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Hypokalemia lab value description

answer

<3.5 mEq/L

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Hypokalemia etiology

answer

inadequate intake, NPO, renal losses, magnesium depletion, GI losses, vomiting, dirrhea, diuretics, enemas, beta blockers, steroids, alkalosis.

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Hypokalemia manifestations

answer

Slowed smooth muscle contractions, abdominal distention, constipation, muscle weakness/leg cramps, fatigue, paresthesias, hyporeflexia, irritability.

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Hypokalemia nursing interventions

answer

EKG monitoring, administer high K+ foods or supplements, assess H & P,determine and correct underlying cause. Severe Hypokalemia (3- 3.4 mEq/L) requires IV intervention(100- 200 mEq of IV potassium).

question

Hypokalemia nursing diagnosis

answer

1. risk for injury- low K+ can lead to weakness, falls, or seizures. 2. imbalanced nutrition- less than body requirements

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Foods high in potassium

answer

Fish, whole grains, nuts, artichokes, broccoli, brussels sprouts, carrots, celery, cucumbers, apricots, bananas, melons, oranges, strawberries, brewed coffee, tomato juice, fruit juice.

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Hyperkalemia lab value description

answer

>5 mEq/L

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Hyperkalemia etiology (3 major causes)

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1. Retention because of decreased urine output 2. Excessive release from the cells after traumatic injury, burns, or from cell lysis or acidosis. 3. Excessive IV infusion of solutions that contain K+, especially in someone with renal disease.

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Hyperkalemia manifestations

answer

may not present until >7 mEq/L. Abnormal EKG, nerve and muscle irritability, tachycardia, colic, diarrhea.

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Hyperkalemia nursing interventions

answer

Assess H & P, EKG monitoring, treat imbalance (force fluids, IV saline, diuretics). For severe Hyperkalemia infusion of IV calcium gluconate.

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Hyperkalemia teaching

answer

Teach dietary potassium sources, avoid salt substitutes, and OTC medications that affect K+ balance.

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Hypocalcemia lab value

answer

< 4.5 mEq/L

question

Hypocalcemia etiology

answer

Inadequate intake, inadequate intake of vit. D, diseases that impair absorption, parathyroid disease, medications, pancreatitis, Cushing's disease, inadequate sunlight.

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Hypocalcemia manifestations

answer

Neuromuscular hyperexcitability, numbness and tingling of hands, toes, lips, irritability/anxiety, brittle bones/fractures. Late signs: Hypotension, dysrhythmias, trousseau's/ Chvostek's signs, seizures, tetany, death.

question

Hypocalcemia nursing interventions

answer

Review H & P, replacement therapy with oral supplements, increase dairy products, treat underlying cause of Hypocalcemia. Tetany requires immediate attention. IV calcium chloride must be given slowly to avoid hypotension and bradycardia.

question

Hypocalcemia teaching

answer

intake of a well-balanced diet, avoid high-protein diets, encourage weight bearing exercise, consult GP about supplementation.

question

Hypercalcemia lab values

answer

>5.5 mEq/L

question

Hypercalcemia etiology (3 main causes)

answer

1. Metastatic malignancy (lung, breast, ovary, prostate, bladder, bone, kidney, lymph) 2. hyperparathyroidism 3. thiazide diuretic therapy

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Hypercalcemia manifestations

answer

anorexia, n/v, polyuria, muscle weakness/fatigue/lethargy, dehydration, constipation, confusion, EKG changes, coma

question

Hypercalcemia nursing interventions

answer

Review H & P, treat underlying condition, restore Ca+ levels. For severe hypercalcemia IV NS with furosemide to prevent fluid overload.

question

Hypophosphatemia lab values

answer

<1.2 mEq/L

question

Hypophosphatemia etiology

answer

long term lack of intake, increased growth or tissue repair, recovery from malnourished states, prolonged intake of antacids, burns, lead poisoning.

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Hypophosphatemia manifestations

answer

decreased cardiac and respiratory function, muscle weakness, fatigue, brittle bones, bone pain, confusion, seizures

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Hypophosphatemia nursing interventions

answer

Review H & P and lab data, restore levels with diet and supplementation. Severe Hypophosphatemia: may require TPN

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Hyperphosphatemia lab values

answer

> 3 mEq/L (rare but serious)

question

Hyperphosphatemia etiology

answer

excessive intake of high phosphate foods, increased intake of vit. D, impaired colonic motility, hypoparathyroidism, addision's disease

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Hyperphosphatemia manifestations

answer

tachycardia, palpitations, restlessness, anorexia, n/v, hyperreflexia, tetany, dysrhythmias.

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Hyperphosphatemia nursing interventions

answer

review h & p and lab data, restore normal levels by limiting high-phosphate foods like dairy, meat, fish, and carbonated beverages.

question

Hypomagnesemia lab values

answer

< 1.5 mEq/L

question

Hypomagnesemia etiology

answer

critically ill, alcoholics, DM, pregnancy, chronic malnutrition, crohn's disease, pancreatits.

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Hypomagnesemia manifestations

answer

myocardial irritability, anorexia, nausea, abdominal distention, depression, psychosis, confusion.

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Hypomagnesemia nursing interventions

answer

EKG monitoring, correct underlying cause (oral mag replacement), monitor vital signs, IV mag may be necessary.

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High magnesium foods

answer

Cashews, chili, halibut, swiss chard, tofu, wheat germ.

question

Hypemagnesemia lab value

answer

> 2.5 mEq/L (rare disorder)

question

Hypemagnesemia etiology

answer

renal insufficiency, excessive use of laxatives or antacids, K+ sparing medications, severe dehydration, over-correction of premature labor or pre-eclampsia.

question

Hypemagnesemia manifestations

answer

decreased muscle cell activity, hypotension, EKG changes, lethargy/drowsiness, loss of deep tendon reflexes, respiratory paralysis, loss of consciousness, PVC's, elevated t-waves

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Hypemagnesemia nursing interventions

answer

decrease use of mag sulfate, use saline solution with a diuretic, IV calcium, monitor vitals and EKG, urinary output, ventilator assistance, dialysis in extreme cases.

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Dehydration

answer

When the normal compensation for fluid loss in the bloodstream cannot be corrected by stored fluid elsewhere.

question

mild dehydration

answer

loss of 1-2 L of water (2% of body weight)

question

moderate dehydration

answer

loss of 3-5 L of water (5% of body weight)

question

severe dehydration

answer

loss of 5-10 L of water (8% of body weight)

question

Why are older adults at risk for dehydration?

answer

1. decreased renal concentration of urine 2. Altered ADH response 3. Increase in body fat and thus a decrease in total quantity of body water in proportion to body weight.

question

ADH and aldosterone- role during dehydration

answer

secretion increases to reabsorb water and sodium in the kidneys.

question

Baroreceptors- role during dehydration

answer

Sense low blood pressure and the sympathetic NS is stimulated to increase peripheral vasoconstriction and HR.

question

Hyponatremia lab value

answer

<135 mEq/L (most common electrolyte disorder)

question

Hypovolemic Hyponatremia - cause

answer

Renal loss of sodium from diuretic use, diabetic glycosuria, aldosterone deficiency, intrinsic renal disease, increased sweating, vomiting, diarrhea, high volume ileostomy.

question

Euvolemic Hyponatremia- cause

answer

Sodium deficit resulting from SIADH (syndrome of inappropriate secretion of antidiuretic hormone), or increased ADH because of pain, emotion, medication.

question

Hypervolemic Hyponatremia- cause

answer

Edematous disorders resulting in sodium deficits: congestive heart failure, cirrhosis of liver, nephtotic syndrome, acute and chronic renal failure, psychogenic polydipsia.

question

Redistributive Hyponatremia- cause

answer

Pseudohyponatremia, hyperglycemia, hyperlipidemia.

question

Hyponatremia manifestations

answer

Headache, hallucinations/seizures, behavioral changes, hypotension, tachycardia, tachypnea, n/v, diarrhea

question

Hyponatremia nursing interventions

answer

asses h & p, get detailed info on diet and medications, measure client's body weight, treat underlying cause and imbalance. Restrict fluids, increase sodium ingestion, NS or LR. If sodium is <115 concentrated solution of 3% NaCl may be indicated.

question

Hypernatremia lab values

answer

> 145 mEq/L

question

Hypernatremia etiology

answer

inadequate water intake, lack of access to drinkable water, physical or chemical restraint, mental confusion and NPO status. Increased sodium intake, retention of sodium

question

Hypernatremia manifestations

answer

polyuria, oliguria, anorexia, nausea, vomiting, weakness, restlessness.

question

Hypernatremia nursing interventions

answer

H & P, daily weights, hypo-osmolar electrolyte solution (0.2% or 0.45% Nacl) or (D5W), monitor lung sounds, treat underlying cause. Must reduce levels slowly to prevent cerebral edema.

question

Anasarca

answer

severe generalized, massive edema. Often occurs in congestive heart failure, liver failure, or renal disease

question

Overhydration manifestations

answer

coughing, dyspnea, crackles, pallor, cyanosis, decreased tissue o2 levels, anxiety, increased CO2 levels, jugular vein distention, bounding pulse, elevated BP, confusion, headache, lethargy.

question

Dehydration manifestations

answer

loss of body weight, thirst, oliguria, decrease in systolic blood pressure, weak pulse, decreased cardiac output, postural hypotension, lethargic*, increased cap refill time*, dry mucous membranes*, sunken eyes, slow skin turgor.

question

Hypotonic Solution

answer

Replaces deficits of total body water. (D5W) no electrolytes, supplies 170 kcal/L and free water.

question

Isotonic Solutions

answer

0.9% NaCl, LR. For pt's with low serum Na or Cl and for fluid loss from burns, bleeding, dehydration from loss of bile or diarrhea.

question

Hypertonic Solutions

answer

D5/LR, D5/0.9NS, D5/0.45NS, D5/1/2NS, Commonly used as maintenance fluid, provides modest calories, provides more water than sodium.

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