    18. 18. Body Fluid Movement<br /><ul><li>Osmolality 275-295 mOsm/kg
    19. 19. Used to describe concentration of body fluids
    20. 20. # solutes /kg H20 (by weight)
    21. 21. Estimated by doubling serum Na concentration
    22. 22. Osmolarity of ECF depends on Na+ concentration</li></li></ul><li>Body Fluid Movement<br />Diffusion<br />Molecules -> from an area of ↑ concentration to an area of ↓ concentration<br />Osmotic Pressure <br /><ul><li>Power of fluid to draw H20</li></ul> across a membrane<br />
    23. 23. Body Fluid Movement<br />Filtration<br />H2O & dissolved substances -> from an area of &gt; hydrostatic pressure to an area of &lt; hydrostatic pressure<br />
    24. 24.
    25. 25. Body Fluid Movement<br />
    26. 26.
    27. 27.
    28. 28.
    29. 29.
    30. 30.
    31. 31. Fluid Replacement<br />
    32. 32. Fluid Replacement<br />
    33. 33. Why should you care?<br />↑ sodium concentration in ECF<br />Causes H2O to shift from ICF -> ECF compartment<br />Treatment: 0.45% NS (hypotonic) facilitates H2O back into intracellular space<br />
    34. 34.
    35. 35. Body Fluid Regulation<br />
    36. 36. Renin-Angiotensin-Aldosterone System<br />
    37. 37.
    38. 38. Hydration: Important for Good Health<br />
    39. 39. Assessment of Fluid Balance<br />Diagnostic and Laboratory Data<br /> Osborn page 420<br />
    40. 40. Assessing Fluid Balance<br />
    41. 41. Assessing Fluid Balance<br />
    42. 42. Assessing Fluid Balance<br />
    43. 43. Assessing Fluid Balance<br />
    44. 44. Nursing Diagnosis: Fluid Imbalances<br />Fluid volume excess<br />Fluid volume deficit<br />Fluid volume deficit, risk for<br />Gas exchange, impaired<br />Cardiac output, decreased<br />Knowledge deficit<br />Breathing pattern, ineffective<br />Anxiety<br />Thought processes, altered<br />Injury, risk for<br />Oral mucous membrane, altered<br />
    45. 45. Fluid Balance: Common Interventions<br />Monitoring daily weight<br />Measuring vital signs<br />Measuring intake and output<br />Providing oral hygiene<br />Initiating oral fluid therapy<br />Maintaining tube feeding<br />Monitoring intravenous therapy<br />
    46. 46. Fluid & Electrolyte disorders<br />Excess fluids result from excessive intake or decreased output, from any cause<br />Fluid deficits result from poor intake or excessive output, from any cause<br />Both occur from shifts that occur with various health disorders <br />
    47. 47. FVD: Cause<br />
    48. 48. FVD: Cause<br />
    49. 49. FVD: Cause<br />
    50. 50. FVD: Cause<br />
    51. 51. Fluid Volume Deficit<br />Hypovolemia<br />Loss of extracellular fluid volume<br />Isotonic fluid volume deficit<br />Electrolytes loss along with fluid<br />
    52. 52. FVD<br />Third spacing<br />Shift of fluid into vascular space <br />abdomen, pleural/ peritoneal space<br />
    53. 53. Signs & Symptoms: FVD<br /><ul><li>Weight loss
    54. 54. 1 liter of body fluid weighs 1 kg (2.2lb)
    55. 55. ↓interstitial fluid→ diminished skin turgor
    56. 56. ↓skin turgor less accurate in elderly
    57. 57. More accurate indicator of FVD
    58. 58. Assess tongue for size, dryness, longitudinal furrows</li></li></ul><li>Test Yourself<br /><ul><li>You are caring for a patient taking the diuretic furosemide.
    59. 59. Yesterday, the patient’s weight was 62 kg.
    60. 60. After the dose of furosemide yesterday, the patient’s urine output was 2,500 ml.
    61. 61. What do you expect the patient’s weight to be today?</li></li></ul><li>Signs & Symptoms: FVD<br /><ul><li>Hypovolemia
    62. 62. Orthostatic hypotension
    63. 63. >15 mmHg drop in SBP from lying to standing
    64. 64. Loss of intravascular volume
    65. 65. ↑HCT
    66. 66. Venous pressure falls
    67. 67. Flat neck veins</li></li></ul><li>Signs & Symptoms: FVD<br /><ul><li>To conserve water & sodium pt may experience
    68. 68. Tachycardia
    69. 69. Pale, cool skin (vasoconstriction)
    70. 70. Decreased urine output
    71. 71. Specific gravity increases as water is reabsorbed in the tubules</li></li></ul><li>Diagnostic Tests: FVD<br />Serum electrolytes<br />Isotonic deficit Na+ wnl <br />Water loss only Na+ ↑<br />↓ K+ common<br />Serum osmolality ↑ with water loss<br />Serum Hgb & Hct ↑<br />Urine specific gravity & osmolality ↑<br />
    72. 72.
    73. 73. Assessment: FVD<br /><ul><li>Health History
    74. 74. Medication
    75. 75. Renal or endocrine disease
    76. 76. Hot weather
    77. 77. Excessive exercise
    78. 78. Lack of access to fluids
    79. 79. Recent illness accompanied by fever, vomiting/diarrhea</li></li></ul><li>Assessment: FVD<br />Physical Assessment<br />Weight<br />Vital signs<br />Peripheral pulses/capillary refill<br />Jugular neck vein <br />Skin color<br />Temperature<br />Turgor<br />LOC/mentation<br />Urine output<br />
    80. 80. Fluid Management: FVD<br />Isotonic Electrolyte solutions <br />0.9% NaCL/Ringer’s solution<br />Expand plasma volume (↓ BP pt’s)<br />Replace abnormal losses<br />Total body water deficits<br />D5W <br />Dextrose is metabolized to carbon dioxide & water ->availability of free water for tissue needs<br />
    81. 81. Fluid Imbalance<br />Nursing Process: Patient Care Plan for<br /> Dehydration <br /> Osborn page 421<br />
    82. 82. Dehydration<br /><ul><li>When more water is lost from the body than is replaced.
    83. 83. Dehydration refers to loss of water alone
    84. 84. Caused by water deprivation, excessive urine production, profuse sweating, diarrhea, and extended periods of vomiting.</li></li></ul><li>
    85. 85. Nursing Diagnosis: FVD<br />Deficient Fluid Volume<br />Ineffective Tissue Perfusion<br />Risk for Injury<br />
    86. 86. Test Yourself<br /><ul><li>In prioritizing patient care, you recognize that the pt most at risk for FVD is
    87. 87. A 30 year old man with a fractured tibia
    88. 88. An 82 year old women with a fractured hip
    89. 89. A 62 year old man with a heart attack
    90. 90. A 35 year old woman who just delivered a baby</li></li></ul><li>Ms. Hicks<br />39 year old female<br />history of vomiting & diarrhea from the flu<br />rapid pulse<br />orthostatic hypotension<br />urine output of 20 mL/hr<br />skin turgor poor with tenting<br />increased respiratory rate<br />
    91. 91. Ms. Hicks<br />Which type of<br />dehydration do you<br />suspect that this<br />Ms. Hicks has? Explain<br />your answer. <br />
    92. 92. Ms. Hicks<br />In evaluating the<br />client’s laboratory<br />values, would you<br />expect the following<br />values to be normal,<br />elevated, or<br />decreased?<br />Urine specific gravity<br />Urine volume<br />Serum sodium<br />Serum hct & hgb<br />BUN<br />Serum osmolality<br />
    93. 93. Ms Hicks<br />When assessing a patient with FVD, the nurse would expect to find:<br />Increased pulse rate and BP<br />Dyspnea and respiratory crackles<br />Headache and muscle cramps<br />Orthostatic hypotension and flat neck veins<br />
    94. 94. Ms Hicks<br />What compensatory mechanism responsible for the client’s rapid pulse?<br />
    95. 95. Ms Hicks<br />What immediate interventions are necessary to correct this client’s fluid volume imbalance?<br />
    96. 96. Ms Hicks<br />Admitted with hypovolemia. Which IV solution would the nurse anticipate administering?<br />Ringer’s solution<br />10% dextrose in water<br />3% sodium chloride<br />0.24% sodium chloride<br />
    97. 97. Ms Hicks<br />What would be most important to monitor to determine the client’s response to corrective interventions?<br />
    98. 98. Mr Hicks<br />What assessment data would indicate that the client is having a negative response to fluid resuscitation?<br />
    99. 99. Fluid Volume Excess (FVE)<br /><ul><li>Results from water & sodium retention
    100. 100. Hypervolemia
    101. 101. Excess intravascular fluid
    102. 102. Edema
    103. 103. Excess interstitial fluid</li></li></ul><li>FVE: Causes<br />
    104. 104. FVE: Cause<br />
    105. 105. FVE: Cause<br />
    106. 106. FVE: Cause<br />
    107. 107. Signs & Symptoms: FVE<br />
    108. 108. Signs & Symptoms: FVE<br />
    109. 109. Signs & Symptoms: FVE<br />Weight gain &gt;5% of body weight<br />
    110. 110. Diagnostic Tests: FVE<br />To determine cause<br />Serum creatinine<br />BUN<br />liver enzymes<br />
    111. 111. Medications: FVE<br />Diuretics<br />Inhibit Na+ & water reabsorption<br />Increase urine output<br />
    112. 112. Diuretics: Pt & Family Teaching<br />Take in morning and afternoon<br />Change position slowly<br />Weigh daily<br />Avoid salt shaker & processed foods<br />Read food labels<br />↑ potassium foods (banana/orange juice)<br />Potassium sparing diuretics do not use salt substitute<br />
    113. 113. Assessment Data: FVE<br /><ul><li>Health history:
    114. 114. Meds or change of meds
    115. 115. Heart failure; recent illness
    116. 116. Acute/chronic renal or endocrine disease
    117. 117. Change in diet/recent weight gain
    118. 118. Persistent cough, SOB
    119. 119. Swelling of feet and ankles
    120. 120. Difficulty sleeping when lying down</li></li></ul><li>Assessment Data: FVE<br /><ul><li>Physical Assessment
    121. 121. Weight, vital signs
    122. 122. Peripheral pulses & capillary refill
    123. 123. Jugular neck vein distention, edema
    124. 124. Lung sounds (crackles or wheezes)
    125. 125. dyspnea, cough, & sputum
    126. 126. Urine output
    127. 127. Mental status</li></li></ul><li>Edema<br />Amount of interstitial fluid (fluid in tissue spaces around each cell) returning to the circulatory system lessens<br />Fluid accumulate in the tissue spaces, the tissues become swollen. <br />
    128. 128.
    129. 129. Pitting Edema<br />Extravasation & accumulation of interstitial fluid in tissues <br />Dependent areas of the body<br />Leaves indentation when skin surface is pressed by a finger<br />Reflects high right atrial pressure, for example, in heart failure<br />More severe than non-pitting edema<br />
    130. 130. Nursing Diagnosis: FVE<br />Excess fluid volume<br />Risk for Impaired Skin Integrity<br />Risk for Impaired Gas exchange<br />
    131. 131. Mrs. Hsu<br /><ul><li>Admitted to the hospital with a decreased serum osmolality and a serum sodium of 126 mEq/L.
    132. 132. You recognize that dehydration or overhydration may accompany hypotonic conditions.</li></li></ul><li>Mrs. Hsu<br />A priority assessment for this client with FVE is:<br />Mental status<br />Weight<br />Postural vital signs<br />Urine output<br />
    133. 133. Mrs Hsu<br />In further assessing the client, what assessment data would indicate that the client has fluid volume excess?<br />Distended hand & neck veins<br />Decreased urine output<br />Decreased capillary refill<br />Increased rate and depth of respirations<br />
    134. 134. Mrs. Hsu<br />Increased, bounding pulse<br />JVD<br />Diminished peripheral pulses<br />Presence of crackles<br />Thirst<br />Elevated blood pressure<br />Orthostatic hypotension<br />Skin pale & cool to touch<br />Which of the following<br />assessments would<br />indicate that Mrs. Jones<br />has fluid volume excess?<br />
    135. 135. Mrs Hsu<br />After determining the client is not dehydrated, which of the following interventions would be appropriate to correct this hypotonic overhydration?<br />Administration of 0.9% NS<br />Restriction of free water<br />Administration of antihypertensives<br />Restriction of potassium<br />
    136. 136. Mrs. Hsu<br />A patient is exhibiting sudden onset of crackles in the lungs, moist respirations, & rapid respiratory rate. Which intervention should be performed first?<br />Weigh the patient<br />Assess capillary refill<br />Measure edema<br />Reduce IV rate<br />
    137. 137. Mrs Hsu<br />What would you assess for evidence of a worsening hypotonic condition?<br />Mental status<br />Urine output<br />Skin changes<br />Bowel sounds<br />
    138. 138.
    139. 139.
    140. 140. Potassium (K+) 3.5 to 5.5 mEq/L<br />Major cation in the ICF<br />Affects cardiac muscle concentration, electrical conductivity, & cell excitability<br />Aids neuromuscular transmission of nerve impulses.<br />Alteration in K+ balance will result in acid-base imbalance<br />Regulation of protein synthesis<br />Regulation of glucose use & storage<br />
    141. 141. Hypokalemia K+ &lt;3.5 mEq/L<br />
    142. 142. Hypokalemia K+ &lt;3.5 mEq/L<br />
    143. 143. Hypokalemia K+ &lt;3.5 mEq/L<br />
    144. 144. Hypokalemia K+ &lt;3.5 mEq/L<br />Hyperaldosteronism<br />
    145. 145.
    146. 146. Diagnostic Tests: ↓ K+<br />
    147. 147. Assessment: Hypokalemia<br />Health history<br />Anorexia, nausea, vomiting, abdominal discomfort<br />Muscle weakness or cramping<br />Diuretic use<br />Prolonged vomiting or diarrhea<br />Diabetes, Addison or Cushing disease<br />Current medications<br />
    148. 148. Assessment: Hypokalemia<br /><ul><li>Mental status</li></ul>Physical assessment<br /><ul><li>Vital signs, including orthostatic
    149. 149. Apical and peripheral pulses
    150. 150. Bowel sounds, abdominal distention
    151. 151. Muscle strength & tone</li></li></ul><li>Treatment: ↓ K+<br />Oral potassium supplements<br />Oral: dilute liquid K+ in fruit or vegetable juice or cold water<br />Never give K+ if pt is not voiding<br />Chill to increase palatability<br />Give with food to minimize GI effects<br />Parental potassium supplements<br />
    152. 152. Pt Teaching: K+ Supplement<br /><ul><li>No K+ supplement if taking K+ sparing diuretic
    153. 153. Do not chew enteric-coated tablets
    154. 154. Take with meals
    155. 155. Do not use salt substitutes (potassium based)</li></li></ul><li>Foods High in K+<br />
    156. 156. Nursing Diagnosis: ↓K+<br />Activity intolerance<br />Decreased cardiac output<br />Risk for Imbalanced Fluid Volume<br />
    157. 157. The assessment of a patient with hypokalemia should focus on<br />BP<br />Edema<br />Chvostek’s sign<br />Heart rhythm<br />
    158. 158. <ul><li>Laboratory results for a patient show a potassium level of 2.2 mEq/L. Which of the following nursing actions is highest priorty for this patient?</li></ul>Keep the patient on bedrest<br />Initiate cardiac monitoring<br />Start oxygen at 2L/min<br />Initiate seizure precautions<br />
    159. 159. Hyperkalemia: K+&gt;5.0 mEq/L<br />Causes<br />
    160. 160. Hyperkalemia: K+&gt;5.0 mEq/L<br />
    161. 161. ↑ K+<br />
    162. 162. Hyperkalemia: K+&gt;5.0 mEq/L<br />
    163. 163.
    164. 164. Diagnostic Tests: ↑ K+<br />
    165. 165. Assessment: ↑ K+<br /><ul><li>Health history
    166. 166. Numbness, tingling, muscle weakness
    167. 167. Nausea, vomiting, abdominal cramping
    168. 168. Palpitations
    169. 169. Use of salt substitutes & potassium supplements
    170. 170. Reduced urine output
    171. 171. Renal failure/endocrine disorders
    172. 172. Current medications</li></li></ul><li>Assessment: ↑ K+<br />Physical assessment<br />Apical & peripheral pulses<br />Bowel sounds<br />Muscle strength<br />ECG pattern<br />
    173. 173. Management: ↑ K+<br />Medications<br />Calcium gluconate (emergency)<br />Regular insulin & 50g of glucose (emergency)<br />Sodium bicarbonate (acidosis) (emergency)<br />Kayexalate & Sorbital<br />Diuretics<br />Dialysis<br />
    174. 174. Nursing Diagnosis: ↑ K+<br />Risk for Activity Intolerance<br />Risk for Decreased Cardiac Output<br />Risk for Imbalanced Fluid Volume<br />
    175. 175. <ul><li>You are caring for a patient with hyperkalemia. You prepare for administration of which medication?
    176. 176. Kayexalate
    177. 177. K-Lor
    178. 178. Kaopectate
    179. 179. Keflex</li></li></ul><li>Mr. Williams<br />Adm for palpitations<br />K+ 5.4 mEq/L <br />Takes Spironolactone 50 mg daily for HTN<br />Missed 1 month follow-up appointment<br />
    180. 180. Mr. Williams<br /><ul><li>Day prior to admission he ate:
    181. 181. Which foods in his diet contribute to his hyperkalemia?</li></li></ul><li>Mr. Williams<br />What would be a relevant nursing diagnosis for this client based on the client’s assessed data?<br />
    182. 182. Mr. Williams<br />C/O abdominal cramping and several very loose diarrhea stools since yesterday.<br />What is the etiology of the client’s symptoms?<br />
    183. 183. Mr. Williams<br />Physician orders Kayexalate retention enema to be given stat.<br />Should you clarify the physician’s orders before administering the enema?<br />
    184. 184. Mr. Williams<br />Will the physician continue the order for Spironolactone? Explain.<br />What would be some teaching and learning priorities for d/c.<br />
    185. 185. Sodium (Na+) 135-145 mEq/liter<br />Normal physiologic function<br />Maintains ECF volume <br />Maintenance of ECF osmolality.<br />Initiation of skeletal muscle contraction<br />Initiation of cardiac contractility<br />Transmission of neuronal impulses<br />Maintenance of renal urine-concentration system<br />
    186. 186. Sodium Imbalance<br />Affect osmolality of ECF<br />Affect water distribution between fluid compartments<br />Low Na+ H2O is drawn into cells (swell)<br />High Na+ H20 drawn out of cells<br />
    187. 187. Signs & Symptoms<br />Hyponatremia<br />Muscle cramps, Weakness, fatigue<br />Dulled sensorium, irritability, personality changes<br />Hypernatremia<br />Most serious effects are seen in the brain<br />Lethargy, weakness, irritability can progress to seizures, coma, death<br />
    188. 188. Point to Remember<br />Pt’s with low Na+ will present with acute onset of confusion<br />Risk for falls in the elderly<br />
    189. 189. Foods High in Sodium<br />
    190. 190.
    191. 191. A patient presents with a serum sodium level of 115 mEq/L. A priority nursing intervention is<br />Seizure precautions<br />Vital signs every two hours<br />Frequent mouth care<br />Cardiac rhythm monitoring<br />
    192. 192. <ul><li>The nurse caring for a client with hypernatremia includes which of the following in the plan of care? (Select all that apply)
    193. 193. Conduct frequent neurologic checks
    194. 194. Restrict fluids to 1500 ml per day
    195. 195. Orient to time, place, & person frequently
    196. 196. Maintain intravenous access
    197. 197. Limit length of visits</li></li></ul><li>A patient receiving D5W at 100 mL/hr is most at risk for developing<br />Hypernatremia<br />Hyponatremia<br />FVE<br />FVD<br />
    198. 198. Mrs. Hudson<br />77-year-old female<br />Found confused, unable to get up to the bathroom<br />Weak, anxious, confused to time & place<br />P 110; B 108/58<br />Skin dry<br />Urine Specific gravity 1.028<br />Deep tendon reflexes slightly reduced<br />
    199. 199. Mrs. Hudson<br />Would the client’s serum sodium be elevated, decreased, or normal?<br />What would be your priority assessment plan?<br /><ul><li>What treatment would you expect this client to receive at this time?
    200. 200. What would be a teaching plan for this client?</li></li></ul><li>Chloride (Cl-) 95 to 108 mEq/liter<br />Formation of hydrochloric acid in stomach<br />Cl- and Na+ levels usually change in direct proportion to one another.<br />Works with Na+ to maintain ECF osmotic pressure & water balance<br />
    201. 201. Calcium (Ca++)8.5 – 10.5 mEq/dl (4-5.5 mEq/L)<br />Functions<br />Enhances activity of enzymes or reactions<br />Skeletal muscle contraction<br />Cardiac contractility<br />Helps activate steps in blood coagulation.<br />Bone strength & density<br />Regulation of neural impulse transmission<br />
    202. 202. Calcium Imbalance<br />Calcium levels regulated by <br />parathyroid hormone<br />Calcitonin<br />Calcitriol<br />
    203. 203. Ca+ Imbalance: Signs & Symptoms<br />Hypocalcemia<br />Tetany, paresthesias, muscle spasms<br />Hypotension<br />Anxiety, confusion, psychosis<br />Hypercalcemia<br />Muscle weakness, fatigue<br />Personality changes<br />Anorexia, nausea, vomiting<br />
    204. 204. Foods High in Calcium<br />
    205. 205. The most important assessment in a patient with hypercalcemia is<br />Heart rhythm<br />Urine output<br />Trousseau’s sign<br />Weight<br />
    206. 206. The nurse evaluates teaching about calcium supplement therapy as effective when the patient states that she will take her calcium tablets<br />All at one time in the morning<br />With meals<br />As needed for tremulousness<br />With a full glass of water<br />
    207. 207. Phosphorus 2.5 – 4.5 mEq/dl<br />Vital for intracellular activities<br />Activation of B complex vitamins<br />Plays major role in acid-base balance through its action as a urinary buffer<br />Cell division<br />Plays essential role in muscle, RBC, neurological function<br />Aids in carbohydrate, protein and fat metabolism<br />
    208. 208. Hypophosphatemia<br />Muscle pain & tenderness<br />Muscle weakness<br />Paresthesia<br />Confusion <br />Manifestations of hypophosphatemia<br />Muscle spasms, tetany<br />Soft tissue calcifications<br />
    209. 209.
    210. 210. Magnesium (Mg++) 1.5-2.5 mEq/l<br />Muscle contractility<br />Carbohydrate and protein metabolism.<br />Affects neuromuscular irritability & contractility of cardiac and skeletal muscle.<br />Facilitates transport of Na+ and K+ across cell membranes.<br />DNA & Protein synthesis<br />
    211. 211. Magnesium Imbalance<br />Hypomagnesemia<br />Muscle weakness & tremors<br />Dysphasia<br />Tachycardia, HTN<br />Mood & personality changes<br />Hypermagnesemia<br />Depressed DTRs<br />Hypotension<br />Respiration<br />
    212. 212. <ul><li>A patient who is known to be an alcoholic presents with confusion, hallucinations, and positive Chvostek’s sign. Which medication should the nurse anticipate administering?
    213. 213. Magnesium sulfate
    214. 214. Calcium chloride
    215. 215. Insulin and glucose
    216. 216. Sodium bicarbinate</li></li></ul><li>A patient is experiencing nausea with severe vomiting.<br />The nurse realizes that this patient is at risk for which of the following?<br />
    217. 217. Interstitial fluid volume overload<br />Intracellular fluid volume deficit<br />Extracellular fluid volume deficit<br />Interstitial fluid volume deficit<br />
    218. 218. A male patient’s hematocrit is 56% <br />Serum sodium 150 mEq/L and <br />Potassium of 5.8 mEq/L<br />Which of the following would be indicated for this patient?<br />
    219. 219. Prepare to administer a hypertonic IV soultion <br />Prepare to administer a hypotonic IV solution <br />Prepare to administer an isotonic IV solution<br />Implement a fluid and sodium restriction for the patient <br />
    220. 220. The nurse is caring for a patient and has just received the laboratory data report. <br />Which of the following results would cause the most concern to the nurse?<br />
    221. 221. Na+: 115 mEq/L<br />K+: 4.0 mEq/L<br />Ca+: 9mg/dL<br />Mg+: 2.0mg/dL<br />
    222. 222. The nurse is caring for a patient with severe vomiting and diarrhea <br />Nasogastric tube to low wall suction. <br />The nurse realizes that this patient is at risk for which of the following electrolyte imbalances?<br />
    223. 223. Hypokalemia<br />Hypercalcemia<br />Hypermagnesemia<br />Hypophosphatemia<br />
    224. 224. A patient is admitted to the hospital with a fluid volume excess. <br />Which of the following will the nurse most likely assess for this patient?<br />
    225. 225. Dependent edema<br />Blood pressure: 92/55 mm Hg<br />Respiratory rate 14 breaths/minute and unlabored<br />Heart rate 86 beats per minute without ectopy<br />
    226. 226. The nurse is caring for a patient in renal failure with a serum potassium level of 7.1mEq/L. <br />Which of the following should the nurse do first to assist this patient? <br />
    227. 227. Assess level of consciousness.<br />Measure urine output hourly.<br />Have arterial blood gases drawn.<br />Obtain an electrocardiogram.<br />
    228. 228. The nurse is providing discharge instructions to a patient with hypokalemia. <br />Which of the following should the nurse include in these instructions?<br />
    229. 229. Take oral Kaexylate as prescribed.<br />Limit the intake of spinach and carrots.<br />Eat a balanced diet, including tomato juice and potatoes. <br />Expect muscle cramps and weakness for at least six weeks.<br />