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Fluid and Electrolyte Imbalances
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Fluid and Electrolyte Imbalances
Fluid and Electrolyte Imbalances
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1
Question
What are the roles of PTH (Parathyroid Hormone)?
Answer
Reabsorbs calcium from bones into the bloodstream, aids calcium absorption from the intestine, and facilitates calcium reabsorption into the bloodstream from renal tubules.
2
Question
Summarize the Renin-Angiotensin-Aldosterone System (RAAS) pathway.
Answer
Low perfusion/BP -> Renin release -> Angiotensinogen to Angiotensin I -> ACE converts to Angiotensin II -> Vasoconstriction & Aldosterone secretion -> Increased Na+/H2O reabsorption, K+ excretion, raised BP.
3
Question
What are the roles of lungs, kidneys, and chemical buffers in maintaining acid-base balance?
Answer
Lungs regulate CO2; kidneys excrete acids/bases, reabsorb HCO3-; chemical buffers neutralize excess acids/bases.
4
Question
Describe metabolic acidosis: causes, clinical manifestations, diagnosis, and management.
Answer
Causes: CKD. Clinical: Headache, confusion, hyperventilation. Diagnosis: Low bicarbonate, low pH. Management: Treat cause, dialysis (if needed).
5
Question
Describe metabolic alkalosis: causes, clinical manifestations, diagnosis, and management.
Answer
Causes: NG suctioning, diuretics. Clinical: Tingling, dizziness, tetany, hypoventilation. Diagnosis: High pH, high bicarbonate. Management: Monitor I/O, NS, PPIs.
6
Question
Describe respiratory acidosis: causes, clinical manifestations, diagnosis, and management.
Answer
Causes: COPD, emphysema. Clinical: Tachycardia, hypertension, confusion, decreased LOC. Diagnosis: Low pH, high PCO2. Management: Improve ventilation, bronchodilators, hydration.
7
Question
Describe respiratory alkalosis: causes, clinical manifestations, diagnosis, and management.
Answer
Causes: Anxiety. Clinical: Lightheadedness, numbness, tinnitus, arrhythmias. Diagnosis: High pH, low PCO2. Management: Treat underlying cause.
8
Question
What is Fluid Volume Deficit (FVD) and how does it relate to dehydration?
Answer
Loss of ECF volume exceeds intake; water and electrolytes lost proportionally. Dehydration is loss of water alone.
9
Question
What are some causes of dehydration?
Answer
Abnormal fluid loss, vomiting, diarrhea, GI suctioning, sweating, decreased intake, nausea, lack of access to fluids, third-space fluid shifts, diabetes insipidus, adrenal insufficiency, osmotic diuresis, hemorrhage, coma, gastroparesis, ascites.
10
Question
What are the clinical manifestations of dehydration?
Answer
Acute weight loss, poor skin turgor, oliguria, concentrated urine, prolonged cap refill, hypotension, dizziness, weakness, thirst, confusion, tachycardia, muscle cramps, sunken eyes, nausea, cool, clammy, pale skin.
11
Question
What diagnostic studies are used to assess dehydration?
Answer
Increased hemoglobin and hematocrit, increased serum and urine osmolality, decreased urine sodium, increased BUN and creatinine, increased urine specific gravity.
12
Question
What is the care for dehydration?
Answer
Oral fluids are preferred. IV route for acute/severe losses or intubated/dysphagia patients. Monitor I/O, vital signs, skin turgor, urine concentration, mental function. Administer antidiarrheals, replacement fluids. May need antiemetic.
13
Question
What are some causes of hypervolemia (FVO)?
Answer
Heart failure, kidney dysfunction, cirrhosis of the liver, excessive sodium intake.
14
Question
What are the clinical manifestations of hypervolemia?
Answer
Bounding pulse, tachycardia, JVD, hypertension, dysrhythmias, tachypnea, crackles/cough, edema/anasarca, AMS, headaches, diarrhea, hyperactive bowel sounds, increased/decreased UO.
15
Question
What are some assessment and diagnostic studies of hypervolemia?
Answer
Increased BNP, diluted labs.
16
Question
What is the care for hypervolemia?
Answer
Measure I/O, daily weights, assess breath sounds, monitor edema. Sodium restriction, avoid OTC meds with sodium. Diuretics (monitor potassium), dialysis.
17
Question
What are some causes of hyponatremia?
Answer
Diuretics, loss of GI fluids, renal disease, adrenal insufficiency, excessive D5W/water supplements, SIADH, head trauma, oat-cell lung tumor, psychogenic polydipsia, hyperglycemia, heart failure.
18
Question
What are some clinical manifestations of hyponatremia?
Answer
Poor skin turgor, dry.
19
Question
What are the causes of hypernatremia?
Answer
Fluid deprivation in patients who cannot respond to thirst, hypertonic tube feedings without adequate water supplements, diabetes insipidus, heart stroke, hyperventilation, watery diarrhea, burns, diaphoresis, excess corticosteroid, sodium bicarbonate, and sodium chloride administration, saltwater nonfatal drawing victims.
20
Question
What are the clinical manifestations of hypernatremia?
Answer
Thirst, elevated body temperature, swollen dry tongue, sticky mucous membranes, hallucinations, lethargy, restlessness, irritability, simple partial or tonic-clonic seizures, pulmonary edema, hyperreflexia, twitching, nausea, vomiting, anorexia, tachycardia, hypertension, decreased urine output
21
Question
What are the care measures for hypernatremia?
Answer
Monitor abnormal loss of water or low water intake, note patient thirst or elevated body temps, monitor for behavior changes (restlessness, disorientation, lethargy).
22
Question
What are the nursing interventions for hypernatremia?
Answer
Seizure Precautions, Fluid Restriction to prevent further dilution, PO Salt tabs, Detecting/Controlling/Promoting rest, Restricting sodium intake, water/fluid restriction, Monitoring parenteral fluid therapy, Administering appropriate medications
23
Question
What are the causes of hypokalemia?
Answer
Diarrhea, vomiting, gastric suction, corticosteroid administration, hyperaldosteronism, carbenicillin, amphotericin B, bulimia, osmotic diuresis, alkalosis, starvation, diuretics, digoxin toxicity
24
Question
What are the clinical manifestations of hypokalemia?
Answer
Fatigue, anorexia, nausea, vomiting, muscle weakness, polyuria, decreased bowel motility, ventricular asystole or fibrillation, paresthesias, leg cramps, hypotension, ileus, abdominal distention, hypoactive reflexes, EKG flattened T waves, prolonged PR interval
25
Question
What are the care measures for hypokalemia?
Answer
Monitor for fatigue, anorexia, muscle weakness, decreased bowel motility, paresthesias, and arrhythmias (TORSADES)
26
Question
What are the methods for correcting hypokalemia?
Answer
Oral or IV potassium replacement. IV Potassium: If central line present, can give 20mEq/hr. If no central line, limit is 10 mEq/hr. PO Potassium: Comes in ER, cannot chew or crush. Can cause GI upset.
27
Question
What are important considerations when administering potassium supplements?
Answer
Take with food; enteric coated option available; powder form can be mixed with water or Sprite; encourage potassium-rich foods (bananas, avocado, potatoes).
28
Question
What are the common causes of hyperkalemia?
Answer
Renal failure (elevated BUN/creatinine), potassium-sparing diuretics, ACE inhibitors, NSAIDs, burns, rhabdomyolysis, Addison's disease, prevents reabsorption of aldosterone
29
Question
What are the clinical manifestations of hyperkalemia?
Answer
Muscle weakness, bradycardia, arrhythmias, flaccid paralysis, paresthesias, intestinal colic, cramps, abdominal distention, irritability, anxiety, EKG changes (tall tented T waves, prolonged PR interval and QRS duration, absent P waves, ST depression)
30
Question
What are the key nursing interventions for hyperkalemia?
Answer
Monitor I/O, monitor for muscle weakness and arrhythmias, monitor vital signs, potassium restriction diet (permitted: butter, margarine, cranberry juice/sauce, ginger ale, gumdrops/jelly beans, hard candy, root beer, sugar, and honey), caution patient using salt substitutes and potassium-sparing diuretics