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fluid electrolytes RJ

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Randy Graf

on 15 September 2012

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Transcript of fluid electrolytes RJ

BY: RJ Graf
13 May 2012 Sodium Maintains the concentration of ECF volume

Generation and transmission of nerve impulses

Regulation of Acid-base balance Action Lewis 2011 Measurement: mEq

Hyponatremic: <135 mEq/L

Normal Range: 135-145 mEq/L

Hypernatremic: >145 mEq/L Normal Values 10 mEq

Proves to be delicate ballance that is highly dependent on the amount of fluid in ECF compartment

Constantly Changing

lab values based on concentration
Do no directly relate to sodium intake/output Sodium: Differentiation between
high and low lab values Lewis 2011 Craven 2009 ADH imbalances (Pituitary & Hypothalamus function)
Diabetes Insipidus
Decreased kidney responsiveness to blood serum osmolality

Post-operative patients
inappropriate use of isotonic solutions
increased ECF volume
decreases concentration of sodium, lowering osmolality
Common stressed release of ADH (hypothalamus/ pituitary glands) that results in retention of fluids

diuretic drug therapy (furosemide most common)

Impaired Level of consciousness: body unable to perceive thirst sensation from hypothalamus and unable to attain fluids, resulting in hypernatremia

Situations that result in large amounts of fluid loss (exercised induced sweating, diaphoresis, trauma, etc.) Patients at Risk Lewis 2011 Clinical Manefestations HYPERnatremia HYPOnatremia Restlessness
dry mucous membranes
decreased skin turgor
capillary refill time > 3 seconds
increased HR, Decreased BP
high respiratory rate
seizures........coma Peripheral edema
high BP
pulmonary edema
muscle spasms
weight gain
seizures......coma Tests Anticipated Prescriptions & Tx HYPERnatremia HYPOnatremia Minor:
Low sodium diet
Dextros 5%
0.45% NaCl
increases ECF fluid volume Diuretics:
Decreases ECF volume
most common: furosemide
3% NaCl Lewis 2011 Adams 2011 Nursing Assessment Monitor
lab values:
Serum osmolarity between 280-300 mOsm/kg
I & O's Anticipate Complications:
recent history of underlying causes known to cause imballances Watch for Signs:
Dizzines, confusion, dry mucus membranes, weight loss Lewis 2011 Nursing Interventions Unique to individual Symptom Fall Risk, due to dizziness patient education to raise awareness for further preventative care Monitor patient to ensure safety Lewis 2011 Geriatric Considerations confusion can be overlooked as a cognitive disorder injury and previous conditions that would contribute to fall risk associated with dizziness & confusion related to sodium imbalances renal function is decreased with age, and may be hypersensitive to sodium imbalances skin dryness may be exaggerated with hypernatremia diuretic therapy for older population may pose as fall risk due to incontinence, and immobility Craven 2009 Potassium Magnesium Calcium Phosphorus Main ICF

essential for cardiac, muscular and neural function

levels controlled by insulin and aldosterone levels Action Craven 2009 3.5-5.0 mEq/L

Hypokalemia: <3.5 Normal Values Hyperkalemia: >5.0 1.5 mEq/L range

Both hyper and hypokalemic ranges effect cardiac function Differentiation between low and high values Hyperkalemia:
Cardiac arrest (sudden and severe)
irregular pulse Hypokalemia:
weak, irregular pulse
muscle crams
paralytic ileus
decreased reflexes Lewis 2011 High stress lifestyles (increased epinephrine levels)

impaired renal, or dialisis patients (most common)

patients with massive cell destruction

hypokalemia rarely result of low potassium intake

diarrhea, vomiting Patients at risk Clinical Manifestations HYPERkalemia HYPOkalemia irritability


abd cramping/ diarrhea

lower extremity weakness

irregular pulse

Cardiac arrest (sudden and severe) Lewis 2011 fatigue
muscle weakness/ leg cramps
nausea/ vomiting
paralytic ileus
decreased reflexes
hypergylcemia Complete blood count (CBC) Test: Diagnostic Testing Causes Hypokalemia Hyperkalemia abnormal loss of potasium from shift to ECF (then excreted)

Route: Kidney/GI dysfunction

elevated aldosterone level (from low blood volume) -> retention of NA, loss of potasium in kidneys massive intake of Potassium

impaired renal excretion

shift of fluids from ECF to ICF

combination factors Lewis 2011 Lewis 2011 Test: Complete blood count (CBC) used to determine levels within patient. action upon corrective action if imbalances exist which is centered upon the underlying cause of imballance Cause Hypernatremia excessive sodium intake (IV)

inadequate water intake

excessive water loss
impared renal function-> retention of sodium

diseases: Diabetes insipidus, cushings syndrome & uncontrolled diabetes melitus Hyponatremia excessive sodium loss

low sodium intake (fasting diets)

excessive water gain

Diseases: heart failure, primary hypoaldosteronism, SIADH anticipated prescriptions and treatment Potassium sparing diuretics

Potassium supplements rate, pharmacotherapy treats underlying cause

ACE inhibitors (enalipril, lisinopril, ect) Nursing assessment Hyperkalemia Hypokalemia identify S/S, anticipate complications
Potassium sparing diuretics, monitor Potassium intake EKG changes

anxiety levels Lewis 2011 Lewis 2011 anticipate if patient has:
diarrhea, excessive vomiting
place on non-potassium sparing diuretics
hyperglycemia eliminate parenteral or oral sodium intake

increase excretion of potassium elimination
increased water intake (increases kidney excretion Nursing interventions Force potassium from ECF to ICF by administering IV insulin & glucose diuretics common use for high blood pressure which may be associated with age, and is considered to be a common drug for the elderly

geriatric patients may have lower kidney responsiveness from age

geratric population may be less able to adapt to differentiating diets such as low potasium intake, from established diets prior to hyperkalemic state, which may require further and closer monitoring from the nurse Geriatric considerations Lewis 2011 Craven 2009 Adams 2011 Adams 2011 Coenzyme in metabolism of:
nucleic acids Action Hypermagnesemia Differentiation between hyper and hypo levels Hypermagnesemia Clients at risk Hypomagnesemia Clinical manifestations Tests: CBC
associated with potassium and cacium levels Tests Parental magnesium given in some situations when needed

most treated with oral magnesium supliments, or foods high in magnesium
green vegitables
peanut butter
chocolate Anticipated prescriptions The nurse must be able to differentiate S/S of magnesium imballances from other similar S/S of different disease processes Nursing assessment focus on prevention

intervene when pt is:

severe diarrhea, vomiting
prolonged malnutrition
large urine output
NG suction
poorly controlled diabetes mellitus
hyperaldosteronism Nursing interventions effects of magnesium imbalances may be exagerated with geriatric patients

lethargy may be confused with other processes of healing

confusion may be hard to detect with patients diagnosed with dementia disorders Geriatric considerations neuromuscular and CNS hyperirritability Hypomagnesemia depressess CNS and neuromuscular functions Lewis 2011 important for normal cardiac function Renal insufficency with increased magnesium intake Hypomagnesemia prolonged fasting

chronic alcoholism

excessive fluid loss in GI tract (diarrhea and vomiting) confusion

hyperactive deep tedont reflexes


seizures Hypermagnesemia Mild: lethargy, drowsines, N/V
Moderate-severe: los of deep tendon reflexes, somnolence, respiratory and cardiac arrest Lewis 2011 Lewis 2011 Causes Hypermagnesemia renal failure + magnesium intake

excessive administration to treat eclampsia

adrenal insufficiency Hypomagnesemia diarrhea


impaired GI absorption

prolonged malnutrition


poorly controlled diabetes mellitus Hypomagnesemia confusion

hyperactiver deep tendon reflexes


seizures Hypermagnesemia lethargy, drowsiness

nausia, vomiting

loss of deep tendon reflexes


respiratory & eventually cardiac arrest renal failure + given magnesium suppliments

adrenal insufficiency

excess administration for Tx of eclampsia Hypermagnesemia Hypomagnesemia Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Adams 2011 Lewis 2011 Lewis 2011 Dysrhythmia's may cause serious side effects with aging heart
special consideration with heart failure Geriatric considerations involved with:

transmission of nerve impulses

myocardial contractions

blood clotting

formation of teeth and bone

muscle contractions action Normal: 8.6-10.2 Normal values High values (hypercalcemia):

reduced excitability of nerves and muscles Difference between high and low values x-ray to check for calcium deficiency and screening for some diseases

CBC most common test to check complete calcium levels

further tests may include testing for levels of vitamin D, PTH and calcitonin levels Diagnostic testing Hypercalcemia Clinical manifestations Hypercalcemia
Mitracin: inhibits bone resorption, lowers calcium levels
Aredia: inhibits osteoclast activity, results in calcium release from bones lowering calcium levels Anticipated prescriptions Chvostek's Sign

Trousseau's sign Nursing assessment metabolic acidosis
metabolic alkalosis
alters calcium binding, effects overall calcium levels Clients at risk Encouragement of movement and weight bearing activity

vitamin D rich foods (assists in absorption of calcium)

300-400 intake water with hypercalcemia
assists in natural excretion of calcium VIA renal function Nursing interventions stored in bones Lewis 2011 Hypercalcemia: > 10.2 Hypocalcemia: < 8.6 Lewis 2011 calcium levels ussual reflect total calcium levels
bound to protein
complexed with phosphate, citrate and carbonate both produce EKG changes low values: (hypocalcemia):
Tetany : Trousseau's & Chvostek's sign apply blood pressure cuff, or cut off circulation to arm

reflex shows:
flexation of wrist toward forearm + thum & index finger touch Trousseau' sign Contraction of face muscles initiated by light tap over facial nerve anterior of patient's ear Chvostek's Sign parathyroid diseases
Alterations in PTH Thyroid gland diseases
Production of Calcitonin
important for: opposes action of PTH = safegard from hypercalcemia Vitamin D imballances
absorbed through UV light
Alterations in skin
inability for the exposure to sunlight Hypocalcemia lethargy & weakness
depressed reflexes
decreasd memory
personality changes & psychosis
anorexia, nausea & vomiting
bone pain, fractures
polyuria & dehydration
nepholithiasis fatigues easily
depression, anxiety and confusion
numbness and tingling around oral cavity
hyperreflexia & muscle cramps
chvostek's sign
Trousseau's sign
Tetany, siezures Hypocalcemia
Oral or IV calcium suppliments
IM injections not given due to increased side effects shortened ST segment
shortened QT interval
ventricular dysrhythmias
increased digital effect elongation of ST segment
prolonged QT interval
ventricular tachycardia EKG changes: Hypercalcemia Hypocalcemia kidney funciton decreased with nursing intervention of increased water intake to encourage excretion of calcium
mobility level must be assesst prior to increased water intake
increased water intake, incontinence, difficulty in mobility and cluttered environment (throw rugs, un-clear paths to bathroom, and long distance to bathroom, etc.) heightens fall risk Skin is more sensitive, and burns easier if UV light therapy is sugested to increased Vitamin D intake for hypocalcemia Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Craven 2009 Essential to the function of:
nervous system Action Elseveir 2003 normophosphatemia: 0.78-1.42 mmol/L

hyperphosphatemia: >1.42 mmol/ L

Hypophosphatemia: <0.78 mmol/L Difference between high and low values kidney dysfunction Clients at risk Hyperphosphatemia Clinical manifestations dependent on underlying cause;
calcium supliments may be prescribed with hypercalcemia Anticipated prescriptions assess for calcium imbalances:
EKG changes
Muscle complications
cardiac dysrhythmias
etc. Nursing assessment encourage and suggest altered dietary intake

adequate hydration, and correction of hypocalcemic conditions Nursing implementation cardiac function decreased with age, phosphate imbalances tied with calcium imbalances, which effect cardiac function

increased water intake may interfere with decrease in renal function associated with age Geriatric considerations primary ICF anion deposited with calcium for bone and tooth structure hypercalcemia (inverse relationship with phosphate) hypocalcemia

muscle complications: tetany

deposition of calcium phosphate found in:
skin precipitation

soft body tissues

cornea, viscera, blood vessels Hypophosphatemia CNS dysfunction: Confusion, coma

muscle weakness: Respiratory, difficulty weaning

renal tubular wasting of: magnesium, calcium, HCO

cardiac problems: dysrhythmias, decreased stoke volume


Rhabdomyolysis Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Lewis 2011 Craven 2009 Lewis 2011 thank you The End
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