Fluid And Electrolytes

Sodium

100

What are the serum Sodium levels for hyponatremia and hypernatremia?

Hyponatremia: <135 mEq/L Hypernatremia: >145 mEq/L

200

What would medical Management be for Hyponatremia and Hypernatremia?

Hyponatremia: water restriction and sodium replacement Hypernatremia: hypotonic electrolyte solution or D5W

300

What are the nursing Managements for Hyponatremia and Hypernatremia?

Hyponatremia: assessment and prevention, dietary sodium and fluid intake, identify and monitor at risk pts., effects of medications (diuretics, and lithium) Hypernatremia: assessment and prevention, assess for OTC sources of sodium, offer and encourage fluids to meet pts. needs, provide sufficient water w/ tube feedings

400

What are the causes of Hyponatremia and Hypernatremia?

Hyponatremia: Adrenal insufficiency, water intoxication, SIADH or losses by vomiting, diarrhea, sweating, and diuretics Hypernatremia: excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions, hyperventilation

500

What are manifestations of hyponatremia and hypernatremia?

Hyponatremia: poor skin turgor, dry mucosa, h/a, decreased salivation, decreased B/P, tachycardia, nausea, abdominal cramping, neurologic changes (Confusion) Hypernatremia: thirst, elevated temp., dry and swollen tongue, sticky mucosa, neurologic symptoms, restlessness, weakness, increased pulse and B/P

Potassium

100

What are the serum potassium levels for hypokalemia and hyperkalemia?

Hypokalemia: <3.5 mEq/L Hyperkalemia: >5.0 mEq/L

200

What are Medical Managements for hypokalemia and hyperkalemia?

Hypokalemia: increased dietary potassium, potassium replacement, IV for severe deficit Hyperkalemia: monitor ECG, limitation of dietary potassium, cation-exchange resin (kayexalate), IV sodium bicarbonate, IV calcium gluconate, regular insulin and hypertonic dextrose IV, B-2 agonist, dialysis

300

What are Nursing Managements for hypokalemia and hyperkalemia?

Hypokalemia: assessment, severe hypokalemia is life-threatening, monitor ECG and ABG's, dietary potassium, nursing care related to IV potassium administration Hyperkalemia: assessment of serum potassium levels, mix IV's containing K+ well, monitor meds affects, dietary potassium restriction

400

What are the causes of hypokalemia and hyperkalemia?

hypokalemia: GI losses (bulimia and starvation), medications, alterations of acid-base balance (alkalosis), hyperaldosterism, poor dietary intake hyperkalemia: usually treatment related, impaired renal function, hypoaldosteronism, tissue trauma, and acidosis

500

What are some Manifestations of hypokalemia and hyperkalemia?

Hypokalemia: fatigue, anorexia, nausea, vomiting, dysrhythmias, muscle weakness and cramps, parasthesias, glucose intolerance, decreased muscle strength, and DTR's (deep tendon reflexes) Hyperkalemia: cardiac changes and dysrhythmias, muscle weakness w/ potential respiratory impairment, parasthesias, anxiety, and GI manifestations

Calcium

100

What are the serum calcium levels for hypocalcemia and hypercalcemia?

hypocalcemia: <8.5 mg/dL hypercalcemia: >10.5 mg/dL

200

What are the Medical Managements for hypocalcemia and hypercalcemia?

Hypocalcemia: IV of calcium gluconate, calcium and Vitamin D supplements, Diet Hypercalcemia: treat the underlying cause, fluids, furosemide, phosphates, calcitonin, and bisphosphonates

300

What are the Nursing Managements for hypocalcemia and hypercalcemia?

Hypocalcemia: assessment, severe hypocalcemia is life threatening, weight bearing exercise to decrease bone calcium loss, pt. teaching related to diet and medications, and nursing care related to IV calcium administration Hypercalcemia: assessment, hyperalcemic crisis has high mortality, encourage ambulation, fluids of 3 to 4 L/d, provide fluids containing sodium unless contraindicated, fiber for constipation, ensure safety (mental symptoms)

400

Name some causes of Hypocalcemia and Hypercalcemia.

Hypocalcemia: hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure, medications, open wounds, and others Hypercalcemia: malignancy and hyperparathyroidism, bone loss related to immobility, prolonged use of thiazide diuretics

500

Name some manifestations of hypocalcemia and hypercalcemia.

Hypocalcemia: tetany, circumoral numbness, parasthesias, hyperactive DTR's, Trousseau's sign, Chovstek's sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting and anxiety Hypercalcemia: musle weakness, incoordination, anorexia, constipation, nausea and vomiting, abdominal and bone pain, polyuria, thirst, ECG changes and dysrhythmias

Magnesium

100

What are the serum Magnesium levels for Hypomagnesium and Hypermagnesium?

Hypomagnesium: <1.8 mg/dL Hypermagnesium: >2.7 mg/dL

200

What are the medical Managements for hypomagnesium and hypermagnesium?

Hypomagnesium: diet, oral magnesium, magnesium sulfate IV Hypermagnesium: IV calcium gluconate, loop diuretics, IV NS of RL, hemodialysis

300

What are some nursing Managements for hypomagnesium and hypermagnesium?

Hypomagnesium: assessment, assure safety (seizure precautions, monitor confusion, dysphasia screening), pt. teaching related to diet, medications, alcohol use, and nursing care related to magnesium sulfate IV Hypermagnesium: assessment (VS), do NOT administer medications containing magnesium especially pt. w/ renal failure, pt. teaching regarding magnesium containing OTC medications- check w/ MD

400

Name some causes of Hypomagnesium and Hypermagnesium.

Hypomagnesium: alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood, contributing causes include diabetic ketoacidosis, sepsis, burns, and hypothermia Hypermagnesium: renal failure, diabetic ketoacidosis, excessive administration of magnesium, Addison's disease

500

What are some manifestations of hypomagnesium and hypermagnesium?

Hypomagnesium: neuromuscular irritability (Trousseau's and Chvostek's sign), muscle weakness, tremors, athetoid movements, ECG changes and dysrhythmias, alterations in mood (apathy and depression) and LOC (delirium, confusion, and hallucination) Hypermagnesium: flushing, decreased B/P and shallow resp., nausea, vomiting, decreased deep tendon reflexes, drowsiness, muscle weakness, depressed resp., ECG changes, and dysrhythmias

Phosphate

100

Serum level for hypophosphatemia and hyperphosphatemia.

hypophosphatemia: <2.5 mg/dL hyperphophatemia: >4.5 mg/dL

200

What are some Medical Managements for hypophosphatemia and hyperphosphatemia?

Hypo: Oral or IV phosphorus replacement Hyper: treat the underlying disorder, Vitamin D preparations, calcium-binding antacids, phosphate-binding gels or antacids, loop diuretics, NS IV, dialysis

300

What are some Nursing Managements for hypophosphatemia and hyperphosphatemia?

Hypo: assessment, encourage foods high in phosphorus, gradually introduce calories for malnourished pts. receiving parenteral nutrition. Hyper: assessment, avoid high phosphorus foods, pt. teaching related to diet, phosphate- containing substances, signs of hypocalcemia

400

What are some causes of hypophosphatemia and hyperphosphatemia?

Hypo: alcoholism, anorexia nervosa, refeeding of pt. after starvation, pain, heat stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, hepatic encephalopathy, major burns, hyperparathyroidism, use of diuretic and antacids Hyper: renal failure excess phosphorus, excess Vitamin D, acidosis, hypoparathyroidism, and chemotherapy

500

What are some manifestations of hypophosphatemia and hyperphosphatemia?

Hypo: neurologic symptoms (irritability, dysphagia, diplopia, seizures), confusion, muscle weakness, tissue hypoxia, muscle and bone pain (osteomalacia), increased susceptibility to infection Hyper: few symptoms, soft-tissue calcifications, symptoms occur due to associated hypocalcemia